TIME Infectious Disease

New Fears About Ebola Spread After Plane Scare

Sierra Leone West Africa Ebola
In this photo taken on Sunday, July 27, 2014, medical personnel inside a clinic take care of Ebola patients on the outskirts of Kenema, Sierra Leone Youssouf Bah—AP

It's an unprecedented public-health scenario: since 1976, when the virus was first discovered, Ebola outbreaks were limited to remote corners of Congo and Uganda

(DAKAR, Senegal) — No one knows for sure just how many people Patrick Sawyer came into contact with the day he boarded a flight in Liberia, had a stopover in Ghana, changed planes in Togo, and then arrived in Nigeria, where authorities say he died days later from Ebola, one of the deadliest diseases known to man.

Now health workers are scrambling to trace those who may have been exposed to Sawyer across West Africa, including flight attendants and fellow passengers.

Health experts say it is unlikely he could have infected others with the virus that can cause victims to bleed from the eyes, mouth and ears. Still, unsettling questions remain: How could a man whose sister recently died from Ebola manage to board a plane leaving the country? And worse: Could Ebola become the latest disease to be spread by international air travel?

Sawyer’s death on Friday has led to tighter screening of airline passengers in West Africa, where an unprecedented outbreak that emerged in March has killed more than 670 people in Guinea, Sierra Leone and Liberia. But some health authorities expressed little confidence in such precautions.

“The best thing would be if people did not travel when they were sick, but the problem is people won’t say when they’re sick. They will lie in order to travel, so it is doubtful travel recommendations would have a big impact,” said Dr. David Heymann, professor of infectious diseases at the London School of Hygiene and Tropical Medicine.

“The important thing is for countries to be prepared when they get patients infected with Ebola, that they are isolated, family members are told what to do and health workers take the right steps.”

The World Health Organization is awaiting laboratory confirmation after Nigerian health authorities said Sawyer tested positive for Ebola, WHO spokesman Gregory Hartl said. The WHO has not recommended any travel restrictions since the outbreak came to light.

“We would have to consider any travel recommendations very carefully, but the best way to stop this outbreak is to put the necessary measures in place at the source of infection,” Hartl said. Closing borders “might help, but it won’t be exhaustive or foolproof.”

The risk of travelers contracting Ebola is considered low because it requires direct contact with bodily fluids or secretions such as urine, blood, sweat or saliva, experts say. Ebola can’t be spread like flu through casual contact or breathing in the same air.

Patients are contagious only once the disease has progressed to the point they show symptoms, according to the WHO. And the most vulnerable are health care workers and relatives who come in much closer contact with the sick.

Still, witnesses say Sawyer, a 40-year-old Liberian Finance Ministry employee en route to a conference in Nigeria, was vomiting and had diarrhea aboard at least one of his flights with some 50 other passengers aboard. Ebola can be contracted from traces of feces or vomit, experts say.

Sawyer was immediately quarantined upon arrival in Lagos — a city of 21 million people — and Nigerian authorities say his fellow travelers were advised of Ebola’s symptoms and then were allowed to leave. The incubation period can be as long as 21 days, meaning anyone infected may not fall ill for several weeks.

Health officials rely on “contact tracing” — locating anyone who may have been exposed, and then anyone who may have come into contact with that person. That may prove impossible, given that other passengers journeyed on to dozens of other cities.

Patrick Sawyer had planned to visit his family in Minnesota next month to attend two of his three daughters’ birthdays, his wife, Decontee Sawyer, told KSTP-TV in Minnesota.

“It’s a global problem because Patrick could have easily come home with Ebola, easy,” she said. The Associated Press left phone and email messages for her Monday.

International travel has made the spread of disease via airplanes almost routine. Outbreaks of measles, polio and cholera have been traced back to countries thousands of miles away. Even Ebola previously traveled the globe this way: During an outbreak in Ivory Coast in the 1990s, the virus infected a veterinarian who traveled to Switzerland, where the disease was snuffed out upon arrival and she ultimately survived, experts say.

Two American aid workers in Liberia have tested positive for the virus and are being treated there. U.S. health officials said Monday that the risk of the deadly germ spreading to the United States is remote.

The mere prospect of Ebola in Africa’s most populous nation has Nigerians on edge.

In Nigeria’s capital, Abuja, Alex Akinwale, a 35-year-old entrepreneur, said he is particularly concerned about taking the bus, which is the only affordable way to travel.

“It’s actually making me very nervous. If I had my own car, I would be safer,” he said. “The doctors are on strike, and that means they are not prepared for it. For now I’m trying to be very careful.”

It’s an unprecedented public health scenario: Since 1976, when the virus was first discovered, Ebola outbreaks were limited to remote corners of Congo and Uganda, far from urban centers, and stayed within the borders of a single country. This time, cases first emerged in Guinea, and before long hundreds of others were stricken in Liberia and Sierra Leone.

Those are some of the poorest countries in the world, with few doctors and nurses to treat sick patients let alone determine who is well enough to travel. In Sawyer’s case, it appears nothing was done to question him until he fell sick on his second flight with Asky Airlines. An airline spokesman would not comment on what precautions were being taken in the aftermath of Sawyer’s journey.

Liberian Assistant Health Minister Tolbert Nyenswah told The Associated Press last week that there had been no screening at Liberia’s Monrovia airport. That changed quickly over the weekend, when President Ellen Johnson Sirleaf said a new policy on inspecting and testing all outgoing and incoming passengers will be strictly observed. She also announced that some borders were being closed and communities with large numbers of Ebola cases would be quarantined.

International travelers departing from the capitals of Sierra Leone and Guinea are also being checked for signs of fever, airport officials said. Buckets of chlorine are also on hand at Sierra Leone’s airport in Freetown for disinfection, authorities said.

Still, detecting Ebola in departing passengers might be tricky, since its initial symptoms are similar to many other diseases, including malaria and typhoid fever.

“It will be very difficult now to contain this outbreak because it’s spread,” Heymann said. “The chance to stop it quickly was months ago before it crossed borders … but this can still be stopped if there is good hospital infection control, contact tracing and collaboration between countries.”

Nigerian authorities so far have identified 59 people who came into contact with Sawyer and have tested 20, said Lagos State Health Commissioner Jide Idris. Among them were officials from ECOWAS, a West African governing body, airline employees, health workers and the Nigerian ambassador to Liberia, he said. He said there have been no new cases of the disease.

___

Associated Press Medical Writer Maria Cheng reported from London. Jonathan Paye-Layleh in Monrovia, Liberia; Clarence Roy-Macaulay in Freetown, Sierra Leone; Erick Kaglan in Lome, Togo; and Heather Murdock in Abuja, Nigeria, also contributed to this report.

TIME Cancer

House Passes Bill to Update Sunscreen Review Process

The first of its kind in more than a decade

The U.S. House of Representatives on Monday passed a bill that will streamline the process for reviewing and approving ingredients in sunscreen products.

The Sunscreen Innovation Act (H.R. 4250) was created in cooperation with the Food and Drug Administration and is the first major update to the review process since the 1990s.

The act won’t change the level of scientific review required for FDA approval, only some of the procedural steps that can draw out the review process.

If it becomes a law, the Sunscreen Innovation Act would only apply to sunscreen products that have been marketed outside the U.S. for at least five years. Most of the ingredients pending approvals could have their reviews completed within the following year, according to the American Cancer Society, whose advocacy wing the Cancer Action Network supports the bill.

“Educating people about good sun safety behaviors is only half of the story,” ACS CAN President Chris Hansen said in a statement. “American consumers should have access to the broadest choice of sunscreens — including those in use for years in other countries — once they are shown to be safe and effective.”

TIME Exercise/Fitness

Even If You’re Super Slow, Running Reduces Risk of Death

"Hazard ratios (HRs) of all-cause and cardiovascular mortality by running characteristic (weekly running time, distance, frequency, total amount, and speed). Participants were classified into 6 groups: nonrunners (reference group) and 5 quintiles of each running characteristic. All HRs were adjusted for baseline age (years), sex, examination year, smoking status (never, former, or current), alcohol consumption (heavy drinker or not), other physical activities except running (0, 1 to 499, or $500 MET-minutes/week), and parental history of cardiovascular disease (yes or no). All p values for HRs across running char- acteristics were <0.05 for all-cause and cardiovascular mortality except for running frequency of $6 times/week (p 1⁄4 0.11) and speed of <6.0 miles/h (p 1⁄4 0.10) for cardiovascular mortality."

Whether you are the tortoise or the hare, running can help reduce the risk of heart disease

Whether you log a marathon or a single city block, running—even slowly—may greatly reduce the risk of a cardiovascular-related death when compared to people who do not run, says a new study published Monday in the Journal of the American College of Cardiology.

The U.S. government and the World Health Organization currently suggest either 150 minutes of moderate-intensity (brisk walking, gardening or physical chores around the house) or 75 minutes of vigorous-intensity aerobic exercise (running, cycling, swimming or competitive sports) per week. Yet very little research exists looking at the benefits of vigorous exercise below 75 minutes.

Researchers examined data from the Aerobics Center Longitudinal Study to see if there was a connection between running and longevity. The research followed more than 55,000 adults between the ages of 18 and 100 over a period of 15 years, recording their daily activity, including running. They found that the benefits of running were the same regardless of sex, age, weight, health conditions and substance-use history, with all runners showing a 30% lower risk of death from all causes, and a 45% lower risk of death from a heart attack or stroke. Out of the original sample of people, 1,217 died of cardiovascular disease—and only 24% of them reported running as part of their exercise routine.

Ascent—Getty Images

Dr. DC Lee, lead author of the study and assistant professor of kinesiology at Iowa State University, found that runners who ran less than an hour per week had the same longevity benefits as runner who clock more than 3 hours a week. However, those who ran more consistently over a period of six years benefited most.

 

TIME Infectious Disease

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

After a passenger brought Ebola to Africa’s largest city, health officials are on alert for signs of the infection among passengers. Here's the latest

The Ebola outbreak has already led to more than 670 deaths in West Africa, but a man who became ill on a flight from Liberia to Lagos, Africa’s largest city, has raised alarms for public-health officials after he later died of the virus.

Liberia has closed most of its borders, and airports in Nigeria are now screening passengers arriving from foreign countries for Ebola’s symptoms, which include fever, headache, joint pain, lack of appetite, difficult breathing and sore throat. In its advanced stages, Ebola leads to diarrhea, vomiting and internal bleeding. While the airport screenings are meant to ease travelers’ minds, the reality is that the Ebola virus can’t be detected soon after infection — the first signs of the virus are red eyes and a rash, which could be caused by many different things. Plus, outgoing flyers are not being tested and its unclear at this point if over countries will follow suit. People have recovered from infection with the virus, but the mortality rate ranges from 50% to 90%.

(MORE: Here’s What It Will Take to Contain the Worst Ebola Outbreak in History)

Who can spread the virus?

The virus takes anywhere from two to 21 days to incubate and start causing symptoms, but Dr. Stephan Monroe, deputy director of the National Center for Emerging and Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention (CDC), said during a telebriefing Monday that infected patients only spread the disease when they have symptoms. Because the virus is transmitted through direct contact with fluids like saliva or blood from infected patients, airport officials are essentially looking for passengers who might have severe vomiting, diarrhea or other bodily secretions that could reach other travelers.

Are Nigeria’s airport screenings enough?

Nigeria is screening incoming passengers for such symptoms and may also take passengers’ temperature. Nigerian officials have also created holding rooms to isolate patients or passengers who are suspected of being infected, so they can be triaged to further medical care.

But because some of the early symptoms of Ebola mirror those of other ailments, including malaria, CDC officials say the strongest way to contain spread of infectious diseases is by instituting travel restrictions at the source. That’s why Liberia has closed all its borders except for three land crossings where travelers can be screened and treatment services provided if needed.

Dr. Marty Cetrone, director of the division of global migration and quarantine at the CDC, said during the briefing that officials can also try to contain the outbreak by using questionnaires asking travelers at these checkpoints about their recent travel history as well as their potential exposure to the virus through friends or other close contacts.

How did this outbreak get so bad?

Health officials aren’t sure why this particular outbreak has led to a historic number of deaths, but note that social and cultural practices may be driving spread of the virus. In many of the communities where the virus remains active, there is still denial about the disease, and stigma associated with getting ill, which discourages patients from getting early hydration and nutrition that can help them to overcome the infection. While there is no treatment for the virus, these measures can lower the death rate for some. Funeral practices that involve touching the deceased may also help the virus move from host to host.

How at-risk are Americans?

Monroe says the risk of Ebola for U.S. citizens who haven’t traveled to West Africa remains low. There are no restrictions on travelers entering the U.S., but the CDC has issued a Level 2 travel advisory for people traveling to Guinea, Liberia or Sierra Leone, recommending that they avoid contact with blood or other bodily fluids that might contain the virus, and use the proper protective equipment to avoid infection. The advisory applies mostly to health care or humanitarian aid workers, who so far make up the largest group of people affected by Ebola. “[Transmission] involves not only touching the contaminated body fluid but introducing it through some mucous membrane or cut on the skin,” said Monroe.

For anyone who has recently traveled to those countries or might have been exposed to someone who was ill in that area, health officials are advising a 21-day fever watch to ensure that no active infection is occurring.

What if an infected person flies into the U.S.?

The CDC is also preparing for the remote possibility that a passenger from the region who is ill boards a plane and lands in the U.S. and starts infecting residents. The agency is informing its network of physicians in state and local public-health facilities about how to look for signs of Ebola. “We are sending Health Alert Network notices about the importance of taking steps to prevent spread of the virus,” said Monroe. That includes procedures on asking patients about their recent travel history, as well as using the proper personal protective equipment, such as masks, gloves and gowns if they suspect an Ebola infection.

They’re confident that these measures will be effective, since infection with a virus related to Ebola, Marburg, was successfully contained in the Netherlands with isolation and barrier procedures. No health care workers contracted the virus from that patient. Health officials hope that with the proper preparation and education, that record can apply to Ebola as well, if it makes it beyond the heavily affected countries in West Africa.

TIME infectious diseases

Liberia Closes Borders to Curb Ebola Outbreak

Ebola in Liberia
Liberian health workers in protective gear on the way to bury a woman who died of the Ebola virus from the isolation unit in Foya, Lofa County, Liberia on July 2, 2014. Ahmed Jallanzo—EPA

Outbreak is already the largest on record

The Liberian government closed off most of the country’s border crossings Sunday in an effort to curb an Ebola outbreak that has already killed over 670 people across Guinea, Liberia, and Sierra Leone and become the largest outbreak of the virus on record.

President Ellen Johnson Sirleaf said the airport will remain open, but that all travelers coming in and out will be tested for the virus, Reuters reports. “All borders of Liberia will be closed with the exception of major entry points,” she said. “At these entry points, preventive and testing centers will be established, and stringent preventive measures to be announced will be scrupulously adhered to.”

Ebola kills around 90% of those who contract it, although the current outbreak has only killed around 60%. Numerous medical personnel have succumbed to the most recent outbreak, including Dr. Samuel Brisbane, one of Liberia’s most high-profile doctors, who died Saturday.

Two Americans, Dr. Kent Brantly and missionary Nancy Writebol, have contracted the virus and are currently in stable condition, NBC reports. Both worked for North Carolina-based aid group Samaritan’s Purse, and spokeswoman Melissa Strickland said that they are both “alert.”

Brantly and Writebol had followed all CDC and WHO guidelines and worn full protective equipment when treating Ebola patients, including gloves, goggles, face protection, and full body coverings, Strickland said.

Since Ebola is highly contagious, Liberia has also restricted public gatherings such as marches and demonstrations until the outbreak is brought under control. “No doubt, the Ebola virus is a national health problem,” President Sirleaf said in a statement. “And as we have also begun to see, it attacks our way of life, with serious economic and social consequences.”

TIME Medicare

Medicare Hospital Fund to Last 4 Years Longer

(WASHINGTON) — The government says Medicare’s finances have improved. The program’s hospital trust fund won’t be exhausted until 2030 — four years later than last year’s estimate.

Social Security’s massive retirement program will remain solvent until 2034, although disability benefits are in more immediate danger.

The disability trust fund is now projected to run dry in 2016. At that point, the program will collect enough taxes to pay 81 percent of benefits.

The trustees who oversee Social Security and Medicare issued their annual report Monday on the financial health of the government’s largest benefit programs.

In 2030, when the hospital trust fund is projected to be depleted, Medicare will collect enough payroll taxes to pay 85 percent of benefits.

Medicare’s improved finances are largely due to a slowdown in health care spending.

TIME Research

Google Seeks Human Guinea Pigs for Health Project

The model of a skeleton of a human body on June 05, 2014 in Berlin.
The model of a skeleton of a human body on June 05, 2014 in Berlin. Michael Gottschalk—Photothek/Getty Images

Google's "Baseline Study" aims to get clear picture of human health

Google’s newest project aims to create a crowd-sourced picture of human health by collecting anonymous genetic and molecular information from users.

The project, called Baseline Study, will start off by collecting data from 175 people, but Google hopes to expand that sample size to thousands more, the Wall Street Journal reports.

The researchers hope the project can help move medicine towards prevention over treatment by giving scientists a more accurate picture of what a healthy body looks like, which can help them detect ailments like heart disease and cancer much quicker.

The lead researcher, Dr. Andrew Conrad, said that part of detecting disease is getting a clear picture of how a healthy body works. “We are just asking the question: If we really wanted to be proactive, what would we need to know?” he told the WSJ, which originally reported on this project. “You need to know what the fixed, well-running thing should look like.”

The project will collect hundreds of samples, and then find “biomarkers,” or patterns, within the data. Scientists hope these biomarkers will help them detect disease much sooner, or tell them which kinds of biological conditions make someone a likely candidate for high cholesterol.

Google said that the information from Baseline would be both private and anonymous, would be used only for medical purposes, and wouldn’t be shared with insurance companies. Institutional review boards from Duke University and Stanford University will monitor the study to make sure the data isn’t being misused, Google said, and will only have access to the samples once they’ve already been stripped of identifying data, like names and social security numbers. The samples will be collected by independent testing companies.

But Google wants to collect a staggering amount of information about each of its anonymous human guinea pigs. They’re mapping each person’s entire genome, and their parents’, not to mention looking at how they metabolize food, and how their hearts beat, and their oxygen levels. Participants will even wear special smart contact lenses so Google can monitor their glucose levels.

The Baseline project is the latest endeavor of GoogleX, the arm of the company devoted to long-term, high-risk projects with potential for high reward.

[WSJ]

TIME Germs

Bumping Fists Spreads Fewer Germs Than a Handshake, Study Says

From right: U.S. President Barack Obama and First Lady Michelle Obama bump fists at an election night rally at the Xcel Energy Center on June 3, 2008 in St. Paul, Minn. during his first presidential campaign.
From right: U.S. President Barack Obama and First Lady Michelle Obama bump fists at an election night rally at the Xcel Energy Center on June 3, 2008 in St. Paul, Minn. during his first presidential campaign. Scott Olson--Getty Images

Plus, they're cooler

President Barack Obama’s famous fist bumps may have health benefits as well as a cool factor, because a new study shows that greeting someone with your knuckles is much more hygienic than shaking their hand.

Dr. Dave Whitworth, of Aberystwyth University in Wales, tested the germ-carrying potential of various greetings by high-fiving, fist-bumping, and shaking hands with with a PhD student. One wore a glove covered in bacteria, the other wore a clean glove.

They found that handshakes transferred the most germs, with high-fives transferring only half as many and fist-bumps transferring 90% less, which means that fist-bumping instead of shaking hands could help limit the spread of illness.

The study will be published in the August issue of the American Journal of Infection Control.

Dr. Whitworth hypothesized that fist-bumps are more hygienic mostly because they minimize the surface area of hand-to-hand contact, and they’re usually quicker than handshakes.

“People rarely think about the health implications of shaking hands,” he said in a statement. “If the general public could be encouraged to fist-bump, there is genuine potential to reduce the spread of infectious diseases.”

Plus, if we all fist-bump, then we’d never have to deal with that limp-fish thing again.

TIME Liberia

Ebola Kills Liberian Doctor, 2 Americans Infected

Handout of Dr. Kent Brantly of Samitan's Purse relief organization in Monrovia
Dr. Kent Brantly, left, cares for Ebola patients at the ELWA Hospital in Monrovia, Liberia Samaritan's Purse—Reuters

(MONROVIA, Liberia) — One of Liberia’s most high-profile doctors has died of Ebola, officials said Sunday, and an American physician was being treated for the deadly virus, highlighting the risks facing health workers trying to combat an outbreak that has killed more than 670 people in West Africa — the largest ever recorded.

A second American, a missionary working in the Liberian capital, was also taken ill and was being treated in isolation there, said the pastor of a North Carolina church that sponsored her work.

Dr. Samuel Brisbane, a top Liberian health official, was treating Ebola patients at the country’s largest hospital, the John F. Kennedy Memorial Medical Center in Monrovia, when he fell ill. He died Saturday, said Tolbert Nyenswah, an assistant health minister. A Ugandan doctor died earlier this month.

The American physician, 33-year-old Dr. Kent Brantly, was in Liberia helping to respond to the outbreak that has killed 129 people nationwide when he fell ill, according to the North Carolina-based medical charity, Samaritan’s Purse.

He was receiving intensive medical care in a Monrovia hospital and was in stable condition, according to a spokeswoman for the aid group, Melissa Strickland.

“We are hopeful, but he is certainly not out of the woods yet,” she said.Early treatment improves a patient’s chances of survival, and Brantly recognized his own symptoms and began receiving care immediately, Strickland said.

The American missionary, Nancy Writebol, was gravely ill and in isolation in Monrovia, her husband, David, told a church elder via Skype, according to the Rev. John Munro, pastor of Calvary Church in Charlotte, N.C.

Munro said the couple, who had been in Liberia for about a year, insisted on staying there despite the Ebola threat. “These are real heroes — people who do things quietly behind the scenes, people with a very strong vocation and very strong faith,” Munro said.

There is no known cure for the highly contagious virus, which is one of the deadliest in the world. At least 1,201 people have been infected in Liberia, Sierra Leone and Guinea, according to the World Health Organization, and 672 have died. Besides the Liberian fatalities, 319 people have died in Guinea and 224 in Sierra Leone.

Ominously, Nigerian authorities said Friday that a Liberian man died of Ebola after flying from Monrovia to Lagos via Lome, Togo. The case underscored the difficulty of preventing Ebola victims from traveling given weak screening systems and the fact that the initial symptoms of the disease — including fever and sore throat — resemble many other illnesses.

Health workers are among those at greatest risk of contracting the disease, which spreads through contact with bodily fluids.

Photos of Brantly working in Liberia show him swathed head-to-toe in white protective coveralls, gloves and a head-and-face mask that he wore for hours a day while treating Ebola patients.

Earlier this year, the American was quoted in a posting about the dangers facing health workers trying to contain the disease. “In past Ebola outbreaks, many of the casualties have been health care workers who contracted the disease through their work caring for infected individuals,” he said.

There is no known cure for Ebola, which begins with symptoms including fever and sore throat and escalates to vomiting, diarrhea and internal and external bleeding.

The WHO says the disease is not contagious until a person begins to show symptoms. Brantly’s wife and children had been living with him in Liberia but flew home to the U.S. about a week ago, before the doctor started showing any signs of illness, Strickland said.

“They have absolutely shown no symptoms,” she said.

A woman who identified herself as Brantly’s mother said the family was declining immediate comment when reached by phone in Indiana.

Besides Brantly and the two doctors in Liberia, Sierra Leone’s top Ebola doctor and a doctor in Liberia’s central Bong County have also fallen ill.

The situation “is getting more and more scary,” said Nyenswah, the country’s assistant health minister.

Meanwhile, the fact that a sick Liberian could board a flight to Nigeria raised new fears that other passengers could take the disease beyond Africa.

Nigeria’s international airports were screening passengers arriving from foreign countries, and health officials were also working with ports and land borders to raise awareness of the disease. Togo’s government also said it was on high alert.

Security analysts were skeptical about the usefulness of these measures.

“In Nigeria’s case, the security set-up is currently bad, so I doubt it will help or have the minimum effectiveness they are hoping for,” said Yan St. Pierre, CEO of the Berlin-based security consulting firm MOSECON.

An outbreak in Lagos, a megacity where many lived in cramped conditions, could be a major public health disaster.

The West Africa outbreak is believed to have begun as far back as January in southeast Guinea, though the first cases weren’t confirmed until March.

Since then, officials have tried to contain the disease by isolating victims and educating populations on how to avoid transmission, though porous borders and widespread distrust of health workers have made the outbreak difficult to bring under control.

News of Brisbane’s death first began circulating on Saturday, a national holiday marking Liberia’s independence in 1847.

President Ellen Johnson Sirleaf used her Independence Day address to discuss a new taskforce to combat Ebola. Information Minister Lewis Brown said the taskforce would go “from community to community, from village to village, from town to town” to try to increase awareness.

In Sierra Leone, which has recorded the highest number of new cases in recent days, the first case originating in Freetown, the capital, came when a hairdresser, Saudata Koroma, fell ill. She was forcibly removed from a government hospital by her family, sparking a frantic search that ended Friday. Kargbo, the chief medical officer, said Sunday that Koroma died while being transported to a treatment center in the east of the country.

TIME

14 Fad Diets You Shouldn’t Try

Dubious diets

Every day it seems a new diet is ready to make weight loss faster and easier than ever before. Or at least they say they are. “Most fad diets go something like this: Take a few foods, give them ‘magic’ power, and set a plan to convince people that eating this way and only this way will promote weight loss,” says Alexandra Caspero, RD, a nutritionist based in Sacramento, Calif. The following diets might spur short-term weight loss, but many are difficult to follow, have arbitrary rules, and a few could put your health in danger.

The raw food diet

Any weight-loss expert would agree that boosting your veggie and fruit intake while reducing the amount of junk you eat is a safe and effective way to lose weight, but this diet bans foods that have been cooked or processed in any way. Why? Raw foodies say cooking destroys nutrients. Though it’s true that cooking produce can sometimes reduce nutrient levels, cooked veggies still pack plenty of fiber, vitamins, and minerals, and in some instances cooking actually enhances nutrients while also killing bacteria. The biggest issue with this extreme form of veganism? Food prep—it’s totally impractical, says Christopher N. Ochner, PhD, director of research development and administration at the Mount Sinai Adolescent Health Center. Raw foodies spend hours upon hours juicing, blending, dehydrating, sprouting, germinating, cutting, chopping, and rehydrating.

Health.com: 12 Things You Need to Know Before Going Vegan

Alkaline diets

The alkaline diet—also known as the alkaline ash diet and the alkaline acid diet—requires you cut out meat, dairy, sweets, caffeine, alcohol, artificial and processed foods, and consume more fresh fruits and veggies, nuts, and seeds. The diet certainly has positive points; it’s heavy on fresh produce and other healthy, satisfying foods while eliminating processed fare, which in itself may spur weight loss. But your body is incredibly efficient at keeping your pH levels where they need to be, so cutting out these foods really won’t affect your body’s pH, says Ochner. Not to mention there’s no research proving that pH affects your weight in the first place. The bottom line: the diet is strict, complicated, and bans foods that can have a place in a healthy eating plan, such as meat, dairy, and alcohol.

The Blood-Type Diet

Developed by naturopathic physician Peter D’Adamo, the Blood Type Diet is based on the notion that the foods you eat react chemically with your blood type. For example, on the diet, those with type O blood are to eat lean meats, vegetables, and fruits, and avoid wheat and dairy. Meanwhile, type A dieters go vegetarian, and those with type B blood are supposed to avoid chicken, corn, wheat, tomatoes, peanuts, and sesame seeds. However, there’s no scientific proof that your blood type affects weight loss. And depending on your blood type, the diet can be extremely restrictive.

Health.com: 10 Bogus Health Trends That Waste Your Time

The werewolf diet

Also called the lunar diet, this one is simply fasting according to the lunar calendar. Its quick-fix version involves a day of fasting allowing only water and juice during a full or new moon—and supposedly losing up to six pounds in water weight in a single day. The extended version starts with that daylong fast and continues with specific eating plans for each phase of the moon. While you’ll lose some weight from not eating, it has nothing to do with the moon, and it will come right back, Ochner says.

Cookie diets

Dr. Siegal’s Cookie Diet, The Hollywood Cookie Diet, and the Smart for Life Cookie Diet all promise that eating cookies will help you drop pounds. Of course, you don’t get to chow down chocolate-chip cookies—you eat about 500 to 600 calories a day from high-protein and high-fiber weight-loss cookies (one cookie company even makes the cookies from egg and milk protein) for breakfast, lunch, and any snacks. Then you eat a normal dinner, for a total of 1,000 to 1,200 calories a day. If you stick to the diet, you will likely lose some weight, but by depriving yourself all day, you set yourself up for bingeing come dinnertime, Ochner says.

The Five-Bite Diet

Eat whatever you want—but only five bites of it. On this diet, developed by obesity doctor Alwin Lewis, MD, you skip breakfast and eat only five bites of food for lunch and five more for dinner. “I’m OK with the idea of eating whatever you want in smaller portions, but you need to round out the rest of your eating with nutrient-dense foods to give your body the fuel it needs,” Caspero says. “On this diet, even if you take giant bites of heavily caloric food, you’re still barely consuming 900 to 1,000 calories a day.”

Health.com: Best and Worst Foods for Bloating

The Master Cleanse/lemonade diet

This diet has been around for decades, and there are a ton of variations. Pretty much all involve subsisting for days on only lemon juice, maple syrup, and cayenne pepper mixed in water. “You are essentially just drinking diuretics,” Ochner says. “You’ll shed mostly water weight.” Once you start eating solid foods again, you will gain all the weight back. Common side effects include fatigue, nausea, dizziness, and dehydration. Plus, on an extremely low-calorie diet like this one, you are going to lose muscle, exactly the kind of weight you don’t want to lose, Caspero says.

The baby food diet

If a baby can grow up eating the mushy stuff, eating some definitely won’t hurt you, but guess what: You aren’t a baby. Dieters replace breakfast and lunch with about 14 jars of baby food (most baby food jars contain 20 and 100 calories apiece), and then they eat a low-calorie dinner. It’s easy to get too few calories for your body to run its best, Ochner says. Besides, who really wants to take jars of baby food to work each day?

The cabbage soup diet

The grandmother of all fad diets, the bulk of this plan is fat-free cabbage soup, eaten two to three times a day for a week along with other low-calorie foods such as bananas and skim milk. In the short term, it does yield weight loss. “It works because you are eating a low-calorie diet full of fiber and water to help aid in fullness,” Caspero says. “But it’s just a quick fix diet. It can also promote bloating and gas from all the cabbage, and is lacking in protein, which is needed to preserve lean body mass. While I am a fan of nutrient-dense, low calorie foods for weight loss, it should be balanced with other foods such as fruits, carbohydrates, healthy fats, and lean protein.”

The grapefruit diet

We are all for including produce at every meal, but the various versions of this 80-year-old fad diet instruct dieters to focus all of their meals on grapefruit or grapefruit juice, claiming that the fruit contains fat-busting enzymes that will help dieters lose 10-plus pounds in 12 days. “In reality, any time you are following a very-low calorie diet you will lose weight,” Caspero says. And this diet definitely hits that, limiting dieters to 800 to 1,000 calories a day. Some iterations also prohibit eating extremely hot or extremely cold foods, preparing foods in aluminum pans, and requires dieters to space “protein meals” and “starch meals” at least four hours apart.

Health.com: 24 Food Swaps That Slash Calories

The Sleeping Beauty diet

If you’re asleep, you’re not eating. Rumored to have been followed by Elvis Presley, this diet takes that simple fact to the extreme, encouraging people to use sedatives to stay asleep for days on end. But sleeping the days away not only starves the body and causes muscle deterioration from a lack of movement, but actually risks death: “Every time you go under, there’s a risk,” Ochner says. “Sure, you might wake up 2 pounds lighter, but you might not wake up at all.”

The HCG diet

This edge-of-starvation diet limits you to about 500 calories a day while taking human chorionic gonadotropin (HCG), a hormone that proponents tout as a powerful appetite suppressant. However, there’s no evidence that HCG does more than act as a placebo, Ochner says. Yes, you’ll lose weight, but only due to the extreme calorie restriction. Though a health care provider may legally give you HCG injections, they’re typically used to treat fertility issues in women and the FDA has not approved them for weight loss. As for over-the-counter homeopathic products that supposedly contain HCG? Those are illegal.

The tapeworm diet

“You don’t need a doctor to tell you that ingesting a tapeworm is a bad idea,” Ochner says. But apparently, some people do. This weight-loss tactic has been around for decades, preying on especially desperate dieters. Here’s how it goes: Ingest tapeworm eggs, let the tapeworm eat the food you consume once it gets to your intestines, and then, when you lose enough weight, get a doctor to prescribe you an anti-worm medication. But some tapeworm eggs can migrate to various parts of your body or cause other potentially life-threatening problems. Freaked out yet? Good.

The cotton ball diet

Consuming cotton balls soaked in orange juice—a diet technique may have been born on YouTube, in chat rooms, and on Facebook—is an incredibly dangerous way to suppress your appetite. “This makes my eating-disorder therapy head spin,” Caspero says. Not only does consuming cotton balls in place of food deprive the body of nutrients, eating anything that isn’t actually food can cause blockages in your intestines. What’s more, most cotton balls aren’t even made of cotton—they’re composed of bleached, synthetic fibers.

This article originally appeared on Health.com.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser