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.

New Cases of Ebola Cause for Concern, Islamic State Continues To Capture New Territory and Same Sex Marriage in the United States Gains Momentum

https://i0.wp.com/media.cagle.com/46/2014/10/02/154482_600.jpg https://i0.wp.com/thefederalistpapers.integratedmarket.netdna-cdn.com/wp-content/uploads/2014/08/mrz082114dAPC.jpgSack cartoon: Gay marriage

On Monday, a nurse in Spain was the first person to be diagnosed outside the outbreak zone in West Africa, raising further concerns across the globe, according to the Associate Press, New concern worldwide as nurse in Spain gets Ebola. In the U.S., President Barack Obama said the government is weighing an order for more careful screening of airline passengers arriving from he region. In dealing with potential Ebola cases, Obama said, “we don’t have a lot of margin for error.” Already hospitalized in the U.S., a critically ill Liberian man, Thomas Duncan, has received an experimental drug in Dallas as another American video journalist who returned from Liberia arrived Monday at the Nebraska Medical Center for treatment has shown signs of improvement. Ashoka Mukpo, 33, was able to walk off the plane before being loaded on a stretcher and taken to an ambulance, and his father said his symptoms of fever and nausea appeared mild. The Spanish nurse had been part of a team that treated two missionaries flown home to Span after contracting Ebola in West Africa. The nurse only showed signs of fever, but the infection was confirmed by two tests, according to Spanish health officials. She was being treated in isolation, while authorities drew up a list of people she had had contact with. Medical workers in Texas were among Americans waiting to find out whether they had been infected by Duncan, the African traveler. In Washington, the White House continued to rule out any blanket ban on travel from West Africa. People leaving the outbreak zone are checked for fevers before they’re allowed to board airplanes, but the disease’s incubation period is 21 days and symptoms could arise later. Nancy Castles, a spokeswoman for Los Angeles International Airport, said the Centers for Disease Control and Prevention has had employees on site at more than a dozen major international airports in the U.S. like LAX for many years. Screening of passengers starts with Customs and Border Protection agents, who work with CDC when they have a case they are concerned about. Obama said the U.S. will be “working on protocols to do additional passenger screening both at the source and here in the United States.” The Obama administration maintains that the best way to protect Americans is to end the outbreak in Africa. To that end, the U.S. military was working Monday on the first of 17 promised medical centers in Liberia and training up to 4,000 soldiers this week to help with the Ebola crisis. White House spokesman Josh Earnest said, “The tragedy of this situation is that Ebola is rapidly spreading among populations in West African who don’t have that kind of medical infrastructure.” The virus has taken a heavy toll on health care workers in a region where shortages of doctors and nurses before Ebola were rampant and so far the disease has killed or sickened more than 370 in the hardest hit countries of Liberia, Guinea and Sierra Leone. Airlines have dealt with previous epidemics, such as the 2003 outbreak in Asia of SARS, or severe acute respiratory syndrome. The U.S. didn’t ban flights or impose extra screening on passengers during the SARS outbreak or the 2009 swine flu pandemic. Both of those were airborne diseases that spread more easily than the Ebola virus, which is spread by contact with bodily fluids. The SARS death rate was about 10 percent, higher for older patients. Its new relative MERS, now spreading in the Middle East, appears to be more deadly, about 40 percent. About half of people infected with Ebola have died in this outbreak. The Ebola outbreak this year has killed more than 3,400 people in West Africa, the World Health Organization estimates, and it has become an escalating concern to the rest of the world. Mukpo is the fifth American sick with Ebola brought back from West Africa for medical care. The others were aid workers – three have recovered and one remains hospitalized. On Tuesday, Reuters reports, More cases of Ebola in Europe unavoidable: WHO, the World Health Organization believes more cases Ebola will likely occur in Europe but the continent is well prepared to control the disease. Speaking to Reuters just hours after Europe’s first local case of Ebola infection was confirmed in a nurse in Spain, the WHO’s European director, Zsuzsanna Jakab, said further such events were “unavoidable”. Spanish health officials said four people had been hospitalized to try and stem any further spread of Ebola there after the nurse became the first person in the world known to have contracted the virus outside of Africa. Jakab told Reuters via phone interview for her Copenhagen office: “Such imported cases and similar events as have happened in Spain will happen also in the future, most likely. It is quite unavoidable … that such incidents will happen in the future because of the extensive travel both from Europe to the affected countries and the other way around.” Several countries in the WHO’s European region, including France, Britain, the Netherlands, Germany, Switzerland, Norway and Spain, have treated patients repatriated after contracting the disease in West Africa, where Ebola has been raging through Guinea, Sierra Leone and Liberia since March. Cases have also been imported into Nigeria, Senegal and the United States. Jakab said that within Europe, health workers caring for repatriated Ebola patients, as well as their families and close contacts, were most at risk of becoming infected. With case numbers in the West Africa rising exponentially, experts say it is only a matter of time before Ebola spreads internationally, but they stress the chances of sporadic cases leading to an outbreak in Europe, the United States or elsewhere beyond Africa are extremely low. Jakab added, “If they see any need for support or advice, we are always behind them. We are well prepared. I really don’t think that at this stage we should be worried about these particular cases. This was to be expected. We expected it in other parts of the region – and it came in Spain, but it did not come totally as surprise.”

While it seems the threat of Ebola can be controlled through a coordinated effort, the threat of ISIS seems far from under anyone’s control as the group captures new territory raising concerns for Turkey. On Monday Daren Butler reports, Islamic State raises flag in eastern Kobani, Kurds say town has not fallen, the Islamic State after a three week assault has raised its flag on a building on the outskirts of the Syrian frontier town of Kobani, but the town’s Kurdish defenders said its fighters had not reached the city center. A black flag was visible from across the Turkish border atop a four story building close to the scene of some of the most intense fighting in recent days. American and Gulf State warplane air strikes have failed to halt the assault on Kobani which it has surrounded on three sides and pounded with heavy artillery. Local sources inside Kobani confirmed that the group had plants its flag, but Kurdish forced had repelled further advances. Ismail Eskin, a journalist in the town, said, “ISIL have only planted a flag on one building. That is not inside the city, it’s on the eastern side. They are not inside the city. Intense clashes are continuing. The bodies of 25 (Islamic State) fighters are there.” Despite the presence of Turkish tanks along the border and within sight of the town, Kurdish please for more effective military help have gone unanswered. Islamic State also fought intense battles over the weekend for control of Mistanour, a strategic hill overlooking Kobani. Beheadings, mass killings and torture have spread fear of the group across the region, with villages emptying at their approach and an estimated 180,000 people fleeing into Turkey from the Kobani region. Turkish hospitals have been treating a steady stream of wounded Kurdish fighters being brought across the frontier. Esmat al-Sheikh, head of the Kobani Defense Authority, said via phone early Monday: “If they enter Kobani, it will be a graveyard for us and for them. We will not let them enter Kobani as long as we live. We either win or die. We will resist to the end.” Last Week, the co-chair of the Kurdish Democratic Union Party (PYD) told Reuters that Islamic State had a large arsenal from its de facto capital Raqqa to assault Kobani. Asya Abdullah said, “If (Islamic State) is defeated here in Kobani, it will be defeated in Raqqa and throughout Syria. We are happy about the U.S. air strikes. But really, this is not enough. We need more air strikes to be effective against (Islamic State) weapons, to eradicate and destroy (them).” On Monday, Kurdish politicians confirmed that the PYD’s other co-chair, Saleh Muslim, had met Turkish officials to urge them to allow weapons into Kobani from Turkey, although no further details were available. Over the weekend, President Tayyip Erdogan vowed to retaliate if Islamic State attacked Turkish forces, and on Monday Turkish tanks deployed along the border for the second time in a week, some with guns pointing towards Syria, apparently in response to stray fire. Last month, the Islamic State group released 46 Turkish hostages and a parliamentary motion last week renewed a mandate to allow Turkish troops to cross into Syria and Iraq leasing many to believe Ankara may be planning a more active role. According to Butler: “For three decades, Ankara has fought an armed insurgency by its own Kurdish PKK militants demanding greater autonomy in Turkey’s southeast. Analysts say it is now wary of helping Syrian Kurdish forces near Kobani as they have strong links with the PKK and have maintained ambiguous relations with Assad, to whom Turkey is implacably opposed. Against that are warnings from the leaders of Turkey’s Kurds that allowing Syria’s Kurds to be driven from Kobani would spell the end of Erdogan’s delicately poised drive to negotiate an end to his own Kurdish insurgency and permanently disarm the PKK.” Ryan Gorman reports, ‘Boots in the air’: US combat troops engage ISIS rebels as Canada deploys soldiers to Iraq, the U.S. military has begun to fight ISIS in Iraq despite Obama’s promise to not put boots on the ground as Canada sends reinforcements to help in the fight. On Sunday, Army attack helicopters began an assault on insurgent positions outside Baghdad, according to Central Command announced. Early Monday, Canadian officials announces that an advanced team of hundreds of soldiers is also on its way to Iraq. This strike changes the U.S. strategy in Iraq from one of using drones and fighter jets for targeted air strikes to combat troops directly engaging the militants. News of the escalation by the Army came shortly before Canada announced plans to send an advance team of 600 soldiers to Iraq, according to the CBC. Previous reports suggested the Canadian military would not send ground combat troops abroad. But it was also previously reported the U.S. would not engage ISIS in ground combat. Turkey’s president on Tuesday said the Islamic State is about to capture the Syrian border town of Kobani where the Kurdish forces are outgunned and struggle to repel the extremists with limited aid from U.S. led coalition airstrikes, the Associate Press reports, Turkey: Syrian border town about to fall to IS. Turkish President Recep Tayyip Erdogan said the coalition air campaign launched last month would not be enough to halt the Islamic State advance and called for greater cooperation with the Syrian opposition, which is fighting both the Islamic State and forces loyal to Syrian President Bashar Assad. Erdogan told Syrian refugees in the Turkish town of Gaziantep, near the border: “Kobani is about to fall. We asked for three things: one, for a no-fly zone to be created; two, for a secure zone parallel to the region to be declared; and for the moderate opposition in Syria and Iraq to be trained and equipped.” Erdogan said more than 200,000 people have fled the fighting in and around Kobani in recent weeks. Their flight is among the largest single exoduses of the three-year Syrian conflict. The Observatory, which relies on a network of activists across Syria, said Tuesday that 412 people have been killed since the Kobani fighting began.

As disease, war and famine are running rampant in much of the world and little justice can be found, the Supreme Court of the United States have finally done the best thing it could of possibly done…absolutely nothing. By the Supreme Court declining to review petitions from lower courts whose jurisdiction covers nearly a dozen states, the highest court in the land has made same sex marriage legal Monday in 11 additional states. Even though the decision was announced quietly, the resulting shock waves have reverberated across the nation, according to Ryan Gorman, Supreme Court effectively legalizes same-sex marriage in 11 more states. The court validated three federal appeals covering Colorado, Indiana, Kansas, North Carolina, Oklahoma, South Carolina, Utah, Virginia, West Virginia, Wisconsin and Wyoming, according to Bloomberg. By declining to hear the petitions brought forth from the jurisdictions, the Supreme Court left intact appeals courts decisions to strike down same-sex marriage bans in the locales. Couples in those states should soon be able to obtain marriage licenses and be legally wed. The announcement led a large group of same-sex marriage supporters gathered outside the court to celebrate. They cheered, waved flags, hugged each other and embraced the landmark decision. Supreme Court and #SSM (a same-sex marriage hashtag) immediately shot to the top of trending topics in the United States on Twitter. A case can only be reviewed it at least four of the nine sitting justices want to hear it. The justices also did not signal if they would be willing to hear a same-sex marriage case in the future. No reason was given for the decision. The court has previously showed support for gay marriage when it struck down a federal law last year denying benefits to same-sex married couples. Refusing to hear an appeals on lower court decisions to strike down same-sex marriage bans sets a precedent. The remaining 20 states banning gay marriage will likely also be bound to appeals courts decisions should their bans be overturned. The unions are now legal in a total of 30 states, plus the District of Columbia. Same-sex couples in multiple states across America are getting married after Monday morning’s landmark Supreme Court decision to not hear same-sex marriage cases. Wyoming’s justification for not recognizing the marriage license applications is on the grounds it’s state constitution clearly defines marriage as between a man and a woman. The stipulation was originally made during the state’s founding in order to prevent polygamy. Legal experts believe an injunction will have to be granted by a federal court in order for same-sex marriages in the state to proceed. Monday’s non-decision came 16 years to the day that Matthew Shepard, a 21-year-old college student, was tortured in Wyoming for being gay. He died six days later. It is not clear when marriage licenses will be issued to couples in the other states, while the remaining 20 states have constitutional bans on the unions. The Associate Press reports, Status of gay marriage in all 50 states, the number of states where the practice is legal has skyrocketed from 19 to 30, in addition to Washington, D.C. Here’s the legal status of gay marriage in all 50 states:

WHERE GAY MARRIAGE IS LEGAL (And when it was legalized):

– CALIFORNIA (2013)

– COLORADO (Oct. 6, 2014) – Pueblo and Larimer counties began issuing marriage licenses to gay couples Monday, although official guidance from state Attorney General John Suthers is still pending.

– CONNECTICUT (2008)

– DELAWARE (2013)

– HAWAII (2013) – The state Legislature legalized gay marriage last year. Meanwhile, an appeal is pending of a federal court ruling that upheld Hawaii’s previous ban.

– ILLINOIS (June 2014)

– INDIANA (Oct. 6, 2014) – Gov. Mike Pence reaffirmed his commitment to traditional marriage but said people are not free to disobey the Supreme Court decision to reject an appeal of a ruling striking down Indiana’s gay marriage ban. County clerks issued a few licenses to same-sex couples.

– IOWA (2009)

– KANSAS (Oct. 6, 2014) – The American Civil Liberties Union says the Supreme Court decision in the 10th Circuit cases affects Kansas because it’s in that circuit; the group plans to seek a federal court ruling to block Kansas’ constitutional ban on gay marriage. Gov. Sam Brownback was defiant, saying he swore to uphold the constitution, and some same-sex couples who applied for marriage licenses were turned away.

– MAINE (2012)

– MARYLAND (2013)

– MASSACHUSETTS (2004) – The first state to legalize gay marriage.

– MINNESOTA (2013)

– NEW HAMPSHIRE (2010)

– NEW JERSEY (2013)

– NEW MEXICO (2013)

– NEW YORK (2011)

– NORTH CAROLINA (Oct. 6, 2014) – The American Civil Liberties Union of North Carolina says it will seek an immediate ruling in federal court overturning the state’s ban. North Carolina Attorney General Roy Cooper has previously said he wouldn’t challenge such a ruling.

– OKLAHOMA (Oct. 6, 2014) – The Tulsa County Court Clerk’s Office issued a marriage license Monday to Mary Bishop and Sharon Baldwin, the couple who successfully challenged the state’s ban on gay marriage. Several other Oklahoma counties also issued same-sex marriage licenses.

– OREGON (May 2014)

– PENNSYLVANIA (May 2014)

– RHODE ISLAND (2013)

– SOUTH CAROLINA (Oct. 6, 2014) – A lawyer for a gay couple seeking to overturn the state’s ban on gay marriage said she will ask a federal judge to immediately rule in their favor. South Carolina Attorney General Alan Wilson said he will continue to fight to uphold the ban.

– UTAH (Oct. 6, 2014) – Gay couples in Utah began applying for marriage licenses, and a handful of same-sex weddings occurred in Salt Lake County after Gov. Gary Herbert directed state agencies to recognize the marriages Monday.

– VERMONT (2009) – The first state to offer civil unions, in 2001.

– VIRGINIA (Oct. 6, 2014) – Gay couples started marrying in Virginia. Thirty-year-old Lindsey Oliver and 42-year-old Nicole Pries received the first same-sex marriage license issued from the Richmond Circuit Court Clerk’s office then were married by gay-rights advocate The Rev. Robin Gorsline.

– WASHINGTON, D.C. (2010)

– WASHINGTON STATE (2012)

– WEST VIRGINIA (Oct. 6, 2014) – Attorney General Patrick Morrisey was studying the implications for the state in light of the Supreme Court decision.

– WISCONSIN (Oct. 6, 2014) – County clerks began accepting applications from gay couples for marriage licenses which, by Wisconsin law, can’t be issued until after a five-day waiting period. In Milwaukee and Dane counties, where most of the roughly 500 same-sex weddings took place this summer before a federal judge’s decision was put on hold, a few couples applied for licenses.

– WYOMING (Oct. 6, 2014) – A state case, scheduled for a court hearing Dec. 15, is similar to gay marriage cases in federal court but Wyoming supporters weren’t ready Monday to declare unconditional victory. They say same-sex marriage could be legal in the state by year’s end.

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WHERE GAY MARRIAGE IS NOT LEGAL AND CASES ARE PENDING:

– ALABAMA

– ALASKA

– ARIZONA – In a ruling that called into question Arizona’s gay marriage ban, a U.S. District Court judge handed a victory Sept. 12 to a gay man denied death benefits after losing his spouse to cancer.

– ARKANSAS – A state judge in May struck down the state’s ban. The state Supreme Court brought marriages to a halt and is weighing state officials’ appeal. Same-sex couples are also suing the state in federal court. The attorney general’s office has asked that proceedings in both cases be put on hold while the U.S. Supreme Court considers whether to take up a case from Utah.

– FLORIDA – A federal judge declared the state’s ban unconstitutional in mid-August, joining state judges in four counties. He issued a stay delaying the effect of his order, meaning no marriage licenses would be issued immediately issued for gay couples.

– GEORGIA

– IDAHO – State officials are appealing a federal judge’s decision to overturn the state’s ban. The 9th U.S. Circuit Court of Appeals panel in San Francisco heard arguments Sept. 8 along with appeals from Hawaii and Nevada.

– KENTUCKY – Two Kentucky cases were among six from four states heard in the 6th U.S. Circuit Court of Appeals in Cincinnati on Aug. 6. Rulings are pending on recognition of out-of-state marriages, as well as the ban on marriages within the state.

– LOUISIANA – A parish judge ruled Sept. 22 that the state’s ban on same-sex marriage is unconstitutional; the attorney general has appealed to the state’s Supreme Court.

– MICHIGAN – The state’s ban was overturned by a federal judge in March following a rare trial that mostly focused on the impact on children. The 6th U.S. Circuit Court of Appeals in Cincinnati heard arguments Aug. 6, and a ruling is pending.

– MISSISSIPPI

– MISSOURI – Attorney General Chris Koster announced Monday he wouldn’t appeal a state court order that Missouri recognize same-sex marriages legally performed in other states. But two other same-sex marriage cases are pending in Missouri. One is a federal challenge in Kansas City; the other is a St. Louis case that focuses on city officials who issued marriage licenses to four same-sex couples to trigger a legal test of the ban.

– MONTANA

– NEBRASKA

– NEVADA – Eight couples are challenging Nevada’s voter-approved 2002 ban, which a federal judge upheld a decade later. The 9th U.S. Circuit Court of Appeals panel heard arguments Sept. 8, along with appeals from Hawaii and Idaho.

– NORTH DAKOTA

– OHIO – Two Ohio cases were argued Aug. 6 in the 6th U.S. Circuit Court of Appeals, and a ruling is pending. In one, two gay men whose spouses were dying sued to have their out-of-state marriages recognized on their spouses’ death certificates. In the other, four couples sued to have both spouses listed on their children’s birth certificates.

– SOUTH DAKOTA

– TENNESSEE – The 6th U.S. Circuit Court of Appeals heard arguments Aug. 6 on an appeal of a federal judge’s order to recognize three same-sex couples’ marriages while their lawsuit against the state works through the courts. A ruling is pending.

– TEXAS – A federal judge declared the state’s ban unconstitutional, issuing a preliminary injunction. The state is appealing to the 5th U.S. Circuit Court of Appeals in New Orleans, which is soon expected to set a date for arguments.