TIME ebola

Nebraska Hospital Recalls ‘Heroic Effort’ to Save Ebola Victim Martin Salia

Doctor Being Treated For Ebola In Nebraska Dies Of Virus
FREETOWN, SIERRA LEONE - APRIL 5, 2014: In this handout provided by the United Methodist News Service, surgeon Dr. Martin Salia, poses for a photo at the United Methodist Church's Kissy Hospital April 5, 2014 outside Freetown, Sierra Leone. Salia, was flown to Omaha, Nebraska from Sierra Leone for treatment at the medical center's specialized bio-containment unit after testing positive for Ebola. According to the Medical Cental Martin Salia died on November 17, 2014 as a result of the advanced symptoms of the disease. (Photo by Mike DuBose/United Methodist News Service via Getty Images) Handout—Getty Images

Doctor arrived critically ill from Sierra Leone on Saturday

Doctors in Omaha who helped to treat a surgeon who had contracted Ebola in Sierra Leone said at a news conference Monday that the virus had progressed too far for him to be saved.

Nebraska Medical Center called its treatment of Dr. Martin Salia a “heroic effort.” Salia arrived critically ill on Saturday and was given the experimental drug ZMapp as well as a transfusion of blood from someone who had survived the disease. The hospital, which had previously treated two other cases successfully, did not disclose the donor.

“Even though this was the best possible place for a patient, at the very advanced stages, even the most modern techniques that we have at our disposal are not enough to treat these patients,” said a hospital representative involved in Salia’s care during the news conference.

Salia was said to have no kidney function, working extremely hard to breathe and was unresponsive. The hospital placed Salia on dialysis but he eventually went into complete respiratory failure. He had severely low blood pressure and progressed to cardiac arrest. He died around 4 a.m. on Monday.

“It was an absolute honor to care for Dr. Salia,” said one of the nurses involved in his care.

The White House issued a statement after news of Salia’s death became public: “Dr. Salia’s passing is another reminder of the human toll of this disease and of the continued imperative to tackle this epidemic on the frontlines, where Dr. Salia was engaged in his calling.”

More than 5,000 people have died in the Ebola outbreak, the World Health Organization reports, including at least 324 health care workers.

TIME ebola

Red Cross Officials: Ebola Flaring Anew in Africa

(BRUSSELS) — Red Cross officials helping to lead the fight against Ebola in West Africa say the virus is spreading, and they’re having trouble recruiting health care workers to combat it.

Antoine Petitbon of the French Red Cross said Monday that it’s easier for him to recruit people to go to Iraq, despite the security hazards there. He said the French Red Cross is facing a problem it’s never had before: Sixty percent of people who sign up to work in the Ebola zone back out later due to pressure from families and friends.

Meanwhile, Birte Hald of the International Federation of Red Cross and Red Crescent Societies told reporters in Brussels that the virus “is flaring up in new villages, in new locations.”

She said: “It is absolutely premature to start being optimistic.”

TIME ebola

Kaci Hickox: ‘Stop Calling me the ‘Ebola Nurse’ — Now!’

Maine Nurse Challenges Mandatory Quarantine Order
Kaci Hickox walks outside of her home to give a statement to the media on October 31, 2014 in Fort Kent, Maine. Spencer Platt—Getty Images

Nurse who was quarantined upon return from West Africa points out she never actually had Ebola

Kaci Hickox, the health worker who objected to the conditions of her quarantine upon returning from west Africa, is now objecting to being called “the Ebola Nurse” in a new op-ed that accuses state politicians of cynically manipulating public fears for political gain.

“I never had Ebola,” Hickox wrote (original emphasis hers) in a Monday op-ed in the Guardian, “so please stop calling me “the Ebola Nurse” – now!”

Hickox accused Governors Chris Christie and Paul LePage, of New Jersey and Maine respectively, of imposing “overzealous” quarantines and exaggerating the risks posed by asymptomatic health workers.

Read more at the Guardian.

TIME ebola

Nebraska Hospital Says Surgeon From Sierra Leone Dies of Ebola

An undated photo shows Dr. Martin Salia at United Methodist Kissy Hospital outside Freetown, Sierra Leone.
An undated photo shows Dr. Martin Salia at United Methodist Kissy Hospital outside Freetown, Sierra Leone. Mike DuBose—United Methodist News Service/EPA

Dr. Martin Salia had arrived for treatment on Saturday

(OMAHA, Neb.) — A surgeon who contracted Ebola in his native Sierra Leone died Monday while being treated in a biocontainment unit at a Nebraska hospital, the facility said.

Nebraska Medical Center said in a news release that Dr. Martin Salia died as a result of the disease. Hospital spokesman Taylor Wilson said Salia died shortly after 4 a.m. Monday.

“Dr. Salia was extremely critical when he arrived here, and unfortunately, despite our best efforts, we weren’t able to save him,” said Dr. Phil Smith, medical director of the biocontainment unit.

Salia arrived Saturday to be treated at the Omaha hospital, where two other Ebola patients have been successfully treated.

Salia had advanced symptoms when he arrived at the hospital Saturday, which included kidney and respiratory failure, the hospital said. He was placed on dialysis, a ventilator and given several medications to support his organ systems.

“We used every possible treatment available to give Dr. Salia every possible opportunity for survival,” Smith said. “As we have learned, early treatment with these patients is essential. In Dr. Salia’s case, his disease was already extremely advanced by the time he came here for treatment.”

Salia’s wife, Isatu Salia, said Monday that she and her family were grateful for the efforts made by her husband’s medical team.

“We are so appreciate of the opportunity for my husband to be treated here and believe he was in the best place possible,” Salia said.

Ebola has killed more than 5,000 people in West Africa, mostly in Liberia, Guinea and Sierra Leone. Five other doctors in Sierra Leone have contracted Ebola, and all have died.

The 44-year-old Salia had been working as a general surgeon at Kissy United Methodist Hospital in the Sierra Leone capital of Freetown. It’s not clear whether he was involved in the care of Ebola patients. Kissy is not an Ebola treatment unit, but Salia worked in at least three other facilities, United Methodist News said, citing health ministry sources.

Salia, a Sierra Leone citizen who lived in Maryland, first showed Ebola symptoms on Nov. 6 but tested negative for the virus. He eventually tested positive on Nov. 10.

Isatu Salia said in a telephone interview over the weekend that when she spoke to her husband early Friday his voice sounded weak and shaky. But he told her “I love you” in a steady voice, she said.

They prayed together, she said, calling her husband “my everything.”

TIME ebola

Meet America’s Top Ebola Doctor

Dr. Bruce Ribner.
Dr. Bruce Ribner. Spencer Lowell for TIME

Emory's Dr. Bruce Ribner may be the only man in America who was truly prepared for Ebola

It was 2:30 in the morning on Oct. 15 when Dr. Bruce Ribner received a call from Texas Presbyterian Hospital in Dallas, asking if he could treat their nurse, Amber Vinson, for Ebola.

Ribner, medical director of Emory University Hospital’s serious communicable disease unit in Atlanta, was already spending hours a day on the phone with staffers at the Dallas hospital, remotely guiding them through their first case of Ebola, Thomas Eric Duncan. But in mid-October, Presbyterian doctors learned they now had two Ebola-positive nurses, and dozens of their staff were quarantined. They needed the doctor with a strong track record to take over.

Two weeks later, Vinson walked out of Emory’s state-of-the-art isolation unit. That put the hospital at four-for-four in Ebola-patient survival; Dr. Kent Brantly, medical aide Nancy Writebol, and another unnamed patient also survived Ebola after treatment at Emory. It helps that he and his team were ready. Indeed, having an Ebola patient in the United States was a scenario Ribner says he predicted more than 10 years ago.

“We’ve learned that we were right,” Ribner tells TIME. “You need to do an enormous amount of preparation.”

“Enormous” in this case is not an overstatement. Ribner’s staff of seven physicians were specially selected for their infectious disease expertise, their personal skills and their meticulous attention to detail. Many doctors have been turned away from the center for failing to master their protective gear. The unit was built 12 years ago in collaboration with the Centers for Disease Control and Prevention (CDC), which is headquartered down the street, as a place to treat the agency’s health care workers should they come down with something unfamiliar or highly contagious or both. It was an idea Ribner had had for a long time, suggesting it to his other bosses through the years. Emory was the first to go for it.

So they built the CDC-funded 622 sq. foot isolation unit with room for two patients, with amenities like special ventilation to keep air pressure lower inside patients’ rooms so it can’t escape if a door opens, and a pressure chamber to sterilize equipment.

And then they waited.

“Over the last several years, there were people questioning whether what I was doing was really something that had value,” says Ribner, who says he felt like Noah building an Ark for a storm no one thought was coming. Though they drilled at least two times a year, the unit only received two patients prior to 2014, and both tested negative for anything serious.

“Over the last several years, there were people questioning whether what I was doing was really something that had value”“Part of me said, ‘Gee, this is frustrating that we’ve had this open all these years and spent all these resources and we haven’t really been needed,’” he says. “But while I always wondered whether or not we’d have a real patient, I always felt that there was value in having that level of insurance. I guess it ultimately turned out I was right.”

MORE: Doctors Inside Emory’s Ebola Unit Speak Out

Quality Control

When he was at Harvard Medical School, Ribner says he couldn’t imagine himself focusing on only one part of the body, like the heart or the lungs, and that’s what drew him to infectious diseases. “As an infectious disease specialist, you have to know everyone else’s specialty,” he says. He decided eventually to focus on hospital epidemiology, working to improve hospitals’ infection control and help think about—and prepare for—the unimaginable.

“He’s a hardworking guy,” says Dr. Herbert DuPont, Ribner’s former boss at the University of Texas School of Public Health. “Anyone can build a unit, but Ribner is the one who was interested in it and saw the need for it.” Hospital preparedness—and caution—are a running theme in Ribner’s career. And when he was setting up the Emory unit, he was adamant that the physicians be set up to take every possible precaution for their own safety—sometimes going above and beyond what leading infectious disease experts recommend.

When TIME first visited Emory in August, Ribner and his team refused to be photographed in their personal protective equipment (PPE) because it differed from what the CDC recommended for health workers treating Ebola. At the time, the CDC instructed hospitals to wear at least gloves, a gown, eye protection and a face mask; at Emory, they wear full tyvek suits with powered air purifying respirators (PAPRs). After the Dallas hospital had two nurses become infected with Ebola while following those protocols, the CDC adopted more conservative PPE recommendations.

“It’s been semi-satisfying to see our colleagues down the street gradually shift their guidelines to look awfully similar to what we’ve been doing,” Ribner says. “Quite frankly, we always felt that our position was the one we were the most comfortable with.” His former colleague at Emory Dr. David Kuhar, now a medical officer with the CDC’s division of healthcare quality promotion, told TIME: “I think [Ribner] is very sensible, very reasonable,” says Kuhar. “He’s a fantastic infectious disease physician.”

Ebola in the U.S.

“We knew we had a opportunity to do something that basically had not been done before,” he says of treating Brantly, the first American Ebola patient. “There were lots of people dealing with patients with Ebola, but never in an environment like this.”

Ebola is spread through contact with bodily fluids, and some patients at Emory have excreted multiple liters of feces in a single day, for multiple days at a time. “It’s an intensive environment and those people are pretty sick,” says Ribner. That’s why he repeatedly talks to his staff about their mental stamina, and has an Emory chaplain work closely with them. When a patient is in the unit, there’s someone with them 24/7.

When it comes to specifics about his patients, Ribner say this: “Our first patients were appalled when they came back to the U.S. and found out how much was known about them,” he says. “They had no idea what a media circus was going on in the U.S., and I respect my patients.” When he was treating the Ebola patients, Ribner says he would come home to his wife at midnight and she’d tell him his name and the hospital were all over the news. “When I come up for air every once in awhile, I’m reminded what a big deal this is in the U.S.”

Though Ribner says he has no intention of going to West Africa, he feels a responsibility to the people there. “I feel greatly for my colleagues in Africa. The bottom line is you can’t expect good outcomes when you’re dealing with patients that way,” he says. “In the process of getting our patients better, we are learning an enormous amount, which we hope to feed to our colleagues in West Africa so perhaps they can not have such high fatality rates.”

Ribner and his team have published every detail of their procedures online, as well as what they’ve learned clinically from treating patients. They most recently spent a couple of hours a day on the phone with the team at Bellevue Hospital in New York while they were treating Dr. Craig Spencer. But what they’ve really offered the U.S. is hope: proof that Ebola is not always fatal and the motivation to try to do more for patients abroad.

Ribner says his team is ready for more patients, and he’s surprised there haven’t been more in the U.S. already given the fact that the outbreak is still raging in West Africa. But he’s also looking to, and preparing for, the future. “Who knew Ebola virus was going to spread to the hideous outbreak that it is? Who knew MERS was going to come up? Who knew SARS was going to come up?” he says. “We really focus on an all-cause approach, because we know that whatever comes is likely going to be something we didn’t plan for.”

Says the man who’s planned for everything.

Read next: Nebraska Hospital Recalls ‘Heroic Effort’ to Save Ebola Victim Martin Salia

TIME Infectious Disease

British, Dutch Slaughter Poultry to Fight Bird Flu

(LONDON) — Chickens were being slaughtered in the Netherlands and Britain was preparing to kill ducks after two cases of bird flu were discovered in Europe — but officials insisted Monday that the risk to public health was very low.

British officials said they were investigating a case of the H5 bird flu virus in northern England, but noted it’s not the more dangerous H5N1 strain. They said all 6,000 ducks at a breeding farm in the Driffield area of East Yorkshire will be killed and a restriction zone was being set up to prevent further spread of the infection. Tests were also being carried out at nearby farms.

The UK government food agency said there is no risk to the food chain and British Chief Veterinary Officer Nigel Gibbens told BBC the risk of the disease spreading is probably quite low.

It was the first bird flu outbreak in Britain in six years, officials said. A government spokeswoman said Britain has a “strong track record of controlling and eliminating previous outbreaks of avian flu in the UK.”

The Dutch government, meanwhile, banned the transport of poultry and eggs throughout the Netherlands after finding the H5N8 strain of bird flu at a chicken farm. All 150,000 chickens at the farm in Hekendorp, 65 kilometers (40 miles) south of Amsterdam, were being slaughtered and 16 other nearby farms were being checked. It was not clear how the farm became infected.

“There is a small risk that it can be transmitted from animal to humans but there has to be intensive contact. Those at risk are really only the farmer, his family and the workers slaughtering the animals. They are being monitored by health authorities,” said Harald Wychgel, a spokesman for the Dutch National Institute for Public Health and the Environment.

TIME ebola

Ebola Among Top 3 Health Concerns for Americans: Study

A protester dressed in protective equipment demonstrates in Brisbane
A protester dressed in protective equipment demonstrates, calling for for G20 leaders to address the Ebola issue, near the G20 leaders summit venue in Brisbane Nov. 15, 2014 Jason Reed—Reuters

Health care costs and access came in first and second places

The U.S. may only have seen four cases of Ebola, but the virus is still one of the top three health worries for Americans, according to a new poll.

The disease was mentioned by 17% of adults surveyed by Gallup’s annual Health and Health Care survey as their principle medical concern, coming after only health care cost (19%) and access (18%).

The cost of health care in particular has been prominent on the list for over a decade and is likely to remain so, says Gallup. Next came obesity and cancer, which were both cited by 10% of respondents as the nation’s “most urgent health problem.”

The Gallup poll was based on 828 telephone interviews conducted Nov. 6-9 with Americans aged 18 and older living in all 50 U.S. states and the District of Columbia.

TIME ebola

Passengers Arriving in the U.S. From Mali Will Now Be Screened for Ebola

Coast Guard Corpsman checks the temperature of a traveler at Washington Dulles International Airport
A U.S. Coast Guard Corpsman working with the Office of Field Operations checks the temperature of a traveler who has recently traveled to either Guinea, Sierra Leone or Liberia in this handout picture from the U.S. Customs and Border Protection taken at Washington Dulles International Airport on Oct. 16, 2014 Handout—Reuters

Travelers will also have to monitor their temperatures and any potential symptoms for 21 days

From Monday, airports around the U.S. will begin to screen and monitor for Ebola passengers flying into the States from the West African country of Mali.

The Department for Homeland Security (DHS) says although there are no direct flights from Mali to the U.S., around 15 to 20 travelers each day transit through other countries to reach America, NBC reports.

“The CDC [Centers for Disease Control and Prevention] recommended this measure because there have been a number of confirmed cases of Ebola in Mali in recent days, and a large number of individuals may have been exposed to those cases,” the DHS said in a statement.

Travelers flying from Mali will also have to monitor their temperatures and any potential symptoms for 21 days after they arrive.

The U.S. already carries out these protocols on passengers flying from Ebola-hit Liberia, Guinea and Sierra Leone.


TIME Research

Here’s How Many Bacteria Spread Through One Kiss

lips kiss
Getty Images

Pucker up, ladies and germs

First base is a great place to get your mouth microbes some new friends, finds a new study in the journal Microbiome. A ten-second French kiss can spread 80 million bacteria between mouths.

Study author Remco Kort, a professor and scientist at Netherlands Organisation for Applied Scientific Research (TNO), asked couples visiting a zoo in the Netherlands if they wanted to participate in a study on French kissing. 21 couples agreed and had their tongues swabbed and saliva collected, both before and after a kiss.

Researchers discovered that the bacteria on the tongues of couples was much more similar than the oral bacteria of two strangers. “Apparently, being with somebody for an extended amount of time and having a relationship leads to a similar collection of bacteria on the tongue,” Kort says.

In order to find out just how similar the shared bacteria were, one person in the couple was instructed to sip a probiotic yogurt drink, wait a bit and kiss their partner a second time. The probiotic bacteria, which aren’t usually found in the mouth, indeed transferred: along with about 80 million other bacteria. Through questionnaires, the team found that the more often a couple kisses, the more bacteria they seem to share.

“There are a number of studies that show if the diversity in bacteria increases—more different types of species—this is a good thing,” Kort says. Kissing might also act as a form of immunization, he adds, allowing you to build up resistance from exposing yourself to more microorganisms. “If you look at it from this point of view, kissing is very healthy.” (Of course, he admits, the health boons kind of depend on who you’re kissing, and what types of oral microbial colonies they have.)

If you want to learn what kind of bacterial kisser you are, grab your partner and head to Micropia in Amsterdam, the brand-new museum of microbes—like a zoo for invisible animals, Kort says. A “Kiss-o-meter,” based on this research, will rate your make out on a scale from “dry, prudent kiss,” which transfers a meager 1,000 bacteria, to a “hot” one, spreading bacteria in the millions. You’ll even get a readout of the microorganisms you’ve exchanged.

And if you’re single? There’s never been a better scientific defense to bring back the kissing booth.

TIME Infectious Disease

CDC: 172 People on Cruise Fell Ill With Norovirus

The Crown Princess cruise ship returns to the port at Cape Canaveral, Fla. on July 18, 2006. John Raoux—AP

Over 4,100 people on board and will be met by CDC staff upon arrival in San Pedro

LOS ANGELES — The Centers for Disease Control and Prevention says that 172 people on a cruise ship arriving in California on Sunday have fallen ill with the highly contagious norovirus during a nearly monthlong trip.

The Crown Princess has more than 4,100 people on board and will be met by CDC staff upon arrival in San Pedro. CDC staff will conduct testing and evaluate the response.

Princess Cruises has “enacted our stringent disinfecting protocols” developed in consultation with the CDC and will do a deep cleaning of the ship and terminal in Los Angeles before departing Sunday night for a weeklong cruise through the Mexican Riviera, said spokeswoman Susan Lomax.

In April, 129 people on the same ship contracted norovirus during a seven-day cruise off the California coast. Lomax said that the ship went through the same stringent disinfecting process after it docked.

“As it is the cold and flu season, when the stomach flu circulates on land, we encourage all of our guests to be diligent in following the widely accepted practices of frequent hand washing with soap and water and the use of hand sanitizers,” Lomax said.

Symptoms of norovirus include vomiting, diarrhea, fever and body aches. According to the CDC, most people recover within three days.

The 28-day cruise visited Hawaii and Tahiti.

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