TIME Infectious Disease

How the American Ebola Patients Are Being Brought to the U.S.

This is an example of the tent Ebola patients will be placed in to fly to the U.S. photo courtesy of CDC

Similar past experiences show how Americans who are overseas with a highly fatal disease can safely get to a U.S. hospital

Soon after the Centers for Disease Control and Prevention (CDC) issued a travel advisory on Thursday for Guinea, Liberia, and Sierra Leone, all struggling to contain an outbreak of Ebola, it was reported that two Americans infected with the virus would be evacuated. Nancy Writebol, a missionary with an NGO called SIM USA, and Dr. Kent Brantly of Samaritan’s Purse, contracted Ebola in Liberia. A hospital in Atlanta has announced it will receive at least one patient, but does not yet know which one or when they will arrive. SIM USA says the plane can accommodate only one patient at a time.

“Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC to treat patients who are exposed to certain serious infectious diseases,” the hospital said in a statement. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country.”

Their transport was arranged by SIM USA, with support of the State Department, and they are using Phoenix Air, the same contractor that the CDC and other U.S. agencies have used for infectious disease evacuations.

The CDC and other major public health groups have established certain protocols for transporting and evacuating patients, ranging from cabin depressurization to waste disposal, and the State Department has said it will help coordinate those efforts. Although the CDC and Emory University did not respond to requests for comment on the specifics of the carriers, the setup is likely very similar to what the CDC has recommended for handling SARS patients, and what the now-dissolved U.S. Army Medical Research Institute of Infectious Diseases’ (USAMRIID) aeromedical isolation team used to do when evacuating patients with serious infectious diseases.

Here’s what typically can happen. Depending on the virus, health care workers will remain covered with gowns, gloves, eye equipment and possibly face masks. Some may also have full-body suits. The aircrafts used to transport the patients are equipped with medical equipment, too. The CDC recommends one area of the plane to be distinguished as the isolation zone for patient care that is somehow separate from other areas where health care workers can put on or remove their equipment (one former CDC researcher says the workers may never take the gear off during transport). In this case, a tent-like system is easily set up in the aircraft. The patient can be additionally isolated in a sealed container that has negative air pressure, so that the air inside actually stays inside (even if Ebola isn’t airborne). The isolator that the patient is in could have oxygen tanks, medication, defibrillators and intravenous fluids.

When it comes to waste from the patient or sheets that have blood or bodily fluid, the CDC advises that all of it must be disposed of in biohazard bags. Once the plane has landed and the patient has been delivered for care, the aircraft will undergo very specific and intensive cleaning. Dr. Eileen Farnon, an associate professor at the Temple University School of Medicine who was a CDC researcher during the Ebola outbreak in 2007, says that when the plane lands, a similarly equipped ambulance will likely meet it to take the patient to the hospital. As Emory indicated, they have protocols and isolations units in place to safely transport and treat the patient—or patients—upon arrival.

The Aeromedical Biological Containment System (ABCS), which houses the patients on their flight photo courtesy of CDC

“Unfortunately one of the tragedies of these outbreaks is the lack of resources in rural parts of Africa, including basic things like gloves and gowns and face masks—certainly eye shields. Things that we take for granted in the United States,” says Farnon. “At our hospitals, there are standards of care that don’t exist everywhere. Here, we can adequately protect health care workers and provide high level of care to patients.”

That’s one of the primary reasons CDC Director Tom Frieden said the Ebola outbreak in Guinea, Liberia and Sierra Leone has grown: Many health systems in these countries “are not highly functional.” In Atlanta, Emory’s hospital has an isolation unit that was set up in collaboration with the CDC to care for patients with serious infectious diseases. Treating a patient there with highly trained experts and CDC oversight (CDC headquarters is nearby) is likely a better location for American patients who, tragically and unlike many victims in West Africa, could have a chance at better care and survival.

TIME Infectious Disease

U.S. Will Evacuate 2 Americans With Ebola from West Africa

Emory Hospital in Atlanta announced on Thursday that it will treat at least one patient

The State Department announced Friday that together with the Centers for Disease Control, it is working to bring home two U.S. citizens infected with the Ebola virus in West Africa “over the coming days.”

Although the State Department did not identify the patients by name, two Americans working in Liberia— one as a physician and the other as a missionary — have been infected with the virus. Both Dr. Kent Brantly and missionary Nancy Writebol were working to fight the outbreak of the deadly virus.

CDC protocols and equipment are used for these kinds of medical evacuations, according to State Department spokesperson Marie Harf, who added:

The safety and security of U.S. citizens is our paramount concern. Every precaution is being taken to move the patients safely and securely, to provide critical care en route on a non-commercial aircraft, and to maintain strict isolation upon arrival in the United States.

Harf did not disclose where the patients would be sent in the U.S., but on Thursday Emory University Hospital said in a statement that it expects to receive one patient with Ebola in the “next several days.” it is unclear if the second patient will be treated at Emory as well.

The Ebola virus, which has infected at least 729 people in West Africa this year, only spreads through direct contact with bodily fluids. Margaret Chan, the director-general of the World Health Organization, told presidents from affected countries on Friday that it is moving faster than it can be controlled. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socio-economic disruption and a high risk of spread to other countries,” she said.

Medical personnel caring for the two patients in the U.S. will wear full-body protective suits, and the patients will remain “in strict isolation upon arrival” and while being treated on U.S. soil, according to Harf.

CDC director Dr. Thomas Frieden has said he does not believe Ebola will spread in the U.S. “That’s not in the cards,” he said in a call with press on Thursday.

TIME ebola

No, The UK Isn’t About To Be Hit By an Ebola Epidemic

Doctors Without Borders staff carry the body of a person killed by viral haemorrhagic fever, at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. Seyllou—AFP/Getty Images

Though an infected person could technically arrive in the UK, the risk of onward transmission is exceedingly low

A Liberian asylum-seeker was tested for Ebola-like symptoms at a British immigration center earlier this week, The Telegraph reported Thursday. The day before, media outlets said another man had been similarly examined in Birmingham, England. Both tested negative for the often-fatal virus.

The United Kingdom’s Department of Health said that Ebola “is not an issue that affects the UK directly.” It added that should an infected person arrive in the UK., there are “experienced people who are ready to deal with [Ebola] if it were to arrive here.” Two agencies under the Department of Health, the National Health Service and Public Health England further pointed out that the threat Ebola poses to the UK is “very low.”

Strangely, this advice has been largely ignored by a number of national media outlets. The Daily Mail, a right-leaning tabloid, questioned whether “the world’s deadliest disease” — which Ebola certainly isn’t — was heading for Britain. For eight paragraphs, the paper told a terrifying tale: A man had arrived in Britain from Lagos, Nigeria with Ebola. According to the Daily Mail, “[Ebola] would soon be spreading across the country, killing almost everyone it touched.”

Then, in paragraph nine, came relief: “Fortunately this is an imaginary situation.”

This clear scare-mongering might be expected of a tabloid, but The Telegraph, a national broadsheet, has also opted for alarmism. In a seemingly impartial report on the Liberian asylum seeker — whose symptoms had been spotted by immigration officials — the newspaper added, with no explanation: “The incident shows how easy it would be for the deadly disease to enter Britain through illegal channels.”

There is no denying that Ebola is a terrifying illness. Approximately 728 of the 1,322 people in Guinea, Liberia and Sierra Leone, the West African countries hardest-hit by the virus, have died of it, according to the World Health Organization. Ebola has no vaccine, no cure and its most terrifying symptom — external hemorrhaging — makes it perfect media fodder.

Though the image of a patient weeping blood is the very stuff of horror films, Ebola isn’t that easy to catch. The virus is spread through contact with the blood and bodily fluids of an infected person, and a person is only contagious when they’re symptomatic.

“It’s not like flu or the SARS [Severe Acute Respiratory Syndrome] virus,” says David Lalloo, Professor of Tropical Medicine at the Liverpool School of Tropical Medicine adds. “You can’t catch Ebola through the air.”

Sitting next to someone with the early flu-like symptoms of Ebola wouldn’t lead to infection. A victim with the later symptoms — hemorrhaging, vomiting and diarrhea would likely be too sick to board a plane.

“The reality is the risk to the UK’s public health is really quite small,” says Lalloo. Though it is possible that an infected person may make it undetected to the UK — Ebola has an incubation period of up to 21 days — they would most likely be prevented from infecting all of Britain. “All [UK health workers] have been alerted to the possibility that people traveling from the region might be infected with Ebola if they’re displaying a fever,” Lalloo adds.

Public Health England, a government health agency, told TIME that comprehensive measures are in place to deal with the potential arrival of an Ebola patient. They have created a detailed algorithm for healthcare workers to assess and treat people suspected of suffering from a viral hemorrhagic fever that may be caused by Ebola. “If there is a symptomatic person on board the flight, the aircraft contacts air traffic control, who makes contact with primary responders and the health control unit at Heathrow [Airport], a Public Health England spokesperson said. “Other airports would send the person to [the] hospital for assessment if that was appropriate.”

Anyone found to have Ebola would be immediately quarantined, and anyone they had contact with would be tested.

“There have been odd cases of viral hemorrhagic fever that have come into the UK,” says Lalloo. However, fast and effective treatment has meant “there hasn’t been onward transmission.”

It’s likely that the media hysteria was sparked by the arrival of an infected Liberian official in Nigeria on July 20. The man later died, and news outlets were frantic that a similar traveler could reach the UK. What wasn’t as widely reported was that the Lagos hospital was evacuated and quarantined, and Nigeria’s current number of confirmed Ebola cases remains at one. As Lalloo points out, the current epidemic “has been going on for three to four months now … the only difference is someone arrived in Nigeria with Ebola.”

The West isn’t about to be hit by an Ebola epidemic soon. Well-resourced and prepared for such diseases, any case will most likely be rapidly contained and dealt with. Ebola is tearing through West Africa because the three impoverished nations of Guinea, Liberia and Sierra Leone lack the facilities and staff to manage Ebola — Western media would do well to focus on that.


TIME Research

15 Diseases Doctors Often Get Wrong

Doctor looking at x-ray
Chris Ryan—Getty Images/OJO Images RF

When you experience strange pains, mysterious digestive issues, or other unexplained symptoms, you’d hope a trip to the doctor would solve your health woes. But sometimes, doctors have just as much trouble identifying certain disorders and conditions as their patients. “A lot of symptoms are nonspecific and variable, depending on the person,” says David Fleming, MD, president of the American College of Physicians and a professor of medicine at the University of Missouri. “On top of that, many diagnostic tests are expensive and aren’t done routinely, and even then they don’t always give us a black and white answer.” The following 5 conditions are notoriously difficult to pin down.

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Irritable bowel syndrome

Some conditions are difficult to diagnose because there is no real test to prove their existence; rather, they require a “diagnosis of elimination,” says Dr. Fleming, as doctors rule out all other possibilities. Irritable bowel syndrome (IBS)—a chronic condition that affects the large intestine and causes abdominal pain, cramping, bloating, diarrhea, and/or constipation—is one of these cases. According to diagnostic criteria, a patient should have symptoms for at least six months before first being seen for a formal evaluation, and discomfort should be present at least three days a month in the last three months before being diagnosed with IBS.

Celiac disease

So much confusion surrounds celiac disease—an immune reaction to gluten that triggers inflammation in the small intestine—that it takes the average patient six to 10 years to be properly diagnosed. Celiac sufferers would, in theory, have digestive problems when eating gluten-containing foods like wheat, barley, and rye, but in fact, only about half of people diagnosed with the disease have experienced diarrhea and weight loss. Celiac disease can also cause itchy skin, headaches, joint pain, and acid reflux or heartburn, and it’s all too easy to blame these symptoms on other things. A blood test can diagnose celiac disease no matter what symptoms are present, and an endoscopy can determine any damage that’s been done to the small intestine.

Health.com: 14 Reasons You’re Always Tired


Fibromyalgia, which is characterized by widespread musculoskeletal pain, involves “medically unexplained symptoms”—a term doctors use to describe persistent complaints that don’t appear to have an obvious physical cause. When doctors can’t find a root cause for a patient’s chronic pain and fatigue, they often settle on this diagnosis. This may involve seeing specialists and ruling out other diseases, some of which prove equally difficult to diagnose, says Eugene Shapiro, MD, deputy director of the Investigative Medicine Program at Yale University. “There are studies that show that people with certain symptoms who show up at a rheumatologist will be diagnosed with fibromyalgia, but if the same patients show up at a gastroenterologist they’ll be diagnosed as having irritable bowel syndrome.”

Rheumatoid arthritis

Unexplained aches and pains may also be caused by rheumatoid arthritis (RA), an autoimmune disorder. Unlike osteoarthritis (the “wear and tear” kind that appears as people get older), RA causes inflammation and painful swelling of joints and can occur at any age. “Early stages of RA can mimic many other conditions—sometimes it’s just a sense of aches or stiffness in the joints, which could be caused by a lot of different things,” says Dr. Fleming. Blood tests can help detect the presence of inflammation in the body, he says, but an exact diagnosis of RA also must take into account a patient’s medical history and a doctor’s careful physical exam.

Multiple sclerosis

Another autoimmune disease, multiple sclerosis (MS) occurs when the immune system attacks the body’s own nerve cells and disrupts communication between the brain and the rest of the body. Some of the first symptoms of MS are often numbness, weakness, or tingling in one or more limbs, but that’s not always the case. “Multiple sclerosis can be episodic; the disease waxes and wanes,” says Dr. Shapiro. Depending on the number and location of lesions in the brain, he adds, signs and symptoms may be more or less severe in different people. Once a doctor does suspect MS, however, a spinal tap or MRI can help confirm the diagnosis.

Health.com: Could You Have MS? 16 Multiple Sclerosis Symptoms

Lyme disease

You probably know to look out for tick bites and the telltale bullseye rash that can form around them if a person is infected with Lyme disease. But not everyone develops this rash—and Lyme disease’s other symptoms (like fatigue, headaches, joint pain, and flu-like symptoms) can easily be confused for other conditions, says Dr. Shapiro.

A blood test can check for Lyme disease antibodies in the blood, but those usually don’t show up until a few weeks after infection and the test is notoriously unreliable. It’s important to remove the tick immediately and see a doctor right away. Quickly removing a tick can possibly prevent the transfer of dangerous bacteria, and antibiotics for Lyme disease are most effective when given immediately.


The most distinctive sign of lupus—another chronic inflammatory disease—is a butterfly-shaped rash across a patient’s cheeks, but that’s not present in all cases. For those who don’t develop the rash, diagnosis can be a long and difficult process, says Dr. Shapiro. “Lupus can present in different ways; it can affect the joints, kidneys, brain, skin, and lungs, and can also mimic many different issues.” There is no one way to diagnose lupus, but blood and urine tests, along with a complete physical exam, are usually involved. Treatment also depends on a patient’s individual signs and symptoms, and medications and dosages may need to be adjusted as the disease flares and subsides.

Polycystic ovary syndrome

Irregular periods, unexplained weight gain, and difficulty getting pregnant can all be symptoms of polycystic ovary syndrome (PCOS), a hormonal disorder affecting women of reproductive age. Many women with this condition also have enlarged ovaries with numerous small cysts, but not everyone with PCOS has these enlarged ovaries, and not everyone with enlarged ovaries has PCOS. To be diagnosed with PCOS, a woman must also be experiencing infrequent or prolonged periods or have elevated levels of male hormones, called androgens, in her blood. Androgen excess may cause abnormal hair growth on the face and body, but women of certain ethnic backgrounds (like Northern European and Asian) may not show physical signs.


You might think that an inflamed or burst appendix should be easy to identify, and often, it is: typical appendicitis symptoms include nausea, pain and tenderness around the belly button, and possibly a low-grade fever. But not always. “Some people have an appendix that points backward instead of forward in the body, so the symptoms present in a different location,” says Dr. Shapiro. “And sometimes people do have pain, but then the appendix ruptures and the pain is relieved so they think they’re fine.” In this case, he says, intestinal fluids can seep into the abdominal category and cause a potentially life-threatening infection—but it can take days or even weeks before these symptoms appear.


Many perfectly healthy women deal with menstrual pain and discomfort, so it’s not surprising that endometriosis is often misdiagnosed. However, women with endometriosis (in which uterine tissue grows outside the uterus) often report pelvic pain, cramping, and heavy bleeding that’s far worse than usual, and that gets worse over time. A pelvic exam can sometimes detect endometrial tissue or cysts that have been caused by it. In other cases, an ultrasound or laparoscopy is required for a definite diagnosis.


For many migraine sufferers, nothing could be more obvious than the severe headaches, which are usually characterized by intense throbbing or pulsing and can be accompanied by nausea, vomiting, or sensitivity to light and sound. But some people may get migraines without even knowing it, says Dr. Fleming.

“Sometimes migraine symptoms can be very severe, where the patient can even develop paralysis, and other times they can be very subtle,” he says. “Patients might feel dizzy or lightheaded or feel a vague discomfort in their heads, and oftentimes they’ll get treated with medication that might not be appropriate for a true migraine.” A neurologist should be able to rule out other possibilities, and make the proper diagnosis.

Cluster headaches

Another headache disorder that’s often misunderstood, cluster headaches are extremely painful but also very rare—affecting less than 1 million Americans. Cluster headaches tend to occur close together, often on the same day, and last 30 minutes to three hours, on average. Scientists aren’t sure why, but cluster headaches tend to occur when seasons change. Because of this, they can sometimes be misdiagnosed as allergy-related sinus headaches.


Hypothyroidism (also known as underactive thyroid) is a condition in which the thyroid gland produces an insufficient amount of the hormones that help regulate weight, energy, and mood. In the early stages, thyroid problem symptoms are subtle and can include fatigue, weight gain, dry skin, muscle aches, and impaired memory. “It can mimic depression, fibromyalgia, and many other conditions,” says Dr. Shapiro. And because hypothyroidism is most common in people (especially women) over 60, it’s easy to attribute its symptoms to simply getting older and more out of shape.

Health.com: 19 Signs Your Thyroid Isn’t Working Right


Type 2 diabetes can’t stay hidden forever; if left untreated, it can cause life-threatening damage to the body’s major organs. Before signs of diabetes develop, says Dr. Fleming, adults can have diabetes for years without knowing it. “There are a lot of people out there with elevated blood sugar levels who aren’t getting to the doctor regularly, so they aren’t getting checked for it,” he says. “They won’t realize it until it gets severe enough that they start developing side effects, like problems with their vision or numbness in their feet or hands.” To avoid these problems, watch for earlier symptoms like increased thirst or hunger, frequent urination, sudden weight loss, and fatigue.

Inflammatory bowel disease

There are primarily two types of inflammatory bowel disease (IBD)—Crohn’s disease and ulcerative colitis. Both cause inflammation of the digestive tract, as well as pain, diarrhea, and possibly even malnutrition. Because there’s no one test for IBD, however, it is diagnosed primarily by excluding everything else. “If a patient comes in with severe abdominal pain, we might first think it’s their gallbladder,” says Dr. Shapiro. “If he comes in with loose stools, we might think it’s an infection. So we go through a litany of tests—imaging, blood tests, assessments—and sometimes we finally come down to the fact that we’ve ruled out every other possibility, so this is what we’re going to treat you for and we’ll see if it works.”

15 Diseases Doctors Often Get Wrong originally appeared on Health.com.

TIME Diet/Nutrition

5 Most Confusing Health Halo Food Terms

Local vegetables
David Malan—Getty Images

I frequently meet my clients at their local supermarkets so we can walk the aisles together. Most find it incredibly eye-opening: sometimes what they think they know about which products to select or how to read food labels turn out to be misconceptions. For example, one client recently told me she avoids oats because they contain gluten. In reality oats are gluten-free, unless they’ve been contaminated with gluten during growing or processing, but many companies make pure, uncontaminated oats, and label them as such. She was thrilled to be able to eat oats for breakfast again!

But gluten aside, there are a number of other issues and terms that can confuse even the most educated shoppers. Many of them sound healthy on their own—that is, they have a health halo effect. Here are five of the buzziest, what they really mean, and what they don’t.


The Food and Drug Administration has not developed a formal definition for the term natural. However, the government agency doesn’t object to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances. Natural does not mean organic though, and it doesn’t necessarily indicate that a food is healthy. For example, today I saw a cereal labeled natural, and it contained a whopping four different types of added sugar. Tip: when you see this term, read the ingredient list. It’s the only way to really know what’s in a food, and if it’s worthy of a spot in your cart.

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The USDA Organic Seal indicates that a food was produced without synthetic pesticides, bioengineered genes (GMOs), or petroleum or sewage sludge-based fertilizers. The symbol also means that organic meat and dairy products are from animals fed organic, vegetarian feed and are provided access to the outdoors, and not treated with hormones or antibiotics. If the seal says ‘100% Organic’ the product was made with 100% organic ingredients. Just the word ‘Organic’ indicates that the food was made with at least 95% organic ingredients.

Health.com: 16 Most Misleading Food Labels

‘Made With Organic Ingredients’ means the product was made with a minimum of 70% organic ingredients, with restrictions on the remaining 30%, including no GMOs. I strongly support organics, but like natural, the term organic doesn’t necessarily mean healthy—in fact, there are all kinds of organic “junk foods” like candies and baked goods. Once again, when buying packaged food, the real litmus test is the ingredient list.


This term generally indicates that a food was produced within a certain geographical region from where it’s purchased or consumed, such as within 400 miles or 100 miles or perhaps within the borders of a state. Like natural, there is no formal national definition for the term local. What local does not mean is organic, which is something 23% of shoppers falsely believe according to a recent U.S. and Canadian survey (17% also believe that a food labeled organic is also local, which isn’t accurate either).

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Nearly 30% also think that “local” products are more nutritious, and that’s not a given, since there are no specific standards pertaining to ingredients or processing. Also, it’s important to know that a locally produced food may not contain a Nutrition Facts label, because small companies with a low number of full-time employees or low gross annual sales are often exempt from the FDA’s food labeling laws. Hopefully a locally produced goody, like a pie from your farmer’s market, will include a voluntary ingredient list, but if not, be sure to ask what’s in it and how it was made.


According to the FDA, the term gluten-free means that a food must limit the unavoidable presence of gluten to less than 20 parts per million (ppm). The FDA also allows manufacturers to label a food as gluten-free if it does NOT contain any ingredient that is any type of wheat, rye, barley, or crossbreeds of these grains, or has been derived from these grains, or if it contains ingredients that have been derived from these grains, but have been processed to remove gluten to less than 20 ppm.

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This means that foods that are inherently gluten-free like water, vegetables, and fruits, can also be labeled as gluten-free. The term gluten free-does not indicate that a food is whole grain, organic, low carb, or healthy. In fact, many gluten-free foods are highly processed and include ingredients like refined white rice, sugar, and salt.


Recently, I’ve had several clients who eat beef and dairy tell me that they only buy grass-fed, but most mistakenly believed that grass-fed also means organic. The actual parameters, as defined by the USDA, state that the cattle must be fed only mother’s milk and forage (grass and other greens) during their lifetime. The forage can be grazed during the growing season, or consumed as hay or other stored forage, and the animals must have access to pasture during the growing season.

Grass-fed does not mean that the cattle’s feed is organic, and it doesn’t mean they cannot be given hormones or antibiotics. Compared to products produced conventionally, grass-fed meat and dairy have been shown to contain more “good” fats, less “bad” fats, and higher levels of vitamins and antioxidants. But if you want to ensure that the product also meets the organic standards, look for that label term and the USDA organic seal as well.

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics.

5 Most Confusing Health Halo Food Terms originally appeared on Health.com.

TIME health

The Truth About Ebola

The real way to control Ebola is to stop the fear and misunderstanding


It was with heavy hearts that we learned Tuesday of the death of our colleague and friend Dr. Sheik Hummar Khan. Dr. Khan devoted his life to controlling hemorrhagic fever viruses, like the Ebola virus that brought his life to a brutally short end. His loss adds to the mounting numbers of our colleagues who have been taken by the current West African Ebola outbreak: Alex Moigboi, Iye Gborie, Mbalu Fonnie, Sahr Niokor. They were brave people who died in the service of their communities and their countries. Three other health workers are now positive for Ebola. We pray that they recover from this deadly disease. They are all heroes who continued to care for afflicted people despite knowing that their affliction was with one of the deadliest viruses known.

It is vital that our friends not die in vain. Rather than the fog of misinformation that currently surrounds this horrific outbreak, the world must understand Ebola for what it really is. The fear and ignorance that often surround it serve no one; only real knowledge and understanding will permit us to prevail. While devastating in its impact, the real enemy is not the Ebola virus or the animals from which it emerges. Whether on a local level in regions affected by the outbreak, or through the international media, ignorance and fear are our true adversaries.

While viruses like Ebola emerge relatively infrequently, we know a great deal about them. Ebola and the other hemorrhagic fever viruses like it kill dramatically and often painfully. As demonstrated through the current outbreak, they can have a devastating impact on local communities and can harm the countries and regions where they exist. Nevertheless, they definitely do not move like a common cold or have the potential to spread around the world igniting a global pandemic that will kill millions. Everything we know about Ebola suggests that it spreads in a limited number of well-defined ways, such as the intensive care of sick patients and the mortuary preparation of those that have succumbed to the disease. With circumscribed capacity to spread along with distinct, identifiable symptoms, this virus doesn’t have pandemic potential.

Ignorance and hysteria around this virus inflame its spread and thwart the development of systems that have the potential to stop it. Among the incredible challenges in the response to the current outbreak include misinformation and rumor. Lack of common knowledge about how Ebola spreads is causing some of the people in affected regions at greatest risk to shun health authorities and to avoid reporting the disease. Silence, denial and fear kill. Instead of permitting hard-working Ministries of Health to identify affected regions and anticipate future spread, they fan the flames.

But a lack of understanding in afflicted regions is not the only problem. The desire of the international media to attract viewers has led some careless journalists to focus almost exclusively on the fear-invoking mode of death from the disease. While it may increase their ratings, it lets the real culprits off the hook. Limited health infrastructure, insufficient numbers of trained health workers, too few fully equipped labs, and not enough education and preventative epidemiology are the sad realities that push this scourge on. The image of a victim coughing up blood creates stigma instead of engaging international viewers with the true and preventable human tragedy in these communities. It also distracts from one of the more disturbing facts associated with this outbreak, which is how wealthy communities feel content to live in a world where society spends more on eliminating wrinkles than with basic health infrastructure that could, among many other things, help quench an outbreak like the one we’re currently experience in West Africa.

Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun, Sierra Leone on July 20, 2014.
Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment centre in Kailahun, Sierra Leone on July 20, 2014. Reuters

While Ebola virus won’t be the next global Andromeda strain, there are viruses out there that could be. Coronaviruses (like SARS) and influenzaviruses (like the H1N1 virus of 1918) for example, show that some viruses truly can spread around the world in ways that will blindside and impact our entire planet. It is notable that a novel coronavirus, the Middle Eastern Respiratory Syndrome (MERS), and a novel influenzavirus, the H7N9 virus, receive very little attention from the international media. Perhaps as importantly, there are millions of still unidentified viruses in animal reservoirs, among which, almost certainly is a virus that we’d have no capacity to understand or stop were it to suddenly emerge today.

Our world is increasingly susceptible to potentially devastating epidemics. And the notion that all of them are the same is absurd. We need to understand the diversity of the viruses in nature. We need to double down on global activities that track new agents from their sources. We need to ensure that health infrastructure in emerging disease hotspots, which include some of the poorest regions of the world, have adequate capacity for surveillance and early detection. Capacity building and training aren’t sexy activities and they won’t make headlines, but they will stop the events that lead to the headlines.

Please join us in honoring the memories of our colleagues–not by seeing Ebola as a gory plague, but by respecting those on the front lines and empathizing with the countries and communities that are impacted. Encourage and fund the hard-working governmental agencies and NGOs that support development of epidemic response, epidemic preparedness and prevention, and critical training and infrastructure development. We have the potential to stop future generations of healthcare workers and communities from suffering from the devastation we’re currently experiencing. This will happen only if we join forces to prevent the outbreaks, as well as the fear and misunderstanding that surround them.

Metabiota, Inc. develops and supports human and animal infectious disease control efforts in Sierra Leone and more than 15 other countries worldwide. Metabiota supports programs such as the United States Agency for International Development (USAID) Emerging Pandemic Threats Program and Defense Threat Reduction Agency’s (DTRA) Cooperative Biological Engagement Program (CBEP). The views expressed here are ours alone. Professor Gbakima leads Metabiota’s efforts in Sierra Leone, Dr. Gonzalez has led outbreak research and response efforts around the world for more than 30 years, and Dr. Wolfe (@virushunter) is the founder of Metabiota, Inc.. Please follow us on Twitter at @metabiota.

TIME Infectious Disease

Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

Members of the Red Cross provide information on Ebola to residents in Conakry, Guinea on April 11, 2014 at the start of the largest Ebola outbreak in history CELLOU BINANI—AFP/Getty Images

It's not about high-tech solutions but good old-fashioned legwork

Given the fact that the Centers for Disease Control and Prevention (CDC) is now urging Americans to avoid non-essential travel to Sierra Leone, Liberia and Guinea, which are battling the largest outbreak of Ebola in history, and the Peace Corps has pulled out its volunteers from the region, the key to bringing the epidemic under control will rest not with the highly trained scientists flown in from around the world, but with local volunteers.

In outbreaks like this, which has so far claimed more than 720 lives, the only way to control the spread of disease is by ensuring that anyone who is infected is isolated in a hospital, and that anyone they contacted are also monitored for symptoms. “The main way we have of controlling the outbreak is by preventing further spread of cases,” says Dr. Eileen Farnon, associate professor of medicine at Temple University School of Medicine. “You have to take people who are symptomatic out of the community so they don’t continue to spread disease.”

MORE: Here’s What You Need to Know Now About the Ebola Crisis

In 2007, Farnon, then at the CDC, traveled to the Democratic Republic of Congo and Uganda to help those nations battle smaller Ebola outbreaks. Farnon helped local health officials coordinate contact tracing, which involves asking every infected patient for a list of people they had contact with since they started experiencing symptoms, and then finding and monitoring those contacts for 21 days. “As you can imagine, the more infected patients there are, the number of contacts really grows exponentially,” she says.

The follow-up required an army of volunteers to visit the contacts daily during the incubation period, often taking their temperature and asking them about any unusual health symptoms. If people started showing signs of illness, the volunteers were responsible for contacting a hot line and arranging for them to come to a hospital for further testing and possibly isolation if they were infected.

MORE: Everything You Need to Know About the Deadly Ebola Virus Outbreak

Such contact tracing is also occurring now in West Africa, but it’s likely more challenging because of the denser and more fluid nature of the populations there, says Farnon. In the Democratic Republic of Congo and Uganda, the outbreaks occurred in remote regions and the contacts weren’t mobile and potentially infecting others in densely populated places like airports.

Farnon guesses that if contacts in the current outbreak mention that they are intending on traveling to another country, the health workers will likely discourage them from doing so, but that some, if they aren’t feeling sick, may still continue with their trip. That’s why national health officials need to coordinate screenings at border crossings to ensure that people who become ill are identified and cared for before they can spread the virus.

MORE: Infographic: Ebola By the Numbers

Farnon says there are social challenges as well. “People in the community will realize early on that patients who get admitted to the hospital, usually late in their infection, may die. And many start getting fearful about going to the hospital because they think it means they are going to die,” she says. While there are no treatments for Ebola infection, early care with proper hydration and nutrition can keep patients strong enough to overcome the virus. But even patients who survive are stigmatized because their neighbors think they are still contagious. Farnon says her groups provided a volunteer to accompany patients back to their homes to help them and their community to understand that they were no longer a threat.

The volunteers were the key to keeping the virus contained, says Farnon, and contact tracing, while labor intensive, was the key to managing the outbreaks in which Farnon was involved—and certainly essential to the west African situation as well. “The village health workers and volunteers are the primary means of getting messages to communities, because they have the relationships with the communities and the ability to mobilize others to help people look for the signs and symptoms of Ebola,” says Farnon.

“It’s a huge logistical undertaking,” she says—but it’s necessary.

TIME Diet/Nutrition

Pepsi Made With Real Sugar: Is It Healthier?

Nutrition experts say sugar has the same nutritional value.

Pepsi Made With Real Sugar is the drink of summer, perfect—from the looks of their TV ads, anyway—for pool parties, river rafting, and other outdoor activities for the young and fit. The product, which is the centerpiece of a summer marketing blitz, ditches high fructose corn syrup for real sugar, but nutritionist experts say it isn’t really any healthier.

“It really doesn’t matter. Sugar is just sugar,” said Lisa Sasson, a faculty member at New York University’s Department of Nutrition, Food Studies, and Public Health “It’s broken down and it’s the same in our body.”

Dr. David Katz, founder of the Yale Prevention Research Center and editor of the journal Childhood Obesity, adds that replacing corn syrup with sugar would not yield any public health benefit.

Of course, Pepsi hasn’t explicitly said that real sugar makes the product healthier. Its advertisements focus on summer fun and a hearkening back to the soda’s origins, and a Pepsi spokesperson told TIME that the offering is designed to meet a consumer demand for a soda with real sugar.

“I can easily imagine people thinking that cane sugar is less processed than corn syrup and is some ways more natural and healthier for you,” said John T. Gourville, a professor at Harvard Business School, who studies marketing and consumer behavior. “It’s an attempt to expand a product category that is struggling to build sales.”

Indeed, carbonated beverage sales, especially in the diet market, have been on the decline in recent years. This summer isn’t the first time Pepsi has used real sugar. It began selling the product for a limited time as Pepsi Throwback in 2009. The company launched the Throwback as a permanent fixture in 2011 and added Pepsi Made With Real Sugar last month. The cola in both real sugar products are the same, but the cans are different.



TIME Cancer

Recent Birth Control Pill Use Linked With Breast Cancer Risk

Birth control pills Raymond Forbes—Getty Images/age fotostock RM

But only pills containing high-dose estrogen

Oral contraceptives and an increased risk for breast cancer have been linked in the past, but now researchers have made the link again, showing women who recently used birth control pills with high-dose estrogen have an increased risk for breast cancer compared to women using other versions.

The researchers looked at pharmaceutical oral contraceptive records and prescriptions of 1,102 women diagnosed with breast cancer and and 21,952 controls. Compared to women who formerly used birth control pills or never used them, the risk for breast cancer was increased by about 50% for women who did. The researchers note that the highest risk was for high estrogen—and there was no risk found for low-dose pills. The study is published in the journal Cancer Research, under the American Association for Cancer Research.

The researchers stress that caution is needed when interpreting their findings. “Given that these results have not yet been confirmed, and the importance of assessing the many established benefits of oral contraceptives as well as the risks, we are not able to give any clinical recommendations based on this study,” says study author Elisabeth F. Beaber, a staff scientist in the Public Health Services Division of Fred Hutchinson Cancer Research Center. “It’s an intriguing finding, but there really do need be larger studies with larger sample sizes in different populations to really confirm if these results hold up.”

The formulations of oral contraceptives have changed over the years, and in fact, Beaber says that in general that there are few high dose estrogens formulations on the market. In their study, among the controls, less than 1% filled a prescription for a high-estrogen pills.

For now, the study is a call for further research. With prior evidence, the National Cancer Institute says that evidence shows their might be an increased risk for breast cancer, especially younger women, but that their risk returns to normal after 10 years of discontinued use. Women using oral contraceptives are shown to have a lower risk of ovarian and endometrial cancer. You can learn more about the link between oral contraceptives and cancer.

TIME ebola

Emory Hospital Will Treat Ebola Patient

CDC Ebola
The Ebola virus in an undated photo provided by the Centers for Disease Control and Prevention CDC/AP

Two Americans are fighting the virus in Liberia

Emory University Hospital in Atlanta announced Thursday that it expects to receive a patient with the Ebola disease within the “next several days.”

Two Americans, Nancy Writebol and Dr. Kent Brantly, contracted the infection in Liberia. The hospital does not yet know whether the patient is one of these two Americans or when he or she will arrive.

“Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC [the Centers for Disease Control and Prevention] to treat patients who are exposed to certain serious infectious diseases,” the hospital said in the statement. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country.”

The Ebola virus can spread through bodily fluids, putting health care workers treating patients at risk. The doctors and nurses who work with the patient will wear full-body protective suits.

Meanwhile American health officials have advised against nonessential travel to Guinea, Liberia and Sierra Leone, where the disease has taken 729 lives this year. Up until now, the CDC has only advised travelers to take precautions when traveling in West Africa. This is the first time the CDC has issued a high-level warning since the SARS outbreak in Asia in 2003. The warning is meant both to protect U.S. citizens and help overwhelmed hospitals and clinics in West Africa.

“It is frankly a dreadful and merciless virus. The current outbreak is bad. It’s the biggest, most complex and the first time it’s been present in this region of the world which means that response systems and community understanding of the disease is not what it is elsewhere,” CDC director Dr. Thomas Frieden said during a call with the press on Thursday.

However, Frieden says that he does not think Ebola can spread in the U.S. “That’s not in the cards,” he told reporters.

In terms of evacuating the Americans who are infected, Frieden said that any organization looking to airlift the infected would have to exercise caution. “We do not have effective treatment or vaccine for Ebola. There is no proven treatment. There is no proven vaccine. There is not likely to be one for at least a year, even in the best case scenario,” he said.

“There is the potential that the actual movement of the patient could do more harm than the benefit from more advanced supportive care outside of the country.”

Emory University Hospital says it is well equipped to handle any patients it does receive. “Emory University Hospital physicians, nurses and staff are highly trained in the specific and unique protocols and procedures necessary to treat and care for this type of patient,” the statement says. “For this specially trained staff, these procedures are practiced on a regular basis throughout the year so we are fully prepared for this type of situation.”

Some have recovered from Ebola, but the mortality rate for people infected ranges from 50% to 90%. Experts estimate that about 60% of the people infected with the virus during this particular outbreak have died.

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