TIME Infectious Disease

How the American Ebola Patients Are Being Brought to the U.S.

This is an example of the tent Ebola patients will be placed in to fly to the U.S. photo courtesy of CDC

Similar past experiences show how Americans who are overseas with a highly fatal disease can safely get to a U.S. hospital

Soon after the Centers for Disease Control and Prevention (CDC) issued a travel advisory on Thursday for Guinea, Liberia, and Sierra Leone, all struggling to contain an outbreak of Ebola, it was reported that two Americans infected with the virus would be evacuated. Nancy Writebol, a missionary with an NGO called SIM USA, and Dr. Kent Brantly of Samaritan’s Purse, contracted Ebola in Liberia. A hospital in Atlanta has announced it will receive at least one patient, but does not yet know which one or when they will arrive. SIM USA says the plane can accommodate only one patient at a time.

“Emory University Hospital has a specially built isolation unit set up in collaboration with the CDC to treat patients who are exposed to certain serious infectious diseases,” the hospital said in a statement. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation. It is one of only four such facilities in the country.”

Their transport was arranged by SIM USA, with support of the State Department, and they are using Phoenix Air, the same contractor that the CDC and other U.S. agencies have used for infectious disease evacuations.

The CDC and other major public health groups have established certain protocols for transporting and evacuating patients, ranging from cabin depressurization to waste disposal, and the State Department has said it will help coordinate those efforts. Although the CDC and Emory University did not respond to requests for comment on the specifics of the carriers, the setup is likely very similar to what the CDC has recommended for handling SARS patients, and what the now-dissolved U.S. Army Medical Research Institute of Infectious Diseases’ (USAMRIID) aeromedical isolation team used to do when evacuating patients with serious infectious diseases.

Here’s what typically can happen. Depending on the virus, health care workers will remain covered with gowns, gloves, eye equipment and possibly face masks. Some may also have full-body suits. The aircrafts used to transport the patients are equipped with medical equipment, too. The CDC recommends one area of the plane to be distinguished as the isolation zone for patient care that is somehow separate from other areas where health care workers can put on or remove their equipment (one former CDC researcher says the workers may never take the gear off during transport). In this case, a tent-like system is easily set up in the aircraft. The patient can be additionally isolated in a sealed container that has negative air pressure, so that the air inside actually stays inside (even if Ebola isn’t airborne). The isolator that the patient is in could have oxygen tanks, medication, defibrillators and intravenous fluids.

When it comes to waste from the patient or sheets that have blood or bodily fluid, the CDC advises that all of it must be disposed of in biohazard bags. Once the plane has landed and the patient has been delivered for care, the aircraft will undergo very specific and intensive cleaning. Dr. Eileen Farnon, an associate professor at the Temple University School of Medicine who was a CDC researcher during the Ebola outbreak in 2007, says that when the plane lands, a similarly equipped ambulance will likely meet it to take the patient to the hospital. As Emory indicated, they have protocols and isolations units in place to safely transport and treat the patient—or patients—upon arrival.

The Aeromedical Biological Containment System (ABCS), which houses the patients on their flight photo courtesy of CDC

“Unfortunately one of the tragedies of these outbreaks is the lack of resources in rural parts of Africa, including basic things like gloves and gowns and face masks—certainly eye shields. Things that we take for granted in the United States,” says Farnon. “At our hospitals, there are standards of care that don’t exist everywhere. Here, we can adequately protect health care workers and provide high level of care to patients.”

That’s one of the primary reasons CDC Director Tom Frieden said the Ebola outbreak in Guinea, Liberia and Sierra Leone has grown: Many health systems in these countries “are not highly functional.” In Atlanta, Emory’s hospital has an isolation unit that was set up in collaboration with the CDC to care for patients with serious infectious diseases. Treating a patient there with highly trained experts and CDC oversight (CDC headquarters is nearby) is likely a better location for American patients who, tragically and unlike many victims in West Africa, could have a chance at better care and survival.

TIME Infectious Disease

U.S. Will Evacuate 2 Americans With Ebola from West Africa

Emory Hospital in Atlanta announced on Thursday that it will treat at least one patient

The State Department announced Friday that together with the Centers for Disease Control, it is working to bring home two U.S. citizens infected with the Ebola virus in West Africa “over the coming days.”

Although the State Department did not identify the patients by name, two Americans working in Liberia— one as a physician and the other as a missionary — have been infected with the virus. Both Dr. Kent Brantly and missionary Nancy Writebol were working to fight the outbreak of the deadly virus.

CDC protocols and equipment are used for these kinds of medical evacuations, according to State Department spokesperson Marie Harf, who added:

The safety and security of U.S. citizens is our paramount concern. Every precaution is being taken to move the patients safely and securely, to provide critical care en route on a non-commercial aircraft, and to maintain strict isolation upon arrival in the United States.

Harf did not disclose where the patients would be sent in the U.S., but on Thursday Emory University Hospital said in a statement that it expects to receive one patient with Ebola in the “next several days.” it is unclear if the second patient will be treated at Emory as well.

The Ebola virus, which has infected at least 729 people in West Africa this year, only spreads through direct contact with bodily fluids. Margaret Chan, the director-general of the World Health Organization, told presidents from affected countries on Friday that it is moving faster than it can be controlled. “If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socio-economic disruption and a high risk of spread to other countries,” she said.

Medical personnel caring for the two patients in the U.S. will wear full-body protective suits, and the patients will remain “in strict isolation upon arrival” and while being treated on U.S. soil, according to Harf.

CDC director Dr. Thomas Frieden has said he does not believe Ebola will spread in the U.S. “That’s not in the cards,” he said in a call with press on Thursday.

TIME Infectious Disease

The CDC Says You Shouldn’t Fly to Countries Hardest Hit by Ebola Outbreak

Staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA Hospital in Monrovia, Liberia, on July 24, 2014 Zoom Dosso—AFP/Getty Images

CDC director calls the disease a "dreadful and merciless virus"

The Centers for Disease Control and Prevention (CDC) has issued a travel advisory for Guinea, Sierra Leone and Liberia in response to an Ebola outbreak ravaging those West African countries, CDC director Dr. Tom Frieden announced in a press conference Thursday.

The CDC’s warning recommends against nonessential travel to the three countries. Frieden also said the CDC is sending an additional 50 disease-control specialists into the three countries over the next 30 days in order to establish emergency operation centers in collaboration with the World Health Organization. The centers will provide resources and fast diagnoses, according to Frieden. The CDC already has workers tracking the epidemic and its spread.

“The bottom line is Ebola is worsening in West Africa,” said Frieden. “CDC, along with others, are surging to begin to turn the tide. It is not going to be quick. It is not going to be easy. But we know what to do. The current outbreak is bad. It’s the biggest, the most complex, and the first time it’s been present in this region.”

Frieden said the shared border of Guinea, Sierra Leone and Liberia appears to be the epicenter of the outbreak. One of the greatest problems facing containment efforts, he said, is that the three countries’ health care systems are not highly functional. Some residents of the worst-hit countries also lack an understanding of the disease, and many have developed a hostility toward health workers over fears they are spreading the very disease they are working to prevent.

So far, the Ebola outbreak has been isolated to West Africa. It recently spread into Nigeria, when a traveler from Liberia was recently diagnosed with the virus. Sierra Leone, meanwhile, has declared a public-health emergency over the outbreak.

Despite the CDC’s travel warnings, Frieden said Ebola, which he called “frankly a dreadful and merciless virus,” poses little risk to the American population. Even if the U.S. were to have a confirmed case, the director says it is highly unlikely the disease would spread significantly — every hospital with an intensive-care unit can isolate a patient, he said. Ebola transmission, meanwhile, only happens via direct contact with infected bodily fluids.

“In past outbreaks, we’ve been able to stop every outbreak, but it takes meticulous work,” said Frieden. “It’s like fighting a forest fire. If you leave behind even one burning ember, one case undetected, it could reignite the epidemic. But as difficult as it is, it can be done.”

Currently, the CDC is not screening travelers from the affected countries.

For the basics on the disease, check out the infographic below.

Sources: WHO, CDC, Mayo Clinic
TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME Research

The High Risks of High Summer Temperatures

When the mercury rises, so do some health risks

A new CDC report out Wednesday shows that 2,000 Americans died each year from 2006 to 2010 from weather-related causes and, as TIME reported earlier, twice as many Americans died of winter cold compared to summer heat.

While the recent CDC numbers show more weather-related deaths attributed to the cold, the agency says heat-related health problems are concerning—and growing. According to the agency, a good example is Chicago. In 1995, there were 465 heat-related deaths in the city, but from 1999 to 2010, there were 7,415, which averages to 618 deaths a year. Low-income Americans without access to air conditioning—or those who have A/C but can’t afford to run it—are at a particular risk, as are children and the elderly.

This has some scientists concerned. “Previous research shows that extreme heat on average causes more deaths per year than tornadoes, floods, and hurricanes combined” says Olga Wilhelmi, a scientist who studies heat-related illness and climate at the National Center for Atmospheric Research. “Heat-related deaths are a serious concern. When you look at the relationship between human health and extreme heat, it presents very complex medical, social, and environmental issues, and that’s what we’re trying to understand.”

Wilhelmi is studying what combination of factors influence heat-related health problems and death in a given place–primarily focusing on cities. The idea is that by gaining a vast knowledge of who are at the greatest risks and why, local health departments can better protect their residents.Wilhelmi has done a lot of recent work in the city of Houston, looking partly at the number of 911 calls made for heat-related health problems. One of her early findings is that the majority of Houston nights hit heat-stress levels, and that cities may need to consider issuing more alerts and interventions to protect its most vulnerable residents.



TIME Infectious Disease

CDC Reports More Cases of Mosquito-Borne Chikungunya Virus

A doctor examines a patient during a medical brigade to detect suspicious cases of Chikungunya fever in a school of the town of Ayutuxtepeque, 4 km north of San Salvador, El Salvador on June 18, 2014. Jose Cabezas—AFP/Getty Images

Nearly all American cases were contracted while traveling

More than 600 Americans have been infected with the mosquito-borne chikungunya virus so far this year, the Centers for Disease Control and Prevention said Wednesday. The vast majority of cases, the CDC says, were not contracted locally.

The disease (pronounced: chik-en-gun-ye), which causes fever, joint pain, headaches, swelling and rashes is not fatal, but it can be very painful. Earlier this month, the first locally-transmitted case was reported in Florida. There is no vaccine for chikungunya, but it is not contagious. The best way to avoid the disease is to stay protected from mosquitos by wearing adequate clothing and by getting rid of standing water.

The CDC says it expects more cases of the virus to pop up among travelers, given recent outbreaks in regions like the Caribbean and the Pacific. Imported cases of the virus could mean the disease will spread locally, the CDC said.

You can read more about chikungunya in the U.S. here.

TIME Infectious Disease

There’s a Vaccine Against Cancer, But People Aren’t Using It

The only vaccine to protect against cancer, the HPV shot, isn't being used by young people who could benefit most

In a new report on immunization rates among young people, the Centers for Disease Control (CDC) reports relatively low numbers of adolescents getting the HPV vaccine, the only vaccine that can protect against cancers — in the cervix, anus and mouth — caused by the human papillomavirus virus.

The new data, published in the CDC’s Morbidity and Mortality Weekly Report, shows that only about one-third of adolescent girls between the ages 13 and 17 got all three doses of the HPV vaccine, which the CDC says is about the same as last year. The shot is recommended to protect adolescents before they become sexually active. Only about 57% of adolescent girls and 35% of adolescent boys for whom the shot is recommended received one or more doses.

The vaccine continues to face challenges from parents concerned that it would promote sexual activity among pre-teens and adolescents, despite data showing that immunized teens aren’t more promiscuous. The CDC data also shows that doctors can play a critical role in discussing the shot with parents and improving vaccination rates. Among parents whose daughters were vaccinated against HPV, 74% said their doctors recommended the vaccine. But the data also showed that among parents who did not vaccinate their girls, nearly half were never told by their doctor that they should consider it. The effect was even greater among boys, where only 26% of parents who did vaccinate their son received any advice from their doctor about it.

To boost vaccination rates, some researchers are investigating whether fewer doses of the vaccine could be effective, and so far those studies look promising.

TIME Infectious Disease

CDC Lab Director In Anthrax Incident Resigns

MED CDC Anthrax
A sign marks the entrance to the federal Centers for Disease Control and Prevention in Atlanta on Oct. 8, 2013. David Goldman—AP

The lab director is now permanently out of the job

The director of the bioterror lab involved in an incident which caused over 80 lab workers to be potentially exposed to anthrax has resigned.

Michael Farrell, head of the Centers for Disease Control’s Bioterror Rapid Response and Advanced Technology Laboratory had submitted his resignation on Tuesday. The resignation was first reported by Reuters and has been confirmed by TIME.

Last month, the CDC reported that procedures to deactivate anthrax when leaving a lab were not followed and that while the workers were protected, the bacteria was passed to other labs. When it was determined that anthrax had not been deactivated, the labs and CDC building were shut down and decontaminated. Lab workers have not contracted the disease.

Last month, Dr. Farrell was reassigned as the CDC conducted its investigation. Earlier this month, CDC Director Dr. Thomas Frieden said the incident was due to a lack of oversight, and that the CDC would increase safety precautions.


TIME Obesity

Most Overweight Kids Don’t Think They’re Overweight, a New Study Finds

New data from the CDC shows many kids and adolescents misperceive their weight status

About 81% of overweight boys and 71% of overweight girls believe they are about the right weight, according to recent data released by the U.S. Centers for Disease Control and Prevention (CDC) from the National Health and Nutrition Examination Survey.

Overall, the survey, which collected data on the weight of U.S. adolescents between the ages of 8 and 15 from 2005 to 2012, found that about 30% of children and adolescents perceive their weight status incorrectly. That’s estimated to equate to about 9.1 million young people.

While the majority of overweight kids incorrectly classified their weight status, general weight misperception in the study also meant that kids who were not obese could think that they were, or that they could incorrectly consider themselves underweight.

The data also shows that weight misperceptions tended to be slightly higher among boys than girls, and had a higher prevalence among non-Hispanic black and Mexican-American kids. Weight misperception was significantly lower among kids and adolescents in higher-income families compared with kids in lower-income families.

Sadly, these are the same populations whose parents are more likely to be overweight, Dr. Daniel Neides, medical director for the Wellness Institute at the Cleveland Clinic, tells TIME. That suggests the possibility that overweight kids view their weight status as normal because that’s what they see in their own families. “As our country gets heavier, children don’t necessarily see it as abnormal,” he says. (Neides was not involved with the survey.)

The trouble is also that parents often don’t want to hear that their child is overweight. Prior research has shown that only about a quarter of parents of overweight kids say a doctor has told them that their kids were overweight. “People are very sensitive to weight and to growth charts, and [parents] will argue it hasn’t been updated in years,” says Neides. “We feel like young people are immortal and will be fine, and that population also doesn’t see the long-term implications.”

But overweight children is serious business. Kids are increasingly being diagnosed with diseases that usually only appear in adults, like Type 2 diabetes. A 2013 Harvard Medical School study also found a 27% increase in the proportion of children ages 8 to 17 with elevated blood pressure. “I am seeing people younger and younger coming into my office with osteoarthritis from weight,” says Neides. “We weren’t learning about kids with these problems when I was in medical school.”

The new data should serve as a warning to families and physicians that young people are confused about their weight status, and that if overweight kids continue to believe they’re the right weight, it could have detrimental effects on progress being made against the obesity epidemic.


Chikungunya in Florida Man Is First Case Acquired in the U.S.

WS photography—Getty Images/Flickr RF

The Centers for Disease Control and Prevention (CDC) says that the first case of the mosquito-borne virus chikungunya infection picked up in the U.S. occurred in a Florida man who had not recently traveled abroad.

This year, 243 people in the U.S. became infected, but this is the first case of a disease believed to originate from a mosquito in the U.S.

Chikungunya is a disease caused by a virus that leads to fever, joint pain, headaches, swelling and rash. The infection is usually not fatal, but the pain can be debilitating.

“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” Roger Nasci, chief of CDC’s Arboviral Diseases Branch said in a statement.

The CDC is teaming up with the Florida Department of Health to confirm how the Florida man became infected and is monitoring the area for additional cases. The CDC believes that chikungunya in the U.S. will follow a similar pattern to that of the dengue virus, in which imported cases cause some local transmission, but did not cause a widespread outbreak. Public health officials are investigating how the mosquitoes were infected with the virus, including whether the insects acquired the virus by biting infected individuals. Since 2006, there have been an average of 28 cases a year of chikungunya infection; none of those cases have prompted an outbreak, however. Countries in Africa, Asia, Europe, India, the Middle East, and the French side of the Caribbean island of St. Martin have experienced outbreaks in the past and 23 countries have experienced local transmission of the virus in recent years.

The best way to stay protected from the virus is to keep mosquitoes at bay by wearing repellants and creating a physical barrier from being bitten, with long sleeves and pants when possible. Health officials also recommend getting rid of any standing water outside the home, where mosquitoes generally breed.

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