Ebola news 10/16

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Ebola comes to last safe district in Sierra Leone
Associated Press
By CLARENCE ROY-MACAULAY and PAUL SCHEMM  1 hour ago



In this Aug. 18, 2014, file photo, bed frames are laid out to be used at a newly built MSF, 'Doctors Without Borders', Ebola treatment center in the city of Monrovia, Liberia. The Ebola crisis is not prompting as large of a response from donors as other recent disasters. The American Red Cross, for example, received $2.8 million from Microsoft co-founder Paul Allen, but only about $100,000 in Ebola-related gifts from other donors. By comparison, the Red Cross received more than $85 million in response to Typhoon Haiyan. (AP Photo/Abbas Dulleh, File)



FREETOWN, Sierra Leone (AP) — The deadly Ebola virus has infected two people in what was the last untouched district in Sierra Leone, the government said Thursday, a setback in efforts to stop the spread of the disease in one of the hardest-hit countries.

The Emergency Operations Center in its report covering Wednesday announced the two Ebola cases in the Koinadugu district, in Sierra Leone's far north, which had taken aggressive measures to keep the virus out of its mountainous territory since the outbreak early this year.

"It was the only place we are counting on where you can go and breathe a sigh of relief and to know that now in the whole country no district is safe, is heartrending," said John Caulker, the executive director of the nonprofit Fambul Tok, a group that worked on keeping Ebola out of the district.

"Now we will increase our activities in the district and take the necessary measures to make sure the area is safe and it does not spread," he told The Associated Press, noting it was just in a single chiefdom so far.

Ebola is rampant in the rest of the country, with 425 new cases just in the last week and a health care system that is struggling to deal with the onslaught of the disease. The World Health Organization said there have been more than 3,000 infections in Sierra Leone with nearly 1,200 deaths.

Last week, the Koinadugu district's health team received word of people dying in the village of Fakonya, some 60 miles over very rough terrain from the town of district center of Kabala, said Abdul Sesay, a local health official.

Some 15 people had died and then two of the six samples tested came back as positive for the virus — the deaths had originally been attributed to witchcraft, according to Sesay.

The town has now been isolated and nearby communities have been put under observation.

Momoh Konte, a businessman born in the district and educated in the United States who has been very active in protecting Koinadugu, told local press Thursday that the dead and their homes would be cremated to protect the living.



In this Sept. 3, 2014, file photo, a health worker, left, uses a thermometer on a man outside the Youyi government buildings, part of measures to stem the spread of the Ebola virus, in Freetown, Sierra Leone. The Ebola crisis is not prompting as large of a response from donors as other recent disasters. The American Red Cross, for example, received $2.8 million from Microsoft co-founder Paul Allen, but only about $100,000 in Ebola-related gifts from other donors. By comparison, the Red Cross received more than $85 million in response to Typhoon Haiyan. (AP Photo/Michael Duff, File)


Under the system put in place by Konte and Caulker, movement in and out of the district was through a strict pass system and protective equipment and chlorine were brought in to stem the transmission of the disease.

The deadly Ebola virus is transmitted by bodily fluids and has hit hardest in Sierra Leone, Liberia and Guinea.

Koinadugu survived infection free for so long in part because it cut itself off from infected areas, but the affected countries have been begging their neighbors and the international community to maintain ties and help them fight the disease, amid increased discussions of cutting off all contact.

Planes can't fly to the affected countries because they are afraid they will be refused landing elsewhere, said the African Union chair Nkosazana Zuma on Thursday and airlines that wanted to restart service couldn't.

Currently only Moroccan airlines and Brussels Air fly to all three countries.

Sierra Leone's Finance Minister Kaifalah Marah on Thursday warned that border closures and cutting flights were "killing our economies," describing the isolation as a de facto economic embargo.

Sierra Leone had growth rates of 9 percent before the outbreak.

"It's critically important that these countries stay connected to the rest of the world, part of the reason for making this trip is that if you take the proper precautions, it is safe to travel and work here," U.S. Agency for Development director Rajiv Shah told AP during his trip through Sierra Leone Wednesday.

Sierra Leone President Ernest Bai Koroma said that Ebola is killing more youth than any other age group. Koroma spoke via a satellite link to the World Food Prize Foundation symposium in Des Moines, Iowa Thursday.

He said many of the youth who work on farms are instrumental in economic growth, and since Ebola is striking the youth population "gains have been reversed, the economy is slowing down and nurses, the overwhelming majority of whom are youth, are dying."

Koroma says the international community is helping but the country must "sprint very fast to get ahead of the virus and stop it."

International agencies and countries are trying to boost the capacity of the countries to fight the disease where overstretched health care systems and minimal sanitation have allowed transmission to rage almost unchecked.

Shah, who announced an additional $142 million in projects and grants to battle the outbreak, described the fight against Ebola as a top U.S. priority after meeting the president of Guinea.

There has been investment in new treatment centers and equipment for health care workers but so far, the disease continues to spread in Sierra Leone where the WHO has described rate of transmission in the capital Freetown as "intense." Liberia has also been particularly hard hit.

More than 4,400 people have died from the disease so far, according to WHO.

_____

Schemm reported from Rabat. Associated Press reporters Boubacar Diallo from Conakry, Guinea; Elias Meseret in Addis Ababa, Ethiopia; and David Pitt in Des Moines, Iowa contributed to this report.


http://news.yahoo.com/district-sierra-leone-gets-ebola-110510994.html

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Nurse with fever admitted to French hospital on Ebola fears: media
Reuters  2 hours ago



PARIS (Reuters) - A nurse suspected of having caught the Ebola virus through contact with an infected humanitarian worker was admitted to a hospital near Paris on Thursday, media said.

The woman, suffering from a high fever, was transferred under high security from her home in the Hauts de Seine region of greater Paris to the Begin de Saint-Mande military hospital outside the capital, Le Parisien daily said.

The woman had been in regular contact with a French volunteer working with humanitarian group Doctors Without Borders (Medecins sans Frontieres) who contracted Ebola in Liberia and was repatriated to France last month.

It was not immediately clear from the report if the two came into contact in France or Liberia or what the nurse's nationality was.

The volunteer, the first French national to be infected with the disease, received an experimental treatment for the virus and subsequently recovered.

French Health Minister Marisol Touraine told RTL radio she would make no comment on "situations that may or may not be ongoing." The ministry said last week it would not comment on suspected Ebola cases until after tests were performed.

BFM-TV said the nurse with the suspected case of Ebola had been quarantined but tests had yet to be carried out.

(Reporting By Alexandria Sage, Editing by John Irish and Andrew Heavens)


http://news.yahoo.com/nurse-fever-admitted-french-hospital-ebola-fears-144328468.html

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What it's like to be an ambulance driver in Ebola-ravaged Liberia
Yahoo News
By Dylan Stableford  4 hours ago



Ambulance drivers in Monrovia, Liberia's Ebola-ravaged capital, are being inundated with calls from desperate families asking them to pick up their sick loved ones.

The New York Times' Ben Solomon spent a week on the road with one, Gordon Kamara, who picks up between 15 and 30 Ebola patients a day, on average.

"It never stops,” Kamara said from the seat of his ambulance, one of about 15 servicing a city of 1.5 million. "I don't rest, even when I go to bed."

According to the World Health Organization, there have been at least 4,249 reported cases of Ebola in Liberia, and 2,458 deaths, making it the hardest-hit among West African countries affected by the outbreak.

"I'm tired of seeing people getting sick," said Kamara, who moved his family, including his fiancee and six children, to a separate house to protect them from the virus. "Every morning, I pray. I pray that one day Ebola will go."

In Monrovia, hundreds of new Ebola cases are reported each week, but only a small percentage of patients ever make it to a hospital. And even when they do, they're often turned away from overcrowded treatment centers:

At the end of a recent 15-hour shift, Mr. Kamara took his final patient of the night, a 17-year-old girl, to an Ebola treatment center. Wrought with fever, she had stripped off her clothes in the back of the ambulance and fallen off the stretcher, lying twisted and barely conscious on the floor.

“If she does not get treatment, she will die,” Mr. Kamara said.

But as soon as they arrived, he and his team were turned away. All the beds were full. The center, meant to house 50 patients, was packed with 85.

“We could either leave her on the ground to die, or return her to die at home,” Mr. Kamara said. “There’s no hope here.”

Kamara returned the girl to her home, explaining to her family that the hospital was full. She died the next morning.

“When there are beds at the centers, we can do our work,” Kamara said. “When there aren’t, we must sit and wait."

He added: "We try our best. But we cannot do more than we can do.”


http://news.yahoo.com/fighting-ebola-street-by-street-video-154723494.html

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U.N.'s $1 billion Ebola fund gets just $100,000 so far
Reuters
By Michelle Nichols and Lesley Wroughton  1 hour ago



A health worker in protective equipment prepares a sample taken from the body of someone who is suspected to have died from Ebola virus, near Rokupa Hospital, Freetown October 6, 2014. REUTERS/Christopher Black/WHO/Handout via Reuters



UNITED NATIONS/WASHINGTON (Reuters) - A United Nations trust fund, seeking $1 billion to fight Ebola in West Africa, has received a deposit of just $100,000 nearly a month after it was set up to allow for rapid, flexible funding of the most urgent needs on the ground.

As of Thursday, just $100,000 was paid into the fund by Colombia, although $365 million had been committed. Much of the pledged amount was donated directly to U.N. agencies and nonprofits working on the ground in the three worst affected countries of Liberia, Sierra Leone and Guinea, according to U.N. records.

The $365 million was committed by 28 countries, the African Union, the European Union, the World Bank, the African Development Bank and several foundations and corporations.

But nearly all that money was donated directly to U.N. agencies and nonprofits working on the ground in the three worst affected countries of Liberia, Sierra Leone and Guinea, with just $100,000 paid into the fund by Colombia, the records show.

"This is a very serious problem," U.N. Secretary-General Ban Ki-moon said of the lack of money in the fund, adding that while he appreciated all the support given to the U.N. appeal so far, it was time more countries with the capacity to help step up assistance.

"It's time that those other countries who really have capacity, (that) they would provide financial support and other logistical support," Ban told reporters on Thursday.

Ban created the Multi-Partner Trust Fund to accept donations after the U.N. Office for the Coordination of Humanitarian Affairs launched an appeal Sept. 16 for $988 million to tackle the deadly hemorrhagic fever over the next six months.

Dr. David Nabarro, who is heading the U.N. response to the Ebola crisis, told Reuters the trust fund was intended to offer "flexibility in responding to a crisis which every day brings new challenges; it allows the areas of greatest need to be identified and funds to be directed accordingly."

World Bank President Jim Yong Kim said on Thursday the world does not have a choice in whether to support to Ebola fight.

"It is not a matter of choosing whether to do it or not. It's just a question of when we pay the price for it," Kim told a Reuters summit.

"Countries need to support the U.N. fund, they have to step up and they have to put the money in right now. It is the most rational thing to do from humanitarian, public health and economic perspective, it is the right thing to do," he said.


'PRETTY DISAPPOINTING'

Erin Hohlfelder, policy director for global health for international campaign and advocacy group ONE, said the response to the U.N. appeal was "pretty disappointing" and that it was important to coordinate contributions so "we don't let aid resources go to waste."

"We have enough speeches and enough rhetoric that it starts to feel the case is solved," she said. "We're really concerned that until those speeches and that rhetoric translate into real services on the ground, we're not doing much to ebb the flow of this crisis."

Nearly 4,500 people have died from the worst Ebola outbreak on record, the World Health Organization said Wednesday, with confirmed, probable and suspected cases of Ebola reported in seven countries, including the United States.

The United Nations has established a special mission, known as UNMEER, in Liberia, Sierra Leone and Guinea to coordinate efforts to contain Ebola, which is spread through direct contact with body fluids from an infected person.

"We are hopeful that in the coming days and weeks we will see more countries investing in the Fund, using this mechanism to support the coordinated U.N. response on the ground. There are critical funding needs that must be met now," Nabarro said.

Australia has committed to a contribution of more than $8.7 million into the trust fund, while Chile, Estonia, India and Romania have made non-binding pledges to the fund totaling $19 million, according to a trust fund document.

The United Nations relies on donors, agencies and nonprofits to inform its Financial Tracking Service of their cash or in-kind contributions to the Ebola response and the list is by no means complete.

In addition to the $365 million in cash and contributions of resources already registered under the U.N. appeal, another $204 million in pledges have been made and are yet to be filled. From that U.N. appeal, the World Health Organization said it has so far received $125 million out of the $260 million it says it requires for the next six months to tackle Ebola.

(Additional reporting by Stephanie Nebehay in Geneva; Editing by Bernadette Baum and Tom Brown)


http://news.yahoo.com/u-n-1-billion-ebola-fund-gets-deposit-150436290--sector.html

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Experts fault changing U.S. guidelines on Ebola protective gear
Reuters
By Julie Steenhuysen  28 minutes ago



CHICAGO (Reuters) - When Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), visited Ebola-stricken sites in West Africa last August, he was dressed in a full protective bodysuit and ventilator.

That level of protection was far greater than the basic gear the CDC initially recommended for U.S. hospital workers, which at minimum included a gown, a single pair of gloves, a mask and face shield.

After a second nurse at Texas Health Presbyterian Hospital in Dallas fell ill with Ebola after caring for a dying Liberian patient, the CDC this week beefed up its recommendations for personal protective equipment to include hooded full-body suits that cover the neck, more frequent hand washing and a supervisor who oversees the removal of infected gear, steps experts said should have been done long ago.

"The frightening truth is that we cannot guarantee the safety of our healthcare workers on the front lines of response," U.S. Representative Michael Burgess of Texas said on Thursday at a congressional hearing focused on missteps in the Ebola response on American soil. Burgess brandished a picture of Frieden in full protective garb in Africa.

Frieden responded that the type of protection varied from one Ebola setting to the next. But the issue of how well nurses and doctors are protected against the virus has become a flashpoint as the United States now handles its first cases of the disease that has already killed nearly 4,500 people in Sierra Leone, Guinea and Liberia.

"Most U.S. hospitals will tell you they are following CDC protocols, but CDC protocols are evolving," said Dr. Dan Kelly, an infectious disease doctor based at University of California, San Francisco, who is currently in Sierra Leone.

Frieden said on Wednesday that unfamiliarity and inconsistent use of protective gear may have contributed to the infection of the two Dallas nurses, Nina Pham and Amber Vinson, who cared for Thomas Eric Duncan through bouts of extreme vomiting and diarrhea.

When a CDC team arrived in Dallas, they noticed some hospital workers were putting on three or four layers of gloves and apparel "in the belief that this would be more protective," Frieden said on Wednesday.

But adding more layers makes it "much harder to take them off," increasing the risk of contamination, he said.

Dr. Daniel Varga, chief clinical officer and a senior vice president for the hospital's parent company, Texas Health Resources, defended its use of protective gear at the hearing, saying both nurses "were using full protective measures under CDC protocols." But he acknowledged that hospital staff had not been trained to handle Ebola patients.


INADEQUATE PROTECTION

Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, has given training on Ebola preparedness at five U.S. hospitals in the past few weeks. He believes the CDC's protocols were inadequate.

Macgregor-Skinner instructs healthcare workers to wear a protective suit, rubber boots that can be decontaminated, two pairs of gloves, head covering, a mask and a face shield or goggles.

Several U.S. medical centers have adopted policies that exceed CDC's guidelines for protective gear based on standards set by the World Health Organization and protocols developed by Emory University in Atlanta and the Nebraska Medical Center in Omaha, which have successfully treated Ebola patients airlifted from Africa to their high-security biocontainment units.

"We are going higher than what the CDC has said," said Dr. Marc Napp, deputy chief medical officer at Mount Sinai Health System in New York. "We have been really grappling with this for two-and-a-half months."

For example, when Mount Sinai admitted a suspected Ebola patient in August, one of the hospital's infectious disease physicians who does research on Ebola "insisted on going to his lab" and getting his impermeable hooded Tyvek suit.

That set a model for all hospital staff. Mount Sinai is bringing in experts to train them on the proper way to put on and take off the suits.

Luke Chen, an infection prevention expert at Duke University Medical Center in North Carolina said the hospital is designating a specific group of experienced staff to treat Ebola using full-length Tyvek suits.

"We know the patient requires basically 24/7 care. You don't want to be looking down at your shoe or checking your pant leg," to see if your protective gear is intact, Chen said.

Ensuring nurses remain confident while dealing with what can be a terrifying disease is essential, experts said.

When Macgregor-Skinner was in Port Harcourt, Nigeria, an Ebola patient vomited on a nurse he was training.

"She was very upset and reacted by wanting to remove her (protective gear) right away. I had to hug and hold so she didn't, and so now I was also covered in vomit," he said.

Once she calmed down, they went through the slow process of decontaminating and removing her protective clothing, using the buddy system, a strategy now recommended by the CDC.

"She never became a patient."

(Reporting by Julie Steenhuysen; Additional reporting by Terry Wade in Dallas; Editing by Michele Gershberg and Jonathan Oatis)


http://news.yahoo.com/experts-fault-changing-u-guidelines-ebola-protective-gear-230907282.html

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No, budget cuts aren't the reason we don't have an Ebola vaccine
Vox
Updated by Sarah Kliff on October 16, 2014, 2:20 p.m. ET



WPA Pool/Getty Images



One of the biggest challenges of fighting the ongoing Ebola outbreak is that we have no known cure, or treatment, for the disease. When doctors treat Ebola, all they can do is keep the patient's immune system as strong as possible, so that he or she can fight off the vicious infection.

Francis Collins, director of the National Institutes of Health, says it doesn't have to be this way. In an interview with the Huffington Post's Sam Stein, Collins argued that we don't have an Ebola vaccine because of budget cuts at the NIH.

"If we had not gone through our 10-year slide in research support," Collins told Stein, "We probably would have had a vaccine in time for this that would've gone through clinical trials and would have been ready."

But is that true? There are two assumptions embedded in Collins' remarks. One is that Ebola vaccine research has been hurt by National Institute of Health budget cuts. The other is that, without those budget cuts, Ebola was on the fast path to a successful vaccine. Neither of these claims, when you dig into the data, appear to hold up especially well.


Government funding for Ebola research has been steady (and small)

There has no doubt been a slowdown in the National Institute of Health's budget's growth in recent years.

The NIH's budget rose rapidly during the early 2000s, growing from $17 billion in 2000 to a peak of $31 billion in 2010. This meant more money for everything. The budget for the National Institute of Allergy and Infectious Diseases — the unit that researches Ebola — grew from $3.7 billion to $4.7 billion over that time period.

Funding then began to decline in 2010 and has continued to fall slightly over the past four years (this was during a period when Obama was in the White House, Democrats controlled the Senate, and Republicans controlled the House). By 2013, funding was down to $29.3 billion. These figures do not account for inflation.



 

So how did this affect Ebola research? It's hard to get exact numbers, since the NIH only began reporting information on how much it spent on particular diseases in 2010. But what that data shows is that the NIH has consistently spent a relatively small amount of money on Ebola research since 2010.

At my request, the American Society for Biochemistry and Molecular Biology pulled data from an NIH reporting database on funding for various diseases. They included data on hemorrhagic fevers (essentially Ebola and Marburg) and other infectious diseases, like the flu and malaria. Here's what funding patterns have looked like since 2010:



 

There was a decline in funding for Ebola research between 2010 and 2011, from $142 million to $101 million, respectively. This was when stimulus funding dollars ran out, and the entire agency had to cut back. Since 2011, funding has been small and slightly declining: research for Ebola and Marburg received $101 million in grants in 2011, $100 million in 2012 and $96 million in 2013, after the sequester took effect.

In fact, the cuts to Ebola research have been less severe than cuts for research on other diseases. The numbers show that Ebola research funding fell 4 percent between 2012 and 2013. During the same time frame, malaria funding fell by 7 percent — and overall NIAID dollars dropped by 5.5 percent.


Vaccine research is unpredictable

NIH funding definitely matters. "It's fair to say that, without the budget cuts, we would be closer to a cure than we are right now," says Benjamin Corb at the American Society for Biochemistry and Molecular Biology. "We would have understood the virus and perhaps understood how to counteract the virus if we didn't have budget cuts."

But as Corb pointed out to me, there's a long space between being closer to a vaccine — and "probably" having one (which is what Collins claimed).

Drug research is incredibly unpredictable. Building any vaccine is a long, tedious job typically marked with failure. From the lab to the pharmacy, a typical drug takes about 12 years to build. Of the 5,000 different compounds that drug companies experiment with, five typically make it to human tests — and one gets approved for sale.





Most drugs do not survive this process, and it's incredibly hard to know whether the candidate Ebola vaccines would be winners or losers. Drug manufacturers can only find this out when they go into trials. They find out if the treatments that work well in animal models are safe and effective in humans.

There have been a handful of Ebola vaccine trials that began in 2003; none of them have thus far made it past phase 1, although the NIH does say the information learned in early trials has helped inform further drug development.

The part of Collins' statement that irks scientists is the sense of certainty, the idea that if only more money had been spent, we'd likely have a vaccine by now. They know that's not how vaccine development works. Scientists don't get to name a price for the development of a vaccine — the science is just too uncertain.

The NIH is not the only player necessary to take vaccines to market. The agency's role in pharmaceutical development is usually basic research, giving scientists grants to look at how diseases function and what can stop them.

When it's time to use that science to build a vaccine, that's where drug companies typically come in, paying for the trials and manufacturing. We don't know whether, in a world where the NIH had more funding, a pharmaceutical company would have stepped forward to do this. There's decent reason to believe there wouldn't have been; a vaccine to treat Ebola, an infrequent disease that hits low-income areas of the world, is hardly a blockbuster.

It's possible that, in the wake of this Ebola outbreak, the United States decides to put more money towards Ebola research. But that extra funding will not be a guarantee that a vaccine is right around the corner. That just isn't how drug research works.


http://www.vox.com/2014/10/16/6987825/ebola-budget-nih-collins-vaccine