H5N1

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.”

Ebola in the US: The aftermath for Nina Pham

This ls a very big story in The Dallas Morning News: Exclusive: Nurse Nina Pham after Ebola: Terrible side effects, lawsuit against employer. Excerpt from a long report and then a comment:

Experimental drugs and special care helped make Nina Pham Ebola free. But today she fears she may never escape the deadly disease. 

The 26-year-old nurse says she has nightmares, body aches and insomnia as a result of contracting the disease from a patient she cared for last fall at Texas Health Presbyterian Hospital Dallas. 

She says the hospital and its parent company, Texas Health Resources, failed her and her colleagues who cared for Thomas Eric Duncan, the first person in the United States diagnosed with Ebola. 

“I wanted to believe that they would have my back and take care of me, but they just haven’t risen to the occasion,” Pham told The Dallas Morning News last week in an exclusive interview. 

Pham says she will file a lawsuit Monday in Dallas County against Texas Health Resources alleging that while she became the American face of the fight against the disease, the hospital’s lack of training and proper equipment and violations of her privacy made her “a symbol of corporate neglect — a casualty of a hospital system’s failure to prepare for a known and impending medical crisis.” 

She says that Texas Health Resources was negligent because it failed to develop policies and train its staff for treating Ebola patients. She says Texas Health Resources did not have proper protective gear for those who treated Duncan. 

Texas Health Resources responded Friday with a statement from spokesman Wendell Watson. “Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain optimistic that constructive dialogue can resolve this matter.”

Watson declined to address the specifics of Pham’s allegations. 

Pham wants unspecified damages for physical pain and mental anguish, medical expenses and loss of future earnings. But she said that she wants to “make hospitals and big corporations realize that nurses and health care workers, especially frontline people, are important. And we don’t want nurses to start turning into patients.” 

In her 90-minute interview, Pham described working in chaotic surroundings at the hospital with ill-prepared nurses who received little guidance on how to treat Ebola and protect themselves. She talked about her life since her diagnosis and recovery, as well as her anxiety about the future. 

Pham occasionally twisted a ring on her finger or slid a finger inside the cuff of her shirt and nervously tapped her wrist. She kept her composure except when she recalled the nurses who became “like family” to her when they cared for Duncan together and later risked their lives to treat her and Amber Vinson, another nurse at the hospital who contracted the disease from Duncan.  

“I was proud of us. We fought in the trenches together, the frontline health care workers. That’s what nursing is about: putting the patient first. We did what we had to do,” Pham said. 

She remembers spending hours alone with Duncan cleaning up his bodily fluids, monitoring his vital signs and reassuring him that everything would be OK. Pham said Duncan was in a great deal of pain and frightened but always polite. He told her “he felt very isolated.” She held his hand and told him she would pray for him. 

But when Duncan tested positive for Ebola, it sent panic and fear throughout Presbyterian — and the nation. Pham, too, was frightened.

"I was the last person besides Mr. Duncan to find out he was positive," she said. "You'd think the primary nurse would be the first to know. ... I broke down and cried, not because I thought I had it but just because it was a big, 'whoa, this is really happening' moment."

If you're a healthcare worker, you'd better click through to read the whole story. Then get in touch with your professional association or union local and tell them to get in touch with their lawyers. This is a major occupational health and safety problem.

Thomas Eric Duncan gave Texas Health Presbyterian a near-death experience. Nina Pham and Amber Vinson gave them a narrative lifeline: brave, attractive young nurses risk death and come through OK, so go to sleep. 

Compared to the catastrophic damage Ebola has done to West Africa's health systems, Texas has barely been bruised. But Nina Pham may be able to snap the whole US health system out of its overfed complacency. I wish her well; she couldn't save Thomas Eric Duncan, but she may save American healthcare.

Recommended reading

I've added a new list of books on infectious diseases; you'll find it at the bottom of the middle column. It reflects a very agreeable vice I've developed in my old age: when I find a book that interests me, I order it online, whether in paper or ebook. In exchange for one unpleasant monthly shock on my credit card, I get 30 days of undeferred gratification.

Click on a title and you'll find yourself in a position to indulge in the same vice. I've read almost all the books on the list, and they're very much worth it. If you know of titles that should be on the list, let me know.

Confronting the gender impact of Ebola virus disease in Guinea, Liberia, and Sierra Leone

Via ReliefWeb, a report from the UN Development Programme: Confronting the gender impact of Ebola virus disease in Guinea, Liberia, and Sierra Leone. Click through to download the PDF. The summary:

Women need to be at the center of all efforts to help Guinea, Liberia and Sierra Leone recover from the Ebola crisis, according to a study by UNDP. 

The epidemic has affected women disproportionately because of the essential role they play as caretakers, health personnel, farmers and small traders. For instance, as of December 2014, women represented 62 percent of the sick in Guéckédou, Guinea where the epidemic first appeared, and up to 74 percent in Télémilé, north of the capital Conakry. 

“Buried in the aggregated impact is the plight of Ebola’s voiceless victims and agents of change—women and children,” say the authors of the study, adding that “Ebola response and recovery, and national development strategies must be gender-sensitive in addressing the associated negative impacts on women and girls.” 

More than 800,000 women will give birth during the next 12 months in all three countries. But with the severe shortage of health facilities and professionals, compounded by the fear of getting infected in a clinic, many could die without proper care. In the three countries, HIV screenings have decreased by 90 percent. 

UNFPA has also warned that teenage pregnancy, early marriage and violence and exploitation of women are on the rise. 

The document says improved health and birthing facilities are urgently needed to prevent mothers from dying in childbirth. 

The study also calls for the creation of specific safety net mechanisms, such as cash transfers and employment schemes for women as survivors and heads of households. It also calls for longer-term support for women in agriculture or as entrepreneurs. Because their livelihoods have often dwindled or disappeared, many women who used to received funds from microfinance institutions have been unable to repay their loans. 

In addition, health officials and organizations working to combat the Ebola epidemic must involve women in efforts to raise awareness about the disease, share risk mitigation measures, and discuss prevention and eradication.

Saudi Arabia: Special clinics to segregate suspected MERS patients

Via the Saudi Gazette: Special clinics to segregate suspected MERS patients. Excerpt:

The Ministry of Health has set up specially-equipped external clinics at every public hospital to check and assign patients to the right emergency wards and specialized clinics, announced Deputy Minister of General Health and head of the Ministry of Health’s Command and Control Center Dr. Abdulaziz Bin Saeed. 

“It is very important for patients suffering from Middle East Respiratory Syndrome (MERS) caused by coronavirus to be isolated and not to mix with other patients,” he said. 

“We need to avoid incidents such as when King Khalid Hospital’s emergency ward was shut down as a precaution when other patients faced the risk of coronavirus infection,” Saeed said. 

He added that certain categories of patients, such as the elderly, have a weak immune system and any form of contact with a patient infected by coronavirus could prove fatal. 

“I urge the general public to refrain from going to emergency rooms when their condition is not critical. They can always visit the health care centers available in every neighborhood,” Saeed said. 

Meanwhile, 10 more people died from MERS over the past week, Health Ministry figures showed on Friday, after an international mission urged extra measures to combat the virus.

Sierra Leone vice president places himself in Ebola quarantine

Via Reuters: Sierra Leone vice president places himself in Ebola quarantine. Excerpt:

Sierra Leone's Vice President Samuel Sam-Sumana said on Saturday that he had placed himself in a 21-day quarantine after one of his bodyguards died of Ebola amid a worrying recent surge in new infections in the West African nation. 

Cases of Ebola, which has killed nearly 10,000 people in Sierra Leone, Liberia and Guinea during a year-long epidemic, have fallen off sharply in recent weeks. 

Of 99 new confirmed Ebola cases in the region during the week to Feb. 22, however, 63 were in Sierra Leone according to the World Health Organization's weekly report. 

Sam-Sumana's bodyguard John Koroma died early this week. 

"I have decided to be put under quarantine because I do not want to take chances and I want to lead by example," the vice president told Reuters. "I am very well and showing no signs of illness."   

Sam-Sumana said his entire staff will also be placed under observation and anyone showing symptoms of the disease would be tested. 

The vice president is the country's first senior government figure to subject himself to a voluntary quarantine. However, officials in neighboring Liberia, including the chief medical officer and transport minister, were placed under observation late last year.

For more on this development, see the Sierra Leone Issues Facebook page.

Ebola in Sierra Leone: Survivors praise Chinese medical team

Via Xinhua: Ebola survivors commend Chinese medical team. Excerpt:

"But for the treatment I received from the Chinese, I should not be alive today," said Memunatu Fofanah when recalling the experience at a Chinese treatment center in Sierra Leone after tested positive for Ebola. 

Fofanah, a community health nurse in Sierra Leone's capital Freetown, was one of the Ebola survivors thanks to China's aid in consonance with the government and other development partners. 

Fofanah said she contracted the Ebola virus through her father who was brought from North of the country very ill. As a nurse she decided to receive some medical care and was later taken to her health clinic at Upper Allen town about 30 km from the city where her father passed away. 

A few days later she started feeling sick and developed high fever, then she decided to consult medical attention but was advised to call 117, the Ebola Emergency Response Center. 

"I listened to the advice and promptly the command center dispatched an ambulance that conveyed me to the Chinese treatment center at Jui on the outskirts of the city, where I was diagnosed positive of the Ebola virus," said Fofanah. 

"My first week in the hospital was not easy. I had lost hope because I had lost considerable weight, vomiting and could hardly work. The Chinese started to give me intravenous fluids as well as treatment for the high fever, this was also coupled with words of consolation that 'I would not die', that 'I would survive," she said. 

Fofanah recalled that indeed within two weeks, "I must say that I owe my survival to the care and treatment I got at the center for which I am very grateful". 

Like Memunatu Fofanah, all the survivors that spoke to Xinhua had similar stories of harrowing experience with the dreaded disease and the support from the Chinese treatment center. 

Maseray Kamara, Another Ebola survivor who had lost her five- month-old child, said it was through this confused state of mind that she probably might have contracted the disease. 

Like her compatriots, Kamara got her healing through the support and treatment from the Chinese medical team. She explained that she manifested the symptoms a week of her child's death and was rushed to the Jui treatment center where she was handled with care, noting that they were visited at least two times a day by the Chinese doctors and nurses to administer medicines and psychosocial support. 

According to the figures available from the Chinese Embassy, the center has treated about 671 patients, among which there are 151 Ebola positive patients.

Saudi Arabia: Four new MERS cases, one death as of noon February 28

Via the KSA MOH Command and Control Center: MOH: '4 New Confirmed Corona Cases Recorded'. The new cases are all men; three are expatriates, and one is healthcare worker. An expatriate man in Najran has recovered, and a 40-year-old man in Aljawf has died.

The numbers are now 23 cases under care plus one in home isolation, 501 recovered, 920 total, and 395 deaths.

Fatality rate is falling in West African Ebola clinics

Via The New York Times, a February 26 report: Fatality Rate Is Falling in West African Ebola Clinics. Excerpt:

Seattle - As the Ebola epidemic in West Africa wanes, physicians from Doctors Without Borders are confronting a mystery: More of their patients are surviving. They do not know why. 

“The reasons are really unclear,” said Dr. Gilles van Cutsem, who helped run the agency’s response in Liberia and gave a presentation describing its experience at an AIDS conference here. 

Doctors Without Borders — better known by its French name, Médecins Sans Frontières — has cared for more Ebola patients in West Africa than any other organization. At its peak, it was running 22 centers; it now runs eight. 

Since last March, the average death rate at those remaining centers has dropped to 52 percent, from about 62 percent. 

Although patients are getting more intravenous hydration and more nursing care as staff members have more time, the agency does not believe that accounts for the whole difference. 

Rather, patients are arriving with less virus in their blood. Viral loads have dropped by almost half, Dr. van Cutsem said, which increases a patient’s chances of survival enormously. 

Initially, he said, the assumption was that patients were coming in earlier in the course of their illnesses. Rumors that everyone who entered Ebola centers died were once rife, but now have faded. 

But that was not the case, either. According to interviews with patients, the time between the first appearance of symptoms and the day they arrive has not changed. 

“That leaves us with two hypotheses,” Dr. van Cutsem said. 

One is that fear has made West Africans more careful, and that even those who are infected have gotten smaller amounts of virus into their eyes or mouths. Perhaps they are wearing gloves when they bury bodies, he said, or at least partially protecting themselves while caring for sick relatives. 

In many diseases, the size of a viral dose may make the difference between life and death. Even though viruses multiply, immune systems handle small amounts of virus better than large ones. 

The other theory is that the virus has mutated to be less lethal. But Dr. van Cutsem said he knew of no genetic evidence to prove that.

Canada: University of Toronto instructor and speaker boosts ‘alternative vaccines’

Via The Globe and Mail: University of Toronto instructor and speaker boosts ‘alternative vaccines’. Excerpt:

A homeopath who promotes ineffective “alternative vaccines” and counsels patients about the dangers of immunization is an instructor at the University of Toronto and a headline speaker at a university-sponsored conference on non-traditional health care on Saturday. 

The university is facing intense criticism from public health experts who question why it is aligning itself with an anti-vaccine advocate and sponsoring a conference focusing on alternative health care, homeopathy and unproven complementary therapies. 

“It’s staggering to me that U of T is providing a platform for the promotion of messages that are not only controversial messages, but unsafe,” said Yoni Freedhoff, an assistant professor of family medicine at the university. “It’s hugely troublesome.” 

Public health experts have been putting pressure on the federal government to remove homeopathic “vaccines” called nosodes from the market. Health Canada has approved more than 100 nosodes, which homeopaths and naturopaths promote as safe, effective alternatives to vaccines for measles and other illnesses. Health Minister Rona Ambrose said she has no plans to remove them, noting that nosode package labels are supposed to state they are not vaccine alternatives. Homeopaths who mix their own nosodes do not need to include the warning. 

Toronto-based homeopath Beth Landau-Halpern is a health studies instructor and teaches a course in alternative medicine at U of T’s Scarborough campus, where her husband, Rick Halpern, is dean. Last year, she wrote a blog post on her clinic’s website about teaching fourth-year health studies students to have “a healthy degree of skepticism about the limits of science in understanding health and disease.” 

On her website, Ms. Landau-Halpern has also written that “normal childhood illnesses like measles and chicken pox are almost always followed by massive developmental spurts” and to “avoid vaccinations” because they are “of questionable efficacy, full of ingredients that definitely should not be in the blood stream, and may compromise your general immunity irreparably.”