American Ebola patient worsens to critical condition

An American health care worker being treated for Ebola has deteriorated to critical condition, the National Institutes of Health said Monday.

The patient, who has not been identified, tested positive for the Ebola virus while volunteering with Partners in Health at an Ebola treatment unit in Sierra Leone. The patient was airlifted by private charter to the NIH Clinical Center in Bethesda, Md., on Friday. The patient is the 11th person with Ebola to be treated in the USA.

On Sunday, 10 health care workers who came in contact with the patient in Sierra Leone were flown to the USA. In case they become sick, all were staying near hospitals with high-level biocontainment units capable of treating Ebola.

On Monday, one of those health workers was moved into the biocontainment unit at Nebraska Medical Center in Omaha because of a change in symptoms, officials said. The hospital staff did not reveal what sort of symptoms the person experienced. Early symptoms of Ebola -- such as a fever, nausea or diarrhea -- can be caused by many unrelated conditions from the flu to food poisoning.

"At this point, this person has not tested positive for the Ebola virus," said Phil Smith, medical director of the biocontainment unit at the Nebraska Medical Center. "However, because of a change in symptoms, we decided the most prudent course of action was to bring the individual to the biocontainment unit, where we can better monitor symptoms and safely perform testing. However, some of the symptoms which prompted the move to the biocontainment unit have resolved this morning."

The other nine evacuated health workers had no symptoms as of Sunday, according to Partners in Health, a Boston-based aid organization.

NIH officials have not revealed whether their patient has received any experimental treatments. There are no approved vaccines or therapies, but previous Ebola patients treated in the USA have received experimental drugs such as ZMapp, TDK-Ebola and brincidofovir,as well as blood donations from survivors. Because the drugs were given to a small number of Ebola patients with no control group for comparison, scientists say it's impossible to know if any of those interventions helped.

Being listed in critical condition may be an ominous sign.

"Ebola goes through various stages as symptoms progress, and the fact that this patient has now become critical suggests that symptoms have reached a dangerous stage," said Amesh Adalja, senior associate at the Center for Health Security of the University of Pittsburgh Medical Center, who has no direct knowledge of the patient. "The patient may be experiencing low blood pressure, massive fluid losses, difficulty breathing or kidney failure. Early diagnosis and prompt treatment can help forestall these complications. From press reports, it appears that this patient had 'collapsed' prior to transport, suggesting the virus had a head start before treatment was initiated."

Being listed in critical condition could mean that the patient is on life support, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, who has no direct knowledge of the patient. "Most of the patients who have survived have not progressed to the critical stage," Hotez said.

Thomas Geisbert, an Ebola expert at the University of Texas Medical Branch in Galveston, noted that some very ill people have survived.

Ian Crozier, a doctor working for the World Health Organization who became infected with Ebola in Sierra Leone, was hospitalized at Emory University Hospital in Atlanta for 40 days -- the longest of any Ebola patient treated in the USA.

Crozier, who allowed his identity to be revealed only several weeks after he had been discharged, came close to death, with a fever of 104, a rash throughout his body and a level of the Ebola virus in his blood that was 100 times higher than what his Emory doctors had seen in other patients. At one point, Crozier was on a ventilator and dialysis.

The United Kingdom recently evacuated six people from West Africa: a health worker who contracted Ebola, four people who had contact with that person, and a sixth person who, in an unrelated event, was stuck with a needle while caring for Ebola patients.

The World Health Organization said Tuesday that Sierra Leone, Guinea and Liberia have recorded 24,597 cases of Ebola and 10,114 deaths since the epidemic began more than a year ago.