H5N1

Ebola in US: What flight did the case take from Monrovia?

Via The New York Times: Ebola Is Diagnosed in Texas, First Case Found in the U.S. Excerpt:

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

The man left Monrovia's Roberts International Airport on September 19, a Friday, and arrived in Dallas on Saturday. On the assumption that it was a regularly scheduled flight, then the departures schedule for Friday, October 3, should indicate the most likely flight: One codeshared as United Airlines 9974, Air Canada 6374, and Lufthansa 5549. The flight would have left at 8:40 p.m. for Brussels, where the case would have arrived about 5:15 a.m. local time. He would then have transferred to at least one other flight to Dallas. 

I may be wildly wrong, but any competent travel agent could figure out the man's complete itinerary in a few minutes. So it seems pointless for Dr. Frieden to "decline to disclose" that information. The CDC certainly has it, whether or not it thinks tracing the passengers is worthwhile, and the Belgian health authorities presumably have it as well.

Ebolavirus in West Africa, and the use of experimental therapies or vaccines

Thanks to Greg Folkers for sending the link to this BMC Biology report: BMC Biology. The conclusion: 

Research has made significant progress in combating ebolavirus infections. We now have to translate these scientific advances into tangible benefits for the people affected by this devastating disease. Events in the current outbreak are rapidly developing, and it is impossible for the authors to predict what measures will have been taken by the time this article is published. 

However, regardless of whether experimental countermeasures are eventually used in the current ebolavirus outbreak, it is clear that their use can only be considered a last resort and that the strengthening of traditional public health and outbreak response measures are of paramount importance. 

For the future, the major challenge lies in advancing the experimental treatments and vaccines towards licensing for human use. Further, deployment strategies have to be put into place both for delivering countermeasures into an outbreak area, and for their administration. It will also be necessary to consider the possibility that infections will be imported into countries in which infections with ebolaviruses do not normally occur, and to develop management plans. 

Again, overcoming this challenge will require collaboration between scientists, aid organizations, pharmaceutical companies, local communities, regulatory bodies, and governments. Noteworthy is the currently increasing interest in industry as well as in politics in ebolaviruses, something that has to be seen as a positive development [20]. 

Finally, future efforts should not be restricted to ebolaviruses, but also include other communicable pathogens with the potential to cause devastating outbreaks, such as the closely related marburgviruses. 

Even once the current EHF outbreak in West Africa ceases, it is only a matter of time until the next outbreak strikes. One should wisely use this opportunity to be proactive.

Sweden: Stockholm patient tests negative after Ebola fears

Via The Local.se: Stockholm patient tests negative after Ebola fears. Excerpt:

A patient in a Stockholm hospital who was suspected of having contracted the Ebola virus was given the all clear on Tuesday morning. 

"We've analysed the tests and we can announce that the person has not contracted Ebola," Åke Örtqvist, spokesperson for doctors dealing with infectious diseases in the Stockholm region, said in a statement.    

The case marked the fifth suspected case in Sweden since the virus started spreading rapidly in Africa earlier this year, all of which has been proven negative.

Ebola in Liberia: Government condemns health workers at JFK

Via The New Dawn: Gov't condemns health workers at JFK. Excerpt:

The Government of Liberia has frowned at health care workers at the John F. Kennedy Hospital in Sinkor, Monrovia for not being professionally active, which led to the death of the daughter of Montserrado County district #16 Representative, Edward Forh, over the weekend. 

The government reminded that health care workers’ primary duty is to save lives, but they are now using fear of Ebola as an excuse to reject patients in critical condition, leading to deaths. 

Speaking Tuesday, September 30th at the Ministry of Information, Cultural Affairs and Tourism, Deputy Information Minister for Public Affairs, Isaac Jackson, cautioned health workers not to use fear of the Ebola virus as an excuse to abandon patients, stressing that health care workers have been trained provided all necessary Personal Protective Equipment to cater to patients. 

He said government vehemently condemned the circumstances that led to the death of Miss Naketa Forh, daughter of Rep. Forh as well as a student and queen of the Stella Maris Polytechnic, a Catholic-run institution. The deputy Information boss said government seriously regrets the incident, adding that President Ellen Johnson-Sirleaf is concerned about the death of Naketa Forh and wants authorities of the hospital to investigate the matter without delay. 

But critics say the government’s position on the death of the daughter of the lawmaker, demonstrates favoritism or insensitivity to the well being of ordinary citizens, noting that hundreds of Liberians have faced a similar fate of neglect and death at the hands of health workers in the last three months without any concern from the authorities. 

Seven Liberian army officers in Ebola treatment unit

Via The New Dawn, worrying news: Ebola attacks AFL - 7 admitted at ETU. Excerpt:

As the government and international partners intensify efforts against the deadly Ebola disease, the epidemic continues to spread in every loop and corner of the Liberian society on a daily basis. 

The Armed Forces of Liberia or AFL has become the latest target of the tropical disease. According to credible information received by this paper, seven uniformed officers of the U.S-trained army, have been hit by the deadly virus and reportedly transferred to the JFK Ebola Treatment Center. 

The information from the Camp Binyan Edward Kesselly Barracks, formerly Camp Schefflin  located on the Roberts International Airport highway, the seven officers (names withheld) are currently at the John F. Kennedy Ebola holding center undergoing medical treatment. 

Last Friday, a four-door pickup truck of the AFL was seen in front of the JFK Ebola holding center being disinfected by medical practitioners following the admission of the suspected AFL Ebola patients.  

According to the information, a female visitor with the disease who had gone to the Barracks to visit one of the officers without realizing that she was carrying the virus, transmitted the disease to her host, further spreading it to six additional officers who were very close friends. 

Another account had it that a woman, visiting the barracks recently from Tubmanburg City, Bomi County, had fallen ill and rushed to the military clinic for treatment at Camp Kesselly, when medical practitioners contracted the disease. 

As a result of the outbreak at Camp Kesselly, the nation’s biggest barracks, the authorities headed by AFL Chief of Staff B/Gen. Daniel Zanigar yesterday ordered all non-military personnel out of the barracks with immediate effect or face eviction. Some parts of the Binyan Kesselly barracks were also quarantined by the Ministry of Health and Social Welfare for proper observation for 21 days. 

“We are now living in total fear here, because we as soldiers do almost everything in common, ranging from training to lunch-sharing at times if deemed necessary by the commander,” our source said.  

As the result of the outbreak, officers, who had earlier left the barracks apparently to visit family members and relatives in Monrovia and other parts of the country, are reportedly hesitant to return to to the military base, as their commanders continue to make both cell phone and radio calls to them on a daily basis.

CIDRAP: US Ebola case confirmed in traveler from Liberia

Via CIDRAP, Lisa Schnirring writes: US Ebola case confirmed in traveler from Liberia. Excerpt:

Lab tests in Texas and at the US Centers for Disease Control and Prevention (CDC) today confirmed an Ebola virus disease (EVD) infection in a man from Liberia who is isolated in a Dallas hospital, the first travel-related case to be detected outside of West Africa's outbreak region. 

At a media briefing today, CDC Director Tom Frieden, MD, MPH, said the top priorities are providing the best care possible for the patient and identifying all people who had contact with him while he was sick. 

"The bottom line is I have no doubt that we will control this importation," he said, emphasizing that US hospitals have strong infection control practices and strong core public health capacities, which include tracing of people who come in contact with patients. Frieden added that good contact tracing practices helped curb the impact of similar travel-linked cases in two African nations, Nigeria and Senegal, described in two CDC reports today (see related CIDRAP News story). 

"While it is not impossible that there could be additional cases associated with this patient in the coming weeks, I have no doubt that we will contain this," Frieden said. 

However, he warned that similar exported cases are likely to continue as long as disease levels are high in West Africa's hot spots: Liberia, Sierra Leone, and Guinea. 

Symptoms began Sep 24 

Yesterday, officials at Texas Health Presbyterian Hospital in Dallas announced that a patient with symptoms and a travel history suggestive of EVD was being treated in isolation and that tests were under way, with results expected today. 

Frieden said the patient, who is in the United States visiting family, didn't have a fever or other symptoms when he was screened at the airport in Liberia on Sep 19 when he departed for the United States. He arrived the next day. 

The man's symptoms began on Sep 24, and he sought care 2 days later. He was admitted to the hospital on Sep 28. He is critically ill and receiving intensive care treatment. Frieden said the man won't be moved to another facility. 

"Any hospital that can do isolation can do isolation for Ebola," he said, adding that five patients in the United States have been treated for other viral hemorrhagic illnesses over the past decade, and no transmission has occurred. 

Discussions are under way with the hospital and the patient's family about possible use of experimental therapies, if supplies are available, Frieden said. 

David Lakey, MD, commissioner with the Texas Department of State Health Services (TDSHS), said a state public health laboratory in Austin has a special team that is certified to do Ebola testing. He added that early this afternoon polymerase chain reaction tests were positive for the disease, as was testing at the CDC.

No, Ebola in Dallas does not mean you and everyone else in the US is going to get it, too

Via The Guardian, Dr. Tara C. Smith prescribes a megadose of common sense: No, Ebola in Dallas does not mean you and everyone else in the US is going to get it, too. Excerpt:

In the immortal words of Douglas Adams, Don’t Panic. 

The Centers for Disease Control (CDC) announced on Tuesday evening that a patient undergoing treatment in the United States does, indeed, have the Ebola virus. Nearly two weeks ago, the traveler left Liberia, one of the West African countries at the center of the current Ebola outbreak, and flew back to Texas – asymptomatic at that point. 

This is key, because Ebola spreads when a person is exhibiting symptoms. At the time of that flight, the patient was not ill. And when the patient later reported to a hospital in Dallas, doctors there quickly suspected it was Ebola and put the patient into isolation. Those who came into contact since the patient’s arrival are being traced as a precaution and will be watched for symptoms for three weeks – the incubation period of the virus. 

Odds are good those contacts do not include you, and your odds of dying of Ebola in the US are lower than your chances of dying on a rollercoaster. 

It’s not out of the realm of possibility that we’ll see other cases here in the US, but, seriously: relax. We got this. 

Ebola is already here in the United States. It’s existed in labs for decades, among researchers and experimental primates and other animals with no spread out into the open. And based on models of travel patterns published earlier this month, we already knew that an imported case of Ebola might make its way here. Hospitals across the country have been busy preparing, and there have been a few suspected cases that ended up testing negative, so we’ve already had test runs in Ohio, New York, California and other areas. 

We saw it coming. We have great infection control officers in our hospitals who have been watching the outbreak unfold from afar. Our hospitals are trained better than ever. Your cousin from Dallas is not going to turn your town into a scene from 28 Days Later.

The implications of more Ebola bombs

Today's announcement by the CDC and Texas health authorities certainly got everyone's attention. Dr. Tom Frieden's news conference was brisk and reassuring and not too dominated by talking points. 

It was also not too dominated by real information. Dr. Frieden and his colleagues were excessively coy about the patient, citing privacy to decline saying whether he was an American citizen. Like the US MERS cases a few months ago, the Ebola patient was "visiting family in the US." But we do know that he was not involved in fighting Ebola in Liberia. 

So he could be a Liberian visiting émigré relatives, or an American working in a Liberian mining enterprise, or a Chinese merchant in Monrovia visiting his Texas cousins. 

No doubt the CDC itself knows this person's curriculum vitae down to the last comma, and is tracing his contacts in Liberia at least as assiduously as his contacts in Dallas. We can hope that CDC will eventually publish its findings, carefully laundered of anything that might identify this person. 

(Digression: If we're going to deplore the irrational stigma attached to Ebola cases and their families in West Africa, could we please not treat it here as a stigma-free misfortune instead of something that might shame the case's children unto the seventh generation?)

We've already seen several HCWs return to the US from West Africa with Ebola, and no doubt more will follow. As a commenter noted earlier this afternoon, if Ebola can get into the US, it can get into anywhere. That seems to me the lesson of this particular case.

As a recent survivor of air travel to and from Scandinavia, I can attest to the absurdity of the security theatre in several major Canadian and European airports. (At Schiphol, a young Dutch guy patted me down with almost erotic zeal, which at 73 I found oddly flattering. The Finns at Vantaa didn't find me attractive at all.)

Nowhere, amid all the trays full of men's belts and iPads, did anyone aim a high-tech thermometer at me. No one asked me to stick out my tongue and say "Ah." I could have been crawling with fleas infected with Yersinia pestis; if I had, my cute Dutch pal would now be studying his buboes in some damn good Dutch hospital.

Airport security for over a decade has obsessed over suicidal lunatics with exploding shoes, inflicting stress and humiliation on millions of ordinary people. It will take something like a bureaucratic upheaval to get the Dutch to quit copping a feel on septuagenarians and start taking temperatures. 

Guys like today's anonymous Ebola case are far more dangerous than quartets of idiots with box cutters and a bad case of "Let's Pretend." Whoever today's guy is, he's the harbinger of many more Ebola bombs with the price of an air ticket out of Freetown or Monrovia. 

They may be headed for countries with far feebler health security than the US, and if they get through some airport in Nairobi or Singapore or Jeddah, Hell will present us with an invoice we'd rather not pay.

CDC statement on first US Ebola case

Via the CDC's Ebola page: First Imported Case of Ebola Diagnosed in the United States.

CDC confirmed on September 30, 2014, through laboratory tests, the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from West Africa. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the United States. 

The person sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. Based on the person’s travel history and symptoms, CDC recommended testing for Ebola. The medical facility isolated the patient and sent specimens for testing at CDC and at a Texas lab participating in CDC’s Laboratory Response Network. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure. 

The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight. 

CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. 

CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times. 

We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

Ebola in US: Early local coverage of the Dallas case

Via the Dallas Observer: UPDATE: Ebola Has Landed in Dallas.

UPDATE, 3:44 p.m.: The Centers for Disease Control and Prevention has confirmed that a patient at Dallas' Texas Health Presbyterian Hospital is the first case of Ebola confirmed in the United States. 

ORIGINAL POST: Dallas County Health and Human Services gave an update Tuesday morning on the status of a patient potentially infected with Ebola currently being cared for in isolation at Dallas' Texas Health Presbyterian Hospital and the county's' preparation in the event an Ebola case is confirmed. No details have been given about the patient, other than that he or she is being kept in "strict isolation" and was admitted based on symptoms and "travel history." 

"This is not Africa," DCHHS Director Zach Thompson said. "We have a great public health infrastructure to deal with this type of disease." 

Christopher Perkins, the medical director for county health services, made it clear the risk for outbreak is low because Ebola cannot be spread through the air. Ebola can only be spread through contact with blood or bodily fluids. 

Two men who visited West Africa, the epicenter of this year's Ebola outbreak, warned the commissioners about the effects of the disease and urged Dallas County to send whatever help it could in order to stem Ebola where it's most prevalent. 

After leaving the commissioner's court meeting to participate in conference call with the Centers for Disease Control, Texas Health Presbyterian and state health officials, Thompson and Perkins returned with an update. 

The potential Ebola patient's test results are not in yet, but are expected later Tuesday afternoon or Tuesday evening. CDC personnel are on their way to Dallas in case either of the two samples from the patient being screened are positive for Ebola. If the test was to come back positive, the CDC would lead any actions necessary, with the county providing support, Thompson said.