TIME ebola

Ebola’s Orphans Have No Place to Go

Ebola's toll includes children who lose their parents to the disease. One charity is coming up with a solution

Berlinda watched her mother die. The three-year-old may not have understood what exactly was going on as the ambulance team transported her and her grievously ill mother to Redemption Hospital, one of Monrovia’s dedicated Ebola treatment centers, but at least she knew she was with the one person who loved her more than anything else in the world.

By the time the ambulance arrived at the clinic in Liberia’s capital city on September 15, her mother had slipped into silence, then death. Berlinda, dressed in a pink plaid shirt and ruffled shorts, emerged from the ambulance wide eyed and scared. There was no one there to receive her, just a phalanx of faceless health care workers covered head-to-toe in white biohazard suits. She too was a potential Ebola patient, so no one could risk picking her up for a comforting hug. Instead she was escorted into the center, given a bed and left for observation. A day later her Ebola test came out negative, but there was no one to celebrate, no one to take her home. Her father unknown and her mother dead; she had nowhere to go.

In a crisis as overwhelming as the Ebola outbreak in west Africa, it is easy to forget that behind each daily death toll there are people left to live with unimaginable loss. For children who lose their parents to sickness or death, the results can be devastating. The United Nations Children’s Fund estimates that around 3,700 children have lost at least one parent in an outbreak that has devastated Sierra Leone, Liberia and Guinea. Those numbers are likely to double by mid-October. Sometimes relatives can be rounded up to take in the child, but with fears of contagion so strong, Ebola’s stigma is starting to eclipse even close blood ties.

“Thousands of children are living through the deaths of their mother, father or family members from Ebola,” said Manuel Fontaine, UNICEF’s Regional Director for West & Central Africa. “These children urgently need special attention and support; yet many of them feel unwanted and even abandoned.”

Berlinda was one of the lucky ones. As she peered through the ambulance doors before entering the clinic, she caught the attention of Katie Meyler, the American founder of a Monrovia-based education charity who was at the clinic checking in on one of her Ebola-assistance programs. Meyler snapped a few photos for Instagram (she initially thought her name was Pearlina, until she saw the girl’s paperwork a few days later). In the months before Ebola struck Liberia, Meyler’s charity, More Than Me, had been in the process of setting up a beachside guesthouse designed to earn an income for the organization, which provides schooling for vulnerable Liberian girls. Those plans had been put on hold, but when Meyler saw Berlinda she realized that she had the resources and the housing to be able to do something. “I told the doctors that I could take care of her until they figured out how to find her family,” says Meyler. Two days later, Berlinda was out of the clinic and in a clean, welcoming home full of new toys, staffed with a nurse and a former teacher, and Meyler had a new project on her hands.

For Meyler, whose decade-long, seat-of-the-pants approach to running an NGO in Liberia can be best defined as “give love and the rest will follow,” such a rapid change in objective came easy. (A few weeks ago she brought $500 worth of toys, candy and ice cream to pass out to patients in a treatment center. She admits that giving lollypops to a person afflicted with Ebola may not be sound medical practice, but “if someone is dying, it can’t be bad to bring them some joy.”)

That kind of aid in Liberia has raised eyebrows among the more traditional international NGOs, who prefer to strengthen local institutions instead of providing alternatives. But in the case of Ebola’s orphans, the need has simply become overwhelming. Ebola can take up to 21 days between exposure to the virus and the development of symptoms, so anyone who has been in direct contact with a patient must be treated as potentially contagious throughout a three-week quarantine. Few are willing to take in children under those conditions.

“The best place for those children to be quarantined is with family members,” says Amy Richmond, a child protection officer in Liberia for the Save the Children NGO. “But fear and stigma around Ebola is a growing phenomenon here, and relatives are scared to take these kids in.”

Even without the need for quarantine, Ebola’s stigma lingers. Three weeks ago, ten-year-old Esther and her family were admitted to a clinic for treatment. She survived, but her parents and her brother did not. Even though she is now immune from Ebola and cannot pass on the virus, distant relatives refused to take her.

“There was this big celebration for all the survivors at the clinic,” recalls Meyler. “Everyone was laughing and praying, but she was bawling her eyes out,” because she had nowhere to go.

That’s where Meyler’s guesthouse-turned-temporary-orphanage comes in. The cheerful blue and yellow building, dubbed HOPE House (Housing, Observation and Pediatric Evaluation), is now home to four children, including Esther and Berlinda. Once Meyler gets the appropriate registration through the government, she plans to welcome up to some 70 more. All of the city’s Ebola treatment centers are already calling, she says. “Everyone is telling me they have kids . . . I can tell you that as soon as we open our doors, it is going to be flooded.”

HOPE House isn’t limited just to orphans. The parents of the two other residents, 3-year-old twins Praise and Praises, are still alive, undergoing treatment for Ebola at Monrovia’s MSF-run isolation center. The twins’ grandmother, Marthalyne Freeman, would gladly take them in, but she works 12-hour shifts as an Ebola nurse. Letting them stay with their parents in the center, she says, is out of the question.

“The children get infected or they get traumatized because their parents can’t take care of them,” says Freeman. She has been working as a nurse since the start of the ongoing Ebola outbreak, she says, and she has seen a lot difficult cases. “Children are being abandoned, and when they are discharged there is no place to keep them. And I don’t think the government has any plans for that right now. The situation in Liberia is very hard.” It is. But for at least some children separated from their parents, things are about to get slightly less hard.

TIME Infectious Disease

Ebola Vaccines Are Being Expedited

Professor Adrian Hill, Director of the Jenner Institute, and Chief Investigator of the trials, holds a phial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine (CCVTM) in Oxford, southern England on Sept. 17, 2014.
Professor Adrian Hill, director of the Jenner Institute and chief investigator of the trials, holds a vial containing the Ebola vaccine at the Oxford Vaccine Group Centre for Clinical Vaccinology and Tropical Medicine in Oxford, southern England, on Sept. 17, 2014 Steve Parsons—Reuters

"Nothing can be allowed to delay this work"

International experts want a fully tested and licensed Ebola vaccine scaled up for mass use in the near future, according to a recent World Health Organization (WHO) meeting.

WHO organized a panel of more than 70 experts, from scientists to medical ethicists, to reach consensus over the status of Ebola vaccines currently being tested. WHO released news from the meeting on Wednesday, the day after the U.S. confirmed its first patient with Ebola. According to the WHO statement, the mission is to “accomplish, within a matter of months, work that normally takes from two to four years, without compromising international standards for safety and efficacy.”

Two vaccines have great potential and are ready for safety testing. The first vaccine is developed by the U.S. National Institute of Allergy and Infectious Diseases (NIAID) and GlaxoSmithKline. That vaccine is currently undergoing a human-safety trial at the National Institutes of Health (NIH) campus in Bethesda, Md., as well as at the University of Oxford. The second vaccine is under development by the Public Health Agency of Canada in Winnepeg. That vaccine will start a human-safety trial in early October. Canada has already donated 800 vials of their vaccine to WHO, the organization says. Once more data is available on what dosing should be used, WHO says these vials could translate to around 1,500 to 2,000 doses of the vaccine.

The goal of the safety trials is to confirm that the vaccines are safe enough to move on to a larger human trial. Dr. Anthony Fauci, director of NIAID and the lead on the NIH vaccine, tells TIME the safety trial is so far “uneventful,” which is a good thing. “There really [are] no red flags so it seems to be going along quite well,” he says. The vaccine had already been tested in monkeys and showed very promising results.

WHO and other organizations have been expediting the testing and approval processes for these drugs since early summer, but the NIH’s vaccine has been under development since 2003. At the time, it did not have the pharmaceutical funding to move forward. “[In 2003] there was very little interest for the obvious reasons that there was no disease around,” says Fauci. “Recently, we now have a much more vigorous interest from pharmaceutical companies.”

WHO hopes that in October and November, the vaccines will make it through their safety trials and into next-stage human testing. Between January and February 2015, the goal is to have next-phase human trials approved and initiated in countries affected with Ebola. People at a higher risk for the disease, like health care workers, are a priority.

The meeting did not highlight ZMapp, the drug given to two American patients who were evacuated from Liberia to Emory University in Atlanta. Mapp Biopharmaceutical, the company that produces ZMapp, is a small team that says its resources are now exhausted. Their drug is grown in tobacco plants and requires waiting for a crop in order to produce more of it.

One of the ways trials could be quickened is if the researchers take a “wedge” approach, which means that a wedge or slice of the study population is selected for a first step in the trial, and what is learned in that step is then used on the next slice of the participants. While trials are ongoing, there are still significant technical obstacles that need to be addressed once a vaccine is ready for mass use: how vaccines will be distributed, for instance, and how low-resource health systems can ensure that vaccines are stored below –100 degrees.

In the WHO meeting, the phrase “Nothing can be allowed to delay this work” was repeated multiple times, and since Ebola has now infected more than 7,000 people and even made it to the U.S., the race to develop an effective vaccine is becoming all the more frantic.

TIME Sex/Relationships

Teenage Girls Given Choice of Free Contraceptives Get Far Fewer Abortions

IUDs
Illustration by Miles Donovan for TIME

Girls allowed to choose between free contraceptive methods had 76% fewer abortions than their peers in the general population — and most chose IUDs

Three in 10 teenage girls in the U.S become pregnant each year—a rate far higher than in other industrialized countries. But when girls are counseled about the most effective contraceptives and given their pick of birth control at no cost, their rates of pregnancy drop by 78% and they get 76% fewer abortions than the general population of sexually active teens.

That’s what a new study published in the New England Journal of Medicine suggests, in which researchers at Washington University School of Medicine in St. Louis attempted to see what would happen when they tore down the three main barriers to teenage birth control—ignorance of options, limited access and prohibitive cost.

They studied a group of 1,404 teenage girls enrolled in the Contraceptive CHOICE project, a study of adolescents and women at high risk for unintended pregnancy. 62% of the girls were black and 99% were sexually active. Black teens have even higher rates of pregnancy than the rest of the population: 4 in 10 become pregnant, compared with 2 in 10 white teens.

In the study, peer educators, volunteers, medical students and others interested in health education counseled the girls on the available methods, presenting them in order of effectiveness—IUDs and implants, followed by Depo-Provera injection, pills, patch and ring, and condoms. They stuck to a script that encouraged the girls to choose for themselves, emphasizing that they can always change their method later. The contraceptives were in the room for the girls to see and touch. The clinic had flexible scheduling so that even if a teen was late to her appointment, she was guaranteed to be seen, and every girl received her birth control right after the counseling session.

That’s a world away from the experience of girls in the outside world, who are often asked by providers to come back several times before they start a method, given false information about IUD risks, and eventually mass-prescribed pills, says project director Gina Secura. “It’s often a one-sentence conversation: what do you want, and here’s a prescription,” she says.

MORE: How Having an (Insurance-Covered) IUD Is Saving My Life

Focusing the conversation purely on effectiveness was, well, extremely effective. “When we first started the project, we had hoped to double the national rate [of IUD or implant use]—about 5%,” says Secura. Instead of the hoped-for 10%, a whopping 72% of teems chose IUDs or implants. “We were shocked,” she says. And they stuck with them. Two-thirds of the girls were still on long-acting reversible contraception (LARC, which includes implants and IUDs) after 2 years, compared to one third of girls on short-acting methods like the pill.

IUDs are a solid choice according to the American Academy of Pediatrics, who just endorsed IUDs as the best method of birth control for teenage girls. And the evidence bears it out. The researchers tracked the girls for 2-3 years and followed up every few months by phone. They found that 3.4% of CHOICE teens got pregnant, compared to 15.85% of sexually experienced teens in the general population. Fewer than 1% of CHOICE teens got abortions (0.97%, to be exact), while 4.15% of the other population did.

That means that girls in the program were 78% less likely to get pregnant and had 76% fewer abortions than their peers in the general population. Of course, it’s not quite fair to compare these two groups, since the girls in the research project were given free access and would have been more encouraged to stick to their methods with follow-ups, but the implications are incredibly important for clinics and counselors.

Most notable of all, the low pregnancy rates between white and black teenagers in the project were almost identical. “If we really want to tackle this health disparity, that shows we can actually do it,” Secura says.

These rates far outpace even the CDC’s 2015 goal for teenage births; they’re aiming for 30.3 teenage births per 1,000 teens. The CHOICE rate was 36% lower than that, at 19.4 teenage births.

Secura attributes these dramatic drops largely to the high uptake of long-term contraceptive methods, options that are cost-prohibitive to many low-income teens and free clinics. “It can be difficult to justify spending the same amount of money on 10 devices, where they could buy five times as many packs of pills,” Secura says.

The researchers put their CHOICE methods on a site called LARC FIRST designed to guide clinics, and since data from the study began coming out over the past two years, Secura says they’ve gotten about 300 requests from clinics asking for help in implementing their best practices—including training people who aren’t time-pressed providers and nurse practitioners to deliver effectiveness counseling. Having a kind of AmeriCorps for contraceptive effectiveness counselors, Secura says, would be a dream.

Though the study is over, several clinics are trying to adapt some of CHOICE’s methods to their real world practices and evaluate them scientifically. “I’m hoping we build the demand in terms of teens wanting these,” Secura says.

TIME has called IUDs the best form of birth control that no one is using—but when teens are informed and cost barriers disappear, this study shows that teenage girls are clearly hungry for better birth control.

TIME Aging

How Moodiness and Jealousy May Lead to Alzheimer’s

Researchers say certain personality traits, like jealousy, worry, anxiety and anger, can double a woman’s chances of developing Alzheimer’s

We’re familiar with many of the brain-related factors that can contribute to Alzheimer’s disease—letting thinking networks go inactive, putting off exercise and healthy eating, having few social connections, enduring head injuries and genetic factors. But what about personality? Can the way you look at the world affect your risk of developing the neurodegenerative disorder?

Dr. Ingmar Skoog, professor of psychiatry and director of the research center on health and aging at the University of Gothenburg believes the answer is yes. In a paper published in the journal Neurology, he and his colleagues show that women with certain personality characteristics in middle age were twice as likely to have Alzheimer’s nearly 40 years later.

MORE: New Research on Understanding Alzheimer’s

“Getting Alzheimer’s disease is some sort of sum of a lot of different damages to the brain, and different things happening to the brain,” he says. “[Personality] is one of them.”

Specifically, a suite of features linked to what mental health experts call neuroticism showed the strongest connection to Alzheimer’s. Skoog and his colleagues tapped into a database of health information involving 800 women who were 38 years to 54 years old in 1968, when they filled in personality questionnaires and agreed to come in periodically to evaluate their cognitive functions. The personality evaluation placed women on a spectrum of neuroticism and extraversion; those showing more neuroticism included women who reacted more emotionally to events and experiences, worried more, showed lower self esteem and were more likely to express jealousy, guilt and anger. Those who were more extroverted showed high levels of trust, gregariousness and fewer emotional peaks and valleys.

MORE: New Insight On Alzheimer’s: What Increases Your Risk

At each of the four follow ups over the next 38 years, the women reported their stress levels—and women with higher neuroticism scores consistently showed higher levels of stress than those with lower scores.

Skoog believes that stress is the linchpin between the personality traits and Alzheimer’s dementia; previous studies have connected stress to dementia, and he says that the neuroticism characteristics are highly correlated to stress. “It seems like the personality factor makes people more easily stressed, and if people are more easily stressed, then they have an increased risk of dementia,” he says.

What’s more, when he controlled for the effect of stress, the association between neuroticism and Alzheimer’s disappeared, strengthening the idea that personality may lay a foundation for being more vulnerable to the effects of stress. Higher stress, particularly if it’s persistent as it is with certain personalities, can bathe the brain in hormones like cortisol. Those can damage blood vessels and cells in the brain that can then make Alzheimer’s more likely.

MORE: Scientists Are Getting Closer to a Blood Test for Alzheimer’s

The results hint that people can lower their risk of Alzheimer’s not just by keeping the brain active and improving social connections, as earlier work suggests, but by addressing stress-related personality factors as well. That, however, may require being aware of your later Alzheimer’s risk as early as during childhood, when personalities are forming. “Personality is something that occurs early in life, but you may be able to do something about it,” says Skoog. Especially when it comes to stress and how people respond to stress, interventions such as psychotherapy, for example, can help people to cope in healthier and less harmful ways.

He doesn’t believe that addressing stress and traits like jealousy and worry alone will protect a person from developing Alzheimer’s, but, he says, “it’s important to try to find as many factors as you can that contribute to common disorders. The more factors we can do something about, the more we can reduce risk quite substantially.”

TIME Infectious Disease

CDC Received Over 90 Calls About Potential Ebola Cases Before Dallas Patient

The Dallas patient is the 13th patient in the U.S. tested by the CDC

On the afternoon of Sept. 28, U.S. Centers for Disease Control and Prevention (CDC) epidemic intelligence officers—sometimes referred to as disease detectives—received a call from Texas Health Presbyterian Hospital of Dallas concerned about a patient the hospital thought could be at risk for Ebola. This was at least the 90th call the team had received during the Ebola outbreak from hospitals concerned that one of their patients could possibly be infected. But until Tuesday, there had never been a diagnosed case.

CDC director Dr. Tom Frieden said in a press conference on Tuesday that “As long as the outbreak continues in Africa, we need to be on-guard.” The statement rings true since the U.S. now has its first patient, but the CDC has been awaiting the possibility that Ebola would make it to American soil for months.

On Sunday afternoon, an epidemic intelligence service officer took the hospital through a decision-tree of sorts that helps the CDC determine whether the patient is at a real risk for Ebola. Factors that are taken into account are where the patient had traveled in the past and what their symptoms were. Since the patient continued through the CDC’s algorithm with enough red flags, the CDC requested that the patient be isolated and that a blood specimen be sent to the CDC’s level 4 testing lab for confirmation.

MORE: Inside the CDC’s Emergency Operations Center Tackling Ebola

The Dallas patient is the 13th person that the CDC has actually tested for Ebola. “Every morning, Dr. Frieden is updated on all of the individuals that we have looked at and the numerous individuals under investigation,” a CDC spokesperson told TIME. There have been a few false alarms already, including patients in New York City and Miami—all eventually tested negative.

The CDC campus is in Atlanta, Georgia, and since early August, the headquarters has had its Emergency Operations Center on a Level 1 response—the highest possible level for a public health crisis. Just a couple days after the CDC kicked operations into high gear, the World Health Organization (WHO) declared the outbreak in West Africa a global public health emergency. In the Emergency Operations Center, several epidemic intelligence officers sit in rows of long tables tapping away at their computers facing a wall of computer screens that show where Ebola clusters are in West Africa, as well as graphs of the disease’s trajectory. The officers offer aid both domestically and to their colleagues in the field. Many have been traveling in and out of West Africa since the spring.

After the CDC determined that the patient, reportedly a man named Thomas Eric Duncan, was indeed at a very high risk for the disease, the hospital sent blood specimens for testing to both the CDC’s lab as well as a Texas Health Department lab. The specimens arrived at the CDC around 10 a.m. on Tuesday morning, and by Tuesday afternoon, both the CDC and the Texas Health Department had confirmed that the patient was in fact positive for Ebola. “We made sure the hospital spoke with the patient and their family first,” said a CDC spokesperson to TIME.

Once the patient was told they were positive, the CDC quickly informed the public by sending out a confirmation to media late Tuesday afternoon and holding a press conference an hour later. During that time, CDC disease specialists were already deploying to Dallas—landing on Tuesday evening to begin the process of tracking down and monitoring all the people that the patient with Ebola had come in contact with while infectious. It’s a process that will continue until the 21-day incubation period of the disease ends.

Though the Dallas patient is the first patient to have confirmed Ebola, the CDC has long said that an Ebola patient making it to the U.S. was always a possibility. However, due to the quality of health care in the United States, patients are not facing the same dire situations as patients in Liberia, Sierra Leone or Guinea, and Ebola in the states will likely have a much different prognosis.

TIME ebola

Mistake Led to Ebola Patient’s Initial Release

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
A general view of Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on Sept. 30, 2014 in Dallas. Mike Stone—Getty Images

Texas officials are scrambling to trace Ebola patient's contacts after he was sent home from the hospital

Updated 7:45 p.m. Wednesday

The Dallas hospital patient who has tested positive for Ebola virus indicated on his first visit that he had traveled to the city from West Africa, but was released after that information was not communicated to the entire medical team who treated him.

The patient first arrived at Texas Health Presbyterian Hospital in Dallas late on Sept. 25, complaining of a fever and abdominal pains, hospital officials said at a news conference. A nurse administered a checklist, on which the patient indicated that he had recently traveled from Liberia. Nevertheless, the hospital sent him home.

“The overall clinical presentation was not typical at that point yet for Ebola,” said Dr. Mark Lester, vice president and zone clinical leader with Texas Health Resources, noting that the patient lacked some traditional hallmarks of the disease, which include vomiting and diarrhea. “Regretfully, that information was not fully communicated throughout the full team.”

The patient, who was confirmed Tuesday as the first direct case of Ebola on U.S. soil, was re-admitted two days later and placed immediately in isolation. On Wednesday, the hospital said he was in serious but stable condition. He is being held in a private ward under round-the-clock care.

The Associated Press, citing the patient’s sister, reported that his name was Thomas Eric Duncan. Local officials would not confirm the report in accordance with patient confidentiality requirements.

In a statement Wednesday afternoon, United Airlines said the Centers for Disease Control and Prevention (CDC) told the airline the patient flew two legs of his flight from Liberia to Dallas on Sept. 20 United flights, one from Brussels to Washington, D.C., and then from Washington to Dallas-Fort Worth. The director of the CDC said there is “zero risk” of any Ebola transmission to anybody who was traveling on either flight.

The patient’s initial release will raise questions about whether the miscommunication between hospital staff may have increased the chance of additional people becoming infected. Local, state and federal officials have launched a broad effort to trace the contacts made by the patient between the time he began suffering symptoms and his second trip to the hospital, on Sept. 28.

“This is all hands on deck,” Texas Governor Rick Perry said, flanked by a battery of doctors and political officials.

Dr. Christopher Perkins, Dallas County Health and Human Services Medical Director, said 12 to 18 people were being monitored after possibly coming into contact with the sick patient. Of that number, five were members of his immediate household and five were school-aged children.

Mike Miles, the superintendent of the Dallas Independent School District, said the children may have come into contact with the patient over the weekend. The children are being kept out of school, but attended earlier this week, Miles said. None of the potential contacts are currently being quarantined.

The ambulance workers who transported the Ebola patient on his second trip to the hospital are in isolation as a precaution. The hospital is still deciding what precautions to take with the medical staff who had contact with the patient. “Contact and exposure are not the same,” said Dr. Edward Goodman, an epidemiologist at the hospital, who stressed that there was little likelihood that anybody at the hospital has been exposed.

Officials cautioned the public not to panic. While deadly, Ebola is not easy to transmit. It is passed on through contact with bodily fluids, such as blood or vomit, but it cannot be transmitted through the air. Patients carrying Ebola are not contagious unless they are presenting symptoms of the disease.

This story has been updated to reflect new information about the patient’s trip to Dallas and the timing of his visit to the hospital.

TIME Infectious Disease

First U.S. Ebola Patient Identified

His sister identified him

The first patient to be diagnosed with Ebola in the U.S. was identified Wednesday as Thomas Eric Duncan.

Duncan’s sister Mai Wureh told the Associated Press it was her brother who is at the center of the country’s latest Ebola scare. Wureh said her brother went to the emergency room on Friday complaining of fever and a nurse asked about whether he had recently been in Ebola-affected countries. He said yes, but, according to Dr. Mark Lester, a clinical leader for Texas Health Resources, the “information was not fully communicated throughout the whole team.”

Duncan was sent home with antibiotics, and returned two days later in an ambulance with more severe symptoms. He is currently in serious but stable condition at Texas Health Presbyterian Hospital.

[AP]

TIME Infectious Disease

Second Patient Monitored for Ebola in Texas

Ebola
Transmission electron micrograph of an Ebola virus virion Getty Images

Health officials assure the public that only friends and family of the first patient are at serious risk

Health officials in Texas are monitoring a second patient for Ebola, as they investigate over a dozen individuals who were in contact with the first person diagnosed with the disease in the United States.

“Let me be real frank to the Dallas County residents: The fact that we have one confirmed case, there may be another case that is a close associate with this particular patient,” Zachary Thompson, director of Dallas County Health and Human Services (DCHHS), said in a morning interview with WFAA-TV. “So this is real. There should be a concern, but it’s contained to the specific family members and close friends at this moment.”

The Dallas County bureau later underscored that there had been no confirmation of a second case, as some media outlets had reported:

Officials have said the man came into contact with 12 to 18 people after returning from Liberia, all of whom are being investigated.

The first case of Ebola was confirmed at the Texas Health Presbyterian Hospital Dallas on Tuesday. The patient had flown from Liberia to Texas on Sept. 19 and sought treatment for symptoms on Sept. 26. Health officials say they have contained the virus to the area and are working closely with the Dallas County school district.

[WFAA-TV]

TIME Infectious Disease

This Is the 21-Day Process for Stopping Ebola

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
Dr. Edward Goodman, epidemiologist at Texas Health Presbyterian Hospital Dallas, and Dr. Mark Lester, Southeast Zone clinical leader for Texas Health Resources, answer questions during a media conference at Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on Sept. 30, 2014 in Dallas. Mike Stone—Getty Images

Experts are tracking anyone who could have come in contact with the first patient to be diagnosed in the U.S.

U.S. health officials were working Wednesday to determine whether the first diagnosis of Ebola on American soil is an isolated case—or whether the patient may have infected others.

The Centers for Disease Control and Prevention (CDC) dispatched a nine-person epidemiology team to Dallas on Tuesday night. Their job is to contain any potential spread of the virus by working with local health officials to document whether the patient had contact with other people—who, where and when. How they’ll do this is less like the movie Outbreak and more of a labor-intensive process of interviews and monitoring.

The trail they will investigate starts Sept. 26, when a man came into Texas Health Presbyterian Hospital in Dallas for medical care. For two days, he had been feeling ill with fever and muscle aches—generally not concerning, which is why he was sent home. Two days later, he was worse, and was brought back to the hospital by ambulance.

It wasn’t immediately clear if doctors had asked the patient the critical question they should be asking all people who seek medical care for fevers, which is whether he had recently been outside of the U.S., and whether he had traveled to any of the countries in West Africa—including Guinea, Liberia or Sierra Leone—now battling the worst Ebola outbreak in the disease’s history. A Texas health official clarified Wednesday that a nurse had indeed asked the patient if he’d been to Africa and that he said he had, but hospital staff never factored that into their initial treatment.

MORE: How U.S. Doctors Can Contain Ebola

It turned out he had. Four days before he began feeling sick, the patient had been in Liberia before flying to the U.S. This time, based on his symptoms and his travel history, the doctors admitted him into an isolated room and called the state health department and the CDC’s 24-hour hotline; officials recommended testing the patient’s blood for the Ebola virus.

It tested positive, and now health officials from national and local agencies are on the scene. Their job is to contain any potential spread of the virus by documenting who, where and when the patient had contacted other people who might have been exposed via the patient. Because Ebola is only transmitted by droplets—in urine, blood or other body fluids—and only contagious when patients become symptomatic, those at highest risk are people who would have had the closest and most direct contact with the patient. Those who are exposed would also have to have direct mucous contact with infected fluids, such as via the eyes, nasal passages, or through a cut in the skin. So the passengers on the patient’s flights from Liberia to the U.S., for example, aren’t considered at high risk of exposure since he was not experiencing symptoms then.

MORE: Ebola in the United States: What You Need to Know

But the emergency medical personnel who brought the patient to Texas Health Presbyterian in the ambulance might be. They, and the man’s close family members, are being monitored for the virus’ longest incubation period—21 days—for any symptoms of Ebola, such as fever, nausea, vomiting or muscle weakness. If they don’t show any symptoms after that time, they’re likely in the clear.

Epidemiologists take a ring approach to tracing contacts of patients—starting with the circle of people with the most direct contact, such as family members or those who share close living arrangements. Each contact is asked about their own recent interactions with people, and this information is built into a contact tree of folks, not all of whom would be put on watch. Depending on how direct the contact with the patient was, even family members may not be quarantined but asked to refrain from traveling out of the city or country, for example, and avoiding public areas like movie theaters or shopping malls. A handful of children who were in the home with the patient are being monitored, local health officials said at a news conference on Wednesday, but they were allowed to attend school as usual.

MORE: Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

If anyone in the first circle of contacts develops symptoms, then doctors would step up their monitoring of the next ring of contacts, asking them to stay away from public gatherings for 21 days. This pattern continues until no one in a ring reports symptoms in the incubation period; that suggests they were not exposed and therefore don’t have the infection.

All of this, of course, depends on honest and accurate information from the patient and his contacts about where they have been and with whom—something that has been an issue in west Africa, where stigma against Ebola has led patients to flee health volunteers who are attempting to trace contacts, or fail to report people they have interacted with.

That shouldn’t be a problem here, CDC director Tom Frieden said. “We have identified all the people who could have had contact with the patient while he was infectious,” he said during a news conference. “We are stopping it in its tracks in this country. There is no doubt in my mind that we will stop it here.”

TIME Opinion

How Celebrities Helped Me Get Through Breast Cancer

When I was diagnosed at 40, Betty Ford, Betsey Johnson and Sheryl Crow stepped in

If you’re diagnosed with cancer and you live, you’re graced with a label that’s meant as an honor: “Survivor.” And yes, surviving cancer is a powerful experience that can enrich and embolden the rest of one’s days. But what of people whose lives are taken by the disease? Anyone who has lost a loved one to cancer knows well that people who die of cancer commonly display extraordinary determination, clarity, and grace. We don’t have a fitting term for those people — “victims” is not exactly empowering — and yet, as Breast Cancer Awareness month begins, their experience is just as worthy of being honored.

I took a crash course in these issues when I was diagnosed with breast cancer, at age 40, in 2008. Part of what I learned during that time came from close connections, especially those I found in a national group called the Young Survival Coalition, which provides support and information for younger women facing this diagnosis. At the same time, I also found a community somewhere less expected: with celebrities.

Before connecting with others dealing with the disease, I could immediately turn to the famous women whose experiences I had watched throughout the decades before. I thought of Betsey Johnson, who’d been diagnosed in 2002. She had apparently come through more fabulous than ever; I’d interviewed her a few years before and found her insightful, buoyant, and laughter-filled. I thought of Minnie Riperton, a musician I’d loved all my life. Her candor about her diagnosis earned her a spokesperson position for the American Cancer Society in 1977 and the ACS’s Courage Award, presented by President Jimmy Carter, in 1978. She ultimately died of breast cancer, at 31, but I remembered the impression she’d made on me when I was a child by communicating in public about her illness with honesty and grace.

The list goes on: Sheryl Crow and Christina Applegate emerged from their breast cancer treatments determined to help others who face the disease. Edie Falco was diagnosed at 40, in 2003; she later said that the way long-held wishes came to the fore in her life after cancer treatment encouraged her to adopt her children. Robin Roberts came out about her sexuality after she was treated for a blood disorder that appears likely to have resulted from the chemotherapy she received for breast cancer five years before. I also thought of photographer Linda McCartney, diagnosed with breast cancer in 1995. In March of 1998, her face somewhat gaunt and her hair just growing back from chemotherapy, she nonetheless shone with pride at her designer daughter Stella’s fashion show. One month later, she died of the disease — but I will never forget the photos I saw of her that day and how she put herself, though very ill, in the public eye for an event she held dear, living on her terms till the end.

The impact these women can have on those fighting the disease out of the spotlight just goes to show how important it is that celebrities now feel free to speak out if they want to.

That’s where Shirley Temple Black comes in. When the former child star was diagnosed with breast cancer in 1972, it was not only common for women to keep the diagnosis a secret from others, but also for their doctors to keep secrets from them: Doctors often told women they were having a biopsy when in fact a mastectomy was planned; the thinking was that a woman would not be able to handle the news in advance. Black, one of the first women in this country to speak publicly about her breast cancer diagnosis, expressed outrage at this practice: “The doctor can make the incision; I’ll make the decision,” she wrote in McCall’s magazine.

Just two years later, First Lady Betty Ford was diagnosed, mere weeks after her husband took the oath of office. TIME reported that she received what was then the standard surgery for breast cancer: a “radical mastectomy” that “removed the entire right breast, its underlying pectoral muscle, and lymphoid tissue in the adjacent armpit.” Today, less invasive surgical options are far more common, even when a mastectomy is performed. (Ford went on to commit herself to many causes, most famously helping to erase stigma from another illness she faced: addiction.) Within weeks, Happy Rockefeller, the Vice President-designate’s wife, had decided to learn from Ford’s example and perform a breast self-exam. She found a lump in her breast and was diagnosed with breast cancer; Ford was publicly credited with leading Rockefeller toward the diagnosis and what proved to be successful treatment.

The First Lady’s decision to be open about what was still a taboo topic — a frightening illness in a private part of the body — had paid off immediately. And I can attest that the trend she helped start, of sharing a breast cancer experience publicly, continues to make a difference.

These days, of course, one needn’t even be a global celebrity to have a broad impact. In mid-2010, I discovered the writings of journalist Mary Herczog, who had also been treated for breast cancer. I loved her warm, witty writing style; and I loved that she had decided to pursue a doctorate after her initial cancer treatments. I wanted to meet this remarkable survivor — but was devastated to learn that Herczog had died of breast cancer a few months before, at age 45. In a blog entry about a month before her death, Herczog acknowledged her somewhat unusual refusal to despair over terrible medical news. “Either there’s a whole lot of unavoidable bad coming at me,” she said, “in which case I don’t see the need to rush up and greet it, or I feel pretty swell, and I roll out with cookies and good books.” Words to live by, from one whose legacy will continue to survive.

As for what to call those who, like Herczog, were not themselves survivors, one of my friends from the Young Survival Coalition has a suggestion: call them by their names. That goes for boldface names as well as the names of beloved friends.

Meanwhile, whatever term you want to use for someone who had cancer and now shows no evidence of the disease, that’s what I am. And I carry in my heart others who touched my life while they faced the disease — those who survived and those who didn’t — even if I only ever knew them from a distance.

Read TIME’s 2013 cover story about the impact of Angelina Jolie’s mastectomy, free of charge, here in TIME’s archives: The Angelina Effect

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