Ebola Survivors Become Caregivers, Testing Their Immunity

Amie Subah spends her days feeding Ebola patients, giving them medicine and changing children’s diapers at a treatment center in Liberia.

Her most valuable asset: As an Ebola survivor, she believes she is now immune. That means Subah doesn’t need to wear the stifling protective suits that limit doctors’ shifts to 45 minutes, and can spend hours caring for her patients protected by only a blue surgical robe, apron, mask, gloves and red boots.

“I’m not worried,” the 39-year-old midwife said in a telephone interview between shifts. “I know I will not contract the virus even if someone vomits on me.”

Subah is one of 11 survivors working at the Elwa 3 hospital in Monrovia with the aid group Doctors Without Borders. The physicians’ group, which has treated about a third of the 9,000 people infected in West Africa, has never seen a survivor become reinfected with the same strain of virus, said Athena Viscusi, a social worker for the aid organization who works alongside the survivor caregivers.

“We don’t say people are immune for life because we don’t know,” Viscusi said by telephone. “But we do tell them that they will not get Ebola again during this epidemic.”

While other researchers generally agree, there is little definitive evidence on how long immunity may last. Furthermore, if the virus evolves, as it has more than 300 times over the years, a loss of immunity can’t be ruled out, said Marie-Paule Kieny, the World Health Organization’s assistant director-general for health systems and innovation.

Scientific Evidence

“To the best of my knowledge, there has not been a case of a person who has been infected who has recovered and has been infected again,” Kieny said yesterday at a briefing in Geneva. Still, she added, “there is really no scientific evidence.”

The survival rate during this outbreak is about 30 percent, according to the WHO. Immunity may stem from antibodies produced by the immune system to help people survive the disease in the first place. The antibodies are then primed to aggressively fight off any future threat from the same virus.

The WHO and others are investigating whether survivors’ blood, which would contain these antibodies, can be used to help hold off the disease in the current outbreak.

It can take a long time to fully recover from an Ebola infection, said Joseph McCormick, who was involved with first three Ebola outbreaks in Africa in 1976 and ran the U.S. Centers for Disease Control and Prevention’s high-security laboratory for a decade. Most patients lose weight and feel weak as a result.

Survivor Fate

There are no known long-term consequences, though few patients have been rigorously followed because the outbreaks were in remote locations, McCormick, a professor and a regional dean at the University of Texas School of Public Health, said in a telephone interview. The fate of survivors will become more clear following this latest, biggest outbreak, he said.

There has been very little change seen in the virus in fruit bats, its normal host, which suggests those who have recovered will have broad-based immunity, he said. In addition, the different strains seem to cross-react and thus should cross-protect, offering greater immunity, he said.

While scientists probe the immunity issue, the survivors themselves are plowing ahead, providing valuable services on the ground.

Recovery Possible

British nurse William Pooley, who also recovered from Ebola, earlier this week returned to Sierra Leone to work with the U.K.’s King’s Health Partners in Freetown, the BBC reported. Silje Lehne Michalsen, a Norwegian physician with Doctors Without Borders, another survivor, is also determined to return to the field, her father Baard Michalsen said in a phone interview yesterday.

Survivors also have the added advantage of having endured the disease, an experience they can share with patients as they provide hope that recovery is possible, Viscusi said.

Subah says she often advises her patients that “the more you drink, the more you get strength,’” she said. “And I say, ‘make sure you eat the food,’ even if they have low appetite.”

Zaizay Mulbah, 34, is another survivor who was cleared of the virus on Sept. 23. He says he now works at the treatment center from 7 a.m. to 7 p.m., taking care of babies who’ve lost their parents and bathing elderly patients who are too weak to shower.

“We are the survivors who have agreed to give assistance to our brothers and sisters,” he said.

Survivors helping other patients may also serve to reverse the stigma they experience after being discharged, Viscusi said. Many have been shunned by their communities, even evicted from their homes by landlords, she said.

“These are people who are very strong and very devoted,” Viscusi said. “They should be welcomed and embraced.”

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