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NASHVILLE, Tennessee - During the height of the Ebola outbreak in West Africa in 2014, infectious disease specialist Dr. Ian Crozier was on the ground in Sierra Leone, serving as part of a World Health Organization medical team deployed to handle the unprecedented 28,000 cases of Ebola in the region.
Crozier had been treating patients around the clock for about a month when he began experiencing the symptoms he knew all too well.
“I had fever and muscle aches and at the time, a severe headache. The next morning I alerted the team and took my blood and then, a few hours later, had a positive test,” he recalled.
Within 48 hours Crozier was back in the U.S. On Sept. 9, 2014 he emerged, in full protective gear, from an ambulance that brought him to Emory University Hospital — one of only four biocontainment facilities in the country prepared to treat Ebola patients at the time.
“The last thing I can remember,” Crozier says “is going into the back doors at Emory from the ambulance.”
Crozier was in the ICU biocontainment unit for 40 days. His kidneys and lungs failed. He was put on dialysis and a ventilator and given experimental drugs. He even received plasma from another Ebola survivor.
“If you had told me on day one that a week later I would develop what we call multi-system organ failure — brain failure, respiratory failure, kidney failure — and asked me to predict my survival, it probably would have been zero,” Crozier said.
When, in October, he walked out of Emory University seemingly free of Ebola, it shocked the medical community.
But little did anyone know, the virus was still there – hiding in one of his eyes.
Soon after, Crozier developed severe inflammation in his left eye. In December they sampled the fluid inside of it, and found that the virus was there “at very high levels.”
The levels of Ebola in his eye weren’t just “high” – they were 10 times the level that was once in his blood. The virus even changed the color of his eye, from blue to green.
Doctors think that the active virus remained in Crozier’s eye, undetected because the human eye is a “sanctuary” site. In the human body, sites such as the eyes, semen and central nervous system are believed to be “immune-privileged,” protected from the collateral damage to bodily tissue that can occur when the immune system is fighting infection.
Previously, it was unknown whether the virus could hijack immune-privileged sites. Crozier described the discovery as a “canary in a coal mine."
Doctors from the U.S. and Liberia are now undertaking a study, examining the long-term health effects of Ebola virus disease on 7,500 people, including 1,500 Ebola survivors and 6,000 of their close contacts. In an interview with America Tonight, NIAID Director Anthony S. Fauci said that in addition to long term health effects, the study will look at symptoms of Ebola survivors and determine if any are "associated with a hiding of the virus in a very secluded place, like the eye or the semen or even in the central nervous system."
About 30 to 40 percent of Ebola survivors suffer from some type of eye problem, but experts don’t know how many could harbor the virus deep within their eye. That’s because specialists and sophisticated procedures are needed to make the diagnosis, and neither is readily available in countries hardest hit, like Sierra Leone, where there is one doctor for every 45,000 people.
Those abysmal doctor-to-patient ratios are troubling for all kinds of reasons – not the least of which is the ability to fight debilitating ailments that the disease has left behind. Many Ebola survivors are now experiencing what’s called “post-Ebola syndrome.” PES is a host of ailments ranging from fatigue and headaches to severe joint and muscle pain, as well as hearing, vision and short-term memory loss.
Crozier said that so far, he’s the only survivor with eye complications who has actually been tested and found to have virus in the eye. He has undergone treatment, but it’s unclear whether the Ebola is still active. Crozier says there’s clinical evidence that suggests it is no longer there; his eye has returned to its original color.
None of this has stopped him from going back to the continent to work; though he moved to America when he was 10 years old, Crozier was born in Zimbabwe. Africa, he says, is in his heart.
“I feel particularly attached now to these survivors. I'm one of them. It's fairly clear that I would have been dead in a week had I not been med-evacuated,” he said. “I'm a little haunted by the fact that so many of my patients, and some of my colleagues and a few friends of mine did not have access to the same care.”
In 2015, Crozier and a team of eye specialists from Emory made two trips to West Africa, to help educate doctors on this latest discovery about Ebola’s aggressive persistence, and donate much needed diagnostic equipment.
And on January 18, 2016, Crozier again returned to West Africa to treat more patients, as Ebola claimed another life in Sierra Leone.
In the wake of his own battle with Ebola, Crozier says he’s looking at medicine through a new lens: He’s now in a position to bring the pathos of the disease to doctors, while working to impart more understandable medical information to huge populations of West Africans.
“I’ve always loved that sacred space that is the bedside,” Crozier said. “But I haven’t known it to the degree that I do now. And I think I probably have a new, just a small new appreciation for what it means to be helpless and vulnerable in that space. And that, ultimately, will change how I practice medicine for the rest of my days.”