American doctor declared free of Ebola finds the virus in his eye months later

American doctor Ian Crozier was treated for Ebola in Atlanta last year and declared free of the virus in his blood. But he had no way of knowing it still lurked in his eye.

At the time, his eyes were the least of his worries.

“There were lots of things sort of higher on the food chain,” he told CNN’s “Anderson Cooper 360.” “I was struggling to learn to walk again.”

But not long after, mild burning and light sensitivity afflicted his eyes.

Less than two months later, he was back at Emory University Hospital in Atlanta; testing showed the virus was still living in his eye.

Perplexed

His case has left doctors stunned and highlighted the need for eye checkups for Ebola survivors.

Crozier, 44, was hospitalized at Emory University Hospital for more than a month in September after contracting the disease in Sierra Leone, where he worked at a hospital.

At the time, the hospital said he was the sickest of all the four Ebola patients treated there.

Crozier was discharged in October, and about two months later, he developed eye problems and returned to Emory. Doctors stuck a needle in his eye and removed some fluid, which tested positive for the virus.

At the time, Crozier thought the problems were “an immune-related Ebola complication,” but nothing to do with the return of the virus.

“We certainly didn’t think it was related to active and replicating virus in the eye,” Crozier said. “As my sight started to go bad, it became clear that this was a very different animal.”

No risk of spreading the virus

Despite the presence of the virus in the eye, samples from tears and the outer eye membrane tested negative, which means the patient was not at risk of spreading the disease during casual contact, Emory said in a statement Thursday.

It did not name Crozier, but The New York Times did. The New England Journal of Medicine also released a study on the case. Crozier and Dr. Steven Yeh, an associate professor of ophthalmology at Emory University School of Medicine who helped treat him, were both listed as authors of the study.

Though the patient was not at risk of spreading the virus, all health care providers treating survivors, including eye doctors, must follow Ebola safety protocols, said Jay Varkey, assistant professor at Emory University School of Medicine.

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Ebola patient for a second time

When the virus was found in Crozier’s eye, the eye started losing its original blue hue. It turned green.

Bewildered, doctors tried different forms of treatment as he relived his Ebola nightmare.

They gave him steroids and an antiviral agent (which required special approval from the Food and Drug Administration, according to the Times.)

His eye gradually returned to normal, but doctors are not sure whether it was as a result of the steroid shot, pill or his body’s immune system.

While Ebola survivors in West Africa have reported eye problems, it’s unclear how prevalent the condition is and how often it happens. Emory advises that Ebola patients should be monitored for the development of eye symptoms like pain, redness, light sensitivity and blurred vision.

Crozier said he hopes his case will bring light to the enormous challenges Ebola survivors face.

“You can imagine an Ebola survivor who’s already been through their own personal hell,” he said. “And as they emerge from that place, to then in a sense face the tragedy of going blind; it’s a story that we must pay attention.”

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Epidemic slowly fading

Over the past year, about 25,000 people have fought Ebola infections. More than 10,000 have died, mostly in the West African nations of Liberia, Sierra Leone and Guinea.

While the intensity of the largest Ebola epidemic in history has died down, a few people are still newly infected each week.

At least 18 new cases of Ebola were reported in the week ending May 3, the latest World Health Organization report said. All were in Guinea and Sierra Leone.

But as the number of new cases plummet, many unknowns remain on the aftereffects of the virus.

In October, a Doctors Without Borders health worker carries a child suspected of having Ebola in Liberia. Nonprofits often have to fill in the gaps in West Africa, where the health care system was extremely limited even before the epidemic. Because of civil wars and extreme poverty, there aren't enough doctors: Liberia has 0.014 physicians per 1,000 people, Sierra Leone has 0.022 and Guinea has 0.1. In contrast, the United States has 2.5 doctors per 1,000 people.

This picture from August shows a nurse disinfecting a doctor's protective gear at an Ebola hospital in Monrovia, Liberia. The fragile public health systems at the heart of the epidemic in Liberia, Sierra Leone and Guinea became Ebola's first mass casualty. They collapsed as hundreds of health care workers with limited protective gear got sick. As of March 29, there were 861 cases and 495 deaths among medical staff in the three West African countries.

A boy in Monrovia pushes a woman in a wheelchair past a wall bearing information about Ebola in September. Some villages lost their entire working-age populations, leaving countless orphans behind in their place. One nonprofit that works with orphans believes that more than 12,000 children have lost their primary caregiver. Schools were shut down for almost a year and only recently reopened.

In September, a local market area stands empty as Sierra Leone's government enforces a three-day lockdown. The economies of Sierra Leone, Guinea and Liberia will lose at least $1.6 billion in economic growth in 2015, according to the World Bank. With poverty comes chronic disease and undernourishment, which can also have serious consequences on a population's health.

Health workers in Liberia place a man suspected of dying from Ebola into a body bag in September. All the international attention brought to the region has improved public health in these countries: safer burial practices, better disease control, more health facilities and better public awareness about Ebola, the World Bank report said. The United States pledged more than $750 million to fight the disease. It sent troops, supplies and additional aid to West Africa. But it soon had its own concerns at home.

In October, Texas nurse Nina Pham is helped out of the back of an ambulance. She contracted Ebola treating Thomas Eric Duncan. Duncan, a Liberian and the first patient diagnosed with the virus in the United States, died October 8. This case showed the United States how limited its security and its infection-control plan was.

Duncan was contagious but didn't know it. He was able to come into the country with limited scrutiny. After the two nurses caring for him at a Dallas hospital got sick, his case prompted the United States to shift gears. U.S. airports that had flights from Ebola-stricken areas started health screenings for travelers in October. Passengers arriving from Liberia, Sierra Leone and Guinea had their temperatures taken, were assessed for signs of illness and questioned about their health history.

A nurse at Mount Sinai Health Systems in New York demonstrates the proper technique for donning and removing protective gear. The Centers for Disease Control and Prevention updated its protective gear and disease-management protocols. It also sent out guidance to help frightened Americans better understand that the virus was unlikely to get them in their homes.

People peer into a bedroom in Monrovia as a dead body awaits the arrival of an Ebola burial team in October. Globally, the world's health leaders had to take another look at their own safety systems. The United Nations' health arm, the World Health Organization, admitted it was too slow to act. Doctors Without Borders, a group that had a long-term presence in the region, says thousands of lives were lost because of this inaction. Nonprofits with tight budgets had to fill in the gaps, and they continue to sound the alarm.

A child who survived the Ebola virus is fed by another survivor at a treatment center in Hastings, Sierra Leone, in November. The Ebola outbreak started with an infected toddler in a remote village in December 2013, but it wasn't until April 2014 that WHO leaders conceded the epidemic was a "concern." They didn't declare it a Public Health Emergency of International Concern until August. They initially contradicted international aid organizations that had labeled the epidemic "unprecedented." In January, the nonprofit Oxfam called for a Marshall-type of plan to put the three West African countries hit by the crisis back on their feet. The agency said that the world "cannot dither" on putting the countries' economies on an inclusive growth plan.

World Health Organization Director-General Margaret Chan asked wealthier nations to step up and help the poor countries' fragile health systems, suggesting that working systems were not a "luxury" and that they "hold societies together."

A medical worker feeds an Ebola victim at a Doctors Without Borders facility in Kailahun, Sierra Leone. There were hundreds of volunteers from all around the world who answered the call to help the people at the heart of the epidemic.

David and Nancy Writebol were in Liberia with the missionary group Serving in Mission. The North Carolina couple worked for decades to care for orphans and other vulnerable children in Africa and in Ecuador. In August 2013, the group hired the couple to work on their projects in Monrovia. Nancy worked as the personnel coordinator and as a nurse assistant, making sure doctors and nurses were properly outfitted in safety suits and following the decontamination protocols.

Nancy Writebol was diagnosed with Ebola on July 25, 2014. She was flown back to the United States and taken for treatment at the isolation unit at Emory University in Atlanta.

"As a young girl I was always taught that I am no better or more deserving as an American," Nancy Writebol said. "Ebola has made me painfully aware of the number of lives that have quietly slipped into eternity. I will be forever grateful for the medical care and trial drug I received both in Liberia and America." She added, "Our prayer is that the awareness brought by the Ebola crisis will improve the broken health-care systems and serve to train doctors and nurses for Liberia."

Just eight months ago, a young woman named Fatu Kekula was single-handedly trying to save her Ebola-stricken family in Liberia, donning trash bags to protect herself against the deadly virus.

Kekula cared for four of her family members with Ebola, keeping three alive without infecting herself. Her trash-bag method is being taught to others in West Africa who can't get personal protective equipment. All but her cousin survived -- a high success rate considering that about 70% of Ebola patients were dying in Liberia at the time. She had been studying nursing, but her studies were suspended when the schools were closed during the outbreak.

Today, because of a CNN story and the generosity of donors from around the world, Kekula wears scrubs bearing the emblem of the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta, where she's learning skills she can take back home to care for her fellow Liberians. "It's a surprise -- a young child like me who came from a very poor background coming to the U.S.," she said. "These things that I have learned here I am going to take back to my fellow nurses. I love to care for people. I love to save lives."

Tim Callaghan works as a Team Leader with USAID. Normally, he runs the Latin American office, but he is often deployed when there is a major global crisis like the Haitian earthquake in 2010. USAID sent him to Liberia as the team leader to coordinate multiple agency responses. He stayed through October. "When I got to Liberia, I knew from Day 1 we had to focus on changing mindsets. I saw how effective social mobilization was. It was a huge undertaking," he said. "I'm so proud of the work we did, especially with this being in an urban setting for the first time. It raised a lot of issues, making contact tracing very difficult. This was different from the Haiti earthquake, which while awful, but it was a crisis that happened quickly and became manageable." Ebola was different. "We didn't have a lot of people wanting to run into the situation and help," he said. "People were afraid. It was a deadly virus."

Callaghan noticed during the Ebola crisis how little security there was at the airport. "No one at the airport asked where I'd been. In New York, they asked me three questions, including where I had been and how I was feeling. Then they told me to move on. Of course after the case with Mr. Duncan happened, things changed." Callaghan said his family was "nervous" about being in contact with him when he came home, but he did some self-monitoring and took his temperature for the 21 days and was OK.

Ibrahim Fambulle, sick and weak in Liberia, tries to stand as a corpse lies nearby in an Ebola ward in August. Callaghan said the takeaway from the epidemic was that "quick rapid intervention was so important. The faster we could intervene with mobile labs and protective material for health workers, the better we bent the curve," he said. "I also hope what we take away from this experience is that we need to act fast and we need to know how a country will react. We need know where the gaps are. It is a real challenge if you have to do that on the fly. I always say the time to exchange business cards is not three days before the storm. Lay the groundwork now. Of course, a limited budget makes this a challenge."

Daniel F.K. James works with Sierra Leone's Red Cross Society as a supervisor for the national safe and dignified burials program. "I am no longer actively involved in the burials. I have more of a monitoring and quality-control role," he said. "My job over the past year has changed greatly from doing active burials to monitoring, training and supervising Red Cross SDB teams which have greatly contributed to a lower rate of infection." His work, he believes, has been essential to helping his country improve their infection rate, and he keeps his team safe in the process.

Health workers from Sierra Leone's Red Cross Society Burial Team carry a corpse out of a house. "We receive very positive feedback from the communities," James said. "We have had zero cases of infection of our burial team members, which really goes to show the standards of our protocols and how strictly the teams follow the dressing and undressing rules. Most importantly, the teams abide by the practices of no touch and avoiding crowded spaces. We do continuous training with our burial teams so that they remain alert. Although cases levels are going down, we cannot become complacent."

James believes the program will need to continue until they reach zero cases. "We must continue to knock on people's doors and engage the community leaders to spread the word, fight against incorrect information and dispel myths," he said. "Most people accept that Ebola is real, but there are still gaps in how Ebola is contracted." Complacency is not an option. "Even though cases are going down, we still need the logistical means and manpower to respond to the situation and continue with safe and dignified burials."

Katie Meyler is one of the people singled out by Time magazine as a person of the year, one of the people who felt called to fight Ebola in Liberia. She wasn't a health-care worker, nor was she from the area. Instead, she had spent the last nine years of her life in Liberia setting up More Than Me Academy, a tuition-free school for at-risk Liberian girls. When the epidemic was at its height, she had been visiting with her family in the United States. Rather than stay and enjoy her summer break, she went back to Liberia to help. "I think anybody that has any feelings for the countries in West Africa that were hit was feeling helpless," Meyler said. She leveraged her relationships with the local community, working as a bridge between the international aid organizations coming into the crisis and those who needed help. "The people knew what was needed," Meyler said. "They knew what to do. They just didn't have the resources."

Meyler got fathers of her students to volunteer to drive the ambulances she found. She coordinated a group of volunteers who would go door to door in search of the sick. She opened up a building at her school to help quarantine children that may be sick. All of that changed her. "I'm not the same person that I was before Ebola hit," she said. All the while she has kept the world, or at least her nearly 100,000 followers on Instagram, informed about her fight to continue to educate girls. And now she has an added mission to help those who survived Ebola and those orphaned by it. And she is left with great admiration for those who answered the call to help. "The people on the front lines that were risking their lives were the people who were fighting for their own lives, who were fighting for their children's lives," she said.

Rebecca "Bex" Levine works as an officer with the epidemic intelligence service at the Centers for Disease Control and Prevention. She was deployed to the Ebola hot zone not once but three times, and she was tasked with the critical process of contact tracing. That means finding everyone who comes into direct contract with a sick Ebola patient. The hope is to isolate those who are sick quicker. During her first deployment in August, she worked in Freetown, Sierra Leone, as a part of the epidemiology team. She was the first one assigned to the Western Area district. "We were thinly staffed, and it was showing signs of developing into a potential hotspot. It was vital to track potential Ebola cases, because Freetown is tightly packed with people," she said. "There were real surveillance challenges, as Ebola was not yet well-known or understood."

For Levine's second deployment in December and January, she worked in a more rural area where Ebola was just beginning to flare up. "As before, we faced some important challenges, as it is a very remote part of the country. And, as a result, cases were under-reported because of the inability of the health team to quickly reach and educate communities," she said. In Sierra Leone's Kambia district, "there are also cultural barriers to Ebola prevention due to strongly held traditional beliefs," she said, but they staffed up quickly and started tracking data.

"Things are improving throughout much of Sierra Leone, which is a cause for great hope," Levine said. Kambia, though, remains one of the few districts that has not been able to get to zero cases. That's where she was on her third deployment. She kept a video diary on each trip. "We are hopeful that the intensified efforts of a large and dedicated team will soon turn the tide," she said. About her experience, she calls it "truly incredible to watch the response change over the past eight months, going from a terrifying and daunting situation in August to the present time, where getting to zero cases is a now a goal that is in sight." What's worked, she said is the coordination between agencies. "I feel privileged to be a part of this historic response and also feel tremendous respect and admiration for the people of Sierra Leone who are working so hard to get to zero cases."

Dr. Richard Sacra cares for a patient at his clinic in Liberia. In August, Sacra was working as a missionary with SIM, a family physician providing maternity care at ELWA Hospital. However, Ebola was never far away, and he unexpectedly became infected from a patient. His missionary organization flew him back to the United States for treatment in Nebraska. He fully recovered and went back to Liberia in January to help out. "I'm so grateful to all those who lent a caring, loving hand to me in my time of need," he said. "I have been deeply humbled by my Ebola experience. I'm grateful to God for allowing me to live, to continue to make a small difference in people's lives."

"I am no different, certainly no better, than many who lost their lives just trying to provide health care in West Africa to people who needed it -- and others who right now continue to serve on the front lines of the epidemic," Sacra said.

Sacra holds a baby named Noah on the morning of his discharge. For the future, "for the sake of the courageous doctors, nurses, lab technicians and aides who continue to face the same risk I faced, the global community needs to press forward with the task of improving protocols for preventing Ebola in hospitals, clinics and communities," Sacra said. "We need to press on with generous funding for Ebola vaccine and treatment trials so that some good science backed up by data can inform our actions. We should be doing our best to enroll every health worker in Sierra Leone, Guinea and Liberia in a vaccine trial. And even when we get to zero cases of Ebola, we need to turn our attention to training thousands of doctors and nurses to form a stronger health-care work force for these nations, so they will be ready to quickly contain the next outbreak of Ebola or other highly infectious disease." That, he argues, is essential. "If we think about it, we'll realize that we can't afford to do otherwise."

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