TIME Infectious Disease

Ebola Treatment May Emerge From Drug For Another Virus

Ebola and Marburg belong to the filovirus family, and encouraging results from a gene-based therapy against Marburg could jump-start a similar treatment for Ebola

With the latest outbreak of Ebola in western African claiming more than 1,200 lives since March, any advances on the treatment front are welcome—even if they come from studies of a related virus.

Thomas Geisbert, professor of microbiology and immunology at the University of Texas Medical Branch at Galveston, is getting more attention than he expected for his work on a promising therapy for a virus called Marburg because of its potential application against Ebola. In the journal Science Translational Medicine, Geisbert, who spent two decades at the U.S. Army Medical Research Institute of Infectious Diseases working on treatments for emerging and lethal pathogens, reports that delivering bits of RNA encased in a protein to monkeys infected with the nastiest Marburg strain can save their lives. While all of the 16 animals treated with the experimental treatment survived, none of the animals who weren’t treated did.

MORE: We’re Getting Closer to Vaccines and Drugs for Ebola

In 2010, he and his colleagues published equally promising results using the same technique against Ebola Zaire, the same strain responsible for the deaths in western Africa. In that study, however, the animals were treated within an hour of being infected with a highly lethal dose. The animals survived, so Geisbert is eager to test whether delaying treatment longer, up to several days after infection, will also protect patients, just as it did with the monkeys in the current study. Having such a window is critical because in reality, people may not even know they have been infected until they experience symptoms like fever or headaches.

“This is the first study showing that we can treat [filovirus infections] when we first start seeing signs of illness,” he says. “I am very confident that the same will hold true with Ebola. We demonstrated in 2010 that the same strategy works against Ebola Zaire and I think we certainly can optimize the strategy to perhaps do even better.” The animals in the study were dosed with a much higher amount of virus than people would generally see, so Geisbert believes that if it’s possible to extend protection against Ebola, it would buy up to a week of time in which people could be successfully treated. What’s making Geisbert so optimistic is the fact that the technique involves blocking the virus’ ability to reproduce, unlike the therapy that two American health workers received, which relies on antibodies that stick to the virus and incapacitate it before it can infect healthy cells.

MORE: Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

Tekmira, a Canadian biotech company, has begun early human trials testing the safety of the Ebola version of the therapy. While the Food and Drug Administration requires human trials for all new drugs and vaccines, for so-called exotic viruses like Ebola and Marburg, for which intentionally infecting volunteers wouldn’t be ethical because of their lethality, the agency makes an exception. It accepts tests involving animals that replicate the human course of disease, and a trial of the drug’s safety in uninfected, healthy human volunteers. The FDA had put a hold on the company’s application for approval, pending more confirmation that the product was safe to study in healthy people in escalating doses, but that in August the agency changed that to a partial hold. That makes it possible for any person, or country, that requests the treatment to receive it under emergency conditions.

“There is a lot of pressure to move studies [on Ebola] to the forefront and do them sooner rather than later,” says Geisbert. And now there’s more evidence that doing so could potentially save more lives.

MORE: Inside the CDC’s Emergency Operations Center Tackling Ebola

 

TIME Infectious Disease

4 Injured in Violent Clashes as Liberians Storm Ebola Barricades

Liberia Battles Spreading Ebola Epidemic
A Liberian Army soldier, part of the Ebola Task Force, pushes back local residents while enforcing a quarantine on the West Point slum on August 20, 2014 in Monrovia, Liberia. John Moore—Getty Images

The clashes mark a deepening sense of mistrust at official responses to contain the Ebola outbreak

At least four people were injured in clashes with Liberian soldiers and police after the government laid barbed wire barricades around a densely populated slum in an attempt to contain the spread of Ebola.

Young men surged towards the barricades and hurled stones at troops, who responded by firing live rounds of ammunition, the New York Times reports. Agence France-Presse reports that at least four people were injured in the skirmish.

The unrest highlights a deepening sense of mistrust among residents of West Point, a district that government officials designated as a quarantine zone on Wednesday morning. Tensions flared in the area earlier in the week as the opening of an Ebola treatment clinic in a local school fueled fears that health officials were bringing in infected patients from other parts of the city. The clinic was ransacked on Saturday, enabling several quarantined patients to escape.

The death toll from suspected and confirmed cases of Ebola across west Africa climbed to 1,350 people, the World Health Organization said on Wednesday.

[NYT]

TIME Infectious Disease

Aid Group Slams Global Response to Ebola Outbreak

A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on Aug. 17, 2014 near Monrovia, Liberia.
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on Aug. 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Countries are securing their own borders and leaving West Africa to fend for itself

The main agency fighting the Ebola outbreak in West Africa is lashing out at the international response, calling it “non-existent.”

“We are completely amazed by the lack of willingness and professionalism and coordination to tackle this epidemic,” Brice de le Vingne, the operations director of Doctors Without Borders, told the Financial Times. “We have been screaming for months. Now the situation is even worse – we are today on the verge of seeing an entire country collapsing.”

An estimated 2,240 people have been infected with the virus in Guinea, Sierra Leone and Liberia since it first surfaced in March, and more than half of the afflicted have died. Doctors Without Borders (MSF) describes the current situation in Liberia as “catastrophic” and continuously deteriorating. The country has closed its borders, declared a state of emergency and on Tuesday it imposed a curfew on the main slum area in the capital of Monrovia, where Ebola panic has lead to public unrest.

Fear of infection has compounded the disaster, with workers and patients fleeing Monrovia hospitals in recent days, leading to an almost complete collapse of the health system and causing increased risks for other diseases such as malaria.

To be fair, many countries and organizations are sending aid to the affected region. The African Development Bank has pledged $56 million, the United Kingdom has increased its assistance to $8 million, China has sent supplies worth $4.9 million, E.U. support stands at $15.8 million, and the U.S. has pledged the same amount of aid as well as deployed a Disaster Assistance Response Team (DART). According to MSF, however, that’s far from enough.

“Leaders in the West are talking about their own safety and doing things like closing airlines – and not helping anyone else,” Brice de la Vingne told the Guardian, comparing it with the rapid international response to the earthquake in Haiti, where 300,000 people died. “You need very senior people with high profiles, the kind of people who can coordinate a response to a million people affected by an earthquake.”

A million people are currently residing in quarantined regions and are at risk of not receiving adequate supplies of food and water, although the World Health Organization said Tuesday that it had started delivering food aid to hospitalized patients and quarantined districts, in cooperation with the World Food Program. This aid will continue for another three months.

However, the biggest unmet need is for additional well-trained health workers. Professionals on the ground are exhausted, and several hundred have died in part because of a lack of training. MSF and other organizations are stretched to breaking point, some of them because of their involvement in other crises. USAID, for example, is responding to four humanitarian crises at the same time: South Sudan, Syria, Iraq and the Ebola outbreak. It must also weigh up whether to put people at risk.

“There may be a lot of well-intentioned medical staff in the world, but this is Ebola,” DART leader Tim Callaghan told the development web site Devex.

MSF president Dr. Joanne Liu told told the New York Times that it is also more difficult to recruit medical professionals to deal with Ebola than for any other emergency, because of the risk of infection and the dangers of giving constant care to the patients. “You have to learn to live with fear,” she said.

TIME Infectious Disease

A Patient Is Being Tested for Ebola at a California Hospital

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Getty Images

The hospital has not divulged details of the patient or stated if the patient has recently been in West Africa, the disease's epicenter

An unnamed patient has been admitted to a hospital in Sacramento over possible exposure to the Ebola virus, the San Francisco Chronicle reports.

“We are working with the Sacramento County Division of Public Health regarding a patient admitted to the Kaiser Permanente South Sacramento Medical Center who may have been exposed to the Ebola virus,” Dr. Stephen M. Parodi, an infectious-diseases specialist and director of the hospital’s operations, said in a statement.

He said patient samples had already been collected and sent to the Centers for Disease Control and Prevention for further testing. The hospital has also taken the necessary precautions to protect other patients, staff and doctors.

“This includes isolation of the patient in a specially equipped negative pressure room and the use of personal protective equipment by trained staff, coordinated with infectious disease specialists,” said Parodi.

The hospital did not give details about the patient, state when the patient was admitted, or say if the patient had recently been in West Africa, the Chronicle reported.

The world’s worst-ever Ebola outbreak has swept through several countries in West Africa and has killed more than 1,200 people since the first case was reported in Guinea in December of last year.

Two American aid workers, who contracted the disease in Liberia, returned to the U.S. for treatment earlier this month.

[San Francisco Chronicle]

TIME Infectious Disease

Doctors Without Borders Opens New Ebola Ward in Liberia

Liberia Battles Spreading Ebola Epidemic
A Doctors Without Borders staffer supervises as construction workers complete the new Ebola treatment center on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Doctors Without Borders just opened a new ward in Monrovia, Liberia to care for the growing number of patients suffering from the virus

In its latest move to combat a growing outbreak of the deadly Ebola virus in West Africa, Doctors Without Borders/Médecins Sans Frontières (MSF) opened a new ward in Liberia this week to accept more people confirmed or suspected to be infected with the disease.

“There are some really urgent needs here, and much more needs to be done,” says Tim Shenk, lead field communications officer for MSF, speaking to TIME from nearby the new ward.

The new Ebola management center, called ELWA 3, took just two weeks to build, with the help of MSF staff members and local workers hired by the organization. It opened on Aug. 17, and as of Tuesday, it had 32 patients. MSF’s plan is to gradually increase the number of patients in the facility, as the ward is using a novice staff. MSF will slowly accept more patients as the workers get used to the procedures they must go through to protect themselves from contracting the Ebola virus.

The ward has 120 beds, and its layout is meant to reduce risk of exposure to other victims and those treating them. There’s a low-risk area where physicians and workers put on their protective equipment. After that, they can move on to the high-risk area, which is separated into two parts. Each side has four tents with 15 beds each. One side is for suspected cases, and the other is for confirmed cases. The ward is staffed by some of the MSF’s international staff members as well as local health care workers. The new facility has two doctors, with a third on the way.

The new facility’s first batch of patients are people with suspected Ebola who could not be admitted to a facility run by the Ministry of Health due to lack of space. Liberia has 834 confirmed cases of Ebola, with 466 deaths, per the World Health Organization. Worldwide, there have been 2,240 cases with 1,229 deaths.

“The needs of Ebola patients are greater than our capacity and it’s likely it will remain that way for quite some time,” says Shenk. “That’s why the center was constructed, and it’s certainly the case that there are few places where people can be admitted as Ebola patients in this city.”

Over the weekend, reports came out of Monrovia that patients in a temporary holding and quarantine center were missing as members of the community raided the facility. Shenk says that’s not the type of reaction they are experiencing, but that the event proves there needs to be more international support for educating and sensitizing communities on what Ebola is and how it can be prevented.

“Now, not only do we need to contain the outbreak, but we need to respond to the urgent needs of people affected, like kids,” says Shenk. “Schools have shut down, family members have died. These are very urgent social needs. It’s a disaster, and it’s in need of a greater response.”

TIME Infectious Disease

Hospital Says It’s Unlikely Berlin Woman Has Ebola

Suspected case of Ebola in Berlin
People at the main entrance to Campus Virchow Hospital where a woman suspected of being infected by the Ebola virus is being treated in Berlin, Germany, 19 August 2014. Paul Zinken—EPA

A woman displaying symptoms of infectious disease is being treated at a hospital in Berlin and being tested for Ebola

A female patient in Berlin is currently awaiting tests to determine whether she has Ebola, but spokespeople from the Charité hospital where she is being treated say it is unlikely she has the virus.

“The patient suspected of having Ebola has arrived at the Charité. The Charité experts do not assume at this time that they are dealing with a case of Ebola. The patient has not stayed in one of the affected regions. The physicians are leaning more toward an infectious gastrointestinal disease. Of course, in order to formally rule out Ebola, a blood analysis will be carried out,” Manuela Zingl, a spokeswoman for the Berlin Charité hospital where the patient is being treated, said in a statement sent to TIME.

The woman had recently returned from West Africa when she collapsed at her workplace. About 60 police, medics and firefighters were sent to the office, which was put under a lockdown, the Wall Street Journal wrote. A reported 600 people were involved in the quarantine.

If any hospital in Germany is prepared to take in a patient with Ebola or suspected Ebola, it’s the Charité hospital. The hospital recently underwent drills—which you can see in TIME’s coverage—in order to prepare for the possibility, though Dr. Florian Steiner, an infectious disease physician at Charité hospital told TIME he thought the likelihood they would get a patient was slim. In the photos, the physicians wear intensive full body suits, which Dr. Steiner acknowledges is conservative, given that Ebola is not an airborne illness and not easily transmitted. You can read more about their prep here, and see the photos below.

 

TIME Infectious Disease

WHO: Ebola Casualties Top 1,200

A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia.
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Another 84 deaths reported in just three days

The World Health Organization has tallied another 84 deaths from confirmed or probable cases of Ebola virus over the past three days, bringing the death toll in West Africa to 1,229 people.

The WHO released the updated figures on Tuesday and announced an increase in food and aid shipments to roughly 1 million people living within the quarantined areas of Guinea, Liberia and Sierra Leone.

“It is essential that people in those zones have access to food, water, good sanitation and other basic supplies,” the WHO said in a statement, adding that it had partnered with the United Nations World Food Programme to scale up its aide shipments to affected areas and target its deliveries to hospitals and quarantined homes. “Providing regular food supplies is a potent means of limiting unnecessary movement,” the organization said.

Liberia’s information minister said Tuesday that three Ebola-stricken African doctors who were treated with a regimen of the experimental drug, ZMapp have shown “remarkable signs of improvement,” Reuters reports. The minister also confirmed that 17 Ebola patients who escaped from a quarantine center in Monrovia had been found and transferred to a treatment center.

TIME

Ebola Health Workers Battle Death, Heat, Rumors

Ebola Caregivers
Local staff and health care workers for Doctors Without Borders exit an isolation ward in Guekedou, Guinea AP

The outbreak has hit three of the world's poorest countries, where health systems are already woefully understaffed and ill-equipped

(LONDON) — Doctors and nurses fighting Ebola in West Africa are working 14-hour days, seven days a week, wearing head-to-toe gear in the heat of muddy clinics. Agonizing death is the norm. The hellish conditions aren’t the only problem: Health workers struggle to convince patients they’re trying to help them, not hurt them.

Rumors are rife that Western aid workers are importing Ebola, stealing bodies or even deliberately infecting patients. Winning trust is made harder by a full suit of hood, goggles, mask and gown that hides their faces.

“You want to say so much … because they’re in so much pain,” said nurse Monia Sayah, of Doctors Without Borders. “They suffer so much, but they can only see your eyes.”

The outbreak has hit three of the world’s poorest countries, where health systems there were already woefully understaffed and ill-equipped. In Liberia, there is only one doctor for every 100,000 people, while in Sierra Leone there are two, according to the World Health Organization; there were no statistics available for Guinea. The figure is 245 for the United States.

Emotional distress conspires with exhaustion and dehydration, but doctors say it’s hard to stop working. “When the need is so great, you can’t justify not being there for a day or going home earlier,” said Dr. Robert Fowler, who recently worked in Guinea and Sierra Leone.

The critical care doctor at Sunnybrook Hospital in Toronto, Canada — now on sabbatical with the World Health Organization — said that the barrier of the protective suit is big but not insurmountable.

“There was a young girl, about 6, who came in late in the illness who was bleeding from her bowels, very dehydrated and delirious,” he said. Ebola wiped out her immediate family — so she was all alone.

“She was very frightened and very reluctant to engage, and just wanted to push people away,” he said. Fowler spent days trying to help her, bringing her things she wanted like Fanta soda. “She eventually developed this sense that this person in the suit who’s a bit scary is trying to help me.”

One day he brought the girl her favorite dish: cucumbers and lime. “She chowed down,” he said — a sign that she was on the mend. Fowler said the girl was close to being discharged by the time he left Guinea.

The girl is the exception rather than the rule. Death is the fate of more than half of the West Africans infected in the Ebola outbreak.

“With the mortality rate being what it is,” Fowler said, “you know every day there will be a couple of patients on your ward who didn’t make it through the night.”

Dr. Kent Brantly — an American who fell sick from Ebola last month treating patients — echoed Fowler in speaking of the moral weight of the struggle.

“I held the hands of countless individuals as this terrible disease took their lives away from them,” Brantly said in a statement this month. “I witnessed the horror firsthand and I can still remember every face and name.”

Brantly is now being treated in an Atlanta hospital. His condition was improving.

Sayah, the nurse, said that heat makes it impossible to work continuously for more than an hour. It means tasks have to be completed with near-military precision. Her makeshift Ebola tent hospital in Gueckedou, southern Guinea, was converted from an earlier clinic set up by Doctors Without Borders to handle cholera epidemics.

“If you have to do patients’ blood work and IVs, you focus only on this, and you know your other team members will get the patients food and drink,” she said.

The tough odds don’t make it easier to see a patient die.

“There was a very strong, resilient, gentleman, who always made an effort to sit up and open his eyes and tell us how grateful he was that we were here,” said Sahah. She said the man appeared to be improving but suddenly deteriorated. She was forced to take a break after getting dehydrated. When he returned about 40 minutes later, he was dead.

“When a patient dies like that, it’s very upsetting because we’re their last hope.”

Cokie van der Velde, a sanitation specialist for Doctors Without Borders in Guinea and Liberia, cleaned Ebola wards — washing floors, emptying buckets and collecting bodies.

One day, she came across a harrowing sight.

“I walked into a room with four bodies and they’d all died in the most grotesque positions, with a lot of blood and feces everywhere,” she said. “During the night, one man had crawled to the door and the other people who died, they seemed to have fallen off their beds and were bent backwards.”

Normally, the Briton spends her days in Yorkshire, England, tending to her garden and looking after her grandchildren. Van der Velde has worked on two previous Ebola outbreaks and says she does it because she believes in justice and equality.

She said the need for medical care is overwhelming in this outbreak because of the heavy toll Ebola has taken on health workers. Many of those sickened and killed have been doctors and nurses. That has sparked fear among local staffers and led to strikes and resignations.

“I can’t blame them,” van Der Velde said. “They’re scared.”

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