TIME Health Care

The Price of Staying Alive For the Next 3 Hours

Stayin' alive—and cheap at the price
Stayin' alive—and cheap at the price ZU_09; Getty Images

A new study suggests a little spending now can buy you a lot of time later

How much do you reckon you’d pay not to be dead three hours from now? That probably depends. If you’re 25 and healthy, a whole lot. If you’re 95 and sickly, maybe not so much. But for people in one part of the world—the former East Germany—the cost has been figured out, and it’s surprisingly cheap: three hours of life will set you back (or your government, really) just one euro, or a little below a buck-thirty at current exchange rates.

That’s the conclusion of a new study out of Germany’s Max Planck Institute, and it says a lot about the power of a little bit of money now to save a lot of suffering later—with implications for all manner of public health challenges, including the current Ebola crisis.

The new findings are a result of one of the greatest, real-time longitudinal studies ever conducted, one that began the moment the Berlin Wall fell, on Nov. 9 1989. Before that year, there were two Germanys not just politically, but epidemiologically. Life expectancy in the western half of the country was 76 years; in the poorer, sicker east, it was 73.5. But after unification began, social spending in the East began rising, from the equivalent of €2,100 per person per year to €5,100 by the year 2000. In that same period, the difference in lifespan across the old divide went in the opposite direction, shrinking from 2.5 years to just one year as the east Germans gained more time. Crunch those numbers and you get the three extra hours of extra life per person per euro per year.

“Without the pension payments of citizens in east and west converging to equivalent levels,” said Max Planck demographer Tobias Vogt in a statement, “the gap in life expectancy could not have been closed.” Increased public spending, Vogt adds, is often framed as an unfortunate knock-on effect of longer life. “But in contrast,” he says, “our analysis shows that public spending can also be seen as an investment in longer life.”

The idea that generous, tactical spending now can be both a money-saver and lifesaver is one that health policy experts tirelessly make—and that people in charge of approving the budgets too often ignore. Bill Gates often makes the point that $1 billion spent to eradicate polio over the next few years will save $50 billion over the next 20 years, not just because there will no longer be any cases of the disease to treat, but because the global vaccination programs which are necessary just to contain the virus can be stopped altogether when that virus is no more.

As TIME reported in September, British inventor Marc Koska made a splash at the TEDMed conference in Washington DC when he unveiled his K1 syringe—an auto-destruct needle that locks after it’s used just once and breaks if too much force is used to pull the plunger back out. That prevents needle re-use—and that in turn not only reduces blood-borne pathogens from being spread, it does so at a saving. According to the World Health Organization (WHO), $1 spent on K1 syringes saves $14.57 in health care costs down the line—or $280 for a $20 order of the shots.

All across the health care spectrum, such leveraging is possible. Critics of the Affordable Care Act have slammed the law for the cost of the preventative services it provides, and while it’s way too early to determine exactly how successful the law will be, the encouraging stabilization in the growth of health costs suggests that something, at least, is working.

Global health officials are making a similar, though more urgent, preventative argument concerning the Ebola epidemic in West Africa. Americans are rightly jumpy over the few cases that have landed on our shores, but the 1,000 new infections per week that are occurring in the hot-spot nations of Liberia, Guinea and Sierra Leone make our concerns look small. Frighteningly, according to the WHO’s newest projections, that figure will explode to 10,000 cases per week by December if the resources are not deployed to contain the epidemic fast.

“We either stop Ebola now,” WHO’s Anthony Banbury said in a stark presentation to the U.N. Security Council on Sept. 14, “or we face an entirely unprecedented situation for which we do not have a plan.”

Suiting up and wading into the Ebola infection zone is a decidedly bigger and scarier deal than spending an extra euro on public health or an extra dollar for a new syringe. But the larger idea of intervention today preventing far larger suffering tomorrow remains one of medicine’s enduring truths. We lose sight of it at our peril.

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

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Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Why Protective Gear Is Sometimes Not Enough in the Fight Against Ebola

Health workers receive assistance with putting on their protective gear before entering the high-risk zone at the Bong County Ebola Treatment Unit near Gbarnga in rural Bong County, Liberia, Oct. 5, 2014.
Health workers receive assistance with putting on their protective gear before entering the high-risk zone at the Bong County Ebola Treatment Unit near Gbarnga in rural Bong County, Liberia, Oct. 5, 2014. Daniel Berehulak—The New York Times/Redux

Human error can endanger even the most experienced health care workers in the fight against Ebola

When it comes to Ebola, the full-body Personal Protective Equipment [PPE] suit is probably the best way to prevent infection. But a PPE can also be one of the easiest ways to get Ebola. A PPE is usually made up of a full-body, impermeable suit with a hood, rubber boots covered by Tyvek booties, multiple pairs of surgical gloves, a surgical mask over the nose and mouth, a plastic bib, goggles, a plastic apron and a lot of duct tape. There is a reason why they are nicknamed moon suits: worn properly, they shouldn’t show an inch of skin. Putting them on right requires two people and about 10 minutes. Taking them off, in even the best of circumstances, is a clumsy, arduous process with multiple opportunities to make a lethal mistake.

It is not yet clear how, exactly, two health care workers at a Dallas hospital tending Thomas Eric Duncan, the first man to be diagnosed with Ebola in the United States, caught the disease, but health authorities are looking closely at the protective measures used at the hospital, and whether or not they were sufficient. Meanwhile, in Spain, where a nurse, Teresa Romero Ramos, is being treated for Ebola that she caught from a patient recently returned from Sierra Leone, officials are questioning whether or not she wore her PPE properly. On a Spanish television program quoted by the New York Times, Madrid’s regional health minister, Javier Rodríguez, questioned the need for extensive training on using the PPEs. “You don’t need a master’s degree to explain to someone how you should put on or take off” a protective suit, he said.

Maybe not, but no matter how experienced and qualified you are in putting on and taking off a PPE there is always room for error. I recently spent two weeks in Monrovia, Liberia, reporting on Ebola, and climbing into, and out of, PPEs on a regular basis, and I am still not sure I ever got it right. I was trained by the best, too: the Red Cross Dead Body Management teams, the guys responsible for picking up deceased Ebola victims and transporting them to the crematorium for safe disposal. An Ebola patient is at his most infective in the hours and days after death, when the virus swarms the skin and bodily fluids.

When the Dead Body Management team workers finish zipping a corpse into a double-sealed body bag they undergo an extensive decontamination process that best resembles a military drill in its precision and attention to detail. Each worker is paired with a sanitizer, a man wearing a backpack sprayer filled with a chlorine and water solution. The process is initiated with a good dousing of chlorine solution and a vigorous washing of the gloved hands. The worker removes his goggles, which are sprayed thoroughly and then discarded. His hands are sprayed again. Then the hood goes down, and the zipper is sprayed, as are the hands for another time. He unzips, and his hands are sprayed yet again. Then he has to shrug out of the suit without allowing any of the external surfaces to come into contact with his hands or the clothing underneath. And so it goes, layer after layer until the worker is left standing in boots, medical scrubs, and the last pair of gloves. Again he is liberally sprayed down with the chlorine solution, at which point he has to jigger off his gloves in a way that ensures that the surface does not come into contact with the skin.

Each organization, be it the Red Cross or Médecins Sans Frontières [MSF], has a similar ritual, even if small details vary. Still, mistakes are made. Even MSF, which has spearheaded the Ebola response in west Africa since day one, and probably knows more than any other organization about how to prevent infection, has seen two international health workers sickened with the disease. A United Nations medical worker infected in Liberia and transported to Germany for care died on Oct. 13. A doctor working for an Italian medical charity contracted Ebola last month, and is still receiving treatment in Germany.

The gear works, but the possibility of human error is still high, especially when working in a high-stress environment, when fatigue and fear stalk every move. PPEs can also provide a dangerously false sense of security. When they are not put on right, or if they are taken off incorrectly, they may as well not be there at all.

If you are lucky the droplet of sweat dropping into your eye as you remove your goggles without bending over first didn’t pass over some Ebola-contaminated material on your hood. I met one health care worker who thinks he caught Ebola when a young patient vomited on him, and the vomit passed through a chink in his Tyvek armor, where his suit didn’t entirely zip up over his mask. Both he and the patient survived. Which is why having the right kind of protection is only the beginning. There needs to be training, and it has to be drilled in daily. There needs to be a buddy system, in which one health care worker is always watching the other, to ensure that the protective gear is on correctly, and that it is taken off correctly. But there will always be mistakes. Ebola will get through. The important thing is to be ready when it does.

TIME Cancer

Can Low-T Therapy Promote Prostate Cancer?

lab rat
Getty Images

New rat research raises health questions for researcher

“Low T” therapy is a fast-growing trend for men who want to jack up testosterone—which declines naturally with age but which can also be clinically low in some people—and the testosterone therapy industry is predicted to reach $5 billion by 2017. The long-term safety effects of supplementing with the hormone is still in question, however—especially in light of a study earlier this year that found double the heart attack risk in certain men after starting testosterone treatments. Other research suggested there was no meaningful increase in heart risk, adding to the confusion. But a new rat study published in the journal Endocrinology raises some alarming questions about the increasingly popular drugs.

Maarten Bosland, PhD, study author and professor of pathology at the University of Illinois at Chicago’s College of Medicine, devised an animal model to test the tumor-promoting effects of testosterone in rats. He exposed a group of rats to a carcinogen, which would put them at risk of developing cancer. He also gave some of the rats testosterone, but no carcinogen. In a third group, he administered both the carcinogen and the testosterone. Then, he measured tumor growth among the two groups.

None of the rats developed prostate cancer when they were just exposed to the carcinogen, but 10-18% of them did when they were just given testosterone. When the rats were exposed to the carcinogen and then given testosterone—even at very low doses—50-71% developed prostate cancer. “I was totally amazed about how strong testosterone can work to promote the formation of prostate cancer in these animals,” he says.

Of course, an animal model can’t determine what will happen in men, but Bosland thinks a similar effect is possible. “Absent of having solid human studies, we won’t be able to say that—it’s just an extra warning signal,” he says. “But I think it’s a clear indication that there is risk.”

TIME Diet/Nutrition

Why Health Officials Are Concerned About Energy Drinks

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WendellandCarolyn—Getty Images

New report advocates for more regulation

The energy drink market is booming, but that’s not necessarily a good thing when it comes to public health, says the World Health Organization’s regional office for Europe.

In a new report in the journal Frontiers in Public Health, João Breda, who works in the division of noncommunicable diseases at WHO Europe, and his colleagues reviewed data on the health risks of energy drinks and the current policies that regulate them. They concluded that health concerns from the scientific and medical community are valid, and that consuming high levels of caffeine very quickly can cause negative health effects or “caffeine intoxication.” Those effects can include nausea, high blood pressure and heart palpitations. Some deaths have even been linked to energy drink consumption, like that of a 16-year-old girl who went into cardiac arrest after drinking the beverages, but none have been definitively proven.

MORE: What’s In Your Energy Drink?

WHO is especially concerned about what happens when people mix energy drinks and alcohol. “The consumption of high amounts of caffeine contained within energy drinks reduces drowsiness without diminishing the effects of alcohol resulting in a state of ‘wide-awake- drunkenness,’ keeping the individual awake longer with the opportunity to continue drinking,” the authors write in the journal. (A small study in July suggests the same thing: people who drank spirits mixed with energy drinks had a greater desire to keep drinking than those sipping regular mixed drinks.)

Sleep-starved college students aren’t the only ones guzzling energy drinks. The WHO report cites estimates that energy drinks make up 43% of caffeine exposure in children.

In Europe, some countries are taking energy drink regulation very seriously: Sweden has banned the sale of energy drinks to kids. In the U.S., energy drink regulation is incredibly weak, and depending on how an energy drink makes it to market, it may not even have to disclose how much caffeine it contains. The WHO report recommends that policymakers adopt more measures to get a tighter grip on the industry, including establishing an upper limit for caffeine content, enforcing labeling and marketing standards, regulating the sale of energy drinks to kids, training healthcare workers about the risks and even screening patients with a history of diet issues and substance abuse for dangerous energy drink consumption. They also call for more research on how energy drinks affect us. “From a review of the literature, it would appear that concerns in the scientific community and among the public regarding the potential adverse health effects of the increased consumption of energy drinks are broadly valid,” they write—a finding that warrants further research, policy and caution.

TIME ebola

CDC to Send Dallas Healthcare Worker Infected with Ebola to Special Hospital

CDC Atlanta Ebola
Exterior of the Center for Disease Control (CDC) headquarters in Atlanta on Oct. 13, 2014. Jessica McGowan—Getty Images

Officials are weighing the possibility in the wake of failures in Dallas, but there is only room for 19 patients

Thomas Eric Duncan, the first Ebola case diagnosed in the U.S., was a warning to hospitals that a patient infected with the deadly virus could walk into their emergency room at any time. Hospitals from New York City to Seattle are now running Ebola drills, testing their staffs to ensure they are prepared to diagnose the disease without putting healthcare workers at risk of contracting it.

“Every hospital in the country needs to be ready to diagnose Ebola,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention (CDC), said at a news conference on Tuesday.

The question is whether every hospital is equipped to care for a patient who tests positive for the disease, which has killed nearly 4,500 people in West Africa. During this outbreak, the most deadly since the disease was first discovered in 1976, the mortality rate is about 70%, according to statistics compiled by the World Health Organization. Health care workers are at particular risk for infection, which is transmitted through contact with a symptomatic patient’s bodily fluids, like blood or vomit.

Those risks have been born out in Texas Health Presbyterian Hospital in Dallas, where Duncan was admitted on Sept. 28 and died on Oct. 8. Early Wednesday, the hospital said a second healthcare worker who administered care to Duncan had tested positive for the disease. The hospital’s stumbles have prompted critics to question whether the additional infections were avoidable—and whether future patients should be cared for at specialized hospitals with the expertise and facilities to treat Ebola cases.

Frieden said Tuesday that the second healthcare worker would be transported to Emory University Hospital in Atlanta, which has a specialized isolation unit for treating diseases like Ebola and has successfully cared for patients with the virus in the past.

Some doctors say moving future Ebola patients to specialized hospitals makes sense. “Given some of the complexities, patients who have this disease are probably best cared for by those who have experience caring for it, and whose healthcare workers are highly trained and drilled in self-protection,” says Dr. Gabe Kelen, the director of the Johns Hopkins Office of Critical Event Preparedness and Response. “It’s not appropriate to think that each and every hospital in the country could bring the resources, the intense training for the healthcare workers that is required.”

There are four hospitals in the U.S. with special isolation units designed to contain biohazards like Ebola. In addition to Emory, they are the National Institutes of Health Clinical Center, in Bethesda, Md., a hospital at the University of Nebraska in Omaha and St. Patrick Hospital in Missoula, Mt. The facilities in Atlanta and Omaha have successfully treated Americans infected with Ebola overseas without any healthcare workers contracting the virus.

Though transporting future cases to these facilities may be prudent, they have limited beds: only 19 between them, according to CNN. Exclusively using specialized hospitals to treat Ebola is only an option so long as the number of cases in the U.S. remains extremely low.

A CDC spokesman said the agency may announce further measures for Ebola on Wednesday.

-Additional reporting by Zeke J. Miller

TIME ebola

U.S. Scrambles to Contain Ebola

An ambulance carrying Amber Vinson, the second health care worker to be diagnosed with Ebola in Texas, arrives at Emory University Hospital on Oct. 15, 2014 in Atlanta.
An ambulance carrying Amber Vinson, the second health care worker to be diagnosed with Ebola in Texas, arrives at Emory University Hospital on Oct. 15, 2014 in Atlanta. David Tulis—AP

After third case diagnosed in the country

The Texas health care worker who tested positive for Ebola late Tuesday flew on a plane just a day before she reported a fever, officials said Wednesday, as the third diagnosis of the deadly disease in the U.S. stoked fear in travelers across the country and sent officials scrambling to make sure it doesn’t spread further.

President Barack Obama rescheduled a planned trip Wednesday to campaign for Democrats before November’s midterm elections to focus on the Ebola response. He met with Cabinet and Homeland Security officials at the White House on Wednesday afternoon, and the Administration announced later that the President would also reschedule campaign travel that had been set for Thursday because of the crisis.

“We are taking this very seriously at the highest levels of government,” Obama told reporters after meeting with officials managing the response. “And we are going to be able to manage this particular situation, but we have to look to the future.” He promised that the Centers for Disease Control and Prevention (CDC) would deploy an Ebola “SWAT team” wherever needed “as soon as a new case is diagnosed,” and health officials would be “monitoring, supervising, and overseeing” the efforts to fight the virus “in a more aggressive way.”

The newly infected health care worker, identified as 29-year-old Amber Joy Vinson, became the third person to be diagnosed with Ebola in the U.S. late Tuesday. She was the second health care worker infected after treating the first patient diagnosed in the U.S., Thomas Eric Duncan, a Liberian man who died of the virus on Oct. 8.

The revelation Wednesday that she flew Frontier Airlines on an Oct. 13 had officials working Wednesday locate and monitor 131 other people who were on the plane. Vinson was also moved Wednesday to an Atlanta hospital with experience treating the disease.

“She should not have flown on [a plane],” Dr. Tom Frieden, the CDC director, told reporters Wednesday.

It became clear late Wednesday night that Frieden was mistaken, and a CDC official confirmed the agency had actually cleared Vinson to fly. Dave Daigle, a CDC spokesman, told TIME that as officials widened the net of people who needed to be monitored, Vinson was in Ohio and the CDC told her to go back to Dallas. Her temperature was 99.5°F, Daigle said. “Most doctors would call that a slight temperature, not a fever,” he said. “At that point, she was asked by CDC to come back to Dallas so she could be monitored, and she came back.”

Addressing Frieden’s comments that Vinson “should not have flown,” Daigle said the threshold for a fever is 100.4°F. “We may end up lowering that threshold,” he said, “but under the current guidance, she was clear to fly.”

Vinson was stable condition Wednesday, Frieden said. She was transferred to Atlanta’s Emory University Hospital, which has already sent nurses to Dallas to aid in Ebola-related care, is currently treating another patient who was diagnosed in West Africa and successfully treated missionaries Dr. Kent Brantly and Nancy Writebol for the disease. The hospital has a specialized unit and team that are trained to treat patients with diseases like Ebola, and Vinson’s transfer comes as U.S. officials are considering transferring all Ebola patients to specialized hospitals.

The news clearly had travelers on edge, with reports of people at airports across the country wearing face masks and even makeshift hazmat suits. Meanwhile, the World Health Organization said Wednesday that the epidemic, which has ravaged counties in West Africa, has now claimed 4,493 lives, with a total of 8,997 confirmed, probable and suspected cases.

Vinson was isolated within 90 minutes after reporting a fever on Tuesday, whereupon she was tested for Ebola, Dallas County Judge Clay Jenkins told reporters Wednesday, adding that “the protocol to find the virus worked well.” The results came back positive from a state lab in Austin around midnight, the Texas Department of State Health Services said.

The CDC is reaching out to passengers on Vinson’s plane, Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth. There were 132 passengers on the flight, and the CDC is asking those passengers to call 1-800-CDC-INFO. Public-health workers will begin interviewing the passengers later Wednesday. Any passengers determined to be at risk will be monitored.

Frontier Airlines said the plane on which the patient flew was cleaned after landing as part of its normal procedure and according to CDC guidelines “prior to returning to service the next day.” The plane was again cleaned Tuesday night before being taken out of service upon notification of the passenger’s status by the CDC. The airline said it will continue to work closely with the CDC to ensure proper protocols and procedures continue to be followed.

Frieden said Wednesday that the several days before Duncan was diagnosed with Ebola were the highest-risk period for other infections. Nina Pham, a nurse who also treated Duncan, was diagnosed with Ebola on Sunday. Both had “extensive contact with the patient when they were having substantial amounts of both vomiting and diarrhea,” Frieden said.

— With reporting by Maya Rhodan, Zeke J Miller and Siobhan O’Connor

READ: Why Protective Gear Sometimes Isn’t Enough in the Fight Against Ebola

TIME Infectious Disease

Here Are The Diseases In NYC Rats

sewer rat
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A new reason to dodge the rodents

Infected with 1.6 bacterial agents and 3.1 viruses, the average New York City rat is a cesspool of disease. But perhaps more frightening to hear is that they’re also host to “many more novel viruses” with unknown potential to harm city dwellers, according to a new study in the journal mBio.

“Our findings indicate that urban rats are reservoirs for a vast diversity of microbes that may affect human health and indicate a need for increased surveillance and awareness of the disease risks associated with urban rodent infestation,” says the study, which looked at samples of blood, urine and feces in 133 rats.

The report found that about 40% of the rodents had at least one viral infection and nearly all had a bacterial infection. A total of 13 rats had more than five viruses. Salmonella and Bartonella were among the bacteria in the sample, but E. coli took the crown as the most common bacterial pathogen. Nearly 40% of rats in the sample had the bacteria, known to cause severe illness replete with vomiting and diarrhea. Pathogens associated with hepatitis C, which can cause liver failure, were among the most common viral pathogens present.

MORE: FDA Approves Combined Hepatitis Drugs

Diseases in rats can have implications for people who live in urban areas in close proximity to the rodents, which can often access the food supply. Despite the prevalence of rats in urban areas, the health implications of rat infestation has not been studied in great depth, but the study says that should change.

“With continued urbanization, highly successful synanthropic species like the Norway rat are likely to play increasingly important roles in zoonotic disease ecology as the size and complexity of the human-rodent interface increases,” the study reads.

To translate, as humans and rats cross paths more often, the potential to pass along disease will increase.

TIME Diet/Nutrition

You Asked: Do Fruit Flies Come From Inside Fruit?

Illustration by Peter Oumanski for TIME

You might not love this answer—but getting rid of them is easy.

Fruit fly moms lay their eggs on everything, from just-starting-to-ripen fruit—like the kind you recently brought home from the market—to the small bits of old produce rotting in your kitchen garbage can, according to the University of Michigan. Even some vegetables, particularly old potatoes and onions, foster fruit flies.

That’s gross. Fortunately, if your fruit isn’t overripe or rotting, the fruit fly larvae and their proud parents haven’t yet burrowed their way deep inside your apples or pears, explains Dr. Gregory Courtney, an entomologist at Iowa State University. They’re just hanging out around the surface of your produce, waiting for the juices inside to start fermenting. (If the risk of pesticides or dirt never inspired you to wash your fruit, maybe the possible presence of fruit fly eggs will do the trick: washing produce rinses away the eggs before they’ve hatched, as long as the fruit is ripe and fresh.)

When the eggs hatch, the babies tunnel into your old bananas and tomatoes and lap up the bacteria and yeast they need to grow big and strong—and to produce hundreds more like themselves. Adult fruit flies likewise feed on the byproducts of the fermentation process, which are also found in wine, soda and everything else you’ve noticed the little buggers hovering around.

In cozy indoor temperatures, the whole birth to reproduction cycle lasts only a couple of weeks, Courtney says.

These insects tend to show up in large numbers in late summer and early fall because it’s the harvest season, and America is filled with the fruits of the earth. With those fruits come fruit flies. And that’s a good thing, Courtney stresses. “They’re not disease spreading, they’re just annoying,” he says. Also, they’re one of many insects that feed on decomposing food. We’d all be neck deep in rotting banana peels and apple cores without them.

But even if you appreciate the bugs’ utility around the compost or trash heap, you probably don’t want them buzzing through your kitchen or lounging on the rim of your wine glass. To get rid of them, Courtney says the best defense is the most obvious: banish all but the freshest produce from your countertops. “Bananas seem to be a big culprit, but that may just be because there are always bananas in my house,” he says.

Buy produce only as you need it, and keep ripe or overripe fruits and vegetables in your refrigerator. Make sure there are no old food scraps hanging out on your floors, countertops or trash. Keep your kitchen free of all those sources for a few weeks, and you’ll wipe out your local fruit fly population, Courtney says.

If a few weeks seems like too long to wait, the University of Nebraska—Lincoln offers a more aggressive solution: Fill a jar with an inch or two of warm water, a teaspoon of yeast and a small amount of sugar to activate the yeast. Take a plastic sandwich baggie, poke a small hole in one corner of it using a sharpened pencil and stick that corner inside the top of the jar. Now secure the bag around the rim of the jar with a rubber band.

The yeasty water will attract fruit flies, which will creep down the bag and through the hole but won’t be able to get back out. Clean out the jar and start over once a week until the fruit flies are gone. Just don’t dump the jar’s old contents in the garbage. The water will likely harbor many fruit fly eggs, so it’s best to dump it away from your house. If you toss it down the sink, run your faucet for a full minute to ensure the eggs are washed away, the UNL report advises.

Or you could just live with your fruit fly friends. They’re pesky, but they serve a purpose.

TIME ebola

Second Texas Health Care Worker Tests Positive for Ebola

Third case in the U.S.

A second Texas health care worker involved in treating a Liberian patient who died of Ebola has tested positive for the disease, officials said Wednesday, marking the second such worker and third person overall to be diagnosed with the virus on U.S. soil in the past several weeks.

The worker was identified by a family member as registered nurse Amber Joy Vinson, the Dallas Morning News reports, citing her grandmother. Vinson, 29, helped care for Thomas Eric Duncan, an Ebola patient who died one week ago at Dallas’ Texas Health Presbyterian Hospital after he was diagnosed with the disease following travel from Liberia.

She was isolated within 90 minutes after reporting a fever on Tuesday, whereupon she was tested for Ebola, Dallas County Judge Clay Jenkins told reporters Wednesday, adding “the protocol to find the virus worked well.” The results returned positive from a state lab in Austin around midnight, according to a statement from the Texas Department of State Health Services.

(PHOTOS: See How A Photographer Is Covering Ebola’s Deadly Spread)

“Health officials have interviewed the latest patient to quickly identify any contacts or potential exposures, and those people will be monitored,” said the Texas DSHS in its statement.

Authorities are moving swiftly to decontaminate the newly diagnosed patient’s apartment as well as the area around it. Dallas Mayor Mike Rawlings said Wednesday morning he anticipates the cleaning will be done by Wednesday afternoon. Officials are calling residents and distributing pamphlets in the area of the patient’s apartment to notify them about risks posed by the virus.

(PHOTOS: Inside the Ebola Crisis: The Images That Moved Them Most)

The U.S. Centers for Disease Control and Prevention (CDC) has been roiled by allegations that it bungled setting appropriate safety protocols for treating Duncan after a nurse treating him contracted the Ebola virus last week. A top nurses union has spoken out about the problems that need to be resolved at the hospital where the 26-year-old nurse, Nina Pham, contracted the illness.

The CDC has acknowledged it did not move fast enough to set protocols at the Dallas hospital when the virus was first reported there, and it has pledged to better its response in the event of future cases.

Texas Health Presbyterian has also come under fire after two health workers have contracted Ebola caring for just one patient. No health workers have become ill after treating several patients for Ebola at Nebraska Medical Center and Emory University Hospital in Atlanta.

However, Chief Clinical Officer for Texas Health Resources Dr. Daniel Varga said that the new Texas patient’s speedy isolation is evidence that the local monitoring program is working effectively. “I don’t think we have systematic institutional problem,” Varga said. “The case of this patient here shows that our ability to intake [those affected] and isolate them has been very effective.”

Read next: Ebola Health Care Workers Face Hard Choices

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