Ebola Virus Disease: Experience and Decision Making for the First Patients outside of Africa

Points• Ebola hemorrhagic fever, or Ebola virus disease (EVD), has emerged in the last year as a global threat and humanitarian disaster for the affected countries of West Africa and has also come to the United States (US) and Europe.• The treatment of the first and three subsequent US patients outside of Africa at Emory University provided a number of challenges, as well as strategic and tactical lessons that included detailed planning and team work across multiple academic and health care units, emphasizing biosafety, the importance of institutional communications, addressing unanticipated challenges such as waste management, and the logistics of working closely with governmental agencies and outside collaborators.• In providing effective care for individuals, the value of mobilizing a diverse health and academic community to work collaboratively to addressing a global threat is emphasized.This includes dissemination of best practice information; providing education and training about EVD; expansion of new knowledge about the clinical course, complications, and pathogenesis of EVD; the creation of new institutional forums, and engagement in the broader policy and equity issues of contagious health threats.Ebola hemorrhagic fever, or Ebola virus disease (EVD), is caused by a highly contagious group of enveloped, single-stranded, negative-sense RNA viruses of the family Filoviridae.The disease has historically carried 53%-88% mortality [1-3].In December 2013, what has now become the largest and most devastating Ebola outbreak ever recorded, caused by a new strain of the Zaire species (Zaire ebolavirus), began in Meliandou, Guinea, West Africa and soon enveloped neighboring Sierra Leone and Liberia, with cases also in Nigeria, Senegal, and Mali [1-5].WHO (World Health Organization)/CDC (United States Centers for Disease Control and Prevention) reports 27,550 cases and 11,235 deaths in the three principal countries as of June 28, 2015 [6], which may be an underestimation of at least a factor of 2. On August 2 and 5, 2014, two medical missionaries who developed EVD in late July while working at Eternal Love Winning Africa (ELWA) hospital in Liberia were evacuated from Monrovia by a specially designed air ambulance to Emory University Hospital (EUH) [7].Until August 2, 2014, EVD had not been seen or treated in humans outside of Africa.The initial call for help for these missionaries came to our institution on July 30 and would mobilize