Ebola news 10/5

[Buster's Uncle]

Nebraska hospital prepares for arrival of Ebola patient
Reuters
56 minutes ago



Dr. Mark Rupp, chief of the division of infectious diseases in the department of internal medicine at the Nebraska Medical Center, speaks at a news conference in Omaha, Neb., Friday Sept. 5, 2014, on the condition of ebola patient Dr. Rick Sacra, 51, who is treated at the center. Sacra, who served with North Carolina-based charity SIM, is the third American aid worker infected by the Ebola virus. He will begin treatment in the hospital's 10-bed special isolation unit, the largest of four such units in the U.S. (AP Photo/Nati Harnik)



(Reuters) - A Nebraska hospital is preparing for the expected arrival of an Ebola patient who contracted the disease in Liberia, a spokesman said on Sunday.

Nebraska Medical Center spokesman Taylor Wilson would only identify the patient as a male U.S. citizen expected to arrive on Monday.

But the father of Ashoka Mukpo, a freelance NBC cameraman who contracted Ebola in Liberia, told Reuters on Friday that his son was going to Nebraska for treatment.

The Nebraska hospital last month treated and released Dr. Rick Sacra, an American missionary who also contracted Ebola in Liberia.

Sacra was admitted to a Massachusetts hospital on Saturday for a likely respiratory infection that is not believed to be a recurrence of the disease, hospital officials there said.

The Ebola outbreak has killed at least 3,300 people in West Africa.

(Reporting by Jonathan Kaminsky; Editing by Alison Williams and David Goodman)


http://news.yahoo.com/nebraska-hospital-prepares-arrival-ebola-patient-141536244.html

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Ebola patient in Dallas 'fighting for his life' says CDC head
Reuters
2 hours ago



A general view of Texas Health Presbyterian Hospital in Dallas, Texas October 1, 2014. REUTERS/Mike Stone



DALLAS (Reuters) - The first person to develop Ebola in the United States was struggling to survive at a Dallas hospital on Sunday after his condition worsened to critical, the director of the U.S. Centers for Disease Control said.

Thomas Eric Duncan became ill after arriving in Dallas from Liberia two weeks ago - heightening concerns that the worst Ebola epidemic on record could spread from West Africa, where it began in March and has killed more than 3,400 people.

"The man in Dallas, who is fighting for his life, is the only patient to develop Ebola in the United States," CDC Director Dr. Thomas Frieden said on CNN's "State of the Union."

Duncan's case has highlighted problems that American public health officials are trying furiously to address: The Dallas hospital that admitted him initially did not recognize the deadly disease and sent him home, only for him to return two days later in an ambulance.

"The issue of the missed diagnosis initially is concerning," Frieden said, adding that public health officials had redoubled their efforts to raise awareness of the disease.

"We're seeing more people calling us, considering the possibility of Ebola - that's what we want to see," he said on CNN. "We don't want people not to be diagnosed."

Frieden said he was confident the disease would not spread widely within the United States. U.S. officials are also scaling up their response in West Africa, where Ebola presents an enormous challenge, he added.

"But it's going to take time," Frieden said. "The virus is spreading so fast that it's hard to keep up."

In Dallas, a spokesman for Texas Health Presbyterian Hospital, Wendell Watson, said Duncan remained critical on Sunday. He would not elaborate.

In Nebraska, another hospital is preparing for the arrival of an Ebola patient who contracted the disease in Liberia, a spokesman said on Sunday. Nebraska Medical Center spokesman Taylor Wilson would only identify the patient as a male U.S. citizen expected to arrive on Monday.

Fox TV in Boston identified the Nebraska patient as Ashoka Mukpo, a freelance NBC cameraman working for NBC who contracted Ebola in Liberia. It said he was expected back in the United States on Sunday.

The Nebraska hospital last month also treated, and released, Dr. Rick Sacra, an American missionary who also contracted Ebola in Liberia.

Sacra was admitted to a Massachusetts hospital on Saturday for a likely respiratory infection that is not believed to be a recurrence of the disease, hospital officials there said.

The CDC has identified 10 people who had direct contact with Duncan as being at greatest risk of infection. Another 40 were being monitored as potential contacts, out of a group of 114 people initially evaluated for exposure risks, though none from either group has shown symptoms, Frieden said.

Ebola, which can cause fever, vomiting and diarrhea, spreads through contact with bodily fluids such as blood or saliva.


http://news.yahoo.com/ebola-patient-dallas-fighting-life-says-cdc-head-150920122.html

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High risk Ebola could reach France and UK by end-October, scientists calculate
Reuters
4 hours ago



Health workers, wearing head-to-toe protective gear, prepare for work outside an isolation unit in Foya District, Lofa County, Liberia, July 2014. REUTERS/Ahmed Jallanzo



LONDON, Reuters - By Kate Kelland, Health and Science Correspondent

- Scientists have used Ebola disease spread patterns and airline traffic data to predict a 75 percent chance the virus could be imported to France by October 24, and a 50 percent chance it could hit Britain by that date.

Those numbers are based on air traffic remaining at full capacity. Assuming an 80 percent reduction in travel to reflect that many airlines are halting flights to affected regions, France's risk is still 25 percent, and Britain's is 15 percent.

"It's really a lottery," said Derek Gatherer of Britain's Lancaster University, an expert in viruses who has been tracking the epidemic - the worst Ebola outbreak in history.

The deadly epidemic has killed more than 3,400 people since it began in West Africa in March and has now started to spread faster, infecting almost 7,200 people so far. Nigeria, Senegal and now the United States - where the first case was diagnosed on Tuesday in a man who flew in from Liberia - have all seen people carrying the Ebola haemorrhagic fever virus, apparently unwittingly, arrive on their shores. [ID:nEBOLATAL]

France is among countries most likely to be hit next because the worst affected countries - Guinea, Sierra Leone and Liberia - include French speakers and have busy travel routes back, while Britain's Heathrow airport is one of the world's biggest travel hubs.

France and Britain have each treated one national who was brought home with the disease and then cured. The scientists' study suggests that more may bring it to Europe not knowing they are infected.

"If this thing continues to rage on in West Africa and indeed gets worse, as some people have predicted, then it's only a matter of time before one of these cases ends up on a plane to Europe," said Gatherer.

Belgium has a 40 percent chance of seeing the disease arrive on its territory, while Spain and Switzerland have lower risks of 14 percent each, according to the study first published in the journal PLoS Current Outbreaks and now being regularly updated at http://www.mobs-lab.org/ebola.html.

The World Health Organisation (WHO) has not placed any restrictions on travel and has encouraged airlines to keep flying to the worst-hit countries. British Airways and Emirates airlines have suspended some flights [ID:nL6N0RX2B2]

But the risks change every day the epidemic continues, said Alex Vespignani, a professor at the Laboratory for the Modeling of Biological and Socio-Technical Systems at Northeastern University in Boston who led the research.

"This is not a deterministic list, it's about probabilities - but those probabilities are growing for everyone," Vespignani said in a telephone interview. "It's just a matter of who gets lucky and who gets unlucky."

The latest calculations used data from October 1.

"Air traffic is the driver," Vespignani said. "But there are also differences in connections with the affected countries (Guinea, Liberia and Sierra Leone), as well as different numbers of cases in these three countries - so depending on that, the probability numbers change."


PATIENTS UNAWARE

Patients are at their most contagious when Ebola is in its terminal stages, inducing both internal and external bleeding, and profuse vomiting and diarrhoea - all of which contain high concentrations of infectious virus.

But the disease can also have a long incubation period of up to 21 days, meaning that people can be unaware for weeks that they are infected, and not feel or display any symptoms.

This, it seems, is what allowed the Liberian visitor Thomas Eric Duncanto to fly to the United States and spend several days there unaware that he was carrying the deadly virus, before being diagnosed and isolated. [ID:nL2N0RZ0J3]

In the European Union, free movement of people means someone unknowingly infected with Ebola could easily drive through several neighbouring countries before feeling ill and seeking help, and spend weeks in contact with friends or strangers before becoming sick enough to show up on airport scanners.

Jonathan Ball, a professor of molecular virology at Britain's Nottingham University said that even with exit screening at airports of affected countries, the long, silent incubation period meant "cases can slip through the net".

"Whilst the risk of imported Ebola virus remains small, it's still a very real risk, and one that won't go away until this outbreak is stopped," he said. "Ebola virus isn't just an African problem."

However, the chance of the disease spreading widely or developing into an epidemic in a wealthy, developed country is extremely low, healthcare specialists say.

According to the latest Ebola risk assessment from the European Centres of Disease Prevention and Control, which monitors health and disease in the region, "the capacity to detect and confirm cases...is considered to be sufficient to interrupt any possible local transmission of the disease early."

Gatherer cited Nigeria as an example of how Ebola can be halted with swift and detailed action.

Despite being in West Africa and being home to one of the world's most crowded, chaotic cities, Nigeria has managed to contain Ebola's spread to a total of 20 cases and 8 deaths, and looks likely to be declared free of the virus in coming weeks.

"Even if we have a worse case scenario where someone doesn't present for medical treatment, or..it's not correctly identified as Ebola, and we get secondary transmission, it's not likely to be a very long secondary transmission chain," he said.

"People aren't living in very crowded conditions (in Europe), so the disease doesn't have the same environment it has in a shanty town in Monrovia, where the environment is perfect for it to spread. It's a different matter in modern western cities with the very sanitised, sterile lives that we live."

(The story is refiled to clarify paragraph five)

(Editing by Sophie Walker)


http://news.yahoo.com/high-risk-ebola-could-reach-france-uk-end-113015476.html

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At Dallas church service, prayers of Ebola patient and families
Reuters
By Lisa Maria Garza  20 minutes ago



Parishioners pray during a church service dedicated to the victims of the Ebola crisis at New Life Fellowship Church in Euless, Texas, October 5, 2014. REUTERS/Jim Young



DALLAS (Reuters) - It was like any other Sunday morning worship service at Wilshire Baptist Church in Dallas, where Louise Troh, the quarantined girlfriend of the first patient in the United States diagnosed with Ebola, is a member of the congregation.

Greeters passed out bulletins and shook hands at the church entrances. Members hugged each other in greeting shortly before the service began. A couple hundred people sat in the pews of the church and began to pray for the patient, Thomas Eric Duncan, and for Troh and both of their families.

Associate Pastor Mark Wingfeld led the opening prayer and encouraged members not only to focus on the family in Dallas but also on those stricken with the deadly virus in West Africa who don't have the same access to medical care. At least 3,400 people have died in the outbreak worldwide, predominantly in West Africa.

"Although this disease has become personal to us, we realize we're not the first to know its devastation and we are not the ones most desperately affected," Wingfeld told parishioners.

"We pray that you calm the anxious hearts of so many in our city. Help the ignorant understand the truth."

Parishioners were told by church officials earlier in the week that neither Troh nor any of her family members had attended services since Duncan's arrival so there was no chance of exposure within the congregation.

Medical authorities have identified 10 people who had direct contact with Duncan as being at greatest risk of infection. Troh, whom Duncan has been staying with since he arrived on a visit from West Africa, is one of them.

"Whether there had been contact or not, maybe we would be acting differently, but I'd like to think we wouldn't," Julie Sorrels, 33, said.

"Before this, I was concerned about the Ebola situation in Africa. This made it more personal to have a name of someone specifically to pray for," she said.

(Reporting By Frank McGurty; Editing by Jonathan Oatis and Chizu Nomiyama)


http://news.yahoo.com/dallas-church-prayers-ebola-patient-families-183914316.html

[Buster's Uncle]

Doctor successfully treated for Ebola hospitalized
Associated Press
10 hours ago



WORCESTER, Mass. (AP) — A Massachusetts doctor and missionary who was successfully treated for Ebola he contracted in Africa is back in the hospital with what appears to be a respiratory infection, but doctors don't suspect a recurrence of the virus.

UMass Memorial Medical Center said in a statement that Dr. Richard Sacra was hospitalized Saturday for observation and is in stable condition. He has a cough and conjunctivitis, commonly known as pinkeye, hospital officials said.

Sacra will remain in isolation until doctors have confirmation from tests by the U.S. Centers for Disease Control and Prevention that he is not infected with the virus, the hospital said. Doctors expect to know with certainty by late Monday.

"We are isolating Dr. Sacra to be cautious pending final confirmation of his illness," said Dr. Robert Finberg, who is heading Sacra's medical team. "We think it is highly unlikely that he has Ebola. We suspect he has an upper respiratory tract infection."

Sacra, of Holden, returned to Massachusetts on Sept. 25 after weeks of treatment at an Omaha, Nebraska, hospital.

He spent much of the last two decades in Liberia, working with a missionary group. He also works at Family Health Center of Worcester.

Bruce Johnson, president of the SIM USA missionary group, said in a news release that Sacra first visited a Boston-area hospital emergency room Saturday morning because of a persistent cough and low-grade fever and concern that he might be developing pneumonia. Johnson said Sacra was transferred to UMass Memorial for observation as a precaution under CDC guidelines.

Johnson said Dr. Phil Smith of the Nebraska Medical Center, where Sacra was treated, told SIM that Sacra's recent viral illness lowered his immune system but his current symptoms aren't those of someone suffering from Ebola.

"Dr. Sacra did the right thing by going to the hospital," Smith said in a statement released by SIM. "He's been through a lot over the last month, and he wanted to be sure his respiratory illness didn't worsen. Being a doctor himself, he knows the importance of preventative care."


http://news.yahoo.com/doctor-successfully-treated-ebola-hospitalized-034840827.html

[Buster's Uncle]

Why Closing Borders Won't Solve The Ebola Crisis
Business Insider
By Erin Brodwin  4 hours ago



Ebola distribution map  CDC



Ebola is ravaging West Africa.

Close to 7,200 people in Liberia, Guinea, and Sierra Leone have been diagnosed with the virus; nearly 3,400 have already died. Another 4,000 West African children have been orphaned since the virus broke out in Dec. 2013. These shocking numbers, along with the recent news that the US diagnosed its first Ebola, have spurned the question: Why doesn't the world simply seal the borders of the hardest-hit countries?

Put simply, preventing people from entering or leaving the three countries where Ebola is raging will do nothing to stop the virus from spreading. On the contrary, cordoning off Liberia, Guinea, and Sierra Leone would likely make the outbreak worse.

Aside from being "simple and wrong," quick fixes like isolation will make it even harder to get help into the countries that need it, Centers for Disease Control and Prevention director Tom Frieden told reporters on Thursday. All isolation will do, said Frieden, is "enable the disease to spread more widely" in the most affected countries, which will in turn create "more potential for it to spread elsewhere and become more of a problem."

The longer the outbreak goes on, the more opportunities there will be for the virus to jump from the region. The first priority should be to focus all resources on containing the outbreak, not sealing off the area that needs the most help.


Making A Bad Situation Worse

One of the biggest obstacles currently facing the three countries where Ebola is raging is a lack of people power.

This is the first time Ebola has broken out in West Africa, and most people there (many of whom lack access even to basic medical care) don't know how to diagnose it or what to do when someone becomes ill. “The whole country has been hit by something for which it was not ready,” Dr. Amara Jambai, director of prevention and control at Sierra Leone’s health ministry, told the New York Times.

Making it even harder for potential sources of aid to reach the country certainly won't help.

Affected countries need more health workers trained to organize efforts to locate, isolate, and treat all the infected patients. Then they need more people to investigate the network of people sick patients may have infected. Potential contacts must be monitored for 21 days, the total period of time someone can carry Ebola before showing symptoms.



Mobility patterns and connectivity in West Africa demonstrate why intra-regional spread is an ongoing risk. PLOS Currents


Two Countries, Two Very Different Outcomes

In Sierra Leone, Ebola patients in many of the country's cities  linger in holding centers guarded by police, where barely-trained staff wearing little to no protective gear provide the best care they can. International aid to the area has been too little and too late.

In Nigeria, the opposite has happened: As of last week, Africa's most populous country — and one of its major trade and transit centers — succeeded in containing the outbreak. With the help of support from the Bill and Melinda Gates Foundation, the CDC, the World Health Organization, Unicef, Doctors Without Borders, and the International Committee for the Red Cross, the country's top doctors executed a quick and concentrated effort to contain the virus. Nigeria is also wealthier than the three main countries affected by the virus, and unlike in those countries, its outbreak began with a single person who flew into the country in July.

The people of Sierra Leone, Guinea, and Liberia need more attention, not less. They need to make sure their economies, already hollowed out by the crisis, do not grind to a complete halt. They need more support, including trained health workers; supplies like gloves, masks, and disinfectants; and money for treatment facilities.

The only way to do that is with a concerted, international effort.


Managing Risk

Air traffic connections from West African countries to the rest of the world. PLOS Currents


The CDC advises Americans traveling to West African countries affected by Ebola to take several precautions to avoid infection, including avoiding contact with wild animals, staying out of hospitals where Ebola patients are being treated, and  not touching the blood or body fluids of the infected, or the bodies of those  who have died from Ebola.

West African airports, meanwhile, are routinely screening travelers, both by inquiring about their exposure to Ebola and checking for fever. The CDC is helping with those efforts. In the US, t he  CDC has reminded airlines  that people can legally deny boarding to a passenger who is visibly ill. (Ebola patients are not contagious until they have symptoms.)

Officials have also asked workers in airports and on airlines to be on guard.

"We've provided guidance to pilots, flight attendants and others who are responsible for staffing our transportation infrastructure to ensure that if they notice individuals who are exhibiting symptoms... that the proper authorities are notified," White House spokesman Josh Earnest told reporters on Wednesday.

The governments of Guinea, Liberia, and Sierra Leone have, of course, also  taken whatever steps they can  to reduce the virus' spread, including limiting mass gatherings,  instituting screenings  at major points of travel, quarantining communities acutely affected by Ebola, and visiting homes to search for people who've been infected.

In this context, completely sealing the countries' borders would be an ill-proportioned response to a manageable level of risk — and one that would very likely make the outbreak even worse.


http://news.yahoo.com/why-closing-borders-wont-solve-152400673.html

[Buster's Uncle]

Ugandan Health Worker Dies Of Marburg Virus, Ebola Relative
Forbes
David Kroll  10/05/2014 @ 2:16PM



The Ugandan Ministry of Health is reporting today that a 30-year-old male health care worker died of Marburg hemorrhagic fever on September 30.

The gentleman had been a radiographer, or X-ray technician, at the Mpigi Health Centre IV, but was recruited two months ago for a similar position at Mengo Hospital, about 20 miles (33 km) away. When he felt ill on September 17, he traveled back to Mpigi for treatment since “he felt more confortable with a facility that he had worked with for a long time.”

Today’s statement from Elioda Tumwesigye, Minister of State for General Duties & Holding the Portfolio of Minister for Health, describes a total of 80 people who were in contact with the man have been identified and isolated to follow for signs and symptoms during the 21-day incubation period, the same incubation period for Ebola.

Most concerning is that 38 of the contacts are health care workers from Mengo Hospital, including the man’s brother, and 22 health care workers from Mpigi Health Center IV. The remaining 20 contacts are residents of the Kasese district.

The official reports that the man’s brother has already developed signs consistent with Marburg infection. He has been quarantined and isolated for further monitoring while his blood samples are being analyzed at the Uganda Virus Research Institute.

Marburg is one of the five members of the family of filoviruses, to which Ebola belongs. Like Ebola, a person infected with Marburg will experience a sudden onset of fever. The most common additional signs are headache, joint and muscle pains, vomiting blood, and bleeding through body openings. The disease has a two to 21-day incubation period and, like Ebola, has no cure other than supportive treatment.

Sarepta Therapeutics of Cambridge, Massachusetts, has been developing an RNA-interfering drug against Marburg virus as part of a collaboration with the U.S. Department of Defense. The drug, called AVI-7288, is targeted against the nucelocapsid protein of Marburg virus. In March, the company reported infection protection rates of up to 83% to 100% in non-human primates when given at up to four days post-infection. As a result, Sarepta initiated a multiple, ascending dose Phase I safety trial in humans in May.

Tekmira Pharmaceuticals of Burnaby, British Columbia, has a lipid nanoparticle, RNA interfering drug that also protects non-human primates from Marburg infection. This work, done with Thomas Geisbert at the University of Texas Medical Branch at Galveston, appeared in Science Translational Medicine in August. There, the drug is called NP-718m-LNP, but Tekmira’s website currently calls it TKM-Marburg.



Colorized electron micrograph of Marburg virus from the laboratory of Dr. Thomas W. Geisbert, UTMB-Galveston. Credit: NIAID


Kent State University infectious disease specialist, Tara C. Smith, PhD, wrote an excellent history of Marburg virus in 2007. The 1967 discovery of the virus precedes that of Ebola (1976), but occurred outside of Africa, in Marburg, Germany.

Dr. Smith writes,

The year was 1967. Several laboratory workers, all from the same lab in Marburg, Germany, were hospitalized with a severe and strange disease. The physicians on staff realized the workers were all suffering from the same ailment, with symptoms that included fever, diarrhea, vomiting, massive bleeding from many different organs, shock, and eventually circulatory system collapse. An investigation began in an attempt to uncover the source of the outbreak. This led to the identification of the source of the virus in Germany: a species of African green monkeys, imported from Uganda, which were being used by the scientists for polio vaccine research. The virus was isolated, and found to exhibit a unique morphology, leading to the designation of a new group: the Filoviridae In that outbreak, a total of 31 human cases were observed, and the disease presented with a 23% mortality rate (7 deaths occurred out of 31 total infections).

http://www.forbes.com/sites/davidkroll/2014/10/05/ugandan-health-worker-dies-of-marburg-ebola-relative/?partner=yahootix

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Washington hospital rules out Ebola for patient back from Nigeria
Reuters
8 hours ago



The sign for Howard University Hospital is pictured in Washington October 3, 2014. REUTERS/Joshua Roberts



(Reuters) - Howard University Hospital said on Saturday that a medical team has determined that a patient feared afflicted with Ebola does not have the disease.

The Washington-based hospital, working with the District of Columbia Department of Health and U.S. Centers for Disease Control and Prevention said it was able to rule out Ebola for the patient, whose identity was not disclosed. The patient is to be treated for "other illnesses," according to the health department.

The hospital said on Friday that it had admitted a patient who returned from travel to Nigeria and placed him in isolation due to concerns he might have Ebola.

The first Ebola patient diagnosed in the United States took a turn for the worse on Saturday, slipping from serious to critical condition, as health officials reported fielding scores of possible cases around the country that proved to be false alarms.

The governments of Guinea, Sierra Leone and Liberia are struggling to contain the worst outbreak on record of the deadly hemorrhagic fever. The World Health Organization on Friday said nearly 3,450 people had died of the disease since its outbreak in March.


http://news.yahoo.com/washington-hospital-rules-ebola-patient-back-nigeria-112801568.html

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Aid workers ask where was WHO in Ebola outbreak?
Reuters
By Daniel Flynn and Stephanie Nebehay  12 hours ago

     
* Calls for reform of U.N. health agency after mishandling Ebola

* Hit by cuts, WHO rebuffed calls to play more active role

* Crisis was complicated by weak governments, cultural factors

* MSF coordinator says agency displayed shocking amateurism

* Calls for larger WHO budget, more powerful leadership



DAKAR/GENEVA, Oct 5 (Reuters) - In the first days of the Ebola outbreak in West Africa, as aid workers and health authorities battled to contain the deadly virus, Mariano Lugli asked himself a simple question: where was the World Health Organization?

Lugli, an Italian nurse, was among the first responders from medical charity Medecins Sans Frontieres (MSF) to reach the remote forests of Guinea in March where the hemorrhagic fever - one of the most lethal diseases known to man - was detected.

When the epidemic spread to the capital Conakry, Lugli set up a second Ebola clinic there. He encountered a foreign medic and a logistician sent by the U.N. health agency but saw no sign of a WHO official in charge of handling the escalating outbreak.

"In all the meetings I attended, even in Conakry, I never saw a representative of the WHO," said Lugli, deputy director of operations for MSF Switzerland. "The coordination role that WHO should be playing, we just didn't see it. I didn't see it the first three weeks and we didn't see it afterwards."

The worst outbreak of Ebola on record has killed more than 3,400 people in four West African countries and spread to the United States, where the first case was confirmed in Dallas this week.

After a dire warning from the U.S. Centers for Disease Prevention and Control (CDC) that the virus could infect up to 1.4 million people, many health professionals and politicians are asking how the crisis got so badly out of hand. In the past 40 years, Ebola had killed just 1,500 people in sporadic outbreaks in Africa.

Some aid workers and U.N. officials blame a lack of WHO leadership in the emergency response, particularly in the early stages when it would have been easier to contain. On several occasions, WHO officials played down the outbreak, they say.

MSF International President Joanne Liu, who warned that her organisation could not cope with the rising number of Ebola victims, has accused the WHO of failing its mandate to help member states cope with health emergencies.

Stung by the criticism, WHO officials say the organisation was overstretched by a series of health care crises. They blame weak health care systems and uncooperative populations in poor African nations still reeling from civil war in the 1990s for allowing the outbreak to explode.

Senior WHO staff, including Director General Margaret Chan, said the organisation's role was not to run Ebola clinics or campaigns but advise states how to do so.

Yet after a direct appeal from the leaders of Guinea, Liberia and Sierra Leone - the worst affected countries - for the United Nations to do more on Ebola, Secretary-General Ban Ki-moon stepped in to create a special U.N. mission last week, effectively stripping WHO of its coordination role.

"I hope the Ebola crisis will become a turning point for WHO, a needed wake-up call," said Lawrence Gostin, global health law professor at Georgetown University. "The WHO's budget and capacity to respond are in tatters, and it has become mostly a technical organisation."

"The WHO's narrow view of its role is in stark contrast to its constitutional mission as the global health leader."


POLITICISED

Insiders say the WHO is amongst the most politicised of U.N. agencies, with governments holding sway over its regional operations. The director of its regional African bureau (AFRO) based in Brazzaville, Congo, is appointed by governments and has access to locally raised funds, allowing autonomy from Geneva.

"Neither donors nor WHO headquarters has a true hold on it," said one diplomat, familiar with the workings of WHO management, who said relations between Geneva and AFRO were weak.

"There was never anybody from AFRO on the coordination calls ... They were invisible throughout."

AFRO Director Dr Luis Sambo denied his bureau was slow to react, saying he immediately sent an emergency coordinator to Guinea, deployed international experts and disbursed money to help the Guinean government.

Despite some differences of opinion on conference calls, coordination remained strong with Geneva from March onwards, Sambo told Reuters.

However, experts contrasted the handling of the outbreak with the WHO's exemplary management of the 2003 SARS crisis.

During SARS, then WHO director general Gro Harlem Brundtland - a former Norwegian prime minister - gave free rein to staff in Geneva and aggressively pushed China to take greater action.

Brundtland was not re-elected and Chan, a former director of health in Hong Kong who orchestrated its fight against SARS, has taken a more low key approach in dealing with national governments since she took office in 2007.

"Dr. Chan feels that national governments need to take the lead," said Georgetown's Gostin. "But if you have governments with such fragile health systems and wide distrust among its own population, WHO needs to take the lead."

With SARS the WHO could rely on robust Asian health care systems, but when Ebola hit Liberia it had only 50 doctors, and rural clinics lacked even basic equipment like latex gloves.

When it became clear health care systems were buckling under the strain in Liberia, Sierra Leone and Guinea, the WHO declared Ebola an international public health emergency on Aug. 8.

WHO headquarters took responsibility for coordination away from AFRO, sending experienced staff to run country offices.

Peter Piot, a former WHO official who co-discovered the Ebola virus in 1976, said the delay in doing this was a crucial factor in allowing the epidemic to reach unprecedented levels.

"It took another five months and 1,000 deaths before the WHO declared this a public health emergency," said Piot, director of the London School of Hygiene and Tropical Medicine.

Some diplomats suggest the WHO may have hesitated to flag up the Ebola outbreak after it was accused of overhyping the 2009 H1N1 swine flu epidemic and pandering to pharmaceutical firms.

"Could it have declared earlier? Sure," said Keiji Fukuda, WHO assistant director-general for health security, who had led the fight against H1N1. "We're always having to balance, because if you're perceived as crying wolf it doesn't help."


BUDGET CUTS

WHO insiders say cuts to the WHO's budget after the 2008 financial crisis left it ill-prepared to fight major epidemics. Its $2 billion annual spending is less than a third the size of the CDC budget, and smaller than that of many U.S. hospitals.

With most of WHO's funding allocated by donors to specific diseases, such as polio or HIV-AIDS, the outbreak and crisis department had its funding cut by 51 percent. Dealing with hemorrhagic fevers was increasingly left to the AFRO bureau.

Francis Kasolo, head of a WHO regional Ebola response centre set up in Guinea, said budget cuts forced AFRO to cut its epidemic team from 12 to four staff over the past two years.

A 2011 proposal by a WHO committee for a $100 million task force to tackle epidemics that might have prevented Ebola spinning out of control was not approved by member states.

When Ebola struck, WHO's international outbreak team in Geneva led by Fukuda was already swamped by outbreaks of MERS and H7N9 in China.

Kasolo said the WHO brought in hundreds of foreign experts and health workers, paid for construction of Ebola clinics and supplied thousands of protective suits but it did not have the skills or personnel to run the centres, as MSF was asking.

"We're a public health agency not a clinical management agency," said Kasolo. "We don't run hospitals but we can provide the necessary guidance on how the hospital should run."


LAGGING FROM THE START

WHO officials say the epidemic raced ahead of efforts to control it from the start because Guinea took more than three months to notify the agency of the disease.

The traditional practice of cleaning bodies by hand at funerals spread the virus, which is transmitted by body fluids.

First detected in central Africa, Ebola had never struck West Africa and doctors had no idea what they were seeing. The outbreak was initially misdiagnosed as cholera.

Only on March 13 did Guinea notify the WHO, which sent a team to the southeast the next day. Samples dispatched to a laboratory in France showed on March 21 what many feared - Ebola had struck a completely unprepared region.

"It was way too late," said AFRO's Sambo, "Hundreds of unidentified people were already infected."

Once alerted to the outbreak, however, the WHO appeared to underestimate its scale dramatically. At Geneva HQ, there was a consensus that it was better not to cause panic.

When drug-maker GlaxoSmithKline told the WHO in March it had an experimental vaccine, the agency said it was focused on containment, only to ask the firm to fast-track clinical trials in August as the outbreak span out of control, a GSK spokeswoman said.

At least three times in April and May, new Ebola cases in West Africa seemed to dry up, creating a false sense that the outbreak was contained.

By contrast, MSF warned as early as March 31 that the geographic spread of the outbreak made it "unprecedented". It received a strong rebuttal from a WHO spokesman.

"A few days or a week after our statements, there was always WHO saying 'no, it's not true'," said MSF's Lugli. "Except later they confirmed it."

The key to defeating Ebola is tracing people who have come into contact with infected people, monitoring them and quickly isolating new infections. In this too, the WHO and local governments struggled, partly due to popular resistance.

Communities hid their sick because of mistrust of foreign doctors clad in plastic suits that led to attacks on aid workers. Ebola clinics were seen as death traps, while people resented a ban on their traditional burial practices.

Local politics also played a role. In both Guinea and Sierra Leone, regions affected by the virus were home to ethnic groups resistant to central government and when health workers tried to trace victims in May, they were denied access.

But Michel Poncin, MSF emergency coordinator in Guinea, said the WHO failed to establish its own network of community contacts, relying instead on government officials. Teams were often not paid, given vehicles or fuel.

"WHO kept saying it's not our role to do it, we just advise the health ministry," he said. "I've been really shocked by the WHO's level of amateurism in responding to this crisis." (Additional reporting by Kate Kelland; editing by Pascal Fletcher and Giles Elgood)


http://news.yahoo.com/aid-workers-ask-where-ebola-070000471.html

[Buster's Uncle]

Man dies from Ebola-like Marburg virus in Uganda
AFP
4 hours ago



In this photo dated May 6, 2005, a member of the World Health Organisation (WHO) takes an oral sample from a patient suspected of having Marburg haemorrhagic fever in Kinguangua, Angola (AFP Photo/Christopher Black)



Kampala (AFP) - A hospital technician has died of the Ebola-like Marburg virus in Kampala, the Ugandan government announced on Sunday.

The man, aged 30, died in the Mengo hospital where he worked in the capital of the east African country on September 28, 11 days after falling ill, the authorities said.

Tests confirmed the presence of the disease two days later.

The Marburg virus is one of the most deadly known pathogens. Like Ebola, it causes severe bleeding, fever, vomiting and diarrhoea.

The victim's brother and one other person he was in contact with have so far "developed signs" of the disease, the ministry of health said in a statement.

"So far, a total of 80 people who got into contact with the initial confirmed case have been identified and isolated" for the 21-day incubation period, it added.

"These include 38 health workers from Mengo hospital and 22 health workers from Mpigi Health Center IV."

Like Ebola, the Marburg virus is transmitted via contact with bodily fluids and fatality rates range from 25 percent to 80 percent.

Uganda's Prime Minister Dr Ruhakana Rugunda said the government could deal with any outbreak. "Uganda has previously successfully handled similar situations of health threats involving hemorrhagic fevers," he wrote on Twitter.

A Marburg outbreak in Uganda in October 2012 killed 10 people, about half of those who were confirmed infected with the disease.

The Ebola epidemic that has been raging in west Africa has so far claimed almost 3,500 lives, with Liberia, Guinea and Sierra Leone worst hit.

Researchers announced in August that a drug developed by Canada's Tekmira Pharmaceuticals helped monkeys survive the deadly Marburg infection in tests.


http://news.yahoo.com/man-dies-ebola-marburg-virus-uganda-212501930.html

[Buster's Uncle]

Federal officials cast doubt on Ebola travel ban
Associated Press
By MARK SCOLFORO  3 hours ago



CDC Director Tom Frieden said Sunday that Tomas Eric Duncan, the lone Ebola patient in the U.S., has taken a 'turn for the worse' in his fight to recover from the potentially-deadly virus. (Oct. 5)



Top government health officials said Sunday that they are opposed to placing a ban on travelers from Ebola-infected countries, warning that shutting down borders could impede efforts by aid workers to stop the spread of the deadly virus.

The idea of a ban gained currency this past week after the nation's first case was diagnosed in Dallas. Proponents have argued that it would help ensure public safety.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, said a travel embargo on West African countries that are struggling with Ebola would make it much harder for them to control the virus.

"You isolate them, you can cause unrest in the country," Fauci told "Fox News Sunday." ''It's conceivable that governments could fall if you just isolate them completely."

British Airways and some other airlines have suspended flights from those countries, and overall traffic to and from the affected areas has dropped.

Sen. Mark Kirk, an Illinois Republican, has said the federal government should gradually halt flights to the region to protect Americans. Rep. Tim Murphy plans to conduct hearings on the policy this coming week. He leads the House Energy and Commerce Subcommittee on Oversight and Investigations.



In this photo provided by CBS News, the National Institute of Health's Dr. Anthony Fauci, the nation's top infectious disease expert, speaks on CBS's "Face the Nation" in Washington. Speaking on the Ebola virus, Fauci said it's perfectly normal to feel anxious about a disease that kills so fast and is ravaging parts of West Africa, but predicts there won't be an outbreak in the U.S. (AP Photo/CBS News, Chris Usher)


Asking travelers to report their own activities at airports "has been a demonstrated failure, and it is nearly impossible to retrace steps to try and track down everyone who has been in contact with a carrier taking multiple international flights across the globe," Murphy, a Pennsylvania Republican, said Friday.

Louisiana Gov. Bobby Jindal, a physician, said the U.S. should halt flights from Ebola-stricken countries.

"The Obama administration keeps saying they won't shut down flights. They instead say we should listen to 'the experts,'" Jindal said Friday. "In fact, they said it would be counterproductive to stop these flights. That statement defies logic."

Tom Frieden, director of the federal Centers for Disease Control and Prevention, said on ABC's "This Week" that the administration was open to practical suggestions that won't backfire.

"We don't want to do something that inadvertently increases our risk by making it harder to stop the outbreak there, because if it spreads more widely throughout different countries in Africa, that will be even more of a risk to us," said Frieden, whose agency has cautioned against non-essential travel to Liberia, Sierra Leone and Guinea.



Centers for Disease Control and Prevention director Dr. Tom Frieden speaks at a news conference Sunday Oct. 5, 2014 at the CDC in Atlanta. Frieden said that he was aware that Ebola patient Thomas Eric Duncan's health had "taken a turn for the worse," but he declined to say what signs of poor health Duncan had shown. (AP Photo/Johnny Clark)


Frieden has also noted that a ban on incoming flights could affect Americans trying to return home from those countries.

"There are many other people who have the right to enter into this country," he said during a Saturday briefing. "And we're not going to be able to get to zero risk no matter what we do unless and until we control the outbreak in West Africa."

An airline passenger traveling from Liberia to Dallas brought Ebola into the U.S. last month. He is hospitalized in isolation, and public-health officials are monitoring a few dozen people who may have been exposed to the virus.

U.S. officials have emphasized that the United States has a modern medical system that is far better equipped to contain an outbreak than the African countries where Ebola is currently spreading.

Airline passengers have their temperatures taken as they board planes in the outbreak zone, although those infected with Ebola can go up to 21 days before they exhibit symptoms. Passengers are also asked about contact with infected people, but that process would not be useful if a passenger lies or simply does not realize the medical condition of people they have encountered.


http://news.yahoo.com/federal-officials-cast-doubt-ebola-travel-ban-214142658.html

[Buster's Uncle]

5th American with Ebola returning from Liberia
Associated Press
By JOSH FUNK  1 hour ago



CDC Director Tom Frieden said Sunday that Tomas Eric Duncan, the lone Ebola patient in the U.S., has taken a 'turn for the worse' in his fight to recover from the potentially-deadly virus. (Oct. 5)



OMAHA, Neb. (AP) — An American photojournalist who contracted Ebola while working in West Africa began his journey home for treatment Sunday, while a man who recently arrived in Dallas from Liberia remained in critical condition with the disease.

Ashoka Mukpo, 33, will be the second Ebola patient to be treated at the Nebraska Medical Center's specialized isolation unit.

Mukpo was working as a freelance cameraman for NBC News in Liberia when he became ill last week. NBC reported Sunday evening that Mukpo had started his journey to the U.S. for treatment and that he would arrive Monday morning. Mukpo's family said Friday he would be treated in Omaha. Hospital officials said they expected an Ebola patient to arrive Monday, but declined to provide a name.

He is the fifth American to return to the United States for treatment since the start of the latest Ebola outbreak, which the World Health Organization estimates has killed more than 3,400 people.

The hospital's biocontainment unit was created in 2005 specifically to handle illnesses like this, said Dr. Phil Smith, who oversees the unit.

"We are ready, willing and able to care for this patient," Smith said. "We consider it our duty to give these American citizens the best possible care we can."



Centers for Disease Control and Prevention director Dr. Tom Frieden speaks at a news conference Sunday Oct. 5, 2014 at the CDC in Atlanta. Frieden said that he was aware that Ebola patient Thomas Eric Duncan's health had "taken a turn for the worse," but he declined to say what signs of poor health Duncan had shown. (AP Photo/Johnny Clark)


Mukpo's father, Dr. Mitchell Levy, told NBC Sunday that his son was "counting the minutes" until he could leave Liberia but that he was not feeling that ill Sunday. Levy said the family was travelling from Rhode Island to Nebraska.

Doctors at the isolation unit — the largest of four nationwide — would evaluate Mukpo when he arrives before determining how to treat him. They said they will apply the lessons learned while treating American aid worker Rick Sacra in September. Sacra was successfully treated in the Nebraska unit and was allowed to return to his home in Massachusetts after three weeks, on Sept. 25.

"Truly, focusing on symptom management is key with these patients," Dr. Rosanna Morris said Friday.

Sacra received an experimental Tekmira Pharmaceuticals drug called TKM-Ebola, as well as two blood transfusions from another American aid worker who recovered from Ebola at an Atlanta hospital. The transfusions are believed to help a patient fight off the virus because the survivor's blood carries antibodies for the disease. Sacra also received supportive care, including IV fluids and aggressive electrolyte management.

In Dallas, Thomas Eric Duncan was listed in critical condition Sunday. Duncan has been hospitalized at Texas Health Presbyterian Hospital for one week. Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, said he was aware that Duncan's health had "taken a turn for the worse," but he declined to describe Duncan's condition further.



Dr. Mitchell Levy, father of Ashoka Mukpo, an American freelance cameraman who is diagnosed with Ebola, talks with a reporter at his home in Providence, R.I., Friday, Oct. 3, 2014. Levy's son, Ashoka Mukpo is scheduled to fly to the Nebraska Medical Center in Omaha, when he leaves Liberia. (AP Photo/Stew Milne)


Duncan arrived in Dallas from Liberia on Sept. 20 and fell ill a few days later.

Four members of a family who hosted Duncan in their northeast Dallas apartment are being kept in isolation, though they have not shown symptoms of infection. Ten people definitely had close contact with Duncan and a further 38 may have been around him when he was showing symptoms of the disease, officials said.

The virus that causes Ebola is not airborne and can only be spread through direct contact with the bodily fluids — blood, sweat, vomit, feces, urine, saliva or semen — of an infected person who is showing symptoms.

Earlier Sunday, authorities found a homeless man who may have had contact with Duncan, Dallas city spokeswoman Sana Syed said.

Dallas County Judge Clay Jenkins called the man, whom he didn't identify, a "low-risk individual," and said he would be placed in housing that would allow health workers direct access to him daily.

___

Associated Press writer Nomaan Merchant in Dallas contributed to this report.


http://news.yahoo.com/officials-look-possible-ebola-patient-contact-164109700.html

[Buster's Uncle]

Worst Ebola outbreak on record tests global response
Reuters
2 hours ago


(Reuters) - International agencies and governments are fighting to contain the world's worst Ebola epidemic since the disease was identified in 1976.

The virus, which causes fever and bleeding, has killed at least 3,439 people.

Here is a timeline of the outbreak:

March 22: Guinea confirms a previously unidentified hemorrhagic fever, which killed over 50 people in its southeastern Forest Region, is Ebola. Cases are also reported in the capital.

March 30: Liberia reports two Ebola cases; suspected cases reported in Sierra Leone.

April 1: Medical charity Medecins Sans Frontieres (MSF) warns the epidemic's spread is "unprecedented." But a World Health Organization (WHO) spokesman calls it "relatively small still."

April 4: A mob attacks an Ebola treatment center in southeastern Guinea. Healthcare workers in Guinea, Sierra Leone and Liberia face growing hostility from fearful, suspicious local people.

May 26: WHO confirms first Ebola deaths in Sierra Leone.

June 17: Liberia says Ebola has reached its capital, Monrovia.

June 23: With deaths above 350, making the West African outbreak the worst Ebola epidemic on record, MSF says it is "out of control" and calls for massive resources.

July 25: Nigeria, Africa's biggest economy, confirms its first Ebola case, a man who died in Lagos after traveling from Monrovia.

July 29: Dr. Sheik Umar Khan, who was leading Sierra Leone's fight against the epidemic, dies of Ebola.

July 30: Liberia shuts schools and quarantines the worst-affected communities, using troops for enforcement.

Aug. 2: A U.S. missionary physician infected with Ebola in Liberia is flown to Atlanta in the United States for treatment.

Aug. 5: A second U.S. missionary infected with Ebola is flown from Liberia to Atlanta for treatment.

Aug. 8: WHO declares Ebola "international public health emergency."

Aug. 12: WHO says death toll has topped 1,000, approves use of unproven drugs or vaccines.

A Spanish priest with Ebola dies in a Madrid hospital.

Aug. 15: MSF says the epidemic will take about six months to control.

Aug. 20: Security forces in Monrovia fire shots, tear gas to disperse crowd trying to break out of quarantine, killing a teenager.

Aug. 21: The two U.S. missionary aid workers treated in Atlanta are released from the hospital free of the virus.

Aug. 24: Democratic Republic of Congo declares Ebola outbreak, apparently separate from larger epidemic.

An infected British medical worker is flown home from Sierra Leone for treatment.

Aug. 28: WHO puts death toll at above 1,550, warns outbreak could infect more than 20,000.

Aug. 29: Senegal reports first confirmed Ebola case.

Sept 2: MSF President Joanne Liu tells U.N. members the world is "losing the battle" to contain Ebola, slams "a global coalition of inaction."

Sept. 3: Epidemic's pace accelerates; deaths top 1,900. Officials say there were close to 400 deaths in the past week.

A third U.S. missionary doctor infected with Ebola is flown from Liberia for treatment in Omaha, Nebraska.

Sept. 5: Latest WHO tally: More than 2,100 dead out of about 4,000 people thought to have been infected.

Sept. 7: President Barack Obama says in an interview the United States needs to do more to help control Ebola to prevent it from becoming a global crisis.

Sept. 8: Britain says it will send military and humanitarian experts to Sierra Leone to set up a treatment center; United States says it will send 25-bed military field hospital to Liberia to care for health workers.

A fourth Ebola patient will be flown to the United States for treatment in Atlanta.

Sept. 9: New WHO tally: At least 2,296 dead out of 4,293 cases recorded in five countries.

Sept. 13: Liberian President Ellen Johnson Sirleaf appeals to Obama for urgent aid in tackling Ebola.

Sept. 16: The United States promises to send 3,000 military engineers and medical personnel to West Africa to build clinics and train healthcare workers.

New WHO tally: 2,461 dead out of 4,985 infected, a doubling of the death toll in the past month.

Sept. 17: MSF says a French nurse volunteering for the medical charity in Liberia has Ebola.

Sept. 18: New WHO tally: 2,630 dead out of 5,357 believed infected.

The United Nations says a special mission to combat Ebola will deploy staff in Liberia, Guinea and Sierra Leone. U.N. Security Council adopts U.S.-drafted resolution calling for lifting of travel and border restrictions.

French President Francois Hollande says a military hospital will be set up in Guinea.

Sept. 19 - Streets in Sierra Leone's capital, Freetown, are deserted as the country imposes a controversial three-day lockdown to try to halt Ebola's spread.

Sept. 20 - Liberian national Thomas Eric Duncan flies from Liberia to Dallas via Brussels and Washington after reportedly trying to help a woman with Ebola in his home country.

Sept. 22 - WHO says the outbreak has been largely contained in Senegal and Nigeria but says Ebola has killed more than 2,811 people in West Africa.

Sept. 23 - The CDC estimates between 550,000 and 1.4 million people in West Africa may be infected with Ebola by January.

Sept. 25 - At a meeting on the sidelines of the U.N. General Assembly, Obama calls on more countries to help fight Ebola, saying hundreds of thousands of lives are at stake.

Duncan goes to a Dallas hospital complaining of fever and abdominal pain. He is sent back to the apartment where he is staying, with antibiotics, despite telling a nurse he has traveled from West Africa.

Sept. 26 - New WHO tally: 3,091 dead out of 6,574 probable, suspected and confirmed cases.

Cuba says it will send nearly 300 doctors and nurses to West Africa, to join 165 healthcare workers slated to arrive in early October.

Sept. 28 - Duncan's condition worsens, and he is taken to the Dallas hospital by ambulance.

Sept. 30 - CDC confirms Duncan has Ebola, making his first case diagnosed in the United States.

Oct. 1 - WHO updates West Africa death toll to 3,338 dead out of 7,178 cases.

Oct. 2 - Britain pleads for international help to fight epidemic at "Defeating Ebola" conference in London.

NBC News says an American freelance television cameraman working for the network has tested positive for Ebola and will be flown back to the United States for treatment.

Oct. 3 - New WHO tally: 3,439 dead out of 7,492 suspected, probable and confirmed cases in West Africa and the United States, which has one case.

A Ugandan doctor suffering from the disease arrives in Frankfurt from Sierra Leone for treatment at a hospital in the German city.

Oct. 4 - The volunteer nurse in Liberia who was the first French national to contract the virus leaves a hospital outside Paris after being successfully treated for the disease.

Duncan's condition worsens from serious to critical.

(Writing by Jonathan Oatis; Editing by Lisa Shumaker)


http://news.yahoo.com/worst-ebola-outbreak-record-tests-global-response-234110988.html

[Buster's Uncle]

Here's how a hospital builds an Ebola-proof room
Vox
Updated by Sarah Kliff on October 4, 2014, 12:30 p.m. ET@sarahkliffsarah@vox.com



Texas Health Presbyterian Hospital in Dallas is now treating the first case of Ebola diagnosed in the United States.  Mike Stone/Getty Images 



There are four hospitals in the United States with special isolation wings to treat highly infectious patients. George Risi runs one of them.

Risi is an infectious disease specialist at St. Patrick's Hospital in Missoula, Montana. In 2007, his hospital became the support facility for the nearby Rocky Mountain Laboratories, a federal lab that does work with certain rare and contagious diseases. If anyone got sick at the Rocky Mountain Labs, they could go to St. Patrick's.

So far, the other three hospitals with these isolation wings are the three facilities that have treated Americans who contracted Ebola  abroad: Emory, the University of Nebraska, and the National Institutes of Health. Risi's hospital has not had a patient yet, but his hospital could be a natural choice in the future.

I spoke with Risi on Thursday about how his hospital's isolation unit was built, what makes it different from other hospital facilities, and why he thinks any American hospital could handle an Ebola patient.

Sarah Kliff: Tell me a little bit about when your isolation unit was built and what that entailed.

George Risi: Our hospital is the support hospital for the Rocky Mountain Labs, which deals with high hazard, infectious diseases and its part of the National Institute of Allergies and Infectious Diseases campus out here.

When we were asked to be the support facility, we looked at the other models like the stand alone unit at Emory. The problem with that model is that its expensive to maintain a unit that's stand alone unit if it won't be used regularly.

 

One of Emory University's isolation units (Emory University)


For those kinds of reasons, we went ahead and retrofitted rooms in our intensive care unit to provide that kind of support. That allows us to have full access to the pharmacy and  also see other patients in those rooms. We use these rooms all the time as regular ICU rooms.

SK: What makes these rooms different from typical ICU rooms? What makes them isolation units?

GR: The difference is there is special air handling. Each of those three rooms has negative pressure: the air is drawn in from the hallway and then goes out through a series of high efficiency particulate air [HEPA] filters. The HEPA filters connect to duct work that goes up to the top of the roof of the hospital and is discharged 8 feet above the roof.

Nothing gets through two sets of HEPA filters but, if it did, anything would be dispersed and all of these viruses are killed by ultraviolet light.

We put in anterooms, which are the entrance rooms with two sets of doors. Also all the surfaces are smooth and readily cleanable without a lot of cracks and crevices where blood and bodily fluids could stay. But a lot of this has really become standard. Most hospitals have some rooms with anterooms. The Dallas hospital, I'm sure has something quite similar.

SK: What kind of protective gear do you keep on hand for people who might have to work with a highly contagious disease at some point?

GR: The gear depends on the stage of illness and which disease. For someone with tuberculosis, we would use N95 masks [which filter out air particles]. Those are the ones that are appropriate for isolation of an airborne isolation. We'd also be gowning and gloving depending on the nature of the disease.

SK: I'm curious about the larger suits that we saw Emory doctors wear when they escorted Kent Brantley out of an ambulance. Is that something that your hospital, or others, keep on hand?

GR: We certainly have a supply of them on hand and would probably put in a big order to get more if someone were admitted with a highly contagious disease. Right now, we have enough to manage somebody for several days.

SK: Has your hospital done any work to prepare for the possibility of treating an Ebola patient?

 

Dr. Kent Brantley leaves Emory University after being cured of Ebola (Jessica McGowan / Getty News Images)


Ever since the Rocky Mountain Labs has had us as their support hospital, we've had a training program. Every six months or so we have a workshop and also do periodic drilling.

Its true that these are exotic diseases but, in a way, they're not that exotic at all. If you trust your protective gear and if you use it appropriately, the risk of getting infected is minimal and that's no different from other diseases. The key is not to become excited or overwhelmed if you're asked to care for a patient like this.

SK: One challenge some hospitals have talked about is what to do with the waste from Ebola patients and how to dispose of that. Does your hospital have a plan?

GR: We're in the process of re-evaluating that. We have an autoclave on site, which is what you use to sterilize surgical items but from what we've heard from Emory about the volume, we may need to get more. That's something we're working through right now.

SK: Are there are things you've learned from hospitals like Emory that have seen Ebola patients that are helping you prepare right now?

GR: I think we've learned a lot about the importance of keeping moral up and the importance of emphasizing the ways that the disease can and can't be spread. A lot of this is leading from the front, such that the physicians who need to be involved will be willing and able to see an Ebola patient if that happens. That was part of the reason of my going to Sierra Leone with Kate Hurley, who is the head nurse of the isolation unit. We wanted to get over the fear factor.

This is something we've been talking about for years, how you handle this kind of patient, so its not new to us. The possibility is a little more real with the patient now in Dallas.

SK:  What's different about treating Ebola in Sierra Leone, compared to the type of facility you work in in Montana?

GR: It's a very different situation over there in a country that is trying to emerge from decades of civil war, poverty and a stressed health care system.

There are limits in terms of the medical support and the sheer numbers. At our hospital, the average daily census was 90 patients. This is equatorial Africa, so you could spend maybe three and a half hours in one of the protective suits before you had to come out and rehydrate.

We were very limited in what we could do. We didn't have access to blood products, or investigational drugs. It was really just IV hydration, that was kind of all we could provide. Despite that, we did save more people than we lost. Our mortality rate was 40 to 45 percent, which means 55 to 60 percent of our people survived and are immune. Some of them actually helped us manage our patients after they survived and became immune. They were able to help clean up and bring food, things like that.


http://www.vox.com/2014/10/4/6896867/hospitals-ebola-how-to-prepare

[Buster's Uncle]

Outbreak of Ebola-like Marburg fever kills man in Uganda
Reuters
By Elias Biryabarema  9 hours ago



KAMPALA (Reuters) - A man has died in Uganda's capital after an outbreak of Marburg, a highly infectious hemorrhagic fever similar to Ebola, authorities said on Sunday, adding that a total of 80 people who came into contact with him were quarantined.

Marburg starts with a severe headache followed by hemorrhaging and leads to death in 80 percent or more of cases in about nine days. It is from the same family of viruses as Ebola, which has killed thousands in West Africa in recent months.

There is no vaccine or specific treatment for the Marburg virus, which is transmitted through bodily fluids such as saliva and blood or by handling infected wild animals such as monkeys.

The health ministry said in a statement that the 30-year old radiographer died on Sept. 28 while working at a hospital in Kampala. He had started feeling unwell about 10 days earlier, and his condition kept deteriorating. He complained of headache, abdominal pain, vomiting blood and diarrhea.

Samples were taken and tested at the Uganda Virus Research Institute, and results confirmed the man had the Marburg virus.

Doctors said his brother, one of the people he came into contact with, has developed similar symptoms and has been quarantined in a group of 80 others, 60 of whom are health workers.

Those quarantined came into contact with the victim either in Kampala or his burial place in Kasese, a district in western Uganda bordering the Democratic Republic of Congo.

Marburg has a shorter incubation period of 14 days, compared with Ebola's 21.

The current outbreak of Ebola, the deadliest on record so far, has killed more than 3,400 people in four West African countries.

Uganda has been hit by several outbreaks of Marburg and Ebola in the past, but it has contained the outbreaks quickly, limiting fatalities.

Its worst occurrence of hemorrhagic fever occurred in 2000, when 425 people contracted Ebola and more than half of them died.

(Writing by James Macharia; editing by Jane Baird)


http://news.yahoo.com/outbreak-ebola-marburg-fever-kills-man-uganda-171031354.html