TIME Infectious Disease

1 Million People Have a Disease You’ve Never Heard Of

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Photo Researchers—Getty Images/Photo Researchers RM

Chikungunya virus has infected over one million people this year, but Big Pharma still isn't stepping up

It’s a tale scientists are tired of telling: a disease that’s been carefully watched and studied for years is suddenly infecting an unprecedented number of people while promising drugs and vaccines sit on shelved, unfunded.

This time it’s not Ebola but a mosquito-borne disease called chikungunya, which causes debilitating joint pain and has infected more than 1 million people just this year. Originating in Africa, the virus has rapidly spread into the Caribbean and Central and South Americas, with a smattering of cases in the United States. Chikungunya is nothing like Ebola, but scientists who study it find themselves in a predicament similar to Ebola researchers: Despite decades of study, there’s still no way to treat or prevent it, due in part to a lack of interest from drug companies.

“[Chikungunya] is another example of an emerging infectious disease that we clearly have a light at the end of the tunnel for in a vaccine, and it’s pharmaceutical interest that really seems to be the road block,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who is trying to get support for a chikungunya vaccine his team developed. “It’s the big dilemma. The frustration. Back when Ebola was not on the front pages, we didn’t have very many enthusiastic pharmaceutical companies.”

MORE: TIME Person of the Year: The Ebola Fighters

In late 2013, chikungunya hit the west for the first time, in St. Martin. Now, in Puerto Rico alone, there were 10,201 reported cases from May to August 2014. In prior years, the Centers for Disease Control and Prevention (CDC) would only see an average of about 28 cases of chikungunya in the United States brought by travelers who had visited affected countries, primarily in Asia. But so far in 2014, there’s been over 1,900 recorded cases stateside.

Often, chikungunya is compared to dengue fever, but while chikungunya is not often fatal, up to 80% of people infected will show symptoms, which can be excruciating, says Dr. Pilar Ramon-Pardo, a PAHO/World Health Organization adviser in clinical management. “People cannot move because it’s so painful. There are tears in their eyes,” she says. “Sometimes there’s not an appreciation for chikungunya because it has a low fatality rate, but it’s a real public health problem. The economic impact from disability is high.”

Chikungunya was first identified in 1952 in Tanzania, and the more recent outbreaks started emerging in 2003 in East Africa, then spread into Southeast Asia, the Pacific Islands, and eventually to India, where millions of people were infected in 2006. In 2007, it touched down in Italy, at which point the CDC with the Pan American Health Organization (PAHO) doubled down to ensure countries were equipped to keep an eye on—and diagnose—the disease.

“We are very concerned about chikungunya moving into the Western Hemisphere,” says Dr. Roger Nasci of the CDC. “We have the two different species of mosquitoes in the U.S. capable of spreading the virus.” Massive outbreaks in the United States are unlikely; the temperate U.S. climate isn’t especially mosquito friendly, and widespread use of window screens and bug spray limit most Americans’ risk. Still, the disease takes a toll, and other countries are at risk of even more massive outbreaks.

Researchers at the National Institutes of Health (NIH) recently published results from a successful vaccine trial for chikungunya showing it’s safe but in order to take that vaccine to the masses, it needs to undergo an efficacy trial—and then it needs a distributor. Without a pharmaceutical partner, Fauci says a timeline for a chikungunya vaccine is “impossible to predict,” though the NIH is currently meeting with two undisclosed companies for possible partnerships.

A frequent source of funding for neglected infectious diseases, the Bill & Melinda Gates Foundation, does not have any active grants or investment in chikungunya. Meanwhile, for Fauci, getting backing for chikunhunya is a “here we go again” task of trying to churn up interest in a disease that doesn’t make headlines. “It’s a theme that continues to recur among my colleagues and I,” says Fauci.

Read next: The Unexpected Animal Group Dying from Climate Change

TIME Diet/Nutrition

Why Raw Milk Outbreaks Are On the Rise

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This is one health trend you don't want to try

Raw milk skips the commercial chain of pasteurization and homogenization, and many proponents drink to the promise of a purer, less processed food. But the Centers for Disease Control and Prevention (CDC) has long warned that the consumption of raw milk, which poses serious risks to Americans’ health, is nothing more than a misguided health trend. Now, a new report from the agency shows that the yearly number of outbreaks from raw milk is increasing.

Nearly 1,000 people were sickened from raw milk outbreaks from 2007-2012, the report says, and 73 went to the hospital. The new study shows there were an average of 13 outbreaks per year from disease-causing bacteria that can be present in unpasteurized milk between the years 2007-2012, with 81 total outbreaks in 26 states.

That rate has quadrupled since 1993-2006, the data set used when CDC last studied the subject. That time period saw only three outbreaks per year.

Some advocates have argued raw milk is a solution for people who are lactose intolerant, but the CDC and U.S. Food and Drug Administration (FDA) says this is untrue.

“I think there are a lot of people [who are part of] this back-to-nature movement, wanting to support local farms and eat organically. I think the raw milk movement has emerged as part of that,” says CDC epidemiologist Hannah Gould. But because it’s not pasteurized, raw milk can be dangerous. Bacteria like salmonella, E. coli and Campylobacter can all be found in raw milk, and you’d have to heat it to 161 °F for about 20 seconds to kill it off, says the CDC. One of the CDC’s awareness campaign shows a raw milk horror story from a mother who fed it to her son, than saw him go into kidney failure and be placed on a ventilator.

In 1987, the FDA banned interstate sale or distribution of unpasteurized milk, but states set their own laws when it comes to what can be sold in-state. Currently, 30 states allow the legal sale of raw milk, and since 2004, eight new states have allowed the sale. The new data shows more than 80% of the outbreaks tallied in the new report occurred in states where selling raw milk is allowed.

“As states continue to legalize raw milk, I would expect it’s likely we will see more outbreaks and illnesses associated with it,” says Gould. “When we see something happening like this huge increase in the number of outbreaks caused by raw milk, we try to put out the message that this going on, and provide that information to state legislators trying to make decisions about raw milk as well as alert consumers to the risks.”

Read next: Now Coming to Your Morning Cereal Bowl: Quinoa

TIME ebola

How Effective Is Screening for Ebola at Airports?

New York's JFK Airport Begins Screening Passengers For Ebola Virus
A plane arrives at New York's John F. Kennedy Airport (JFK) airport on October 11, 2014 in New York City. Spencer Platt—Getty Images

Since August, 80,000 passengers have been screened for Ebola at various airports around the world. Here’s what health officials found

As the Ebola outbreak in West Africa escalated over the summer, the World Health Organization recommended airport screening as a way to contain spread of the disease. WHO advised that all people leaving the most severely affected countries—Guinea, Liberia and Sierra Leone—should have their temperatures taken and be asked about any Ebola-related symptoms they might have, including fever, headaches, vomiting and diarrhea.

Since the program began in August, more than 80,000 passengers have been screened as they left these countries, 12,000 of them headed for the U.S. Do the screenings work? In a report published in the MMWR, officials at the U.S. Centers for Disease Control reveal the latest information from the program.

Anyone with a fever or other symptoms—or who reported having a high risk of being exposed to Ebola, such as having contact with Ebola patients—was not allowed to fly. According to the CDC report, none of those who were denied boarding were diagnosed with Ebola. But two patients without symptoms when they left West Africa, Thomas Eric Duncan and Dr. Craig Spencer, eventually developed Ebola after arriving in the U.S.

The MMWR report also details the U.S.’s more stringent airport entry screening for all passengers arriving from the three affected countries. Beginning Oct. 11, all passengers coming to the U.S. from these countries were required to fly into one of five airports: John F. Kennedy International Airport in New York, Newark Liberty International Airport in New Jersey, Washington-Dulles International Airport, Chicago O’Hare International Airport or Hartsfield-Jackson Atlanta International Airport. They are also required to take their temperatures for 21 days, the incubation period for the Ebola virus, and report them to local health officials. The designated airports are equipped with trained public health personnel who meet passengers and provide them with a kit to help them record their temperatures, as well as educate them about who to call if they develop symptoms.

From Oct. 11 to Nov. 10, 1, 993 passengers were screened this way, and 4.3% were referred to the CDC for additional evaluation. Seven people had symptoms and were referred to proper medical personnel, but none developed Ebola. “Using these processes to educate each traveler and then link the traveler to public health authorities for the duration of the incubation period is of critical importance to facilitate rapid detection of illness and implementation of appropriate public health control measures,” the authors write.

But the most effective way to prevent the epidemic from spreading is to control it at its source. In a separate MMWR report, researchers at the CDC say that their first assessment of Ebola infection and control in Sierra Leone reveals many gaps. In a review of six of the 14 districts in Sierra Leone that are affected by Ebola, the CDC Ebola Response Team found that none had a dedicated infection control supervisor to oversee training and implementation of infection control procedures, such as wearing protective equipment and isolating patients. There were also no national, district or facility standards for infection control, and screening of patients for Ebola was inadequate. All districts also lacked sufficient personal protective equipment, the gear that is critical for protecting health care workers treating Ebola patients, and many did not have running water, enough chlorine bleach to sanitize contaminated objects, or incinerators for burning disposable medical waste.

“An increasingly coordinated and comprehensive [infection and prevention control] program with district and health facility level support is urgently needed to prevent Ebola in districts where the prevalence is low and to strengthen the existing…response in areas with high prevalence of Ebola,” the CDC officials write.

TIME Parenting

U.S. Birthrate Declines as American Women Wait

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In troubling sign for economy

U.S. birth rates hit a record low in 2013, federal researchers said Thursday, down 9% from a high in 2007.

The “baby bust,” revealed in a report from Centers for Disease Control and Prevention, indicates that women are delaying having children until later in life. The declines were among women under 30, while the rates for women over 35 actually went up. Childbearing among older women has risen over the last three decades, according to the CDC, with rates for women 35 and older at the highest levels in roughly 50 years.

The decline in childbirths is not good news for the U.S. economy. Years of declining populations rates have created economic crises in Europe and Japan, as labor forces contract, the tax base shrinks, and the population gets older.

The good news? Birth rates did fall 10% among teenagers.

TIME medicine

That Flu Shot You Had May Not Work This Year

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David Cheskin—PA Wire/AP

You should still get vaccinated

The Centers of Disease Control and Prevention (CDC) have warned doctors that flu vaccines may not be effective against the most common strain of flu circulating in the U.S..

According to Reuters, the U.S. health agency issued an advisory to doctors Wednesday saying that of the flu samples they had taken between October 1 and November 22, less than half were good matches for the current flu shots.

The flu shots will still protect against certain strains of the flu, and can help reduce the risk of complications even among the strains that have mutated.

[Reuters]

 

TIME ebola

WATCH: Emotional Videos of Idris Elba and Soccer Players On Ebola

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"Our fans treat us like heroes, but I am no hero"

As part of a new Ebola campaign, the nonprofit arm of the CDC—the Centers for Disease Control Foundation—as well as soccer stars, celebrities and international health organizations created moving PSAs about Ebola to spread through West Africa.

The first video, “We’ve Got Your Back,” made by the newly formed Ebola education group Africa United, features well-known soccer players, many from or playing for African countries. “Our fans treat us like heroes, but I am no hero,” says Yaya Touré who plays for Manchester City. He’s followed by several other soccer players like Patrick Viera and Kei Kamara, all acknowledging they are not heroes. “The health workers fighting Ebola are the real heroes,” the video says, highlighting several West Africans fighting the Ebola virus. The players wear the health care workers’ names on the back of their jerseys, in hopes of spreading awareness that health care workers are heroes and should be treated as such.

Actor Idris Elba, perhaps best known for playing Stringer Bell on The Wire, stars in the second video, where he gives a rallying speech about Ebola to a locker room of soccer players. “For me the battle against Ebola is a personal one. To see those amazing countries in West Africa where my father grew up and my parents married being ravaged by this disease is painful and horrific,” said Elba in a statement.

The campaign is using #wevegotyourback to show support for the people fighting the disease.

TIME ebola

Here Are The 35 U.S. Hospitals Approved To Treat Ebola

Emory University Hospital in Atlanta, seen in august 2014.
Emory University Hospital in Atlanta, seen in August 2014. Jessica McGowan—Getty Images

These treatment centers are specially equipped to care for Ebola patients

The Centers for Disease Control (CDC) has designated 35 hospitals across the U.S. as Ebola treatment centers: facilities that will take in Ebola patients from wherever they first present and provide the more intensive care in isolation wards that the cases require.

The hospitals were evaluated by the CDC’s Rapid Ebola Preparedness team, and staff were trained in infection control, use of personal protective equipment and removal of waste from patient rooms. The CDC reviewed 50 hospitals in 15 states.

About 80% of people entering the U.S. from the affected West African countries live within 200 miles of one of the centers, according to the agency. Every person returning from these regions is required to take their temperature daily for 21 days, the incubation period for the virus. More than 3,000 travelers have been monitored by the CDC and state health departments since the program was implemented in November.

More Ebola treatment centers may be added in coming weeks, but for now, here is a list of the approved facilities:

  • Kaiser Oakland Medical Center; Oakland, California
  • Kaiser South Sacramento Medical Center; Sacramento, California
  • University of California Davis Medical Center; Sacramento, California
  • University of California San Francisco Medical Center; San Francisco, California
  • Emory University Hospital; Atlanta, Georgia
  • Ann & Robert H. Lurie Children’s Hospital of Chicago; Chicago, Illinois
  • Northwestern Memorial Hospital; Chicago, Illinois
  • Rush University Medical Center; Chicago, Illinois
  • University of Chicago Medical Center; Chicago, Illinois
  • Johns Hopkins Hospital; Baltimore, Maryland
  • University of Maryland Medical Center; Baltimore, Maryland
  • National Institutes of Health Clinical Center; Bethesda, Maryland
  • Allina Health’s Unity Hospital; Fridley, Minnesota
  • Children’s Hospitals and Clinics of Minnesota; St. Paul, Minnesota
  • Mayo Clinic Hospital; Minneapolis, Minnesota
  • University of Minnesota Medical Center, West Bank Campus, Minneapolis;Rochester, Minnesota
  • Nebraska Medicine; Omaha, Nebraska
  • North Shore System LIJ/Glen Cove Hospital; Glen Cove, New York
  • Montefiore Health System; New York City, New York
  • New York-Presbyterian/Allen Hospital; New York City, New York
  • NYC Health and Hospitals Corporation/HHC Bellevue Hospital Center; New York City, New York
  • Robert Wood Johnson University Hospital; New Brunswick, New Jersey
  • The Mount Sinai Hospital; New York City, New York
  • Children’s Hospital of Philadelphia; Philadelphia, Pennsylvania
  • Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania
  • University of Texas Medical Branch at Galveston; Galveston, Texas
  • Methodist Hospital System in collaboration with Parkland Hospital System and the University of Texas Southwestern Medical Center; Richardson, Texas
  • University of Virginia Medical Center; Charlottesville, Virginia
  • Virginia Commonwealth University Medical Center; Richmond, Virginia
  • Children’s Hospital of Wisconsin, Milwaukee; Milwaukee, Wisconsin
  • Froedtert & the Medical College of Wisconsin—Froedtert Hospital, Milwaukee; Milwaukee, Wisconsin
  • UW Health—University of Wisconsin Hospital, Madison, and the American Family Children’s Hospital, Madison; Madison, Wisconsin
  • MedStar Washington Hospital Center; Washington, DC
  • Children’s National Medical Center; Washington DC
  • George Washington University Hospital; Washington DC
TIME Addiction

Drug-Overdose Deaths Have More Than Doubled in the U.S.

Opioids and heroin are two of the greatest offenders

Drug overdose deaths more than doubled from 1999 to 2012, according to a new CDC National Center for Health Statistics’s report.

The new data shows drug overdose deaths from drugs like painkillers and heroin have risen from 6.1 per 100,000 population in 1999 to 13.1 in 2012. Drug overdose deaths involving heroin in particular have nearly tripled over the time period.

According to the report, in 2012 alone, there were 41,502 drug overdose deaths, of which 16,007 involved opioid analgesics and 5,925 involved heroin.

It’s no question America has a painkiller problem. An earlier CDC report from July revealed that 46 people die from an overdose of prescription painkillers every day. The data also showed that doctors in the U.S. wrote 259 million prescriptions for painkillers in 2012, which comes out to enough for every American adult to have a bottle of pills. States with overall higher rates were primarily in the south.

The city of Chicago has even gone after Big Pharma, filing a lawsuit in June 2014 arguing that pharmaceutical companies deceptively marketed opioid painkillers like Percocet and OxyContin to manage chronic pain, even though they have a low success rate come with a high addiction risk.

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CDC/NCHS, National Vital Statistics System, Mortality File

 

The CDC recommends increase use of prescription-drug-monitoring programs that use databases to track prescriptions for painkillers so that states can identify problem areas where over-prescribing is more prevalent. The agency also recommends the implementation of policies that would lower prescribing rates to risky patients.

 

TIME Cancer

U.S. Smoking Rate Hits Historic Low

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And the number of people who say they smoke every day has dropped, too

Cigarette smoking among American adults has hit at an all-time low, health officials said Wednesday.

The percentage of smokers over the age of 18 dropped from 20.9% in 2005 to 17.8% in 2013, according to a new Centers for Disease Control and Prevention (CDC) report. That’s the lowest rate of smoking adults since the CDC started tracking the numbers via its National Health Interview Survey in 1965. Over the course of eight years, the number of U.S. smokers dropped from 45.1 million to 42.1 million, the report reveals.

Still, the CDC worries too many Americans still smoke, and a Nov. 13 report from the agency showed that a high number of young people still smoke, putting millions at risk for premature death.

The good news for health officials is that people seem to be cutting back, if not quitting. The number of people who smoke every day has dropped nearly 4% from 2005 to 2013, and the proportion of smokers who smoke only some days has increased. Of course, smoking less habitually still poses tremendous danger for the health.

“Though smokers are smoking fewer cigarettes, cutting back by a few cigarettes a day rather than quitting completely does not produce significant health benefits,” said Brian King, a senior scientific adviser with the CDC’s Office on Smoking and Health, in a statement.

Cigarette smoking continues to be the leading cause of preventable death among Americans, reportedly racks up $289 billion a year in medical costs and productivity loss.

Around 70% of all cigarette smokers want to kick the habit, and if a smoker quits by the time they turn 40, they can gain almost all of the 10 years of life expectancy they lose by smoking.

Americans who want to quit smoking can call 1-800-QUIT-NOW for free counseling and resources, or visit the CDC’s antismoking tips site here.

TIME World

A CDC Epidemiologist Talks About Life on the Front Lines of the War Against Ebola

Redd, right, with local medical student Francis Abu Bayor.
Redd, right, with local medical student Francis Abu Bayor. Christina Socias—CDC

The CDC's Dr. John Redd spent weeks in Sierra Leone, combatting Ebola. He talks with TIME about the experience

Dr. John Redd, a captain in the U.S. Public Health Service, was sent in September by the Centers for Disease Control and Prevention (CDC) to Sierra Leone, one of the three West African countries most devastated by the Ebola epidemic. The 52-year-old was assigned to Makeni, the capital of the northern district of Bombali (pop. 434,000). After six weeks battling the deadly disease, Redd returned to his home in Santa Fe, N.M., where he described his experience to Time Inc. senior editorial adviser Richard B. Stolley.

 

THE ROLE OF CDC DOCTORS DEPLOYED TO FIGHT EBOLA IS NOT PATIENT CARE. WHY?

I am a medical epidemiologist, and epidemiologists control disease at a population level. I volunteered to go to Sierra Leone with CDC to help control the outbreak and support local efforts to slow it down.

 

WASN’T IT DIFFICULT FOR YOU NOT TO TREAT PATIENTS?

I was treating patients, but not one at a time. That’s public health. I was supporting the system of outbreak control so that there will ultimately be fewer patients to treat.

 

WHAT WAS YOUR GOAL?

To slow down the spread and reduce transmission, because that’s what really controls an outbreak like Ebola. It’s the public health measures that will end the outbreak, not treatment, as important as treatment is.

 

HOW DID YOU PROCEED?

First is case identification or case finding. That means helping local authorities find people in the community as early as possible who have the disease or may have it, moving them into holding centers so they are removed from their community while their labs are pending, and then sending patients who are positive to an ETU, Ebola Treatment Unit. That’s where personnel from Doctors Without Borders, the International Red Cross and other aid organizations work – the part of the Ebola system most people are familiar with.

 

WHAT WAS THE LOCAL MEDICAL INFRASTRUCTURE LIKE?

Though extremely under-resourced by American standards, there is an existing public health surveillance system, just as in the U.S., where we have systems to count cases of diseases like influenza. In Sierra Leone, it had been used for diseases other than Ebola, like malaria and typhoid fever. The country also has an existing clinical medical system, which starts with very small health stations in many villages. In my district there were more than 100 of those, leading all the way to the government hospital in Makeni.

 

WHAT WAS THE EBOLA SITUATION WHILE YOU WERE THERE?

We investigated more than 800 patients with suspected Ebola, and more than half were confirmed with the disease. There were over 100 deaths, but that is probably an underestimate. There’s a delay in reporting deaths from ETUs, and some deaths in rural areas are not reported. By the time I left, the numbers in our district had begun to decrease. But in -areas around Freetown—the capital of Sierra Leone—cases are still on the rise.

 

WHAT WAS YOUR FIRST CONTACT WITH A PERSON WITH EBOLA?

I saw my first patient the day after I arrived, through a window in a holding center in Makeni. We could not go inside. We had three holding centers with a total of 140 beds, with a physical gradation according to patient risk. In the middle of each center were confirmed patients waiting transit to an ETU in another district. They were vomiting, had diarrhea and were very weak. Anyone who treated those patients, mainly nurses from Sierra Leone, needed to be in full protective gear in spite of the heat – near 100ºF – and high humidity. Those nurses were incredibly heroic. There was another section for patients waiting for blood test results, and a third for patients being observed for 21 days after their tests turned out negative. This separation of patients, and the nursing procedures, were all designed to minimize the risk that someone who was negative could get the disease there.

 

WHEN DID YOU WITNESS YOUR FIRST EBOLA DEATH?

It was the same morning. As many as eight people were dying some days.

 

HOW DID THE SURVEILLANCE PROCESS WORK?

We had about 100 college and public health students from Sierra Leone, mostly men, some women, whose classes had been cancelled because of Ebola. For now, school isn’t happening in Sierra Leone. They were the team’s disease detectives. Every morning they would ride their motor bikes out to respond to alerts that a household member was ill or had died. They would call an ambulance to remove the body or take the patient to a holding center. We had only four ambulances, so sometimes we would have to ask patients to walk to the holding center. We had to be very practical about it. Then the surveillance officer would talk to the family about who might have come in contact with the patient. These contacts would be followed for 21 days.

 

WHERE WERE THESE FAMILIES LOCATED?

Mostly in the south of the district, around Makeni. But some were in villages in the rural north. Many did not have electricity, and most did not have running water or flush plumbing. Unfortunately these conditions are conducive to the transmission of Ebola.

 

THESE INVESTIGATORS WERE GOING HOUSE TO HOUSE AND LITERALLY KNOCKING ON DOORS?

That is correct.

 

YOU SEEM TO HAVE GOTTEN CLOSE TO THOSE YOUNG PEOPLE. HAVE YOU STAYED IN TOUCH?

Yes, especially with a med student named Francis Abu Bayor. We worked side by side over there, and we’ve been emailing since. He was the leader of the surveillance team and in charge of our database on all the patients. He was an absolute optimist. His phrase was “challenge.” He would say, “Dr. John, we have a challenge” and that could mean anything from a new Ebola outbreak in a previously unaffected neighborhood to the printer being out of paper. Everything was just a challenge to be overcome.

 

IS HE STILL THERE?

He’s waiting for medical school to reopen. On my last day there, we gave him a stethoscope, which is traditional in medicine. My parents gave me one when I graduated from med school. Getting hold of a stethoscope was pretty convoluted. I ordered it from Amazon.com and had it delivered to a doctor in Atlanta who was coming to Sierra Leone. When he arrived in Freetown, he gave it to another doctor who was staying in my hotel. Then the three of us who had worked with Francis — Brigette Gleason, Tiffany Walker and I — presented it to him. He told me he was so inspired by his connection with CDC that he was going to make his career in public health.

 

WHAT WERE OTHER OBSTACLES YOU HAD TO OVERCOME?

Fuel was a constant problem because the investigators had to travel so far. So I put in a request to the CDC Foundation for fuel money, and it was granted. One of my jobs most afternoons was to take those fuel vouchers to the gas station and fill up the vehicles that were transporting the blood samples. And sometimes I’d fill up the investigators’ motor bikes as well.

 

WAS A SICK PERSON EVER RELUCTANT TO GO TO THE HOLDING CENTER?

Sometimes, at first. I helped in a few cases. We would talk to the head of the household and to the chief of the village. And we talked to the sick person, of course. To make sure I myself was not exposed to Ebola, I never passed over the threshold of a house. I’d ask the person to come out and we would talk from a distance in the street, usually a dirt path or road. Nobody was taken against their will, and I never saw anyone refuse to go. People were quite aware of Ebola because the education they had received had been very effective.

 

HOW DID FAMILIES REACT WHEN THIS HAPPENED?

It could be tragic. In some cases, it was the last time they ever saw their loved one. They would say goodbye in the house, and because they were contacts, they would have to remain there and be monitored for Ebola. Getting information on that patient in the holding center could be very difficult, though the surveillance officers tried. If the person turned out to be positive, he or she would be taken away to a distant treatment unit, where sometimes they died. Those were some very touching situations.

 

ONCE IN THE HOLDING CENTER, WHAT HAPPENED?

Patients with possible Ebola would receive medications for malaria and typhoid fever, intravenous fluids and also oral rehydration solution, which contains water, sugar and salt. And the blood draw would go as quickly as possible. That had to be done in full protective equipment. It’s quite a heroic job for someone to be drawing blood on Ebola patients all day long. Their dedication is hard to imagine. I was there 42 days, which I found very challenging, physically, mentally and emotionally. But the local health workers have been working like that for months.

 

HOW WERE THE BLOOD SAMPLES TESTED?

They had to be driven four to five hours to a CDC run lab in a town called Bo, which would email or telephone me the results. We had more than 800 samples sent for testing while I was there, and our goal was to have no more than 48 hours between someone’s lab test and learning whether they were positive or negative. It’s below 48 hours now, which considering the logistics is a real victory.

 

THEN WHAT?

There were many days when I would go to the holding centers to deliver blood test results to the nurses and help with the disposition of patients. If positive, we would get that person to a treatment center as quickly as possible, but it was three to four hours away. We, the lab and the treatment center were all in different locations. One way to conceptualize this is to imagine someone is suspected of Ebola in Dallas, has to be taken to Fort Worth to draw blood, then the blood is driven to Wichita, Kans., and if positive, the patient is transported from Fort Worth to Little Rock, Ark., for treatment. That is based on the actual drive times in Bombali.

 

HOW WERE THE ROADS?

Mostly dirt. It was the end of the rainy season, which meant that they were often mud. The vehicle carrying the lab samples crashed twice in one week because of road conditions. One of the scariest moments for me was hearing about those two accidents. I worried that there were unsecured blood samples at the site, but they were packed in a strong puncture-resistant container, and the samples were fine and were tested normally.

 

WHAT WAS THE CDC PRESENCE IN YOUR DISTRICT?

About 60 CDC personnel were in Sierra Leone at any one time, and we had seven staying in Makeni and working in Bombali and the adjacent district, Tonkolili. Six were doctors or epidemiologists, and one was a communications specialist because a vast part of outbreak control is educating people. We all stayed in the same hotel, and often ate breakfast and dinner together. Lunch was a PowerBar at our desks. Most everybody worked until midnight or 1 a.m., but one evening we all got together to relax and watch a movie I had on my laptop —Die Hard—and some of the hotel employees watched too. It was a nice diversion. I felt extremely close to the CDC colleagues I was working with.

 

ANY CHANCE TO EXERCISE?

Four or five times a week, I got on the elliptical at the hotel for an hour at the end of the day. It didn’t plug into the wall, didn’t need electricity. So when the power went out, which happened frequently, I kept going in the dark. The other people in the gym would laugh, but exercise is very important to me, both at home and traveling. When the lights were on, I was on my BlackBerry most of the time on the elliptical. That was routine multi-tasking.

 

HOW DID YOU PROTECT YOURSELF FROM EBOLA?

The most important thing was no touching. No shaking hands, no hugging. It was a massive societal change. I’d never been to Sierra Leone before, but I’d heard that the people are affectionate and physical. It was really something to live in that reality where you never touch another person — except a couple of times when I inadvertently bumped into someone at a meeting. Also, before being posted, we were trained at CDC in Atlanta in the use of personal protective equipment which all of us carried in backpacks at all times. Fortunately I never needed to put mine on.

 

DID YOU EVER GET SICK OVER THERE?

I got mild food poisoning after a weekend trip to CDC headquarters in Freetown. At first, I didn’t know what it was, but I followed all our established procedures. I isolated myself in my hotel room for 24 hours. We had a supply of MREs [meals ready to eat] so I didn’t have to leave. I checked my temperature and reported it to my supervisor so a decision could be made as to how to handle it, depending upon the symptoms, and if needed, discussions with Atlanta. My symptoms went away quickly, and I never had a fever. It wasn’t Ebola.

 

WHAT WERE BURIALS LIKE?

Every person who died, no matter what the circumstances were, was supposed to be tested for Ebola with a cheek swab and then buried safely. The body was quickly placed in a body bag, which was sprayed with chlorine by a protected burial team. Then it was taken to a new and separate communal cemetery especially set aside for this purpose. To the burial teams’ great credit, they were extremely respectful. Families could not say goodbye at a funeral and could not be at the burial, but could wait nearby. And after the ground was also sprayed with disinfectant, loved ones could leave small memorials and markers there. Seeing that cemetery was one of the most moving experiences of my entire life.

 

THESE WERE HIGHLY EMOTIONAL MOMENTS. DID YOU EVER FIND YOURSELF IN TEARS?

I did cry a couple of times, but only in the evenings at the hotel, not in public. I think most of the CDC workers cried at one time or another. All of the CDC people supported one another a great deal, because everyone realized how stressful it was. So I never felt alone. I felt emotional very frequently, and tears were close, but the days were so busy and long that I was able for the most part to keep my attention on the matters at hand.

 

DID YOU FINALLY GET ACCUSTOMED TO THE DANGER?

I never felt personally threatened, but of course my risk was not zero. To keep it at zero, I would have had to stay home. We were all accepting some level of risk. But it was more the constant psychological cost of having to worry about it, of never touching people, maintaining distance, having to stay disconnected from potential patients. It was like a blanket over all our activities. On a human level, it was very difficult, many hours a day, seven days a week, and it was frequently very sad.

 

WHAT WAS THE FEELING ABOUT AMERICANS THERE?

I didn’t feel a negative vibe even once. People said thank you routinely. It was really touching. When I spoke to the young men and women we were working with, I would emphasize that we were brothers and sisters in the fight against Ebola. We were all on the same team. I think that’s the way everyone felt.

 

HOW DID YOUR OWN FAMILY FEEL ABOUT YOUR ASSIGNMENT?

They were very supportive. My wife, Bernie, actually encouraged me to go to Sierra Leone. She is a physician herself and understood both the gravity of the situation and the contribution I could make to it. Most deployments are for 29 days, and when the CDC asked me to stay longer, she said it sounded like a good idea. We kept in touch mostly by email, but I bought a local phone card and we talked a couple times each week. The connection wasn’t bad. I was able to see my daughters at college on Skype from time to time. It helped that they didn’t seem worried. When we talked or e-mailed, I tended to emphasize the positive aspects of what we were doing and minimized the sad things I’d seen.

 

NOW THAT YOU’RE BACK HOME, ARE YOU IN QUARANTINE?

Technically, I was not. I was in a category that’s called low risk, but not zero risk for 21 days. I had to report on my temperatures twice a day to both the state of New Mexico and CDC. I wasn’t supposed to go to work, but Sandia National Laboratories was very supportive and understanding. I am detailed there by CDC as an epidemiologist on their International Biological Threat Reduction team. I could leave home briefly to buy food or something like that, but my wife was happy to take care of those things. I was told to report any illness or symptoms immediately. It ended November 19, and I’m fine.

 

WHAT DID YOU LEARN IN SIERRA LEONE?

As a physician, I learned how quickly someone can get terribly sick from Ebola and die. As a medical epidemiologist, I saw that the public health efforts to which CDC is contributing are going to be what eventually ends this outbreak. As a human being, I learned how hard working, brave and heroic my Sierra Leonean colleagues were. At no time did I feel that what I was doing was futile. Ultimately, what I really learned about Ebola is that it is controllable.

 

WOULD YOU GO BACK?

Without question.

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