TIME Infectious Disease

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

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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.

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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 ebola

No, The UK Isn’t About To Be Hit By an Ebola Epidemic

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Doctors Without Borders staff carry the body of a person killed by viral haemorrhagic fever, at a center for victims of the Ebola virus in Guekedou, on April 1, 2014. Seyllou—AFP/Getty Images

Though an infected person could technically arrive in the UK, the risk of onward transmission is exceedingly low

A Liberian asylum-seeker was tested for Ebola-like symptoms at a British immigration center earlier this week, The Telegraph reported Thursday. The day before, media outlets said another man had been similarly examined in Birmingham, England. Both tested negative for the often-fatal virus.

The United Kingdom’s Department of Health said that Ebola “is not an issue that affects the UK directly.” It added that should an infected person arrive in the UK., there are “experienced people who are ready to deal with [Ebola] if it were to arrive here.” Two agencies under the Department of Health, the National Health Service and Public Health England further pointed out that the threat Ebola poses to the UK is “very low.”

Strangely, this advice has been largely ignored by a number of national media outlets. The Daily Mail, a right-leaning tabloid, questioned whether “the world’s deadliest disease” — which Ebola certainly isn’t — was heading for Britain. For eight paragraphs, the paper told a terrifying tale: A man had arrived in Britain from Lagos, Nigeria with Ebola. According to the Daily Mail, “[Ebola] would soon be spreading across the country, killing almost everyone it touched.”

Then, in paragraph nine, came relief: “Fortunately this is an imaginary situation.”

This clear scare-mongering might be expected of a tabloid, but The Telegraph, a national broadsheet, has also opted for alarmism. In a seemingly impartial report on the Liberian asylum seeker — whose symptoms had been spotted by immigration officials — the newspaper added, with no explanation: “The incident shows how easy it would be for the deadly disease to enter Britain through illegal channels.”

There is no denying that Ebola is a terrifying illness. Approximately 728 of the 1,322 people in Guinea, Liberia and Sierra Leone, the West African countries hardest-hit by the virus, have died of it, according to the World Health Organization. Ebola has no vaccine, no cure and its most terrifying symptom — external hemorrhaging — makes it perfect media fodder.

Though the image of a patient weeping blood is the very stuff of horror films, Ebola isn’t that easy to catch. The virus is spread through contact with the blood and bodily fluids of an infected person, and a person is only contagious when they’re symptomatic.

“It’s not like flu or the SARS [Severe Acute Respiratory Syndrome] virus,” says David Lalloo, Professor of Tropical Medicine at the Liverpool School of Tropical Medicine adds. “You can’t catch Ebola through the air.”

Sitting next to someone with the early flu-like symptoms of Ebola wouldn’t lead to infection. A victim with the later symptoms — hemorrhaging, vomiting and diarrhea would likely be too sick to board a plane.

“The reality is the risk to the UK’s public health is really quite small,” says Lalloo. Though it is possible that an infected person may make it undetected to the UK — Ebola has an incubation period of up to 21 days — they would most likely be prevented from infecting all of Britain. “All [UK health workers] have been alerted to the possibility that people traveling from the region might be infected with Ebola if they’re displaying a fever,” Lalloo adds.

Public Health England, a government health agency, told TIME that comprehensive measures are in place to deal with the potential arrival of an Ebola patient. They have created a detailed algorithm for healthcare workers to assess and treat people suspected of suffering from a viral hemorrhagic fever that may be caused by Ebola. “If there is a symptomatic person on board the flight, the aircraft contacts air traffic control, who makes contact with primary responders and the health control unit at Heathrow [Airport], a Public Health England spokesperson said. “Other airports would send the person to [the] hospital for assessment if that was appropriate.”

Anyone found to have Ebola would be immediately quarantined, and anyone they had contact with would be tested.

“There have been odd cases of viral hemorrhagic fever that have come into the UK,” says Lalloo. However, fast and effective treatment has meant “there hasn’t been onward transmission.”

It’s likely that the media hysteria was sparked by the arrival of an infected Liberian official in Nigeria on July 20. The man later died, and news outlets were frantic that a similar traveler could reach the UK. What wasn’t as widely reported was that the Lagos hospital was evacuated and quarantined, and Nigeria’s current number of confirmed Ebola cases remains at one. As Lalloo points out, the current epidemic “has been going on for three to four months now … the only difference is someone arrived in Nigeria with Ebola.”

The West isn’t about to be hit by an Ebola epidemic soon. Well-resourced and prepared for such diseases, any case will most likely be rapidly contained and dealt with. Ebola is tearing through West Africa because the three impoverished nations of Guinea, Liberia and Sierra Leone lack the facilities and staff to manage Ebola — Western media would do well to focus on that.

 

TIME Infectious Disease

The Psychological Toll of Ebola in Sierra Leone

A nurse from Liberia sprays preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus, Monrovia, Liberia, 28 July 2014.
A nurse from Liberia sprays preventives to disinfect the waiting area for visitors at the ELWA Hospital where a US doctor Kent Bradley is being quarantined in the hospitals isolation unit having contracted the Ebola virus, Monrovia, Liberia, 28 July 2014. Ahmed Jallanzo—EPA

Ane Bjoru Fjeldsaeter has been counselling staff, patients and their families at the Doctors Without Borders' Ebola treatment center in Sierra Leone

In West Africa, the deadly Ebola outbreak is worsening daily. The U.N. announced Thursday that 1,323 people have been infected in Guinea, Liberia, Nigeria and Sierra Leone. Of those afflicted, 729 have died.

The tiny country of Sierra Leone has been hit hardest, with 533 reported cases. The President of Sierra Leone, Ernest Bai Koroma,
has announced a public health emergency, some schools and banks have closed, and doctors are scrambling to treat people for a virus they can’t cure—or contain. As patients worsen, their bodies—and their minds—take a toll.

Amid that chaos and fear was Ane Bjoru Fjeldsaeter, a psychologist who was working at a Doctors Without Borders’ treatment center in Kailahun until recently, when she returned home to Norway. The only mental health professional in the 64-bed center, she was tasked with providing emotional support and counseling to victims, their families and those treating them.

“The fear is widespread,” she says. “When we first started working in the region there was a lot of denial. It’s a common psychological response when faced with a horrible situation.”

For those inside the treatment center, the grim reality of Ebola was impossible to ignore. “They see people around them with a rapidly progressing and ugly disease,” Fjeldsaeter says. “It’s a scary situation to be in.”

Doctors Without Borders has been operating in Kailahun since June 25 and the mortality rate within the center has dropped from 90% to 60%, according to Fjeldsaeter. She counseled patients at a distance of 1.5 meters, separated by two orange fences that came up to waist height. “If someone is so sick they can’t come to the fence, I’ll wear protective equipment and go to the isolation ward,” she says.

“Most of the patients were more concerned about their relatives than their own lives,” she explains. For others, the isolation can be extremely trying, and as their health worsens and their own mortality looms, many turn to God. “Sometimes they asked me to pray with them or for them,” she says.

In such an emotionally charged environment, staff are often affected. “It’s a workplace where it’s common at times to become overwhelmed with emotion,” Fjeldsaeter says. “Staff told me they didn’t feel professional. I had to tell them, ‘Nobody’s made of stone, we’re all affected by this. It’s a national tragedy and it’s okay to cry.'”

She also offered some group counseling for staff. “They have shared concerns. There’s a fear of contamination and the feeling of helplessness because there’s no cure. They’re up against the disease and they don’t know what to do. There’s clear sadness.”

Despite the horrors that she witnessed during her month in Sierra Leone, Fjeldsaeter remains stoic. She admits to being scared but adds: “If you’re not scared then you’re not careful. You have to embrace your fear a bit, but you can’t let it paralyze you.”

 

 

TIME Sierra Leone

Sierra Leone Declares Health Emergency Amid Ebola Outbreak

"Fellow citizens, this is a national fight, and it behoves all of us to stand together to promote the truth about this deadly disease."

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Updated 9:16 a.m. ET July 31

The president of Sierra Leone has declared a public health emergency over a deadly Ebola outbreak that has killed 729 people across West Africa, according to the World Health Organization.

In a statement posted online late Wednesday, President Ernest Bai Koroma said he is implementing for up to 90 days a series of measures aimed at tackling the Ebola virus, including quarantining areas where the disease has emerged and banning most public meetings. Koroma also said he is canceling a planned trip to the United States and instead meeting with regional leaders to address the outbreak.

“Fellow citizens, this is a national fight, and it behoves all of us to stand together to promote the truth about this deadly disease,” Koroma said in the address. “Ebola is real, and we must stop its transmission.

“I hereby proclaim a State of Public Emergency to enable us take a more robust approach to deal with the Ebola outbreak,” he added.

Koroma also called on the country’s parliament to convene and for officials to avoid non-essential foreign trips.

The measures, which came a day after Sierra Leone’s top Ebola doctor, Sheikh Umar Khan, died from complications caused by the disease, are in line with similar policies announced Wednesday in Liberia, which said it would shutter schools.

On Wednesday, the U.S. Peace Corps said it was pulling all 340 volunteers from Sierra Leone, Guinea and Liberia amid what has become the worst-ever global Ebola outbreak, while two volunteers were isolated after having been exposed to a person who was later killed by the virus.

Sources: WHO, CDC, Mayo Clinic

For more on the Ebola outbreak, see the infographic and video above.

TIME West Africa

Peace Corps Pulls Volunteers Out of West Africa Amid Ebola Scare

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Gloves and boots used by medical staff, drying in the sun, at a center for victims of the Ebola virus in Guéckédou, on April 1, 2014 Seyllou—AFP/Getty Images

Because of the spread of the Ebola virus, the organization announced Wednesday

The Peace Corps announced Wednesday that it’s pulling volunteers out of parts of West Africa amid an outbreak of the deadly Ebola virus. Volunteers in Liberia, Sierra Leone and Guinea are being recalled until further notice.

“The Peace Corps has enjoyed long partnerships with the government and people of Liberia, Sierra Leone, and Guinea and is committed to continuing volunteers’ work there,” the group’s statement reads. “A determination on when volunteers can return will be made at a later date.”

The organization currently has 102 volunteers in Guinea, 108 in Liberia and 130 in Sierra Leone, it says. On Wednesday, CBS News reported two Peace Corps volunteers in Liberia had been quarantined after possibly being exposed to the deadly virus, though neither currently exhibits symptoms.

As of July 23, 672 people have died from Ebola during the current outbreak, which has spread between Guinea, Sierra Leone, Liberia and other parts of West Africa. Earlier this week, a hospital in Nigeria shuttered its doors after admitting a man who had contracted and later died from the virus.

World leaders are on high alert in light of the outbreak, which is the largest in history. Symptoms of Ebola include fever, diarrhea, vomiting and intense weakness; the fatality rate of this epidemic is about 60%.

TIME Infectious Disease

Infographic: Ebola By the Numbers

West African countries are trying to contain the deadly disease

The number of Ebola cases have continued to climb this week in Guinea, Sierra Leone, Liberia, and now a recent victim in Nigeria. Here’s everything you want to know about the disease.

Sources: WHO, CDC, Mayo Clinic

You can also read more here.

TIME infectious diseases

Liberia Closes Borders to Curb Ebola Outbreak

Outbreak is already the largest on record

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The Liberian government closed off most of the country’s border crossings Sunday in an effort to curb an Ebola outbreak that has already killed over 670 people across Guinea, Liberia, and Sierra Leone and become the largest outbreak of the virus on record.

President Ellen Johnson Sirleaf said the airport will remain open, but that all travelers coming in and out will be tested for the virus, Reuters reports. “All borders of Liberia will be closed with the exception of major entry points,” she said. “At these entry points, preventive and testing centers will be established, and stringent preventive measures to be announced will be scrupulously adhered to.”

Ebola kills around 90% of those who contract it, although the current outbreak has only killed around 60%. Numerous medical personnel have succumbed to the most recent outbreak, including Dr. Samuel Brisbane, one of Liberia’s most high-profile doctors, who died Saturday.

Two Americans, Dr. Kent Brantly and missionary Nancy Writebol, have contracted the virus and are currently in stable condition, NBC reports. Both worked for North Carolina-based aid group Samaritan’s Purse, and spokeswoman Melissa Strickland said that they are both “alert.”

Brantly and Writebol had followed all CDC and WHO guidelines and worn full protective equipment when treating Ebola patients, including gloves, goggles, face protection, and full body coverings, Strickland said.

Since Ebola is highly contagious, Liberia has also restricted public gatherings such as marches and demonstrations until the outbreak is brought under control. “No doubt, the Ebola virus is a national health problem,” President Sirleaf said in a statement. “And as we have also begun to see, it attacks our way of life, with serious economic and social consequences.”

TIME Infectious Disease

Report: U.S. Citizen Tested for Ebola in Ghana

U.S. Embassy is working to confirm case of deadly virus

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A U.S. citizen who traveled in regions of West Africa in the grip of an ebola virus outbreak is being tested for the disease in Ghana.

“He is an American and records showed that he had been to Guinea and Sierra Leone in the past few weeks,” a senior health ministry official told Reuters in an interview. The patient is reportedly quarantined in a clinic in the capital Accra and test results, which should be available later on Monday, are being examined at the Noguchi Memorial Institute of Medical Research.

According to Reuters, the U.S. embassy in Ghana has been informed of the case and is working to confirm it.

The ebola outbreak, which started in Guinea, has been declared “out of control” by the health group Doctors Without Borders, which is treating patients in Western Africa. Ebola causes fevers, vomiting, diarrhea and death, and has spread from Guinea to Sierra Leone and Liberia.

[Reuters]

TIME

Here’s What It Will Take to Contain the Worst Ebola Outbreak in History

Doctors Without Borders is calling the latest outbreak in west Africa “out of control,” and here’s why

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The “perfect storm” analogy is often over-used when it comes to disease outbreaks–all the elements that you don’t want to see converge to make conditions ripe for a bacteria, or, in this case, a virus, to rip through a population at lightning speed: geography, society, culture, a potent virus, reluctant politicians and a weak health care system. But all those factors are contributing to history’s largest-ever Ebola outbreak, which the World Health Organization now calls a “crisis.” Since early spring, Ebola has spread to two additional countries, Sierra Leone and Liberia, infecting 635 people and claiming nearly 400 lives.

MORE: Ebola Outbreak Beyond Our Control, Doctors Without Borders Says

The Ebola virus causes a nasty infection that triggers an inflammatory reaction so intense, patients essentially drown in their own fluids as they bleed internally and externally — victims’ bodies are overtaken with a well-intentioned defensive system run amok. Anyone who comes into contact with the infected fluids can also get infected. As of now, there are no treatments for Ebola. The only hope is for the body to remain strong enough to overcome the initial onslaught from the virus and start to develop antibodies to fight it. As patients get sick, they stop eating and drinking, becoming too weak to develop these critical antibodies. Left alone, nine out of 10 infected people die. At treatment centers, where doctors can provide supportive care with nutrients and hydration, that figure improves to seven out of 10.

Those aren’t great odds, and social and cultural practices in west Africa may be stacking the deck even further. Dr. Michel Van Herp, a physician and epidemiologist with Doctors Without Borders who traveled to Guinea when the outbreak began, says he has been confronted by hostile villagers who did not welcome the medical help.

“I have had aggressive people in front of me in the village,” Van Herp says, as he tried to bring infected patients to treatment centers. “Most villagers are denying the existence of Ebola.”

MORE: 6 Things to Know About the Latest Ebola Outbreak

That denial is fueled by a strong stigma against the disease. In other parts of central Africa where smaller outbreaks occurred, survivors of Ebola returned to their villages only to find their homes burned and their remaining family members ostracized for having been infected.

Such denial not only increases the risk that the close contacts of those infected by Ebola will be affected, but it also creates the ideal situation for the virus to gain an even broader foothold. A critical first step in containing any outbreak of infectious disease involves carefully tracing which people patients have been in contact with. Only then can scientists start to create barriers against the virus by keeping it contained to people known to have already been exposed. In Guinea, denial and stigma against Ebola means some patients who believe they are infected are fleeing to other villages or even crossing the border to another country.

“If you have a guy who runs away to a village 20 kilometers away, then you need to start from scratch in that village to trace his contacts,” says Van Herp.

MORE: What You Need to Know About the Ebola Virus

Making things worse is the fact that in the part of western Africa where the outbreak is centered, the population is particularly mobile, often traveling to nearby Sierra Leone and Liberia in search of work.

“We’ve seen kids who travel between three or four villages, and between the countries before they are too sick and weak that they aren’t able to work any more,” says Van Herp. “In the meantime they have contaminated three or four villages.”

Cultural practices mean that the potential for transmitting Ebola is also amplified if a respected elder is affected.

“If a guy like this falls sick, then more people try to cure him,” says Van Herp. “If he dies, more people are involved in the process of the funeral–in cleaning the dead body, and preparing the body. We have seen that one patient can give disease to 15 or 20 other people.”

Van Herp plans to return to Guinea in July, but he says that so far, there hasn’t been much improvement in people’s education and acceptance about Ebola, despite the rising number of deaths. The WHO has called an emergency meeting of 11 nations next week to discuss ways of containing the outbreak. Attending will be the Minister of Health from Uganda, where the government has made efforts to address the stigma associated with Ebola by creating a survivors network to educate and inform the public about the disease–and hopefully reduce fear and misperceptions about the virus.

TIME Infectious Disease

Ebola Outbreak Beyond Our Control, Doctors Without Borders Says

Doctors Without Borders/Médecins Sans Frontières staff carrying the body of a person killed by viral hemorrhagic fever at a center for victims of the Ebola virus in Gueckedou on April 1, 2014.
Doctors Without Borders/Médecins Sans Frontières staff carrying the body of a person killed by viral hemorrhagic fever at a center for victims of the Ebola virus in Gueckedou on April 1, 2014. Seyllou—AFP/Getty Images

The medical group treating Ebola patients in Africa says it can't keep up with emerging cases

Doctors Without Borders/Médecins Sans Frontières (MSF), the medical organization treating Ebola patients in West Africa, says it has reached the limit of what the group can do to fight the worsening outbreak there.

In a statement released Monday, the organization said it is the only group treating people infected with the disease in Guinea, Sierra Leone and Liberia. “We have reached our limits. Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites,” said Dr. Bart Janssens, MSF director of operations, in a statement.

Since the outbreak started in March in Guinea, MSF says it has treated 470 patients (215 of them confirmed cases) related to Ebola. The group has 300 international and national staff working in West Africa and has sent more than 40 tons of equipment and supplies. But with new cases emerging in new places like Sierra Leone and Liberia, the organization says it cannot keep up. Earlier, the group said the outbreak is “out of control.”

Since the disease emerged earlier this year, there have been over 520 cases and 330 deaths. Ebola is a very infectious hemorrhagic fever that has up to a 90% fatality rate. In April, Guinea’s Health Ministry said deaths from Ebola slowed and that the outbreak was close to being brought under control. But the World Health Organization reported earlier this month that in Guinea alone, there were 37 new cases and 21 new deaths between May 29 and June 1, 2014.

MSF said more groups need to help quell public anxiety over the disease, and that people are distrusting health facilities and not heeding warnings about funeral rituals that put them at risk. “Civil society and political and religious authorities are failing to acknowledge the scale of the epidemic, with few prominent figures spreading messages promoting the fight against the disease,” the organization said. In the statement, Janssens says the WHO and neighboring countries need to provide resources necessary for an epidemic.

The WHO has not released a response to the MSF statement but says it is working with local governments and is planning a regional meeting in Ghana on July 2, the Associated Press reports. The WHO does not currently recommend any restrictions to travel or trade in Guinea, Liberia or Sierra Leone.

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