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How Ebola can hide in the bodies of survivors

Liberia was declared Ebola-free this weekend, marking a major milestone in the fight against the epidemic in West Africa, where it killed more than 10,000. But for survivors, the disease can still wreak serious after-effects. Judy Woodruff learns more about those health complications from Ebola patient Dr. Ian Crozier, who nearly went blind from the virus after making a narrow escape from death.

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    This weekend marked a major milestone in the fight to end the Ebola outbreak. Liberia was declared Ebola-free after 42 days without a new case. Many took to the streets to celebrate.

    And efforts are under way to rebuild schools, hospitals and other clinics. The disease has killed more than 10,000 people in West Africa, including 500-plus health care workers. While the outbreak has slowed considerably, there are new health complications for survivors.

    Dr. Ian Crozier is one American health care worker who nearly lost his life while volunteering in Sierra Leone with the World Health Organization. After contracting the virus, he was evacuated to Atlanta's Emory University Hospital and he eventually recovered. Months later, the virus was found in his eye and it nearly blinded him before a series of procedures and treatments. He is still experiencing a number of other symptoms.

    And he joins me now.

    And, Dr. Crozier, welcome. And we're so glad to see you doing much better.

  • DR. IAN CROZIER, Ebola Patient/Survivor:

    Good afternoon. It's a pleasure to be here. It's a pleasure to be anywhere.



    Tell us, first of all, how are you doing? It's, what, been eight months since you were first diagnosed.


    So, I'm doing remarkably well, given what I have been through.

    First of all, I'm fortunate to be here and to be alive, and, secondly, to be looking at you through two fairly clear eyes is quite remarkable. So still struggling with a few symptoms that have been part of my sort of post-Ebola syndrome, but I'm doing much better than I was a few months ago. Thank you.


    Tell us briefly about what happened in your eye, and is it gone? Is the Ebola now gone from your eye?


    So, in early December, I developed what we call uveitis. Forgive the medical-speak, but it actually reflected a great deal of inflammation inside the eye, to put it simply.

    And once that began, it became obvious that it was going to be severe and that it was going to be sight-threatening. As part of my evaluation, because we were really worried about a risk for other viruses after a long hospital stay, Steve Yeh at the Emory Eye Clinic introduced a needle into the front room of my eye, the anterior chamber, and there he found incredibly, incredibly high numbers of active and replicating Ebola virus, which was a great surprise at the time.


    And that was treated. And, today, you are much better, but, as I understand it, it may still be there.



    So, to get back to your question, I received some experimental treatment and a lot of anti-inflammatory medicine, steroids by mouth, steroids by injection into the eye, and topical steroids. And, unfortunately, to actually know for sure that the virus is no longer there, we would need to reintroduce that needle and tap the eye again.

    And given the fact the pressures in my eye have been low, that procedure's risks probably outweigh the benefits. That may come down the road. There is every indication, given the clinical improvement that I have had — it really has been sort of a Lazarian return of the eye, that the virus is no longer there. But I can't say that for sure.


    But we — it's our understanding that it's not contagious, though.


    So, it's very important to point out, actually, this was inside the eye, in the anterior chamber.

    My tear fluids, the conjunctiva, which is outside the eye, those swabs were all negative, even at very high levels inside the eye. So, it's important to point out that, even despite finding Ebola inside the eye, there's no risk of transmission by casual contact.

    This is important because Ebola survivors on the ground are facing a fair amount of stigma already. And I don't want this finding to add to that difficulty.


    Well, this was not only an enormous physical challenge for you, battling your way back, but it has to have also been a psychological challenge. You have spoken of having survivor's guilt.


    Yes, I suppose, though unwarranted, I have a fair amount of survivor's guilt.

    You know, if you had told me on day one of my symptoms that within a week, I would develop multisystem organ failure — it's an ominous term, but my brain failed, and my kidney failed, and my lungs failed. And I needed sort of a level of critical care that really had never been given to that degree before, especially in someone who survived.

    As I was going through that, I'm, of course, incredibly grateful to the WHO and to the State Department. I would have been dead in a week, had I not received that care. But I'm also haunted a little bit by many of my patients and some colleagues and friends who didn't have that opportunity, and that really reflects an inequity in global health that I think we're all about trying to change for years now.

    It's particularly gratifying to me that this — my eye case, which is really on the front edge of essentially a new disease — we had a little signal back in the 1990s of some eye disease in survivors, but this is really a new disease in some ways. And so the fact that my case can hopefully directly and immediately and relevantly be translated to West Africa and prevent West African eyes from going blind is very gratifying, because I certainly struggle with holding those two things in tension.


    Well, and I did want to ask you about that. You just — you just went back to Sierra Leone a few weeks ago. And what did you find there?

    And it is the case, as you say, that your own experience can be of help, as doctors try to figure out the post-Ebola difficulties that other survivors are having.


    Yes. So, people are obviously taking care of survivors on the ground there.

    And John Fankhauser at the ELWA Hospital, an SIM mission hospital, who has been caring for survivors for some time now and is in a sense one of on-the-ground expert, was seeing patients with eye disease. He invited a small team from Emory headed by Dr. Steve Yeh.

    And we, within a short week, saw over 100 Liberian survivors with eye complaints. And though we need to learn a great deal about this disease, it is important. I think the window will be short in which to diagnose and to classify and to provide treatment for these eyes. And this really was the first look, in one sense, especially by Steve, who had fairly rapidly become the world's expert in this disease.

    And so we saw indeed that Liberian survivors, some portion of them are developing eye symptoms and some of those patients are developing sight-threatening disease. If we can change the natural history of that process, it will be remarkable and extremely gratifying to me, if my case can be useful that way.

    You can imagine that a survivor who has, in a sense, survived their first death in the unit and come out and then faces the tragedy of a second death — you know, going blind is not so far down the food chain from dying. And if we can change the natural history of that process, I would like to be part of that.


    Well, Dr. Ian Crozier, it is quite a journey you have been on. I know everyone is celebrating with you your remarkable recovery, but also listening to what you say about the lessons learned and what more has to be done.

    Dr. Ian Crozier, we thank you.


    Thank you, Judy.

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