TIME Infectious Disease

CDC Confirms First Case of Ebola Diagnosed in the U.S.

Outbreak has claimed more than 3,000 lives in Africa

Health officials confirmed Tuesday that a patient in Dallas has Ebola, marking the first such diagnosis of the deadly disease ever to occur on U.S. soil.

Until now, the only cases of Ebola in the U.S. have been Americans who were infected abroad and were brought back for treatment. The death toll from the worst Ebola outbreak ever, which has hit several countries in West Africa, surpassed 3,000 last week.

The patient, who has not been identified, had traveled to the U.S. from Liberia, leaving Liberia on Sept. 19 and arriving in the U.S. on Sept. 20. The patient had no symptoms when departing Liberia or when first landing in the U.S., but began developing symptoms for the deadly virus four days after arrival. On Sept. 28, the patient was placed in isolation at Texas Health Presbyterian Hospital in Dallas. The patient’s specimens tested positive for Ebola on Tuesday afternoon.

U.S. Centers for Disease Control and Prevention (CDC) director Dr. Tom Frieden said that the medical team’s priorities are to care for the patient, as well as to track down everyone the patient came in contact with while the patient was infectious. A patient with Ebola is only contagious once an infected person starts presenting symptoms. The CDC and Dallas Health and Human Services will identify all the contacts and monitor them for 21 days, which is the incubation period for the disease. If any of the contacts comes down with a fever, they will be isolated and cared for. The CDC says it has just started the contact tracing.

Frieden acknowledged that it’s possible someone with close contact with the patient could come down with the disease, but is confident the U.S. healthcare system can handle that possibility. “The bottom-line here is I have no doubt that we will control this case of Ebola so that it does not spread widely,” said Frieden during a news conference.

The CDC said that they do not know how the individual was infected, but the patient must have had close contact with someone infected with the disease. The CDC is sending disease specialists to Texas. The CDC has long acknowledged that it’s possible for Ebola to reach the U.S., though concern for widespread infections is low given the quality of U.S. health care. “As long as the outbreak continues in Africa, we need to be on-guard,” Frieden said.

TIME Infectious Disease

Ebola Outbreak Contained in Nigeria, Officials Say

After a total of 19 cases and seven deaths

The Ebola outbreak in Nigeria appears to be contained, health officials said Tuesday.

The U.S. Centers for Disease Control and Prevention (CDC) said that due to a very rapid local and international response, the country may have fully contained its Ebola outbreak. The 21-day incubation period for the disease has passed.

Nigeria saw its first confirmed case of Ebola on July 17 when a Liberian-American man collapsed at a Nigerian airport after traveling from Liberia. The man infected the health workers who treated him, and the country experienced a total of 19 cases and seven deaths. Unlike in other countries like Guinea, Sierra Leone and Liberia, where it took months for Ebola to be recognized, the Nigerian government quickly declared a public health emergency when it discovered the traveler may have come in contact with 72 people at the airport and hospital.

The Nigerian government coordinated the outbreak response with state and national networks and rolled out a massive public education initiative, with trained “social mobilizers” who were deployed to do house to house visits in areas where an Ebola contact resided. Nigeria also recently worked to eradicate polio, and the country tapped into those strategies as part of their response.

Still, if there’s a lesson to be learned from Ebola thus far, it’s not to overestimate containment. As TIME reported last week, there was a period in April when it appeared Guinea’s outbreak had subsided. In actuality, there were several unreported and hidden cases that re-ignited the outbreak with an even greater wave of infections.

TIME human behavior

The One Equation That Explains All of Humanity’s Problems

Relax, it's not nearly this complicated
Relax, it's not nearly this complicated niarchos Getty Images

There's you, there's me and there's everyone else on the planet. How many of those people do you care about?

Good news! If you’re like most Americans, you don’t have much reason to worry about the dangerous state of the world. Take Ebola. Do you have it? No, you don’t, and neither does anyone in your family. As for Ukraine, it’s not your neighborhood, right? Ditto ISIS.

Reasonable people might argue that a position like this lacks a certain, well, perspective, and reasonable people would be right. But that doesn’t mean it’s not a position way too many of us adopt all the same, even if we don’t admit it. If it’s not happening here, it’s not happening at all—and we get to move on to other things.

I was put freshly in mind of this yesterday, after I wrote a story on the newest—and arguably least honest—argument being used by the dwindling community of climate deniers, and then posted the link to the piece on Twitter. Yes, yes, I know. If you can’t stand the tweet heat stay out of the Twitter kitchen. But all the same, I was surprised by one response:

Just out of curiosity, how has ‘climate change’ personally affected you? Has it brought you harm?

And right there, in 140 characters or less, was the problem—the all-politics-is-local, not-in-my-backyard, no-man-is-an-island-except-me heart of the matter. It is the sample group of one—or, as scientists express it, n=1—the least statistically reliable, most flawed of all sample groups. The best thing you can call conclusions drawn from such a source is anecdotal. The worst is flat out selfish.

No, climate change has not yet affected me personally—or at least not in a way that’s scientifically provable. Sure, I was in New York for Superstorm Sandy and endured the breakdown of services that followed. But was that a result of climate change? Scientists aren’t sure. The run of above-normal, heat wave summers in the city are likelier linked to global warming, and those have been miserable. But my experience is not really the point, is it?

What about the island nations that are all-but certain to be under water in another few generations? What about the endless droughts in the southwest and the disappearance of the Arctic ice cap and the dying plants and animals whose climates are changing faster than they can adapt—which in turn disrupts economies all over the world? What about the cluster of studies just published in the Bulletin of the American Meteorological Society firmly linking the 2013-2014 heat wave in Australia—which saw temperatures hit 111ºF (44ºC)—to climate change?

Not one of those things has affected me personally. My cozy n=1 redoubt has not been touched. As for the n=millions? Not on my watch, babe.

That kind of thinking is causing all kinds of problems. N=1 are the politicians acting against the public interest so they can please a febrile faction of their base and ensure themselves another term. N=1 is the parent refusing to vaccinate a child because, hey, no polio around here; it’s the open-carry zealots who shrug off Sandy Hook but would wake up fast if 20 babies in their own town were shot; it’s refusing to think about Social Security as long as your own check still clears, and as for the Millennials who come along later? Well, you’ll be dead by then so who cares?

N=1 is a fundamental denial of the larger reality that n=humanity. That includes your children, and it includes a whole lot of other people’s children, too—children who may be strangers to you but are the first reason those other parents get out of bed in the morning.

Human beings are innately selfish creatures; our very survival demands that we tend to our immediate needs before anyone else’s—which is why you put on your own face mask first when the plane depressurizes. But the other reason you do that is so you can help other people. N=all of the passengers in all of the seats around yours—and in case you haven’t noticed, we’re all flying in the same plane together.

TIME Bizarre

The 35 Most Surprising Photos of the Month

From eating ice cream in the senate to kissing Tony Bennett, each photograph will give you an intriguing experience, as TIME shares the most outrageous images from September 2014

TIME Infectious Disease

5 Reasons We May Never Know Ebola’s True Impact

Ebola Liberia
A Medecins Sans Frontieres (MSF) worker is sprayed and disinfected as he leaves a high risk zone of MSF's Ebola isolation and treatment center in Monrovia, Liberia, Sept. 29, 2014. Jerome Delay—AP

In this unprecedented Ebola outbreak, measuring and predicting the virus' true impact is nearly impossible

The U.S. Centers for Disease Control and Prevention (CDC) published a report in mid-September estimating that if current trends in the Ebola outbreak continue without a ramped up effort, then Ebola cases in West Africa would double every 20 days. In that situation, Ebola cases could reach up 1.4 million by January.

It’s a worst-case scenario estimate, but that’s only one caveat behind the 1.4 million figure, which remains muddled by research limitations and assumptions. While health experts and a CDC official told TIME that it’s common in public health surveillance projects to report overestimates, the fact that this is the worst Ebola outbreak in history adds additional levels of uncertainty in forecasting an unprecedented epidemic.

Here are five reasons why we may never know Ebola’s true impact, despite health experts’ best efforts to fully understand the virus’ deadly potential:

1. Most Ebola cases aren’t reported

CDC researchers believe that for every 1 reported case of Ebola, there are 1.5 additional cases that go unreported. They estimated that without additional intervention, 550,000 Ebola cases will be reported by January, a lower bound that doesn’t account for the cases that go unreported. By correcting for underreporting, they arrived at the upper bound of 1.4 million.

“Underreporting is always an issue with communicable diseases,” says Thomas Gift, an economist at the CDC. “We believe the actual incidence of disease is higher than what shows up in case reports.”

In West Africa, a lack of on-the-ground healthcare resources has meant that many Ebola patients haven’t been treated by doctors, or, in some instances, they have been turned away by doctors, which has resulted in an incomplete headcount of afflicted people.

2. Adjusting the projected numbers accurately is extremely difficult.

“It’s always difficult with these models to try to capture what’s really going on on the ground,” says Dr. Eden Wells, an epidemiology professor at the University of Michigan. “Given the data they used, it’s the best projection they could get at the time.”

The projections were based on data from only one day in only one country—Liberia—Gift said. Researchers used a model to predict the number of beds in use in Liberia on Aug. 28, 2014—the occupied beds were a measure of reported cases. They then surveyed experts at Ebola treatment clinics in Liberia to estimate the actual number of beds in use, weighing that estimate by the proportion of those who stay at home (and are therefore “unreported” cases) who eventually arrive in hospitals: a measure of both reported and unreported cases.

Gift added that while on-the-ground conditions made it difficult to collect more frequent data, there was also an urgency in releasing information about the outbreak. “Why didn’t [researchers] do more to get a range of confidence? Partially because this was designed to provide a tool to be used by people to assess the potential impact of intervention while the outbreak is going on,” Gift says.

3. The projection, based on a slice of data from Liberia, was applied to all of West Africa.

Liberia has been the most hard-hit country in the Ebola outbreak, with more than 1,800 deaths and 3,400 confirmed cases, according to the CDC. Sierra Leone and Guinea have suffered significant death tolls as well, though far fewer than Liberia. “Notable regional differences in underreporting might mean that using one [assumption] across an entire country is inappropriate,” the report said. This could, in theory, result in an overestimate.

“The 2.5 correction factor”—meaning that for every one reported case, there are potentially 1.5 unreported cases, according to the CDC’s modeling—”seems to have been correct for that day,” Gift says. “But [that] might change over time.”

Still, the fact that an Ebola outbreak has never been this widespread—and thus never modeled so extensively—allows the study some liberty in deciding its parameters, the report said.

“The purpose is to show that this epidemic was not going to show signs of peaking on its own. In historic outbreaks, there were a few hundred cases, and the epidemic diminished. That didn’t happen this time,” Gift says.

4. Much of the data coming from West Africa is likely inaccurate or incomplete.

A recent World Health Organization report said that in Liberia, “data were being reported from 4 different and uncoordinated streams, resulting in several overlaps and duplicated numbers.” The report added that many deaths were not being properly documented.

Last week, the New York Times similarly reported a discrepancy between the number of reported deaths in Sierra Leone and the number of buried victims, a fact that further complicates researchers’ efforts to measure Ebola’s true impact.

5. Projecting all the way to January is difficult.

“It’s a bit like weather prediction,” says Marisa Eisenberg, an epidemiology professor at the University of Michigan. “There’s a lot more uncertainty if you’re going all the way out to January versus the end of October.”

The obvious difficulty is that the report is based on the assumption of no significant additional intervention, which, with each passing week, is changing. A shorter-term projection of Ebola cases was provided by the WHO in a report published last week in the New England Journal of Medicine. The projection’s limited time span indicates a more realistic prediction of Ebola cases, even though it also assumes “no change in the control measures for this epidemic.” If Ebola cases were to double every 20 days without additional measures, as the CDC reported, then the WHO’s estimate indicates that there will be about 150,000 cases by January, a markedly more conservative figure.

Still, experts believe there is value in examining the CDC’s “worst-case scenario” of 1.4 million cases. Overestimation offers a safety net in ensuring adequate assistance is provided. If anything, it also adds an urgency to prove wrong the study’s chilling caveat: that this is what could happen if no additional resources are used to battle the deadly disease.

“[The researchers] are trying to cover their bases, and make sure they don’t under-deploy resources,” Eisenberg says. “If you’re going to be wrong in one direction or the other, it’s better safe than sorry.”

TIME Infectious Disease

NIH to Care For US Doctor Exposed to Ebola Virus

Ebola virus
Getty Images

WASHINGTON — The National Institutes of Health is preparing to care for an American doctor who was exposed to the Ebola virus while volunteering in Sierra Leone.

As early as Sunday, the physician is expected to be admitted to the special isolation unit at NIH’s hospital out of what the agency called “an abundance of caution,” for observation.

NIH infectious disease chief Dr. Anthony Fauci wouldn’t discuss details about the patient but said that in general, an exposure to Ebola doesn’t necessarily mean someone will become sick.

Four other American aid workers who were infected with Ebola while volunteering in the West African outbreak have been treated at hospitals in Georgia and Nebraska. One remains hospitalized while the rest have recovered.

TIME Infectious Disease

Liberia’s Ministry of Sound

Education is key to stopping Ebola's spread in this West African nation. Monrovia’s musicians are taking up the call

It seems like any typical Friday night in Monrovia. Out on the streets traffic snarls around the intersections, and taxis and buses are crammed with commuters on their way home after a long week. The ubiquitous sidewalk video bars are filing with patrons settling in to watch European club football on open air screens (Chelsea and Barcelona are favorites here), and the base is starting to thump at Code: 146, the Liberian capital’s hottest live music club. Blake, the house DJ, is priming the audience with promises of a new band. Then he opens with an unusual mike check for a bar known best for getting down: “Let’s get started, but let’s respect the rules. So no too much rubbing, no too much hugging, no too much sweating, no too much drinking. You have to be cautious.”

At first glance it’s hard to tell that Monrovia is the epicenter of an Ebola outbreak that has killed nearly 3,000 people and sickened thousands more in the West African nations of Liberia, Sierra Leone and Guinea. But a closer look reveals what Ebola has wrought. No one shakes hands any more, and the shared taxis, which used to careen around town with as many as five passengers stuffed in the back, are only allowed three, by a new government decree. Public buses are limited to four passengers per row. The video bars, which used to cram as many as 12 football fans to a bench for the big games, are stopping at eight. And at Code: 146 the smell of old beer and fresh marijuana is nearly masked by the pervasive scent of chlorine emanating from a hand washing station placed prominently near the dance floor. “Ebola is real,” Blake shouts over the microphone, as he launches into a rap about a guy who called it a myth. “And now he’s dead.”

Not exactly the most uplifting way to launch into an evening of dance and revelry, but, says the bar’s owner Takun J, “We have a responsibility as musicians to spread the message about Ebola.” Takun J is one of the country’s most well known singers, his style a reggae-tinged Liberian hip-hop dubbed Hipco. He is working on a new song about Ebola, and hums a few refrains as he gets ready for the evening show. “Musicians have the ear of the people,” he says. “Everyone loves Takun J, so when I talk about Ebola, everyone knows it’s serious.” He pauses for a moment, then grins. “They will listen to me more than to the President.”

Takun’s efforts, along with a widespread education campaign conducted by various NGOs, seem to be having an impact. “When the crisis first started, I would say 30% took Ebola seriously and 70% of the people didn’t believe it was real,” says Matthew G. Slermien, head of a teenage empowerment program in the Monrovia slum of Westpoint. “Now those numbers are reversed.” Slermien’s project, Adolescents Leading Intensive Fight Against Ebola (ALIFE), has trained 142 young women and men to go through the community educating residents about Ebola and how to protect themselves.

“People are starting to listen,” says ALIFE volunteer Hazel Toe. It’s not perfect—the organization doesn’t have the money to distribute chlorine or buckets or gloves to the slum dwellers who can’t buy their own—but it’s a start, she says. “Once people start listening, the rest will follow.” That’s what DJ Blake and Takun J are hoping as well.

TIME Infectious Disease

Ebola Death Toll Tops 3,000

More than 6,500 cases have been confirmed

At least 3,080 people have died of Ebola in West Africa, the World Health Organization said Friday, bringing the death toll from the worst Ebola ever above 3,000 for the first time. More than 6,500 total cases have been confirmed.

The newly-released figure, which includes deaths in Guinea, Liberia and Sierra Leone, comes after a week of worsening news about the deadly disease. Estimates released Tuesday suggest that as many as 1.4 million people may be infected by the end of January under worst-case-scenario circumstances.

Under the best of circumstances, the disease will still have wrecked havoc on a region that has been wholly unprepared for the public health disaster. Currently, countries from around the world are contributing millions of dollars to build facilities to treat patients. WHO officials noted in a statement Friday that current heath facilities are overwhelmed and struggling to handle routine ailments.

“The current situation is so dire that, in several areas that include capital cities, many of these common diseases and health conditions are barely being managed at all,” the WHO said.

TIME health

Stop Making the Ebola Crisis About the United States

Courtesy of Janjay Mason

If you're American and your loved ones aren't anywhere near the affected West African countries, absolutely nothing is happening to you and probably nothing ever will

xojane

This story originally appeared on xoJane.com.

On Christmas break of 2011, my parents both decided that their home country of Liberia was safe enough for my younger brother and me to visit. After sustaining a military coup and a nearly 20-year civil war, the country seemed ready for a turnaround once the war ended in 2003.

The only things I knew about Liberia before then were by word of mouth. Most pictures of the Liberia my parents grew up in had been destroyed by military rebels back in the 1990s. My parents did make sure to visit Liberia on separate occasions before our family trip, just to make sure they could actually bring their children in the future.

We stayed in Liberia for nearly a month. Seeing, hearing and tasting everything that Liberia had to offer opened my eyes and solidified my identity as a Liberian American more than ever. While sitting in a small gazebo in my mom’s birth town of Marshall I looked out at the tranquil bay before me while my mom and aunt half-jokingly talked about us adopting my younger cousin who suffers from sickle cell.

As I looked out at the horizon I felt nothing but peace knowing that life at home could continue without me and that I could survive without life at home.

“This is my country,” I thought. “I could never think otherwise and I will make sure to come back.”

Three years and many pleas to return to Liberia later, an outbreak of Ebola erupted through West Africa. At first I felt a little worried but the intervention of the UN placated me a bit. Still, I made a point to check up on my cousin and her family. Marshall’s location is pretty remote and there isn’t a hospital for miles over there.

I thought the situation would be handled in a matter of weeks. Wrong.

Almost overnight my Liberian friends and family members’ Facebook pages mentioned almost nothing but Ebola. Scrolling down my feed I would see pictures of friends’ summertime selfies or the occasional post about their lives and then right under them a sobering post from an aunt or uncle about the Liberian government’s lack of preparation for Ebola or symptoms and ways to avoid the spread of Ebola. I had a Facebook friend from Liberia who asked me to friend her because we shared the same first and last name. She hasn’t been online since April which is really unlike her.

The talk in my house fluctuates between everyday conversations of dog walking and lunch to the subject of who’s dying, who’s dead, government corruption, and on days when all hope seems lost, how we’ll probably have to wait five or more years to return to Liberia at best. If I happen to be around two or more Liberians, the topic of Ebola is inescapable. Lately, I’m too scared to contact my cousin’s family only to hear more bad news. Reports from Liberia seem to be getting more worrisome. The worst part however, is that no one in the United States seems to be focusing on these problems.

Doctors Kent Brantly and Nancy Writebol bravely risked their lives to help combat Ebola. From what I’ve heard both are recovering here in the United States. Amen! However, people on social media seem to be focusing on two things: the possibility of Ebola spreading to the United States and whether transporting the doctors infected with Ebola into the United States could have spelled the end for us all.

Yes, people are aware that Ebola is occurring, but they don’t think of it as a problem until it comes knocking at their back door. It’s not a tragedy until two highly educated white American doctors contract it. It’s especially heartbreaking because in reality Americans whose relatives are in non-infected countries aren’t being affected at all. They’re just worried.

The people and places that I and many others hold dear are wasting away. Liberians and Liberian Americans alike are scared and angry, and all the while most people are worrying about a virus that would most likely be extremely manageable in a country as developed as the United States.

If you’re currently living in the United States or virtually anywhere that isn’t the affected areas, you’re fine. Don’t worry about an outbreak. Worry about workers like Sister Chantal Pascaline, a Congolese nun who died of Ebola in a Liberian hospital while a Spanish nun and priest from the same order were flown back to Spain to be given better care. Worry about the fact that some colleges had to ask their employees to make sure that their international African students weren’t being ostracized for being rumored to be infected and contagious.

If you’re American and your loved ones aren’t anywhere near the affected West African countries absolutely nothing is happening to you and probably nothing ever will. While many Americans keep watch on Liberia, Guinea, and Sierra Leon to make sure no one makes it overseas, a certain percentage of us watch to make sure everyone we love will make it through this outbreak.

Janjay Mason is a Liberian American, a Texan and a writer.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME health

We Need a Global Health Emergency Corps to Fight Ebola

Liberia Battles Spreading Ebola Epidemic
A worker checks a list of of Ebola relief aid after it was airlifted by the United Nations Children's Fund (UNICEF), on August 23, 2014 in Harbel, Liberia. John Moore—Getty Images

A new health defense strategy is needed that brings immediate, concerted interventions across whole regions

The West Africa Ebola outbreak is fast becoming a disease of mass destruction. A recently issued projection from the U.S. Centers for Disease Control and Prevention (CDC) forecasts a worst case scenario of 1.4 million cases of Ebola by late January if the disease transmission cycle isn’t broken soon. The disease may become so widespread that it may become permanently entrenched and spread elsewhere.

The lagging response in West Africa is laying bare the failure of the world’s health preparedness system. Countries aren’t simply prepared to fight complex disease wars that straddle multiple national borders.

President Obama’s emergency package that sends 3,000 military personnel and 1,700 beds brings badly needed help, but that aid could take weeks to arrive. A further problem is that intervention is slated primarily for Liberia, leaving out Sierra Leone and Guinea. Lopsided U.S. aid on the Liberia side could trigger two unintended consequences: the acceleration of the epidemic in Sierra Leone and Guinea, which in turn could trigger mass migrations of their people clamoring for care at the U.S. hospitals.

In spite of the U.S. commitment, other countries have yet to commit comparable aid to the other two countries or even to the response at large. The UN is stepping in to bolster the response, but the UN and its health agency, the World Health Organization, are hampered by their lack of ability to render direct medical treatment to patients. The battles along the medical front lines are being borne by non-government organizations such as Doctors Without Borders, taking over for the decimated ranks of local health workers. All are besieged by the extent and intensity of the struggle, and if CDC’s ominous scenarios were to be realized, even American aid may not be enough to contain the spread.

To confront Ebola and future waves of “flashdemics” — high velocity, high lethality outbreaks — a new intervention strategy is needed: The creation of an international medical ground force that can be immediately dispatched to stricken zones, endowed with authority to enter countries unimpeded and begin operations. This rapid response unit can quickly and directly treat the ill, humanely care for the dying, and prevents spread to the vulnerable. This unit would implement strategies worked out in advance from a response playbook with pre-determined roles for responders.

A medical reserve force could terminate nascent outbreaks quickly and spare further cost in lives and resources. A stricken country can then recover and rebuild from the emergency response to strengthen its health system against future threats. A coalition of countries, especially those with advanced health systems, could create a force in short order by contributing teams from existing agencies.

However, this kind of badly needed at-the-ready, direct intervention capacity, at a national or regional scale, does not currently exist. International aid organizations are spread out over many regions and are focused on delivering long term aid, not emergency flashpoint response. The largest national donors, prominently the U.S., conduct health aid programs with favored nations, but run relatively few operations in countries whose politics are hostile to the west.

Unpreparedness has left impoverished countries vulnerable to outbreaks that could readily leapfrog worldwide. To counter the potency of Ebola and other powerful diseases, a new health defense strategy is needed that brings immediate, concerted interventions across whole regions. Waiting for individual governments to act alone is simply too risky. Creating a new global health emergency corps should be a top priority for world leaders.

Jack C. Chow is a former assistant director-general at the World Health Organization on HIV/AIDS, tuberculosis, and malaria (2003-2005), and former U.S. ambassador on global health and HIV/AIDS (2001-2003). He is presently a professor of global health at Carnegie Mellon University’s Heinz College for Public Policy, and is based in Washington DC.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

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