TIME Infectious Disease

Ebola Just the Latest Hardship for Liberian Patient in the U.S.

Ebola US Thomas Eric Duncan Brother
A man who gave his name only as "Joe" and stated he was the brother of Ebola patient Thomas Eric Duncan talks to members of the media in front of a home in Kannapolis, N.C., Oct. 1, 2014. Chuck Burton—AP

Thomas Eric Duncan endured war, refugee camps, and joblessness before getting sick

For Thomas Eric Duncan, the visa to visit his family in the United States was a golden reprieve: a chance to escape the poverty and sickness surrounding him in the Liberian capital of Monrovia; a chance to visit family and friends, including his mother, sister, son and girlfriend; and a chance, maybe, to stay on and build a better, safer life. All those opportunities now hang in the balance as Duncan fights Ebola for his life in a Dallas hospital.

Duncan’s is the first case of Ebola diagnosed on U.S. soil, and in many ways, the 42-year-old is lucky to have developed the disease here. He caught it, according to the New York Times, helping carry a heavily pregnant neighbor back from the hospital where she was turned away from the overflowing Ebola ward. The 19-year-old girl died that night, early on Sept. 16. Her 21-year-old brother, who also helped carry her, died a week later in an ambulance on the way to the hospital. Duncan, by contrast, has a whole ward to himself in Dallas and a team of top doctors.

Duncan flew to the U.S. on Sept. 19 and exhibited the first symptoms of Ebola four of five days later. For weeks his sister, Mai Wureh, a nurse from Charlotte, N.C., and his mother, who was in Texas when family members spoke to her three weeks ago, had been desperately trying to get Duncan out of Liberia and over to the U.S., fearing for his life.

Wureh told the Associated Press on Wednesday that her brother had clearly told Texas Health Presbyterian Hospital Dallas on his visit to their ER on Sunday that he’d recently arrived from Africa, but due to a miscommunication, no infectious protocols were raised and Duncan was sent home with antibiotics for his fever. It wasn’t until three days later when the family, worried at how sick he’d become, called the Texas Department of Health and alarms were raised, according to CNN.

Duncan has not had an easy time of it in recent years. He spent years in a refugee camp in Ghana during and after Liberia’s civil war, only returning home, “three or four years ago,” according to Rebecca Sele, a cousin of Wureh’s ex-husband, James. Sele, also a nurse who lives in Windsor Mill, MD, kept in touch with Wureh even after her divorce a decade ago.

Sele tells TIME she isn’t sure what kind of visa Eric, as the family calls him, has but “many Liberians try to stay as long as they can, trying to avoid the Ebola. Life is hard there. First civil war, then no jobs, no work. Then Ebola. Mai spends all her time working to send money home. She supports her siblings.”

One of Duncan’s brothers died a couple of years ago and the others have struggled to make ends meet, tinkering with cars and bartering for trade. According to the Times, Duncan worked as a driver for the past year for Safeway Cargo, the Liberian customs clearance agent for FedEx, until he quit abruptly on Sept. 4, soon after a visit from his sister.

This was Duncan’s first trip to the United States, according to Gabriel Wureh, Mai’s ex-husband’s brother, who lives in Bowie, MD. Wureh, who hadn’t spoken to his former sister-in-law in years, got in touch with her on Facebook after the news broke. For Gabriel Wureh, the news hit close to home because he’d just returned from Liberia a month ago himself.

Wureh quarantined himself for 21 days in the family’s home in an abundance of caution, according to his son, Eugene. That said, the accountant said he was never afraid in Liberia and he plans to go back soon to finish his business there. Like Mai, he is trying to help family in Liberia, including Mai’s ex-husband, James, who moved back there eight years ago.

Such is the story for many Liberians living in the U.S., trying to make ends meet and help sustain increasingly desperate relatives back home. “It’s so expensive living here and then you do–she does–nothing but work, work, work to spend money home,” Sele says. “Frankly, I’m worried about Mai, she’s always been a pillar for her brothers and sisters.”

The Dallas County Department of Health has asked Duncan’s family, including Mai, to remain in isolation at an apartment in The Ivy complex in the Fair Oaks area of Dallas for three weeks to ensure that if any of them have caught the disease, they do not pass it to others. The incubation period of the disease is two to 21 days.

“Mai’s afraid to leave her house,” Sele says. “She’s surrounded by reporters. It’s such a tough situation on top of what was already a tough situation.”

TIME ebola

4 People Quarantined Over Ebola Fears, About 100 Being Monitored

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

But health officials are reminding the public Ebola is extremely difficult to spread

About 100 people are now being monitored for the Ebola virus, according to health officials, while four family members of the Texas hospital patient diagnosed with the disease were placed under quarantine Wednesday night to stem its potential spread.

Thomas Eric Duncan’s close family members, who spent time with Duncan in an apartment near the north Dallas hospital where he is now battling the virus, received hand-delivered orders from Texas and Dallas County officials not to leave the apartment or to receive visitors without approval until at least Oct. 19, the end of the virus’s 21-day incubation period.

“We have tried and true protocols to protect the public and stop the spread of this disease,” said Dr. David Lakey, the Texas state health commissioner. “This order gives us the ability to monitor the situation in the most meticulous way.”

The number of people being monitored for Ebola symptoms swelled overnight as local, state and federal officials scrambled to compile a list of anyone who had immediate or secondary contact with Duncan, the first person to develop Ebola in the United States. None of the people being monitored have exhibited any signs of the virus.

Health officials will use a technique known as contact tracing to identify the circle of people who are potentially at risk. It involves finding everyone who came into close contact with the patient and then interviewing them to identify additional potential contacts, who are subsequently tracked down and interviewed themselves. This form of shoe-leather epidemiology will continue until officials are confident that no one is at risk for contracting or spreading the virus, health officials said.

Compiling a list of possible contacts is the preliminary phase of a technique known as contact tracing. The contact tracing will be carried out by a team of five epidemiologists with the Centers for Disease Control and Prevention (CDC) in concert with county and state health officials. The process involves both phone calls and in-person visits, during which interviews are conducted and possible contacts are provided with information about the virus and informed about best practices to prevent its spread. Health officials will check in with those contacts daily to monitor for symptoms of the virus, which include high fever, severe headache, vomiting and diarrhea.

It is no surprise the tally of possible contacts has grown. Health officials are casting a very wide net, and the number of people on the list of possible contacts is expected to shrink dramatically as the investigation continues and contacts are divided into high-risk, low-risk and no risk categories, health officials said.

It is unclear exactly how many people are being monitored for symptoms of the virus. The Texas Department of State Health Services pegged the number at “about 100.” A second health official with knowledge of the investigation confirmed that figure to TIME. Erikka Neroes, a spokeswoman for Dallas Count Health and Human Services, told TIME that just over 80 people were on the list.

The majority of people being monitored did not necessarily have contact with Duncan himself, but rather with someone who Duncan encountered. “No one is symptomatic as of yet,” Neroes says, “either in the first group or that second group.” Apart from the four family members under quarantine, all the people being monitored are able to move freely. Ebola is not contagious until a person shows symptoms of the virus.

Health officials are not ruling out the possibility that more Ebola cases will emerge, but they say they are confident in their ability to contain the situation. While extremely deadly, Ebola is difficult to transmit. It is communicated through bodily fluids like vomit or blood, but cannot travel through the air.


How Much Money Does Your Doctor Get From Medical Companies?

Use this search tool to find out

Doctors received $3.5 billion from pharmaceutical companies and device makers over a five month period in 2013, according to figures the federal government released this week. The massive dataset includes 4.2 million individual payments made to physicians (including dentists) for things like meals, consulting fees and royalty payments for devices they have helped invent. The new data includes 360,000 doctors by name.

In the days leading up the release of the information, physician groups mobilized to argue that the data, which the 2010 Affordable Care Act mandates be disclosed, is incomplete and misleading. For their part, the Centers for Medicare and Medicaid Services, which oversaw the release, states that, “Just because there are financial ties doesn’t mean that anyone is doing anything wrong.” CMS withheld the names of the recipients on 40 percent of the payments over concerns about data quality.

Using the following tool, you can search for any physician in the database by last name and see any gifts, consulting fees, paid travel, or other payment he or she received between August and December of 2013.

Critics of this sort of disclosure are quick to point out that there are many positive benefits to relationships between drug and device companies, which produce new life-saving treatments every year, and the doctors who get those treatments to patients who need them. Meanwhile, some research suggests that even cursory relationships with industry do affect a doctor’s behavior.

Among those doctors who were identified, orthopedic surgeons were by far the most compensated. They account for 11 of the 18 physicians who received over $1 million over the five covered months in the data:

Name Specialty Location Amount
Stephen S Burkhart Orthopaedic Surgery San Antonio, TX $7,356,276
Chitranjan S. Ranawat Counselor New York, NY $3,994,022
Thomas S Thornhill Orthopaedic Surgery Boston, MA $3,921,410
Richard Scott Orthopaedic Surgery Boston, MA $3,849,711
Neal Selim Elattrache Sports Medicine Los Angeles, CA $2,413,281
Lawrence A Lynn Counselor Columbus, OH $2,338,790
Timothy A Chuter Surgical Critical Care San Francisco, CA $2,304,899
Roger P Jackson Orthopaedic Surgery of the Spine North Kansas City, MO $1,764,704
Steven B. Haas Orthopaedic Surgery New York, NY $1,752,797
John Satterfield Fordtran Counselor Dallas, TX $1,715,554
Richard Edward Jones Orthopaedic Surgery Dallas, TX $1,457,517
Regis William Haid JR. Neurological Surgery Atlanta, GA $1,252,971
Amar S. Ranawat Counselor New York, NY $1,216,534
Michael D. Ries Orthopaedic Surgery Carson City, NV $1,185,840
Douglas Edmund Padgett Counselor New York, NY $1,139,670
Carlos Jesus Lavernia Adult Reconstructive Orthopaedic Surgery Miami, FL $1,116,854
Roy W Sanders Orthopaedic Surgery Temple Terrace, FL $1,021,282
Thomas A Russell Orthopaedic Surgery Germantown, TN $1,017,736

While the reason for the prominence of orthopedic surgeons at the top of the list varies for each doctor, orthopedic surgery often involves cutting edge devices for things like knee and hip replacements, many of which are exceedingly expensive. In some cases, doctors are receiving thousands of dollars in royalties for these devices because they have a stake in the intellectual property rights. (This is separate from owning part a stake in the company itself, which is reported separately.)

The picture of which pharmaceutical company pays doctors the most is less clear because payments are often recorded under the name of the subsidiary company making the payment. DePuy Synthes, a subsidiary of Johnson & Johnson that manufactures orthopedic and neurosurgery devices, tops the list of companies making payments to doctors during the period with $34.5 million. Arthrex, Inc., a manufacturer of orthopedic surgical supplies, came in second with $15.5 million. Astra Zeneca and Pfizer are also among the top 10 with $15.3 million and $10.01 million respectively. This analysis does not include anonymized payments.

Company Total Payments State
DePuy Synthes Sales Inc. $34,542,816 Massachusetts
Arthrex, Inc. $15,506,504 Florida
AstraZeneca Pharmaceuticals LP $15,385,817 Deleware
Janssen Pharmaceuticals, Inc $13,778,926 Pennsylvania
Smith & Nephew, Inc. $12,020,808 Tennessee
Forest Laboratories, Inc. $10,398,208 California
Pfizer Inc. $10,017,632 New York
Allergan Inc. $9,709,723 California
Biomet, Inc. $9,675,365 Florida
Otsuka America Pharmaceutical, Inc. $9,238,383 Maryland

Of all payments, $109 million is documented as “compensation for services other than consulting, including serving as faculty or as a speaker at a venue other than a continuing education program.” Consulting fees accounted for $91 million. Food and beverages accounted for $57.4 million, and travel and lodging accounted for $45 million. Because the disclosures require that the location of travel be disclosures, we are able to build a picture of where companies like to fly doctors for conferences, speeches, meetings, and other events:

City No. of Payments Total Payments
Chicago 7098 $2,182,736
New York 5757 $2,100,144
Dallas 5453 $1,333,772
Atlanta 4087 $1,056,913
Miami 3081 $930,366
San Diego 2751 $717,280
San Francisco 2696 $1,022,034
Las Vegas 2503 $750,983
Philadelphia 2478 $597,493
Houston 2368 $623,391

Data that was withheld because of unresolved disputes will be published in future disclosures.

TIME ebola

80 People Came Into Contact With Texas Ebola Patient

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
A medical transport van moves past Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on September 30, 2014 in Dallas, Texas. Mike Stone—Getty Images

Four family members of the first confirmed Ebola patient in the US have been ordered to stay at home as a precautionary measure

Health workers have identified 80 people who came into contact with the first confirmed Ebola patient in the U.S. or with his family, officials said Thursday, as the family of the patient was ordered to stay at home in isolation.

Health experts have been tracking down anyone who could have come into contact with the patient, Thomas Eric Duncan, who first went to a Texas hospital for medical care on Sept. 26, days after arriving in the U.S. from Liberia. Duncan was initially sent home without raising any flags, but was brought back two days later as his symptoms worsened.

The group of 80 people were not necessarily in close contact with the patient but did have some level of exposure, Zachary Thompson, the director of the Dallas County Health and Human Services told NBC.

Health officials in Texas have also ordered four family members who had contact with Duncan to stay at home and not have visitors, the Department of State Health Services said in a statement. The family members, who have not shown symptoms, are legally compelled to comply until at least Oct. 19, when the incubation period for the virus will have passed. The virus is not contagious until symptoms appear.

“We have tried and true protocols to protect the public and stop the spread of this disease,” David Lakey, the Texas health commissioner, said in a statement. “This order gives us the ability to monitor the situation in the most meticulous way.”

Separately, a man in Hawaii is being treated in isolation for what health officials say is a potential Ebola case, though he could be sick with some other ailment. The virus has infected more than 7,200 people primarily in Western Africa and killed more 3,300, making it the most deadly Ebola outbreak ever.

TIME Infectious Disease

How to Keep Health Care Workers in Conflict Zones

About a third of medical and nursing students in developing countries have no intention of working in their homeland, according to a new study.

During the Ebola outbreak, one of the greatest challenges to containment has been the limited number of health care workers. There are few local health care workers who are not already working on the outbreak, and Doctors Without Borders and Red Cross have asked the international community to send more personnel for treatment instead of just money.

Now, a new study published in the Bulletin of the World Health Organization reveals that less than one fifth of health care students intend to work in rural areas when they graduate—which, in the case of the Ebola outbreak in Guinea, Liberia and Sierra Leone—is one of the places they are needed the most.

The report surveyed nearly 3,200 first and final year medical students at 16 government medical schools in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal and the United Republic of Tanzania and Zambia and discovered that often these students had made up their minds to work in less rural places or outside their countries before they even enrolled. “Countries could selectively admit those most likely to work in high-need areas,” said study author Dr. David Silvestri of Brigham and Women’s Hospital and Massachusetts General Hospital in Boston in a statement.

WHO notes in the statement that the report is timely since it is set to review its WHO Global Code of Practice in January and that it may need to rethink its policies when it comes to attracting and training the best health care workers.

Another study released on Oct. 1 in the journal Health Policy and Planning reports that recruiting health care workers for conflict zones is very difficult. By interviewing 26 health care workers who served during a conflict in Northern Uganda, they’ve determined that these workers often feel isolated from social and professional health care systems. The study authors recommend the following to keep health workers motivated and safe:

  • Community support
  • Appreciation by supervisors
  • Effective working conditions
  • The opportunity to learn and develop new skills
  • Formal promotion and recognition of their contributions in a dangerous situation
  • Employment benefits such as food, accommodation, transport and free healthcare
  • Good leadership and communication in the workplace
  • Regular and adequate pay
  • Flexible working and inclusive management
TIME ebola

Man in Isolation in Possible Hawaii Ebola Case

Transmission electron micrograph of an Ebola virus virion Getty Images

"It's still an if. This is not a 'for sure' thing."

A man is being treated in isolation in Hawaii for what health officials say is a potential Ebola case, local ABC affiliate KITV reported Thursday, though he could be sick with some other ailment.

Authorities stress that they are being especially cautious amid concerns over the deadly virus, two days after the first confirmed case in the United States was identified in Texas. They did not release details about the patient or the hospital where he is being treated, according to KITV.

“The hospital is being very careful, as they should be, to take precautions making sure the patient is in isolation and making sure the people and the public stay safe,” Dr. Melissa Viray, an official with the Hawaii Department of Health, told KITV. “That being said, it’s still an if. This is not a ‘for sure’ thing.”

Health officials in Texas are tracking down anyone who may have come into contact with the Ebola patient in Texas and monitoring a second potential case. The virus has infected more than 7,200 people primarily in Western Africa and killed more 3,300 in the worst Ebola outbreak on record.



In The Latest Issue

Ebola Cover
TIME animation; Photo-illustration by Spencer Lowell for TIME

The Race to Stop Ebola in Africa
What the world needs to do to fight the deadly virus

Ebola Arrives in America
The West African epidemic lands stateside

The Delta Blues
Two town meetings, two very different kinds of despair

Our Dysfunctional Financial System
Tapes of what really happens between bankers and regulators show how far we have to go

New Apps for the Brain
These programs turn learning into a game

America’s Real Problem in Iran: Ayatullah Khamenei
The country’s most powerful person isn’t interested in diplomacy

Driving While High
Deadly crashes involving pot are on the rise. But stopping stoned drivers won’t be easy

How Dope Affects Driving
TIME talked to Dr. Marilyn Huestis, a lead marijuana researcher at the National Institute on Drug Abuse, to assess key side effects of driving while high.

Hong Kong Seeks Democracy in China’s Shadow

America’s Not So Distant War in Syria
The air war may be feel remote. Give it time

Leon Panetta: The White House Made a Mistakes in Iraq
The former Secretary of Defense discusses how the U.S. misplayed Iraqi troop talks

Meet Pepsi’s Indra Nooyi
The Big Soda boss is pledging a less sugary future

The Culture

Pop Chart

Alan Cumming’s Life Was No Cabaret
The Scottish actor reveals his harsh boyhood in a new memoir

Tinashe’s Confident Debut
R&B singer arrives right on trend

Lost Boys Come to America in The Good Lie
Horror and heart lie at center of new film

The Internet’s Gone Nostalgia-Crazy
Why our digital lives swirl with the remembrance of everything past

10 Questions with Cornel West
The philosopher and agitator talks about prophets, presidents and breaking the law for John Coltrane




A Risky Business


Charlotte Clinton Mezvinsky
First grandchild of Bill and Hillary Clinton

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