Ebola news 10/26

[Buster's Uncle]

Ebola: NY had jump-start, Dallas had to learn fast
Associated Press
By LAURAN NEERGAARD and DAVID B. CARUSO  19 hours ago



Dr. Craig Spencer, the latest person infected with Ebola in the U.S., is in stable condition while being treated in isolation in New York. Meanwhile, nurse Nina Pham has been released after surviving the virus. (Oct. 24)



NEW YORK (AP) — Talk about a tale of two cities: A Dallas hospital got a pop quiz in Ebola and made an early mistake. New York got a peek at the answer sheet and was better prepared at the start.

The contrast in handling two Ebola diagnoses highlights how differently cities and hospitals prepare for health emergencies.

"The lesson I would take from New York is you have to practice," Dr. Amesh Adalja, a representative of the Infectious Diseases Society of America. "Preparedness isn't something you just make a plan for and put it on the shelf."

Ebola came to New York via a doctor who had volunteered to treat patients in Ebola-stricken Guinea. Dr. Craig Spencer alerted his aid agency that he had developed a fever, and was transported to Bellevue Hospital Center by specially trained emergency workers wearing protective gear.

In Dallas last month, a hospital initially sent home a sick Thomas Eric Duncan, who had traveled from Liberia and who days later would become the nation's first Ebola diagnosis.

A look at differences between the two cases:



A nurse who caught Ebola while caring for the patient diagnosed in Dallas was released from a hospital Friday, free of the virus. (Oct. 24)


HOW NEW YORK PREPARED

New York health officials are known for holdings drills on handling emergencies, and Ebola is no exception. Bellevue, the country's oldest public hospital, had been preparing in earnest for an Ebola patient since August.

The patient registration staff and triage nurses were trained to ask people with certain symptoms about international travel. Actors posed as patients to be sure that anyone who answered "yes" was immediately put into one of the ER's nine isolation rooms. Along the way came some false alarms, sick patients who turned out not to have Ebola.

On the seventh floor is the full isolation unit, originally set up to treat people with drug-resistant tuberculosis. It was overhauled for Ebola in recent weeks and now houses a separate lab for Ebola-infected specimens.

Bellevue isn't alone. New York health authorities designated eight hospitals statewide as capable of properly caring for suspected Ebola patients.



In this Oct. 8, 2014, file photo Bellevue Hospital nurse Belkys Fortune, left, and Teressa Celia, Associate Director of Infection Prevention and Control, wear protective suits in an isolation room in the Emergency section of the hospital during a demonstration of procedures for possible Ebola patients in New York. New York health officials are known for holdings drills on handling emergencies, and Ebola is no exception. Bellevue, the country's oldest public hospital, had been preparing for an Ebola patient in earnest since August. Ebola came to New York via Dr. Craig Spencer, who had been treating patients in Guinea. Spencer alerted his aid agency that he had developed a fever, and was transported to Bellevue by specially trained emergency workers cloaked in protective gear. (AP Photo/Richard Drew, File)


Beyond hospitals, the city's fire department trained an ambulance crew to transport suspected Ebola patients, and 911 dispatchers now ask people calling for an ambulance if they've traveled to West Africa recently.

Also, "New York has the benefit of being the second city to have an imported Ebola case," Adalja said.

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LESSONS LEARNED

Texas Health Presbyterian Hospital in Dallas has apologized for initially misdiagnosing Duncan.



In this Oct. 8, 2014, file photo, a sign points to the emergency room entrance at Texas Health Presbyterian Hospital in Dallas. The hospital has apologized for initially sending home a sick Thomas Eric Duncan, who told an emergency room nurse he’d recently arrived from West Africa, and temporarily spiked a 103-degree fever shortly before discharge. Two days later when he returned, sicker, Duncan tested positive for Ebola. He died Oct. 8. Two nurses who cared for him also, somehow, became infected; both have since been declared virus-free. (AP Photo/LM Otero, File)


Duncan had told an emergency room nurse he recently had arrived from Africa, and he temporarily spiked a 103-degree fever shortly before his discharge. He returned two days later, sicker, and then was tested for Ebola. He died Oct. 8. Two nurses who cared for him became infected; both have since been declared virus-free.

On Friday, the Dallas hospital announced some changes, saying it had learned from its experiences treating Duncan and was sharing them with other hospitals in a stark then-and-now chart.

Patients will be asked about their travels within five minutes of entering the ER. Electronic medical records will highlight that information in a large red box. Nurses and doctors are encouraged to talk face to face rather than rely solely on records.

A new triage procedure calls for high-risk patients to be isolated immediately by a nurse in full protective gear. Before discharge, vital signs are to be rechecked and doctors notified of abnormalities.

"We learn more each day and we will continue to share these important lessons with the health care community and first responders nationwide," said Barclay Berdan, chief executive of Texas Health Resources, the hospital's parent company.



This Oct. 24, 2014 file photo shows health alerts for travelers to particular West African countries posted at the main lobby entrance of Bellevue Hospital in New York. New York health officials are known for holdings drills on handling emergencies, and Ebola is no exception. Bellevue, the country's oldest public hospital, had been preparing for an Ebola patient in earnest since August. And when Ebola did come to New York via Dr. Craig Spencer, who had been treating patients in Guinea, he was transported to Bellevue by specially trained emergency workers cloaked in protective gear. (AP Photo/Bebeto Matthews, File)


Dr. Michael Bell of the Centers for Disease Control and Prevention began working with the hospital after the nurses became ill, stressing improved infection control as a possible legacy.

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PREPARATION IS KEY

The National Institutes of Health and other hospitals with special biocontainment units regularly "do drills about how you need to protect yourself," said Dr. Anthony Fauci, the NIH's infectious diseases chief. The Dallas hospital had transferred infected nurse Nina Pham to NIH; she was discharged Friday.

The isolation unit at Nebraska Medical Center, which has treated two other Ebola patients infected abroad, says it holds drills about every three months on different diseases.



Health alerts regarding people who may have traveled to particular West African countries are posted the main lobby entrance of Bellevue Hospital, Friday Oct. 24, 2014 in New York. Dr. Craig Spencer, a resident of New York City and a member of Doctors Without Borders, was admitted to Bellevue Thursday and has been diagnosed with Ebola. (AP Photo/Bebeto Matthews)


Before the New York case, Fauci praised Bellevue for similar training, while cautioning that, "it would be, logistically, really difficult to get every major hospital in the country drilled to do this."

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FEDERAL HEALTH OFFICIALS ADJUSTED, TOO

The government is adjusting to gaps in the Ebola safety net.

Facing its own criticism for not helping the Dallas hospital enough, the CDC has tightened guidelines on protective gear, and greatly expanded education for hospitals and health workers. The agency will send SWAT-like response teams to help hospitals with cases.



A worker from BioRecoveryCorp carries barrels into the apartment building of Ebola patient Dr. Craig Spencer, in New York, Friday, Oct. 24, 2014. Spencer remained in stable condition while isolated in a hospital, talking by cellphone to his family and assisting disease detectives who are accounting for his every movement since arriving in New York from Guinea via Europe on Oct. 17. (AP Photo/Richard Drew)


Anyone flying in from Ebola-stricken West African countries now is funneled through five U.S. airports for symptom checks and must report their temperature to local health officials for 21 days, Ebola's incubation period.

The governors of New York and New Jersey went a step further, ordering quarantine for travelers who've had contact with Ebola patients.

Adjustments are part of dealing with a public health emergency, said Michael Leavitt, who served as Health and Human Services secretary for President George W. Bush.

"In the midst of a crisis, we ought not to expect perfection," Leavitt said. While that doesn't excuse mistakes, "everyone in this process is going to be acting, adapting, improving. That's the nature of emergency response."

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Neergaard reported from Washington.


http://news.yahoo.com/ebola-ny-had-jump-start-dallas-had-learn-135814413.html

[Buster's Uncle]

US disease expert argues against Ebola quarantine
Associated Press  38 minutes ago



A top federal health official said Sunday, mandatory 21-day quarantines on health care workers returning from Ebola-ravaged West Africa, like those put in place by three states, can have the unintended consequence of discouraging them from volunteering. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that as a physician and scientist, he would have recommended against a quarantine



NEW YORK (AP) — The gulf between politicians and scientists over Ebola widened on Sunday as the nation's top infectious-disease expert warned that the mandatory, 21-day quarantining of medical workers returning from West Africa is unnecessary and could discourage volunteers from traveling to the danger zone.

"The best way to protect us is to stop the epidemic in Africa, and we need those health care workers, so we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

Meanwhile, Kaci Hickox, the first nurse forcibly quarantined in New Jersey under the state's new policy, said in a telephone interview with CNN that her isolation at a hospital was "inhumane," adding: "We have to be very careful about letting politicians make health decisions."

Saying the federal health guidelines are inadequate, the governors of New York and New Jersey announced a mandatory quarantine program Friday for medical workers and other arriving airline passengers who have had contact with Ebola victims in West Africa, and Illinois soon followed suit. Twenty-one days is the incubation period for Ebola.

New Jersey Gov. Chris Christie on Sunday defended quarantining as necessary to protect the public and predicted it "will become a national policy sooner rather than later."



A man has his temperature taken using an infrared digital laser thermometer at the Nnamdi Azikiwe International Airport in Abuja, August 11, 2014. (REUTERS/Afolabi Sotunde)


"I don't believe when you're dealing with something as serious as this that we can count on a voluntary system," said Christie, who is expected to run for the Republican nomination for president in 2016. He added: "I absolutely have no second thoughts about it."

The Obama administration considers the policy in New York and New Jersey "not grounded in science" and has conveyed its concerns to Christie and New York Gov. Andrew Cuomo, said a senior administration official. The official wasn't authorized to comment by name and insisted on anonymity.

Fauci made the rounds on five major Sunday morning talk shows to argue that policy should be driven by science — and that science says people with the virus are not contagious until symptoms appear. And even then, infection requires direct contact with bodily fluids.

He said that close monitoring of medical workers for symptoms is sufficient, and warned that forcibly separating them from others, or quarantining them, for three weeks could cripple the fight against the outbreak in West Africa — an argument that humanitarian medical organizations have also made.

"If we don't have our people volunteering to go over there, then you're going to have other countries that are not going to do it and then the epidemic will continue to roar," Fauci said.

Christie, traveling the country as head of the Republican Governors Association, said he was not worried that quarantining might discourage volunteers.



Patient Nina Pham is hugged by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, outside of National Institutes of Health (NIH) in Bethesda, Md., Friday, Oct. 24, 2014. Pham, the first nurse diagnosed with Ebola after treating an infected man at a Dallas hospital is free of the virus. The 26-year-old Pham arrived last week at the NIH Clinical Center. She had been flown there from Texas Health Presbyterian Hospital Dallas. (AP Photo/Pablo Martinez Monsivais)


Other than saying last week that those under quarantine could be confined to their homes or medical facilities, Christie and Cuomo have given no details on how the measure would be enforced and what would happen to those who refused to cooperate.

But Cuomo, who is up for re-election next week, said the order is legally enforceable, and expressed confidence that medical professionals would go along.

Earlier this month, four members of a family in Texas that Ebola victim Thomas Eric Duncan stayed with before he died were confined to their home under armed guard after failing to comply with a request not to leave their apartment. Also, 75 Dallas hospital workers were asked to sign legally binding documents in which they agreed not go to public places or use mass transit.

The New York-area quarantine measures were announced after Dr. Craig Spencer returned to New York City from treating Ebola victims in Guinea for Doctors Without Borders and was admitted to Bellevue Hospital Center last Thursday to be treated for Ebola. In the week after his return, he rode the subway, went bowling and ate at a restaurant.

Hospital officials said Sunday that Spencer was in serious but stable condition, was looking better than he did the day before, and tolerated a plasma treatment well.



More than 10,000 people have been infected with Ebola, according to figures released Saturday by the World Health Organization, as the outbreak continues to spread, Oct. 26, 2014. (World Health Organization/Yahoo News)


Hickox, the quarantined nurse who just returned from Sierra Leone, said she had no symptoms at all and tested negative for Ebola in a preliminary evaluation.

"It's just a slippery slope, not a sound public health decision," she said of the quarantine policy. "I want to be treated with compassion and humanity, and don't feel I've been treated that way."

Hickox has access to a computer, her cellphone, magazines and newspapers and has been allowed to have takeout food, New Jersey Health Department officials said.

New York City Mayor Bill de Blasio called Hickox a "returning hero" and charged that she was "treated with disrespect," as if she done something wrong, when she was put into quarantine. He said that she was interrogated repeatedly and things were not explained well to her.

Samantha Power, the U.S. ambassador to the United Nations who is on a trip to West Africa, said returning U.S. health care workers should be "treated like conquering heroes and not stigmatized for the tremendous work that they have done."



This Feb. 28, 2014, file photo shows Samantha Power, U.S. Ambassador to the U.N., speaking during a news conference after a private U.N. Security Council meeting. Power is going to visit all three of the West African countries hit hardest by the Ebola outbreak. A statement released late Saturday, Oct. 25, 2014, by the U.S. mission to the U.N. says Samantha Power will visit Liberia, Sierra Leone and Guinea "to draw attention to the need for increased support for the international response." (AP Photo/Bebeto Matthews, File)


In other developments, Florida Gov. Rick Scott ordered twice-daily monitoring for 21 days of anyone returning from the Ebola-stricken areas.

The World Health Organization said more than 10,000 people have been infected with Ebola in the outbreak that came to light last March, and nearly half of them have died, mostly in Guinea, Sierra Leone and Liberia.

Fauci appeared on "Fox News Sunday," ABC's "This Week, NBC's "Meet the Press," CBS' "Face the Nation" and CNN's "State of the Union." Christie was interviewed on Fox and Power spoke to NBC.

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Associated Press writers Bruce Shipkowski in Trenton, N.J., Josh Lederman and Thomas Strong in Washington, and Verena Dobnik in New York contributed to this report.


http://news.yahoo.com/fauci-quarantine-unintended-consequences-123312414--politics.html

[Buster's Uncle]

WHO: Number of Ebola-linked cases passes 10,000
Associated Press
By SARAH DiLORENZO  October 25, 2014 2:44 PM



DAKAR, Senegal (AP) — More than 10,000 people have been infected with Ebola and nearly half of them have died, according to figures released Saturday by the World Health Organization, as the outbreak continues to spread.

The Ebola epidemic in West Africa is the largest ever outbreak of the disease with a rapidly rising death toll in Guinea, Liberia and Sierra Leone. There have also been cases in three other West African countries, Spain and the United States.

The U.N. health agency said Saturday that the number of confirmed, probable and suspected cases has risen to 10,141. Of those cases, 4,922 people have died. Its figures show about 200 new cases since the last report, four days ago.

Even those grisly tolls are likely an underestimate, WHO has warned, as many people in the hardest hit countries have been unable or too frightened to seek medical care. A shortage of labs capable of handling potentially infected blood samples has also made it difficult to track the outbreak. For example, the latest numbers show no change in Liberia's case toll, suggesting the numbers may be lagging behind reality.

On Thursday, authorities confirmed that the disease had spread to Mali, the sixth West African country affected, and on the same day a new case was confirmed in New York, in a doctor recently returned from Guinea.

Mali had long been considered highly vulnerable to the disease, since it shares a border with Guinea. The disease arrived there in a 2-year-old, who traveled from Guinea with her grandmother by bus and died Friday.



In this photo taken on Tuesday, Oct. 21, 2014, a billboard reading 'Stop Ebola' on the Masiaka Highway, forming part of a trans-West African highway, which links all West African States, on the outskirts of the capital city of Conakry, Guinea. Despite stringent infection-control measures, the risk of Ebola’s spread cannot be entirely eliminated, Doctors Without Borders said Friday, Oct. 24, 2014, after one of its doctors caught the dreaded disease while working in Guinea and went to New York City. (AP Photo/ Youssouf Bah)


The toddler, who was bleeding from her nose during the journey, may have had high-risk contact with many people, the World Health Organization warned. So far, 43 people are being monitored in isolation for signs of the disease, and WHO said Saturday that authorities are continuing to look for more people at risk.

To help fight Ebola, the U.N. humanitarian flight service airlifted about 1 ton of medical supplies to Mali late Friday. The seats of the plane were removed to make room for the cargo, which included hazard suits for health workers, surgical gloves, face shields and buckets, according to the World Food Program, which runs the flights.

The spread of Ebola to Mali has highlighted how easily the virus can jump borders, and Malian border police said that neighboring Mauritania closed its border with Mali.

The health minister of Ivory Coast, which borders Guinea and Mali, said authorities there were looking for a nurse who may have Ebola and fled from Guinea, where he was being monitored by officials. But Raymonde Goudou stressed that it was still not clear whether the man had Ebola.

There was concern also in Ghana, where some worried a strike by health care workers could leave the country vulnerable to the disease. Ghana does not border any country with reported cases, but it is serving as the headquarters for the U.N. mission on Ebola.

In Liberia, the country hardest hit by the epidemic, U.S. forces have been building desperately needed treatment centers and helping to bring in aid. On Saturday, Maj. Gen. Darryl Williams, who was in charge of the troops assigned to the Ebola response, handed power to Maj. Gen. Gary J. Volesky, the 101st Airborne commander.

"I've been told that by a number of people that the task we face is extremely hard. Well, a fairly famous person once said hard is not impossible," Volesky said. "Together, we're going to beat it."

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Associated Press writers Baba Ahmed in Kayes, Mali, Hilaire Zon in Abidjan, Ivory Coast, Jonathan Paye-Layleh in Monrovia, Liberia, and Francis Kokutse in Accra, Ghana, contributed to this report.


http://news.yahoo.com/number-ebola-cases-passes-10-000-101744209.html