When Thomas Eric Duncan became the first diagnosed case of Ebola in the United States, his relatives with roots in virus-ravaged Liberia knew what questions to ask.
Would his treatment include experimental drugs? Was a blood transfusion from a survivor an option? What about a transfer from the hospital in Dallas, where he was being treated, to one of four medical centers nationwide that specialize in highly infectious diseases like Ebola?
Duncan, poor and uninsured, did not get all the help his family members said they wanted, and they now question why his care was different in some ways than that of Americans infected with the deadly virus who survived. Of the nine people who have been treated for Ebola in the U.S., only Duncan has died.
Here are some of the questions about his care and answers from health officials.
Q: How quickly was Duncan diagnosed?
A: Duncan was misdiagnosed with a sinus infection after first arriving at Texas Health Presbyterian Hospital Dallas on Sept. 25. He returned in far worse shape on Sept. 28, when a doctor quickly flagged Duncan as a possible Ebola victim. But the misdiagnosis meant Duncan did not get care for Ebola as quickly as possible.
Q: Did Duncan get a blood transfusion from an Ebola survivor?
A: No. The Dallas hospital couldn't find a survivor with a matching blood type for Duncan. As a result, Duncan could not get a transfusion of blood plasma containing antibodies from an Ebola survivor. That tactic has been used as an experimental treatment.
Q: How about experimental drugs?
A: Duncan received an experimental antiviral drug called brincidofovir six days after doctors first suspected he had Ebola, according to his medical records. American video journalist Ashoka Mukpo received the same drug and recovered. Other patients have been treated with ZMapp and TKM-Ebola, which are the only antivirals proven to protect nonhuman primates from Ebola, according to Dr. Thomas Geisbert, an Ebola expert at the University of Texas Medical Branch in Galveston. A manufacturer has run out of ZMapp doses, though limited doses of TKM-Ebola are available.
Q: Would using other drugs or treatments have made a difference?
A: Experts disagree, but they acknowledge it's hard to know anything for certain because so little data is available.
Q: Why wasn't Duncan moved to a hospital specially equipped to treat highly infectious diseases like Ebola?
A: Duncan's relatives say they wanted him sent to Emory University Hospital in Atlanta, which has a special isolation unit and had experience treating Ebola patients. It's not clear who made the decision to keep Duncan at the Dallas hospital. His records don't mention a move. A spokeswoman for the Texas Department of State Health Services said the decision not to move Duncan came from Presbyterian Hospital and the U.S. Centers for Disease Control. Hospital spokesman Wendell Watson said the hospital raised the possibility with the CDC of transferring Mr. Duncan to another hospital such as Emory. But CDC felt that would be unnecessary, Watson said. CDC spokesman Thomas Skinner said the decision to treat Duncan in Dallas was made by the hospital, doctors and the patient.