H5N1

Ebola in the US: More on Nina Pham

Here's another excerpt from yesterday's long story in The Dallas Morning News: Exclusive: Nurse Nina Pham after Ebola: Terrible side effects, lawsuit against employer. Turning a sick employee's situation into a PR opportunity seems especially obnoxious:

The day after Duncan died, Pham said she met with someone from the CDC and the hospital’s employee health manager to walk through her care of Duncan and how she protected herself. 

“They deemed me no risk,” she said. 

She went home and later had a fever of “99-point- something,” about 2 degrees above her normal temperature. Pham said she called the hospital and the Dallas County health department, and was told to monitor her temperature. But unless her temperature reached 100.4, they told her, she should not be concerned. Attorney Charla Aldous, who is representing Pham, says that Texas Health Resources “used Pham as a PR pawn.” 

She woke up early Oct. 10 with a temperature of 100.6. Pham said she called the Presbyterian emergency room and told them who she was and that she was coming to the hospital. She drove to the hospital, where she was put in isolation. Her boyfriend at the time was quarantined but remained Ebola-free. They stopped seeing each other soon after, and Pham is currently not dating anyone. 

When she was admitted to Presbyterian, Pham said, she made it clear that she did not want any information released about her medical condition. 

“I wanted to protect my privacy, and I asked several times ... to put be as ‘no info’ or at least change my name to Jane Doe,” Pham said. “I don’t think that ever happened.” 

When a test confirmed that she did have Ebola, “I broke down crying” and was in disbelief. 

“It was very scary,” she said. “My time at Presbyterian is a bit blurry just because I was in and out of having to take pain medications and just being very, very, very fatigued the whole time. One of the hardest things about having Ebola was the extreme amount of fatigue.” 

Pham said she received three experimental drugs and “one glimmer of hope” when she found out that Brantly could give her plasma. Brantly, a doctor from Fort Worth, contracted Ebola in July while treating patients in Liberia. The plasma of Ebola survivors is helpful in the treatment of others fighting the disease. 

Although Pham was always being watched and she talked with her family on the phone, she was lonely, she said.

“Just knowing the whole world’s watching but you’re so isolated and the people that are coming [in to care for me] are risking their lives,” Pham said. “Touching me is life-threatening. It’s very lonely.” 

By the fifth day of isolation, Pham was sitting up in a chair. She thought she was doing better. But a doctor came in to talk about “end-of-life decisions” with her. 

The day Pham was transferred to NIH, a notation was made in her medical file that “she does not have the mental capability to make end-of-life decisions,” Aldous said. But PR people from Texas Health were trying to talk to her for a media release “about how much she loves Presbyterian,” Aldous said. 

Texas Health, with a PR firm’s help, developed a slogan — “Presby Proud” — aimed at restoring the community’s faith in the beleaguered hospital. 

Before Pham’s flight to Maryland on Oct. 16, she said, a doctor wearing a video camera under his protective hood came into her room and said he was filming her for educational purposes. Pham said she did not give permission for the video, which was released to the media. 

“Thanks for getting well. Thanks for being part of the volunteer team to take care of our first patient,” a man’s voice said in the video. “It means a lot. This has been a huge effort by all of you guys.”  

Pham, still lying in her Dallas hospital bed, got teary-eyed and said, “Come to Maryland, everybody.”

This could be one of the biggest occupational health and safety cases the American public health has ever seen, with repercussions worldwide. 

Saudi Arabia: The February MERS numbers

I've just spent a little time going through the KSA MOH Command and Control Center's Statistics reports for February. Following the cases day by day shows how suddenly they increased. 

During the first week and a half in February we see "routine" numbers, from zero to three cases daily, for a total of 12 with three deaths. On February 11, cases jump to five, then seven on the 12th, eight on the 13th, and six on the 14th—26 in four days, with four deaths.

 

February 15-21 sees 19 new cases and 13 deaths. February 22-28 sees 18 and eight deaths. 

Saudi Arabia started the month with 846 cases and ended it with 920, an increase of 74. Just six cases were under care on February 2, and on the 28th there were 23 plus one in home isolation. Twenty-six cases recovered during the month, and 30 died. 

 

All in all, this was a bad month for MERS, and March, with seven new cases, one recovery, and one death, is not beginning well.

Measles outbreak spreads to Sweden

Via The Local.se: Measles outbreak spreads to Sweden. Excerpt:

Sweden has recorded its first case of measles linked to the recent massive outbreak across Europe with healthcare services responding with calls for extra vigilance. 

The patient, who was unvaccinated, is reported to have been infected during a trip to Germany, according to the Infectious Diseases unit in Västra Götaland. Medical clinics in county have urged residents to be on their guard as the disease is extremely infectious.   

"It was fairly expected that we would have cases here. If you are not vaccinated and spend time in airports or in large crowds for example in Europe or the United States then you run the risk of being infected,"  said Leif Dotevall, a specialist physician in Västra Götaland.   

Dotevall however cautioned that the risk of a major outbreak in Sweden is very small.   

"Vaccination protection in Sweden is very high. But we want people to "think" measles and about the protection they have."   

According to Dotevall, Swedes born after 1960 are generally protected against measles. Of children born in 2010 some 98.5 percent have been vaccinated.   

"There can be age groups which have missed out. It is possible to be receptive without knowing it. If you are in any doubt you should consult healthcare services and take the vaccination," he said.

Saudi Arabia: Seven new MERS cases, one death as of noon March 1

Via the KSA MOH Command and Control Center: MOH: '7 New Confirmed Corona Cases Recorded'. All but one of the new cases are in Riyadh, with one in Buraydah. Three are healthcare workers, indicating that infection control remains an aspiration rather than an achievement.

A 62-year-old Saudi man in Hufoof has recovered, and an 89-year-old Saudi man in Riyadh has died.

The numbers are now 27 cases under care plus two in home isolation, 502 recovered, 927 total, and 396 deaths.

Pakistan: Officials issue arrest warrants for parents refusing polio vaccine

Via The New York Times, a February 27 report: Pakistani Officials Issue Arrest Warrants Over Refusals of Polio Vaccine. Excerpt:

PESHAWAR, Pakistan — Determined to curb Pakistan’s polio crisis, police officials in the northwestern province of Khyber-Pakhtunkhwa said Friday that they had issued hundreds of arrest warrants for parents for refusing to vaccinate their children. 

“We had 13,000 to 16,000 refusal cases,” the deputy police commissioner for Peshawar, Riaz Khan Mahsud, said in an interview. “There is total determination on our part. We shall convince parents of the good of vaccinating their children, but if they refuse, we shall detain them. There is no leniency.” 

The police in other districts of the province also reported issuing warrants, though no official total was released. 

“The number keeps fluctuating,” said a senior government official, speaking on the condition of anonymity because he was not authorized to brief the news media. “We are applying different laws. You have to resort to coercive measures when persuasion fails.” 

The official added: “The application of laws is working. Some parents readily agree to vaccinate children to avoid detention. Others take a few days behind the bars to see reason. We take an affidavit from them and let them go if they bring kids for vaccination.” 

Last year, 306 new polio cases were reported in Pakistan, breaking the country’s previous record high of 199 new cases in 2000. 

“This was due to complacency and a very bad security situation,” said Dr. Imtiaz Ali Shah, head of the government’s polio monitoring group in Khyber-Pakhtunkhwa. 

Dr. Shah said the outbreak was particularly bad in two northwestern tribal regions, North and South Waziristan, remote areas that have been havens for militants from Al Qaeda and the Taliban and their allies, making them mostly inaccessible to vaccination teams. Then, in June, the military began an offensive in North Waziristan to root out the militants, sending hundreds of thousands of refugees into the rest of Pakistan and across the border into Afghanistan. 

The refugees “took the virus with them everywhere they went — in K.P., Baluchistan and Sindh,” Dr. Shah added. “There was a Ping-Pong, cases popping up here, cases popping up there.” 

Despite this, Dr. Shah said the military operation had given officials the best chance in years for polio teams to make progress in the tribal areas.

India: 265 H1N1 deaths in Gujarat so far this year

Via The Times of India: Now, state is H1N1's top hunting ground. Excerpt:

Gujarat has achieved the ignominious distinction of being the state with the highest number of swine flu deaths in the country since January 1. 

On Saturday, with nine more patients succumbing to the deadly H1N1 virus, the state overtook Rajasthan in total number of deaths from the disease. Gujarat's toll stood at 265 while Rajasthan has recorded 261 deaths. 

The total number of swine flu cases in the state has risen to 4,368 but the state government is yet to declare the outbreak of an epidemic. 

Meanwhile, in a sudden change of weather, cold winds began blowing through the city on Saturday evening. The weather department has forecast light rains in Gujarat region on Monday and Tuesday. This will only fuel the spread of swine flu in the state, said health experts. 

"There would be light rain in parts of Gujarat region on March 2. The weather will start clearing from March 3 onwards," said Jayanta Sarkar, director of IMD, Gujarat. Ahmedabad recorded maximum of 30.4 degree day temperature and 15.4 degree night temperature on Saturday. 

On Saturday, Gujarat recorded 206 new cases and nine swine flu deaths. Ahmedabad led with 97 new swine cases and three deaths, followed by Surat which saw 26 new cases and one death. Vadodara saw 10 new swine flu cases, followed by eight new cases in Kutch, Rajkot and Bhavnagar. Gandhinagar, Patan, Sabarkantha recorded six cases each. Banaskantha, Mehsana, Anand, Aravali recorded four cases of swine flu each.

Hong Kong: CHP reports two H7N9 cases in Guangdong

Via the Centre for Health Protection: CHP notified of two additional human cases of avian influenza A(H7N9) in Guangdong. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (March 1) closely monitoring two additional human cases of avian influenza A(H7N9) in Guangdong notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel. 

According to the GDHFPC, two male patients aged 36 (in Foshan) and 45 (in Dongguan) were hospitalised for treatment in stable condition.

To date, 593 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities in Guangdong (178 cases), Zhejiang (156 cases), Jiangsu (70 cases), Fujian (58 cases), Shanghai (45 cases), Hunan (24 cases), Anhui (21 cases), Xinjiang (10 cases), Jiangxi (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

Guinea: The fear of Ebola led to slayings — and a whole village was punished

Via The Washington Post, a long article that will likely be the definitive one on this tragedy: The fear of Ebola led to slayings — and a whole village was punished. Excerpt:

Nearly six months after the Womey massacre, the repercussions have been far-reaching. When the military invaded and looted the village after the killings, thousands fled their homes. More than a dozen died from malnutrition after living for months in the surrounding bushland. 

Hundreds of miles away, in the capital of Conakry, a 36-person “Crisis of Womey” committee seeks ways to help the people of the village recover from the national shunning they have faced. Womey’s residents have returned, but theirs is a place deeply troubled by feelings of stigma and shame. 

Those who died in the bush after being forced to flee their homes will never be counted in the official Ebola death toll. Neither will the eight slaying victims. But they are all just as much casualties of the epidemic as any of the 9,600 who have perished from the disease in West Africa. 

Those who were hacked and beaten to death that September day died not from the Ebola virus — but from the fear of Ebola. By all accounts, villagers attacked them because they believed the delegation had come to kill them with the disease. 

“I think people should not be discounting the fear factor,” said Holomo Koni Kourouma, a member of parliament who handles advocacy and external relations for the crisis committee. “If you don’t understand the Ebola dynamic, and if you don’t understand the fact that people think you are coming to kill them, then it’s going to be hard for you to understand this story.” 

But officials say that is no excuse. Abdoulaye Sampou, the prosecutor assigned to the case, said he is personally “embarrassed” that people could act with such ignorance. 

“We, the children of Guinea, know that the world is waiting for this judgment,” he said. “We are speeding this up.” 

About an hour and a half from Womey, about 30 of those charged in the killings are locked in a dark, stone-walled jail, awaiting a mass trial that could begin within weeks. If found guilty, they could face life imprisonment or the death penalty. 

The rush for justice has villagers, and at least one defense attorney, claiming that the case has turned into a witch hunt. An additional 14 people were accused of the killings and imprisoned for months but later released because of a lack of evidence. 

Sampou said he plans to charge about 40 more people in connection with the killings. He said they remain wanted and on the run.

Man, 61, dies of H7N9 in Hong Kong after contracting virus in mainland China

Via the South China Morning Post: Man, 61, dies of bird flu in Hong Kong after contracting virus in mainland China. Excerpt:

A 61-year-old man has become the first person in Hong Kong to die of H7N9 bird flu this season, after contracting the virus during a visit to mainland China. 

The victim was the third person to be diagnosed in the city in recent weeks. A 69-year-old woman remains in a critical condition in hospital, while another patient has been discharged. All three had travelled to the mainland. 

The man, who died at around 6am this morning, had visited wet market in Dongguan and brought fresh chicken before he developed symptoms. He had other underlying illnesses. 

Secretary for Food and Health Bureau Dr Ko Wing-man reminded the public to remain vigilant. 

“If any citizens feel unwell after visiting mainland China, they must report to medics on where they have been, and whether they have had contact with live poultry,” Ko said today. 

Ko said Hong Kong has recorded around a dozen human bird flu cases since the H7N9 epidemic emerged on the mainland in 2013. All the victims had a history of travelling to the mainland or had had contact with live poultry.

Ebola in Sierra Leone makes a comeback by sea

This is a discouraging way to end the month. Via The New York Times: Nearly Halted in Sierra Leone, Ebola Makes Comeback by Sea. You'd better read the whole thing. Excerpt:

FREETOWN, Sierra Leone — It seemed as if the Ebola crisis was abating. 

New cases were plummeting. The president lifted travel restrictions, and schools were to reopen. A local politician announced on the radio that two 21-day incubation cycles had passed with no new infections in his Freetown neighborhood. The country, many health officials said, was “on the road to zero.” 

Then Ebola washed in from the sea. 

Sick fishermen came ashore in early February to the packed wharf-side slums that surround the country’s fanciest hotels, which were filled with public health workers. Volunteers fanned out to contain the outbreak, but the virus jumped quarantine lines and cascaded into the countryside, bringing dozens of new infections and deaths. 

“We worked so hard,” said Emmanuel Conteh, an Ebola response coordinator in a rural district. “It is a shame to all of us.”   

Public health experts preparing for an international conference on Ebola on Tuesday seem to have no doubt that the disease can be vanquished in the West African countries ravaged by it in the last year. But the steep downward trajectory of new cases late last year and into January did not lead to the end of the epidemic. 

In Sierra Leone, the hardest hit of the countries, the decline leveled off in late January, and the country has reported 60 to 80 new cases weekly since then. Guinea has experienced months of lower-level spread. 

Even in Liberia, where only a handful of treatment beds remain occupied, responders lament that a health care worker who recently became ill might have exposed dozens of colleagues and patients, and that a knife fight had exposed gang members to the blood of a man who tested positive for Ebola. 

“I doubt it will stop just suddenly,” said Dr. Pierre Rollin, an infectious disease expert with the United States Centers for Disease Control and Prevention. “It’s always bumpy, and the bigger the outbreak, the more chance you have a bumpy thing.”