Lack of Ebola volunteers has doctors scrambling to catch up

Doctors and nurses are finally volunteering to fight the Ebola virus in West Africa after a long period of paralyzing fear in which almost none stepped forward.

But, experts say, even though money is now pouring in from the World Bank, the Gates Foundation and elsewhere, and the U.S. Army is to start erecting field hospitals soon, there is likely to be a long gap before those hospitals can be fully staffed to care for the growing numbers of people sick with Ebola.

“As a result, thousands of people will die,” Dr. Joanne Liu, president of Médecins sans frontières (Doctors Without Borders), which treats more patients than any other entity, said Friday. “I can’t say the exact figure because we don’t know how many unreported cases there are. But thousands for sure.”

Because months went by this summer in which almost no volunteers could be found, and because it takes time to train them and get them to Africa, there remains a yawning gap between the number of medical professionals needed and those in place to do the work. Each 100-bed hospital needs a staff of 400, about 40 of whom are foreign doctors or nurses. Meanwhile, about 600 Ebola cases are being recorded every week, according to the World Health Organization, and that number doubles every three weeks.

“If we had 1,700 staffed beds right now, we could maybe turn the tide,” Dr. Liu said. “When we hear the pledges, we ask for timelines. Some say eight to 10 weeks. They’re going to wake up to a much bigger problem at Christmas”

The first U.S. troops with orders to build 17 100-bed hospitals are arriving in Liberia now. Other countries, particularly Britain and France, are under pressure to do the same in Sierra Leone and Guinea.

But the U.S. military now plans to staff only one 25-bed hospital for infected health workers with members of the quasi-military Public Health Service.

“Who will staff the rest?” asked Dr. Liu. “It needs to be hands-on. You have to chip in and expose yourself.”

Ebola field hospitals ideally contain three separate tents for confirmed, probable and suspected cases; separate toilet and washing facilities for each; and a double fence outside so relatives can talk without touching. They also contain separate dressing and undressing rooms for staff members wearing protective gear, and possibly laboratory and kitchen tents.

Liberia: Chief medical officer places herself under Ebola quarantine

Liberia’s chief medical officer is placing herself under quarantine for 21 days after her office assistant died of Ebola.

Bernice Dahn, a deputy health minister who has represented Liberia at regional conferences intended to combat the ongoing epidemic, told The Associated Press on Saturday that she did not have any Ebola symptoms but wanted to ensure she was not infected.

The World Health Organization says 21 days is the maximum incubation period for Ebola, which has killed more than 3,000 people across West Africa and is hitting Liberia especially hard. WHO figures released Friday said 150 people died in the country in just two days.

Liberia’s government has asked people to keep themselves isolated for 21 days if they think they have been exposed. The unprecedented scale of the outbreak, however, has made it difficult to trace the contacts of victims and quarantine those who might be at risk.

“Of course we made the rule, so I am home for 21 days,” Dahn said Saturday. “I did it on my own. I told my office staff to stay at home for the 21 days. That’s what we need to do.”

Health officials, especially front-line doctors and nurses, are particularly vulnerable to Ebola, which is spread via the bodily fluids of infected patients. Earlier this month, WHO said more than 300 health workers had contracted Ebola in Guinea, Liberia and Sierra Leone, the three most-affected countries. Nearly half of them had died.

Making sure health care workers have the necessary supplies, including personal protective equipment, has been a challenge especially given that many flights in and out of Ebola-affected countries have been cancelled.

At an emergency of the African Union on Sept. 8, regional travel hub Senegal said it was planning to open a “humanitarian corridor” to affected countries.

Senegal was expected on Saturday to receive a flight carrying humanitarian staff from Guinea — the first time aid workers from one of the three most-affected countries were allowed in Senegal since the corridor was opened, said Alexis Masciarelli, spokesman for the World Food Program.

The airport in Dakar, Senegal’s capital, has set up a terminal specifically for humanitarian flights where thorough health checks will be conducted, Masciarelli said.

The current plan calls for two weekly rotations between Dakar and Ebola-affected countries and a third weekly rotation between Dakar and Accra, Ghana, where a special U.N. mission to fight Ebola will be headquartered, Masciarelli said.

Physician credits Ebola survival to experimental, Canadian-developed drug

In his many years of medical work in Liberia, Congo and elsewhere, Dr. Omeonga has suffered bouts of malaria and has seen almost everything in tropical medicine. But nothing, he says, feels like Ebola. He was feverish, vomiting, diarrhea and unable to eat. “You can’t even get off the bed. When you get Ebola, you only think you’re going to die.”

Two things helped him survive the lethal illness. One was ZMapp, the experimental Canadian-developed Ebola treatment. He was one of just seven Ebola victims worldwide who received ZMapp before supplies ran out. He believes that the three doses of ZMapp he received intravenously in Monrovia last month were among the keys to his recovery.

The other crucial support came from his four children, three of whom live in Canada. “Daddy, you have to fight,” they told him. “We need you. You’re going to make it.”

Those daily phone calls from Canada “gave me hope,” he said in an interview. “It’s what helped me to fight.”

ZMapp, a cocktail of monoclonal antibodies, was developed at the National Microbiology Lab in Winnipeg. Of the seven people with Ebola who received the treatment, two died and five lived. Because clinical trials have not been conducted, it’s impossible to say scientifically whether ZMapp saved his life, but Dr. Omeonga is convinced it accelerated his recovery.

The 53-year-old surgeon feels even more certain that ZMapp was crucial in saving a Liberian health worker, Kyndy Kobbah, who was in a coma in critical condition when she received it. “If it wasn’t for ZMapp, she wouldn’t have made it,” he said.

“Everybody was amazed. Nobody gave her a chance to survive. She got her recovery because of ZMapp. If they can expedite the production of it, they should try, because we really need it.”

Dr. Omeonga still sometimes feels weak and tired these days, about four weeks after his discharge from hospital, but he says he is gaining strength every day. And he is determined to return to work as a doctor in Monrovia, at the same Catholic hospital, St. Joseph’s, where he has served for the past three years. The hospital was closed in August after nine of its staff and patients died of Ebola, but it is expected to reopen next month or in early November.

It didn’t even cross his mind to abandon Liberia after surviving Ebola. “Now that I’ve recovered from Ebola, it wouldn’t make sense to be selfish,” he said. “I feel strongly that I want to keep helping the people here. Now that I have a second chance, I’ll use it to help others. They really need us.”

He has already volunteered to donate blood to Ebola patients. “The recovery period is the best time to donate blood, because that’s when you have the full antibodies,” he explains.

Dr. Omeonga’s experience reveals the desperately weak state of Liberia’s health system. His hospital director, Patrick Nshamdze, caught the Ebola virus from a patient in July, but his blood results gave a “false negative” – probably because of poor labelling or specimen collection in the testing process, Dr. Omeonga believes.

So as the hospital staff provided care to the dying director, they didn’t take enough precautions, believing that he didn’t have the Ebola virus. Several staff – including Dr. Omeonga – caught the virus from him, and Dr. Nshamdze died.

Health workers are among the most vulnerable in the Ebola epidemic. As of last week, 375 health workers had been infected with Ebola in four West African countries, and 211 had died.

This is because of three key factors, Dr. Omeonga said. First, there are severe shortages of protective equipment for health workers. Second, health workers have almost daily exposure to the Ebola virus. And third, their patients often conceal the fact that they have the virus.

“Some patients don’t tell the truth,” he said. “They come to you with a different story, like ‘abdominal pain.’ It’s because of the stigma of Ebola. They think they won’t be treated and they’ll be sent away.”

Global efforts to fight Ebola are falling far short, he said. “When I discuss it with my colleagues, we don’t feel the impact of the international help. It’s not coming fast enough. The numbers of cases and deaths are just going up. The international community needs to do more – and fast. A lot of hospitals are closed, and thousands of patients are in the community. Even if we go house-to-house, where are we going to put them?”

Yet his own story is an inspirational sign that the Ebola epidemic can be beaten. “There is a lot of hope,” Dr. Omeonga says.

“I’d like to spread the message of hope. It’s a deadly disease, but it doesn’t kill everyone. The key is to diagnose it early and go to treatment early. If you do that, you can survive.”

Questions and Answers on Ebola

What is Ebola?

Ebola, also known as Ebola virus disease, is a rare and deadly disease caused by infection with one of the Ebola virus strains (Zaire, Sudan, Bundibugyo, or Tai Forest virus). Ebola viruses are found in several African countries. Ebola was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in several African countries.

Has patient zero been identified?

Reports in the medical literature and elsewhere have attempted to identify the patient who might have been the initial person infected in the West Africa Ebola outbreak. Descriptions of these reports are available online. It’s important for CDC to learn as much as it can about the source and initial spread of any outbreak.

With regard to the West Africa Ebola outbreak, tracing the lineage of how Ebola has spread thus far can help CDC apply that knowledge toward better prevention and care techniques. The knowledge gained in this work might entail details about specific patients. CDC generally refrains, however, from identifying particular patients in any aspect of an outbreak.

Signs and Symptoms

What are the signs and symptoms of Ebola?

Signs and symptoms of Ebola include fever (greater than 38.6°C or 101.5°F) and severe headache, muscle pain, vomiting, diarrhea, stomach pain, or unexplained bleeding or bruising. Signs and symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, although 8 to 10 days is most common.

How is Ebola spread?

The virus is spread through direct contact (through broken skin or mucous membranes) with blood and body fluids (urine, feces, saliva, vomit, and semen) of a person who is sick with Ebola, or with objects (like needles) that have been contaminated with the virus. Ebola is not spread through the air or by water or, in general, by food; however, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats.

Can I get Ebola from a person who is infected but doesn’t have fever or any symptoms?

No. A person infected with Ebola is not contagious until symptoms appear.

If someone survives Ebola, can he or she still spread the virus?

Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months.

Can Ebola be spread through mosquitos?

There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus.

Could Ebola be brought to the U.S. through imported animals?

Because of the tough restrictions the U.S. federal government has in place for importing animals from Africa, it is highly unlikely for Ebola to be brought into the U.S. through imported animals.

The animals most commonly associated with Ebola are nonhuman primates (for example, apes and monkeys) and bats. Both the CDC and the U.S. Fish and Wildlife Service regulate importation of nonhuman primates and bats. These animals, products made from these animals, and research samples from these animals may only be imported into the United States with a permit. The permit specifies that the animals, animal products, or research samples are arriving ONLY for scientific, educational, or exhibition purposes. It is illegal to import these animals into the United States as pets or bushmeat.

Risk of Exposure

Who is most at risk of getting Ebola?

Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in direct contact with the blood or body fluids of sick patients.

In some places affected by the current outbreak, care may be provided in clinics with limited resources (for example, no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital.

 Top of Page

Treatment

How is Ebola treated?

No specific vaccine or medicine has been proven to cure Ebola. Signs and symptoms of Ebola are treated as they appear. The following basic interventions, when used early, can increase the chances of survival.

·         Providing fluids and electrolytes

·         Maintaining oxygen status and blood pressure

·         Treating other infections if they occur

Early recognition of Ebola is important for providing appropriate patient care and preventing the spread of infection. Healthcare providers should be alert for and evaluate any patients suspected of having Ebola.

Prevention

How do I protect myself against Ebola?

If you are in or traveling to an area affected by the Ebola outbreak, protect yourself by doing the following:

·         Wash hands frequently.

·         Avoid contact with blood and body fluids of any person, particularly someone who is sick.

·         Do not handle items that may have come in contact with an infected person’s blood or body fluids.

·         Do not touch the body of someone who has died from Ebola.

·         Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.

·         Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on medical facilities.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

o    Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

CDC has issued a Warning, Level 3 travel notice for three countries. U.S. citizens should avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has issued an Alert, Level 2 travel notice for Nigeria. Travelers to Nigeria should take enhanced precautions to prevent Ebola. For travel notices and other information for travelers, visit the Travelers’ Health Ebola web page.

Infection Control

Can hospitals in the United States care for an Ebola patient?

Any U.S. hospital that is following CDC’s infection control recommendations and can isolate a patient in their own room‎ with a private bathroom is capable of safely managing a patient with Ebola.

·         These patients need intensive supportive care; any hospital that has this capability can safely manage these patients.

·         Standard, contact, and droplet precautions are recommended.

How can healthcare providers protect themselves?

Healthcare providers can take several infection control measures to protect themselves when dealing with Ebola patients.

·         Anyone entering the patient’s room should wear at least gloves, a gown, eye protection (goggles or a face shield), and a facemask.

·         Additional personal protective equipment (PPE) might be needed in certain situations (for example, when there is a lot of blood, vomit, feces, or other body fluids).

·         Healthcare providers should frequently perform hand hygiene before and after patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves.

 Top of Page

Travelers

What is being done to prevent ill travelers in West Africa from getting on a plane?

CDC works with partners at ports of entry into the United States to help prevent infectious diseases from being introduced and spread in the United States. CDC has staff working 24/7 at 20 Border Health field offices located in international airports and land borders. CDC staff are ready 24/7 to investigate cases of ill travelers on planes and ships entering the United States.

Although someone could become infected with Ebola in Guinea, Liberia, Nigeria, or Sierra Leone and then fly to the United States, it is unlikely that they would spread the disease to fellow passengers. A person infected with Ebola is not contagious until symptoms appear. Nevertheless, CDC and healthcare providers in the United States need to be prepared for the remote possibility that a traveler could get Ebola and return to the United States while sick.

CDC works with key partners like Customs and Border Protection, U.S. Department of Agriculture, U.S. Coast Guard, U.S. Fish and Wildlife Services, state and local health departments, and local Emergency Medical Services staff. CDC also works closely with the airline and cruise industries and cargo ships to ensure that suspected cases of infectious diseases are reported to CDC Quarantine Stations and that appropriate measures are taken to prevent the spread of disease. When CDC receives a report of an ill traveler on a plane, our staff work with EMS crews to evaluate the passenger on the plane, and when necessary, arrange for transfer of ill travelers to local hospitals for testing and treatment as necessary. When CDC receives a report of an ill traveler on cruise or cargo ship, we work with the shipping line to make an assessment of public health risk and to coordinate any necessary response.

CDC is providing information to partners, such as Customs and Border Protection and airlines, on signs and symptoms to look for in travelers arriving from Ebola outbreak-affected countries that should be reported to CDC quarantine station staff.

What do I do if I’m returning to the U.S. from the area where the outbreak is occurring?

After you return, pay attention to your health.

·         Monitor your health for 21 days if you were in an area with an Ebola outbreak, especially if you were in contact with blood or body fluids, items that have come in contact with blood or body fluids, animals or raw meat, or hospitals where Ebola patients are being treated or participated in burial rituals.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

·         Tell your doctor about your recent travel and your symptoms before you go to the office or emergency room. Advance notice will help your doctor care for you and protect other people who may be in the office.

What do I do if I am traveling to an area where the outbreak is occurring?

If you are traveling to an area where the Ebola outbreak is occurring, protect yourself by doing the following:

·         Wash your hands frequently.

·         Avoid contact with blood and body fluids of any person, particularly someone who is sick.

·         Do not handle items that may have come in contact with an infected person’s blood or body fluids.

·         Do not touch the body of someone who has died from Ebola.

·         Do not touch bats and nonhuman primates or their blood and fluids and do not touch or eat raw meat prepared from these animals.

·         Avoid hospitals where Ebola patients are being treated. The U.S. Embassy or consulate is often able to provide advice on facilities.

·         Seek medical care immediately if you develop fever (temperature of 101.5oF/ 38.6oC) and any of the other following symptoms: headache, muscle pain, diarrhea, vomiting, stomach pain, or unexplained bruising or bleeding.

o    Limit your contact with other people until and when you go to the doctor. Do not travel anywhere else besides a healthcare facility.

Should people traveling to Africa be worried about the outbreak?

Currently, Ebola has only been reported in Guinea, Liberia, Nigeria, Senegal, and Sierra Leone (see Affected Countries). A small number of cases in Nigeria have been associated with a man from Liberia who traveled to Lagos and died from Ebola, but the virus does not appear to have been widely spread. CDC has issued a Warning, Level 3 travel notice for United States citizens to avoid all nonessential travel to Guinea, Liberia, and Sierra Leone. CDC has also issued an Alert, Level 2 travel notice for travelers to Nigeria urging them to protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. You can find more information on these travel notices at http://wwwnc.cdc.gov/travel/notices.

CDC currently does not recommend that travelers avoid visiting other African countries. Although spread to other countries is possible, CDC is working with the governments of affected countries to control the outbreak. Ebola is a very low risk for most travelers – it is spread through direct contact with the blood or other body fluids of a sick person, so travelers can protect themselves by avoiding sick people and hospitals where patients with Ebola are being treated.

Why were the ill Americans with Ebola brought to the U.S. for treatment? How is CDC protecting the American public?

A U.S. citizen has the right to return to the United States. Although CDC can use several measures to prevent disease from being introduced in the United States, CDC must balance the public health risk to others with the rights of the individual. In this situation, the patients who came back to the United States for care were transported with appropriate infection control procedures in place to prevent the disease from being transmitted to others.

Ebola poses no substantial risk to the U.S. general population. CDC recognizes that Ebola causes a lot of public worry and concern, but CDC’s mission is to protect the health of all Americans, including those who may become ill while overseas. Ebola patients can be transported and managed safely when appropriate precautions are used.

What does CDC’s Travel Alert Level 3 mean to U.S. travellers?

CDC recommends that U.S. residents avoid nonessential travel to Guinea, Liberia, and Sierra Leone. If you must travel (for example, to do for humanitarian aid work in response to the outbreak) protect yourself by following CDC’s advice for avoiding contact with the blood and body fluids of people who are ill with Ebola. For more information about the travel alerts, see Travellers’ Health Ebola web page.

Travel notices are designed to inform travellers and clinicians about current health issues related to specific destinations. These issues may arise from disease outbreaks, special events or gatherings, natural disasters, or other conditions that may affect travelers’ health. A level 3 alert means that there is a high risk to travellers and that CDC advises that travelers avoid nonessential travel.

In the United States

Are there any cases of people contracting Ebola in the U.S.?

No confirmed Ebola cases have been reported in the United States, with the exception of two U.S. healthcare workers who were infected with Ebola virus in Liberia and were transported to a hospital in the United States. Both patients have been released from the hospital after laboratory testing confirmed that they no longer have Ebola virus in their blood. CDC has advised the hospital that there is no public health concern with their release and that they do not pose a risk to household contacts or to the public.

CDC has received many calls from health departments and hospitals about suspected cases of Ebola in travellers from the affected countries. These calls have been triaged appropriately and some samples have been sent to CDC for testing. All samples sent to CDC have so far been negative.

What is CDC doing in the U.S.?

CDC has activated its Emergency Operations Canter (EOC) to help coordinate technical assistance and control activities with partners. CDC has deployed several teams of public health experts to the West Africa region and plans to send additional public health experts to the affected countries to expand current response activities.

On the remote possibility that an ill traveller arrives in the U.S., CDC has protocols in place to protect against further spread of disease. These protocols include having airline crew notify CDC of ill travellers on a plane before arrival, evaluation of ill travellers, and isolation and transport to a medical facility if needed. CDC, along with Customs & Border Patrol, has also provided guidance to airlines for managing ill passengers and crew and for disinfecting aircraft. CDC has issued a Health Alert Notice reminding U.S. health care workers about the importance of taking steps to prevent the spread of this virus, how to test and isolate patients with suspected cases, and how to protect themselves from infection.

THE IMPACT OF EBOLA VIRUS ON THE WORK FORCE

MORE than 1,900 people have so far died from Ebola in the four affected west African countries, but many more will suffer the economic consequences. Governments reckon the worst of those effects are yet to be felt, but they are still busy trying to calculate what the outbreak is going to cost them. Here are Liberia’s thoughts:

The tiny post-conflict country has been growing at upwards of 8% over the last couple of years, but won’t expect anything like that kind of luck now. The government is still number-crunching with the International Monetary Fund, but it reckons Ebola will shave more than 2% of growth rates this year, putting estimates at 3.5%.

Finance minister Amara Konneh says that’s mostly because of damage done to mining, agriculture and service industries, as investors evacuate foreign workers, borders close, and international flights are suspended. Bread-basket regions are under quarantine, making agricultural trade impossible. Sime Darby, the world’s largest listed producer of oil palm, is slowing production and Sifca Group, an Ivory Coast-based agribusiness, has halted rubber exports. MrKonneh expects iron ore exports to fall in 2015 because investors like China Union and Arcelor Mittal are scaling down their operations and putting expansion plans on hold. Foreign exchange shortages are a big concern.

The finance ministry is bracing itself for up to $30m in lost revenues; a “significant” amount, it says, in the context of its meagre budget. Add to that the high cost of fighting the virus, and the country will run up a big fiscal deficit, even in light of international assistance. The government is putting in place fiscal austerity measures to compensate for that, including suspending all official foreign travel. But it may still may have to turn to the IMF for additional help.

Right now, Mr Konneh says, the priority is that the government allocates enough money to the healthcare sector. After that, it worries about paying its public servants. Security to enforce quarantines and curfews comes next. The rest, for now, may have to wait.

About Ebola Virus Disease

Ebola Virus Disease (EVD) is one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees).

Ebola is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. When infection occurs, symptoms usually begin abruptly. The firstEbolavirus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River. Since then, outbreaks have appeared sporadically.

There are five identified subspecies of Ebolavirus. Four of the five have caused disease in humans: Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus); Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus); and Bundibugyo virus (Bundibugyo ebolavirus). The fifth, Reston virus (Reston ebolavirus), has caused disease in nonhuman primates, but not in humans.

The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) with bats being the most likely reservoir. Four of the five subtypes occur in an animal host native to Africa.

A host of similar species is probably associated with Reston virus, which was isolated from infected cynomolgous monkeys imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facility outbreaks became infected with the virus, but did not become ill
.

9 questions about this new Ebola drug.

Ebola virus strand

 Two American missionary workers infected with the deadly Ebola virus were given an experimental drug that seems to have saved their lives.

Dr. Kent Brantly was given the medication, ZMapp, shortly after telling his doctors he thought he would die, according to a source familiar with his case. Within an hour, doctors say his symptoms -- labored breathing and a widespread rash -- dramatically improved. Nancy Writebol, another missionary working with Samaritan's Purse, received two doses of the medication and has also shown significant improvement, sources say.

As there is no proven treatment and no vaccine for Ebola, this experimental drug is raising lots of questions.

1. Who makes the drug?

The drug was developed by the biotech firm Mapp Biopharmaceutical Inc., which is based in San Diego. The company was founded in 2003 "to develop novel pharmaceuticals for the prevention and treatment of infectious diseases, focusing on unmet needs in global health and biodefense," according to its website.

Mapp Biopharmaceutical has been working with the National Institutes of Health and the Defense Threat Reduction Agency, an arm of the military responsible for countering weapons of mass destruction, to develop an Ebola treatment for several years.

2. Are there other experimental Ebola drugs out there?

Yes. In March, the NIH awarded a five-year,$28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.

"A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why," a news release about the grant said.

Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information.

Map: The Ebola outbreak

At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced a safety trial of another Ebola vaccine will start as early as September.

3. How does ZMapp work?

Antibodies are proteins used by the immune system to mark and destroy foreign, or harmful, cells. A monoclonal antibody is similar, except it's engineered in a lab so it will attach to specific parts of a dangerous cell, according to the Mayo Clinic, mimicking your immune system's natural response. Monoclonal antibodies are used to treat many different types of conditions.

West African Ebola epidemic

Sources told CNN the medicine given to Brantly and Writebol abroad was a three-mouse monoclonal antibody, meaning that mice were exposed to fragments of the Ebola virus and then the antibodies generated within the mice's blood were harvested to create the medicine.

However, the drug can also be produced with proteins made from tobacco plants. ZMapp manufacturer Kentucky BioProcessing in Owensboro has been working with Samaritan's Purse and Emory University Hospital to provide limited quantities of the drug to Emory, according to company spokesman David Howard.

4. Why did American missionary workers get the drug?

Many have asked why these two workers received the experimental drug when so many -- around 1,600 -- others in West Africa also have the virus.

The World Health Organization says it was not involved in the decision to treat Brantly and Writebol. Both patients had to give consent to receive the drug, knowing it had never been tested in humans before.

The process by which the medication was made available to the American patients may have fallen under the U.S. Food and Drug Administration's "compassionate use" regulation, which allows access to investigational drugs outside clinical trials.

5. Did doctors know it would work?

No. The drug had shown promise in primates, but even in those experiments, just eight monkeys received the treatment. In any case, the human immune system can react differently than primates', which is why drugs are required to undergo human clinical trials before being approved by government agencies for widespread use.

The two Americans' cases will be studied further to determine how the drug worked with their immune systems.

6. Will the drug be made available to other Ebola patients?

It's unclear. Rolling out an untested drug during a massive outbreak would be very difficult, Doctors Without Borders said in a statement. Experimental drugs typically not mass-produced, and tracking the success of such a drug if used would require extra medical staff where resources are already scarce.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, says scientists have to be careful about assuming this drug will work in other patients as it appears to have worked in Brantly.

"Having worked with administering antibodies for people for a really long time, that would be distinctly unusual," he told CNN. "As we all know in medicine ... you have to withhold judgment."

7. Does the company have more vials of the drug?

The company has very few doses ready for patient use, Fauci told CNN.

"(Kentucky BioProcessing) is working closely with Mapp, various government agencies, and other parties to increase production of ZMapp, but this process will take several months," Howard said.

8. Who paid for the drug and how much did it cost?

We don't know. Samaritan's Purse covered the cost of Brantly and Writebol's evacuations but did not pay for the drug, according to a spokesman.

When a patient gets an experimental drug, the drug company can donate the product under compassionate use. Mapp Biopharmaceutical Inc. might have done that in this case.

Health insurance companies typically do not pick up the tab for treatments that have not been approved by the FDA. But they usually would cover the cost of any doctor fees associated with giving the drug and any costs associated with monitoring how the drug is working.

9. Would this drug stop the Ebola epidemic?

If it were widely available, it certainly couldn't hurt. An effective Ebola drug could help doctors treat the deadly virus, which is killing about 60% of the people infected in West Africa. But a vaccine would be a much more effective tool in stopping this, and future, epidemics.

Vaccines are given to healthy people to prevent them from ever becoming infected. One challenge with Ebola, experts say, is that companies don't believe they could make much money from developing a vaccine, so few companies show interest.