Blood tests in the early stages of ebola don’t tell much
When I heard that Dr. Martin Salia, a Sierra Leone native who is married to a US citizen and who contacted ebola while treating patients in his native country, had been flown here for treatment and was in “very critical” condition, I thought “if we can cure him, then American medicine is really onto something in the treatment of ebola.”
Sadly, it was not to be: Dr. Salia has died of the disease. He was very very far gone when he arrived:
“He was placed on dialysis, a ventilator and multiple medications to support his organ systems in an effort to help his body fight the disease. He also received a dose of convalescent plasma and ZMapp therapy was initiated on Saturday,” the hospital said in a statement.
“We used every possible treatment available to give Dr. Salia every possible opportunity for survival,” Smith said. “As we have learned, early treatment with these patients is essential. In Dr. Salia’s case, his disease was already extremely advanced by the time he came here for treatment.”
There are two very salient facts about the case of Dr. Salia. The first is that he never knew how he got the disease; he was a general surgeon in Sierra Leone and was not specifically treating ebola patients. This reflects the fact that ebola is not always easy to spot, even for medical personnel who are well-versed in its diagnosis and are treating patients in areas where it is endemic, and therefore would be on high alert for it. That is one of the many many dangers of the disease, and you may recall that the same thing happened with Dr. Rick Sacra, who was treated here much earlier in the disease’s course than Salia and has survived.
The second thing I’d like to highlight is that it took four (or five; I’ve read differing accounts) full days after Dr. Salia first showed ebola symptoms for his blood test to become positive for the disease. By that time he was extremely sick indeed. The loss of those days of possible treatment here may have made a big difference. Here is the story:
When Martin Salia’s Ebola test came back negative, his friends and colleagues threw their arms around him. They shook his hand. They patted him on the back. They removed their protective gear and cried.
But when his symptoms remained nearly a week later, Salia took another test, on Nov. 10. This one came back positive, sending the Sierra Leonean doctor with ties to Maryland on a desperate, belated quest for treatment and forcing the colleagues who had embraced him into quarantine.
We were celebrating. If the test says you are Ebola-free, we assume you are Ebola-free,” said Komba Songu M’Briwa, who cared for Salia at the Hastings Ebola Treatment Center in Freetown. “Then everything fell apart.”…
The doctors who tended to him in Freetown appeared to be unaware that an early Ebola test — taken within the first three days of the illness — is often inconclusive. In a country where information about the disease continues to move slowly, it was another potentially tragic mistake.
In many cases, a negative test at that stage means nothing because “there aren’t enough copies of the virus in the blood for the test to pick up,” said Ermias Belay, the head of the CDC’s Ebola response team in Sierra Leone.
As Dr.Salia worsened, he assumed he had malaria, as many with ebola in Africa do (think again of Thomas Duncan, who thought the woman he helped had either malaria or pregnancy complications, and relied on that—and he was just a layman). Dr. Salia prescribed malaria medication for himself, but it didn’t help:
He [then] called his colleague Alhali Osman Smith, who worked with him at Freetown’s Kissy United Methodist Hospital.
“He told me he thought he still might have Ebola,” Smith said, “in spite of what the test said.”
RIP, Dr. Salia.
Which brings us to the latest from the arrogant Kaci Hickox, who asks us to stop calling her “the ebola nurse”:
I never had Ebola. I never had symptoms of Ebola. I tested negative for Ebola the first night I stayed in New Jersey governor Chris Christie’s private prison in Newark. I am now past the incubation period – meaning that I will not develop symptoms of Ebola.
I never had Ebola, so please stop calling me “the Ebola Nurse” – now!
I, for one, never called Hickox the ebola nurse. In fact, I went so far as to call her “America’s sweetheart,” but do I get any thanks? No!
It is surprising that, although Hickox is a public health nurse, she doesn’t seem to understand the very concept of quarantine. Nor does she seem to understand that (a) she initially appeared to have a major symptom of early ebola, a fever; (b) she had just returned from treating ebola patients; and (c) her negative blood test that night was meaningless, as the story of Dr. Salia demonstrates all too graphically.
[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]DONATE
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