TIME Infectious Disease

There Could Be 20,000 Ebola Cases by November if More Isn’t Done Now

Ebola Lessons
Nurses train to use Ebola protective gear with World Health Organization, WHO, workers, in Freetown, Sierra Leone on Sept. 18, 2014. Michael Duff—AP

Public-health experts warn that the epidemic could turn from “a disaster into a catastrophe”

A new study by the World Health Organization released on Tuesday warned of 20,000 Ebola cases worldwide in just over a month’s time if authorities failed to ramp up efforts to combat the growing epidemic.

“We estimate that, at the current rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 will be 5,740 in Guinea, 9,890 in Liberia, and 5,000 in Sierra Leone, exceeding 20,000 cases in total,” read the report published in the New England Journal of Medicine this week.

The Ebola virus is spread primarily through exposure to body fluids of symptomatic patients. Transmission of the virus is prevented through early diagnosis, contact tracing, patient isolation and infection control along with the safe burial of those killed by Ebola.

However, the virus has primarily hit impoverished West African communities, where many of these protocols are difficult or impossible to enforce.

“If we don’t stop the epidemic very soon, this is going to turn from a disaster into a catastrophe,” Christopher Dye, a co-author of the study and director of strategy at the WHO, told reporters in Geneva. “The fear is that Ebola will become more or less a permanent feature of the human population.”

The publication of the new report comes as Sierra Leone concluded an ambitious lockdown of the country for three days by effectively asking its 6 million residents to stay at home while approximately 30,000 volunteers and health officials canvassed the country to distribute soap and instructions on how to prevent contraction of the virus.

There are currently 5,833 recorded cases of Ebola across six African nations. The disease has killed at least 2,833 people.

TIME White House

U.S. to Commit $500 Million, Deploy 3,000 Troops in Ebola Fight

On Tuesday, President Obama will announce more efforts by the U.S. to lead a global battle against the spread of the deadly virus

Updated at 4:34 p.m. ET

The United States is dramatically escalating its efforts to combat the spread of Ebola in West Africa, President Barack Obama announced Tuesday, during a visit to the Centers for Disease Control and Prevention in Atlanta.

The unprecedented response will include the deployment of 3,000 U.S. military forces and more than $500 million in defense spending drawn from funding normally used for efforts like the war in Afghanistan, senior administration officials outlined Monday. Obama has called America’s response to the disease a “national-security priority,” with top foreign policy and defense officials leading the government’s efforts.

The officials said Obama believes that in order to best contain the disease, the U.S. must “lead” the global response effort. In the CDC’s largest deployment in response to an epidemic, more than 100 officials from the agency are currently on the ground and $175 million has been allocated to West Africa to help combat the spread of Ebola. Those efforts will be expanded with the assistance of U.S. Africa Command, which will deploy logistics, command and control, medical, and engineering resources to affected countries.

Officials said that the Department of Defense is seeking to “reprogram” $500 million in funding from the department’s “overseas contingency operations” fund to assist in the response. Obama has also requested another $88 million from Congress for the U.S. response, including $58 million to expedite the development of experimental treatments for Ebola.

The Pentagon will deliver 130,000 sets of personal protective equipment, thousands of kits used to test for the disease, two additional mobile lab units (one is already on the ground), and a 25-bed mobile hospital to the region. In addition, Africa Command engineers will construct additional treatment units, while the others set up a training center for to educate up to 500 health workers per week. The United States Agency for International Development will also airlift tens of thousands of home health kits and protection kits, including disinfectants and protective equipment, to be delivered to communities affected by the outbreak.

The U.S. effort, named Operation United Assistance, will be based out of Monrovia, Liberia, the country hardest hit by the Ebola epidemic and where the disease is currently spreading fastest, and will be commanded by an Army general. Obama’s announcement follows weeks of calls from global health organizations that global assistance, in particular American help, is needed to address the disease.

The World Health Organization announced last week that as of Sept. 7, there have been 4,366 confirmed, suspected, or probable cases of the disease, with 2,218 deaths. More troubling is the pace of infections, which has steadily risen despite local, regional, and international containment efforts. The WHO has predicted “thousands” of new infections in the coming weeks, calling on the global community to make an “exponential increase” in its response efforts.

U.S. officials have maintained that there is a minimal threat to the United States from the disease, but Obama warned in an interview earlier this month with NBC’s Meet The Press that failing to act could elevate the risk to the nation. “If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates,” Obama said. “It becomes more easily transmittable. And then it could be a serious danger to the United States.”

While the affected countries have imposed screenings at their airports to stop infected individuals from boarding aircraft, U.S. officials outlined efforts to build up detection and prevention capabilities at home, including new training efforts for airline employees and flight attendants to spot ill passengers. Customs and Border Protection officers manning ports of entry to the U.S. have also received additional training to spot potentially infected travelers. Currently the disease can only be spread by direct contact with the bodily fluids of infected patients.

U.S. officials said that in addition to the potential for the disease to spread to the U.S., they are concerned by economic, security, and political instability in countries heavily affected by the outbreak.

Earlier this month, Obama released a video to the people of West Africa, raising awareness about the disease.

TIME Infectious Disease

Ebola Patient in U.S.: ‘I Am Growing Stronger Every Day’

Kent Brantly is one of two Americans being treated for the ebola virus

Kent Brantly, one of two Americans being treated for the deadly Ebola virus in Atlanta, said in a Friday statement that he is “growing stronger every day.” In the message, released by international relief agency Samaritan’s Purse, Brantly also thanked God for aiding his recovery.

Brantly’s words come six days after he arrived in the United States from Liberia, where he was working as a doctor in a post-residency program.

“I am writing this update from my isolation room at Emory University Hospital, where the doctors and nurses are providing the very best care possible,” Brantly’s statement reads. “I am growing stronger every day, and I thank God for His mercy as I have wrestled with this terrible disease.”

The Ebola virus has killed more than 900 people in West Africa. On Friday, the World Health Organization declared the outbreak an international health emergency.

For more about the Ebola outbreak, see TIME’s video above.

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.

 

TIME Infectious Disease

We’re Getting Closer to Vaccines and Drugs for Ebola

Researchers have developed vaccines and treatments that show promise in fighting Ebola in animals, so is the outbreak a good opportunity to test them in people?

On Monday, National Institutes of Health immunologist Dr. Anthony Fauci told CBS This Morning that his research team is working on a vaccine to prevent Ebola, which is completely effective in monkeys, and will be tested in humans in September. And he’s not the only one developing a treatment for the deadly disease. The question is: Should experimental treatments be rushed into practice, given the breadth of this outbreak?

For the nearly 1,400 people who have been infected with Ebola, there isn’t much they can rely on to help them battle the vicious virus. Because the virus hones in on the liver and disrupts the formation of liver cells, which affect blood clotting, people eventually die from shock, when their blood pressure drops too low due to the build up of microscopic clots in the vessels. The only thing that can improve survival is intervening early with proper hydration and nutrition to keep the circulation strong.

But there are several promising interventions in the pipeline, all of which have been very effective in fending off the virus in monkeys, who experience the same symptoms and disease course as humans. Most of these vaccines and drugs, however, have not passed even the Food and Drug Administration’s (FDA) more lenient standards for therapies against exotic viruses like Ebola.

Should drugs get rushed to market?

Normally, companies must prove that a therapy or drug is safe and effective in people through rigorous clinical trials, but no trial would allow participants to ethically get infected with Ebola, given that it’s mortality rate ranges from 50% to 90%. So the FDA recently approved a different pathway for such products in which companies can first prove that the disease progresses similarly in an animal model as it does in people, and that the product is safe when tested in healthy people.

MORE: Picturing Ebola: Photographers Chase an Invisible Killer

Only one of the Ebola vaccines, which uses the cold virus as a vector to introduce the Ebola antigens, has reached the second stage, and public health officials are likely reluctant to introduce them widely in west Africa given their untested status and the fear and suspicion of western medicine that already makes the outbreak so difficult to contain.

“To bring a strictly experimental approach to this population – most people think that’s not a good idea, and not doable,” says Dr. Heinz Feldmann, chief of the laboratory of virology at the National Institute of Allergy and Infectious Diseases.

In order to even consider using such unapproved drugs in the crisis, they have to be requested. So far, neither the governments of the west African countries affected, WHO, nor humanitarian groups like Doctors Without Borders have done so. If they did, then regulatory officials in the U.S. would discuss whether they could be provided on a “compassionate use” basis.

Testing the vaccine on a human

That happened in 2009, when a German researcher received the shot after accidentally pricking herself while working with Ebola in the lab. The immunization she got was developed in 2005 by Feldmann and his colleagues, including Thomas Geisbert, professor of microbiology and immunology at the University of Texas Medical Branch at Galveston. The vaccine both protects against Ebola infection and treats those who are recently infected with the virus.

While it’s not clear whether the lab workers was actually infected – she got the shot 40 hours after the accident – she did not develop symptoms and did not show evidence of the virus in her blood.

“There’s just no financial incentive”

Feldmann says there are other strategies that look equally promising — but taking the next step of testing the products in people is proving more difficult, says Geisbert. “Globally, [Ebola] is not a huge problem in terms of infectious diseases in general. It’s devastating and sad for the people involved but it’s a small market for big pharmaceutical companies. There’s just not a financial incentive to develop a drug or vaccine.”

Unfortunately, it often takes outbreaks like the current one in west Africa, which is the largest in Ebola history (see Infographic: Ebola By the Numbers), to ignite interest in developing treatments. That, Feldmann notes, and the fear that a virus like Ebola could be used as a form of bioterrorism. “The fact is that biothreat countermeasure activities are what pushed multiple governments to do this work,” he says. Some of that investment may pay off in public health benefits, however, since a bioterror event is essentially an intentional and concentrated outbreak. Geisbert recently received a $26 million grant from the National Institutes of Health to study the three strategies, including in combination, to take the interventions to the next step.

And while an outbreak might seem like an ideal opportunity to test new treatments, it may actually be of little use, and may even do more harm than good. “My concern is that if you give the treatment to people in late stage disease, and if the person dies, then everybody is going to blame whatever was given,” says Geisbert. “If the person survives, you may never know if the product worked because it was somebody who was going to survive anyway, without the drug.”

Feldmann agrees. “People like me and others who have worked for years in vaccines and countermeasures are frustrated. But on the other hand, we don’t want to make a step that isn’t well thought through, and ruin the whole approach in the future.”

TIME Infectious Disease

Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

GUINEE-HEALTH-EBOLA
Members of the Red Cross provide information on Ebola to residents in Conakry, Guinea on April 11, 2014 at the start of the largest Ebola outbreak in history CELLOU BINANI—AFP/Getty Images

It's not about high-tech solutions but good old-fashioned legwork

Given the fact that the Centers for Disease Control and Prevention (CDC) is now urging Americans to avoid non-essential travel to Sierra Leone, Liberia and Guinea, which are battling the largest outbreak of Ebola in history, and the Peace Corps has pulled out its volunteers from the region, the key to bringing the epidemic under control will rest not with the highly trained scientists flown in from around the world, but with local volunteers.

In outbreaks like this, which has so far claimed more than 720 lives, the only way to control the spread of disease is by ensuring that anyone who is infected is isolated in a hospital, and that anyone they contacted are also monitored for symptoms. “The main way we have of controlling the outbreak is by preventing further spread of cases,” says Dr. Eileen Farnon, associate professor of medicine at Temple University School of Medicine. “You have to take people who are symptomatic out of the community so they don’t continue to spread disease.”

MORE: Here’s What You Need to Know Now About the Ebola Crisis

In 2007, Farnon, then at the CDC, traveled to the Democratic Republic of Congo and Uganda to help those nations battle smaller Ebola outbreaks. Farnon helped local health officials coordinate contact tracing, which involves asking every infected patient for a list of people they had contact with since they started experiencing symptoms, and then finding and monitoring those contacts for 21 days. “As you can imagine, the more infected patients there are, the number of contacts really grows exponentially,” she says.

The follow-up required an army of volunteers to visit the contacts daily during the incubation period, often taking their temperature and asking them about any unusual health symptoms. If people started showing signs of illness, the volunteers were responsible for contacting a hot line and arranging for them to come to a hospital for further testing and possibly isolation if they were infected.

MORE: Everything You Need to Know About the Deadly Ebola Virus Outbreak

Such contact tracing is also occurring now in West Africa, but it’s likely more challenging because of the denser and more fluid nature of the populations there, says Farnon. In the Democratic Republic of Congo and Uganda, the outbreaks occurred in remote regions and the contacts weren’t mobile and potentially infecting others in densely populated places like airports.

Farnon guesses that if contacts in the current outbreak mention that they are intending on traveling to another country, the health workers will likely discourage them from doing so, but that some, if they aren’t feeling sick, may still continue with their trip. That’s why national health officials need to coordinate screenings at border crossings to ensure that people who become ill are identified and cared for before they can spread the virus.

MORE: Infographic: Ebola By the Numbers

Farnon says there are social challenges as well. “People in the community will realize early on that patients who get admitted to the hospital, usually late in their infection, may die. And many start getting fearful about going to the hospital because they think it means they are going to die,” she says. While there are no treatments for Ebola infection, early care with proper hydration and nutrition can keep patients strong enough to overcome the virus. But even patients who survive are stigmatized because their neighbors think they are still contagious. Farnon says her groups provided a volunteer to accompany patients back to their homes to help them and their community to understand that they were no longer a threat.

The volunteers were the key to keeping the virus contained, says Farnon, and contact tracing, while labor intensive, was the key to managing the outbreaks in which Farnon was involved—and certainly essential to the west African situation as well. “The village health workers and volunteers are the primary means of getting messages to communities, because they have the relationships with the communities and the ability to mobilize others to help people look for the signs and symptoms of Ebola,” says Farnon.

“It’s a huge logistical undertaking,” she says—but it’s necessary.

TIME Infectious Disease

WHO Says All Men Who Have Sex With Men Should Take Antiretroviral Drugs

A nurse takes blood for a free HIV test, during an HIV/AIDS awareness rally on World AIDS Day in San Salvador
A nurse takes blood for a free HIV test during an HIV/AIDS awareness rally on World AIDS Day in San Salvador on December 1, 2011. Luis Galdamez—Reuters

Warns of 'exploding epidemics' of HIV among gay men

The World Health Organization has suggested for the first time that all men who have sex with men should take antiretroviral medicine, warning that HIV infection rates among gay men are exploding around the world.

In guidelines published Friday, it said that it “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection.” Similar guidelines were issued by the U.S. in May.

Gottfried Hirnschall, the head of WHO’s HIV department, says that infection rates among homosexual men are increasing again 33 years after the epidemic hit, partially because the infection doesn’t hold as much fear to a younger generation with access to drugs that enable users to live with AIDS.

“We are seeing exploding epidemics,” Hirnschall told reporters in Geneva.

Although HIV infection rates did drop by a third between 2001 and 2012, Hirnschall characterized progress as “uneven.”

[AFP]

TIME States

Alaska to Put Free Pregnancy Tests in Bar Restrooms

The program will help combat the state's high rate of fetal alcohol syndrome

The University of Alaska is leading a state-funded program to put free pregnancy tests in the bathrooms of 20 bars and restaurants across the state starting this December.

The two-year, $400,000 program is designed to combat Alaska’s rate of fetal alcohol syndrome, which is the highest of any state in the country, the Anchorage Daily News reports. Women of child-bearing age in Alaska are 20 percent more likely to binge drink in comparison to the national average.

“This is not a strategy for the chronic alcoholic who is drinking regardless of whatever message they see,” said Jody Allen Crowe, who founded a Minnesota organization that leads a similar program and is helping with the project. “This is really focused on the 50 percent of unexpected pregnancies, to find out they are pregnant as early as possible.”

Republican Senator Pete Kelly, who has said before that birth control is for women who “who don’t want to act responsibly,” first proposed the program.

[Anchorage Daily News]

TIME Environment

Carbon Regs Will Help Your Health More Than the Planet’s

EPA coal pollution
Carbon dioxide is the chief target of EPA regulations, but they'll also help curb conventional pollutants Photo by Robert Nickelsberg/Getty Images

Public health—through cleaner air—will benefit more from EPA carbon rules than climate change, and that's O.K.

When the White House rolled out the proposed Environmental Protection Agency (EPA) regulations on power-plant carbon emissions on June 2—regs that will reduce emissions 30% below 2005 levels—President Barack Obama attended a conference call with a number of public health groups, including the American Lung Association. Obama talked about the importance of treating carbon as a pollutant, of investments in energy efficiency that would cause electricity bills to shrink, of the momentum behind the move to a low-carbon economy.

But he spent much of his time talking about the health benefits that would come as the regulations cracked down on coal plant pollution:

“I got a letter from Dian Coleman, who is a mother of four. Her three kids have asthma. [...] She keeps her home free of dust that can trigger asthma attacks. Cigarettes aren’t allowed across the threshold of her home. But despite all that, she can’t control the pollution that contributes potentially to her kids’ illnesses, as well as threatening the planet. We’ve got to make sure that we’re doing something on behalf of Dian, and doing it in a way that allows us also to grow the economy and get at the forefront of our clean energy future.”

Carbon dioxide isn’t a pollutant—at least, not in the sense that breathing it in damages health. (If it were, trees would be a lot more dangerous.) CO2 does cause climate change, which in turn can directly threat health by increasing ozone levels, intensifying heat waves and floods and even worsening allergies, all of which the White House detailed in a new report out today. But Obama and his officials have been talking up a different sort of public health benefit that will come with the regulations: the reduction of dangerous, conventional pollutants like nitrous oxides, sulfur dioxide and simple soot. “Our role in this initiative is to protect public health and the environment,” EPA Administrator Gina McCarthy told me in an interview last week. “It’s key in this rule that when we lower carbon, we reduce traditional pollutants.”

The EPA says that the regulations will reduce those conventional pollutants by more than 25% over the lifetime of the rules as a co-benefit. That in turn will avoid up to 6,600 premature deaths, up to 150,000 asthma attacks in children and nearly 500,000 missed work or school days. That might just be the beginning—the more we learn about air pollution, the more dangerous it seems even at lower levels. A new study from the University of Rochester found that exposure to air pollution at a young age caused changes in the brains of mice, including an enlargement in the parts of the brain that is seen in humans with autism and schizophrenia. And air pollution is still a major problem in the U.S.—a recent report from the American Lung Association found that nearly 5 in 10 Americans live in places where the air can be dangerous to breathe.

There’s an added political value to the White House’s focus on the public health benefits of carbon regulations. Note the huge partisan gap on the issue in recent polls: climate change, unfortunately, remains an area where there is deep political division. But air quality and public health is something that Americans can get together on, at least somewhat, without the conversation turning into a debate over temperature trends and IPCC assessments. That could help these regulations, which are supported by a strong majority of Americans, overcome kneejerk Republican opposition. “You don’t need to have a debate over climate change,” says Jim Brainard, the Republican mayor of Carmel, Indiana and a member of the White House task force on climate change. “Who doesn’t want to breathe clean air?”

As I wrote last week, the EPA regulations by themselves will have only a small impact on total U.S. carbon emissions, and a negligible one globally. The hope is that these rules are just the beginning, that they will help prompt other countries to push their own carbon-cutting efforts further, and encourage businesses to find even better ways to accelerate the clean energy revolution. But countless Americans will breathe easier—literally—thanks in part to these rules. That’s reason enough to celebrate.

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