Ebola Crisis Deepens Outside Outbreak Zone

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Health officials on Sunday reported a Texas health care workers tested positive for Ebola after caring for a hospitalized patient who died of the virus even though she wore full protective gear, making it the first known case of the disease being contracted or transmitted in the U.S. the Associated Press reported, State health officials: 2nd Ebola case in Texas. Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, said the diagnosis shows there was a clear breach of safety protocol and all those who treated Thomas Eric Duncan are now considered potentially exposed. The worker wore a gown, gloves, mask and shield while she cared for Duncan during his second visit to Texas Health Presbyterian Hospital, said Dr. Daniel Varga of Texas Health Resources, which runs the hospital. Frieden said the worker has not been able to identify a specific breach of protocol that might have led to her being infected. Duncan came to the U.S. from Liberia to visit family on Sept. 20 and first sought medical care for fever and abdominal pain on Sept. 25. He told the nurse he had been to Africa, but was sent home and returned Sept.28 when he was placed in isolation due to a suspicion of Ebola. Unfortunately, he died on Wednesday. The virus that has killed more than 4,000 people with most being in West Africa has hit Liberia the hardest along with Sierra Leone and Guinea, the World Health Organization figures published Friday reports. Texas health officials have been closely monitoring nearly 50 people who had or may have had close contact with Duncan in the days after he started showing symptoms. The health care worker reported a fever Friday night as part of a self-monitoring regimen required by the CDC, Varga said. A preliminary state test showed the worker was positive late Saturday and the CDC confirmed the result Sunday. Varga said another person is in isolation, and the hospital has stopped accepting new emergency room patients. Frieden said officials are now evaluating and will monitor any workers who may have been exposed while Duncan was in the hospital. Dr. David Lakey, commissioner of the Texas Department of State Health Services, said: “We knew a second case could be a reality, and we’ve been preparing for this possibility. We are broadening our team in Dallas and working with extreme diligence to prevent further spread.” Dallas officials knocked on doors, made automated phone calls and passed out fliers to notify people within a four-block radius of the health care worker’s apartment complex about the situation, though they said there was no reason for neighbors to be concerned. Dallas police officers stood guard outside the complex Sunday and barred people from entering. Officials said there was information that a pet was inside the health care worker’s apartment, but they do not believe the animals has contracted the disease. Frieden on Sunday’s “Face the Nation” on CBS that the CDC will investigate how workers took off protective gear and look at dialysis and incubation where tubes are inserted into a patient’s airway so a ventilator can help them breathe as both procedures can spread infectious material. A Spanish nurse assistant, who cared for a missionary priest at a Madrid hospital, recently became the first health care worker infected outside West Africa during the ongoing outbreak. More than 370 health care workers in West Africa have fallen ill or died since the epidemic began earlier this year. Meanwhile, an American video journalist, 33 year old Ashoka Mukpo, for a second day showed modest improvement after contracting Ebola, according to Dr. Phil Smith, the director of the Nebraska Medical Center’s 10 bed isolation unit. The Associate Press reports, Ebola patient shows modest improvement for 2nd day, the patient from Providence, Rhode Island, is the second Ebola patient treated at the Omaha hospital. He’s receiving an experimental Ebola drug called brincidofovir and IV fluids similar to the treatment Ebola patient Rick Sacra received during his three weeks there. Mukpo became infected while working as a freelance cameraman for Vice News, NBC News and other media outlets. He returned to Liberia in early September to help highlight the toll of the Ebola outbreak. Ryan Gorman reported Monday, Family ID’s Dallas nurse who contracted Ebola from patient who died, the nurse who contracted Ebola was identified by here family as Nina Pham, 26, of Fort Worth, by here family members. Duncan died only days before Pham’s diagnosis on Sunday after seeing a doctor for a low grade fever. Frieden on Sunday said, “Unfortunately, it is possible in the coming days we will see additional cases of Ebola. This is because the health care workers who cared for this individual may have had a breach of the same nature.” Pham, a 2010 TCU graduate, was not one of the 48 people under observation by the CDC, a source told the Dallas Morning News. News of Pham’s identity came one day after images of cleaning crews scouring her apartment were made public. It is not known if the same company used to clean the apartment Thomas Duncan was staying at was also used for Pham’s residence. Pham is in stable condition. About 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Thomas Eric Duncan after he was hospitalized, including a nurse now being treated for the same Ebola virus that killed the Liberian man who was visiting Dallas, according to medical records his family provided to The Associated Press. Until now, the CDC has been actively monitoring 48 people who might have had contact with Duncan after he fell ill with an infection but before he was put in isolation including 10 people known oto have contact and 38 who may have has contact such as the people he was staying with and health professionals who attended to him in the ER. Dr. Tom Frieden, director of the CDC said, “If this one individual was infected – and we don’t know how – within the isolation unit, then it is possible that other individuals could have been infected as well. We do not today have a number of such exposed people or potentially exposed health care workers. It’s a relatively large number, we think in the end.” On Monday, the AP reports, Ebola survivor donates plasma to sick Dallas nurse, that Samaritan’s Purse spokesman Jeremy Blume says Dr. Kent Brantly, the Texas doctor who survived Ebola, traveled to the Texas Health Presbyterian Hospital in Dallas Sunday to donate plasma that, according to Rev. Jim Khoi, pastor of the Fort Worth church attended by Nina Pham’s family, was given to Nina Pham on Monday afternoon that contains Ebola fighting antibodies. Brantly said in a recent speech that he also offered his blood to Thomas Eric Duncan, but that their blood types didn’t match. Duncan died of Ebola on Wednesday. As of Tuesday, the nurse who was the first to contract Ebola on American soil is doing well, according to a statement released on her behalf by Texas Health Presbyterian Hospital Dallas.

In Europe, the fight against Ebola continues to present challenges to those coming home after volunteering in the outbreak zone and those who treat them. The Associated Press reported Tuesday, German hospital: UN worker dies of Ebola, a United Nations medical worker infected with Ebola in Liberia has died despite intensive medical intervention, according to the German hospital treating the 56 year old man. The St. Georg hospital in Leipzig said the 56-year-old man, whose name has not been released, died overnight of the infection. It released no further details and did not answer telephone calls. The man tested positive for Ebola on Oct. 6, prompting Liberia’s UN peacekeeping mission to place 41 staff members who had possibly been in contact with him under “close medical observation.” He arrived in Leipzig for treatment on Oct. 9 where he was put into a special isolation unit. The man was the third Ebola patient to be flown to Germany for treatment. The first patient, a Senegalese man infected with Ebola while working for the World Health Organization in Sierra Leone was brought to a Hamburg hospital in late August for treatment. The man was released Oct. 3 after recovering and returned to his home country, the hospital said. Another patient, a Ugandan man who worked for an Italian aid group in West Africa, is undergoing treatment in a Frankfurt hospital. Meanwhile in Spain, the Associated Press reported Saturday, Ebola: 3 more people under observation in Spain, three more people were under observation for Ebola at a Madrid hospital, boosting the number of those monitored to 16, while a nursing assistant infected with the virus remained in serious but stable condition. The latest three are a nurse who came into contact with nursing assistant Teresa Romero, a hairdresser who attended to her and a hospital cleaner, all of whom were admitted to Madrid’s Carlos III hospital late Friday. A government statement said none of the 16 in quarantine, who include Romero’s husband, five doctors and five nurses, have shown any symptoms. A later government statement said one of the five nurses has tested negative for Ebola, but will remain under “passive observation.” Romero, 44, the first person known to have contracted the disease outside West Africa in the current outbreak, had cared for two Spanish priests who died of Ebola at the hospital, one in August and the other on Sept. 25. Thousands of people gathered in more than 20 cities throughout Spain to show their solidarity with Romero and to protest against how Madrid authorities had euthanized her pet dog named Excalibur on Wednesday instead of placing it in quarantine.

Back in America, while hospitals try to contain the virus and prevent it from spreading, the government continues to delay action to help with containment and spread. On Saturday, Karen Matthews reports, Stepped-up Ebola screening starts at NYC airport, federal health officials said that entry screening from three West African countries at New York’s Kennedy International Airport is meant to prevent the spread of the disease and will expand to four additional U.S. airports in the next week. Dr. Martin Cetron, director of the Division of Global Migration and Quarantine for the federal Centers of Disease Control and Prevention, said at a briefing at Kennedy,”Already there are 100 percent of the travelers leaving the three infected countries are being screened on exit. Sometimes multiple times temperatures are checked along that process. No matter how many procedures are put into place, we can’t get the risk to zero.” The screening will be expanded over the next week to New Jersey’s Newark Liberty, Washington Dulles, Chicago O’Hare and Hartsfield-Jackson in Atlanta. Customs officials say about 150 people travel daily from or through Liberia, Sierra Leone or Guinea to the United States, and nearly 95 percent of them land first at one of the five airports. The article reports: “Public health workers use no-touch thermometers to take the temperatures of the travelers from the three Ebola-ravaged countries; those who have a fever will be interviewed to determine whether they may have had contact with someone infected with Ebola. There are quarantine areas at each of the five airports that can be used if necessary. There are no direct flights to the U.S. from the three countries, but Homeland Security officials said last week they can track passengers back to where their trips began, even if they make several stops. Airlines from Morocco, France and Belgium are still flying in and out of West Africa.” The CDC cited as legal authority the Commerce Clause of the Constitution, under which the government regulates trade with foreign countries. The 1944 Public Health Service Act also allows the federal government to take action to prevent communicable diseases, which include viral hemorrhagic fevers such as Ebola, from spreading into the country. Unfortunately, as the world struggles to combat and contain the disease, Sam Stein reports, Ebola Vaccine Would Likely Have Been Found By Now If Not For Budget Cuts: NIH Director, Dr. Francis Collins, the head of the National Institute of Health, said decades of stagnant spending has slowed down research on effective vaccinations to combat disease such as the current outbreak of Ebola, resulting in the international community having to play catch up on potentially avoidable humanitarian catastrophe. On Friday, Collins told Huff Post, “NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here.’ Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.” Not only have vaccines been hampered by money shortfalls, Collins explains therapeutics to fight Ebola “were on a slower track than would’ve been ideal, or that would have happened if we had been on a stable research support trajectory. We would have been a year or two ahead of where we are, which would have made all the difference.” Despite the growing public health threat, the NIH has not received additional money and instead Collins and others have had to “take dollars that would’ve gone to something else” — such as a universal influenza vaccine — “and redirect them to this.” Collins said he’d like Congress to pass emergency supplemental appropriations to help with the work. But, he added, “nobody seems enthusiastic about that.” Currently, NIH is working on a fifth-generation Ebola vaccine that has had positive results in monkeys, not people. To set up a clinical trial for humans takes time and resources, and doubly so in a country whose social and political fabric is as frayed as Liberia’s. Even so, limited trials have already begun. A second vaccine is being designed in Canada, just weeks behind NIH’s schedule. But recipients have exhibited fever symptoms, which could prove problematic because elevated temperature is also a symptom of Ebola. So far, much of the focus has been on an experimental cocktail of three monoclonal antibodies known as ZMapp. But the current stockpile is not nearly great enough. Collins, a touch exasperated, said it would be all but impossible to have significant doses available by the end of the calendar year — with a lack of funding once again playing a disruptive role. There are other potential therapies. Brincidofovir has been used on an Ebola patient brought to Nebraska and on the late Thomas Eric Duncan, who was diagnosed with the disease after traveling to Dallas from his native Liberia. Unlike ZMapp, there is a large stockpile of Brincidofovir available, and the doses required are small. But, again, a clinical trial is needed in Liberia. The Associated Press reported Tuesday, CDC: Rapid response team for any new Ebola cases, the government will now send a rapid response team to any hospital where an Ebola patient is diagnosed to make sure local health workers can provide care safely. The Centers for Disease Control and Prevention has specialists implementing changes to protect health workers at Texas Health Presbyterian Hospital in Dallas as it cares for a nurse who became infected while treating Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S. Frieden described the new response team as having some of the world’s leading experts in how to care for Ebola and protect health care workers from it. They would be charged with everything from examining how the isolation room is physically laid out, to what protective equipment health workers use, to waste management and decontamination.

Meanwhile on Thursday, due to increased concern over containment and spread pf the virus following another Ebola positive patient at the same hospital where Duncan died, Federal health officials were being called to testify before a congressional committee to explain what went wrong, according to Jim Kuhnhenn, US steps up domestic response to Ebola crisis. President Barack Obama directed his administration to respond in a “much more aggressive way” to oversee the Dallas cases and ensure the lessons learned there are transmitted to hospitals and clinics across the country. For the second day in a row he canceled out-of-town trips to stay in Washington and monitor the Ebola response. Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said nurse Amber Joy Vinson never should have been allowed to fly on a commercial jetliner because she had been exposed to the virus while caring for an Ebola patient who traveled to the U.S. from Liberia. Vinson was being monitored more closely since another nurse, Nina Pham, also involved in Thomas Eric Duncan’s care was diagnosed with Ebola. Still, a CDC official cleared Vinson to board the Frontier Airlines flight from Cleveland to the Dallas area. Her reported temperature – 99.5 degrees – was below the threshold set by the agency and she had no symptoms, according to agency spokesman David Daigle. Vinson was diagnosed with Ebola a day after the flight, news that sent airline stocks falling amid fears it could dissuade people from flying. Losses between 5 percent and 8 percent were recorded before shares recovered in afternoon trading. Frontier has taken the aircraft out of service. The plane was flown Wednesday without passengers from Cleveland to Denver, where the airline said it will undergo a fourth cleaning, including replacement of seat covers, carpeting and air filters. Underscoring his emphasis on international action, Obama called European leaders Wednesday to discuss better coordination in the fight against Ebola in the countries of Sierra Leone, Liberia and Guinea and to issue a call for more money and personnel to “to bend the curve of the epidemic.” British Prime Minister David Cameron’s office said he offered to consult with the Italians to add treatment beds in Sierra Leone. On Thursday, Chinese President Xi Jinping pledged continued support for the fight against Ebola in West Africa, but made no specific new aid offers. China last month pledged $33 million in assistance to Liberia, Sierra Leone and Guinea and dispatched doctors and medical supplies. And France said that on Saturday, it will begin screening passengers who arrive at Paris’ Charles de Gaulle airport on the once-daily flight from Guinea’s capital. But it was Wednesday’s development in Dallas that captured political and public attention in the United States. Republican lawmakers, including House Speaker John Boehner, increased calls for travel bans or visa suspensions from the West African countries where the disease has spread and urged the administration to take other measures to secure the transportation system. The oversight subcommittee of the House Energy and Commerce Committee scheduled a Thursday hearing on Ebola with Frieden and Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. In prepared testimony, Fauci said Duncan’s death and the infections of the two Dallas nurses and a nurse in Spain “intensify our concerns about this global health threat.” He said two Ebola vaccine candidates were undergoing a first phase of human clinical testing this fall. But he cautioned that scientists were still in the early stages of understanding how Ebola infection can be treated and prevented. Late Wednesday, Vinson arrived in Atlanta to be treated at Emory University Hospital, which has already treated three Americans diagnosed with the virus. From now on, Frieden said, no one else involved in Duncan’s care will be allowed to travel “other than in a controlled environment.” He cited guidelines that permit charter flights or travel by car but no public transportation. The second nurse identified as 29 year old Amber Joy Vinson like Pham cared for Duncan before he died and medical records showed she inserted catheters, drew blood and dealt with Duncan’s body fluids, according to medical records provided to the Associate Press by Thomas Eric Duncan’s family. Infected Ebola patients are not considered contagious until they have symptoms. Frieden said it was unlikely that other passengers or airline crew members were at risk because the nurse did not have any vomiting or bleeding. Even so, the CDC is alerting the 132 passengers aboard Frontier Airlines Flight 1143 from Cleveland to Dallas-Fort Worth on Monday “because of the proximity in time between the evening flight and first report of illness the following morning.” Officials are asking them to call the health agency so they can be monitored. The woman flew from Dallas to Cleveland on Oct. 10. Kent State said it was asking the workers related to Vinson to stay off campus for 21 days “out of an abundance of caution.” The nurse reported a fever Tuesday and was in isolation within 90 minutes, Dallas County Judge Clay Jenkins said. The CDC has acknowledged that the government was not aggressive enough in managing Ebola and containing the virus as it spread from an infected patient to a nurse at a Dallas hospital. Emergency responders in hazardous-materials suits began decontamination work before dawn Wednesday at the Dallas apartment complex where the second nurse lives. Police guarded the sidewalk and red tape was tied around a tree to keep people out. Officials said she lives alone with no pets. Dallas city spokeswoman Sana Syed said a hazardous-materials crew has finished cleaning common areas of the complex and that the state was sending a crew to clean the actual apartment. At Cleveland Hopkins Airport, cleaning crews disinfected key areas of the facility. “They’re not prepared” for what they are being asked to do, said RoseAnn DeMoro, executive director of National Nurses United, a union with 185,000 members. Based on statements from nurses it did not identify, the union described how Duncan was left in an open area of the emergency room for hours. It said staff treated Duncan for days without the correct protective gear, that hazardous waste was allowed to pile up to the ceiling and safety protocols constantly changed. The first nurse stricken in the U.S., Nina Pham, who contracted Ebola after treating a Liberian man in Dallas, was being flown to the National Institutes of Health outside Washington on Thursday, while a second nurse has already been transferred to a biohazard infectious disease center at Emory University Hospital in Atlanta.

While the virus has spread minimally so far to other continents, back in West Africa, the number of dead and dying are increasing by the minute. Ryan Gorman reports, Up to 10,000 new Ebola cases expected per week as death rate hits 70 percent, World Health Organization officials have reported the death rate in Guinea, Liberia and Sierra Leone has increased to 70 percent and there could be as many as 10,000 new cases per week within two months. At a Tuesday press conference, WHO assistant director general Dr. Bruce Aylward classified Ebola as a “high mortality disease.” He warned that if the response is not stepped up immediately, “a lot more people will die.” The past four weeks have seen Ebola diagnoses reach about 1,000 per week, he explained. The WHO is working to contain about 70 percent of the cases within the next 60 days in an effort to reverse the epidemic. The UN-affiliated organization announced Monday that the Ebola death toll has increased to 4,447 people out of the 8,914 diagnosed. All except Thomas Duncan, who passed away in a Dallas hospital, and a patient in Germany, died in Africa. Aylward called the Ebola outbreak “the most severe, acute health emergency seen in modern times.” A number of areas have seen decline, Aylward said Monday, but “that doesn’t mean they will get to zero.” Aylward said the WHO is fighting an uphill battle against West Africa’s broken health care system and was strategically setting up clinics to treat the virus instead of quarantining people.

One thought on “Ebola Crisis Deepens Outside Outbreak Zone

  1. It is possible that survival of Ebola virus victims would be much improved if an artificial fever were produced.
    I propose that fever evolved because bacteria grow poorly at elevated temperatures, and that the immune system evolved to become more active at elevated temperatures in order to take advantage of this bacterial weakness [1]. The immune system is markedly stimulated by a rise in temperature. This may be a response arising through interleuken-1 [3]. This phenomenon has been demonstrated for interleukin–1 and interleukin-2 in post operative hypothermia [4]. Heat also stimulates tumor necrosis factor [5]. The above could be the reason why the ability to create a fever arose [6]. Doubling time of pneumococcal meningitis in rabbits is markedly increased at fever temperature, and that bacteria did not grow at all at 41 degrees centigrade in either soy broth or cerebral fluid [7], so it seems that the efficacy of body temperature effectiveness is dependent on more than enhancement of the immune system. It is conceivable in view of their results that rather than the fever evolving in order to enhance an innate characteristic of the immune system, the fever evolved to take advantage of an innate ineffectiveness of most bacteria at high temperatures and the immune system then evolved to be most effective during a fever. I have often cured a cold within a couple hours with an infrared heat lamp directed to my nose and it has been advantageous for me against other infections near the surface of the body such as sore throats and infected skin damage. It is probably necessary to start the temperature treatment early in the disease for viruses, because that is the case for rabies in mice [8]. Also it is possible that its efficacy is on the secondary infections in the case of nose colds as much as on the virus. It is necessary to protect the eyes when applied near them though, because I have reason to believe their optical characteristics can change from a high temperature.
    I have cured abscessed teeth that were not cured by anacardic acids in raw cashew nuts [ http://charles_w.tripod.com/tooth.html ] and were very slow to respond to amoxicillin by heating the jaw with an infrared lamp in conjunction with the amoxicillin. It is possible that a laser directed on the tooth would work better and should be tried. It is very desirable to get rid of an infection first even if a root canal operation is desired, in my opinion, and certainly imperative if a root canal operation is financially or tactically impossible. Development of a device that heated the tooth up directly to the correct temperature should be very advantageous.
    I have cured quite a few other kinds of infections in the last couple of years as well with artificial fever.
    Sincerely, Charles Weber
    CONCLUSION
    It would be desirable to perform experiments to determine whether this is an effectivel phenomenon or not for ebola.
    REFERENCES
    [1] Weber CE 2007 Creation of a local fever using an infrared lamp to cure a tooth abscess. Medical Hypotheses 68; 458.
    [2] Merchant M, Williams S, Trosclair PL 3rd, Elsey RM, Mills K. 2007 Febrile response to infection in the American alligator (Alligator mississippiensis). Comp Biochem Physiol A Mol Integr Physiol. 2007 Dec;148(4):921-5..
    [3] Hanson DE, Murphy PA, Silicano R, Shin HS. The effect of temperature on the activation of thymocytes by interleukin I & II. Journal of Immunol. 1983; 130: 216,
    [4] Beilin B, Shavit Y, Razumovsky J, Wolloch Y, Zeidel A, Bessler H. Effects of Mild Perioperative Hypothermia on Cellular Immune Responses. Anesthesiology. 1998; 89(5):1133-1140,
    [5] Zellner M, Hergovics N, Roth E, Jilma B, Spittler A, Oehler R. Human monocyte stimulation by experimental whole body hyperthermia. Wien. Klin. Wochenschr. 2002 Feb 15; 114(3): 73-75.
    [6] Kluger MJ. The evolution and adabtive value of fever. American Sci. 1978; 66: 38-43.
    [7] Small PM, Täuber MG, Hackbarth CJ, Sande MA. Influence of body temperature on bacterial growth rates in experimental pneumococcal meningitis in rabbits. Infect Immun. 1986 May; 52(2): 484–487.
    [8] Bell JF, and Moore GJ. Effects of High Ambient Temperature on Various Stages of Rabies Virus Infection in Mice. Infect Immun. 1974 September; 10(3): 510–515.
    [9] Meyers WM Shelly WM Conner DH Heat treatment of Mycobacterium ulcerans infections without surgical incision. The American Journal of Tropical Medicine and Hygeine.1974 23(5); 924-929.
    Sincerely, Charles Weber

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