Maine To Enforce Quarantine For Nurse Who Worked In W. Africa

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A photo taken Sunday of Kaci Hickox in an isolation tent at
University Hospital in Newark, N.J. Hickox who was later discharged and
allowed to return to her home in Maine says she has no intention of
abiding by a "voluntary" quarantine there.



Steven Hyman/AP


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Steven Hyman/AP

Maine's Gov. Paul LePage says he will seek to legally force a
nurse to undergo a 21-day quarantine after her return from West Africa,
where she volunteered to treat Ebola patients.

In a tit-for-tat battle over the quarantine issue, Kaci Hickox had first been forced into isolation
upon her arrival in New Jersey over the weekend despite showing no
symptoms of Ebola. After she blasted New Jersey officials for confining
her, she was discharged earlier this week and allowed to return home to Maine. There she has refused to participate in a voluntary quarantine.

Speaking on NBC's Today show and ABC's Good Morning America, Hickox said bluntly: "I don't plan on sticking to the guidelines."

Instead,
she's hired a lawyer, who was quoted by The Associated Press as saying
his client isn't willing to cooperate with state officials unless they
life "all or most of the restrictions."

That prompted this
statement from the LePage's office: "Upon learning the healthcare worker
intends to defy the protocols, the Office of the Governor has been
working collaboratively with the State health officials within the
Department of Health and Human Services to seek legal authority to
enforce the quarantine."

Hickox, who had volunteered for
non-profit Doctors Without Borders in Ebola-stricken Sierra Leone,
showed no signs of the disease on her return to the U.S.

New Jersey Gov. Chris Christie and New York Gov. Andrew Cuomo were also sharply criticized for ordering mandatory quarantines.

The
AP says: "Department of Health and Human Services Commissioner Mary
Mayhew says Maine's policies go above and beyond federal Centers for
Disease Control and Prevention guidelines, which require monitoring but
not quarantine. She says she'll 'pursue legal authority' for anyone
violating the voluntary in-home quarantine."

Meanwhile, World
Health Organization Assistant Director General Bruce Aylward says that
the organization is seeing a decline in the spread of the deadly virus
in worst-hit Liberia and that he's confident health officials are
getting the upper hand.

Aylward says he's cautiously optimistic
that the rate of cases is slowing and, that if trends continue, WHO
should "comfortably" meet its deadline of early December for putting
Ebola containment measures in place, according to Reuters.

The Two-Way : NPR

Ebola Comes To America: First U.S. Ebola Case Just Diagnosed In Texas

Ebola has arrived in America: A patient in Texas has been diagnosed with the deadly disease, the CDC confirmed on Tuesday.


It is the first case of Ebola diagnosed in the United States. That’s
an important distinction because — unlike the medical workers who contracted Ebola in Africa
and were flown back to the United States for treatment — the new Ebola
patient could’ve been circulating in the general U.S. population,
potentially spreading the disease.


From Last Week: Is Ebola Coming To America? Experts Ponder As Ebola Epidemic Rages In Africa

However, experts have stressed that Ebola does not transmit easily,

but instead requires “intimate” contact with someone who’s infected.

“Ebola poses no substantial risk to the U.S. general population,” CDC

said earlier this month.

The U.S. patient diagnosed with Ebola is a man who was traveling in

Liberia, and he started showing Ebola symptoms four days after

returning. The man has been placed in “strict isolation,” according to a

statement from Texas Health Presbyterian Hospital of Dallas.

In a briefing on Tuesday, CDC officials stressed that because the man

was not symptomatic with Ebola while flying, there was “zero risk” of

transmission for other passengers on the plane. They also vowed that

public health officials “would stop [Ebola] in its tracks in the U.S.”

Outbreak Currently Raging In Africa

As I wrote about for Forbes last week, the current Ebola outbreak in West Africa is already the worst on record. And it’s only gotten worse.

More than 3,000 people have died, and CDC estimated that as many as

1.4 million people in Liberia and Sierra Leone could contract Ebola by

January 20. That’s about one in seven members of the population.

(For a sense of perspective on CDC’s worst-case scenario for West

Africa: If a similarly sized outbreak happened in the United States,

more than 45 million Americans would contract Ebola.)

Ebola has hit doctors and nurses especially hard: More than 200 health care workers have already died from the current Ebola outbreak in Africa.

And that’s a reminder that the Americans who initially treated the

Texas patient diagnosed with Ebola might be at elevated risk. “What

wasn’t said in the CDC Ebola briefing,” reporter Helen Branswell pointed out on Twitter. “Where did the patient seek care on Sept. 26? Did his visit lead to [health care worker] exposures?”

The longer the Ebola outbreak goes on, the greater the chance that

the disease could mutate, too. Scott Gottlieb, who served as a top FDA

official under President George W. Bush, has warned that there’s even a chance that Ebola could go airborne, although other experts are pessimistic.

The World Health Organization also warned that given the scale of the

outbreak, there’s a possibility that Ebola will go from epidemic to

“endemic” in West Africa — essentially, the disease won’t go away, but

continue to afflict the local population. That’s “a prospect that has

never previously been contemplated,” WHO researchers wrote in the New England Journal of Medicine.

Writing in the Washington Post on Monday, epidemiologist Gerardo Chowell-Puente noted

that each case of Ebola in the current outbreak is producing about 1.3

to 1.8 secondary cases, on average. And that pace of transmission is

especially troubling given Africa’s weak public health response,

Chowell-Puente writes:

To break the chain of the current Ebola epidemic, our numbers show
that health-care workers need to stop about 50 percent of infectious
contacts by effectively isolating people who are infectious…


The trouble is that the countries suffering from outbreaks have weak
health-care systems – perhaps too weak to halve the number of
infectious contacts.


These countries lack gloves, gowns, face masks and other essential
supplies to protect nurses and doctors from infection, and they don’t
have an adequate surveillance system to catch and identify Ebola cases
in a timely way. The number of doctors and health centers is small as
well.

There are signs for hope, however. In Africa, Nigerian public officials have successfully “broken

the chain” of Ebola transmission. And the U.S. public health response

is considerably more organized and stronger than the public health

framework in Africa.

Also See: Nearly 40% Of Americans Fear An Ebola Outbreak

Emory Healthcare in Atlanta has already treated three victims of the

current Ebola outbreak. Two of those patients — Kent Brantly and Nancy

Writebol, who were doing missionary work in Africa — have since been

discharged.

Why did Emory take on those patients? How did staff respond?

I spoke with John Fox, CEO of Emory Healthcare, in an interview

for the Advisory Board Daily Briefing — and he stressed that he would

do it again. “This is our mission. This is the reason we exist,” Fox

said.

Every Emory patient who treated the Ebola patients volunteered to do so.

Emory staff care for an American missionary who contracted Ebola in Africa. (Graphic via Los Angeles Times.)

How Ebola Kills You


Ebola’s initial symptoms include fever, headache, diarrhea, and
vomiting — all of which sound misleadingly common and relatively
treatable. But the disease can quickly progress, with mortality rates of
upward of 70%.


“At the end stage of the disease, you have small leaks in blood
vessels,” Thomas Geisbert, an immunologist at the University of Texas
Medical Branch at Galveston, told NPR in August. “You end up with essentially no blood pressure. Your body temperature drops and you go into shock.”


That’s largely because Ebola can provoke a “cytokine storm” in the
body, as the immune system launches an all-out response to fight off the
disease — which simultaneously ravages a human body, damages blood
vessels, and further lowers blood pressure to dangerous levels.

Ebola Is Diagnosed in Texas, First Case Found in the U.S.

Play Video

C.D.C. Announces First U.S. Ebola Case Dr. Thomas R. Frieden, director of the Centers for

Disease Control and Prevention, said the infected individual came to the
United States from Liberia.
A man who took a commercial flight from Liberia that landed in Dallas on Sept. 20 has been found to have the Ebola virus, the Centers for Disease Control and Prevention reported on

Tuesday. He is the first traveler to have brought the virus to the United States on a passenger plane and the first in whom Ebola has been diagnosed outside of Africa.

As the disease has swept across West Africa, many health experts said it would be only a matter of time before it reached the United States. Hospitals and health departments

around the country have been preparing for it, and a number of false alarms have occurred. But this time, the case is real.

The man, who was visiting relatives in the United States, was not ill during the flight, health officials said at a news conference Tuesday evening. Indeed, he was screened before he boarded the flight and had no fever. Because Ebola is not contagious until symptoms develop, there is “zero chance” that the patient infected anyone else on the flight, said Dr.

Thomas R. Frieden, director of the disease centers. Ebola is spread only by direct contact with body fluids from someone who is ill.

Continue reading the main story

Key Dates for Man Infected With Ebola

The man who has been found to have Ebola showed no symptoms when he boarded his plane in Liberia.


A team from the C.D.C. is being dispatched to Dallas to help trace any contacts who may have been infected, including family members, health care workers and others with whom the patient spent time in Dallas. Health officials in Texas said they had already begun that process. Dr. Frieden said the family and community contacts were few, no more than a handful. But he said it was possible that family members who were with the man while he was ill would turn out to be infected.

Contact tracing involves identifying people who might have been exposed to the patient during the time he was infectious, and then monitoring them for symptoms every day for 21 days — the full incubation period of the disease. Most people develop symptoms within eight to 10 days of being exposed. Anyone who starts running a fever or having symptoms is then isolated and tested for Ebola. If the test is positive, that person is kept in isolation and treated, and his or her contacts are then traced for 21 days. The process is repeated until there are no new cases.



Describing these methods as “tried and true,” Dr. Frieden said, “I have no doubt that we’ll stop this in its tracks in the U.S.”

Dr. Frieden declined to disclose flight information or to say whether the patient is an American citizen. He said the man was not a health worker, and officials had no idea how he had become infected.




More Ebola Coverage






The man did not get sick until about Sept. 24, several days after he arrived. He is being treated at Texas Health Presbyterian Hospital in Dallas, and is critically ill, Dr. Frieden said. He said there was no reason to move the patient to another hospital, noting that any hospital in the United States capable of isolating patients for other infectious diseases could safely handle an Ebola case. Doctors and the patient’s family are discussing whether to

try experimental treatments, Dr. Frieden said. The hospital’s epidemiologist, Dr. Edward Goodman, said: “We have had a plan in place for some time now for a patient presenting with possible Ebola. Ironically, we had a meeting the week before of all the stakeholders who might be involved. We were well prepared to care for this patient.”

Feeling ill, the man first sought medical help on Friday, and was treated and sent home. Ebola was not recognized. Officials did not say where that initial visit took place. Dr. Frieden said the early symptoms of Ebola, like fever and nausea, can easily be mistaken for other illnesses. But he added that public health experts have for months been urging doctors and nurses to take a travel history on anyone who shows up with such symptoms and to be on the alert for Ebola in anyone who has been to Guinea, Liberia or Sierra Leone.

With worsening symptoms, the man sought care again on Sunday, and was then admitted to the hospital in Dallas and placed in isolation. Blood samples arrived at the disease centers on Tuesday, and tested positive for Ebola. A state lab in Texas also tested samples, and got positive results.

Dr. Frieden briefed President Obama by telephone on Tuesday afternoon about the case, explaining what the White House described as the “stringent isolation protocols” being used to treat the patient and efforts to trace the patient’s contacts to mitigate the risk of the virus spreading.

Dr.Frieden told the president that the C.D.C. had been prepared for an Ebola case in the United States, according to an account of the call distributed by the White House, “and that we have the infrastructure in place to respond safely and effectively.”

Julie Hirschfeld Davis contributed reporting from Washington.

 - NYTimes.com

WHO warns of 'shadow zones', hidden cases in Ebola outbreak

Related Topics

GENEVA (Reuters) - The scale of the world's worst Ebola outbreak has
been concealed by families hiding infected loved ones in their homes and
the existence of "shadow zones" that medics cannot enter, the World
Health Organization (WHO) said on Friday.

The U.N. agency issued a statement detailing why the outbreak in West
Africa had been underestimated, following criticism that it had moved
too slowly to contain the killer virus, now spreading out of control.

Independent
experts raised similar concerns a month ago that the contagion could be
worse than reported because suspicious local inhabitants are chasing
away health workers and shunning treatment.

More than 1,300 people
have died from the disease and many experts do not expect the epidemic
to be brought under control this year.

Under-reporting of cases is
a problem especially in Liberia and Sierra Leone. The WHO said it was
now working with Medecins Sans Frontières (MSF) and the U.S. Centers for
Disease Control and Prevention to produce "more realistic estimates".

The
head of MSF, which has urged the WHO to do more, told Reuters in an
interview on Thursday that the fight against Ebola was being undermined
by a lack of international leadership and emergency management skills.



The
stigma surrounding Ebola poses a serious obstacle to efforts to
calibrate the outbreak in Liberia, Sierra Leone, Guinea and Nigeria,
which has claimed far more victims than any other episode of the disease
that was first discovered nearly 40 years ago in the forests of central
Africa.

"As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home," the WHO statement said.



"Others
deny that a patient has Ebola and believe that care in an isolation
ward – viewed as an incubator of the disease – will lead to infection
and certain death. Most fear the stigma and social rejection that come
to patients and families when a diagnosis of Ebola is confirmed."

Corpses
are often buried without official notification, the WHO said, while an
additional problem is the existence of numerous "shadow zones", or rural
villages where there are rumours of cases and deaths that cannot be
investigated because of community resistance or lack of staff and
transport.

In other cases, where treatment is available, health
centres are being immediately overwhelmed with patients, suggesting
there is an invisible caseload of patients that is not on the radar of
the official surveillance systems.



STRATEGY PLAN

The WHO
said it had drawn up a draft strategy plan to combat Ebola in West
Africa over the next six to nine months, implying that it does not
expect to halt the epidemic before the end of the year.

"WHO is
working on an Ebola road map document; it's really an operational
document how to fight Ebola," WHO spokeswoman Fadela Chaib said at a
news briefing. "It details the strategy for WHO and health partners for
six to nine months to come."

Chaib, asked whether the timeline meant that the United Nations
health agency expected the epidemic now raging in Guinea, Liberia and
Sierra Leone to continue into 2015, said: "Frankly, no one knows when
this outbreak of Ebola will end."

Ebola will be declared over in a
country if two incubation periods, or 42 days in total, have passed
without any confirmed case, she said. Nigeria is the fourth country with
known cases.

"So with the evolving situation, with more cases
reported, including in the three hot places - Guinea, Sierra Leone, and
Liberia - the situation is not yet over," Chaib said.

"So this is a planning document for six to nine months that we will certainly revisit when we have new developments."



The WHO expects to issue details of the plan early next week, she said.

In
a sign of spreading international alarm, Senegal, West Africa's
humanitarian hub, said it had blocked a regional U.N. aid plane from
landing and was banning all further flights to and from countries
affected by Ebola, potentially hampering the emergency response to the
epidemic.

(Reporting by Stephanie Nebehay in Geneva, Ben Hirschler in London and Emma Farge in Dakar; Editing by Mark Heinrich)

| Reuters

The Ebola Outbreak: 'A Dress Rehearsal For The Next Big One' : Goats and Soda

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hide captionThe usual suspect: Bats harbor dozens of deadly viruses, such as rabies and influenza. Several studies suggest that bats may also carry Ebola.

Tyler Hicks/Getty Images

Until this year, the world had recorded 1,640 deaths from Ebola since the virus was discovered in 1976.

Then Ebola appeared in West Africa.

So far this year, 887 people have died of Ebola in West Africa, the World Health Organization said Monday.

hide captionThe graphs include only years in which 50 or more Ebola deaths were reported.

Linda Poon/Data from the World Health Organization

To put that into perspective, more than a third of all people known to have died from the Ebola virus have died in the current outbreak.

And the outbreak is still spreading at a frightening rate. Last week, there were more than 200 new cases reported across four countries.

To find out more about the origins of Ebola — and what may lie ahead — we talked to author David Quammen. He wrote the book Spillover, which traces the evolution of Ebola, HIV and other diseases that move from animals to people.

Here's an excerpt from our conversation, which has been edited for clarity.

The title of your book is Spillover. What does this term mean?

Spillover is the event when a disease, or the agent that causes it, moves from one species to another.

In particular, there's a group of diseases, called zoonotic diseases, which pass from nonhuman animals into humans. And spillover is the moment when a new virus has the opportunity to leap from a bat, monkey or rodent into its first human victim.

We're pretty sure that's what happened with the Ebola outbreak in West Africa.

How widespread is the Ebola virus in Africa? Are there pockets of wild animals, such as fruit bats, carrying Ebola in certain regions? Or is the virus really widespread in animals?

The Ebola virus seems to be confined to the moist forests of Central and West Africa.

We don't know where Ebola lives permanently — its so-called reservoir host. A reservoir is the animal in which a pathogen or virus lives inconspicuously, without causing symptoms. That's its refuge, its home. The virus replicates in the reservoir host at a relatively low rate and doesn't cause trouble.

For Ebola, bats are a key suspect. Three species have been found to carry antibodies to Ebola. But nobody has actually found live Ebola viruses in those bats.

Scientists don't know how the Ebola outbreak in West Africa started. But how have other Ebola outbreaks begun?

Each of these new, emerging diseases is sort of a mystery story. The first mystery to be solved is what's the reservoir host and what caused it to spill over into humans

There was one Ebola outbreak in the Democratic Republic of Congo, where it was suspected that the first case involved contact with a big fruit bat.

There were some large, migratory fruit bats roosting along the river in this area. One man in particular bought a bat at a market and carried it home. Then, I believe, the infection passed from him to his daughter. There was a strong, but not definite, implication that the killing of fruit bats, and the selling and buying of them in the market, is what triggered an outbreak.

How did we go from a virus that's found largely in animals to a virus that can be deadly for humans — and spread across four countries?

Human behavior is causing this problem. More and more, we're going into wild, diverse ecosystems around the world, especially tropical forests.

Some scientists believe that each individual species of animal, plant, bacterium and fungus in these places carries at least one unique virus, maybe even 10 of them.

We, humans, go into those wild ecosystems. We cut down trees. We build mines, roads and villages. We kill the animals and eat them. Or we capture them and transport them around the world.

In doing that, we expose ourselves to all these viruses living around the world. That gives the viruses the opportunity to spill over into humans. Then in some cases, once the virus makes that first spillover, it discovers that it might be highly transmissible in humans. Then you might have an epidemic or a pandemic.

Is the Ebola virus in West Africa changing over time and becoming more contagious in people?

Potentially. That's a real concern.

Viruses evolve by way of Darwinian natural selection. The more cases of Ebola we have, the more chances the virus gets to replicate. And the more chances there [are] for it to mutate in a particular way that it adapts well to living in humans — and perhaps transmitting more easily from human to human.

The longer this outbreak in West Africa goes on, the more chances there are for the Ebola virus to mutate and adapt. That's no small concern.

Do you think this Ebola outbreak is the next "big one"?

I would hope that this outbreak could — however bad it may be become — could be controlled short of the scope of the big epidemics and pandemics. It seems more than likely that it can.

So I don't think this Ebola outbreak is the next big one. But I think it's a dress rehearsal for the next big one.

The experts I talk to say the next big one will almost certainly be caused by a zoonotic virus, coming out of animals. And it's likely to be one that is transmissible through the respiratory route — that is, through a sneeze or cough.

Ebola is not an easily transmissible virus. It requires direct contact with bodily fluids. It doesn't travel on the respiratory route.

Viruses such as the Middle East respiratory syndrome and SARS are much more of a concern to scientists that study these things than Ebola because they are already transmissible through the respiratory route. They are also highly adaptable, and they mutate quickly.

In terms of the next big one, SARS and MERS stand higher on the watch list than Ebola. : NPR

American doctor infected with Ebola virus is on his way to U.S.

Dr. Kent Brantly speaks with a patient in Liberia this year. (Joni Byker / Samaritan's Purse)

An air ambulance carrying an
American doctor who became ill with the Ebola virus while treating
others afflicted in West Africa was en route to the United States and
due to land Saturday, officials said.

A spokeswoman for
Samaritan’s Purse said Dr. Kent Brantly was aboard a plane that left
Liberia overnight. A second stricken American, Nancy Writebol, fell ill
while working for SIM, a Christian aid group.

Brantly’s
arrival time at Dobbins Air Reserve base outside of Atlanta was not
released, but shortly after 10 a.m. Eastern a white vehicle with
flashing red lights could be seen driving across the tarmac from an
adjacent road.

It was not clear when Writebol would arrive in the
United States. Doctors at Emory University Hospital in Atlanta, where
the pair will be treated, said Friday that medical experts on the ground
in Liberia had deemed both of them in good enough condition to make the
trip in the specially outfitted air ambulance.








































Once the ambulance lands, Brantly will be transferred into a
specially equipped vehicular ambulance and placed under a tent-like
enclosure inside of it to ensure the Ebola virus does not spread. The
virus is transferred through bodily fluids.

The Ebola outbreak has
killed more than 720 people in West Africa and has a mortality rate of
at least 60%. There is no cure or vaccine, but doctors at Emory say they
are “cautiously optimistic” that with proper care and close monitoring,
they can successfully treat Brantly and Writebol.

World health officials, meanwhile, have warned that the outbreak is spreading out of control in Africa

Copyright © 2014, Los Angeles Times

Runaway Sierra Leone Ebola patient dies

Experts highlight Ebola problems in Sierra Leone

Freetown (AFP) - Medecins Sans Frontieres has
treated more than 70 patients with symptoms resembling those of Ebola in
Kailahun treatment centre in eastern Sierra Leone. MSF is concerned...

Medecins Sans Frontieres has treated more than 70 patients with

symptoms resembling those of Ebola in Kailahun treatment centre in

eastern Sierra Leone. MSF is concerned about a possible increase in

patients in the coming weeks.

A Sierra Leone Ebola patient whose family sparked a

nationwide hunt when they forcefully removed her from a treatment center

and took her to a traditional healer, died in an ambulance on the way

to hospital, a health official said.

Health officials say fear and mistrust of health workers in Sierra

Leone, where many have more faith in traditional medicine, are hindering

efforts to contain an Ebola outbreak which has killed more than 450

people in the country.

In recent days crowds gathered outside clinics and hospitals to

protest against what they see as a conspiracy, in some cases clashing

with police as they threatened to burn down the buildings and remove the

patients.

Amadu Sisi, a senior doctor

at King Harman hospital in the capital Freetown, from which the patient

was taken, said Saturday that police found her in the house of a healer.

Her family refused to hand her over and a struggle ensued with

police, who finally retrieved her and sent her to hospital, he said.

"She died in the ambulance on the way to another hospital," Sisi said.

Across Guinea, Liberia and Sierra Leone, at least 660 people have

died from the worst outbreak yet of the hemorrhagic fever, the World

Health Organization said, placing great strain on the health systems of

some of Africa's poorest countries.

The virus is still spreading. A 33-year-old American doctor working

for relief organization Samaritan's Purse in Liberia tested positive for

the disease Saturday. In Lagos, Nigeria's commercial capital, a

Liberian man who tested positive died Friday.

West African health officials say the deep cultural suspicions mean

relatives in some countries will continue to try to remove sick patients

from hospitals and carry out traditional funerals, which often involve

the manual washing of the body, instead of allowing the authorities to

bury them.

Angry crowds

Sierra Leone now has the highest number of Ebola cases, at 454,

surpassing neighboring Guinea where the outbreak originated in February.

Police were guarding the country's main Ebola hospital in Kenema in

the West African country's remote east Saturday, where dozens are

receiving treatment for the virus.

Thousands had gathered outside the clinic the day before, threatening

to burn it down and remove the patients. Residents said police fired

tear gas to disperse the crowds and that a 9-year-old boy was shot in

the leg by a police bullet.

Assistant Inspector General Alfred Karrow-Kamara said on Saturday the

protest was sparked by a former nurse who had told a crowd at a nearby

fish market that "Ebola was unreal and a gimmick aimed at carrying out

cannibalistic rituals."

He said calm had been restored to Kenema on Saturday, adding that a

strong armed police presence was in place around the clinic and the

local police station.

Some health workers from the clinic have been reported absent from

work because of "misconceptions by some members of the community,"

according to a local doctor.

Ebola can kill up to 90 percent of those who catch it, although the

fatality rate of the current outbreak is around 60 percent. Highly

contagious, especially in the late stages, its symptoms include vomiting

and diarrhea as well as internal and external bleeding.

President Ernest Bai Koroma said on Saturday the government planned

to "intensify activities and interventions in containing the disease and

stopping it spread" with a view to ending the disease within 60 to 90

days.

The new strategy will focus on contact tracing, surveillance,

communications and social mobilization, social services, logistics and

supplies, according to the president's statement.

Reuters