Three weeks ago, after 20 years in healthcare (radiology), my niece who worked at Texas Health Presbyterian Hospital Dallas resigned to pursue other opportunities outside of healthcare.
MAIN EBOLA DISCUSSION THREAD - 09/16/2014 - 09/30/2014
- Thread starter Countrymouse
- Start date
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Medical Maven
Deceased
This new subclade of Ebola is different. Posted by Pixie at the PFI Forum.
Ebola: Bleeding Less Common but More Deadly
By Lindsey Dow
September 29, 2014.
http://guardianlv.com/2014/09/ebola-bleeding-less-common-but-more-deadly/
Although bleeding is generally considered one of the most tell-tale signs of Ebola, recent data collected on patients in West Africa suggest that bleeding is less common but more deadly, at least with the strain in West Africa. The report, published by the New England Journal of Medicine, contains data on 1,415 Ebola patients from Liberia, Sierra Leone, Guinea and Nigeria, with an onset of symptoms as recent as August 17.
The data consists of 685 males (48.5 percent) and 730 females (51.6 percent), which suggests males and females are about equally likely to contract Ebola in the West Africa epidemic. Of the 685 male patients, 75 percent died and of the 730 female patients, 74 percent died, which suggests that males and females are about equally likely to die from Ebola. The data also suggests that the patients in West Africa who have contracted Ebola are more likely to die from it than previously reported. Among the patients who were sampled, nearly 75 percent died, while only about 25 percent recovered.
Among the symptoms, bleeding amongst patients was less common than previously reported outbreaks, but seemingly increases the risk of death from Ebola. Before the current outbreak in West Africa, approximately 50 percent of those infected with Ebola reportedly experienced unexplained bleeding of some sort. As a result, when the mysterious disease going around in West Africa was finally discovered to be Ebola, locals were told to watch out for a number of symptoms, but most notably bleeding. However, since bleeding is less common in patients in West Africa affected by the Ebola outbreak, many did not feel a need to seek treatment.
This contributed to the spread of Ebola that has now become an epidemic in West Africa. Only 18 percent of Ebola patients sampled in the West Africa outbreak experienced unexplained bleeding. About 83 percent of those who did died compared to the 71 percent of patients who did not experience unexplained bleeding who did not survive. In addition, 20 percent of the sampled Ebola patients who died suffered from unexplained bleeding, compared to approximately 12 percent of patients who recovered from the disease.
The risk of death is especially prevalent in Ebola patients who experience blood in their urine and bleed from areas such as the gums, injection site, nose and underneath the skin. While only 1 percent of patients experienced blood in their urine, 90 percent died. The death rate is similar for those who bleed from their gums, injection site and nose. Only 2 percent of patients sampled experienced bleeding from the gums, but 95 percent of them died. The same is true for those who experienced bleeding at the injection site. Only 2 percent of the patients experienced bleeding from the nose, but 94 percent died. Bleeding underneath the skin, while one of the most well-known symptoms, in part due to the countless photos published of Ebola patients who experience this, was the least common symptom of all. Less than 1 percent of the Ebola patients sampled experienced bleeding underneath the skin, but all who did died.
Overall, the data suggests that bleeding, while apparently less common in West Africa than previous outbreaks, increases the risk of death from Ebola by a minimum of 10 percent. While only one in six Ebola patients in West Africa will experience unexplained bleeding, more than eight out of 10 patients who suffer from it will die. This is compared to approximately seven out of 10 patients who do not. The data suggests that Ebola patients in West Africa that experience unexplained bleeding appear to have a worse prognosis than those who do not. It also suggests that while unexplained bleeding is a symptom of Ebola, it is not the most common one among patients in West Africa, and thus is not the only sign to watch out for.
FURTHER COMMENT: So we must look for initially extreme fatigue, high fever, headaches, and then later vomiting, diarrhea, etc. which can be any number of things. God Help us this coming Cold and Flu season. And if Chikungunya gets here in force next year, (and we last that long), it will greatly complicate matters of detection even further. FOOKED, FOOKED, FOOKED.
Ebola: Bleeding Less Common but More Deadly
By Lindsey Dow
September 29, 2014.
http://guardianlv.com/2014/09/ebola-bleeding-less-common-but-more-deadly/
Although bleeding is generally considered one of the most tell-tale signs of Ebola, recent data collected on patients in West Africa suggest that bleeding is less common but more deadly, at least with the strain in West Africa. The report, published by the New England Journal of Medicine, contains data on 1,415 Ebola patients from Liberia, Sierra Leone, Guinea and Nigeria, with an onset of symptoms as recent as August 17.
The data consists of 685 males (48.5 percent) and 730 females (51.6 percent), which suggests males and females are about equally likely to contract Ebola in the West Africa epidemic. Of the 685 male patients, 75 percent died and of the 730 female patients, 74 percent died, which suggests that males and females are about equally likely to die from Ebola. The data also suggests that the patients in West Africa who have contracted Ebola are more likely to die from it than previously reported. Among the patients who were sampled, nearly 75 percent died, while only about 25 percent recovered.
Among the symptoms, bleeding amongst patients was less common than previously reported outbreaks, but seemingly increases the risk of death from Ebola. Before the current outbreak in West Africa, approximately 50 percent of those infected with Ebola reportedly experienced unexplained bleeding of some sort. As a result, when the mysterious disease going around in West Africa was finally discovered to be Ebola, locals were told to watch out for a number of symptoms, but most notably bleeding. However, since bleeding is less common in patients in West Africa affected by the Ebola outbreak, many did not feel a need to seek treatment.
This contributed to the spread of Ebola that has now become an epidemic in West Africa. Only 18 percent of Ebola patients sampled in the West Africa outbreak experienced unexplained bleeding. About 83 percent of those who did died compared to the 71 percent of patients who did not experience unexplained bleeding who did not survive. In addition, 20 percent of the sampled Ebola patients who died suffered from unexplained bleeding, compared to approximately 12 percent of patients who recovered from the disease.
The risk of death is especially prevalent in Ebola patients who experience blood in their urine and bleed from areas such as the gums, injection site, nose and underneath the skin. While only 1 percent of patients experienced blood in their urine, 90 percent died. The death rate is similar for those who bleed from their gums, injection site and nose. Only 2 percent of patients sampled experienced bleeding from the gums, but 95 percent of them died. The same is true for those who experienced bleeding at the injection site. Only 2 percent of the patients experienced bleeding from the nose, but 94 percent died. Bleeding underneath the skin, while one of the most well-known symptoms, in part due to the countless photos published of Ebola patients who experience this, was the least common symptom of all. Less than 1 percent of the Ebola patients sampled experienced bleeding underneath the skin, but all who did died.
Overall, the data suggests that bleeding, while apparently less common in West Africa than previous outbreaks, increases the risk of death from Ebola by a minimum of 10 percent. While only one in six Ebola patients in West Africa will experience unexplained bleeding, more than eight out of 10 patients who suffer from it will die. This is compared to approximately seven out of 10 patients who do not. The data suggests that Ebola patients in West Africa that experience unexplained bleeding appear to have a worse prognosis than those who do not. It also suggests that while unexplained bleeding is a symptom of Ebola, it is not the most common one among patients in West Africa, and thus is not the only sign to watch out for.
FURTHER COMMENT: So we must look for initially extreme fatigue, high fever, headaches, and then later vomiting, diarrhea, etc. which can be any number of things. God Help us this coming Cold and Flu season. And if Chikungunya gets here in force next year, (and we last that long), it will greatly complicate matters of detection even further. FOOKED, FOOKED, FOOKED.
Hansa44
Justine Case
Interesting coincidence here. Sounds like her hospital has been declared a major spot for Ebola patients. I'd say she did a very smart thing. Wish we knew what she had been told while at the hospital.
Here's the coincidental thread. http://www.timebomb2000.com/vb/showthread.php?455921-Dallas-Hospital-Monitoring-Patient-for-Ebola
Oh that's right. There is no such thing as coincidence. Glad she got out in time.
Medical Maven
Deceased
The timing of this epidemic of Chik to the south of us is going to greatly complicate surveillance for possible outbreaks of Ebola. The health care system down there, already inadequate, is being overwhelmed. The sirens in your head should be going off, not only for that concern, but also because it will soon be here in the U.S. Maybe the Chik epidemic will not be as bad here with air conditioning etc, but it will be major. This article leaves no doubt in my mind.
New mosquito-borne virus spreads in Latin America
By EZEQUIEL ABIU LOPEZ and BEN FOX
September 27, 2014 2:09 PM
http://news.yahoo.com/mosquito-borne-virus-spreads-latin-america-180903793.html
SANTO DOMINGO, Dominican Republic (AP) — An excruciating mosquito-borne illness that arrived less than a year ago in the Americas is raging across the region, leaping from the Caribbean to the Central and South American mainland, and infecting more than 1 million people. Some cases already have emerged in the United States.
While the disease, called chikungunya, usually is not fatal, the epidemic has overwhelmed hospitals, cut economic productivity and caused its sufferers days of pain and misery. And the count of victims is soaring.
In El Salvador, health officials report nearly 30,000 suspected cases, up from 2,300 at the beginning of August, and hospitals are filled with people with the telltale signs of the illness, including joint pain so severe it can be hard to walk.
"The pain is unbelievable," said Catalino Castillo, a 39-year-old seeking treatment at a San Salvador hospital. "It's been 10 days and it won't let up."
Venezuelan officials reported at least 1,700 cases as of Friday, and the number is expected to rise. Neighboring Colombia has around 4,800 cases but the health ministry projects there will be nearly 700,000 by early 2015. Brazil has now recorded its first locally transmitted cases, which are distinct from those involving people who contracted the virus while traveling in an infected area.
Hardest hit has been the Dominican Republic, with half the cases reported in the Americas. According to the Pan American Health Organization, chikungunya has spread to at least two dozen countries and territories across the Western Hemisphere since the first case was registered in French St. Martin in late 2013.
There have been a few locally transmitted cases in the U.S., all in Florida, and it has the potential to spread farther, experts say, but Central and South America are particularly vulnerable. The chief factors are the prevalence of the main vector for the virus, the aedes aegypti mosquito, and the lack of immunity in a population that hasn't been hit with chikungunya in modern medical history, said Scott C. Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch.
"There are going to be some very large populations at risk down there, much larger than the Caribbean," Weaver said.
Chikungunya is a word that comes from the Makonde language of Tanzania in eastern Africa and translates roughly as "that which bends up," in reference to the severe arthritis-like ache in joints that causes sufferers to contort with pain. It's usually accompanied by a spiking fever and headache. There have been only 113 deaths linked to the region's outbreak, according to the most recent data, but chikungunya can be crippling.
Herman Slater, a 60-year-old gardener in Jamaica's capital of Kingston, said he was laid out for almost two weeks this month with unimaginable joint pain, hammer-pounding headaches and fevers that came in waves.
"I tell you, I was surprised by how painful it was. It was taking me five minutes to get out of bed, and then I could hardly even walk," Slater said. "My hands were so bad I couldn't open a bottle, couldn't comb my hair. Every night I was wet from sweat."
In acute cases, pain can last for months. Joanna Rivas, who works as a maid in the Dominican capital of Santo Domingo, said she has had joint pain since May, and her 12-year-old daughter's case is so severe the girl can't hold her pen at school. Both have been taking the pain reliever acetaminophen, the main treatment for chikungunya, which has no cure or vaccine.
Besides the suffering, chikungunya has caused economic damage with the cost of providing treatment and controlling mosquitoes and by absenteeism from work. A study by the Universidad Eugenio Maria de Hostos in the Dominican Republic found nearly 13 percent of businesses said they had people miss work because of chikungunya in June.
Authorities throughout the region have been spraying pesticide and encouraging people to remove water containers where mosquitoes can breed. Oxitec, a British company that has tested genetically modified aedys aegypti to combat dengue in Brazil, Cayman Islands and Panama, says it has received a surge of interest since the start of the outbreak.
Chikungunya, which has been known for decades in parts of Africa and Asia, is transmitted when a mosquito bites an infected person and then feeds on someone else. It may have found fertile ground in Latin America and the Caribbean because many people are outside in the daytime, when aedes aegypti bite, or lack adequate screens on their windows.
In an article in the New England Journal of Medicine, Dr. Erin Staples of the U.S. Centers for Disease Control and Prevention said access to air conditioning to keep mosquitoes at bay might also be a factor. During an outbreak of mosquito-borne dengue in 1999 along the Texas-Mexico border, aedes aegypti were three times as abundant on the U.S. side but the number of people infected with dengue was twice as high on the Mexican side.
Conditions vary widely in the region. Haiti, where many people live in flimsy shacks with little protection from mosquitoes, has been hit hard. In Venezuela, air conditioning is widespread but the country has a shortage of insect repellent and pesticide sprayers due to the country's economic problems.
Staples said past outbreaks have been known to affect around 30 percent of a population, so there is room for the epidemic to grow, although it's too early to accurately project how many will get sick or whether chikungunya will become endemic to the region like dengue.
The good news is that people seem to acquire immunity to all major strains.
"We do believe currently that if someone is unfortunate enough to get infected, they should not be infected again," Staples said.
___
Associated Press writer Ezequiel Abiu Lopez reported this story in Santo Domingo and Ben Fox reported from Miami. AP writers Marcos Aleman in El Salvador, Cesar Garcia in Colombia, Jorge Rueda in Venezuela and David McFadden in Jamaica contributed to this report.
_____
New mosquito-borne virus spreads in Latin America
By EZEQUIEL ABIU LOPEZ and BEN FOX
September 27, 2014 2:09 PM
http://news.yahoo.com/mosquito-borne-virus-spreads-latin-america-180903793.html
SANTO DOMINGO, Dominican Republic (AP) — An excruciating mosquito-borne illness that arrived less than a year ago in the Americas is raging across the region, leaping from the Caribbean to the Central and South American mainland, and infecting more than 1 million people. Some cases already have emerged in the United States.
While the disease, called chikungunya, usually is not fatal, the epidemic has overwhelmed hospitals, cut economic productivity and caused its sufferers days of pain and misery. And the count of victims is soaring.
In El Salvador, health officials report nearly 30,000 suspected cases, up from 2,300 at the beginning of August, and hospitals are filled with people with the telltale signs of the illness, including joint pain so severe it can be hard to walk.
"The pain is unbelievable," said Catalino Castillo, a 39-year-old seeking treatment at a San Salvador hospital. "It's been 10 days and it won't let up."
Venezuelan officials reported at least 1,700 cases as of Friday, and the number is expected to rise. Neighboring Colombia has around 4,800 cases but the health ministry projects there will be nearly 700,000 by early 2015. Brazil has now recorded its first locally transmitted cases, which are distinct from those involving people who contracted the virus while traveling in an infected area.
Hardest hit has been the Dominican Republic, with half the cases reported in the Americas. According to the Pan American Health Organization, chikungunya has spread to at least two dozen countries and territories across the Western Hemisphere since the first case was registered in French St. Martin in late 2013.
There have been a few locally transmitted cases in the U.S., all in Florida, and it has the potential to spread farther, experts say, but Central and South America are particularly vulnerable. The chief factors are the prevalence of the main vector for the virus, the aedes aegypti mosquito, and the lack of immunity in a population that hasn't been hit with chikungunya in modern medical history, said Scott C. Weaver, director of the Institute for Human Infections and Immunity at the University of Texas Medical Branch.
"There are going to be some very large populations at risk down there, much larger than the Caribbean," Weaver said.
Chikungunya is a word that comes from the Makonde language of Tanzania in eastern Africa and translates roughly as "that which bends up," in reference to the severe arthritis-like ache in joints that causes sufferers to contort with pain. It's usually accompanied by a spiking fever and headache. There have been only 113 deaths linked to the region's outbreak, according to the most recent data, but chikungunya can be crippling.
Herman Slater, a 60-year-old gardener in Jamaica's capital of Kingston, said he was laid out for almost two weeks this month with unimaginable joint pain, hammer-pounding headaches and fevers that came in waves.
"I tell you, I was surprised by how painful it was. It was taking me five minutes to get out of bed, and then I could hardly even walk," Slater said. "My hands were so bad I couldn't open a bottle, couldn't comb my hair. Every night I was wet from sweat."
In acute cases, pain can last for months. Joanna Rivas, who works as a maid in the Dominican capital of Santo Domingo, said she has had joint pain since May, and her 12-year-old daughter's case is so severe the girl can't hold her pen at school. Both have been taking the pain reliever acetaminophen, the main treatment for chikungunya, which has no cure or vaccine.
Besides the suffering, chikungunya has caused economic damage with the cost of providing treatment and controlling mosquitoes and by absenteeism from work. A study by the Universidad Eugenio Maria de Hostos in the Dominican Republic found nearly 13 percent of businesses said they had people miss work because of chikungunya in June.
Authorities throughout the region have been spraying pesticide and encouraging people to remove water containers where mosquitoes can breed. Oxitec, a British company that has tested genetically modified aedys aegypti to combat dengue in Brazil, Cayman Islands and Panama, says it has received a surge of interest since the start of the outbreak.
Chikungunya, which has been known for decades in parts of Africa and Asia, is transmitted when a mosquito bites an infected person and then feeds on someone else. It may have found fertile ground in Latin America and the Caribbean because many people are outside in the daytime, when aedes aegypti bite, or lack adequate screens on their windows.
In an article in the New England Journal of Medicine, Dr. Erin Staples of the U.S. Centers for Disease Control and Prevention said access to air conditioning to keep mosquitoes at bay might also be a factor. During an outbreak of mosquito-borne dengue in 1999 along the Texas-Mexico border, aedes aegypti were three times as abundant on the U.S. side but the number of people infected with dengue was twice as high on the Mexican side.
Conditions vary widely in the region. Haiti, where many people live in flimsy shacks with little protection from mosquitoes, has been hit hard. In Venezuela, air conditioning is widespread but the country has a shortage of insect repellent and pesticide sprayers due to the country's economic problems.
Staples said past outbreaks have been known to affect around 30 percent of a population, so there is room for the epidemic to grow, although it's too early to accurately project how many will get sick or whether chikungunya will become endemic to the region like dengue.
The good news is that people seem to acquire immunity to all major strains.
"We do believe currently that if someone is unfortunate enough to get infected, they should not be infected again," Staples said.
___
Associated Press writer Ezequiel Abiu Lopez reported this story in Santo Domingo and Ben Fox reported from Miami. AP writers Marcos Aleman in El Salvador, Cesar Garcia in Colombia, Jorge Rueda in Venezuela and David McFadden in Jamaica contributed to this report.
_____
ainitfunny
Saved, to glorify God.
That disease is also known as "break bone fever" because of the agony of joint pain it causes in the patient.
Tom McDowell
BAMN
Missoula MT.
St. Patrick Hospital 1 of 4 sites in U.S. ready to treat Ebola patients
25 minutes ago • By Rob Chaney
http://missoulian.com/news/local/st...cle_da521772-4839-11e4-b266-4342d105e33f.html
There are four places in the United States set up to handle a patient sickened by the Ebola virus, and Missoula is one of those.
It has been since 2007, in fact.
St. Patrick Hospital administrators have no notice about when or if they will be asked to care for someone stricken with the disease that’s killed more than 3,000 people in Africa in 2014. But the hospital has a special wing of its intensive care unit with three rooms modified to safely handle infectious diseases like Ebola.
“We may never get a patient, but we may someday,” said Carol Bensen, St. Patrick’s senior director for critical care. “We want to help alleviate the rumor mill by making people aware of what we offer. We deal with tuberculosis patients fairly often and nobody expects a press release. We care for lots of different diseases here.”
And any hospital equipped to care for a tuberculosis patient can care for an Ebola patient, according to Dr. George Risi, an infectious disease specialist who recently returned from spending 20 days in a Sierra Leone Ebola ward. Accompanied by St. Patrick’s intensive care nursing director Kate Hurley, Risi helped local clinic staff care for up to 95 patients at a time. While untreated Ebola kills more than 70 percent of its victims, more than half of those who made it to the clinic recovered.
“It’s a disease to be respected, but not feared,” Risi said. “It’s similar to the HIV-AIDS time, when there was this fatal disease and we didn’t know how it was transmitted and people were afraid to touch a patient. We know how to treat Ebola. And this is a cutting-edge center of excellence for a lot of things – for cancer treatment, for cardiac surgery and for infectious diseases as well.”
The “care and isolation unit” of the hospital occupies one hallway of its intensive care unit. It has a set of hallway doors that can close to keep out other hospital traffic. Each room has an anteroom – a double-doored chamber where medical staff can put on or take off their personal protective gear before tending to the patient. The double doors also preserve negative air pressure inside the patient’s space, so air is always being sucked into the room instead of floating out.
Inside the room, more complicated air circulation and filtration systems blow air from the ceiling across the patient and staff and into filters that remove any infectious organisms before release to the general atmosphere on the hospital roof. Otherwise, it has the usual equipment needed for critical care: ports for administering breathing oxygen and medicines, draining fluids and related treatments. Outside, a separate nursing station has all the regular ICU medicines, equipment and supplies.
The three rooms are qualified to handle Level 4 safety concerns. Level 1 has protection against things generally not dangerous to healthy people, like brewer’s yeast. Level 2 is the safety margin of the standard hospital microbiology lab, where clinicians test for routine diseases like chicken pox or staph infections.
Level 3 spaces can handle infectious diseases spread by air, like influenza, bubonic plague or yellow fever – that have known cures. Level 4 units are for exotic agents that may or may not have cures available, or appear in highly concentrated or modified forms from a research institution.
And that’s why St. Patrick has a care and isolation unit. The federal Rocky Mountain Laboratories in Hamilton deals with those kinds of substances on a daily basis, and has done so for years. Some of its researchers are on the forefront of developing a vaccine for Ebola, and have worked with many other unusual disease organisms.
The other U.S. sites cleared for Ebola treatment are in Bethesda, Maryland; Atlanta; and Omaha, Nebraska. The U.S. Centers for Disease Control have deployed teams of health workers to numerous sites in West Africa to slow the epidemic’s progress. U.S. military personnel have also been sent there to build hospital clinics, although Risi said those people would not be performing any care or have contact with Ebola patients.
The CDC reports no confirmed Ebola cases in the United States as of Sept. 29. Affected countries include Guinea, Liberia, Sierra Leone, Nigeria and Senegal. A separate Ebola outbreak has been reported in the Democratic Republic of Congo.
***
Hurley said in addition to the physical facilities, St. Patrick staff have workshops on Level 4 safety practices every six months along with regular drills. She and Risi just returned Friday from a trip to Cuba, where they trained about 200 nurses and doctors in safe clinical procedures for working in an Ebola ward. Those Cuban medical personnel are due to leave for Africa, where they will put the training to work.
“When we started putting them through the PPE (personal protective equipment) exercise, everyone was excited, trying to be first in line to try on the gear,” Hurley said. “But then they’d get it on and start moving around for 30 or 40 minutes and realize – this is kind of tough.”
Ebola clinic staff must wear full-body protective suits including complete face shields. Hurley said the hardest thing for her to get used to was the condensation that would fog over the mask, limiting her vision to the places where sweat had trickled down.
“You can’t touch your face,” Hurley said. “You can’t move your hands above your shoulders. You can’t sit down. And you stay in this for three or four hours at a time. It got to be all about the hydration.”
Hurley said clinicians used a buddy system to check that gear was worn properly, procedures were done carefully and no one was getting too tired to work competently.
“We got really good putting it on and taking it off,” she said of the clothing. Protective suits are disposed of after each use.
While no vaccine for human use has been approved for Ebola treatment, Rocky Mountain Labs researchers have moved very close to a possible formula, Risi said. The goal is to have a medicine that gives health workers advance protection against the virus or, equally important, that could take effect within a few hours or days after exposure.
There are also other treatments that degrade the virus’ ability to multiply or attack the body, some of which have been successfully used on patients brought back to the United States. And some Ebola victims can survive if they’re given fluids and other treatments long enough for their bodies to develop their own antibodies. Such treatments have been available since the 1960s, when they were used to stop a similar disease outbreak in a research lab in Marburg, Germany.
“We know that even with the regular support any Western hospital can provide, we can treat Ebola,” Risi said. “Just with IV fluids and electrolytes and clotting control, we can reduce the mortality rate from 70 or 80 percent down to 30 or 40 percent. We don’t need to talk about exotic treatments.”
The St. Patrick care and isolation unit can be used as a regular part of the ICU when it’s not needed for an infectious disease patient.
===
related
Missoula doctor, nurse return from treating Ebola patients in Africa
September 19, 2014 7:25 pm • By Rob Chaney
http://missoulian.com/news/local/mi...cle_eadb6468-4064-11e4-9540-bfb845256d34.html
Dr. George Risi had to pass a dozen armed checkpoints to leave Sierra Leone – four of which ordered him out of the car so a guard could take his temperature.
The Missoula infectious disease specialist is still checking his thermometer twice daily since his return from 20 days of volunteer work in an Ebola virus ward. He and fellow Missoulian intensive care nursing director Kate Hurley cared for up to 95 patients, from babies to grandparents, suffering from the often-fatal disease.
“We both feel fine,” Risi said Thursday at his office in the St. Patrick Hospital Providence Center. “We had no breaks in technique.”
The same can’t be said for large parts of Sierra Leone, which started a three-day national lockdown Friday in an effort to stop the spread of the disease. More than 5,300 people have been infected in Sierra Leone, Liberia, Nigeria and Senegal, and an estimated 2,600 of those have died, according to the World Health Organization.
Ebola infections start like many other common diseases in the region, with fever and discomfort, but quickly progress to a catastrophic collapse of bodily functions. Once victims start showing symptoms, they can infect others who come in contact with their sweat, blood or bodily fluids. Even corpses can be infectious.
But those who reach medical help in time often survive. While untreated Ebola tends to be 70 percent fatal, Risi said about half of the patients in the Kenema clinic where he worked made it through alive. Those who do usually have antibody resistance for up to 10 years.
And communities that develop strong medical responses can also beat back the disease. Uganda had an Ebola outbreak in 2000 that killed more than 200 people in a few months – considered the worst incident on record at the time. It has had three more flare-ups since 2011, but only 18 people contracted the disease and all but eight survived.
“The health care system in Sierra Leone is just overwhelmed,” Risi said. “It’s great that international agencies are stepping up in a big way. Cuba is sending 165 health care workers next week. But there’s so much more you wish you could do.”
As it was, Risi and Hurley ferried over $1,500 worth of protective garments and other clinic supplies donated by Providence Health International. Their personal luggage got lost, however, forcing them to wash their two sets of personal hospital scrubs every night for 10 days.
Kenema General Hospital had the busiest Ebola center in Sierra Leone. Because of the shortage of trained personnel and the infectious nature of the disease, many of the patients end up caring for one another. Risi told of a woman named Margaret McCauley, who was interred with her husband Eddie.
“They had six children at home, who they had to leave when they got ill,” Risi said. “Eddie was much more ill than his wife, and Margaret was in the bed next to him, nursing him as well as she could until he unfortunately died. After a day of grieving, and with much encouragement by Kate and the others on the team, Margaret took on the care of several of the orphans (in the ward). She carried them around in her arms, fed them, sang to them, put them to bed. Margaret went on to survive, and many of the kids she helped would not have survived without her.”
McCauley returned to her own children, but all her possessions had to be burned.
Risi said fear of Ebola is almost harder on a community than the disease itself. Rumors about its cause or the motives of foreign aid workers have prompted many people to resist treatment or even attack and loot aid centers.
“Any competent hospital can handle Ebola,” Risi said. “We know how to protect ourselves – you just need to be diligent in the use of the guidelines.”
And even places like the United States have regular experience with scary diseases, including a case of Ebola-related Marburg virus in Colorado and numerous hantavirus cases in Montana and elsewhere in the Rocky Mountains. Antibiotic-resistant MRSA bacteria are a regular threat in school locker rooms, while SARS influenza has occasionally shown up in airline passengers coming from Asian countries.
“We’ve had some near-misses,” Risi said. “But we’ve also handled these things with no problems.”
The Missoula volunteers have no current plans to return to Africa, although they may assist in some training programs for other medical personnel heading that way. The international aid groups Doctors Without Borders and Save the Children have both asked governments to forgo sending money, but instead help volunteers get to the stricken regions.
===
.
St. Patrick Hospital 1 of 4 sites in U.S. ready to treat Ebola patients
25 minutes ago • By Rob Chaney
http://missoulian.com/news/local/st...cle_da521772-4839-11e4-b266-4342d105e33f.html
There are four places in the United States set up to handle a patient sickened by the Ebola virus, and Missoula is one of those.
It has been since 2007, in fact.
St. Patrick Hospital administrators have no notice about when or if they will be asked to care for someone stricken with the disease that’s killed more than 3,000 people in Africa in 2014. But the hospital has a special wing of its intensive care unit with three rooms modified to safely handle infectious diseases like Ebola.
“We may never get a patient, but we may someday,” said Carol Bensen, St. Patrick’s senior director for critical care. “We want to help alleviate the rumor mill by making people aware of what we offer. We deal with tuberculosis patients fairly often and nobody expects a press release. We care for lots of different diseases here.”
And any hospital equipped to care for a tuberculosis patient can care for an Ebola patient, according to Dr. George Risi, an infectious disease specialist who recently returned from spending 20 days in a Sierra Leone Ebola ward. Accompanied by St. Patrick’s intensive care nursing director Kate Hurley, Risi helped local clinic staff care for up to 95 patients at a time. While untreated Ebola kills more than 70 percent of its victims, more than half of those who made it to the clinic recovered.
“It’s a disease to be respected, but not feared,” Risi said. “It’s similar to the HIV-AIDS time, when there was this fatal disease and we didn’t know how it was transmitted and people were afraid to touch a patient. We know how to treat Ebola. And this is a cutting-edge center of excellence for a lot of things – for cancer treatment, for cardiac surgery and for infectious diseases as well.”
The “care and isolation unit” of the hospital occupies one hallway of its intensive care unit. It has a set of hallway doors that can close to keep out other hospital traffic. Each room has an anteroom – a double-doored chamber where medical staff can put on or take off their personal protective gear before tending to the patient. The double doors also preserve negative air pressure inside the patient’s space, so air is always being sucked into the room instead of floating out.
Inside the room, more complicated air circulation and filtration systems blow air from the ceiling across the patient and staff and into filters that remove any infectious organisms before release to the general atmosphere on the hospital roof. Otherwise, it has the usual equipment needed for critical care: ports for administering breathing oxygen and medicines, draining fluids and related treatments. Outside, a separate nursing station has all the regular ICU medicines, equipment and supplies.
The three rooms are qualified to handle Level 4 safety concerns. Level 1 has protection against things generally not dangerous to healthy people, like brewer’s yeast. Level 2 is the safety margin of the standard hospital microbiology lab, where clinicians test for routine diseases like chicken pox or staph infections.
Level 3 spaces can handle infectious diseases spread by air, like influenza, bubonic plague or yellow fever – that have known cures. Level 4 units are for exotic agents that may or may not have cures available, or appear in highly concentrated or modified forms from a research institution.
And that’s why St. Patrick has a care and isolation unit. The federal Rocky Mountain Laboratories in Hamilton deals with those kinds of substances on a daily basis, and has done so for years. Some of its researchers are on the forefront of developing a vaccine for Ebola, and have worked with many other unusual disease organisms.
The other U.S. sites cleared for Ebola treatment are in Bethesda, Maryland; Atlanta; and Omaha, Nebraska. The U.S. Centers for Disease Control have deployed teams of health workers to numerous sites in West Africa to slow the epidemic’s progress. U.S. military personnel have also been sent there to build hospital clinics, although Risi said those people would not be performing any care or have contact with Ebola patients.
The CDC reports no confirmed Ebola cases in the United States as of Sept. 29. Affected countries include Guinea, Liberia, Sierra Leone, Nigeria and Senegal. A separate Ebola outbreak has been reported in the Democratic Republic of Congo.
***
Hurley said in addition to the physical facilities, St. Patrick staff have workshops on Level 4 safety practices every six months along with regular drills. She and Risi just returned Friday from a trip to Cuba, where they trained about 200 nurses and doctors in safe clinical procedures for working in an Ebola ward. Those Cuban medical personnel are due to leave for Africa, where they will put the training to work.
“When we started putting them through the PPE (personal protective equipment) exercise, everyone was excited, trying to be first in line to try on the gear,” Hurley said. “But then they’d get it on and start moving around for 30 or 40 minutes and realize – this is kind of tough.”
Ebola clinic staff must wear full-body protective suits including complete face shields. Hurley said the hardest thing for her to get used to was the condensation that would fog over the mask, limiting her vision to the places where sweat had trickled down.
“You can’t touch your face,” Hurley said. “You can’t move your hands above your shoulders. You can’t sit down. And you stay in this for three or four hours at a time. It got to be all about the hydration.”
Hurley said clinicians used a buddy system to check that gear was worn properly, procedures were done carefully and no one was getting too tired to work competently.
“We got really good putting it on and taking it off,” she said of the clothing. Protective suits are disposed of after each use.
While no vaccine for human use has been approved for Ebola treatment, Rocky Mountain Labs researchers have moved very close to a possible formula, Risi said. The goal is to have a medicine that gives health workers advance protection against the virus or, equally important, that could take effect within a few hours or days after exposure.
There are also other treatments that degrade the virus’ ability to multiply or attack the body, some of which have been successfully used on patients brought back to the United States. And some Ebola victims can survive if they’re given fluids and other treatments long enough for their bodies to develop their own antibodies. Such treatments have been available since the 1960s, when they were used to stop a similar disease outbreak in a research lab in Marburg, Germany.
“We know that even with the regular support any Western hospital can provide, we can treat Ebola,” Risi said. “Just with IV fluids and electrolytes and clotting control, we can reduce the mortality rate from 70 or 80 percent down to 30 or 40 percent. We don’t need to talk about exotic treatments.”
The St. Patrick care and isolation unit can be used as a regular part of the ICU when it’s not needed for an infectious disease patient.
===
related
Missoula doctor, nurse return from treating Ebola patients in Africa
September 19, 2014 7:25 pm • By Rob Chaney
http://missoulian.com/news/local/mi...cle_eadb6468-4064-11e4-9540-bfb845256d34.html
Dr. George Risi had to pass a dozen armed checkpoints to leave Sierra Leone – four of which ordered him out of the car so a guard could take his temperature.
The Missoula infectious disease specialist is still checking his thermometer twice daily since his return from 20 days of volunteer work in an Ebola virus ward. He and fellow Missoulian intensive care nursing director Kate Hurley cared for up to 95 patients, from babies to grandparents, suffering from the often-fatal disease.
“We both feel fine,” Risi said Thursday at his office in the St. Patrick Hospital Providence Center. “We had no breaks in technique.”
The same can’t be said for large parts of Sierra Leone, which started a three-day national lockdown Friday in an effort to stop the spread of the disease. More than 5,300 people have been infected in Sierra Leone, Liberia, Nigeria and Senegal, and an estimated 2,600 of those have died, according to the World Health Organization.
Ebola infections start like many other common diseases in the region, with fever and discomfort, but quickly progress to a catastrophic collapse of bodily functions. Once victims start showing symptoms, they can infect others who come in contact with their sweat, blood or bodily fluids. Even corpses can be infectious.
But those who reach medical help in time often survive. While untreated Ebola tends to be 70 percent fatal, Risi said about half of the patients in the Kenema clinic where he worked made it through alive. Those who do usually have antibody resistance for up to 10 years.
And communities that develop strong medical responses can also beat back the disease. Uganda had an Ebola outbreak in 2000 that killed more than 200 people in a few months – considered the worst incident on record at the time. It has had three more flare-ups since 2011, but only 18 people contracted the disease and all but eight survived.
“The health care system in Sierra Leone is just overwhelmed,” Risi said. “It’s great that international agencies are stepping up in a big way. Cuba is sending 165 health care workers next week. But there’s so much more you wish you could do.”
As it was, Risi and Hurley ferried over $1,500 worth of protective garments and other clinic supplies donated by Providence Health International. Their personal luggage got lost, however, forcing them to wash their two sets of personal hospital scrubs every night for 10 days.
Kenema General Hospital had the busiest Ebola center in Sierra Leone. Because of the shortage of trained personnel and the infectious nature of the disease, many of the patients end up caring for one another. Risi told of a woman named Margaret McCauley, who was interred with her husband Eddie.
“They had six children at home, who they had to leave when they got ill,” Risi said. “Eddie was much more ill than his wife, and Margaret was in the bed next to him, nursing him as well as she could until he unfortunately died. After a day of grieving, and with much encouragement by Kate and the others on the team, Margaret took on the care of several of the orphans (in the ward). She carried them around in her arms, fed them, sang to them, put them to bed. Margaret went on to survive, and many of the kids she helped would not have survived without her.”
McCauley returned to her own children, but all her possessions had to be burned.
Risi said fear of Ebola is almost harder on a community than the disease itself. Rumors about its cause or the motives of foreign aid workers have prompted many people to resist treatment or even attack and loot aid centers.
“Any competent hospital can handle Ebola,” Risi said. “We know how to protect ourselves – you just need to be diligent in the use of the guidelines.”
And even places like the United States have regular experience with scary diseases, including a case of Ebola-related Marburg virus in Colorado and numerous hantavirus cases in Montana and elsewhere in the Rocky Mountains. Antibiotic-resistant MRSA bacteria are a regular threat in school locker rooms, while SARS influenza has occasionally shown up in airline passengers coming from Asian countries.
“We’ve had some near-misses,” Risi said. “But we’ve also handled these things with no problems.”
The Missoula volunteers have no current plans to return to Africa, although they may assist in some training programs for other medical personnel heading that way. The international aid groups Doctors Without Borders and Save the Children have both asked governments to forgo sending money, but instead help volunteers get to the stricken regions.
===
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It has taken 2 weeks to get 205 people on the ground ...No hurry the cases have just doubled in that time and we are still waiting on the first hospital a month later They are stone walling I know for a fact our military can work faster than that it all for show.. They the military can build a airport and all support facilities and build living areas, medical facilities, administration building.and have 20000 troops in place..In two weeks
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Ebola-stricken Liberia is descending into economic hell
http://www.washingtonpost.com/news/...ola-liberia-is-descending-into-economic-hell/
Liberia, the West African nation hardest it by Ebola, has begun a frightening descent into economic hell.
That’s the import of three recent reports from international organizations that seem to bear out the worst-case scenarios of months ago: that people would abandon the fields and factories, that food and fuel would become scarce and unaffordable, and that the government’s already meager capacity to help, along with the nation’s prospects for a better future, would be severely compromised.
They are no longer scenarios. They are real. While these trends have been noted anecdotally, the cumulative toll is horrific.
The basic necessities of survival in Liberia — food, transportation, work, money, help from the government — are rapidly being depleted, according to recent reports by the United Nations Food and Agricultural Organization, the International Monetary Fund and the World Bank.
The FAO says that food is in increasingly short supply. Fields in some regions have been abandoned in part because people perceive Ebola may be coming from them or from the water used to irrigate them.
“People are terrified by how fast the disease is spreading,” Alexis Bonte, FAO Representative in Liberia, said in a statement. “Neighbors, friends and family members are dying within just a few days of exhibiting shocking symptoms, the causes of which are not fully understood by many local communities. This leads them to speculate that water, food or even crops could be responsible. Panic ensues, causing farmers to abandon their fields for weeks.”
The International Monetary Fund said in a separate report that restrictions on public transport, internal travel and trade are burdening the country’s ability to distribute the food that is available.
The combination is driving up food prices rapidly, said the IMF even as “panic buying” is boosting demand, according to the World Bank. The IMF is projecting an inflation rate of 13.1 percent by year’s end, compared with 7.7 percent before the Ebola epidemic started taking its toll.
Transportation has been badly disrupted, one indicator being a drop of between 20 and 35 percent in fuel sales.
The services sector, about half of Liberia’s economy, employing about 45 percent of the work force, has experienced a drop in turnover of 50 to 75 percent, the World Bank says.
According to the World Bank report, Liberia’s single-most important agricultural export, rubber, has been severely “disrupted by both the reduced mobility of the workforce and the difficulty in getting the products to the ports due to the quarantine. Rubber exports which were initially expected to be about $148 million in 2014 are estimated to drop 20 percent,” it said.
Palm oil, another big industry in Liberia, has also been hard hit. According to the World Bank, Sime Darby, the world’s largest producer of palm oil, is mostly now focusing on simple maintenance of its facilities because of the “evacuation of managerial and supervisory personnel.” It put on hold the construction of a new $10 million palm mill that was to be completed in 2015.
1 of 46
Struggling to contain Ebola epidemic in Africa
Sept. 24, 2014
Sept. 22, 2014
Sept. 20, 2014
Sept. 19, 2014
Sept. 18, 2014
As the death toll rises to more than 2,800, the U.S. Centers for Disease Control and Prevention issues a dire forecast.
Sept. 27, 2014 Medical staff members prepare to take care of Ebola-stricken patients at the Medecins Sans Frontieres (Doctors Without Borders) facility in Monrovia, Liberia. Liberia welcomed global pledges of action, admitting on Friday that the government was losing the trust of its people with the outbreak still out of control. Pascal Guyot/AFP/Getty Images
Outside of agriculture, the World Bank said a major mining company, China Union, closed its operation in August. It had projected production of about 2.4 million tons of iron ore in 2014.
Savings and loan programs, called “susu,” that finance “micro-trade” and small businesses — especially those run by women — have been “completely depleted,” with participants no longer able to pay their debts, said the FAO.
Projections for short-term and long-term economic growth are getting ratcheted downward, with the worst-case estimates nothing short of catastrophic. The World Bank, looking at 2014 alone, projected a reduction in growth in Liberia from 5.9 percent to 2.5 percent, a plunge that would be considered calamitous in any country. In 2015, under its most dire but altogether realistic scenario, Liberia’s output could decrease by nearly 12 percent in 2015.
Projections for inflation are moving upward, with the IMF estimating an inflation rate of 13.1 percent by year’s end, compared with 7.7 percent the year before.
On top of it all, the revenue coming in to the Liberian government has dropped sharply, by 20 percent, Liberia’s foreign minister Augustine Kpehe Ngafuan told the United Nations earlier this week. “Consequently, our ability to provide for basic social services and continue to fund key development projects are significantly diminished.”
“As we and our many international partners struggle to douse the wildfire caused by Ebola, we have been left with inadequate resources, time and personnel to attend to other routine illnesses like malaria, typhoid fever and measles, thereby causing many more tangential deaths. An increasing number of pregnant women are dying in the process of bringing forth life. In short, our public health system, which totally collapsed during years of conflict and was being gradually rebuilt, has relapsed under the weight of the deadly virus,” said Ngafuan.A
The death toll from the West African Ebola outbreak is at least 3,091, according to the latest figures, which are regarded as signficantly lower than reality because of underreporting. The number of deaths in Liberia, 1,830, is about three times more than either of the other two most affected countries, Guinea and Sierra Leone.
All the countries hit by Ebola are in bad shape, to be sure, but Liberia does indeed appear to be the worst of the lot.
“The Ebola epidemic is washing away years of progress and hard work,” said the FAO in its Sept. 23 report.
“With the highest number of new and cumulative Ebola cases recorded to date, Liberia is the country most affected by the epidemic in West Africa,” said IMF officials in a statement on Sept. 29 recommending more aid to the country. “In addition to exacting a heavy human toll, the Ebola outbreak is having a severe economic and social impact, and could jeopardize the gains from a decade of peace.”
http://www.washingtonpost.com/news/...ola-liberia-is-descending-into-economic-hell/
Liberia, the West African nation hardest it by Ebola, has begun a frightening descent into economic hell.
That’s the import of three recent reports from international organizations that seem to bear out the worst-case scenarios of months ago: that people would abandon the fields and factories, that food and fuel would become scarce and unaffordable, and that the government’s already meager capacity to help, along with the nation’s prospects for a better future, would be severely compromised.
They are no longer scenarios. They are real. While these trends have been noted anecdotally, the cumulative toll is horrific.
The basic necessities of survival in Liberia — food, transportation, work, money, help from the government — are rapidly being depleted, according to recent reports by the United Nations Food and Agricultural Organization, the International Monetary Fund and the World Bank.
The FAO says that food is in increasingly short supply. Fields in some regions have been abandoned in part because people perceive Ebola may be coming from them or from the water used to irrigate them.
“People are terrified by how fast the disease is spreading,” Alexis Bonte, FAO Representative in Liberia, said in a statement. “Neighbors, friends and family members are dying within just a few days of exhibiting shocking symptoms, the causes of which are not fully understood by many local communities. This leads them to speculate that water, food or even crops could be responsible. Panic ensues, causing farmers to abandon their fields for weeks.”
The International Monetary Fund said in a separate report that restrictions on public transport, internal travel and trade are burdening the country’s ability to distribute the food that is available.
The combination is driving up food prices rapidly, said the IMF even as “panic buying” is boosting demand, according to the World Bank. The IMF is projecting an inflation rate of 13.1 percent by year’s end, compared with 7.7 percent before the Ebola epidemic started taking its toll.
Transportation has been badly disrupted, one indicator being a drop of between 20 and 35 percent in fuel sales.
The services sector, about half of Liberia’s economy, employing about 45 percent of the work force, has experienced a drop in turnover of 50 to 75 percent, the World Bank says.
According to the World Bank report, Liberia’s single-most important agricultural export, rubber, has been severely “disrupted by both the reduced mobility of the workforce and the difficulty in getting the products to the ports due to the quarantine. Rubber exports which were initially expected to be about $148 million in 2014 are estimated to drop 20 percent,” it said.
Palm oil, another big industry in Liberia, has also been hard hit. According to the World Bank, Sime Darby, the world’s largest producer of palm oil, is mostly now focusing on simple maintenance of its facilities because of the “evacuation of managerial and supervisory personnel.” It put on hold the construction of a new $10 million palm mill that was to be completed in 2015.
1 of 46
Struggling to contain Ebola epidemic in Africa
Sept. 24, 2014
Sept. 22, 2014
Sept. 20, 2014
Sept. 19, 2014
Sept. 18, 2014
As the death toll rises to more than 2,800, the U.S. Centers for Disease Control and Prevention issues a dire forecast.
Sept. 27, 2014 Medical staff members prepare to take care of Ebola-stricken patients at the Medecins Sans Frontieres (Doctors Without Borders) facility in Monrovia, Liberia. Liberia welcomed global pledges of action, admitting on Friday that the government was losing the trust of its people with the outbreak still out of control. Pascal Guyot/AFP/Getty Images
Outside of agriculture, the World Bank said a major mining company, China Union, closed its operation in August. It had projected production of about 2.4 million tons of iron ore in 2014.
Savings and loan programs, called “susu,” that finance “micro-trade” and small businesses — especially those run by women — have been “completely depleted,” with participants no longer able to pay their debts, said the FAO.
Projections for short-term and long-term economic growth are getting ratcheted downward, with the worst-case estimates nothing short of catastrophic. The World Bank, looking at 2014 alone, projected a reduction in growth in Liberia from 5.9 percent to 2.5 percent, a plunge that would be considered calamitous in any country. In 2015, under its most dire but altogether realistic scenario, Liberia’s output could decrease by nearly 12 percent in 2015.
Projections for inflation are moving upward, with the IMF estimating an inflation rate of 13.1 percent by year’s end, compared with 7.7 percent the year before.
On top of it all, the revenue coming in to the Liberian government has dropped sharply, by 20 percent, Liberia’s foreign minister Augustine Kpehe Ngafuan told the United Nations earlier this week. “Consequently, our ability to provide for basic social services and continue to fund key development projects are significantly diminished.”
“As we and our many international partners struggle to douse the wildfire caused by Ebola, we have been left with inadequate resources, time and personnel to attend to other routine illnesses like malaria, typhoid fever and measles, thereby causing many more tangential deaths. An increasing number of pregnant women are dying in the process of bringing forth life. In short, our public health system, which totally collapsed during years of conflict and was being gradually rebuilt, has relapsed under the weight of the deadly virus,” said Ngafuan.A
The death toll from the West African Ebola outbreak is at least 3,091, according to the latest figures, which are regarded as signficantly lower than reality because of underreporting. The number of deaths in Liberia, 1,830, is about three times more than either of the other two most affected countries, Guinea and Sierra Leone.
All the countries hit by Ebola are in bad shape, to be sure, but Liberia does indeed appear to be the worst of the lot.
“The Ebola epidemic is washing away years of progress and hard work,” said the FAO in its Sept. 23 report.
“With the highest number of new and cumulative Ebola cases recorded to date, Liberia is the country most affected by the epidemic in West Africa,” said IMF officials in a statement on Sept. 29 recommending more aid to the country. “In addition to exacting a heavy human toll, the Ebola outbreak is having a severe economic and social impact, and could jeopardize the gains from a decade of peace.”
Tom McDowell
BAMN
Via PFI
Images and graphs at link.
My Emphasis in bold, the whole article is chilling.
Hollow Words and an Exponential Horror
Obama called the world to action against Ebola, but most countries are only paying lip service to the coming catastrophe.
BY Laurie Garrett
SEPTEMBER 29, 2014
http://www.foreignpolicy.com/articl...words_exponential_horror_ebola_crisis_reponse
At last, a sense of serious urgency imbues the world's response to the Ebola crisis. On Sept. 18, by the largest vote in U.N. history, the Security Council adopted a unanimous resolution, co-sponsored by 130 countries, that declared Ebola a security threat to all nations.
On Sept. 20, the General Assembly gave Secretary-General Ban Ki-moon authority to command an international response to the virus out of a newly created United Nations Mission for Ebola Emergency Response (UNMEER), located in New York. And, on Sept. 25, U.S. President Barack Obama addressed the General Assembly, calling on all nations to step up to the challenge with unprecedented haste, unprecedented commitment, and unprecedented coordination.
"Stopping Ebola is a priority for the United States," Obama said in his address to the U.N. "We'll do our part. We will continue to lead, but this has to be a priority for everybody else. We cannot do this alone. ... To my fellow leaders from Liberia, Sierra Leone and Guinea, to the people of West Africa, to the heroic health workers who are on the ground as we speak, in some cases, putting themselves at risk -- I want you to know that you are not alone. We're working urgently to get you the help you need. And we will not stop, we will not relent until we halt this epidemic once and for all."
The tap is turned, and water is starting to flow. But the questions in this newly announced war on Ebola are now are twofold: Will personnel and resources reach West Africa rapidly enough to dam the viral flow, and will the nations of the world learn from this disaster to build institutions and long-term targets that prevent pandemics in the future?
According to Médecins Sans Frontières (Doctors Without Borders, or MSF) international president Joanne Liu, few of the promised personnel and resources have yet reached Liberia, Sierra Leone, and Guinea. Following Obama's speech to the U.N., she, in graphic detail, told the American network NPR how her organization's Ebola clinics were so overwhelmed that each morning staff were removing the dead from their hospital beds, taking a count, and then admitting that number of ailing from the queues of Ebola-sufferers lying outside hospital doors. Far from getting ahead of the virus, she insisted, the world's response is still racing to simply catch up.
The World Health Organization (WHO) continues to release daily tolls of confirmed cases and deaths, but the WHO notes with each of its releases that the numbers are, at best, snapshots of what might have been the prevalence of Ebola a few days earlier.
As WHO Director-General Margaret Chan told the Security Council, the numbers are "vast underestimates."
As WHO Director-General Margaret Chan told the Security Council, the numbers are "vast underestimates." Nevertheless, the most recent WHO forecast reckons that by Nov. 2, 2014, the three countries will cumulatively have 20,000 Ebola cases.
But I believe the cumulative total is close to, or has already eclipsed, 20,000.
In its official case count for reports received as of Sept. 24, the WHO says a total of 6,242 cases with 2,909 deaths have been officially counted. For weeks I have suggested that the reporting has been off by a factor of three, meaning far more Ebola-sufferers were never identified, as they ailed and died outside the overwhelmed health-care system on the ground in the three countries. Based on that reckoning, the current cumulative instances would be triple the official number of 6,242, making it 18,726 cases. I suggested on radio broadcasts that the epidemic case count could top 400,000 by Christmas if the global community failed to respond rapidly and effectively enough in September.
On Sept. 23, the U.S. Centers for Disease Control and Prevention (CDC) published its best estimates of the epidemic's scale and its likely future course, based on the agency's reckoning that reporting is off by a factor of 2.5. (That would put the cumulative current count at 15,605 cases.) If the global response fails to get to the ground with effect in a timely fashion, the CDC insisted, even a less severe caseload forecast would put the number of infected -- both survivors and dead -- at 500,000 by January 2015. In a worst-case calculation, the CDC forecasts 1.4 million cases in the same time period.
My reckoning of 400,000 by Christmas was more conservative, as it turns out, because I was imagining numbers for all three countries. In contrast, the CDC's startling projections are for just two: Liberia and Sierra Leone. The worst-case estimation of 1.4 million would equal 14 percent of the two countries' combined populations.
Those numbers may still be conservative, as there is growing evidence that Sierra Leone has grossly undercounted its epidemic and may actually have a larger crisis than neighboring Liberia. Quarantines now encompass the majority of Sierra Leone's villages and much of its capital, Freetown.
Mortality estimates for this epidemic have run a wild empirical course. On the one hand, based on the 1976 original outbreak in Yambuku, Zaire, it is commonly reported in both scientific literature and popular media that Ebola mortality can be "as high as 90 percent," but that has never occurred in the post-1976 epidemics. On the other hand, many skeptics in both medical and popular press circles say that the death tolls in the current outbreak are well below that 90 percent -- and that, in fact, the numbers are closer to 50 percent, indicating there may have been some early sensationalism in the descriptions of Ebola's lethality in the current outbreak.
Actual reported deaths to date run at about 55 percent of reported cases. That would put the mortality rate below the prior 20 Ebola epidemics. Odd, given the 2014 epidemic is caused by the same viral strain as plagued Yambuku, Zaire, in the original 1976 epidemic. Odder still, the officially reported fatality rate in Liberia is about 50 percent, but next door in Sierra Leone government reports put the identical strain down to a mere 30 percent mortality rate.
But the numbers are deceptive as most of the dead are never counted -- they are buried without government notice in private family locations with discreet ceremonies or no funerals at all. Moreover, in all of the past 20 Ebola outbreaks, fatality reporting has lagged far behind case counts. Researchers from the London School of Hygiene & Tropical Medicine recently scrutinized the current and past epidemics, concluding that the true fatality in today's epidemic is 70 percent. The London team reached that conclusion based largely on computations of the time lags between deaths and their official reporting in the 20 prior Ebola outbreaks. Combined with the worst-case dire CDC forecast, this could mean that by February, Ebola will have slaughtered 980,000 Liberians and Sierra Leoneans -- a number so apocalyptic as to defy our imaginations.
We have dueling narratives emerging in the Ebola fight. On one side, the forecast horrors and MSF's reports from the ground present a dire, nightmarish story. On the other, mobilizations around the world of finances and resources suggest a world prepared to fight the virus into retreat.
The first horrible narrative is accurate, assuming the second one fails to materialize in rapid, coordinated fashion. Tiny Cuba will send 461 doctors and nurses into the epidemic, but huge nations -- Russia, China, India, Brazil, many of those in Europe -- have made little more than symbolic gestures to date amounting to one mobile clinic, small sums of financing, and modest shipments of medical supplies.
"Partners and friends, based on understandable fear, have ostracized us; shipping and airline services have sanctioned us; and the world has taken some time to fully appreciate and adequately respond to the enormity of our tragedy," President Ellen Johnson Sirleaf told the U.N. in a speech delivered via video from her Liberian office. Despite U.S. military efforts to build an air bridge from Senegal to the beleaguered countries, the flow of supplies and personnel is still stifled by a nearly total shutdown of commercial flights and shipments to the region.
"Ebola is not only a disease of Sierra Leone and its neighbors; it is a disease of the world," Sierra Leone's president, Ernest Bai Koroma, said in a speech delivered via teleconference to the U.N. General Assembly on Sept. 25. He continued:
Globalization, increasing urbanization, and denser networks of people rapidly moving between rural and urban areas and across borders is fuel for greater transmission of formerly isolated viral diseases.
None of us recognized that this mix of trends could emerge with such force in West Africa. Our international partners were slow to recognize the threat for what it was, and when the recognition did come, it came with a flurry of fear that led to banning of travel to and from Sierra Leone and our region.
Underscoring the need for historic speed in the delivery of global assistance, Koroma warned further:
Ebola is a disease where even an hour too late leads to exponential transmissions. That is why faster response, of a kind similar to responses to natural disasters like hurricanes and earthquakes, is required. This calls for faster deployment of resources at the global, national, and health-center level. Any break in this chain of fast response would result in more deaths in our country and greater possibilities of the virus mutating and spreading into other countries and continents.
The competing narratives of the Ebola response -- exponential growth in cases versus the arrival of a global rescue mission -- can be charted graphically.
These data from the WHO, in orange, are estimates of publicly available data on weekly incidence of confirmed, probable, and suspected cases of Ebola; the original data are available in the New England Journal of Medicine. The adjusted caseload, in red, is an independent calculation based on these estimates and adjusting for the CDC's reckoning of a 2.5-fold factor of underreporting.
To see a larger version of this chart, click here.
A second chart of personnel and supplies delivered to the countries and of financial commitments illustrates a pace for the response to date. If we look at these numbers side by side, it becomes starkly clear that the world's response effort is crawling compared with the exponential growth in viral spread.
There is another false narrative lurking in the background of this horrible epidemic: that the world was prepared and that only mere tweaks in health systems would be adequate to prevent Ebola from spilling over into other nations.
I recently spoke with a group of journalists from all over the world invited by the U.S. State Department to meet with American officials. A frightened man from Djibouti asked whether health systems in the Horn of Africa would stand up better to Ebola than the very weak infrastructures of Liberia, Sierra Leone, and Guinea. A woman from Zimbabwe asked the same for her more prosperous region of southern Africa. I warned them that wherever syringes are reused due to scarcities or wherever doctors are so rare that each serves more than 10,000 patients per year, surgery is performed without proper hygienic protection for medical staff, nurses lack supplies of disinfectants and latex gloves, and clean water does not flow from hospital taps -- in places like this, Ebola can thrive.
Back in October 1999, I attended a meeting at the Paris headquarters of MSF-France, aimed at finding ways to improve poor countries' access to basic medicines and supplies. Also at the meeting was Ariel Pablos-Méndez, a physician who is now the head of global health efforts for the U.S. Agency for International Development (USAID). The meeting was disturbed by an uproar, as shouting and screaming could be heard from below. An MSF physician raced up the stairs shouting, "We won the Nobel Peace Prize!" and pandemonium ensued. As Pablos-Méndez recalled last week at a health event coinciding with the U.N. General Assembly opening, we all danced late into the night in celebration.
Today MSF has no time to think about that Nobel Prize, as its volunteers are deployed to a staggering array of crises around the world, including the Ebola epidemics in West Africa and, separately, the Democratic Republic of the Congo.
Pablos-Méndez last week recalled the MSF jubilation of 1999 and a commitment born from it to achieve universal health coverage (UHC) for every human being on Earth. Ten years after that day of MSF joy, we co-authored, along with Bangladeshi global-health superstar Mushtaque Chowdhury, the first call for UHC, published in the Lancet. We imagined that the U.N. might one day embrace UHC and aim to bolster countries' abilities to treat and protect their populations from diseases, including such horrors as Ebola. It now appears likely that UHC will, indeed, be among the U.N.'s Sustainable Development Goals -- targets for global achievement by 2030.
But a more recent, sobering connection to noble health targets and MSF came to me this summer when Sophie Delaunay, executive director of MSF in the United States, asked me, "Where are all those Americans that were trained in bioterrorism and epidemics? We need them." USAID told Delaunay there were no such cadres of disease-fighting Americans ready to step into the breach. Similar questions have been raised regarding Ebola drugs, cures, and vaccines -- where are they?
Following the 9/11 attacks and the subsequent anthrax mailings to prominent media and political leaders, George W. Bush's administration ordered billions of dollars' worth of preparedness efforts. As I described in my 2011 book, I Heard the Sirens Scream, the Bush administration and Congress created programs such as Project BioShield that were meant to find cures and vaccines for special pathogens, including Ebola. And through the CDC, billions of dollars were funneled to local health departments across all 50 states and the territories of the United States to create bioterrorism and pandemic preparedness teams. Every local health department and hospital in the United States has, since 2002, undergone repeated drills in which local responders -- police, fire departments, hazmat teams, physicians, public health workers, nurses -- simulate their scripted actions in response to an outbreak of one of the CDC's designated special pathogens (including Ebola). Massive time and money have been spent in towns and cities, often at the expense of other essential public health services. As I wrote, many local health departments felt compelled to fire cancer prevention workers or HIV educators, replacing their budget lines with bioterrorism responders in order to obtain federal funding during the Bush presidency. The Defense Department ran similar training exercises within all branches of the armed forces. And inside the CDC, many of the ranks of science were replaced with terrorism preparedness expertise, chiefly drawn from law enforcement and the military.
Where is all that expertise now?
Where are the miracle drugs, vaccines, hazmat experts, and medevac teams?
They don't exist. Hundreds of billions of dollars and many years later -- they don't exist.
BioShield failed because lab-bench invention of drugs and vaccines could not be translated into clinical trials and commercial development without adequate profit potential for biotech and pharmaceutical industries -- options nobody could guarantee given the rarity with which such diseases as tularemia, anthrax, and Ebola present.
The military's sense of priority in its biopreparedness efforts focused on safe rescue of its personnel from a bioterrorism or outbreak situation. As described in 2005 by officers in the Special Medical Augmentation Response Team-Aeromedical Isolation -- also called the SMART-AIT -- which trained U.S. and allied military cadres, "It's a get-in, get-out situation because a lot of people could be put at risk if they come in contact with the viruses that cause those fevers."
In all the civilian and military training, the focus was similarly on containment and rapid response -- not on months of patient care executed by exhausted doctors and nurses working inside 120-degree spacesuits, facing a virus that has 70 percent odds of killing them should a slip-up leave them exposed to Ebola.
Americans believe in technology. Some have imagined that computers, sifting through worldwide Facebook, Twitter, and news reports, could spot outbreaks before health officials might, offering early-warning systems that would obviate concern for pandemics. The enthusiasm over the now nonexistent experimental drug ZMapp captured American belief in miracle cures and biotech savvy. Almost daily I receive claims from companies and individuals of phone apps that can track Ebola cases, hidden cures, drugs sitting on shelves that might stop Ebola.
If the world wants the epidemic to end without claiming 980,000 lives by the end of January and without spreading beyond its current boundaries, the narratives guiding the response must embrace reality.
The reality is as Obama put it at the U.N. last week: This is an all-hands-on-deck moment for mobilization of the basics. Sure, keep searching for drugs and vaccines. Keep struggling to build UHC and better health systems. But right now the Ebola world needs doctors, nurses, paved roads, electricity, oil, medical supplies, cots, protective gear, hydration kits, food, helicopters, airplanes, logistics expertise, mass communications education, soap, disinfectants, and, most of all, cause for hope.
And it needs all these things, yesterday.
PASCAL GUYOT/AFP/Getty Images
===
.
Images and graphs at link.
My Emphasis in bold, the whole article is chilling.
Hollow Words and an Exponential Horror
Obama called the world to action against Ebola, but most countries are only paying lip service to the coming catastrophe.
BY Laurie Garrett
SEPTEMBER 29, 2014
http://www.foreignpolicy.com/articl...words_exponential_horror_ebola_crisis_reponse
At last, a sense of serious urgency imbues the world's response to the Ebola crisis. On Sept. 18, by the largest vote in U.N. history, the Security Council adopted a unanimous resolution, co-sponsored by 130 countries, that declared Ebola a security threat to all nations.
On Sept. 20, the General Assembly gave Secretary-General Ban Ki-moon authority to command an international response to the virus out of a newly created United Nations Mission for Ebola Emergency Response (UNMEER), located in New York. And, on Sept. 25, U.S. President Barack Obama addressed the General Assembly, calling on all nations to step up to the challenge with unprecedented haste, unprecedented commitment, and unprecedented coordination.
"Stopping Ebola is a priority for the United States," Obama said in his address to the U.N. "We'll do our part. We will continue to lead, but this has to be a priority for everybody else. We cannot do this alone. ... To my fellow leaders from Liberia, Sierra Leone and Guinea, to the people of West Africa, to the heroic health workers who are on the ground as we speak, in some cases, putting themselves at risk -- I want you to know that you are not alone. We're working urgently to get you the help you need. And we will not stop, we will not relent until we halt this epidemic once and for all."
The tap is turned, and water is starting to flow. But the questions in this newly announced war on Ebola are now are twofold: Will personnel and resources reach West Africa rapidly enough to dam the viral flow, and will the nations of the world learn from this disaster to build institutions and long-term targets that prevent pandemics in the future?
According to Médecins Sans Frontières (Doctors Without Borders, or MSF) international president Joanne Liu, few of the promised personnel and resources have yet reached Liberia, Sierra Leone, and Guinea. Following Obama's speech to the U.N., she, in graphic detail, told the American network NPR how her organization's Ebola clinics were so overwhelmed that each morning staff were removing the dead from their hospital beds, taking a count, and then admitting that number of ailing from the queues of Ebola-sufferers lying outside hospital doors. Far from getting ahead of the virus, she insisted, the world's response is still racing to simply catch up.
The World Health Organization (WHO) continues to release daily tolls of confirmed cases and deaths, but the WHO notes with each of its releases that the numbers are, at best, snapshots of what might have been the prevalence of Ebola a few days earlier.
As WHO Director-General Margaret Chan told the Security Council, the numbers are "vast underestimates."
As WHO Director-General Margaret Chan told the Security Council, the numbers are "vast underestimates." Nevertheless, the most recent WHO forecast reckons that by Nov. 2, 2014, the three countries will cumulatively have 20,000 Ebola cases.
But I believe the cumulative total is close to, or has already eclipsed, 20,000.
In its official case count for reports received as of Sept. 24, the WHO says a total of 6,242 cases with 2,909 deaths have been officially counted. For weeks I have suggested that the reporting has been off by a factor of three, meaning far more Ebola-sufferers were never identified, as they ailed and died outside the overwhelmed health-care system on the ground in the three countries. Based on that reckoning, the current cumulative instances would be triple the official number of 6,242, making it 18,726 cases. I suggested on radio broadcasts that the epidemic case count could top 400,000 by Christmas if the global community failed to respond rapidly and effectively enough in September.
On Sept. 23, the U.S. Centers for Disease Control and Prevention (CDC) published its best estimates of the epidemic's scale and its likely future course, based on the agency's reckoning that reporting is off by a factor of 2.5. (That would put the cumulative current count at 15,605 cases.) If the global response fails to get to the ground with effect in a timely fashion, the CDC insisted, even a less severe caseload forecast would put the number of infected -- both survivors and dead -- at 500,000 by January 2015. In a worst-case calculation, the CDC forecasts 1.4 million cases in the same time period.
My reckoning of 400,000 by Christmas was more conservative, as it turns out, because I was imagining numbers for all three countries. In contrast, the CDC's startling projections are for just two: Liberia and Sierra Leone. The worst-case estimation of 1.4 million would equal 14 percent of the two countries' combined populations.
Those numbers may still be conservative, as there is growing evidence that Sierra Leone has grossly undercounted its epidemic and may actually have a larger crisis than neighboring Liberia. Quarantines now encompass the majority of Sierra Leone's villages and much of its capital, Freetown.
Mortality estimates for this epidemic have run a wild empirical course. On the one hand, based on the 1976 original outbreak in Yambuku, Zaire, it is commonly reported in both scientific literature and popular media that Ebola mortality can be "as high as 90 percent," but that has never occurred in the post-1976 epidemics. On the other hand, many skeptics in both medical and popular press circles say that the death tolls in the current outbreak are well below that 90 percent -- and that, in fact, the numbers are closer to 50 percent, indicating there may have been some early sensationalism in the descriptions of Ebola's lethality in the current outbreak.
Actual reported deaths to date run at about 55 percent of reported cases. That would put the mortality rate below the prior 20 Ebola epidemics. Odd, given the 2014 epidemic is caused by the same viral strain as plagued Yambuku, Zaire, in the original 1976 epidemic. Odder still, the officially reported fatality rate in Liberia is about 50 percent, but next door in Sierra Leone government reports put the identical strain down to a mere 30 percent mortality rate.
But the numbers are deceptive as most of the dead are never counted -- they are buried without government notice in private family locations with discreet ceremonies or no funerals at all. Moreover, in all of the past 20 Ebola outbreaks, fatality reporting has lagged far behind case counts. Researchers from the London School of Hygiene & Tropical Medicine recently scrutinized the current and past epidemics, concluding that the true fatality in today's epidemic is 70 percent. The London team reached that conclusion based largely on computations of the time lags between deaths and their official reporting in the 20 prior Ebola outbreaks. Combined with the worst-case dire CDC forecast, this could mean that by February, Ebola will have slaughtered 980,000 Liberians and Sierra Leoneans -- a number so apocalyptic as to defy our imaginations.
We have dueling narratives emerging in the Ebola fight. On one side, the forecast horrors and MSF's reports from the ground present a dire, nightmarish story. On the other, mobilizations around the world of finances and resources suggest a world prepared to fight the virus into retreat.
The first horrible narrative is accurate, assuming the second one fails to materialize in rapid, coordinated fashion. Tiny Cuba will send 461 doctors and nurses into the epidemic, but huge nations -- Russia, China, India, Brazil, many of those in Europe -- have made little more than symbolic gestures to date amounting to one mobile clinic, small sums of financing, and modest shipments of medical supplies.
"Partners and friends, based on understandable fear, have ostracized us; shipping and airline services have sanctioned us; and the world has taken some time to fully appreciate and adequately respond to the enormity of our tragedy," President Ellen Johnson Sirleaf told the U.N. in a speech delivered via video from her Liberian office. Despite U.S. military efforts to build an air bridge from Senegal to the beleaguered countries, the flow of supplies and personnel is still stifled by a nearly total shutdown of commercial flights and shipments to the region.
"Ebola is not only a disease of Sierra Leone and its neighbors; it is a disease of the world," Sierra Leone's president, Ernest Bai Koroma, said in a speech delivered via teleconference to the U.N. General Assembly on Sept. 25. He continued:
Globalization, increasing urbanization, and denser networks of people rapidly moving between rural and urban areas and across borders is fuel for greater transmission of formerly isolated viral diseases.
None of us recognized that this mix of trends could emerge with such force in West Africa. Our international partners were slow to recognize the threat for what it was, and when the recognition did come, it came with a flurry of fear that led to banning of travel to and from Sierra Leone and our region.
Underscoring the need for historic speed in the delivery of global assistance, Koroma warned further:
Ebola is a disease where even an hour too late leads to exponential transmissions. That is why faster response, of a kind similar to responses to natural disasters like hurricanes and earthquakes, is required. This calls for faster deployment of resources at the global, national, and health-center level. Any break in this chain of fast response would result in more deaths in our country and greater possibilities of the virus mutating and spreading into other countries and continents.
The competing narratives of the Ebola response -- exponential growth in cases versus the arrival of a global rescue mission -- can be charted graphically.
These data from the WHO, in orange, are estimates of publicly available data on weekly incidence of confirmed, probable, and suspected cases of Ebola; the original data are available in the New England Journal of Medicine. The adjusted caseload, in red, is an independent calculation based on these estimates and adjusting for the CDC's reckoning of a 2.5-fold factor of underreporting.
To see a larger version of this chart, click here.
A second chart of personnel and supplies delivered to the countries and of financial commitments illustrates a pace for the response to date. If we look at these numbers side by side, it becomes starkly clear that the world's response effort is crawling compared with the exponential growth in viral spread.
There is another false narrative lurking in the background of this horrible epidemic: that the world was prepared and that only mere tweaks in health systems would be adequate to prevent Ebola from spilling over into other nations.
I recently spoke with a group of journalists from all over the world invited by the U.S. State Department to meet with American officials. A frightened man from Djibouti asked whether health systems in the Horn of Africa would stand up better to Ebola than the very weak infrastructures of Liberia, Sierra Leone, and Guinea. A woman from Zimbabwe asked the same for her more prosperous region of southern Africa. I warned them that wherever syringes are reused due to scarcities or wherever doctors are so rare that each serves more than 10,000 patients per year, surgery is performed without proper hygienic protection for medical staff, nurses lack supplies of disinfectants and latex gloves, and clean water does not flow from hospital taps -- in places like this, Ebola can thrive.
Back in October 1999, I attended a meeting at the Paris headquarters of MSF-France, aimed at finding ways to improve poor countries' access to basic medicines and supplies. Also at the meeting was Ariel Pablos-Méndez, a physician who is now the head of global health efforts for the U.S. Agency for International Development (USAID). The meeting was disturbed by an uproar, as shouting and screaming could be heard from below. An MSF physician raced up the stairs shouting, "We won the Nobel Peace Prize!" and pandemonium ensued. As Pablos-Méndez recalled last week at a health event coinciding with the U.N. General Assembly opening, we all danced late into the night in celebration.
Today MSF has no time to think about that Nobel Prize, as its volunteers are deployed to a staggering array of crises around the world, including the Ebola epidemics in West Africa and, separately, the Democratic Republic of the Congo.
Pablos-Méndez last week recalled the MSF jubilation of 1999 and a commitment born from it to achieve universal health coverage (UHC) for every human being on Earth. Ten years after that day of MSF joy, we co-authored, along with Bangladeshi global-health superstar Mushtaque Chowdhury, the first call for UHC, published in the Lancet. We imagined that the U.N. might one day embrace UHC and aim to bolster countries' abilities to treat and protect their populations from diseases, including such horrors as Ebola. It now appears likely that UHC will, indeed, be among the U.N.'s Sustainable Development Goals -- targets for global achievement by 2030.
But a more recent, sobering connection to noble health targets and MSF came to me this summer when Sophie Delaunay, executive director of MSF in the United States, asked me, "Where are all those Americans that were trained in bioterrorism and epidemics? We need them." USAID told Delaunay there were no such cadres of disease-fighting Americans ready to step into the breach. Similar questions have been raised regarding Ebola drugs, cures, and vaccines -- where are they?
Following the 9/11 attacks and the subsequent anthrax mailings to prominent media and political leaders, George W. Bush's administration ordered billions of dollars' worth of preparedness efforts. As I described in my 2011 book, I Heard the Sirens Scream, the Bush administration and Congress created programs such as Project BioShield that were meant to find cures and vaccines for special pathogens, including Ebola. And through the CDC, billions of dollars were funneled to local health departments across all 50 states and the territories of the United States to create bioterrorism and pandemic preparedness teams. Every local health department and hospital in the United States has, since 2002, undergone repeated drills in which local responders -- police, fire departments, hazmat teams, physicians, public health workers, nurses -- simulate their scripted actions in response to an outbreak of one of the CDC's designated special pathogens (including Ebola). Massive time and money have been spent in towns and cities, often at the expense of other essential public health services. As I wrote, many local health departments felt compelled to fire cancer prevention workers or HIV educators, replacing their budget lines with bioterrorism responders in order to obtain federal funding during the Bush presidency. The Defense Department ran similar training exercises within all branches of the armed forces. And inside the CDC, many of the ranks of science were replaced with terrorism preparedness expertise, chiefly drawn from law enforcement and the military.
Where is all that expertise now?
Where are the miracle drugs, vaccines, hazmat experts, and medevac teams?
They don't exist. Hundreds of billions of dollars and many years later -- they don't exist.
BioShield failed because lab-bench invention of drugs and vaccines could not be translated into clinical trials and commercial development without adequate profit potential for biotech and pharmaceutical industries -- options nobody could guarantee given the rarity with which such diseases as tularemia, anthrax, and Ebola present.
The military's sense of priority in its biopreparedness efforts focused on safe rescue of its personnel from a bioterrorism or outbreak situation. As described in 2005 by officers in the Special Medical Augmentation Response Team-Aeromedical Isolation -- also called the SMART-AIT -- which trained U.S. and allied military cadres, "It's a get-in, get-out situation because a lot of people could be put at risk if they come in contact with the viruses that cause those fevers."
In all the civilian and military training, the focus was similarly on containment and rapid response -- not on months of patient care executed by exhausted doctors and nurses working inside 120-degree spacesuits, facing a virus that has 70 percent odds of killing them should a slip-up leave them exposed to Ebola.
Americans believe in technology. Some have imagined that computers, sifting through worldwide Facebook, Twitter, and news reports, could spot outbreaks before health officials might, offering early-warning systems that would obviate concern for pandemics. The enthusiasm over the now nonexistent experimental drug ZMapp captured American belief in miracle cures and biotech savvy. Almost daily I receive claims from companies and individuals of phone apps that can track Ebola cases, hidden cures, drugs sitting on shelves that might stop Ebola.
If the world wants the epidemic to end without claiming 980,000 lives by the end of January and without spreading beyond its current boundaries, the narratives guiding the response must embrace reality.
The reality is as Obama put it at the U.N. last week: This is an all-hands-on-deck moment for mobilization of the basics. Sure, keep searching for drugs and vaccines. Keep struggling to build UHC and better health systems. But right now the Ebola world needs doctors, nurses, paved roads, electricity, oil, medical supplies, cots, protective gear, hydration kits, food, helicopters, airplanes, logistics expertise, mass communications education, soap, disinfectants, and, most of all, cause for hope.
And it needs all these things, yesterday.
PASCAL GUYOT/AFP/Getty Images
===
.
ginnie6
Veteran Member
http://www.cbs46.com/story/26657838/cdc-issues-ebola-guidelines-for-us-funeral-homes
CDC issues Ebola guidelines for U.S. funeral homes
ROSWELL, GA (CBS46) -
CBS46 News has confirmed the Centers for Disease Control has issued guidelines to U.S. funeral homes on how to handle the remains of Ebola patients. If the outbreak of the potentially deadly virus is in West Africa, why are funeral homes in America being given guidelines?
The three-page list of recommendations include instructing funeral workers to wear protective equipment when dealing with the remains since Ebola can be transmitted in postmortem care. It also instructs to avoid autopsies and embalming.
Alysia English is Executive Director of the Georgia Funeral Directors Association, the oldest and largest funeral association in Georgia.
Georgia is comprised of 700 funeral homes and 2,000 funeral directors.
CBS46 asked English if Georgians should be alarmed by these guidelines.
"Absolutely not. In fact, if they weren't hearing about it, they should be a whole lot more concerned," said English.
She said Georgia has one of the country's most thorough public health plans. That includes detailed planning for all hazards such as floods and the flu.
"If you were in the middle of a flood or gas leak, that's not the time to figure out how to turn it off. You want to know all of that in advance. This is no different," said English.
President Barack Obama addressed the Ebola crisis in a speech he delivered during a visit to the Centers for Disease Control and Prevention in Atlanta on Sept. 16.
Three Americans have been treated for Ebola in Atlanta after evacuation from Africa. The most recent patient arrived in Atlanta on Sept. 9.
The two original American patients treated in Atlanta, Nancy Writebol and Dr. Kent Brantly, were eventually discharged.
Copyright 2014 WGCL-TV (Meredith Corporation). All rights reserved.
CDC issues Ebola guidelines for U.S. funeral homes
ROSWELL, GA (CBS46) -
CBS46 News has confirmed the Centers for Disease Control has issued guidelines to U.S. funeral homes on how to handle the remains of Ebola patients. If the outbreak of the potentially deadly virus is in West Africa, why are funeral homes in America being given guidelines?
The three-page list of recommendations include instructing funeral workers to wear protective equipment when dealing with the remains since Ebola can be transmitted in postmortem care. It also instructs to avoid autopsies and embalming.
Alysia English is Executive Director of the Georgia Funeral Directors Association, the oldest and largest funeral association in Georgia.
Georgia is comprised of 700 funeral homes and 2,000 funeral directors.
CBS46 asked English if Georgians should be alarmed by these guidelines.
"Absolutely not. In fact, if they weren't hearing about it, they should be a whole lot more concerned," said English.
She said Georgia has one of the country's most thorough public health plans. That includes detailed planning for all hazards such as floods and the flu.
"If you were in the middle of a flood or gas leak, that's not the time to figure out how to turn it off. You want to know all of that in advance. This is no different," said English.
President Barack Obama addressed the Ebola crisis in a speech he delivered during a visit to the Centers for Disease Control and Prevention in Atlanta on Sept. 16.
Three Americans have been treated for Ebola in Atlanta after evacuation from Africa. The most recent patient arrived in Atlanta on Sept. 9.
The two original American patients treated in Atlanta, Nancy Writebol and Dr. Kent Brantly, were eventually discharged.
Copyright 2014 WGCL-TV (Meredith Corporation). All rights reserved.
Vegas321
Live free and survive
Not yet, but the CDC may have been scrambled to Dallas TX, and thats not a good sign.
Medical Maven
Deceased
Posted by Pixie at the PFI Forum with Comments.
CDC Headed to Dallas in Advance of Ebola Results
By Stephen Young Tue., Sep. 30 2014 at 11:32 AM
http://blogs.dallasobserver.com/unf...ded_to_dallas_in_advance_of_ebola_results.php
Dallas County Health and Human Services gave an update Tuesday morning on the status of a patient potentially infected with Ebola currently being cared for in isolation at Dallas' Texas Health Presbyterian Hospital and the county's' preparation in the event an Ebola case is confirmed. No details have been given about the patient, other than that he or she is being kept in "strict isolation" and was admitted based on symptoms and "travel history."
"This is not Africa," DCHHS Director Zach Thompson said. "We have a great public health infrastructure to deal with this type of disease."
Christopher Perkins, the medical director for county health services, made it clear the risk for outbreak is low because Ebola cannot be spread through the air. Ebola can only be spread through contact with blood or bodily fluids.
Two men who visited West Africa, the epicenter of this year's Ebola outbreak, warned the commissioners about the effects of the disease and urged Dallas County to send whatever help it could in order to stem Ebola where it's most prevalent.
After leaving the commissioner's court meeting to participate in conference call with the Centers for Disease Control, Texas Health Presbyterian and state health officials, Thompson and Perkins returned with an update.
The potential Ebola patient's test results are not in yet, but are expected later Tuesday afternoon or Tuesday evening. CDC personnel are on their way to Dallas in case either of the two samples from the patient being screened are positive for Ebola. If the test was to come back positive, the CDC would lead any actions necessary, with the county providing support, Thompson said.
_________________
Quote:
After leaving the commissioner's court meeting to participate in conference call with the Centers for Disease Control, Texas Health Presbyterian and state health officials, Thompson and Perkins returned with an update.
PIXIE WROTE:
A conference call between CDC, the hospital, and TX state health officials - a clear indication that there's Trouble in River City (note the capital "T").
Quote:
The potential Ebola patient's test results are not in yet, but are expected later Tuesday afternoon or Tuesday evening. CDC personnel are on their way to Dallas in case either of the two samples from the patient being screened are positive for Ebola.
PIXIE WROTE: Ok, they've GOT to stop with this lying nonsense. If they continue, the public will lose all confidence in anything they say.
They can't afford to risk their capital in that way.
CDC has the test results. They don't just climb on planes for sh#ts and giggles these days with Ebola, EV-D68, and everything else that is afoot out there. They're busy. They also didn't hop on a plane to Dallas because they had a sudden hankering for Texas BBQ.
CDC, one piece of advice -- don't lie. Not ever. Not about this stuff. No matter how tempted you may be. Don't do it.
___
CDC Headed to Dallas in Advance of Ebola Results
By Stephen Young Tue., Sep. 30 2014 at 11:32 AM
http://blogs.dallasobserver.com/unf...ded_to_dallas_in_advance_of_ebola_results.php
Dallas County Health and Human Services gave an update Tuesday morning on the status of a patient potentially infected with Ebola currently being cared for in isolation at Dallas' Texas Health Presbyterian Hospital and the county's' preparation in the event an Ebola case is confirmed. No details have been given about the patient, other than that he or she is being kept in "strict isolation" and was admitted based on symptoms and "travel history."
"This is not Africa," DCHHS Director Zach Thompson said. "We have a great public health infrastructure to deal with this type of disease."
Christopher Perkins, the medical director for county health services, made it clear the risk for outbreak is low because Ebola cannot be spread through the air. Ebola can only be spread through contact with blood or bodily fluids.
Two men who visited West Africa, the epicenter of this year's Ebola outbreak, warned the commissioners about the effects of the disease and urged Dallas County to send whatever help it could in order to stem Ebola where it's most prevalent.
After leaving the commissioner's court meeting to participate in conference call with the Centers for Disease Control, Texas Health Presbyterian and state health officials, Thompson and Perkins returned with an update.
The potential Ebola patient's test results are not in yet, but are expected later Tuesday afternoon or Tuesday evening. CDC personnel are on their way to Dallas in case either of the two samples from the patient being screened are positive for Ebola. If the test was to come back positive, the CDC would lead any actions necessary, with the county providing support, Thompson said.
_________________
Quote:
After leaving the commissioner's court meeting to participate in conference call with the Centers for Disease Control, Texas Health Presbyterian and state health officials, Thompson and Perkins returned with an update.
PIXIE WROTE:
A conference call between CDC, the hospital, and TX state health officials - a clear indication that there's Trouble in River City (note the capital "T").
Quote:
The potential Ebola patient's test results are not in yet, but are expected later Tuesday afternoon or Tuesday evening. CDC personnel are on their way to Dallas in case either of the two samples from the patient being screened are positive for Ebola.
PIXIE WROTE: Ok, they've GOT to stop with this lying nonsense. If they continue, the public will lose all confidence in anything they say.
They can't afford to risk their capital in that way.
CDC has the test results. They don't just climb on planes for sh#ts and giggles these days with Ebola, EV-D68, and everything else that is afoot out there. They're busy. They also didn't hop on a plane to Dallas because they had a sudden hankering for Texas BBQ.
CDC, one piece of advice -- don't lie. Not ever. Not about this stuff. No matter how tempted you may be. Don't do it.
___
Hfcomms
EN66iq
The Centers for Disease Control and Prevention on Tuesday confirmed the first case of Ebola has been diagnosed in the United States.
This story is developing. Please check back for further updates.
http://www.cnbc.com/id/102037055
This story is developing. Please check back for further updates.
http://www.cnbc.com/id/102037055
Hfcomms
EN66iq
On Cavuto's show on Fox news the reporter Roberts said of course about the news briefing at 5:30pm but said that the spokesman for the hospital said that Presbyterian Hospital is well equipped to deal with this case. Problem now is how many people did this patient interact with and where before the diagnosis? I would imagine a lot of phones are ringing right now. One case isn't a big deal but this patient didn't arrive here fully encapsulated like the ones in Atlanta did.
JohnGaltfla
#NeverTrump
Roberts is on now. The BS story that "he wasn't showing signs of Ebola infection so that's a good thing" is already being promoted...
ainitfunny
Saved, to glorify God.
You all SHOULD KNOW by now HOW YOUR GOVERNMENT ACTUALLY WORKS.
If they are admitting to the public that there is ONE CASE OF EBOLA, it is only because there is MORE THAN ONE, and they would NOT even be admitting it then UNLESS CIRCUMSTANCES have made the truth impossible to cover up because of what is going to be done very soon! I am betting that they have a problem with how many may have been exposed and tracking them.
If they are admitting to the public that there is ONE CASE OF EBOLA, it is only because there is MORE THAN ONE, and they would NOT even be admitting it then UNLESS CIRCUMSTANCES have made the truth impossible to cover up because of what is going to be done very soon! I am betting that they have a problem with how many may have been exposed and tracking them.
ditto
spiralbinder
Agrarian Separatist
Interesting..on Fox they just said the guy is Liberian, and came here to visit family. I wonder if he is too sick to tell them who he has been in contact with?
Scarletbreasted
Galloping geriatric
USA: 1st case to fall ill in the USA (Texas), imported
--------------------------------------------------------
Date: 30 Sep 2014 [Breaking news alert published at 5:50 p.m. ET]
Source: (CNN) [edited]
<http://www.cnn.com/2014/09/30/health/ebola-us/index.html?hpt=hp_t1>
A person travelling from Liberia to the United States has been
diagnosed with Ebola, Dr. Thomas Frieden, director of the Centers for
Disease Control and Prevention, told reporters Tue [30 Sep 2014]. The
person, whose identity was not released, left Liberia on 19 Sep 2014
and arrived in the USA on 20 Sep 2014, he said. At that time, the
person did not have symptoms. "But 4 or 5 days later" that person
began to show symptoms, Frieden said. The person was hospitalized and
isolated Sun [28 Sep 2014] at a hospital in Texas, he said.
[Original story published at 5:42 p.m. ET]
A patient being treated at a Dallas, Texas, hospital is the 1st person
diagnosed with Ebola in the USA. Several other Americans were
diagnosed in West Africa and then brought to the USA for treatment.
The person who first tested positive for Ebola in the USA is a patient
at Texas Health Presbyterian Hospital in Dallas, hospital spokesman
Stephen O'Brien said Tue 30 Sep 2013.
The adult patient developed symptoms days after returning to Texas
from West Africa, and was admitted into isolation on Sun [28 Sep
2014], according to the Texas Department of State Health Services.
The CDC was expected to provide more details on the case in a press
conference at 5:30 p.m.
--
Communicated by:
ProMED-mail
sb
--------------------------------------------------------
Date: 30 Sep 2014 [Breaking news alert published at 5:50 p.m. ET]
Source: (CNN) [edited]
<http://www.cnn.com/2014/09/30/health/ebola-us/index.html?hpt=hp_t1>
A person travelling from Liberia to the United States has been
diagnosed with Ebola, Dr. Thomas Frieden, director of the Centers for
Disease Control and Prevention, told reporters Tue [30 Sep 2014]. The
person, whose identity was not released, left Liberia on 19 Sep 2014
and arrived in the USA on 20 Sep 2014, he said. At that time, the
person did not have symptoms. "But 4 or 5 days later" that person
began to show symptoms, Frieden said. The person was hospitalized and
isolated Sun [28 Sep 2014] at a hospital in Texas, he said.
[Original story published at 5:42 p.m. ET]
A patient being treated at a Dallas, Texas, hospital is the 1st person
diagnosed with Ebola in the USA. Several other Americans were
diagnosed in West Africa and then brought to the USA for treatment.
The person who first tested positive for Ebola in the USA is a patient
at Texas Health Presbyterian Hospital in Dallas, hospital spokesman
Stephen O'Brien said Tue 30 Sep 2013.
The adult patient developed symptoms days after returning to Texas
from West Africa, and was admitted into isolation on Sun [28 Sep
2014], according to the Texas Department of State Health Services.
The CDC was expected to provide more details on the case in a press
conference at 5:30 p.m.
--
Communicated by:
ProMED-mail
sb
Squib
Veteran Member
I wonder, are TPTB happy now? Are they happy it's here in the US? When will they stop air traffic from West Africa?
If this continues, I can almost guarantee that history will remember the failure of Obama to close the US to African air traffic as main cause of the US outbreak.
If this continues, I can almost guarantee that history will remember the failure of Obama to close the US to African air traffic as main cause of the US outbreak.
Dallas Mayor: Ambulance crew who transported Ebola patient to hospital has been isolated - @NBCDFW
Doctor: Zmapp, the experimental drug that treated other Ebola patients, is not available to treat Dallas patient - @dallasnews
http://www.breakingnews.com/
Doctor: Zmapp, the experimental drug that treated other Ebola patients, is not available to treat Dallas patient - @dallasnews
http://www.breakingnews.com/
Milk-maid
Girls with Guns Member
Exactly...this has been my feelings all along. Everything is a big cover-up don't ya know!... until they can't hide it anymore.
bw
Fringe Ranger
A whole bunch of people are wondering that. Now the rubber hits the road, and we find out if Ebola spreads in Africa just because all those ignorant Africans don't wash their hands, or maybe Ebola really IS a problem. Gosh, this is exciting.
Scarletbreasted
Galloping geriatric
The patient sought care after becoming sick but was initially sent home. (good one USA!!!)
He returned to hospital on September 28 and was admitted to the Texas Health Presbyterian Hospital in Dallas — (more than a week after arriving in the United States.)
The man’s nationality has not been revealed but he came to America to visit relatives. (Liberian?) (See post 664)
Health officials are now trying to reach anyone who might have come into contact with the man during his infectious period.
Those people will be monitored for three weeks after their exposure to the patient to see if fever develops. (Note the use of the word fever, NOT Ebola)
Dr Thomas Frieden, from the Centers for Disease Control, believes “a handful” of people had contact with the patient between September 24 and 28, including family members and “a couple” of community members.
Those people are to be monitored by the CDC. (Now, a handful of sand has many grains!!!)
The man was staying with family and did not stay at a hotel.
Link:http://www.news.com.au/world/first-case-of-ebola-diagnosed-in-us/story-fndir2ev-1227075972493
sb
He returned to hospital on September 28 and was admitted to the Texas Health Presbyterian Hospital in Dallas — (more than a week after arriving in the United States.)
The man’s nationality has not been revealed but he came to America to visit relatives. (Liberian?) (See post 664)
Health officials are now trying to reach anyone who might have come into contact with the man during his infectious period.
Those people will be monitored for three weeks after their exposure to the patient to see if fever develops. (Note the use of the word fever, NOT Ebola)
Dr Thomas Frieden, from the Centers for Disease Control, believes “a handful” of people had contact with the patient between September 24 and 28, including family members and “a couple” of community members.
Those people are to be monitored by the CDC. (Now, a handful of sand has many grains!!!)
The man was staying with family and did not stay at a hotel.
Link:http://www.news.com.au/world/first-case-of-ebola-diagnosed-in-us/story-fndir2ev-1227075972493
sb
bw
Fringe Ranger
Remember Sawyer. The authorities tried to find everyone he contacted, and every person in that group later developed Ebola. In the normal course of events, a dragnet for all contacts should have included a range of people out to several standard deviations of risk. The fact that ALL Sawyer's known contacts got sick indicates that the authorities did not cast a wide enough net, and virtually guarantees that he infected people who were never interviewed.
It is a virtual certainty that they will not be able to contact all the people affected in this case.
crap
Dear God! Here we go.
SusieSunshine
Veteran Member
Information is getting worse over time. He was seen somewhere on the 26th and was sent home
bw
Fringe Ranger
And can those people be located and contacted and safely cocooned in a safe environment before they asymptomatically infect others?
Welcome to exponential growth.
This may be a false alarm. He may be noninfectious. It may come to nothing and we can all sleep safe in our beds. But it is certainly discomfiting.
Possible Impact
TB Fanatic
Medical Maven
Deceased
I think a big Mac Truck just crossed the centerline and hit the U.S. head on. As noted earlier by somebody this chain of contagion will likely filter back into Mexico where it will go absolutely wild.
Squib
Veteran Member
Oh, don't worry. There's only about 20 or so of them - BUT, he DID have sex with his wife twice, his girl friend once (who is a hooker), went to 2 different Wal-Marts, 16 different public bathrooms, gassed up at 4 different gas stations, 5 ATMs, 3 different buffets, and opened 137 doors around the DFW metro area.
- Status