Thursday, March 12, 2015

There was a considerable misunderstanding involving a situation in Sierra Leone. Cliff Lane is trying to expand the randomized controlled trial of ZMapp versus standard of care in countries in addition to Liberia with the protocol he has already started. As it turns out the commanding general in charge of the British military hospital in Sierra Leone, Brig. Gen. Tim Hodgetts, was under the misimpression regarding the protocol was standard of care to see ZMapp + standard of care versus standard of care alone . And so he said that this trial was unethical and refused to participate in it. The reason why this is important is because an American citizen who works for Partners in Health became infected while working in Sierra Leone. We had made arrangements to air evacuate the patient to the NIH clinical Center as soon as possible. Because the patient was in the British facility, we wanted to start the randomization to one or the other arm of the protocol while the patient was still in Sierra Leone before flying back the United States. Brigadier General Hodgetts stated that he would give ZMapp as a compassionate use but would not participate in the randomized protocol. He felt it was unethical to delay the flight to the USA by giving the person a placebo if in fact the person randomized to did not see any droplets coming out of his mouth as he coughed; however, I remember thinking thank goodness for the PPE. This experience brought into sharp relief for me the reason for the high case fatality of Ebola and why so many HCWs get infected. If were in West Africa, would be dead and Rick, Anthony and I would have gotten infected taking care of him if we did not have the state-of-the-art PPE. After an hour and 45 min. we doffed and waited for his parents. They came with Bible in hand to visit their son. Rick Davey, Cliff Lane, and I spent well over an hour with them explaining the situation and the seriousness of it. We then brought them into the nurse’s station where they were able to speak with their son through video link. They could see him but he could not see them. Of note before we brought them into the nurse’s station to see him through the video, we mentioned to that we were going to bring them into the room. He got very concerned that he wanted to get cleaned up from the diarrhea that soiled his bed and was over parts of his leg. In addition, his PIC line was bleeding around site and so that needed to be cleaned up. It took the nurses about 45 min. to an hour to get him perfectly clean so that he could feel comfortable talking to his parents even though his parents would not be able to see any of the soiled linen or pajamas from the distance that they were at the video link. It was a very moving conversation between the parents and ended up the conversation by reading a passage from the Old Testament. And then he turned to us in the room and said “what a wonderful country we live in that would put so much effort into the saving the life of one person - our son. There was not a dry eye in the room. I went home that night completely exhausted and went with Christine to Bourbon Steak bar and restaurant at the Four Seasons Hotel in Georgetown to unwind.