Why didn't Texas Ebola patient receive experimental drug sooner?

Doctors were concerned about the risks the experimental drug posed to the Ebola patient, Thomas Eric Duncan. But a worsening condition appears to have changed the equation.

Wilmot Chayee/AP
This 2011 photo shows Thomas Eric Duncan at a wedding in Ghana. Duncan, who became the first patient diagnosed in the US with Ebola, has been kept in isolation at a hospital since Sept. 28, 2014.

News that Thomas Eric Duncan, the Ebola patient in Dallas, is receiving an experimental antiviral drug is another chapter in a fast-moving geopolitical drama exploring, patient by patient, the frontiers of medicine and ethics.

As the global community scrambles to contain the virus, and as the cases outside Africa grow, questions have been raised about why Mr. Duncan, a Liberian war survivor who came to the United States to marry his son’s mother, hasn’t received the same experimental drug that doctors say may have played a role in the recovery of two American medical workers, Dr. Kent Brantly and aid worker Nancy Writebol.

The medical community, led by the Centers for Disease Control and Prevention (CDC), is scrambling to find a medicine to stave off the disease. Two potential Ebola vaccines are now being tested on humans, but even if they’re deemed successful, it will be months before they’re available.

Meanwhile, with Duncan “fighting for his life,” in the words of CDC Director Tom Frieden, a nephew of Duncan’s said: “I don’t understand why he is not getting the ZMapp [the experimental drug administered to Dr. Brantly and Ms. Writebol].” Joe Weeks made the statement to ABC News.

The maker of ZMapp says it doesn’t have any of the drug left. The doses given to the Americans were part of a small batch that took months to develop. It will take the company several months before more of the serum is available, the drugmaker said.

Dr. Frieden has also said that doctors have balked at giving Duncan experimental drugs because side effects may present a mortal threat. The fact that he’s now receiving an experimental drug suggests that his situation has gotten worse to the point where the potential benefits outweigh the potential risks.

Texas Health Presbyterian Hospital said Monday that Duncan is being given brincidofovir, a “broad spectrum” antiviral that has shown promise stopping Ebola, at least in a test tube. The drug is also judged to have fewer side effects than other experimental treatments, which probably played into the doctors’ decision to try this particular drug.

In cases where doctors want to use drugs on humans in ways that haven’t been tested, they apply directly for special permission from the Food and Drug Administration. The agency granted that permission in the Duncan case for compassionate use.

An American Ebola patient in Nebraska is also being treated with brincidofovir. Ashoka Mukpo is a freelance cameraman working for NBC who was diagnosed with the illness while on assignment.

Other Ebola patients have received other drugs. Dr. Richard Sacra, an American who was diagnosed with Ebola in Liberia and came back to the US for treatment, was given TKM-Ebola, which is also experimental.

And a French nurse has received a Japanese anti-flu drug called favipiravir, in hopes it will stave off Ebola.

In addition, Norwegian health authorities just announced that a Norwegian woman being treated for Ebola in Oslo will receive the last remaining dose of ZMapp in the world. Authorities said they were "lucky" that they were able to secure the serum from storage in Canada.

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