She thought about the love she had found in her life. For a number of years she’d had an on-and-off relationship with Rafe. He was highly successful, extremely good-looking, fun to be with, and he was a father with children of his own. But she and Rafe had their differences. Weeks earlier, just before she left on her deployment, he had told her that he wanted to take a break from the relationship. It hadn’t bothered her that much. Yet there was a romantic part of her that dreamed of living with a man she loved with all her heart, and who loved her the same way. Somehow that storybook hadn’t happened for her. It had happened for David and Nancy Writebol.
Maybe, she thought, the love in her storybook would be that of a mother who had raised a child and had worked hard to find medicines that might help some people. Would Rafe put on PPE and help me out of bed if I was dying? Would he have the courage and love to do that? Would anybody be there to just sit with me and hold my hand as I was leaving this world?
She pulled herself out of these thoughts. She didn’t like dwelling on herself when someone was dying of Ebola. She turned around and faced the window.
By this time, David had helped Nancy back into bed, and she was coughing. Hensley recognized it as the classic Ebola cough. About 35 to 40 percent of Ebola patients have a deep, wet-sounding, unproductive cough known as the Ebola cough. Hensley knew that tiny coughed droplets, invisible to the senses, would be bobbing in the air around Nancy, and the turbulence made by the ceiling fan would be carrying the droplets out through the window and around Lance Plyler and herself. She could smell the air of the sickroom.
MONROVIA, LIBERIA
11:30 p.m., Saturday, July 26
That night, in her hotel room, Hensley sent a text to Lance Plyler. “You guys make me a little bit nervous,” she typed, and she advised them to wear breathing masks outside the windows of the two patients.
She counted up her exposures to the virus: there were three. The first exposure had happened when she was talking with Kent Brantly in the storage room and moving boxes around. The room was an enclosed space, where the air was dead and not circulating, and they had been talking face-to-face. Brantly had had Ebola disease then; he had been infective. As a person talks, extremely fine, invisible drops of saliva are sent into the air around the person’s mouth, and the drops can drift up to six feet. Had an unseen fleck of the virus landed in her eyes, in her mouth, on her skin?
The second exposure had been when she was standing by the crack in Kent Brantly’s window and talking with him. Fine droplets from his mouth, produced when he talked, could have been drifting around her face.
The third exposure had happened while she stood by the open window at Nancy Writebol’s house, feeling and smelling currents of air coming out of the bedroom driven by the ceiling fan. Nancy had been coughing.
Three exposures. Not massive, but they were real. What were the chances she’d gotten infected?
She trusted Gary Kobinger, and decided to call him. It was early evening in Winnipeg. She told him about her exposures, and said, “What do you think?”
Ebola researchers have a habit of making morbid jokes about their work. In a teasing sort of way he said, “Do you have a headache yet, Lisa?”
Hensley laughed somewhat uncomfortably. Kobinger went on to say that it didn’t sound like anything serious, and he advised her not to worry about it.
After talking with Kobinger about her exposures, Hensley made some decisions. She was obligated by ethics and government rules to report her exposures to the Integrated Research Facility, her employer. That is, she had to inform her boss, Peter Jahrling. She made a mental note to call him.
If she was now infected, she would be in the incubation period, the time during which the virus is replicating, but there would be no symptoms. The typical incubation period of Ebola is about eight days, but the virus can incubate in a person for up to twenty-one days before symptoms appear. Her tour of duty was about to end. If she had the virus in her body she could bring it into the United States and break with symptoms afterward. She could infect her colleagues, the general public, or her son. This was an unacceptable risk.
She decided to extend her tour of duty for an extra two weeks, to cover a reasonable incubation period of Ebola virus. If the virus was in her body she simply couldn’t go back home now. And she had made a promise to Samaritan’s Purse and to the two Ebola patients to help them through their crisis, including offering her blood to Kent Brantly for a transfusion. She would stay in West Africa, she would stick with the patients, and she would start taking her temperature twice a day.
WINNIPEG AND SAN DIEGO
Night, Saturday, July 26
Gary Kobinger had joked with Lisa Hensley about her exposures and told her they were nothing to worry about. In fact, though, he was alarmed. The exposures showed that Lisa Hensley was starting to take chances. She was putting herself at risk, getting too close to the virus, not paying enough attention to her personal safety. If she continued to take chances the odds of an infection would go up. She might already be infected.
Soon after he finished talking with Hensley, Kobinger got in touch with Larry Zeitlin, the chief executive of Mapp Bio. The two men spent the next several hours in a back-and-forth discussion about how to help Hensley if she broke with Ebola. They knew very well what had happened to Humarr Khan. Hensley could end up in Khan’s situation, trapped in a camp or in a chaotic Ebola ward in a Monrovia hospital. Humarr Khan was still alive, but he could not be evacuated, and the Doctors had decided not to offer him ZMapp. If Hensley was sick with Ebola, she would not be allowed to get on a plane. Thus she might not be able to get evacuated, either. If she couldn’t get to Switzerland or the United States, someone would have to bring ZMapp to her.
Kobinger and Zeitlin started discussing how to get three doses of ZMapp to Lisa Hensley in case she needed them. There were six official courses of ultra-pure ZMapp in the world. Course No. 1 was sitting in Geneva. Course No. 2 was sitting in the freezer at the Doctors’ camp in Kailahun. The course at the Doctors’ camp might be available for Hensley, except that transferring the drug from Sierra Leone to Liberia, across an international frontier, would be extremely difficult due to bureaucratic restrictions. Official courses Nos. 3 through 6 were sitting in Owensboro, Kentucky, and elsewhere.
In addition, there was that extra unofficial course of ZMapp—the hidden, rainy-day supply. Three little bottles of ZMapp sitting somewhere, frozen, pure, ready for use. This was Course Zero, the secret stash. Kobinger and Zeitlin worked out a plan.
* The incident is described more fully in The Demon in the Freezer (2002).
SURF
WINNIPEG AND SAN DIEGO
Night, Saturday, July 26
As Hensley slept, Zeitlin was at home in San Diego, stretched out on the living room couch, exchanging emails with Kobinger on his laptop. Zeitlin’s house was dark and quiet. His wife was upstairs in the bedroom, and their children—a five-year-old and a baby—were asleep. He typed an email to Hensley:
If you were exposed and god forbid test positive, let us know immediately (our cellphones are on 24 hours/day) and Gary or I will fly with a course from North America to wherever you are. This would likely have to be off the record unless you were able to get to Geneva or the US.
Best
LZ
It seems that the two scientists intended to try to get a course from the Kentucky facility, but this would certainly involve a lot of government bureacracy and paperwork, and Hensley could die. If Hensley was dying, they were ready to take Course Zero out of its hiding place, smuggle it to her, and give it to her themselves, regardless of the consequences. (Hensley herself had nothing to do with this plan.)
It is illegal to transport an experimental, unlicensed, untested drug across international borders with the intent of administering it to a person without any sort of oversight from the governments invol
ved.
“If we got caught bringing ZMapp to Lisa, I certainly didn’t know what the consequences would be,” Zeitlin now says. “It was certainly illegal. It was a dangerous thing. We were a small company, and this was putting the company at risk. Worst case, it could be jail time for me. And I could be banned from drug development,” Zeitlin says.
Whatever the consequences of bringing ZMapp to Lisa Hensley, the two scientists had decided to take the risk if it would increase her chances of survival. Zeitlin’s email also made it quite clear that if the drug failed to save Hensley, and she were to leave this world, Larry Zeitlin or Gary Kobinger, or both of them, would be at her bedside holding her hand.
ELWA HOSPITAL, MONROVIA
6 a.m., Sunday, July 27
Dawn broke over West Africa. As the sun came up, Dr. Lance Plyler, the chief of emergency operations at Samaritan’s Purse at ELWA Hospital, was sitting in bed in his house by the beach, reading a psalm in the Bible. Through an open window came a smell of salt air and the rush and thud of surf breaking on the sand. Farther out to sea, fishermen in wooden boats were hauling nets.
You shall not be afraid of the terror by night,
Nor of the arrow that flies by day,
Nor of the pestilence that walks in darkness.
The words of the psalm didn’t help. Plyler was really afraid of what was coming for Kent Brantly and Nancy Writebol.
He spent the day arranging air evacuation for the patients. Samaritan’s Purse eventually hired Phoenix Air, a private air service, to carry the patients to the United States in a specially equipped Gulfstream III medevac jet, which would have in it a biohazard isolation capsule for one patient. The jet could carry only one patient at a time. The patient would be admitted to a high-biosecurity ICU at Emory University Hospital in Atlanta.
Phoenix Air began installing the capsule in the jet, but the work was time-consuming, and the jet wouldn’t arrive in Monrovia for three days. It wasn’t clear that Nancy or Kent could survive for three more days. While he was arranging for the jet, Lance Plyler also began making phone calls all over the world, trying to find experimental drugs that could be shipped to him in Monrovia. He reached Tekmira Pharmaceuticals, an American company, and they agreed to send him some TKM-Ebola, the company’s experimental anti-Ebola drug.
KENEMA
About 10 a.m., Sunday, July 27
Mohamed Yillah, the brother of Auntie Mbalu Fonnie, had shut himself in his bedroom and told his family to leave food for him outside the door. His first blood test for Ebola came up negative. He got a second test, and this time a technician called him and said the result was positive.
After he got the news, Yillah walked out of his bedroom with a smile on his face. “It’s all over, I’ve tested negative,” he said to his family. In fact, he was feeling much better, he told them, so he would be returning to work. He would be going on a mission to Kailahun for several weeks, and cellphone service was spotty there. “If you call and don’t get me, maybe I have gone off coverage,” he said to his family. Sounding casual, and being careful not to touch anybody, he said goodbye to his wife, his children, and to his mother, and got on his motorbike and drove off. They didn’t realize he had said farewell.
Yillah parked his bike at the hospital and got into the back of an ambulance, which carried him to the Doctors’ camp in Kailahun. Lying next to him in the ambulance was Nurse Alice Kovoma, who had tried to save Mbalu Fonnie and had prepared her body for burial. They ended up in Khan’s tent, lying in cots next to him. By then, a Kenema Hot Lab technician named Mohamed Fullah had also been put in Khan’s tent. Fullah had been running an informal clinic in Kenema, and it seems he had caught the virus from a patient at his clinic.
Yillah was now very sick. Despite his condition, he began giving care to Khan and to the other Kenema staff in the tent. That Sunday night, Yillah’s phone rang. It was President Koroma, calling to offer encouragement to the Kenema medical staff. Yillah told the president that they were all alive by God’s grace, and he handed the phone to Khan. Khan spoke briefly with the president, who offered him words of encouragement. Right then, Joseph Fair was working late at the Ministry of Health in Freetown, and somebody told him that President Koroma was on the phone with Khan. After the president had signed off, Fair got on the line. “Cee-baby, it’s me, Joseph. How are you doing?”
Khan answered in a hoarse voice, in words spoken in short bursts. He had stopped eating, he said. He couldn’t keep anything down.
“Is there anything I can do for you?”
“I really want Pringles and a Sprite.”
Fair promised to do what he could.
ELWA HOSPITAL
5 a.m., Monday, July 28
Kent Brantly woke up in darkness, an hour before dawn. He stumbled into the bathroom and sat on the toilet and had three heavy bursts of diarrhea. When he had finished, he stood up and looked. The toilet was full of blood—black hemorrhage. He had just lost between a pint and a quart of blood. A wave of dizziness hit him, and he almost fainted. He steadied himself, and looked in the mirror. His eyes had turned bright red overnight—he was hemorrhaging into the whites of his eyes, a strong predictor of death. He also could see, for the first time, the classic Ebola rash on his chest and torso, a sea of red pimples mixed with small blotchy, starlike bleeds visible below the surface of his skin. He was bleeding into his skin. This, he knew, was also a strong predictor of death.
Later that day, Brantly’s fever spiked to 104.5. The rash spread up his neck and down his legs, and he became too weak to get out of bed. He hemorrhaged into a bedpan. Then he was put in diapers, which got soaked with diarrhea and blood. A doctor gave him a transfusion of whole blood to replace what he was losing. He prayed with his caregivers and thought constantly about his wife, Amber, and their children back home in Fort Worth.
FREDERICK, MARYLAND
Monday morning, July 28
Mike Hensley made pancakes and sausage for James’s breakfast, and then drove him to camp at the YMCA. Afterward, he stopped at a Starbucks and sat at an outdoor table, drinking coffee and reading the news on his phone. He saw that two American medical workers in Liberia had gotten infected with Ebola. Just then his phone rang.
It was Lisa. There was a roaring noise on the line, and he couldn’t hear her very well. He realized it was the sound of air rushing in her space suit—she was calling from inside the lab.
She needed his advice about antibody drugs when they are delivered by intravenous infusion. Mike Hensley had worked in a trial of an experimental antibody drug for cancer. He had done IV infusions into patients. Lisa wanted to know what could go wrong during such an infusion. Could the patient die of an allergic reaction?
He guessed she was talking about the two Americans sick with Ebola, and he guessed the drug was ZMapp. But he knew she couldn’t tell him anything about it because of medical privacy laws. “The outcome is fairly predictable,” he said to her.
“WHAT, DAD?” she shouted. She couldn’t hear him over the noise of her space suit.
“THE OUTCOME IS FAIRLY PREDICTABLE,” he said loudly. He had already been thinking a lot about the effect of ZMapp on Lisa’s body if it were given to her by infusion. He did not tell her this. Speaking loudly and distinctly, he said there were two kinds of bad reactions from an antibody drug. The first kind, which was rare, would be an immediate severe allergic reaction. The second kind, much more common, was flu-like symptoms—chills, fever, muscle aches.
She asked if an allergic reaction could be managed.
“YES. THE DOCTORS SHOULD HAVE FIVE MILLIGRAMS OF BENADRYL AND A HEFTY DOSE OF IV DECADRON OR SOLU-CORTEF DRAWN UP AND WAITING.”
People at nearby tables were glancing at him.
“What should be done if the patient gets flu-like symptoms?” she asked.
“WITH FLU-LIKE SYMPTOMS, THEY SHOULD STOP THE INFUSION FOR FIFTEEN MINU
TES. GIVE THE PATIENT IBUPROFEN, AND THEN RESUME ADMINISTERING THE DRUG. DON’T STOP THE DRUG EVEN IF THERE’S A SEVERE REACTION, JUST TREAT THE REACTION AND KEEP GOING.”
She thanked him and said she had to get back to work.
“BE SAFE,” he said loudly.
* * *
—
At ELWA Hospital, Lance Plyler had been contacting drug companies about experimental drugs. He phoned Gary Kobinger in Winnipeg, and asked whether it would be possible to have some ZMapp shipped to him.
Kobinger dropped a bombshell on Plyler during the phone call: There was a course of ZMapp sitting in a freezer in Sierra Leone, at the Doctors’ treatment center in Kailahun. Doctors Without Borders had decided not to use the drug.
Samaritan’s Purse arranged for a bush pilot to fly a light plane to pick up the drug, but there was no airstrip near the Doctors’ camp. The nearest airstrip was in Foya, Liberia. Foya was in chaos. A medical team in Foya had been attacked by local people, refugees were fleeing across the border to Guinea, and U.N. soldiers were being sent in to restore order. The pilot might not be able to land in Foya, or the plane might get trapped on the ground after it landed. The American Ambassador to Liberia, Deborah R. Malac, had been following the crisis at Samaritan’s Purse, and she offered the help of the U.S. State Department. Ambassador Malac and her staff then began organizing a backup flight to Foya in case the bush pilot couldn’t complete his mission. By late afternoon, July 28, the Embassy had arranged for a United Nations helicopter to fly to Foya and pick up the drug if the bush pilot couldn’t get through. Since this would be a U.S. government operation, a government official would have to be on board the helicopter. That evening, a Marine lieutenant colonel at the U.S. Embassy named Bryan Wilson phoned Lisa Hensley and asked if she would be available. Hensley was on a military deployment, and she agreed to go. The helicopter was scheduled to leave Monrovia the next morning at first light.
Crisis in the Red Zone Page 30