TIME Infectious Disease

Window to Stop Ebola Outbreak Is ‘Closing Quickly,’ Official Warns

A burial team in protective clothing retrieves the body of an Ebola victim from an isolation ward in the West Point neighborhood of Monrovia, the capital of Liberia on Aug. 28, 2014.
A burial team in protective clothing retrieves the body of an Ebola victim from an isolation ward in the West Point neighborhood of Monrovia, the capital of Liberia, on Aug. 28, 2014 Daniel Berehulak—The New York TImes/Redux

The CDC says more needs to be done to fight Ebola before it's too late

The window of opportunity to stop the Ebola outbreak in West Africa is “closing quickly,” a top health official said Tuesday.

“The number of cases is so large, the epidemic is so overwhelming and it requires an overwhelming response,” Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), told reporters Tuesday after returning to the U.S. Monday from a trip to the affected countries.

Despite the efforts of health workers from the affected countries and elsewhere, cases of Ebola will continue to increase, Frieden said. Moments after his remarks, an aid group announced that another American doctor fighting the outbreak in Liberia has been infected.

Groups like Doctors Without Borders that are treating patients are overwhelmed by the high number of cases, and have had to turn away infected people because of lack of space. Frieden said he saw patients lying on the ground in some West Africa clinics. He stressed that Ebola is a global problem, and that closing off affected countries like Guinea, Liberia and Sierra Leone — many airlines have stopped flying there — will only worsen the outbreak by cutting off access to needed supplies.

“Getting supplies and people in is a big challenge,” Frieden said. “The more the world isolates and stops contact with these countries, the harder it will be to stop the outbreak.”

TIME medicine

Whistleblower Claims CDC Covered Up Data Showing Vaccine-Autism Link

The claim, however, may just be more unsubstantiated fuel from the anti-vaccination movement

If you haven’t noticed, there’s a war going on between those who believe in the health benefits of vaccines – that they can prevent deadly infectious diseases such as measles and polio – and those that believe that the immunizations do more harm than good. Now one of the authors of a 2004 government study that found similar vaccination rates among children with and without autism says the study omitted some important data.

The vaccine war is being fought on social media, in social circles and increasingly in doctor’s offices, as physicians are faced with doubts and questions from parents who find themselves being recruited onto the side of skepticism. Skepticism is healthy, and the sign of curious minds, but not when it flies in the face of evidence. Especially gold standard, rigorous scientific evidence that has been accumulating for decades and shows that vaccines are not linked with an increased risk of the developmental disorder.

William Thompson, a senior scientist at the Centers for Disease Control (CDC) and one of the authors of a 2004 study published in the journal Pediatrics, spoke with Brain Hooker, who serves on the board of Focus Autism (which was founded to “put an end to the needless harm of children by vaccination and other environmental factors”), about the data that was not included in the final report. The study looked at both healthy children and those with autism, to see if there were any differences in their rates of being vaccinated against measles, mumps and rubella (MMR), and found none. That suggested that childhood immunizations likely were not contributing to an increased risk of autism. Hooker and Thompson, however, discussed a subset of the 624 children with autism and 1824 without the condition who were studied and Thompson admitted that among African-American boys, the incidence of autism was higher among those who were vaccinated than among those who weren’t. But that information was not part of the paper. Thompson claims he was not aware that the discussion was being recorded, and his statements appeared in a video released on YouTube on August 22 entitled “CDC Whistleblower Revealed.”

Did the CDC cover up the data, as Hooker claims? A couple of things to keep in mind, both about the people behind the video and about how epidemiological studies like the one published in Pediatrics work (and explained in more detail in this article from Science-Based Medicine). For starters, the video was narrated by Andrew Wakefield, the British researcher responsible for seeding the questions about vaccines and autism in the first place. In 2010, the General Medical Council in the UK revoked his license to practice medicine and a year later, the journal that published his paper concluded that his findings were fraudulent.

Next, any time scientists take the original population of participants in a study, however large, and drill down to analyze trends in a subgroup – in this case the African-American boys – the power of the associations they find dwindles. That’s because the numbers get smaller, and in order to be statistically relevant – something known as statistical significance to statisticians – certain threshold numbers and confidence intervals for the connection have to be reached. In the 2004 study, the scientists looked at a smaller set of 355 children with autism and 1020 without for whom they had Georgia state birth certificates, which included additional information that might be relevant for any associations, such as birth weight, gestational age, and mother’s age, race and education. “This information was not available for the children without birth certificates; hence the CDC study did not present data by race on black, white or other race children form the whole study sample. It presented the results on black and white/other race children from the group with birth certificates,” the CDC notes in a statement responding to the video. Thompson claims that the findings were statistically significant, but results from smaller numbers of subjects still don’t hold as much weight as correlations found in the larger group.

In addition, it’s important to note that the study simply correlated age at vaccination and reports of autism, which says nothing about the direction of the connection. For example, the authors of the 2004 study note that “Case children, especially those 3 to 5 years of age, were more likely than control children to have been vaccinated before 36 months of age.” The association between vaccination and symptoms, however, was more likely due to the fact that the children had to be immunized in order to register in preschool, and doesn’t necessarily indicate that the shots contributed to the autism.

In a statement issued through his attorneys, Thompson says “Reasonable scientists can and do differ in their interpretation of information.” He calls for transparency in the data collecting and reporting process, but says that the way that the 2004 study was presented does not negate the importance of vaccination. “I want to be absolutely clear that I believe vaccines have saved and continue to save countless lives. I would never suggest that any parent avoid vaccinating children of any race. Vaccines prevent serious diseases, and the risks associated with their administration are vastly outweighed by their individual and societal benefits.”

TIME ebola

CDC Director: Ebola Is ‘Worse Than I’d Feared’

Director of Centers for Disease Control and Prevention Tom Frieden testifies during a hearing before the Africa, Global Health, Global Human Rights and International Organizations Subcommittee of the House Foreign Affairs Committee on Aug. 7, 2014 in Washington.
Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, testifies during a hearing before the Africa, Global Health, Global Human Rights and International Organizations Subcommittee of the House Foreign Affairs Committee on Aug. 7, 2014 in Washington, D.C. Alex Wong—Getty Images

Dr. Tom Frieden told CNN the Ebola outbreak is "much bigger" than anyone anticipated

In an interview with CNN on Wednesday, the director of the U.S. Centers for Disease Control and Prevention, Dr. Tom Frieden, said the Ebola outbreak in West Africa is a “much bigger problem than anyone anticipated.”

“It’s even worse than I’d feared,” Frieden said in an interview with CNN in Liberia.

Liberia is one of several West African countries at the epicenter of the world’s largest outbreak in history of the deadly virus. Over 1,400 people have died in Guinea, Liberia and Sierra Leone. The virus has also spread to Nigeria, where the outbreak has killed five people and prompted the shuttering of public schools until October.

But Frieden says hope is not lost; Ebola can be stopped.

“We can stop Ebola,” he said Wednesday, noting that the virus is spread through contact with body fluids, which has often come as a result of caring for the sick and during burial after the infected have perished. “We need to work together to care for people so that they can get the support they need without spreading in communities.”

He added, “The sooner the world comes together to help Liberia and West Africans, the safer we will all be.”

TIME Infectious Disease

Fake Cures and Ebola-Drug Sensationalism Need to Stop, WHO Says

WHO says there's too much hype for unproven treatments, and too many people claiming to have cures on social media

“Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear,” the World Health Organization (WHO) wrote in a statement sent to the media on Friday.

Public fear and anxiety of Ebola is understandable, the WHO says, since the disease has no known cure or vaccine. But the organization warns that there needs to be more reason when it comes to fervor over experimental drugs that are in very limited supply. The WHO says that the public needs to understand that the majority of treatments available are not approved, and have not been tested in humans.

One of the more disturbing outcomes to come out of the Ebola treatment fervor are fraudulent cure claims on social media. “All rumors of any other effective products or practices are false. Their use can be dangerous. In Nigeria, for example, at least two people have died after drinking salt water, [which was] rumored to be protective,” the WHO writes.

Twitter is full of individuals claiming to know of Ebola “cures,” which the WHO is trying to combat, like the one below:

The U.S. Food and Drug Administration (FDA) put out a warning letter to consumers on Thursday about products claiming to treat Ebola. “Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection,” the letter says. “There are currently no FDA-approved vaccines or drugs to prevent or treat Ebola.”

Earlier this week, a WHO panel deemed it ethical to use experimental drugs and vaccines during the Ebola outbreak in West Africa, but it is still developing use guidelines from a panel of experts. The WHO says the Canadian government is donating doses of an experimental vaccine, adding that “a fully tested and licensed vaccine is not expected before 2015,” WHO says.

Recent numbers for Ebola continue to rise. The latest case numbers from WHO put the number of cases at 1,975 and deaths at 1,069. The WHO reports that there have been no new cases of Ebola detected so far in Nigeria, which is the most recent country to have a small cluster of the disease. The WHO says it is in the process of scaling up a massive international response. The CDC is currently tracking cases to prevent further infections, and the World Food Programme is delivering food to over one million people currently quarantined in zones where the borders of Guinea, Liberia and Sierra Leone meet.

TIME motherhood

What the Recent Drop in Single Motherhood Really Means

Thanasis Zovoilis—Getty Images/Flickr RF

Another way to look at the recent figures

According to a new report just released by the National Health Center for Health Statistics, there has been a sharp decline in the number of kids born to single moms.

About 1.6 million women who weren’t married had kids in 2012, down from 1.75 million in 2007 and 2008. And more of those kids were born to co-habiting couples than before. Since not having two parents around is linked with an increased likelihood of having a lousy childhood and a more difficult life, that should be a cause for rejoicing.

This is the first significant decrease in several decades in what’s known as “nonmarital births.” (Probably “out-of-wedlock” sounded too Jacobean). But on closer inspection it’s not unalloyed good news.

Even after the recent sharp decrease, the number of kids born to single moms is still twice as high as it was in the 80s. And while the nonmarital birthrate has dropped 7% since the late 2000s, the overall birthrate—the number of births to all women—has dropped twice as much. What that means is that the percentage of kids born to single moms hasn’t changed much: 40% of all the people born in America have parents who aren’t married.

Similarly, while single black and Hispanic women are less likely to have a kid than they were in 2008 (the rate has dropped particularly sharply for Hispanic women), 72% of black kids and 54% of Hispanic kids are brought into the world via single moms. That number hasn’t budged much since 2011.

There are nuggets of good news in the report: the teen birth rate continues to fall. And the number of births to cohabiting couples (versus mothers who do not live with a partner) represents a much bigger slice of the unmarried birth pie than it did 10 years ago. In 2002, 60% of single women who gave birth were not living with the father. Now it’s down to 42%. But again, this number doesn’t look quite as good under close inspection.

Take this chart for example:

One indicator of a likelihood of a stable childhood is whether or not the child was planned. In the chart above, unintended pregnancies among women who are not living with a guy—the archetypal single mom—are down from 36% of the nonmarital births in 2002 to 28% by 2010. But unintended pregnancies among cohabiting couples went up. So the proportion of kids born to single moms who weren’t trying to have a kid did not change between 2002 and 2010: 57%. (And the raw number of nonmarital births is about 300,000 higher, so that’s a lot more unplanned kids).

How much difference does it make if the father and mother are living together when the kid is born? The jury is out on that. A lot depends on the circumstances under which people shack up. Studies have shown that if a couple is living together and intends to get married in a year or so, there’s very little difference in the stability of their union compared to married couples.

But couples who are living together out of economic necessity, or because they can’t quite decide if they can make the relationship work are less likely to stay together for a longer term. A child can really complicate that. It doesn’t seem yet that the U.S. is at that European-style place where kids born to couples who live together are in the same boat, stability-wise, as those with married parents.

Recent studies suggest cohabitation can make a slight difference, but so does a father’s age, education and race. (Absent black fathers are much more involved in their kids’ lives, than absent Hispanic fathers, and by some measures, than absent white fathers, according to this study.) “The extent to which cohabitation is a marker for social and financial support and for father involvement deserves further exploration,” write the authors of this new study.

One of the clearest findings of the Fragile Families Study done by Princeton University and the Brookings Institute in 2010, was that even if a baby was conceived by accident, many single fathers originally intended to stick around when the infant was born. But they didn’t. The combined pressures of poverty and parenthood proved to be too much for the relationship. The fact that the nonmarital birth rate has dropped is not at all the same as a drop in the number of kids born into very difficult family circumstances.

TIME Infectious Disease

Getting Sick From Planes Is Way Less Likely Than You Think

interior of plane
Martial Colomb—Getty Images

From Ebola to the common flu, viruses don't jump from 32D to 12C all that easily

The person next to you on your eight-hour flight is clearly not feeling well—coughing, running to the lavatory frequently. Great, you think. I’m going to catch some horrible virus.

Actually, probably not. Although most of us would swear that we caught a flu as the result of air travel, airliners are not great at spreading infectious diseases among passengers. (Bacteria is another story, though. See the 6 Germiest Places on a Plane for what to be careful about.) According to a Centers for Disease Control and Prevention (CDC) investigation, if a suspected tuberculosis carrier was aboard a jet, the agency wouldn’t expect exposure to possible infection to extend beyond two rows in either direction.

Airliners are, however, very good at delivering infectious diseases to entire countries. The SARS breakout in Canada in 2003, which sickened 400 people and killed 44, was traced to a single airline passenger—the index patient—who traveled from Hong Kong to Toronto and fell ill after she arrived home. Most of the cases were hospital-acquired, however, including healthcare workers themselves. SARS seemed to have skipped the airline passengers altogether.

Likewise, the chance of catching Ebola from a fellow passenger is remote. The virus is spread through direct contact with infected bodily fluids, not by sitting in a middle seat. “The one thing we have as an advantage is the lack of airborne transmissibility,” says Dr. David R. Shlim, president the International Society of Travel Medicine. “It’s not likely to get in an airplane and then float down the aisle.”

The World Health Organization, which plays traffic cop to the planet’s disease vectors, has warned reasonably for travel restrictions for anyone suspected of having Ebola. Airport and health authorities in Lagos and Monrovia are screening passengers for symptoms before they board and anyone stricken with such symptoms is unlikely to be able to travel, although it’s certainly not impossible. In the U.S., the CDC mans quarantine stations at international airports, such as John F. Kennedy in New York City and Newark Liberty in New Jersey, that act as the front-line defense against infectious visitors.

The bigger issue is that a virulent illness—SARS, MERS, and perhaps some superbug lurking somewhere waiting for a ticket out—can be delivered around the globe with relative ease given the expansion in air travel. A million passengers a day enter the United States, according to the Customs and Border Protection agency. “Diseases that used to smolder can now move more quickly. You can get anywhere in 24 hours,” says Shlim. “All the public health officials know about that and are concerned about it.” Consider chikungunya, a mosquito-borne virus that causes fever and joint pain. According to the CDC, the chikungunya virus reached the Americas via the islands of the Caribbean in late 2013. “There is a risk that the virus will be imported to new areas by infected travelers,” the CDC notes. Sure enough, a case was discovered in Florida this year.

The WHO hasn’t gone so far as recommending a travel embargo to the Ebola-affected nations, but that would be the logical progression if the outbreak can’t be reined in with the current program, called Ebola Virus Disease Outbreak Response Plan. During Canada’s SARS outbreak, the WHO issued a travel advisory that recommended that tourists avoid the Toronto area. It’s not known whether the advisory stopped SARS from spreading, but it did severely damage Canada’s tourism industry before being withdrawn after a few days after the Canadian government protested the advisory.

Stopping the movement of people is the ultimate way of keeping a viral disease in check geographically. But in the more connected world of global logistics it will be increasingly difficult to do so. Although ebola is terrifying in that there is no widely available remedy, there’s no reason to change your flight plans, even to Africa.

That doesn’t mean people won’t. “I can’t think of any example of one person got on a plane and 30 people got off sick,” Shlim notes. The biggest concern on your next jet ride isn’t going to be Ebola. It’s more like measles, which is very contagious. The risk there isn’t from a third-world passenger arriving from Africa. It’s more likely a 7-year American kid who hasn’t been vaccinated.

TIME Infectious Disease

Who Gets the Experimental Ebola Drugs?

The World Health Organization has endorsed the use of experimental drugs to fight the Ebola outbreak in West Africa. But who gets them?

The World Health Organization (WHO) announced this morning that it is medically ethical to offer unproven experimental drugs and vaccines for patients with Ebola.

Since the effects on humans of the drugs—which have shown to be effective on animals—are largely unknown, the panel had to weigh the benefits and risks. The panel ultimately determined it was ethical to administer them experimentally, but that any interventions should include “transparency about all aspects of care, informed consent, freedom of choice, confidentiality” and more. But now the question is: With not enough to go around, who gets them?

That’s ultimately at the discretion of the countries themselves, and before that happens, there’s a waiting period as the WHO formulates another panel of technical experts to create guidelines for the best use of these drugs. Some of the questions they will try to answer are: At what stage of the disease are the drugs or vaccines effective? Are they effective at the beginning of the disease or at the later stages? What are the safety issues related to the drugs? What’s the efficacy of the drug—do 30% of people respond or 50%?

“It think [who gets the drugs] is one of the most difficult questions to answer,” says Dr. Abha Saxena, the coordinator for the global ethics team at WHO. “There is a limited supply and there is a lot of demand. But who gets it is contextual, it will depend upon on the country, the situation, and they type of drug that will eventually go forward into either trial or compassionate use.” The panel will meet by the end of this month.

Sidie Yahya Tunis, head of public relations for the Ministry of Health in Sierra Leone’s Emergency Operations Center told TIME in an email that Sierra Leone will prioritize physicians and health workers, but that they are waiting for more WHO guidance. “We are waiting on WHO to provide the protocol for administering the drugs. We determine who gets the drugs based on the following factors: the number of doses available to us, the clinical expertise in country to administer the drugs, and clear consent from the patient,” Tunis said.

One of the biggest factors will be availability and supply.

The experimental drug ZMapp has been given to the two American patients who were infected with Ebola and evacuated to Emory University Hospital in Atlanta, and it is reported that the drug was also given to a 75-year-old Spanish priest who ended up passing away in a Madrid hospital on Tuesday. The are other drugs in the pipeline, including a vaccine from a National Institutes of Health researcher and a drug that blocks the virus’ ability to copy itself. Unfortunately, supplies of all the drugs are extremely limited. Larry Zeitlin, president of Mapp Biopharmaceutical Inc., the developer of ZMapp, told TIME that the use of ZMapp in humans was “unanticipated” and they’re working to scale up as quickly as possible. The company posted a statement about it’s short supply on its website Tuesday:

The available supply of ZMapp has been exhausted. We have complied with every request for ZMapp that had the necessary legal/regulatory authorization. It is the requestors’ decision whether they wish to make public their request, acquisition, or use of the experimental drug. Any decision to use ZMapp must be made by the patients’ medical team. Drug has been provided at no cost in all cases.

“Right now, the biggest constraint of increasing production of ZMapp is time. Since the antibodies are grown in the tobacco plant, the plant obviously needs time to mature,” says Maura Payne, the vice president of communications for Reynolds American Inc., which heads the Kentucky BioProcessing plant making ZMapp.

As TIME reported earlier, there’s been very low financial incentive to develop drugs for Ebola, which is in part why health responders are empty handed. Whether researchers and manufacturers can develop and produce enough drugs to have any sort of impact on the current outbreak is yet to be seen.

TIME Infectious Disease

What You Bring When You’re Going Into an Ebola Outbreak

Meet the CDC officers going into West Africa to fight Ebola

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This morning, Rebecca Merrill will be deploying from the U.S. to Liberia. She is one of the more than 50 disease specialists being sent to West Africa by the Centers for Disease Control and Prevention (CDC) to help slow the spread of Ebola, a virus that has claimed 961 lives so far—and nearly 300 of those were in Liberia alone.

“Fear is extremely natural, but the bigger picture is that there needs to be support there,” says Merrill, an Epidemic Intelligence Service (EIS) officer at the CDC. “When the opportunity came up, I thought, there’s no way I could avoid applying.”

When TIME met with her a couple of days before her deployment, she told us what she’d be packing, and showed us her pelican case full of gear. Items on the list include GPS systems—both for their own navigation and so that their colleagues at the CDC can track them—radio equipment for public health messaging, a bug hut for sleeping outside if need be, a satellite phone, granola bars, comfortable clothes, and protective equipment like gloves, masks, boots, hats and eye protection. She’ll be gone for 29 days.

Each EIS officer sent to West Africa for the surge response is provided with these necessities. Spencer Lowell for TIME

It’s Merrill’s first time deploying, and though her husband is worried and she’s glad her kids are too young to understand, she says this is what she signed up for. “My husband understands that I applied for this job in order to have this kind of opportunity,” says Merrill. “So whether [my family] is scared or not, no one is letting me know that. It’s all support at this point.”

The EIS is a two-year program that trains doctors and other health professionals in skills they need to investigate infectious disease outbreaks and epidemics. The program began in 1951, in response to biological warfare threats during the Korean War. It’s a highly selective program, with 50% of those selected being doctors, and the rest veterinarians, nurses and pharmacists. Four of the last seven CDC directors were EIS officers.

EIS officers are deployed based on their expertise, and based on need. Dr. Meredith Dixon, for instance, who just returned from Guinea, spent two 30-day deployments doing data input for a pathogens team in Guéckédou, the epicenter of the outbreak. Kelsey Mirkovic, spent her days tracking down Ebola patient contacts by knocking on doors of people who may have come in direct contact with confirmed Ebola patients. Merrill, who served in the Peace Corp and has a PhD in maternal and child nutrition, will help train health care workers and community members, and even write newspaper articles about how to contain Ebola.

Evidently, though EIS agents like Merrill are trying to neutralize a very dangerous disease, there’s excitement and motivation to go into the region many others want to steer clear from. “I just want to get there at this point,” says Merrill. “I hope I can do as I much as I want in 29 days.”

TIME Infectious Disease

Doctors Inside Emory’s Ebola Unit Speak Out

Physicians at Emory University Hospital spoke to TIME about the unit treating the two U.S. Ebola victims, their doubters and the unknown future of emerging diseases

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Emory University Hospital faced its share of doubters when it built its serious-communicable-disease unit more than a decade ago. At a time when the threat of infectious diseases in the U.S. seemed to have receded — replaced by worries over conditions like obesity and Type 2 diabetes — the center appeared unnecessary. But last week, when Emory got word that two Americans were infected with Ebola and would need to be evacuated from West Africa, health experts were all too glad the unit existed.

“I have to admit, a lot of people saw this as Noah’s Ark,” says Dr. Bruce Ribner, the infectious-disease specialist at Emory University Hospital leading the care of the American patients with Ebola virus. “They thought, ‘You are not going to have any activity there, you’re just wasting your time with all that.’”

Now Ribner is fielding an average of 100 emails a day from hospitals here and abroad seeking consultations, and there’s a caravan of news vans seemingly permanently parked along the sidewalk in front of the hospital, with news crews braving the thick Georgia heat in pitched tents on the grass.

“When [news of the patients] finally came, we said, ‘This is what we’ve been preparing for for 12 years,’” says Ribner. Indeed, the infectious-disease team caring for the patients with Ebola has been practicing the process of receiving and treating patients with serious diseases — like Ebola, SARS or anthrax — about two times a year every year since 2002, when it created its program and isolation unit with the help of the Centers for Disease Control and Prevention (CDC).

Dr. Alexander Isakov, who helped get the patients from their landed flight to the isolation room, remembers first hearing the news and thinking, Here’s a chance to finally activate all that they had been preparing for, to help people get better. “It’s gratifying,” he says.

Treating the Patients

Though Emory’s isolation unit was created with this precise type of health emergency in mind, experts stress that nearly all U.S. hospitals are equipped and prepared to receive a patient suspected to have contracted Ebola. When both patients were moved from the ambulance into the hospital, choppers ahead captured footage of the full-body protective suits with air-purifying respirators that were worn by the team. Emory says it’s trying to re-message the idea that physicians need to dress in what some are calling “moon suits” to care for a patient.

“Of course the message goes out that you have to dress like some sort of space person,” says Ribner. “Which is an unfortunate message.” The CDC recommends that anyone entering a patient with Ebola’s room wear at least gloves, a gown, eye protection and a face mask, with the acknowledgement that depending on the amount of fluids being excreted, more may be needed. The hospital agrees with this advice, and Ribner says his nurses felt more comfortable wearing the full-body suits. One of the features of Ebola-virus infection is diarrhea. “One [reason from our nurses] was just pragmatic: I don’t want my shoes full of feces. The other was, ‘You know what? These are kind of comfortable,’” says Ribner.

(The patients at Emory have requested privacy, but one released a statement Saturday saying he was getting “stronger every day.”)

Now that more cases of Ebola are spreading in Lagos, a highly trafficked city in Nigeria, the possibility for more patients in the U.S. is not out of the realm of possibility. “If we had to accept other Ebola patients — and we’ve been in contact about possibly doing that — we could do it,” said Dr. G. Marshall Lyon, one of the Emory physicians treating the patients with Ebola. Lyon says the unit also has a contract with the CDC to handle their employees, should any of them be exposed to serious communicable diseases.

A New Age of Infectious Diseases

While Ebola is new in the U.S., it’s not a novel virus, and health experts remain confident that the outbreak will eventually subside. Still, the current Ebola outbreak, the deadliest in history, begs the question: Is the U.S. prepared for other infectious, and even unknown, emerging diseases?

“We live in a world where we are all connected by the air we breathe, the water we drink, the food we eat, and by airplanes that can bring disease from anywhere to anywhere in a day,” says CDC Director Dr. Tom Frieden. “That’s why it’s so important to strengthen global health security and work with countries all around the world so they can do a better job finding threats.” (In recent months, the CDC experienced two lapses in lab safety that raised skepticism about protection oversight, to which Frieden assures, “We blew the whistle on ourselves and began a comprehensive and aggressive program to address lab safety here.”)

In his opinion, the U.S. is facing three threats when it comes to emerging disease: new infections and organisms spreading in different places; drug-resistant bacteria; and intentionally created organisms. “Those risks require us to put in place robust systems,” he says.

Lyon says he remembers reading an article about 20 years ago stating the age of infectious disease was over. It couldn’t have been more wrong. “The bugs have evolved and kept us on our toes,” he says. “We have to deal with things like tuberculosis and measles having a resurgence.”

In 2009, H1N1 emerged as an influenza virus with little known about its transmission or how virulent it was. Ribner says, “We were really lucky” it wasn’t more lethal. “Do I foresee down the road that we could have a more virulent influenza strain? We’ve had them in the past, so yeah, we could,” he says. “Would we handle it? We would handle it as best we could.”

Learning on the Job

Having two patients with Ebola under treatment in the U.S. not only gives them a better shot at life, but it grants doctors the opportunity to learn something. “We have the unique opportunity to look at a disease that we don’t usually see here,” Dr. Aneesh Mehta, the Emory physician who had what he calls the “honor” to be the first doctor to receive an Ebola patient into the isolation room. “For these two patients, if they agree to participate in research down the road, we will be able to really look in-depth at the pathogenesis and the immunological response to Ebola in ways that can’t be done in Africa.”

Mehta says the drills at Emory — as well as the attention being paid to the effectiveness of governmental responses to this pathogen — will help experts better understand how to take care of patients in the larger context of our health care system. “We can teach other health care systems and physicians not only here in the United States, but throughout the world because our processes seem to be working quite well.”

Dr. Jay Varkey, a physician who joined the Ebola care team this weekend, agrees. “My hope is that by providing excellent care here, that learn processes that can be translated and expanded. In my opinion, in a fair and just world, if these processes are really key to improving survival in a disease like Ebola, that countries that are developing can institute them.”

The Emory team is working 24/7 to neutralize the disease in the two infected Americans, and while it’s uncomfortable to be faced with the dark consequences of our interconnectedness, it’s comforting to know that for over a decade, despite questioning, highly trained specialists have been watching our backs.

TIME Infectious Disease

Inside the CDC’s Emergency Operations Center Tackling Ebola

CDC leaders integral to the Ebola response, including epidemiologists, laboratorians, logistics, and more, assemble in agency’s command center to discuss next steps in directing the response at CDC Emergency operations center in Atlanta, August 8. Spencer Lowell for TIME

The CDC's emergency unit has been called into full-force this week as the Ebola virus continues to ravage West Africa

It’s early Friday morning, just a few hours after the World Health Organization officially declared the Ebola outbreak a global public health emergency, and the Centers for Disease Control and Prevention’s (CDC) Emergency Operations Center (EOC) is buzzing. Their recently roused battle room of computer screens and realtime maps of Ebola spread is fielding calls from U.S. hospitals, offering logistical support for workers in West Africa, and is continuously updating data on the rising number of infections.

The daily 10 o’clock meeting spills out of the EOC’s primary conference room, where the CDC’s heads of infectious disease control as well representatives for the State Department and USAID meet every morning to discuss what’s happening on the ground in West Africa. This is where they anticipate and discuss their next moves. Only a couple of days earlier, the CDC activated the EOC to a Level 1 response unit, the highest possible alert, which means everyone with related expertise is called to the table.

CDC Director Dr. Tom Frieden Spencer Lowell for TIME

“We have been very concerned at CDC for weeks and months about [Ebola], and we’ve increased our activation to the highest level to surge on a response in Africa,” says CDC Director Dr. Tom Frieden, who just returned the night before from testifying in front of the House Committee of Foreign Affairs about the agency’s ongoing efforts to prepare for—and combat—the disease. “This Ebola outbreak is unprecedented. The single most important thing to understand about protecting Americans from Ebola is that [it has to be stopped] at the source in Africa.”

While the CDC has had experts on the ground since the first week of April, it recently announced that it’s sending a surge of 50 more disease specialists, including diseases detectives, laboratory experts and transmission-data analysts, to West Africa in the next 30 days, but those health workers need support from the stateside EOC for resources, data collection and communication.

A large part of the EOC team is made up of Epidemic Intelligence Service (EIS) officers—health professionals who are part of the CDC’s two-year training program for investigating infectious disease. Kelsey Mirkovic, 29, is a second-year EIS with a PhD in pharmacology who just returned from Gueckedou, Guinea. She was tasked with tracking down infected patients’ possible contacts. “One day there were two deaths of people with Ebola in one village, and 218 people were added to our list of contacts that day,” says Mirkovic. “We are talking about tracking down hundreds of people.”

As of Monday, there were six CDC specialists deployed to Guinea, 12 to Liberia, nine to Sierra Leone, and four to Nigeria, where cases of the virus are beginning to spread in Lagos, the largest city in Africa, much to the dismay of global public health groups.

“If current trends continue, it won’t be long before there’s more cases associated with this one outbreak than all previously outbreaks of Ebola virus combined,” says Dr. Stephan Monroe, the deputy director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, who is spending a lot of his time in the EOC these days. “In most of these other countries, the initial event starts in a relatively rural area. So if we can get in quickly and contain it before it spreads, it’s much more effective. If it starts to spread in a large metropolitan area, especially in the very urban slum areas, it will be much more difficult to control.”

Dr. Frieden told TIME that an outbreak in Lagos is likely going to get worse before it gets better. Monroe says the CDC has experts in Nigeria identifying cases and the infected people’s contacts, as well as people helping local authorities with their exit screenings in order to keep infected people from hopping on an airplane and leaving the country. “In order to fully resolve the outbreak, we’re clearly looking at months, not weeks of effort,” says Monroe.

The EOC is also serving as the hub for Ebola containment in the U.S., should the disease present itself here. The CDC is, conveniently enough, just three minutes from Emory University Hospital, where two evacuated Americans with Ebola virus disease are being treated. The CDC has provided care guidelines for U.S. hospitals. And in one nearly windowless room of epidemiologists at the EOC, experts handle several calls daily from U.S. hospitals concerning sick patients with recent travel history to Africa.

As the weekend approaches, the EOC disease specialists start packing up and trickling out, despite a few frazzled workers trying to print off large outbreak maps that could be sent with traveling disease specialists before the day is done. The glow from the wall of computerized data sets and updates fills the room—with large graphs that highlight the early summer spikes in Ebola cases.

The upward trends serve as a sobering reminder that while the day may be done, the work is far from over. And while tired health care workers may be gaining a weekend, we’re still losing time.

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