British national infected with Ebola evacuated to UK

Questions around why ‘heroic’ Sierra Leone doctor was denied same treatment as US aid workers

Matron Breda Athan demonstrates putting on the protective suit which would be used to treat patients suffering from Ebola at The Royal Free Hospital in London. Photograph: Suzanne Plunkett/Reuters/Files

Matron Breda Athan demonstrates putting on the protective suit which would be used to treat patients suffering from Ebola at The Royal Free Hospital in London. Photograph: Suzanne Plunkett/Reuters/Files

 

A British national who tested positive for Ebola in Sierra Leone is being evacuated to the UK on a Royal Air Force jet, Sierra Leone’s health ministry has said.

It is the first confirmed case of a Briton contracting the deadly virus, for which there is no cure, during the recent outbreak.

A spokesman for the Department of Health said: “The patient is not currently seriously unwell and is being medically evacuated in a specially equipped C17 Royal Air Force plane to RAF Northolt in the UK. “Upon arrival in the UK the patient will be transported to an isolation unit at the Royal Free London NHS Foundation Trust.”

The patient is a healthcare worker who was living in the west African country.

Professor John Watson, deputy chief medical officer, said: “It is important to be reassured that although a case of Ebola in a British national healthcare worker residing in Sierra Leone has been identified and is being brought back to the UK the overall risk to the public in the UK remains very low.”

“We have robust, well-developed and well-tested NHS systems for managing unusual infectious diseases when they arise, supported by a wide range of experts.”

“UK hospitals have a proven record of dealing with imported infectious diseases and this patient will be isolated and will receive the best care possible.”

Dr Bob Winter, national clinical director for emergency preparedness and critical care for NHS England, said: “NHS England, together with PHE, the Department of Health and other key stakeholders has been working hard over the past few weeks to ensure any patient who contracts Ebola and needs to be repatriated to the UK receives the best possible care and treatment. The NHS has a special unit at the Royal Free in London which is well prepared to receive this patient.”

Meanwhile, the grieving family of Sierra Leone’s most famous doctor who died from the virus have begun asking why he was denied the same treatment as the two American aid workers who have recovered after being treated with an experimental drug.

Sheik Umar Khan was a hero in his small West African country for leading the fight against the worst ever outbreak of the highly contagious haemorrhagic fever, which has killed 1,427 people mostly in Sierra Leone, Liberia and Guinea.

When Khan fell sick in late July, he was rushed to a treatment unit run by Medecins Sans Frontieres (MSF) where doctors debated whether to give him ZMapp, a drug tested on laboratory animals but never before used on humans.

Staff agonised over the ethics of favouring one individual over hundreds of others and the risk of a popular backlash if the untried treatment was perceived as killing a national hero.

In the end, they decided against using ZMapp. Khan died on July 29th, plunging his country into mourning.

A few days later, the California-manufactured pharmaceutical was administered to US aid workers Kent Brantly and Nancy Writebol who contracted Ebola in Liberia and were flown home for treatment. It is not clear what role ZMapp played in their recovery but the two left hospital in Atlanta last week.

Khan is among nearly 100 African healthcare workers to have paid the ultimate price for fighting Ebola, as the region’s medical systems have been overwhelmed by an epidemic which many say could have been contained if the world had acted quicker.

In their village of Mahera, in northern Sierra Leone, Khan‘s elderly parents and siblings asked why he did not get the treatment. Khan saved hundreds of lives during a decade battling Lassa fever - a disease similar to Ebola - at his clinic in Kenema and was Sierra Leone‘s only expert on haemorrhagic fever.

“If it was good enough for Americans, it should have been good enough for my brother,” said C-Ray, his elder brother, as he sat on the porch of the family home. “It‘s not logical that it wasn‘t used. He had nothing to lose if it hadn‘t worked.”

Doctors who knew Khan and who were involved in the difficult decision, however, said it was based on sound ethical reasoning.

Ebola, which is passed on by direct contact with the bodily fluids of infected persons, strikes hardest at healthcare providers and carers who work closely with patients.

Victims suffer vomiting, diarrhoea, internal and external bleeding in the final stages of the disease, leaving their bodies coated in the virus. To treat the sick, doctors require training and protective clothing, both of them scarce in Africa.

The outbreak - the first in West Africa - was detected five months ago deep in the forests of southeastern Guinea. But it was not until August 8th that the World Health Organization declared an international health emergency and promised more resources.

By decimating healthcare staff in countries that had only a few hundred trained doctors before the outbreak, Ebola has now left millions vulnerable to the next crisis, experts say.

“Dr. Khan knew the risks better than anybody ... but if you work for months in overcrowded facilities, 18 hours a day, anyone will make a mistake,” said Robert Garry, professor of microbiology and immunology at Tulane University in New Orleans, who worked with Khan for a decade.

“The whole international community needs to look back and say we dropped the ball. We should‘ve reacted faster to this.“

To many in his impoverished country, Khan was a saviour for his pioneering work with Lassa fever, a disease endemic to the jungles of eastern Sierra Leone that kills 5,000 people a year. When Ebola struck, he became a figurehead for that fight, too, hailed by President Ernest Bai Koroma as a “national hero”.

Doctors involved in treating Khan were aware that - given sporadic violence against healthcare workers by a frightened local population - a misstep could prove costly.

“Now you can look back at that and say it was a mistake,” said American doctor Daniel Bausch of Tulane University, who worked with Khan and advocated giving him ZMapp at the time.

“But there was a very tense atmosphere on the ground,“ he said. “If he had died from the drug, or even if it was perceived that he had, it could have had dangerous ramifications.“

Doctors also had ethical concerns about giving Khan priority treatment that hundreds of other infected people could not receive, since only a few doses of ZMapp had been manufactured.

The president of Medecins San Frontieres - which has spearheaded the response to Ebola at clinics in Sierra Leone, Guinea and Liberia - said its doctors could not sanction use of a drug on Khan whose effects were unknown.

“We didn‘t know what the consequences would be. We didn‘t know how sick he was and we didn‘t know how efficient it would be,“ Joanne Liu said.

Khan, who had initially appeared to be recovering, was never told that the drug was available. Two weeks after his death, the World Health Organization approved the use of experimental drugs to tackle Ebola.

Reporting from PA and Reuters