TIME Infectious Disease

Here’s How Ebola Spread in the Democratic Republic of Congo: WHO

A suspected Ebola outbreak in the Democratic Republic of Congo may have no connection to the outbreak in West Africa

On Tuesday, the Democratic Republic of Congo reported to the World Health Organization (WHO) that the country is having an outbreak of Ebola, which appears to be separate and unrelated to the outbreak in West Africa.

According to the information given to the WHO and provided to media, here’s how it spread: The first person to contract Ebola in the Democratic Republic of Congo was a pregnant woman who butchered a bush animal given to her by her husband. She was taken to a clinic after she started displaying symptoms of Ebola virus disease and died on Aug. 11 of a hemorrhagic fever, that at the time, was not yet identified as Ebola. The woman died, and was dealt with by health care workers.

The health care workers who cared for the woman, which included one doctor, two nurses, a hygienist and a ward boy, all developed similar symptoms and died. Similar deaths were discovered among relatives of the first pregnant woman, people who were in contact with the health care workers, and people who were involved in the burial process of all the men and women who died. According to the WHO, from July 28 to August 18 there have been 24 suspected cases of the disease there, which includes 13 deaths.

Currently, samples of those infected are being tested for Ebola.

The Democratic Republic of Congo Ministry of Health is currently monitoring the situation and is undergoing contact tracing with support from WHO.

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Nigeria Confirms 2 New Ebola Cases

Nigeria Ebola
Sunday Alamba/AP Nigerian health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria on Aug. 4, 2014.

The two are the first infected people who didn’t have contact with the ill traveler

Nigeria’s health ministry confirmed Friday two new cases of Ebola in the country, the first people to come down with the disease who didn’t have direct contact with an infected traveler who brought the virus into the country from nearby Liberia.

Nigerian Health Minister Onyebuchi Chukwu said both newly infected people are the spouses of two caregivers who contracted the virus and later died after giving treatment to Patrick Sawyer, the Liberian-American man who flew into the country infected with the virus last month.

Sawyer passed Ebola on to 11 other individuals before he died. The two new infections plus Sawyer bring the total number of Ebola patients in Nigeria during this outbreak to 14, five of whom have died while another five have recovered.


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.
John Moore—Getty Images 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.

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 Infectious Disease

WHO: Ebola Outbreak Countries Should Screen Departing Travelers

An MSF medical worker checks their protective clothing in a mirror at an MSF facility in Kailahun, Sierra Leone on August 15, 2014.
Carl De Souza—AFP/Getty Images An MSF medical worker checks their protective clothing in a mirror at an MSF facility in Kailahun, Sierra Leone on August 15, 2014.

Liberia, Guinea, Nigeria and Sierra Leone advised to conduct exit screenings to contain spread of virus

The World Health Organization (WHO) is asking countries affected by Ebola to conduct exit screenings of people leaving at international airports, seaports and major land crossings.

“Any person with an illness consistent with [the Ebola virus] should not be allowed to travel unless the travel is part of an appropriate medical evacuation. There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation,” the WHO said in a statement. The West Africa outbreak has spread to Guinea, Liberia, Nigeria and Sierra Leone.

The announcement comes after a quarantine center was attacked in Liberia on Saturday. Reports suggest that around 17 Ebola-positive patients were taken from the center, which complicates efforts to track down and isolate people who may have come in contact with the disease. Blood-stained bedding was also stolen from the center, which officials warned may be able to spread the disease.

The WHO has created a Travel and Transport Task Force which will continuously monitor the outbreak in order to provide information and advice to the travel and tourism industry, but is currently not recommending any bans on international travel or trade. The WHO is also not recommending entrance screening for countries not affected by the disease and which do not share borders with affected countries.

The WHO also stressed that transmission of the virus on an airplane is a very low risk. People are contagious with Ebola once they start experiencing symptoms, and when that happens, people are usually too sick to attempt any travel. Ebola is also not an airborne disease, and can only be transmitted through direct contact with infected bodily fluids like blood and vomit. “Travelers are, in any event, advised to avoid all such contacts and routinely practice careful hygiene, like hand washing,” the WHO said.

People who are getting sick are usually family members and friends who are personally caring for a sick person or someone undergoing funeral preparations unprotected.

In a separate statement on Monday, the WHO addressed the threats experienced by health workers fighting Ebola. “Assaults on health workers and facilities seriously affect access to health care, depriving patients of treatment and interrupting measures to prevent and control contagious diseases. WHO has a specific mandate to protect the human right to health, especially for people affected by humanitarian emergencies,” Dr. Richard Brennan, director of WHO’s department of emergency risk management and humanitarian response said.

TIME Infectious Disease

Fake Cures and Ebola-Drug Sensationalism Need to Stop, WHO Says

WHO says there's too much hype for unproven treatments, and too many people claiming to have cures on social media

“Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear,” the World Health Organization (WHO) wrote in a statement sent to the media on Friday.

Public fear and anxiety of Ebola is understandable, the WHO says, since the disease has no known cure or vaccine. But the organization warns that there needs to be more reason when it comes to fervor over experimental drugs that are in very limited supply. The WHO says that the public needs to understand that the majority of treatments available are not approved, and have not been tested in humans.

One of the more disturbing outcomes to come out of the Ebola treatment fervor are fraudulent cure claims on social media. “All rumors of any other effective products or practices are false. Their use can be dangerous. In Nigeria, for example, at least two people have died after drinking salt water, [which was] rumored to be protective,” the WHO writes.

Twitter is full of individuals claiming to know of Ebola “cures,” which the WHO is trying to combat, like the one below:

The U.S. Food and Drug Administration (FDA) put out a warning letter to consumers on Thursday about products claiming to treat Ebola. “Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection,” the letter says. “There are currently no FDA-approved vaccines or drugs to prevent or treat Ebola.”

Earlier this week, a WHO panel deemed it ethical to use experimental drugs and vaccines during the Ebola outbreak in West Africa, but it is still developing use guidelines from a panel of experts. The WHO says the Canadian government is donating doses of an experimental vaccine, adding that “a fully tested and licensed vaccine is not expected before 2015,” WHO says.

Recent numbers for Ebola continue to rise. The latest case numbers from WHO put the number of cases at 1,975 and deaths at 1,069. The WHO reports that there have been no new cases of Ebola detected so far in Nigeria, which is the most recent country to have a small cluster of the disease. The WHO says it is in the process of scaling up a massive international response. The CDC is currently tracking cases to prevent further infections, and the World Food Programme is delivering food to over one million people currently quarantined in zones where the borders of Guinea, Liberia and Sierra Leone meet.

TIME Infectious Disease

Doctors Inside Emory’s Ebola Unit Speak Out

Physicians at Emory University Hospital spoke to TIME about the unit treating the two U.S. Ebola victims, their doubters and the unknown future of emerging diseases

Emory University Hospital faced its share of doubters when it built its serious-communicable-disease unit more than a decade ago. At a time when the threat of infectious diseases in the U.S. seemed to have receded — replaced by worries over conditions like obesity and Type 2 diabetes — the center appeared unnecessary. But last week, when Emory got word that two Americans were infected with Ebola and would need to be evacuated from West Africa, health experts were all too glad the unit existed.

“I have to admit, a lot of people saw this as Noah’s Ark,” says Dr. Bruce Ribner, the infectious-disease specialist at Emory University Hospital leading the care of the American patients with Ebola virus. “They thought, ‘You are not going to have any activity there, you’re just wasting your time with all that.’”

Now Ribner is fielding an average of 100 emails a day from hospitals here and abroad seeking consultations, and there’s a caravan of news vans seemingly permanently parked along the sidewalk in front of the hospital, with news crews braving the thick Georgia heat in pitched tents on the grass.

“When [news of the patients] finally came, we said, ‘This is what we’ve been preparing for for 12 years,’” says Ribner. Indeed, the infectious-disease team caring for the patients with Ebola has been practicing the process of receiving and treating patients with serious diseases — like Ebola, SARS or anthrax — about two times a year every year since 2002, when it created its program and isolation unit with the help of the Centers for Disease Control and Prevention (CDC).

Dr. Alexander Isakov, who helped get the patients from their landed flight to the isolation room, remembers first hearing the news and thinking, Here’s a chance to finally activate all that they had been preparing for, to help people get better. “It’s gratifying,” he says.

Treating the Patients

Though Emory’s isolation unit was created with this precise type of health emergency in mind, experts stress that nearly all U.S. hospitals are equipped and prepared to receive a patient suspected to have contracted Ebola. When both patients were moved from the ambulance into the hospital, choppers ahead captured footage of the full-body protective suits with air-purifying respirators that were worn by the team. Emory says it’s trying to re-message the idea that physicians need to dress in what some are calling “moon suits” to care for a patient.

“Of course the message goes out that you have to dress like some sort of space person,” says Ribner. “Which is an unfortunate message.” The CDC recommends that anyone entering a patient with Ebola’s room wear at least gloves, a gown, eye protection and a face mask, with the acknowledgement that depending on the amount of fluids being excreted, more may be needed. The hospital agrees with this advice, and Ribner says his nurses felt more comfortable wearing the full-body suits. One of the features of Ebola-virus infection is diarrhea. “One [reason from our nurses] was just pragmatic: I don’t want my shoes full of feces. The other was, ‘You know what? These are kind of comfortable,’” says Ribner.

(The patients at Emory have requested privacy, but one released a statement Saturday saying he was getting “stronger every day.”)

Now that more cases of Ebola are spreading in Lagos, a highly trafficked city in Nigeria, the possibility for more patients in the U.S. is not out of the realm of possibility. “If we had to accept other Ebola patients — and we’ve been in contact about possibly doing that — we could do it,” said Dr. G. Marshall Lyon, one of the Emory physicians treating the patients with Ebola. Lyon says the unit also has a contract with the CDC to handle their employees, should any of them be exposed to serious communicable diseases.

A New Age of Infectious Diseases

While Ebola is new in the U.S., it’s not a novel virus, and health experts remain confident that the outbreak will eventually subside. Still, the current Ebola outbreak, the deadliest in history, begs the question: Is the U.S. prepared for other infectious, and even unknown, emerging diseases?

“We live in a world where we are all connected by the air we breathe, the water we drink, the food we eat, and by airplanes that can bring disease from anywhere to anywhere in a day,” says CDC Director Dr. Tom Frieden. “That’s why it’s so important to strengthen global health security and work with countries all around the world so they can do a better job finding threats.” (In recent months, the CDC experienced two lapses in lab safety that raised skepticism about protection oversight, to which Frieden assures, “We blew the whistle on ourselves and began a comprehensive and aggressive program to address lab safety here.”)

In his opinion, the U.S. is facing three threats when it comes to emerging disease: new infections and organisms spreading in different places; drug-resistant bacteria; and intentionally created organisms. “Those risks require us to put in place robust systems,” he says.

Lyon says he remembers reading an article about 20 years ago stating the age of infectious disease was over. It couldn’t have been more wrong. “The bugs have evolved and kept us on our toes,” he says. “We have to deal with things like tuberculosis and measles having a resurgence.”

In 2009, H1N1 emerged as an influenza virus with little known about its transmission or how virulent it was. Ribner says, “We were really lucky” it wasn’t more lethal. “Do I foresee down the road that we could have a more virulent influenza strain? We’ve had them in the past, so yeah, we could,” he says. “Would we handle it? We would handle it as best we could.”

Learning on the Job

Having two patients with Ebola under treatment in the U.S. not only gives them a better shot at life, but it grants doctors the opportunity to learn something. “We have the unique opportunity to look at a disease that we don’t usually see here,” Dr. Aneesh Mehta, the Emory physician who had what he calls the “honor” to be the first doctor to receive an Ebola patient into the isolation room. “For these two patients, if they agree to participate in research down the road, we will be able to really look in-depth at the pathogenesis and the immunological response to Ebola in ways that can’t be done in Africa.”

Mehta says the drills at Emory — as well as the attention being paid to the effectiveness of governmental responses to this pathogen — will help experts better understand how to take care of patients in the larger context of our health care system. “We can teach other health care systems and physicians not only here in the United States, but throughout the world because our processes seem to be working quite well.”

Dr. Jay Varkey, a physician who joined the Ebola care team this weekend, agrees. “My hope is that by providing excellent care here, that learn processes that can be translated and expanded. In my opinion, in a fair and just world, if these processes are really key to improving survival in a disease like Ebola, that countries that are developing can institute them.”

The Emory team is working 24/7 to neutralize the disease in the two infected Americans, and while it’s uncomfortable to be faced with the dark consequences of our interconnectedness, it’s comforting to know that for over a decade, despite questioning, highly trained specialists have been watching our backs.

TIME Infectious Disease

Outside Atlanta Hospital, Liberians Praise American Ebola Patients

Spencer Lowell for TIME Garmai Kpardeh, a member of the Liberian Association of Metropolitan Atlanta rallying in front of Emory University Hospital, August 9.

Liberians living in Atlanta have gathered outside Emory University Hospital to sing thanks to the American physicians with the Ebola virus

There are about a dozen yelling and cheering men and women carrying signs in front of Emory University Hospital here in Atlanta Saturday afternoon. On first look, they appear to be demonstrators protesting the hospital’s decision to accept for treatment a pair of Americans who contracted Ebola while working in West Africa. But a closer look reveals the group is actually a rally meant as a thank you to those patients, a physician and an aid worker who contracted the disease on a missionary trip to Liberia.

It’s 77 degrees and nearly 80% humidity, but members of the Liberian Association of Metropolitan Atlanta (LAMA), a nonprofit representing Liberian citizens residing in Atlanta, are out in force, singing the praises of Dr. Kent Brantly and Nancy Writebol, who are currently in isolation and being treated by the hospital’s infectious disease experts.

“We heard about Dr. Kent Brantly and missionary Nancy Writebol and how they risked their lives to serve humanity and also us,” says Leo Mulbah, president of LAMA. “On behalf of a very grateful nation and community, we came to say thank you to them. We don’t have money to give them. We don’t have anything to give them, but we can say thank you. Thanks to them, [Liberians] are getting the attention our downtrodden folks need, and for that, we tell their families we are in solidarity with them.”

The LAMA members outside the hospital are singing praises to God and holding up signs that read: “Nancy Writebol you’re our hero!” and “We are with ya’ll in prayers.” The group has been holding frequent town hall meetings for their roughly 15,000 members to raise money to buy equipment that might help stop the spread of Ebola in Liberia, where it’s killed nearly 280 people and triggered a nationwide state of emergency.

The two Americans being treated at Emory have been given an experimental drug to fight the disease, a decision that’s caused controversy as there’s not enough of the drug for it to be widely deployed. When asked about the disagreements over the drug, Mulbah said his group is entirely disinterested in the politics surrounding the debate. For now, he says, LAMA and its members just want to offer thanks on behalf of Liberia.

“They epitomize what you need from a human being,” said Mulbah. “We are very thankful that their families allowed them to share their talents to the point of death for us.”

TIME Infectious Disease

Inside the CDC’s Emergency Operations Center Tackling Ebola

Spencer Lowell for TIME CDC leaders integral to the Ebola response, including epidemiologists, laboratorians, logistics, and more, assemble in agency’s command center to discuss next steps in directing the response at CDC Emergency operations center in Atlanta, August 8.

The CDC's emergency unit has been called into full-force this week as the Ebola virus continues to ravage West Africa

It’s early Friday morning, just a few hours after the World Health Organization officially declared the Ebola outbreak a global public health emergency, and the Centers for Disease Control and Prevention’s (CDC) Emergency Operations Center (EOC) is buzzing. Their recently roused battle room of computer screens and realtime maps of Ebola spread is fielding calls from U.S. hospitals, offering logistical support for workers in West Africa, and is continuously updating data on the rising number of infections.

The daily 10 o’clock meeting spills out of the EOC’s primary conference room, where the CDC’s heads of infectious disease control as well representatives for the State Department and USAID meet every morning to discuss what’s happening on the ground in West Africa. This is where they anticipate and discuss their next moves. Only a couple of days earlier, the CDC activated the EOC to a Level 1 response unit, the highest possible alert, which means everyone with related expertise is called to the table.

Spencer Lowell for TIMECDC Director Dr. Tom Frieden

“We have been very concerned at CDC for weeks and months about [Ebola], and we’ve increased our activation to the highest level to surge on a response in Africa,” says CDC Director Dr. Tom Frieden, who just returned the night before from testifying in front of the House Committee of Foreign Affairs about the agency’s ongoing efforts to prepare for—and combat—the disease. “This Ebola outbreak is unprecedented. The single most important thing to understand about protecting Americans from Ebola is that [it has to be stopped] at the source in Africa.”

While the CDC has had experts on the ground since the first week of April, it recently announced that it’s sending a surge of 50 more disease specialists, including diseases detectives, laboratory experts and transmission-data analysts, to West Africa in the next 30 days, but those health workers need support from the stateside EOC for resources, data collection and communication.

A large part of the EOC team is made up of Epidemic Intelligence Service (EIS) officers—health professionals who are part of the CDC’s two-year training program for investigating infectious disease. Kelsey Mirkovic, 29, is a second-year EIS with a PhD in pharmacology who just returned from Gueckedou, Guinea. She was tasked with tracking down infected patients’ possible contacts. “One day there were two deaths of people with Ebola in one village, and 218 people were added to our list of contacts that day,” says Mirkovic. “We are talking about tracking down hundreds of people.”

As of Monday, there were six CDC specialists deployed to Guinea, 12 to Liberia, nine to Sierra Leone, and four to Nigeria, where cases of the virus are beginning to spread in Lagos, the largest city in Africa, much to the dismay of global public health groups.

“If current trends continue, it won’t be long before there’s more cases associated with this one outbreak than all previously outbreaks of Ebola virus combined,” says Dr. Stephan Monroe, the deputy director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, who is spending a lot of his time in the EOC these days. “In most of these other countries, the initial event starts in a relatively rural area. So if we can get in quickly and contain it before it spreads, it’s much more effective. If it starts to spread in a large metropolitan area, especially in the very urban slum areas, it will be much more difficult to control.”

Dr. Frieden told TIME that an outbreak in Lagos is likely going to get worse before it gets better. Monroe says the CDC has experts in Nigeria identifying cases and the infected people’s contacts, as well as people helping local authorities with their exit screenings in order to keep infected people from hopping on an airplane and leaving the country. “In order to fully resolve the outbreak, we’re clearly looking at months, not weeks of effort,” says Monroe.

The EOC is also serving as the hub for Ebola containment in the U.S., should the disease present itself here. The CDC is, conveniently enough, just three minutes from Emory University Hospital, where two evacuated Americans with Ebola virus disease are being treated. The CDC has provided care guidelines for U.S. hospitals. And in one nearly windowless room of epidemiologists at the EOC, experts handle several calls daily from U.S. hospitals concerning sick patients with recent travel history to Africa.

As the weekend approaches, the EOC disease specialists start packing up and trickling out, despite a few frazzled workers trying to print off large outbreak maps that could be sent with traveling disease specialists before the day is done. The glow from the wall of computerized data sets and updates fills the room—with large graphs that highlight the early summer spikes in Ebola cases.

The upward trends serve as a sobering reminder that while the day may be done, the work is far from over. And while tired health care workers may be gaining a weekend, we’re still losing time.

TIME Infectious Disease

Nigeria Declares State of Emergency Amid Ebola Outbreak

The country has seven confirmed cases of the disease

Nigerian President Goodluck Jonathan declared a state of emergency Friday amid an Ebola outbreak plaguing West Africa, approving more than $11 million to fight the deadly disease. Jonathan’s move comes as the deadly disease has infected at least 1,700 people and left more than 900 dead, mostly in nearby Sierra Leone, Liberia and Guinea.

Nigeria, the most populous country in Africa, only has seven confirmed cases and two deaths, but health officials fear that the disease’s arrival there would drastically escalate the severity of the crisis.

Nigeria’s state of emergency declaration comes on the heels of the World Health Organization declaring the Ebola outbreak an international public health emergency, while Liberia and Sierra Leone have also declared similar national emergencies over the virus.

Want to know more about Ebola? Watch TIME’s explainer video above.


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