TIME ebola

Ebola’s Orphans Have No Place to Go

Ebola's toll includes children who lose their parents to the disease. One charity is coming up with a solution

Berlinda watched her mother die. The three-year-old may not have understood what exactly was going on as the ambulance team transported her and her grievously ill mother to Redemption Hospital, one of Monrovia’s dedicated Ebola treatment centers, but at least she knew she was with the one person who loved her more than anything else in the world.

By the time the ambulance arrived at the clinic in Liberia’s capital city on September 15, her mother had slipped into silence, then death. Berlinda, dressed in a pink plaid shirt and ruffled shorts, emerged from the ambulance wide eyed and scared. There was no one there to receive her, just a phalanx of faceless health care workers covered head-to-toe in white biohazard suits. She too was a potential Ebola patient, so no one could risk picking her up for a comforting hug. Instead she was escorted into the center, given a bed and left for observation. A day later her Ebola test came out negative, but there was no one to celebrate, no one to take her home. Her father unknown and her mother dead; she had nowhere to go.

In a crisis as overwhelming as the Ebola outbreak in west Africa, it is easy to forget that behind each daily death toll there are people left to live with unimaginable loss. For children who lose their parents to sickness or death, the results can be devastating. The United Nations Children’s Fund estimates that around 3,700 children have lost at least one parent in an outbreak that has devastated Sierra Leone, Liberia and Guinea. Those numbers are likely to double by mid-October. Sometimes relatives can be rounded up to take in the child, but with fears of contagion so strong, Ebola’s stigma is starting to eclipse even close blood ties.

“Thousands of children are living through the deaths of their mother, father or family members from Ebola,” said Manuel Fontaine, UNICEF’s Regional Director for West & Central Africa. “These children urgently need special attention and support; yet many of them feel unwanted and even abandoned.”

Berlinda was one of the lucky ones. As she peered through the ambulance doors before entering the clinic, she caught the attention of Katie Meyler, the American founder of a Monrovia-based education charity who was at the clinic checking in on one of her Ebola-assistance programs. Meyler snapped a few photos for Instagram (she initially thought her name was Pearlina, until she saw the girl’s paperwork a few days later). In the months before Ebola struck Liberia, Meyler’s charity, More Than Me, had been in the process of setting up a beachside guesthouse designed to earn an income for the organization, which provides schooling for vulnerable Liberian girls. Those plans had been put on hold, but when Meyler saw Berlinda she realized that she had the resources and the housing to be able to do something. “I told the doctors that I could take care of her until they figured out how to find her family,” says Meyler. Two days later, Berlinda was out of the clinic and in a clean, welcoming home full of new toys, staffed with a nurse and a former teacher, and Meyler had a new project on her hands.

For Meyler, whose decade-long, seat-of-the-pants approach to running an NGO in Liberia can be best defined as “give love and the rest will follow,” such a rapid change in objective came easy. (A few weeks ago she brought $500 worth of toys, candy and ice cream to pass out to patients in a treatment center. She admits that giving lollypops to a person afflicted with Ebola may not be sound medical practice, but “if someone is dying, it can’t be bad to bring them some joy.”)

That kind of aid in Liberia has raised eyebrows among the more traditional international NGOs, who prefer to strengthen local institutions instead of providing alternatives. But in the case of Ebola’s orphans, the need has simply become overwhelming. Ebola can take up to 21 days between exposure to the virus and the development of symptoms, so anyone who has been in direct contact with a patient must be treated as potentially contagious throughout a three-week quarantine. Few are willing to take in children under those conditions.

“The best place for those children to be quarantined is with family members,” says Amy Richmond, a child protection officer in Liberia for the Save the Children NGO. “But fear and stigma around Ebola is a growing phenomenon here, and relatives are scared to take these kids in.”

Even without the need for quarantine, Ebola’s stigma lingers. Three weeks ago, ten-year-old Esther and her family were admitted to a clinic for treatment. She survived, but her parents and her brother did not. Even though she is now immune from Ebola and cannot pass on the virus, distant relatives refused to take her.

“There was this big celebration for all the survivors at the clinic,” recalls Meyler. “Everyone was laughing and praying, but she was bawling her eyes out,” because she had nowhere to go.

That’s where Meyler’s guesthouse-turned-temporary-orphanage comes in. The cheerful blue and yellow building, dubbed HOPE House (Housing, Observation and Pediatric Evaluation), is now home to four children, including Esther and Berlinda. Once Meyler gets the appropriate registration through the government, she plans to welcome up to some 70 more. All of the city’s Ebola treatment centers are already calling, she says. “Everyone is telling me they have kids . . . I can tell you that as soon as we open our doors, it is going to be flooded.”

HOPE House isn’t limited just to orphans. The parents of the two other residents, 3-year-old twins Praise and Praises, are still alive, undergoing treatment for Ebola at Monrovia’s MSF-run isolation center. The twins’ grandmother, Marthalyne Freeman, would gladly take them in, but she works 12-hour shifts as an Ebola nurse. Letting them stay with their parents in the center, she says, is out of the question.

“The children get infected or they get traumatized because their parents can’t take care of them,” says Freeman. She has been working as a nurse since the start of the ongoing Ebola outbreak, she says, and she has seen a lot difficult cases. “Children are being abandoned, and when they are discharged there is no place to keep them. And I don’t think the government has any plans for that right now. The situation in Liberia is very hard.” It is. But for at least some children separated from their parents, things are about to get slightly less hard.

TIME ebola

Liberia Hopes Ebola Diagnosis in the U.S. Will Lead to More Help

“Now the Americans know Ebola can go there, maybe they will send more doctors to Liberia”

The news that a man who recently traveled from Liberia to Dallas has been diagnosed with Ebola, the first diagnosis on American soil, was met with mixed reaction Wednesday in one of the West African countries struggling to contain the deadly disease.

Government officials in the capital Monrovia said they have no knowledge of the man’s identity, and have privately expressed frustration that the United States, citing patient confidentiality laws, has not revealed his name or even his nationality. Liberians, ever sensitive to the stigma of Ebola, repeatedly point out that just because the man departed from the capital’s international airport on Sept. 19, it does not necessarily mean he is, in fact, Liberian.

That frustration is reflected on the country’s lively call-in radio talk show. Callers want to be able to identify the man, and pinpoint his nationality, because they say they want to “clear Liberia’s name.” Liberians feel they have been unfairly identified with the Ebola outbreak, which, many point out, started in neighboring Guinea and Sierra Leone, even if Liberia now has the majority of cases. Other call-in guests are taking a longer view, expressing hopes that the case, which is already getting around the clock U.S. media attention, may elicit further American support for the Ebola effort in Liberia.

“Now the Americans know Ebola can go there, maybe they will send more doctors to Liberia,” one caller said. Another brought up the case of American-Liberian Patrick Sawyer, who caught Ebola while working in Liberia, and took it to Lagos, Nigeria, on July 20. He died five days later, unleashing a chain of transmission that ultimately infected 20 and killed eight. Nigerian officials are now saying that the outbreak has been contained. Like the Sawyer case, the caller said, this just further “proves to the world that Ebola is real, and a global threat.” The host agreed. “It is good,” he said, that the patient was getting good treatment in Dallas. It was also good, he added, that Americans can now see the reality of Ebola for themselves: “This will raise international attention, this will let Americans know that Ebola is real.”

TIME Infectious Disease

Gates Foundation Pledges $50 Million for Ebola Battle

LIBERIA-HEALTH-EBOLA-WAFRICA
Health workers before entering a high-risk area on Sept. 7, 2014, at Elwa Hospital in Monrovia, Liberia, which is run by Doctors Without Borders Dominique Faget—AFP/Getty Images

The foundation said it would give funds to U.N. agencies combatting the disease

The fight against Ebola received a desperately needed monetary boost Wednesday, with the Bill & Melinda Gates Foundation announcing a $50 million donation.

In a statement, the foundation said it would release flexible funds to U.N. agencies combatting the disease, which has already killed over 2,000 people in its worst ever outbreak.

“We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease,” said Gates Foundation CEO Sue Desmond-Hellmann.

The foundation said it has already committed $10 million out of the total $50 million to fighting Ebola — $5 million to the World Health Organization (WHO) for emergency operations and research, and another $5 million to the U.S. Fund for UNICEF to support efforts in the worst-hit countries of Liberia, Sierra Leone and Guinea. In addition, it will also pledge $2 million to the U.S. Centers for Disease Control and Prevention.

There have been promising developments in the search for a cure, with a new vaccine reportedly producing positive results. However, the rapidly accelerating spread of Ebola has caused the WHO to project that over 20,000 people will be infected by October.

TIME infectious diseases

2 People Die of Ebola in Democratic Republic of Congo

But the deaths are not related to the current outbreak in West Africa, health officials in Congo say

Two people have died of Ebola in the Democratic Republic of Congo, though the cases may be unrelated to the outbreak in West Africa that has killed more than 1,400 people.

Of eight samples taken in the Boende region of Congo’s northwest Equateur province, two came back positive, Health Minister Felix Kabange Numbi said Sunday, the Associated Press reports. Eleven people are sick and in isolation, and 80 contacts are being traced.

“This epidemic has nothing to do with the one in West Africa,” Kabange said.

Ebola has killed 13 people in the region, including five health workers. The current cases are part of the seventh outbreak of Ebola in Congo, where the disease was first discovered in 1976.

[AP]

TIME infectious diseases

The Protective Suits Helping Doctors Treat Ebola Victims

While people rely on doctors to stop the Ebola outbreaks in Sierra Leone, Guinea, and Liberia, doctors rely on suits to protect them.

There’s only one thing standing between caregivers and the Ebola virus in the patients they treat: suits. Or more formally, Personal Protection Equipment suits (PPEs). They resemble Hazmat suits, of the kind workers once used to clean up the Chernobyl chemical disaster area almost 30 years ago.

The suits cover every part of the body, but as Dr. William Fischer of the University of North Carolina at Chapel Hill explains, if doctors don’t follow all the steps in putting the equipment on and then taking them off, they could accidentally contract the virus.

TIME infectious diseases

Ebola Diagnosis ‘Unlikely’ in New York Patient

New York Health Department officials said the patient had none of the known risk factors for Ebola

Updated 7:30 p.m. ET

A man who arrived at Mount Sinai Hospital in New York City on Monday with a high fever and stomach problems is unlikely to be suffering from the Ebola virus, the New York Health Department said.

The patient had been visiting a West African country where Ebola cases have been reported, but department officials said the patient had none of the known risk factors for Ebola.

“After consultation with CDC and Mount Sinai, the Health Department has concluded that the patient is unlikely to have Ebola. Specimens are being tested for common causes of illness and to definitively exclude Ebola,” it said in a statement.

At a press conference Monday, hospital representatives said they believed the patient was suffering from a more common condition than Ebola and hoped to have a specific diagnosis within the next 48 hours.

Africa is in the midst of the worst Ebola outbreak in history, with over 1,600 reported cases and over 887 deaths in Nigeria, Guinea, Liberia, and Sierra Leone.

Dr. David Reich, president and chief operating officer at Mount Sinai, told TIME that because of the recent Ebola news last week, over this past weekend, the hospital had reviewed and prepared for what it would do if it received a patient with Ebola, including immediate isolation and strict infection-control procedures. “We are very pleased our staff reacted immediately based on their initial screening,” says Reich.

The hospital reported that the patient was being kept in isolation to prevent the spread of the deadly virus, and being tested to confirm whether his symptoms are from Ebola.

“All necessary steps are being taken to ensure the safety of all patients, visitors and staff,” Mount Sinai said in a statement.

When it comes to infectious diseases, Reich says the hospital is well equipped, and experienced. “In terms of contagious disease, the measles is in many ways much more contagious than this,” he says.

Outside the hospital, doctors feel similarly confident in Mount Sinai’s abilities. “If that’s the true diagnosis, I hope the patient does well because it’s a devastating disease,” said Dr. Gustavo Fernandez-Ranvier, a metabolic surgeon at Mount Sinai. “But I’m not worried. People weren’t talking about it at all. There’s risk every day, and this is a great hospital.”

The patient was put in isolation within seven minutes of entering the hospital. Staff members asked all incoming patients about their symptoms and travel histories as a part of the hospital’s plan for a possible Ebola patient.

“Any advanced hospital in the U.S., any hospital with an intensive-care unit has the capacity to isolate patients,” CDC director Dr. Tom Frieden told reporters late last week.

Because Ebola is not airborne and instead spreads through direct contact with bodily fluids like blood and saliva, the CDC has long assured Americans that even if there were to be a patient with Ebola in the U.S. (besides the two Americans with Ebola evacuated from West Africa), the risk for the disease spreading is minimal.

“We are confident that we will not have significant spread of Ebola, even if we were to have a patient with Ebola here,” Frieden said. “We work actively to educate American health care workers on how to isolate patients and how to protect themselves against infection.”

Unlike many health care workers in Western Africa, health care workers in U.S. hospitals have the resources to keep themselves adequately protected while treating patients.

TIME infectious diseases

Liberia Closes Borders to Curb Ebola Outbreak

Outbreak is already the largest on record

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 diseases

Ebola Virus Suspected in Lagos, Nigeria

Samples have been sent to the WHO for testing

The deadly Ebola virus that has killed hundreds across West Africa may have hit Africa’s most populous city, according to a Thursday statement from the country’s ministry of health.

Officials in Lagos, Nigeria are testing a Liberian man after he collapsed at the city’s airport displaying symptoms of the disease. Government representatives also expressed concern because the man worked and lived in Liberia where the disease is prevalent. Blood samples have been sent to the World Health Organization to be tested.

The virus has spread rapidly since an outbreak earlier this year, and health organizations have said they are struggling to control its spread.

In a statement, Nigerian health officials asked that residents “remain calm and take appropriate measures for the prevention and control of the disease.” These prevention measures include avoiding contact with people or animals suspected of having the disease.

While the outbreak has killed hundreds already in Guinea, Liberia and Sierra Leone, it could be especially damaging if it hit Lagos, an urban center with a population of 21 million.

TIME HIV

Researchers Find New Way to Kick Out HIV From Infected Cells

Scanning electron micrograph of HIV-1
Scanning electron micrograph of HIV-1 Getty Images

The technique addresses the problem of hidden reservoirs of HIV in the body, and could herald a new way of battling the viral infection

Once HIV invades the body, it doesn’t want to leave. Every strategy that scientists have developed or are developing so far to fight the virus – from powerful anti-HIV drugs to promising vaccines that target it – suffers from the same weakness. None can ferret out every last virus in the body, and HIV has a tendency to hide out, remaining inert for years, until it flares up again to cause disease.

None, that is, until now. Kamel Khalili, director of the Comprehensive NeuroAIDS Center at Temple University School of Medicine, and his colleagues took advantage of a new gene editing technique to splice the virus out of the cells they infected – essentially returning them to their pre-infection state. The strategy relies on detecting and binding HIV-related genetic material, and therefore represents the first anti-HIV platform that could find even the dormant virus sequestered in immune cells.

MORE: Treatment as Prevention: How the New Way to Control HIV Came to Be

Even more encouraging, they also used the system to arm healthy cells from getting infected in the first place, by building genetic blockades that bounced off HIV’s genetic material. “It’s what we call a sterilizing cure,” says Khalili.

His work was done on human cells infected with HIV in cell culture, but, he believes the results are robust enough to move into animal trials and eventually into testing the idea in human patients.

The key to the strategy is the gene editing technique known as CRISPR, a way of precisely cutting DNA at pre-specified locations. CRISPR acts as a customizable pair of molecular scissors that can be programmed to find certain sequences of DNA and then, using an enzyme, make cuts at those locations. Because HIV is a retrovirus, its genetic material comes in the form of RNA; the virus co-opts a host cell’s genetic machinery to transform that RNA into DNA, which it then inserts into the cell’s genome. HIV’s genes, which it needs to survive, then get churned out by the cell.

MORE: David Ho: The Man Who Could Beat AIDS

Khalili designed a CRISPR that recognized the beginning and end of HIV’s DNA contribution, and then watched as the enzyme snipped out HIV from the cell’s genome. “I’ve been working with HIV almost since day 1 [of the epidemic] and we have developed a number of molecules that can suppress transcription or diminish replication of the virus. But I have never seen this level or eradication,” he says. “When you remove the viral genes from the chromosomes, basically you convert the cells to their pre-infection state.”

The advantage of the system lies in the fact that CRISPR can recognize viral genes wherever they are – in infected cells that are actively dividing, and in infected cells in which the virus is dormant. Current drug-based strategies can only target cells that are actively dividing and releasing more HIV, which is why they often lead to periods of undetectable virus but then cause levels of HIV to rise again. That’s the case with the Mississippi baby, who was born HIV positive and given powerful anti-HIV drugs hours after birth and appeared to be functionally cured of HIV when the virus couldn’t be detected for nearly four years, but then returned.

MORE: Rethinking HIV: After Five Years of Debate, a New Push for Prevention

Khalili admits that more work needs to be done to validate the strategy, and ensure that it’s safe. But it’s the start, he says, of a potential strategy for eradicating the virus from infected individuals. That may involve excising the virus as well as bombarding it with anti-HIV drugs. “We can get into cells, eradicate the viral genome, and that’s it,” he says.

TIME infectious diseases

Scientists to Test Dogs and Cats for MERS Virus

Camels are thought to be the main carriers of the virus that has killed at least 200 people, mainly in Saudi Arabia, but researchers now believe other animals could also be spreading the infection

Middle East Respiratory Syndrome (MERS) has killed around 200 people around the world since first being discovered in 2012. Though researchers believe the virus is carried in camels, the head researcher of a new study suggests other animal species such as dogs and cats could be carriers too.

Thomas Briese of Columbia University, in New York City, published a recent study that showed the respiratory virus infecting humans, mainly in Saudi Arabia, is the same as the one circulating in camels. However, the deaths of people who have never had any contact with camels leads him to believe other domesticated animals could also be carrying the virus, the BBC reports.

Goats and sheep have been tested but show no antibodies that indicate exposure. “The others that we are looking into or are trying to look into are cats, dogs where there is more intimate contact, and any other wild species we can get serum from that we are not currently getting,” he told the BBC.

Researchers will begin testing domestic dogs, cats and rats in the region in hopes of stopping the spread of MERS. Scientists have not yet developed a vaccine, and if they do, they will most likely use it on animal carriers like camels, not on humans.

[BBC]

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