But while Sprecher acknowledges the importance of IV rehydration—DWB reinstated the practice in October—he’s also skeptical that rehydration alone can explain the high survival rates of Western patients. Death rates in the Monrovia facility, he notes, were similar during and after the September IV suspension. “That’s not a reason to say it doesn’t work. It’s just reason to dampen down the optimism of people who think that this judicious application of IV therapy is what pulls people back from the grave,” he says, adding that he believes sepsis, or blood poisoning, is a more common cause of death than dehydration.
Still, aggressive IV fluid replacement was a cornerstone of the treatment given to Ebola patients who were evacuated to the West, myself included. “We think that getting a good, secure IV line into patients, and giving cautious but aggressive fluids, is the best thing we did,” says Phil Smith, the physician at the Nebraska Medical Center who treated me and two other Ebola patients last year. Atai Omoruto, a Ugandan doctor who ran one of the World Health Organization’s treatment facilities in Monrovia until December, agrees, saying that the insertion of an IV line was one of her first concerns when admitting new arrivals. Nonetheless, she says the death rate at her facility was around 40 percent.
Besides dehydration, fluid loss poses another danger for Ebola patients: electrolyte deficiencies, which can lead to heart attacks and other complications. “If one can know the electrolyte situation, the patient’s chances of survival are increased,” Omoruto says, but “we lost several of our patients from cardiac arrest due to low potassium.” In Nebraska, doctors analyzed my blood for its mineral content on a regular basis—but in West Africa, the equipment needed to perform those tests is rarely available, and experimental mobile technology has proved unreliable, Sprecher says.
Blood transfusions like the one I received from Kent Brantly, by contrast, are a straightforward procedure that health workers in the field can do with relative ease. But still, they’re rarely administered in West Africa, because doctors still aren’t 100 percent sure that they work.
When the outbreak began, there was some debate between the WHO and DWB about the value of these transfusions, which involve the donation of blood plasma from Ebola survivors. The thinking behind the treatment is that antibodies in the survivors’ plasma already know how to fight the virus, and therefore might help to decrease a new patient’s viral load and kickstart his or her immune system. I felt markedly better the day after receiving my transfusion, although my doctors said there’s no way to know for certain if it was a result of the procedure or simply a coincidence in the timing of my recovery.
Shevin Jacob, an infectious-disease specialist who has worked with the WHO in Sierra Leone and Liberia, says plasma transfusions are still considered an “investigational therapeutic.” There is some evidence that they work—in one well-known study from the mid-1990s, seven out of eight Ebola patients survived after receiving survivors’ blood—but there’s still not enough data to convince the WHO and other health organizations, many of which are hesitant to incorporate the procedure into existing treatment guidelines. “For us to say [that] everyone should be getting this therapy when we don’t know if it’s truly beneficial is almost unethical,” Jacob says. On the other side of the issue, Omoruto recalls being frustrated that she was not permitted to give transfusions from survivors to her patients, and remembers clashing with DWB over their potential treatment value.