TIME Heart Disease

Daily Aspirin May Not Prevent Heart Attacks

Aspirin
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Taking low dose aspirin may not help people with high blood pressure, high cholesterol or diabetes to avoid a heart event

There’s a lot of evidence that taking low doses of aspirin daily can help heart attack patients avoid a second event. Aspirin’s ability to reduce inflammation and keep blood from forming vessel-blocking clots can be a life-saver. But what about the many Americans who take it daily hoping to avoid a first heart attack or stroke? The data there is more conflicting, and a large new study in JAMA published Monday suggests it may not make much of a difference.

The Food and Drug Administration recently said there was not enough evidence to support the idea that aspirin can prevent a first heart attack. So researchers in Japan decided to investigate the issue among 14,646 volunteers between the ages of 60 years and 85 years. Between 2005 and 2007, these participants, none of whom had had any heart events, but all of whom had at least one of the risk factors that could make them vulnerable, were randomly assigned to take a low-dose aspirin every day or not. They were allowed to continue taking whatever medications they were already or, or begin taking new drugs if their doctor prescribed them during the study.

Now, reporting in JAMA, scientists say that after five years, the study’s review board ended the trial when it was clear that there were no significant differences between the two groups when it came to heart attacks, strokes, other heart events or death. In that time, 58 people in the aspirin group died of heart-related causes, while 57 in the non-aspirin group did. Overall, 2.77% of those taking aspirin had a heart attack or stroke, compared to 2.96% among those not taking the drug — a difference that was not statistically significant.

MORE: A Low Daily Dose of Aspirin Can Cut Deaths From 3 Kinds of Cancer

The results add to the growing data on what role aspirin can play in preventing first heart events; previous studies showed that the over-the-counter drug was linked to anywhere between a 12% to 23% lower risk of events compared to non-aspirin use. But concerns over aspirins side effects, which include gastrointestinal bleeding, have made doctors more wary of recommending it for patients who have not yet had a heart event. Studies on aspirin in this group of otherwise healthy people are also difficult to conduct, since many people currently take multiple medications for various heart risks, including blood pressure drugs and cholesterol-lowering medications, making it difficult to determine what effect aspirin may have.

That’s why three other studies are currently investigating aspirin’s potential role in helping patients who have not yet had heart disease to avoid having heart attacks or strokes. One involves those with diabetes, another focuses on those with multiple heart-disease risk factors and the final trial concentrates on people over 70. Until those results are available, the authors say that patients should discuss with their doctors whether daily low-dose aspirin can help them to lower their risk of having a heart attack. For some, the benefits may outweigh the risks of bleeding, while for others, the side effects may not be worth the risks.

 

TIME health

Bird Flu Returns: What Past Outbreaks Can Teach Us

BRITAIN-HEALTH-BIRD-FLU
A man wearing a face mask walks through a duck breeding farm where a case of bird flu has been identified in Nafferton, in Yorkshire, England, on Nov. 17, 2014. Oli Scarff—AFP / Getty Images

As bird flu rears its head once again, take a look at TIME's past coverage of the virus

Usually the health status of chickens in the Netherlands isn’t world news. But reports that the Dutch government had culled tens of thousands of birds at poultry farms that were potentially infected with the avian flu virus H5N8 will worry human health officials as well.

That’s because avian flus have shown the repeated ability to jump the species barrier, infecting human beings—and killing them. The most dangerous virus has been H5N1, which has infected hundreds of human beings over the past decade, mostly in Asia, killing an estimated 60% of them. Bird flu infections in human beings are still very rare, usually occurring because of close contact with a sick birds. Right now avian flus like H5N1 haven’t shown the ability to spread from person to person. But scientists fear that an avian flu virus could eventually mutate, and become more transmissible—potentially starting a new flu pandemic. And if that new flu was as transmissible as the seasonal human flu, but as deadly as H5N1 would be, the result would make Ebola look like a slight cold.

Learn about the potential dangers of avian flu with these stories from TIME’s archives:

Feb. 9, 2004: The Revenge of the Birds

An H5N1 outbreak in Asia kills thousands of chickens — and leads millions more to be slaughtered. Though the number of humans affected is low, the outbreak raises fears about what could happen if the virus mutated.

The virus probably originates in southern China, but no one knows how it has spread so widely. Transport of infected birds to chicken farms is one theory, but it’s also possible that migratory birds such as ducks and geese are spreading it through their droppings. “Did birds in Hong Kong, which nest in Siberia and North Korea, somehow spread the virus elsewhere?” asks Robert Webster, an expert in animal influenzas at St. Jude Children’s Research Hospital in Memphis, Tenn. “That’s a frightening possibility.” If H5N1 does evolve into a flu that humans can spread, a vaccine could be developed but would take months. “Once you know this virus can spread from human to human, region to region,” says Dr. Yi Guan, a SARS and avian-flu expert at the University of Hong Kong, “it’s already too late.”

Sept. 19, 2005: A Wing and a Prayer

The H5N1 virus, previously thought present in domestic animals only, appears in migratory birds, indicating that it has to potential to spread around the world.

For some time, health experts have warned of a worldwide bird-flu pandemic that could kill millions of people and wreck the global economy. “The most serious known health threat facing the world is avian flu,” said WHO director-general Lee Jong-wook earlier this year. And the threat is growing all the time, as nature keeps dropping hints that the links in a chain of events leading to a deadly pandemic continue to be forged. This summer, H5N1 spread west—perhaps in migrating birds—to new territory, including Mongolia, Tibet, Siberia and Kazakhstan. European countries are taking precautions by tightening surveillance of flocks within their borders; in the Netherlands, officials in late August ordered farmers to move the nation’s 90 million poultry indoors to prevent any contact with itinerant fowl. Meanwhile, in Southeast Asia, where at least 58 people have died and 150 million poultry have died or been culled because of avian flu since the end of 2003, the virus is still active; a Jakarta woman died of the disease on Sept. 10. The H5N1 virus has already shown it can be deadly to people who come into direct contact with infected birds or eat uncooked poultry. But bird-to-human transmission is relatively controllable because diseased flocks can be isolated or, usually, eliminated. The sum of all fears is that H5N1 could mutate into a strain with the ability to jump easily from person to person, as ordinary flu does. That could trigger a once-in-a-century catastrophe. How many would die? Nobody knows, or can know.

June 14, 2007: Living Cheek to Beak

A trip to Indonesia reveals some reasons why it’s harder than you might expect to contain the virus in birds: understanding of the potential for pandemic is low among village farmers, and the habits of daily life are harder to break. But, because of the close relationship between humans and livestock, the stakes in such a situation are particularly high.

Indonesia’s chickens are about meat and eggs, of course. But they are also a potentially deadly symbol of changing patterns of food production and consumption. While the H5N1 strain of avian flu has occasionally jumped from birds to people for several years now, the fear is that it will mutate and begin spreading easily from person to person, threatening the lives of millions. So a pandemic is why the world cares about dead chickens in a tiny rural village. Though the rare human bird-flu cases have gotten most of the attention, “the most effective way to prevent a pandemic is to stop the virus in animals,” says Dr. Bernard Vallat, director general of the World Organization for Animal Health (OIE). In other words: save the chickens, save the world.

May 18, 2009: How to Prepare for a Pandemic

An outbreak of swine flu (H1N1) highlights the reason why epidemiologists need to spend their time thinking about animals other than human beings. Many dangerous diseases (including Ebola) originate from animals and mutate into viruses that can be spread among humans.

Why should we spend scarce medical resources swabbing the inside of pigs’ nostrils, looking for viruses? Because new pathogens–including H5N1 bird flu, SARS, even HIV–incubated in animal populations before eventually crossing over to human beings. In the ecology of influenza, pigs are particularly key. They can be infected with avian, swine and human flu viruses, making them virological blenders. While it’s still not clear exactly where the H1N1 virus originated or when it first infected humans, if we had half as clear a picture of the flu viruses circulating in pigs and other animals as we do of human flu viruses, we might have seen H1N1 coming. (When it comes to sniffing out new pathogens, says one epidemiologist, “we’re like a drunk looking for his keys.”) Faster genetic sequencing and the Internet give us the technological means to create an early-warning system. But we need to spend more on animal health and get doctors talking to their veterinarian counterparts. “For too long, the animal side of public health has been neglected,” says Dr. William Karesh, vice president of the Wildlife Conservation Society’s global-health program.

Read more about the current outbreak of bird flu here on Time.com.

TIME Research

Your State Bird Could Be Gone By 2080

birds
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If our climate continues to change, many birds will lose significant portions of their habitat

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By 2080, the skies over North America could be much emptier. A new report from the National Audubon Society, compiled from data collected over 30 years of bird counts and surveys, shows that more than half of North America’s most iconic birds are in serious danger. Of the 588 bird species surveyed, 314 are at risk for losing significant amounts of their habitat to a changing climate.

“Birds are a good barometer of the overall health and wellbeing of the natural systems we depend on for food, water, and clear air,” Audubon chief scientist Gary Langham wrote in an email. “If half the birds are at risk, the natural systems we depend upon are at risk too.”

Ken Rosenberg, a conservation scientist at Cornell University’s Lab of Ornithology, cautions that it can be hard to tie any one specific effect on bird populations directly to climate change—other factors like human development, pollution, and invasive species play big roles. However, both Rosenberg and Langham point to clear examples of climate change affecting the avian landscape. Many birds are shifting their ranges farther north; some migratory species are arriving in the northern areas and the endpoints of their spring migrations earlier and earlier. Higher tides and storm surges are wreaking havoc on the nesting grounds of birds like the Saltmarsh Sparrow and the albatross. And foraging birds that live in Arctic sea ice environments are in decline.

“Some land birds, like the Broad-tailed Hummingbird, are finding that the availability of food supplies no longer matches their migration cycles,” Langham says. “And some seabirds, like Atlantic Puffins, are starting to run out of food as ocean temperatures change, causing adults and young to starve.”

If our climate continues to change, many birds will lose significant portions of their habitat, especially those birds that live in marshes and beaches, low-lying islands and snowy mountaintops. Tropical forests could dry out, spoiling the wintering spots for migratory birds. Drought and fire could devastate the habitats of prairie birds like the sage grouse. Even tiny differences in temperature can have big impacts. The gray jay, for example, hoards perishable food to get it through the winter, relying on freezing temperatures to keep it from spoiling, but a warmer climate will short-circuit its natural refrigerator.

“Every bird species has a ‘tolerance zone’ for climate conditions,” Langham says. “If the climate gets too hot, too cold, too wet or too dry, birds will be forced to leave their homes—but many will have nowhere else to go.”

These climate trends are set to impact birds big and small. By 2080, Audubon’s model predicts the summer range for bald eagles will shrink to 26 percent of the current extent. New areas could open up for them as areas get warmer, but it isn’t certain that food and nesting areas will be available to them in the new spots. Allen’s hummingbird could lose up to 90 percent of its summer range. The spotted owl, already a poster child for endangered birds, is expected to lose 98 percent of its wintering grounds. 10 states could lose their state birds—Maryland’s Baltimore Oriole, Vermont’s Hermit Thrush and the Mountain Bluebird (claimed by both Idaho and Nevada) are all among the imperiled.

But don’t count nature out of the game just yet. “A big ‘wild card’ is the ability of the birds themselves to adapt in ways we can’t predict,” Rosenberg told us. “For example, some Laysan Albatrosses have begun to nest in suburban yards and rooftops in Hawaii, as their usual nesting areas become more threatened.”

Rosenberg is also concerned about how humanity’s response to climate change will affect birds. In many areas, he says, sea walls are being built to protect coastal areas without taking into account how they will affect the ecosystem around them. The flow of water, nourishment of marches, and shaping of seaside habitats could all be negatively impacted by hastily built walls. And the rush to create alternative sources of energy has to be done in a smart way, he says. “Paving over fragile desert ecosystems for solar-panel fields, or placing wind farms in critical migration corridors and bottlenecks, or destroying natural habitats around the world to plant biofuels such as corn for ethanol, are NOT smart alternatives” to fossil fuels, Rosenberg says. “We will just be creating new environmental problems in an attempt to solve another.”

Langham urges bird lovers concerned about climate change to speak up.

“We can’t afford to sit quietly on the sidelines while a well-funded oil lobby gets a small number of people to intimidate the rest of us,” he says. “Decide what you want to say to your child or grandchild in 20 years. The day will come when that generation asks: What did you do to leave a better world when the science was clear? I think about my answer a lot and it motivates me to act boldly.”

This article originally appeared on World Science Festival.

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.

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