It’s been more than three months since missionaries Nancy Writebol and Dr. Kent Brantly became the first U.S. citizens to contract the Ebola virus while working in Liberia.
Both have recovered, and health officials continue to say they don’t know how the two became infected because they had followed strict precautions to protect against infection as they worked at the Ebola treatment unit on the campus of the ELWA hospital in Monrovia.
But one of their colleagues has an idea.
Dr. Lance Plyler, 50, spent two months in Liberia this summer – along with Writebol and Brantly – as medical director of the disaster response unit for Samaritan’s Purse, the Boone-based mission organization.
He doesn’t know exactly how his fellow missionaries got infected, but he has strong feelings about how they did not get it.
“I can’t prove it, but I’m pretty certain they did not … get infected in the Ebola treatment unit,” Plyler said.
That’s because Samaritan’s Purse health care workers in the Ebola unit followed the lead of Doctors Without Borders and used the strictest precautions – complete skin coverage, N95 masks, and a “buddy system” when donning and doffing the protective gear. In that unit, “we think we batted 100 percent” in protecting against Ebola infection of health care workers, Plyler said.
What complicated matters, he said, was that the Ebola unit and the ELWA hospital, which were operated jointly by Samaritan’s Purse and Charlotte-based SIM, were near each other.
That raised the risk of cross contamination for people working in both places, as Writebol and Brantly did.
“Kent was as meticulous as you could possibly be” when working in the Ebola unit, Plyler said. But, in the hospital, health care workers didn’t wear full protective gear unless screening led them to suspect a patient might have an Ebola infection.
“That’s where we failed,” Plyler said. “… It’s hard to know that the patients you’re screening don’t have Ebola” because the symptoms of Ebola – fever, nausea, diarrhea, vomiting – are similar to those of other diseases endemic to Africa.
Plyler said Samaritan’s Purse has changed its policy and would now prohibit staff from working in both places.
“You do not do both. You do either/or,” Plyer said. “The hospital is sometimes the most deadly place to work. We used to say the safest place to be is the Ebola treatment unit.”
Although not a health care worker, Writebol, from Charlotte, worked as a hygienist, spraying down staffers who came out of the Ebola treatment unit to make sure they did not contaminate themselves while removing protective gear. Plyler said both Writebol and Brantly had contact with Ebola patients and also with hospital staffers from Liberia who contracted the infection and later died.
Because the “sheer number” of Ebola cases became “overwhelming,” Plyler said Samaritan’s Purse has turned its attention from hospital care to home care. The agency is now providing family members with the knowledge and equipment to care for Ebola patients at home.
Just as Samaritan’s Purse has adjusted its policies, Plyler praised U.S. health officials for adjusting to the outbreak. “What you learn from preparing for Ebola,” Plyler said, “will prepare you for a lot of other viruses and infections.”