TIME ebola

Flight Grounded in Madrid After Passenger Displays Symptoms of Ebola

Air France jet isolated at Madrid airport over suspected Ebola case
Medical staff wearing protection suits stand next to the Air France Airbus A321, which landed at Barajas International Airport in Madrid, Spain, on Oct. 16 2014 Paco Campos—EPA

A passenger showing fever and shaking during the flight was rushed to a local hospital after landing

An Air France flight from Paris was grounded after arriving at Madrid airport on Thursday after one of its passengers showed Ebola-like symptoms.

The passenger was promptly rushed to a local hospital after shaking and showing signs of fever throughout the flight, the Wall Street Journal reported.

Crew members and the 162 passengers were allowed to disembark on Thursday afternoon, and those who were in direct contact or sat nearby the hospitalized passenger are being closely monitored.

Air France canceled the return flight to Paris and said the aircraft would be thoroughly disinfected before resuming operations.

The London Evening Standard reported that the passenger is believed to have visited Lagos in Nigeria.

[WSJ]

TIME Spain

Spain’s Catalonia Calls Off Independence Vote

(BARCELONA, Spain) — The leader of Spain’s separatist-minded Catalonia region called off a Nov. 9 independence vote on Tuesday but said an unofficial poll would still be held that day to gauge secessionist sentiment.

Separatists in the wealthy northeastern region of Catalonia, which has 7.5 million people, have been trying for several years to hold a vote to break away from Spain and carve out a new Mediterranean nation.

Catalonia leader Artur Mas insisted his regional government was not backtracking with the decision. He said it still intends to push ahead with an official vote at a later date but added the symbolic vote would serve as a “preliminary” ballot.

“The Catalan government maintains its goal of holding a referendum on Nov. 9, it means there will be polling stations open, with ballot boxes and ballots,” said Mas. “It will depend on the people for a strong enough participation to show that people here want to vote.”

Mas was forced to suspended the referendum after the Spanish government challenged its legality before Spain’s Constitutional Court, which suspended its staging while it deliberates on the issue.

Spain says only the Spanish state can call referendums on sovereignty and that all Spaniards would be entitled to vote.

Mas said with the referendum suspended, the Catalan government would rely on another law that allows a public consultation. He said the decision had caused a fracture among the region’s pro-vote parties.

TIME Spain

Spain Euthanizes Pet Dog of Ebola-Infected Woman

(MADRID) — The Madrid regional government says it has euthanized the pet dog of a Spanish nursing assistant infected with Ebola.

Police on Wednesday took the dog, called Excalibur, from the Madrid apartment where Teresa Romero and her husband live. The regional government said the animal was sedated before being euthanized and was then incinerated.

Authorities had obtained a court order to kill the mixed-breed dog, saying they could not rule out the possibility Excalibur could spread the deadly virus.

Animal rights groups launched an online campaign to save Excalibur, and the fight went viral in social media.

Protesters tried to stop the dog being taken away in a van, but police with batons cleared a path.

TIME ebola

360,000 Sign Petition to Spare Ebola Patient’s Dog

Spanish Nurse Tests Positive For Ebola
'Excalibur' barks from the balcony of the private residence for the Spanish nurse who has tested positive for the Ebola virus on October 8, 2014 in Alcorcon, Spain. Pablo Blazquez Dominguez—Getty Images

"Excalibur" is at the mercy of Spanish officials, who want to euthanize the dog after one of its owners contracted the disease

Animal lovers have protested, tweeted and petitioned by the tens of thousands to stop Spanish officials from euthanizing an Ebola patient’s dog.

The outcry began shortly after the patient’s husband, Javier Limon, posted a YouTube plea to animal lovers to help spare the life of “Excalibur”. NBC News reports that Limon has been placed in isolation in a Madrid hospital ever since his wife, nurse-aide Teresa Romero Ramos, became the first person to contract the virus outside of west Africa while caring for a Spanish priest who had returned from the region.

Limon said in the recorded appeal, “I’m in the hospital and I’m sending a call to all the population for them to help me save my dog, Excalibur, who they just want to kill just like that without following any proper procedures.”

There have been no documented cases of dogs spreading Ebola to humans, or vice-versa, though other animals may become carriers.

Animal lovers protested outside the couple’s apartment in a southern suburb of Madrid on Wednesday, where Excalibur had been holed up alone with a bathtub full of drinking water and 33 pounds of dog food, Limon told Spanish daily El Mundo. “Murderer,” several shouted at health workers who had arrived to disinfect the apartment.

Protesters also launched a petition to spare Excalibur which has gathered more than 360,000 signatures to date and flooded Twitter with pictures of their own pet dogs signs reading, “#SalvemosaExcalibur.”

The campaign has intensified amid conflicting reports of the dog’s fate in local media, best summed up by the El Mundo headline “¿Dónde está Excalibur?” The most recent update posted by Limon on Facebook says the dog has not yet been taken away by authorities.

 

TIME ebola

Spanish Ebola Nurse Reported Symptoms 3 Times Before Isolation

A Spanish nurse infected with Ebola is moved to Carlos III Hospital from Alcorcon Hospital on Oct. 7, 2014 in Madrid, Spain.
A Spanish nurse infected with Ebola is moved to Carlos III Hospital from Alcorcon Hospital on Oct. 7, 2014 in Madrid, Spain. Gonzalo Arroyo Moreno—Getty Images

It emerged Wednesday that Teresa Romero Ramos, a nurse who caught Ebola after helping treat a patient, made multiple attempts to report her fever

A Spanish nurse who contracted Ebola in Madrid this week told health authorities at least three times she had a fever before she was finally placed in quarantine, it emerged Wednesday, despite having helped treat a patient who later died of the virus.

The nurse, named by the media as Teresa Romero Ramos, is the first person to have caught the Ebola virus outside of Africa in the current outbreak.

Romero Ramos first called a specialized service dedicated to occupational risk at Carlos III hospital in Madrid on Sept. 30 and complained of a slight fever and fatigue, a government official said, but was advised to visit her local clinic. She called again a few days later,the Guardian reports, but nothing was done.

When Romero Ramos called for a third time on Monday, she was finally transported to a hospital by paramedics who did not wear protective gear. Despite warning staff that she had contracted Ebola, she remained in a bed in the emergency room separated from other patients only by curtains.

“It would have been better if she had entered the hospital on the 30th,” Fernando Simón, emergencies coordinator for the Health Ministry, acknowledged to the press this week.

Some have criticized Spanish authorities for not providing sufficient training in Ebola protocols, and nurses complained that there had been no simulations of Ebola treatment by the time two infected missionaries arrived from west Africa.

The Spanish prime minister Mariano Rajoy said Wednesday morning that the Spanish healthcare system was “one of the best in the world,” and asked that “health professionals, who have a proven reputation, be left to do their work.”

[The Guardian]

TIME ebola

Madrid to Kill Dog of Spanish Nurse Infected With Ebola

NBC News

Madrid’s regional government said it would kill the pet dog of a Spanish nursing assistant who became infected with Ebola — overcoming the family’s objections on Tuesday with a court order.

The nursing assistant was the first person infected outside of West Africa, after caring for a Spanish priest who died of Ebola last month. Authorities have three people under quarantine and said that available scientific knowledge indicates there’s a risk the dog could transmit the deadly virus to humans.

Read the rest of the story at NBC News

TIME ebola

Spain’s Ebola Case Exposes Gap in Disease Defenses

A Spanish nurse infected with Ebola is moved to Carlos III Hospital from Alcorcon Hospital on Oct. 7, 2014 in Madrid, Spain.
A Spanish nurse infected with Ebola is moved to Carlos III Hospital from Alcorcon Hospital on Oct. 7, 2014 in Madrid, Spain. Gonzalo Arroyo Moreno—Getty Images

Despite rigorous checks and protocols, a nursing assistant in Madrid still contracted the disease from a sick patient

When two Spanish missionaries working in Sierra Leone contracted Ebola and were evacuated to Madrid’s Carlos III hospital, city officials and the country’s health minister assured a nervous public that the hospital’s strict protocols would prevent transmission of the virus to health workers and other patients.

But something went wrong. A 40-year-old nursing assistant has become the first person to contract the disease outside of Africa after helping care for one of the missionaries, Manuel García Viejo, before his death on Sept. 25. The nurse, who has not been named by the hospital, was infected despite being fully outfitted with two layers of protective gear on the two occasions she helped treat him. She also reported to the hospital that she was suffering from a fever a full week before she was admitted to a highly secure isolation ward early Tuesday morning. At this point no one knows exactly where a mistake was made. But the fact that the hospital’s rigorous checks couldn’t prevent the nursing assistant from becoming sick raises the question: is Europe less prepared for Ebola than it thinks?

“It came as a true surprise, and a stunning one,” says Máximo González Jurado, president of the General Nursing Council (CGE), which represents Spain’s nurses. “We thought we were well prepared, and that the risk—even if it can’t be zero—was minimal. After all, we have very good, very modern health care. Spain has the seventh best health care system in the world.”

At Hospital Carlos III, the 30 health workers who had contact with the infected missionaries donned double layers of head-to-toe protective gear each time they entered the isolation room where the patients were housed. They were also required to take their own temperatures twice daily during the 21-day incubation period for the disease. It was through that protocol that the infected nurse first reported on Sept. 30th that she had a temperature of 38.6 C (101.5 F).

For reasons that are still unclear—possibly because the fever was relatively low, but perhaps because in its early stages, Ebola’s viral count can be too low for detection—the disease was ruled out. Like Thomas Eric Duncan, the visiting Liberian who presented himself at a Dallas hospital on Sept. 25, the nurse was sent home. On vacation from work, she stayed there until an ordinary ambulance brought her to her neighborhood hospital on Oct. 6 with a fever that was by then raging.

“It would have been better if she had entered the hospital on the 30th,” Fernando Simón, emergencies coordinator for the Health Ministry, admitted to the press. But that possible mistake is not the only one under scrutiny. In August, a male nurse at Hospital La Paz, which is affiliated with Carlos III, wrote an anonymous post for the blog of the Madrid Association of Independent Nursing, in which he complained that the staff was not sufficiently trained in Ebola protocols, and that it had not performed any simulations of Ebola treatment by the time the two missionaries arrived.

It’s a complaint repeated by González, the nursing council’s president. “In the case of avian influenza A, the government formed a crisis cabinet, there was exhaustive information available to the public and complete training for health professionals,” he said. “That was not the case with Ebola. According to the information we have, the staff were not receiving the kind of in-depth training they should have.” Those who cared for the two missionaries were not isolated, a protocol that has since changed with the nurse’s case.

“We don’t do many simulations in Spain, and we need to, we need to professionalize this more,” says Dr. Antoni Trilla, epidemiologist at the Hospital Clinic of the University of Barcelona. “It’s only through achieving real verisimilitude that you discover the flaws in your protocols.” He should know: his hospital has had two Ebola scares, both of which turned out to be negative. But the cases enabled the hospital to improve, for example, its procedure for one of the most dangerous moments of care: removing protective gear after contact with the infected.

But even improved training has its limits, especially for a disease so highly infectious as Ebola. “What we know from the situation of healthcare workers in west Africa is that it is sometimes actually people who appear to have taken all the precautions that fall ill,” says David Moore, Professor of Infectious Diseases and Tropical Medicine at the London School of Hygiene & Tropical Medicine.“They may have dropped their guard when removing protective gear or in disposing of a dead body. In west Africa, they learnt that lesson the painful way.”

Caregivers in Europe are likely to learn that lesson too. “It’s unavoidable that there will be other cases like this,” says Zsuzsanna Jakab, European regional director for the World Health Organization. “But Europe—and especially the European Union—is well prepared. I would even say it’s the best prepared region.”

It may need to be. So long as air travel continues to and from the three countries in west Africa worst affected by the disease, the risk of further outbreaks remains high. With nearly 30% of the air passengers leaving Guinea, Liberia and Sierra Leone flying to Europe, the risk of more cases appearing in Europe is real—and growing. A study published in the scientific journal PLoS on Oct. 6 put the risk of Ebola being imported to France by October 24 at 75% and to the UK at 50%. The results were based on levels of air traffic.

It’s healthcare workers like the Spanish nursing assistant who will likely be worst affected. The unnamed woman was in a stable condition as of Tuesday evening, and is receiving immunotherapy in the form of a serum made from the blood of an Ebola patient who recovered. Three people, including the nurse’s husband, have now been placed in quarantine, with medical staff who treated her under observation, and contact tracing of friends and family. But even if she remains an isolated case, others are sure to follow. “We’re never going to see this become an epidemic among the general public in Europe,” says Dr. Trilla. “But there is definitely a risk for medical personnel. They’re the ones I worry about.”

— With reporting by Naina Bajekal / London

TIME ebola

Spain Confirms First Ebola Transmission Outside of Africa

Spain Ebola
An ambulance transporting a Spanish nurse who is believed to have contracted the ebola virus from a 69-year-old Spanish priest leaves Alcorcon Hospital in Madrid on Oct. 7, 2014. Andres Kudacki—AP

Two tests confirmed the Ebola diagnosis

Updated Oct. 7 9:17a.m ET

A nurse in Spain who treated two Ebola victims has tested positive for the virus, becoming the first known person to have contracted the disease outside of Africa, Spanish Health Minister Ana Mato announced Monday.

The woman had worked as a part of the medical team that treated Spanish priest Manuel García Viejo, who died of the virus in September, the Washington Post reports. She began feeling ill last week and went to a hospital on Sunday, though Mato said she is in stable condition and her only symptom thus far has been a fever. Two tests confirmed the Ebola diagnosis.

Authorities said Tuesday that three people had been put in quarantine, the Associated Press reports, including the nurse’s husband and a colleague who also treated Viejo. Over 50 others were being monitored for having possible contact with the nurse.

[Washington Post]

TIME Spain

Spain Looks to Halt Catalonia Independence Vote

Mas signs decree for non-binding Catalinian independence referendum
Thousands of people attend a rally to support the referendum on Catalonia's independence in Barcelona, Catalonia, Spain on Sept. 11, 2014. Alberto Estevez—EPA

Following Scottish rejection of independence from U.K.

Spain’s leader said Monday that he will ask the country’s Constitutional Court to annul a new law that would allow the semi-autonomous Catalonia region to hold a referendum on independence.

Prime Minister Mariano Rajoy’s move, reported by BBC, follows a decree signed Saturday by Catalonia’s President Artur Mas calling for a Scottish-style referendum on independence to be held on Nov. 9. Spain’s central government quickly denounced the move, and Rajoy called the new Catalan law “anti-democratic” and said the vote “is not compatible with the Spanish constitution.”

Catalonia is home to 7.5 million people and is one of the most wealthy and most industrialized areas in Spain. Pro-independence sentiment in the region has surged in the years following Spain’s economic crisis. On Sept. 19, Catalonian lawmakers voted by a margin of 106 to 28 in favor of authorizing the referendum. Mas believes he can use local laws to hold the regional vote because it would be non-binding. He said “Catalonia wants to speak; it wants to be heard and it wants to vote.”

Rajoy responded by saying “there is no one and nothing that can deprive Spaniards of their constitutional rights” since Spain’s constitution does not allow referendums on sovereignty that don’t include all Spaniards.

[BBC]

TIME Parenting

When Parents and the State Disagree Over a Child’s Medical Treatment

ASHYA KING
Five-year-old Ashya King is accompanied by his parents Brett, left, and Naghmeh King, right, on his arrival at the Motol hospital in Prague on Sept. 8, 2014 Filip Singer—EPA

A British couple prevails after a long fight for access to alternative medical treatment for their son, but the debate over parental rights goes on

It almost sounds like the plot of a dystopian novel: a British couple was arrested in Spain and thrown in jail after they took their 5-year-old boy, who has a brain tumor, out of a British state hospital to seek alternative treatment abroad. The wrenching case has unleashed an international debate over parental rights, medical ethics and who should have the final word when it comes to the fate of an extremely ill child.

The boy, Ashya King, was diagnosed with a brain tumor in July. After a surgery to remove the tumor at Southampton General Hospital, in southern England, doctors recommended that Ashya undergo chemotherapy and radiotherapy. (The hospital told TIME that with such treatment, Ashya’s survival rate was between 70% and 80%.) But Brett and Naghmeh King weren’t comfortable with the idea of chemotherapy and began asking the doctors about proton-beam therapy, which is believed to target tumors more precisely than radiotherapy and is thought to be less physically devastating than chemo. According to Brett King, Ashya’s doctor told him that the treatment “would have no benefit whatsoever.” Yet the Kings, who had researched proton-beam therapy and had contacted a clinic in the Czech Republic that offered the treatment, felt differently. So, on Aug. 28, the couple took their son from the hospital and traveled to Spain, in order to sell their property to raise funds to pay for Ashya’s treatment privately.

Unbeknownst to them, the British hospital then contacted the authorities and notified them that Ashya’s life was in danger without proper medical supervision and the Kings were nowhere to be found. (Brett King later said he had told doctors he planned to take his son abroad.) Britain’s Crown Prosecution Services (CPS) issued a European arrest warrant for the couple on suspicion of neglect and cruelty to a child. It wasn’t long before the Kings were found and arrested by Spanish police, while little Ashya was placed alone in a hospital near Málaga, without his family to comfort him.

The ordeal made headlines across the U.K., where a lot of emphasis was placed on the family’s beliefs (they’re Jehovah’s Witnesses), and more than 130,000 people signed an online petition calling for the boy to be reunited with his parents. It was three days before the couple was released and CPS dropped their arrest warrant. The hospital has also suggested that they would now support the family’s decision to seek proton-beam therapy for Ashya.

On Monday Sept. 8, the family was able to transfer the boy to Prague’s Motol hospital where doctors will assess his condition before a potential move to a proton-therapy center. But the family’s ordeal has set raised a spate of questions. How did this happen? How did this couple — who are, by most accounts, loving, devoted parents that only want the best for their desperately ill child — end up being pursued by the authorities in not one, but two countries and thrown in jail? Why did a small boy find himself alone in a foreign hospital without his parents or siblings to comfort him? It’s a murky, complicated case and, for many reasons, it’s not clear just where the blame lies.

Despite the international police search and the arrest of the worried, loving parents of a sick child, British authorities have now admitted that Ashya wasn’t facing much danger. Though the CPS’s spokesman insisted in a statement that at the time the arrest warrant was issued authorities were convinced that there was a “serious risk of threat to [Ashya's] life,” he also noted that investigators had later found that:

[Brett and Naghmeh King] did take certain steps to safeguard the health of Ashya, for example it appears they had ordered specialist foods to care for Ashya, and had managed to charge [his] food pump using their car battery. Also, evidence from two independent medical experts indicated that the risk to Ashya’s life was not as great or immediate as had been originally thought. Accordingly the necessary element of wilful neglect to support a charge of child cruelty could not be proved to the required standard.

As for University Hospital Southampton Trust (UHS), which runs Southampton General Hospital, they stand behind the decision to alert authorities about Ashya, saying in a statement that it was “in line with Trust policy.” Michael Marsh, the medical director at UHS, also said in a statement on Sept. 1, “We very much regret that the communication and relationship with the King family had broken down in this way and that for whatever reason they have lost confidence in us.”

It’s clear that there was definitely a breakdown in trust and communication between the Kings and the doctors. What’s less clear is how that breakdown occurred. For his part, Brett King has said, in a series of YouTube videos posted online, his son’s doctor didn’t appear to be willing to discuss alternative treatments. “He said, more or less, that if I questioned him in anyway regarding his treatment they would get an emergency protection order and take [Ashya] away from me.”

Peter Haughton, a senior adviser in medical ethics and law at King’s College London, tells TIME that in most medical cases, “the law and the ethics are very clear. Both the parents and the doctors have a duty of care [to act in the child's best interests] and the law backs that.”

But in this case, when the parents and the doctors weren’t seeing eye to eye about what was best for the boy, things spun out of control. Though Haughton maintains that the hospital was in line with “their duty of care” in alerting the police, he adds that it’s typically only when it “can be demonstrated that [the parents] aren’t acting in the best interest of the child that society steps in. One thinks of that [in terms of] neglect and those sorts of things, but this wasn’t neglect. This was actually the parents desperately trying to find the best treatment which they thought they were being denied.”

“Normally these things get resolved with a conversation, you find a common perspective,” he says.

Many have suggested that both the police and the hospital overreacted and stepped out of line. (Court disputes over the medical treatment of minors are rare in the U.K., let alone a full-flung police investigation.) Several high-profile figures have also spoken out in support of the Kings, with Prime Minister David Cameron going so far as to publicly state via a spokesman that he believed they were trying to “do the very best for” their son.

Others have suggested that prejudice might have played a part in the incident. Suzanne Moore, a columnist for the Guardian, wrote on Sept. 1 that the Kings “have been effectively criminalised for their distress. And possibly their faith.”

That’s a view shared by British author Ian McEwan, whose most recent novel, The Children Act, is about judge who has to decide whether to force a child to have a blood transfusion against the wishes of his parents, who happen to be Jehovah’s Witnesses. McEwan weighs in on the case in an interview with TIME, calling it an “almighty screwup” and adding, “I’ve got a strong suspicion that when the hospital and the police overreacted, it was influenced by the fact that the parents were Jehovah’s Witnesses.”

Though there was no indication that the Kings’ faith played any role in their decisions, the clash between doctors’ wishes and the beliefs of Jehovah’s Witnesses, who are generally not allowed to accept blood transfusions, has made headlines in the U.K. in the past. For their part, Southampton General Hospital denies that the King’s beliefs factored into their decision to alert the police.

Despite the arrest warrant being dropped, Ashya still remains a ward of the British court system and any subsequent decisions about his treatment must be approved by authorities. On Monday, Sept. 8, there will be a hearing in the U.K., where a judge will have the final say in Ashya’s course of treatment, if the Kings and the medical authorities are still in dispute. It seems likely that the Kings will be able to try proton-beam therapy in the end. But no matter the outcome, it’s hard not to feel that the intervention of the hospital and the state — all in the name of Ashya’s best interests — have worked against him and his parents all along.

— With reporting by Belinda Luscombe

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