How the U.S. Healthcare System Would Handle Ebola

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Past strains of Ebola have killed 90 percent of those infected, but this one seems slightly less lethal, at just 55 percent. Still, you don’t like those odds. So far the doctors are giving you supportive care—water and antibiotics—but there’s no cure.

There are a few potential therapeutics for Ebola, but none that have cleared human trials yet. In fact, it would take weeks, if not months, for drug companies to develop any sort of reliable treatment.

“If we got some kind of an outbreak in the U.S., we're technically screwed,” said Michael Pollastri, an associate professor of chemistry, also at Northeastern University. “It doesn't work like the movies where you get a cure in three days. The thing is with these antibodies, you have to grow them up in living cells. People don’t just run out of the lab and say, ‘I have it right here! Give it to that guy!’”

You start to think maybe there’s hope for you in an experimental serum like ZMapp, the drug used to treat the missionaries Kent Brantly and Nancy Writebol, who contracted Ebola while treating patients in Liberia.

The first step would be for the hospital to appeal to the FDA for permission to be allowed to use an experimental therapy under the agency’s “compassionate use” provision. The FDA says “yes” 98 percent of the time, so this isn’t your biggest hurdle, according to Arthur Caplan, director of the division of medical ethics at NYU’s Langone Medical Center.

Unfortunately for you, though, neither the hospital nor the government decides who gets experimental treatments; the drug companies do. ZMapp, the antibody given to Brantly and Writebol, is made by a tiny California company called Mapp Biopharmaceutical Inc. It has nine employees and only a tiny amount of ZMapp. Yesterday, Bloomberg reported that Mapp is apparently sending ZMapp to West Africa, and it has now depleted its meager supply of the drug.

But let’s say there was some ZMapp left. The decision to give it to you would be the manufacturer’s.

“There's no authority to compel the company to give you anything,” Caplan said. “A company can set the terms, it can say, ‘Yep, you can have it, you just have to pay us enough money.’”

A tiny company like Mapp, Caplan said, might want to recoup its investment. Antibodies like ZMapp typically run in the tens of thousands of dollars per dose, he added. Insurance likely won’t cover it, since it’s an experimental therapy. If they ask you to pay, it’s up to you to either rake together the cash, make some beseeching media appearances, or run one hell of a Kickstarter.

“It's a measure of whether you're connected or vocal,” Caplan said. “It's not like we have a system. We don’t.”

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Fortunately, Mapp Biopharmaceutical, or some other tiny pharmaceutical company, opts to give you an experimental drug for free. It arrives with a set of instructions describing how it worked when the scientists gave it to monkeys, which is the only kind of primate it’s been tested on so far. Until now, that is.

There’s no clear-cut dosage, so your doctors embark upon a strange sort of trial-and-error mission, jabbing you with syringes full of the stuff until it starts to look like you’re turning a corner. (Brantly, for example, ended up needing two doses of ZMapp.)

After a few days of hiccups—another Ebola symptom—you finally start to feel better. Several weeks after you first fell ill, you stop showing symptoms, are no longer contagious, and can be discharged.

Your doctors will want to observe you for side effects, possibly for months after the ordeal. “If the treatment destroys your liver, that’s not a cure,” Caplan said.

The effects of Ebola can linger: You might have memory problems and other health issues for up to a year after the fact.

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Donald Allegra, chair of infection control at Newton Medical Center in New Jersey, said he strongly doubts there would ever be an Ebola outbreak in the U.S. But local public health officials might still be on the lookout for potential Ebola cases among Americans who have recently traveled to West Africa.

Several aid groups, including the Peace Corps, are currently repatriating Americans who were stationed in the Ebola-affected nations. According to Allegra, that means that some hospitals might soon be getting calls to the effect of, “I just got back from Liberia and I have a little fever. What should I do?"

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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