Wüstenschiff

Welche Nebenfolgen Ebola haben kann zeigt dieser Fall:

Ein Nigerianer kam am Flughafen in Madrid an, wo er sich übergab. Die Flughafenbehörden vermuteten einen Ebolaverdacht und alarmierten Ärzte, die nach 50 Minuten mit Schutzanzügen eintrafen.

Beim Eintreffen des Rettungspersonals war der Nigerianer bereits verstorben. In seinem Bauch waren Kapseln mit Kokain aufgeplatzt, woran der Schmuggler starb.

Ich denke, jeder Rauschgiftschmuggler kennt sein Risiko und vor allem welche Wirkungen die Drogen haben, wenn sie auf den Markt kommen. Von dem her hält sich mein Mitleid in Grenzen.

Grüsse
Alexander

Mit dem ersten Ebola-Fall in New York wird klar: Das Virus ist global. Obwohl in der Metropole nur ein Mensch krank ist, sind Millionen US-Bürger verängstigt. Die Bundesstaaten New York, New Jersey und jetzt auch Illinois haben deshalb harte Quarantänemaßnahmen beschlossen.

Drei US-Staaten planen Quarantäne
26.10.2014 - tagesschau

Gruß
Birgitt

EBOLA VIRUS DISEASE - ex AFRICA (25): NORWAY DOCTOR, USA QUARANTINE, VACCINES
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Norway: MSF doctor recovered
[2] USA: quarantine controversy
[3] Rapid diagnostic test
[4] EU: 24.4 million euros to develop vaccine against Ebola
[5] Russia: vaccine trials
[6] Insurance increase

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[1] Norway: MSF doctor recovered
Date: 22 Oct 2014
Source: MSF [excerpted, edited]
http://www.doctorswithoutborders.org/ar ... vers-ebola


On Mon 20 Oct 2014, SLM, a medical doctor working with Doctors Without Borders/Medecins Sans Frontieres (MSF) was discharged from Oslo University Hospital, Ulleval. She was treated for Ebola hemorrhagic fever after having contracted the disease on Sat 4 Oct 2014, after working 2 weeks at an Ebola center in Bo, Sierra Leone... After testing positive for Ebola on Sun 5 Oct 2014, she was flown to Oslo in an incubator of sorts [sic], which was airtight and infection proof, and then transferred to Ulleval Hospital... She has now recovered and is no longer infectious...

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[2] USA: quarantine controversy
Date: 26 Oct 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/10/ ... 3L20141026


Quarantines imposed on travelers coming from Ebola-affected countries in West Africa could discourage American health workers from going there to help fight the epidemic, a senior U.S. medical official said on Sun [26 Oct 2014]...

New York, New Jersey and Illinois imposed 21-day mandatory quarantines in the last 2 days for anyone arriving with a risk of having contracted Ebola in Sierra Leone, Liberia and Guinea. They are the 3 West African countries that have borne the brunt of an epidemic that has killed nearly 5000 people. But critics worry the policies, going beyond federal regulations and intended to ease public concern over the spread of the disease, will just make matters worse. "I don't want to be directly criticizing the decision that was made, but we have to be careful that there are unintended consequences," said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "The best way to stop this epidemic is to help the people in West Africa, we do that by sending people over there, not only from the U.S.A. but from other places," Fauci told NBC's "Meet the Press." He called such quarantines "a little bit draconian."

The states' policies were abruptly imposed after a New York City doctor was diagnosed with the disease on Thu [23 Oct 2014] after coming home from treating patients in Guinea. A nurse who returned on Fri [24 Oct 2014] through New Jersey's Newark airport after working in Sierra Leone with Ebola patients strongly criticized the quarantine policy on Sat [25 Oct 2014], describing hours of questioning and then transfer to a hospital isolation tent. She called her treatment a "frenzy of disorganization."

Fauci reiterated what the medical officials have been stressing as Americans worry about Ebola: that it is spread only by contact with bodily fluids of people with symptoms. "The science tells us that people who are not sick, if you do not come into contact with body fluid, if someone comes back from wherever, Liberia, and they're well, they are no danger to anyone," Fauci said. But New Jersey Governor Chris Christie, asked to respond to Fauci's comment that it is not good science to quarantine people who are not symptomatic, said, "I don't believe that when you're dealing with something as serious as this that we can count on a voluntary system."

"This is government's job. If anything else, the government's job is to protect the safety and health of our citizens," he told the "Fox News Sunday" program. Asked whether the new rules would discourage health workers from going to West Africa, Christie added, "Folks that are willing to take that step and willing to volunteer also understand that it's in their interest and in the public health's interest to have a 21-day period thereafter if they've been directly exposed to people with the virus."... The governor is considered a likely candidate for the Republican presidential nomination...

[Byline: Douwe Miedema & Jonathan Allen]

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[3] Rapid diagnostic test
Date: 22 Oct 2014
Source: UT San Diego [edited]
http://www.utsandiego.com/news/2014/oct ... bola-test/?


Sprinting into the race to commercialize an Ebola diagnostic, San Diego's Genalyte says it has developed a 10-minute Ebola test. The company said its test uses one drop of blood from a finger prick and offers results in as fast as 10 minutes on its diagnostic platform. The test detects Ebola proteins, even at an early stage of infection before the person is showing obvious symptoms [This last feature could be a game changer - Mod.JW].

Genalyte says validation of the test "is only weeks away," and it wants to work with the federal government to make the test available as rapidly as possible. The test is based on a proprietary silicon chip technology and run on Genalyte's Maverick Detection System testing platform. The platform is being used now to test for immune system rejection of biologic drugs, such as monoclonal antibodies... For the Ebola test, the chip is coated with antibodies that bind to the viral proteins. Blood flows directly over the chip, Gunn said... The Maverick system can process up to 100 tests per hour per instrument. Each instrument costs around USD 120 000, and the chips will cost about USD 10 each, Gunn said. The system requires standard electrical power. But the power ... can come from a generator, he said...

[Byline: Bradley J. Fikes]

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Cost will be a serious limitation. Also, if deployed in West Africa, experience with expensive electronic equipment in the tropics, even inside air-conditioned premises, shows short operational life and difficulty, time and expense of repairing and replacing parts; they have to be flown out with a repair technician, who will need salary, airfare and per diem, a visa and yellow fever vaccination certificate dated at least 10 days earlier, clear customs, etc. - Mod.JW]

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[4] EU: 24.4 million euros to develop vaccine against Ebola
Date: 24 Oct 2014
Source: Tass [edited]
http://en.itar-tass.com/world/756177


The European Union provides EUR 24.4 million euros [USD 31 million, GBP 19 million] for research to develop a vaccine against Ebola, outgoing European Commission President Jose Manuel Barroso said after the 1st day of the EU summit. The research will be aimed at containing the epidemic and protecting medical personnel, 1st of all developing vaccine, he said...

Smaller EU countries have said they are ready to send healthcare workers to West Africa but lack the resources to evacuate them if they caught the disease. The EU addressed this problem this week by providing a guarantee to international health workers that they would either be flown to Europe or receive high-quality treatment on the spot if they caught the disease in West Africa...

[Byline: Dennis M. Sabangan]

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[The high-quality treatment facilities on the spot are still under construction. - Mod.JW]

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[5] Russia: vaccine trials
Date: 24 Oct 2014
Source: Tass [edited]
http://en.itar-tass.com/world/756252


Russia has launched the production of a trial batch of the Ebola vaccine Triazavirin that will be sent to Africa in the coming days for efficiency tests, head of the vaccine producer Yunona (Juno) pharmaceutical holding Alexander Petrov said on Fri [24 Oct 2014]. EU provides EUR 24.4 million [USD 31 million] to develop vaccine against Ebola. The vaccine was created by the Ural Biopharmaceutical Technology Center.

Triazavirin has been approved by the Russian Health Ministry, Petrov said. "Studies have confirmed the medicine's high efficiency against a number of viral infections, influenza, tick-borne encephalitis and exotic viruses that are common in Africa and Asia," the scientist said. Tests of Triazavirin have shown the vaccine's high efficiency (70-90 percent) against various kinds of haemorrhagic fevers, including Marburg fever, which has a close relation to Ebola...

Russia and Guinea will ink a memorandum on the fight with the Ebola virus outbreak in the coming week, Golodets said on Fri [24 Oct 2014]...

[Byline: Dennis M. Sabangan]

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[Presumably, this is to be tested in Guinea. A field trial will have the same problems mentioned before: unknown infection/incubating status of subjects unless isolated for at least 21 days before vaccination; unknown dose of subjects virus positive before even starting, risk of serious or even fatal side-effects discrediting the vaccine, all leading to allegations that the vaccine is transmitting the virus. Then, how would the research team know the date vaccinated persons were subsequently exposed to infection? There would be ethical constraints against requiring them to work in an Ebola Treatment Unit without PPE. - Mod.JW]

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[6] Insurance increase
Date: 23 Oct 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/10/ ... 9X20141022
and
Date: 22 Oct 2014
Source: Business Insider [edited]
http://www.businessinsider.com/insuranc ... ns-2014-10


As fear of Ebola infections spreads to developed economies, U.S. and British insurance companies have begun writing Ebola exclusions into standard policies to cover hospitals, event organisers and other businesses vulnerable to local disruptions. As a result, new policies and renewals will become costlier for companies opting to insure business travel to West Africa or to cover the risk of losses from quarantine shutdowns at home, industry officials told Reuters...

ACE Ltd said on Wed [22 Oct 2014] that its global casualty unit, which offers coverage for U.S.-based companies whose employees travel or that have operations abroad, was using a policy endorsement to exclude Ebola on a "case-by-case basis" during the underwriting process on new policies and renewals. "Probably the biggest issue coming up is business interruption," said Tony DeFelice, managing director of Aon Risk Solutions' national casualty practice in the United States. A business interruption could be anything from the loss of key employees to sickness to the quarantine of an airliner or cruise ship used by a suspected patient suffering from Ebola or any other serious infectious disease.

[Byline: Carolyn Cohn, Richa Naidu & Avik Das]

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Communicated by:
Roger Feldman <promedrf@gmail.com>

[This will drive up prices for all cargo destined for West Africa and further exacerbate their precarious financial situations. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/107.]

EBOLA VIRUS DISEASE - ex AFRICA (26): USA QUARANTINES, DRUG, VACCINES, WHO
**************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: Washington DC airports start quarantine
[2] USA: (New Jersey) quarantined nurse released from hospital
[3] USA: soldiers returning from Liberia, quarantined in Italy
[4] Russia: "vaccine" actually an antiviral drug
[5] Prevention

******
[1] USA: Washington DC airports start quarantine
http://www.mapsofworld.com/usa/states/v ... ports.html

Virginia announces policy for active monitoring of all returning travelers
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Governor Terry McAuliffe announced that starting today, Monday, 27 Oct 2014, the Virginia Department of Health will actively monitor the health of all travelers arriving from the countries of Guinea, Liberia, and Sierra Leone, which are battling an unprecedented Ebola outbreak... "Today, the Commonwealth of Virginia will begin to actively monitor incoming travelers from countries battling the Ebola outbreak so that public health officials can respond quickly in the event of an Ebola case in our state," said Governor McAuliffe. "This plan will strengthen our ability to protect Virginians from Ebola, and increase our readiness to respond promptly in the event that we have a case of the disease in our state." ...

All travelers will be asked to take and record their temperature at least twice per day... Should a traveler develop any concerning symptoms, but an initial medical evaluation is negative, the traveler may be asked to remain at home for the remainder of the 21 days with close monitoring.

"This additional monitoring provides another level of protection from Ebola for the people of Virginia. The plan connects each traveler with our professional staff at Virginia's local health departments who know their community and can assure that the travelers will have the support, guidance and prompt clinical attention if needed. Because we will be able to assess the risk of each traveler, we will be better able to determine when a legal order of quarantine is necessary," said State Health Commissioner Dr. Marissa J. Levine...

[Map showing airports in Virginia state: http://www.mapsofworld.com/usa/states/v ... ports.html.

There are 4 other international airports besides Washington Dulles International Airport (IAD):
- Norfolk International Airport
- Reagan Washington National Airport
- Richmond International Airport
- Newport News/Williamsburg International Airport

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Pennsylvania to monitor travelers from West Africa for Ebola virus
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26 Oct 2014: (TribLIVE) Pennsylvania health officials will order any travelers with potential Ebola virus exposure in West Africa to stay off commercial buses, trains and other mass transportation for at least 21 days, according to protocols released Fri [24 Oct 2014]. The commonwealth is among 6 states that will broaden monitoring next week for people who enter the United States from outbreak-stricken Guinea, Liberia and Sierra Leone. The 6 states account for 70 percent of up to 150 people who arrive each day from those countries...
http://triblive.com/news/healthnews/702 ... z3HNFYMbjC

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[I'm not sure how practical this will be to monitor. What will be done about people who need to get to work but don't have a car? It is also pointless, since Ebola is not transmitted through the air but only by contact with the body fluids of an infected person, a person who is sick and bleeding or vomiting in the USA is more likely to be traveling by ambulance rather than on mass transit. If they do take a bus or other transport, nobody is going to touch them in their condition, so there is very little danger. - Mod.JW]

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[2] USA: (New Jersey) quarantined nurse released from hospital
Date: 27 Oct 2014 [updated]
Source: WSJ [edited]
http://online.wsj.com/articles/nurse-be ... 1414418399


A nurse who was being held at a Newark hospital under an Ebola quarantine left Mon [27 Oct 2014] and was to be privately transported to her home in Maine, officials said Monday. A spokeswoman for University Hospital in Newark confirmed that the nurse, Kaci Hickox, left at 1:20 p.m.

Both New York and New Jersey instituted mandatory quarantines last week for medical workers returning from West Africa. But New Jersey Gov. Chris Christie's administration has faced criticism in recent days after the nurse documented her isolation in Newark. The governor has also faced sharp attacks from medical health professionals and civil liberties groups on the mandatory quarantine for travelers returning from Ebola-ravaged countries.

The governor's office said Ms. Hickox, a 33-year-old nurse with Doctors Without Borders who recently returned from Sierra Leone, had been symptom free for 24 hours. Ms. Hickox has said she never had a fever or Ebola symptoms...

[Byline: Josh Dawsey, Heather Haddon & Jennifer Levitz]

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[3] USA: soldiers returning from Liberia, quarantined in Italy
Date: 27 Oct 2014
Source: CBS News [edited]
http://www.cbsnews.com/news/ebola-outbr ... n-in-italy


"U.S. soldiers returning from Liberia are being placed in isolation in Vicenza, Italy out of concern for the Ebola virus, CBS News national security correspondent David Martin reports. The soldiers being monitored include Maj. Gen. Darryl Williams who was the commander of the U.S. Army in Africa but turned over duties to the 101st Airborne Division over the weekend, Martin reports. There are currently 11 soldiers in isolation. ...

"A Pentagon spokesman calls it "enhanced monitoring." The soldiers are confined to a building and unable to see their families, Martin reports. The decision was made by the Army and applies only to soldiers returning from Liberia." ... They apparently were met by Carabinieri [see comment below] in full hazmat suits. If the policy remains in effect, everyone returning from Liberia -- several hundred -- will be placed in isolation for 21 days; 30 are expected in today [27 Oct 2014], Martin reports... - more

[Byline: David Martin]

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Communicated by:
Jonathan Ezekiel
<jezekiel@his.com>

[The Italian carabinieri (paramilitary police force) are apparently similarly uninformed about the necessity for skin contact with the body fluids of an Ebola victim to transmit the virus. Or perhaps the wearing of hazmat gear is to reassure their families and the general public... - Mod.JW]

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[4] Russian "vaccine" actually an antiviral drug

[Regarding the news item about a Russian Ebola "vaccine," Triazavirin, in ProMED Ebola virus disease - ex Africa (25): Norway doctor, USA quarantine, vaccines: 20141026.2903377, ProMED thanks the readers who have written in to point out that this is not a preventive vaccine but an antiviral drug with claimed activity against multiple viruses. We quoted the Tass report verbatim; it is evidently a mistranslation of the original report in Russian. - Mod.JW]

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******
[5] Prevention

Australia to impose visa ban on West Africans over Ebola
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27 Oct 2014: (Bernama) - Australia has closed the door to people seeking humanitarian entry from Ebola-affected west African countries. Immigration Minister Scott Morrison said in a statement the temporary suspension meant his department was no longer processing any applications from countries including Sierra Leone, Liberia and Guinea. The department is also cancelling and refusing non-permanent or temporary visas held by people from Ebola-affected countries who have yet to leave for Australia. Permanent visa holders from these countries are being required to submit to a 21-day quarantine period before departure for Australia.
http://www.bernama.com/bernama/v7/wn/ne ... id=1079897>

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USA: NY governor modifies quarantine order
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New York Gov. Andrew M. Cuomo (D) on Sunday [26 Oct 2014] revised a controversial policy to quarantine returning health-care workers from Ebola-stricken nations, under pressure from the Obama administration and medical experts over the aggressive measures... Elaborating on the procedures, Cuomo said health-care workers who have been in contact with Ebola patients but do not show symptoms of the deadly virus can return to their homes but will be forced to remain there while being monitored by state health officials for symptoms. He said those being monitored can interact with family and friends. "It's not like this is the toughest duty," Cuomo said in a news conference late Sunday with New York City Mayor Bill de Blasio (D). The change separates the state's quarantine process from that of New Jersey, which has come under scrutiny after the weekend retention of a nurse who showed no symptoms of Ebola. Kaci Hickox, who returned from Sierra Leone after working with Doctors Without Borders, has been held in isolation at a site attached to a New Jersey hospital...
http://www.washingtonpost.com/national/ ... nes&wpmm=1

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USA: (Florida) mandatory Ebola monitoring of travelers from West Africa
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Date: 25 Oct 2014: (Miami Herald) Gov. Rick Scott orders mandatory Ebola monitoring of travelers from West Africa...
http://www.miamiherald.com/news/state/f ... rylink=cpy

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WHO convenes industry leaders and key partners to discuss trials and production of Ebola vaccine
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24 Oct 2014 -- WHO convened a high-level emergency meeting on 23 Oct 2014 to look at the many complex policy issues that surround access to Ebola vaccines. Ways to ensure the fair distribution and financing of these vaccines were discussed, as well as plans for the different phases of clinical trials to be performed concurrently rather than consecutively, partnerships for expediting clinical trials, and proposals for getting all development partners moving in tandem and at the same accelerated pace.
http://www.afro.who.int/en/media-centre ... ccine.html

Read the press release
http://who.int/mediacentre/news/release ... duction/en.
Read full report of the meeting
http://who.int/mediacentre/news/ebola/2 ... er-2014/en.

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WHO eyes mass Ebola vaccines by mid-2015
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25 Oct 2014: (WHO) Hundreds of thousands of Ebola vaccine doses could be rolled out to West Africa by mid-2015, the World Health Organization said Fri [24 Oct 2014]... "All is being put in place to start efficacy tests in the affected countries as early as December [2014]," WHO assistant director general Marie-Paule Kieny said...
http://www.vanguardngr.com/2014/10/eyes ... JtD7Q.dpuf

[A trial of the GSK vaccine was planned for Mali, but now that an unknown number of people there have been exposed to the little girl from Guinea, it may be difficult to find a large group of unexposed people in Mali. - Mod.JW]

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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

EBOLA VIRUS DISEASE - ex AFRICA (27): USA (TEXAS) SECOND NURSE BETTER, TEST, QUARANTINE
***************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: 2nd Dallas nurse recovered
[2] USA: Rapid test deployed in hospitals
[3] USA: (New York, New Jersey) quarantine rules relaxed
[4] USA: New federal Ebola guidelines
[5] An African viewpoint

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[1] USA: 2nd Dallas nurse recovered
Date: 28 Oct 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/10/ ... 1F20141028


A Dallas nurse who contracted Ebola was released from Emory University Hospital in Atlanta on Tuesday [28 Oct 2014] after being found free of the virus and thanked God and her family for helping her recover. "I sincerely believe that with God all things are possible," said nurse Amber Vinson, who looked vibrant at a news conference with the health workers who treated her. Vinson is the 4th patient successfully treated for Ebola at Emory's hospital. She was one of 2 nurses from a Dallas hospital infected with Ebola after treating the 1st patient diagnosed with the disease in the United States.

[Byline: Colleen Jenkins]

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[2] USA: Rapid test deployed in hospitals
Date: 27 Oct 2014
Source: Defense One [edited]
http://www.defenseone.com/technology/20 ... tals/97544


Rapidly screening for Ebola at U.S. hospitals has just gotten easier thanks to military-funded technology. Salt Lake City-based BioFire announced over the weekend that they had received emergency use authorization from the Food and Drug Administration for hospital workers to use their polymerase chain reaction (PCR) screening machine, the FilmArray, to screen for Ebola.

It's the same machine that the U.S. military is using to fight the disease in Africa. But until Sat [25 Oct 2014], the FDA had approved FilmArray for Ebola screening for research purposes only in U.S. hospitals. http://www.defenseone.com/threats/2014/ ... lm%20array.

The Dallas hospital that treated Thomas Eric Duncan, the Liberian man who became the 1st individual to die of Ebola in the United States, [had the machine] but was not authorized to use it to test patients showing symptoms of Ebola.

Health workers in more than 300 hospitals around the country, including 30 hospital labs in the New York tri-state area, use the machine to screen for a wide variety of illnesses such as listeria, influenza and various other respiratory and intestinal sicknesses. With the right diagnostic kit in place, the FilmArray can also be used to screen for Ebola, delivering results in about an hour with higher than 90 percent certainty. More importantly, it can do so days before an Ebola carrier develops a fever and becomes contagious. One of the hospitals scheduled to receive the machine for that purpose is New York's Bellevue.

Doctors and medical staff at Emory University in Atlanta were able to use it to diagnose and treat U.S. doctor Kent Brantly and aid worker Nancy Writebol because the machine there had a research designation http://labmed.ascpjournals.org/content/ ... f0c07c929e.

BioFire, a subsidiary of BioMerieux, began the process of requesting emergency use authorization on 22 Sep 2014 and finally got in the last necessary results and paperwork on 22 Oct 2014, according to an FDA spokesperson...

The availability of more and better Ebola screeners in more hospitals will allow authorities to much more rapidly evaluate potential Ebola cases and do so before symptoms like fever present themselves, in other words, before the carrier is contagious [and] poses a threat. That means that random screening with an effective PCR machine could decrease any public health threat from an individual, without being quarantined.

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Communicated by:
Ryan McGinnis
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[3] USA: (New York, New Jersey) quarantine rules relaxed
Date 27 Oct 2014
Source: NY Times [edited]
http://www.nytimes.com/2014/10/27/nyreg ... .html?_r=0


Facing fierce resistance from the White House and medical experts to a strict new mandatory quarantine policy, New York State Gov. Andrew M. Cuomo said on Sun Oct 26 2014 evening that medical workers who had contact with Ebola patients in West Africa but did not show symptoms of the disease would be allowed to remain at home and would receive compensation for lost income. He said his decision balanced public safety with the need to avoid deterring medical professionals from volunteering in West Africa. "My No. 1 job is to protect the people of New York, and this does that," he said. Those quarantined at home will be visited twice a day by local authorities, he said. Family members will be allowed to stay, and friends may visit with the approval of health officials.

After Mr. Cuomo's announcement, Mr. Christie [New Jersey state governor] issued a statement saying that, under protocols announced on Wed Oct 22 2014, New Jersey residents not displaying symptoms would also be allowed to quarantine in their homes. Yet amid heightened public anxiety about the government's handling of the crisis, state authorities have increasingly calculated that the mandatory quarantines will prove prescient. Since the governors' announcement, Illinois and Florida have said they were instituting similar measures. On Sun Oct 26 2014 afternoon, President Obama gathered top advisers for a meeting at the White House to work on a new, nationwide standard for returning health care workers. That policy is likely to advise against a total quarantine of those workers, a senior administration official said.

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Communicated by:
Roger Feldman <promedrf@gmail.com>

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[4] USA: New federal Ebola guidelines
Date: 27 Oct 2014
Source: Guardian [edited]
http://www.theguardian.com/world/2014/o ... strictions


The UN secretary general praises "exceptional" health workers and says "those who develop infections should not be stigmatised..."

The White House appeared to accept on Mon [27 Oct 2014] that a patchwork system of Ebola restrictions was inevitable given that public health policies were a matter for individual states. "We have a federal system in this country in which states are given significant authority for governing their constituents," White House spokesman Josh Earnest told a briefing. "That is certainly true when it comes to public safety and public health..."

In Georgia, governor Nathan Deal appeared to sidestep the controversy by announcing detentions for all travellers potentially exposed to the disease, but exempted healthcare workers, who will be allowed to monitor themselves at home and choosing other restrictions that may have limited practical impact. Deal said officials at the Atlanta airport, one of 5 designated entry points for travellers from Sierra Leone, Guinea and Liberia, would rely on questioning arrivals on their potential exposure to determine whether they should face the mandatory quarantine detention.

Georgia's rules are likely to provoke less controversy than those in New York and New Jersey by allowing travellers to be monitored at home via video link or visits from officials. "We have learned from what other states have done, especially in the area of healthcare workers where we saw some push back," said Deal. "We believe our policy will give them the freedom they deserve; we trust them to report if they have symptoms." Travellers arriving via Atlanta from affected countries who do not exhibit any symptoms or admit to a history of exposure will be required to sign an agreement requiring them to monitor their temperature and stay in touch with authorities for a 21-day period.

The CDC director again stressed that Americans were highly unlikely to contract Ebola. "I understand that people are afraid. People are unfamiliar," said Frieden. "It is a severe disease, but it is not highly contagious."

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[5] An African viewpoint
Date: 21 Oct 2014
From: Nigeria Health Watch [edited]
http://nigeriahealthwatch.com/mass-hyst ... -next-door


This blog was inspired by a conversation with my friend and colleague Dr Kelechi Ohiri while we watched some of the media coverage of the Ebola outbreak on cable news channels, while acutely aware of our own reality in West Africa.

We recently heard the story of some Korean businessmen cancelling their trip to Nairobi for a conference because of ...wait for it... the Ebola outbreak in Liberia and Sierra Leone. The distance from Nairobi to Monrovia is about 5000 km, about the same distance as between London and Washington, but hey, it is Africa, and there is Ebola in Africa.

The hysteria manifests itself in several forms: Sierra Leone's John Kamara was barred from returning to his Greek club after playing for his country in Yaounde, Cameroun; 2 students from Nigeria who applied to a Texas college were told they wouldn't be admitted because of Ebola; and flights are now being disrupted daily due to Ebola scares. Conspiracy theories on the source of the outbreak and the virus's potential for mutation continue to gain strength with many audiences.

While the hysteria by a few uninformed private individuals and companies may be sad and easily dismissed, it becomes a real challenge when apparently enlightened and responsible citizens take to the airwaves in the same way. There appears to be serious and increasing pressure by parts of the American population, especially Republican lawmakers, to institute an air travel ban to "isolate" West Africa (a term now used to describe a geographic area 2 times the size of Europe, with 15 countries). The apparent purpose of this is to close America off to travelers from the region and protect Americans from exposure to the ebolavirus. This solution is being proffered by panelists invited on several prime time television channels and beamed across the world.

They should know better. There is no evidence that a travel ban can work, and such a ban is likely to cause more harm than good. We will explain. Let's consider why this must be taken seriously.

Firstly, it will not be the 1st time the USA has instituted a travel ban against public health counsel. For many years, those infected with HIV were barred from entry into the USA. There is no evidence that it had any effect at all on the epidemiology of HIV in the USA, but, despite this, it remained in place for 22 years until it was repealed by the Obama administration.

Secondly, hysteria has already led to several countries around the world re-instating airport temperature and symptom screening despite all the evidence that airport screening did not work for SARS in 2006, nor did it for TB in the UK, and there is absolutely no evidence that it will work for Ebola. Despite the constant preaching on the importance of evidence-based decision making in the health sector, the UK and the US as well as several other countries, including Nigeria, have re-instated or introduced airport "screening." This comes in the form of various types of equipment used to measure temperature as well as a self-reported symptoms screening questionnaire. The Liberian Thomas Duncan, who entered the US while incubating Ebola virus did not have a fever on arrival, and honesty in those filling out airport forms is really too much to expect, especially knowing what the consequences of that honesty are likely to be. But by instituting screening at airports, governments are seen to be responding. There is a lot of pressure to be seen to be doing something, even in the absence of any evidence of effectiveness. The only benefit airport symptom and temperature screening has caused is [to the virus. - Mod.JW], an increase in queues and congestion. In an airport like the Murtala Mohammed International in Lagos, this causes additional chaos and congestion, providing the perfect environment for the transmission of infectious diseases.

Apart from providing much needed jobs for hundreds of Nigerians, given what we know about the disease, its natural history and the incubation period of the virus, this exercise is most likely to be ineffectual and very expensive... Just a few weeks ago, there was extensive and severe criticism of the Sierra Leonean lockdown in its attempt to limit transmission, as not being based on evidence, but now everyone seems to be on the bandwagon.

Temperature screening at Lagos Airport
----------------------------------
The very nature of international travel and international travelers makes the proposal of a travel ban naive at best and most likely to make things worse rather than better, an argument made brilliantly by Laurie Garrett in her article "Why travel bans will only make the Ebola epidemic worse." Thankfully, most of the Public Health Leadership in the USA, including the CDC director Tom Frieden, have come out strongly against this. The WHO does not recommend it as a means of controlling the outbreak. There was very little discussion in the mainstream media about a travel ban from China during the SARS outbreak in 2002 or during the Swine Flu epidemic in 2009. Maybe there is something particularly uncomfortable for some folk in America with an outbreak taking place in Africa. So are we facing another round of hysteria-driven public health policy?

Despite the hysteria, the facts remain that the risk of acquiring an Ebola infection in the USA, UK or anywhere in the West remains vanishingly small. The virus is not airborne and cannot be transmitted like some other viruses such as measles or the SARS virus can. Close contact with a patient is required for transmission.

Just one death from Ebola has occurred in the USA, and medical care there is light-years ahead of the medical care available in Liberia, where more than 2000 people have died in the ongoing outbreak. If left without a robust response, the hysteria will hurt us, and not just our brothers and sisters in Liberia, Sierra Leona and Guinea, but all of us. This outbreak must not be allowed to evolve to become our "single story."

So what do we recommend?
-----------------------
Everything we know about outbreaks of infectious diseases has taught us that the best way to control an outbreak is to identify its source and focus our control efforts there. All of us in the global community, North and South must put all our resources into supporting the response in Liberia, Guinea and Sierra Leone. It is worth noting that, while various panic-driven interventions are being put in place, the UN Secretary General Ban Ki Moon is saying that there is still a significant shortfall in the resources needed for tackling the outbreak. There has been a lot of criticism of the West in responding late; we have heard little being said for our own countries in Africa.

In August 2014, the AU announced a contribution of USD one million; South Africa has sent a mobile laboratory and is considering a mobile hospital. Nigeria announced that it was sending volunteers, with little description of the institutional framework for their potential deployment. Below is a graphic describing the contributions to the international Ebola response efforts. You can draw your own conclusions.

Funds pledged to fight Ebola (Image credit: Lauren Friedman /Business Insider): http://static2.businessinsider.com/imag ... uilder.png.
[The UK alone has pledged more than the African Development Bank, and not a single African country appears in the top 14 donors, which include 3 American foundations pledging USD 100 million between them. - Mod.JW]

As I said in an interview at TEDGlobal, it is time we truly commit to dealing with this outbreak as a global community, not just for the "West Africans," but for all of us. The boundaries we hold so dear are not respected by infectious diseases. While we are at it, and despite all the pressure, our leadership, both political and in public health, must stick to the evidence of what works. We need calm heads to lead us through this. It is too early yet to count the heroes, but they may emerge from surprising places; doctors and nurses that have paid with their lives, working in the most grueling of circumstances, communities coming together to look after orphaned children and rebuild their lives.

We hope that the story of this outbreak will ultimately be one of solidarity and partnership and not of victims and saviours. We are in the middle of an unprecedented public health emergency at our doorstep. While it is fitting to celebrate small battle victories, we must not lose sight of the context of a larger war. We need to get over our hysteria and focus on Liberia, Sierra Leone and Guinea.

[Byline: Chikwe Ihekweazu]

--
Communicated by:
Olutayo Olajide Babalobi
<tayobabalobi@gmail.com>

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/245.]

EBOLA VIRUS DISEASE - ex AFRICA (28): USA NURSES, EAST AFRICA TOURISM DOWN, EXPERT OPINION
******************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: (New York City) Bellevue nurses stigmatized
[2] East Africa: tourism down
[3] USA: Opinion: How to make Ebola worse

*******
[1] USA: (New York City) Bellevue nurses stigmatized
Date: Wed 29 Oct 2014
Source: New York Times [edited]
http://www.nytimes.com/2014/10/30/nyreg ... .html?_r=0


Bellevue hospital employees face Ebola at work, and stigma of it everywhere
---------------------------------------------------------------------------
For 6 years, Mayra Martinez had been going to the same beautician in Queens [New York City], and considered her a friend. On Saturday [25 Oct 2014], while getting her hair done, Ms. Martinez, 45, mentioned she had just gotten a new job. "Where?" the beautician asked. "Bellevue," Ms. Martinez said. "She just froze and asked, 'Are you anywhere near him?'" Ms. Martinez recalled. Then the beautician asked her to please find someone else to do her hair. By "him," the beautician meant CS, who is New York's 1st Ebola patient. As Bellevue Hospital Center goes into its 8th day of treating CS, who had worked with Doctors Without Borders [MSF] in Guinea, some of its employees are feeling stigmatized -- a harsh consequence of being at the 1st hospital in the city to deal with an outbreak that has killed about 5000 people in West Africa, and that is known to kill about half the people who become infected....

Bellevue's medical director, Dr. Nate Link, said that more than a dozen employees had reported being discriminated against, including not being welcome at a business or social event. Some nurses who moonlight at other jobs have been told they are not needed there, according to the New York State Nurses Association, a union. One nurse said her child was not allowed to go to day care. "These are obviously related to irrational fears in the community," Dr. Link said. On the subway to work early Tuesday [28 Oct 2014], Ms. Martinez said, she overheard 2 passengers say they were horrified by Ebola, and joked that it would soon turn people into zombies. Ms. Martinez, dressed in tan scrubs with her identification badge hung around her neck, tucked the badge inside her coat, "so they don't retaliate against me." Medical workers who have treated Ebola patients at hospitals in Atlanta [Georgia], Dallas [Texas] and Omaha [Nebraska] have also reported being stigmatized.

The problem is severe enough that Mayor Bill de Blasio acknowledged it during a news conference at Bellevue on Sunday [26 Oct 2014]. "The medical personnel fighting this fight, particularly our nurses, deserve our respect," Mr. de Blasio said. "We heard reports in the last few days of nurses being mistreated in our city -- when it became clear that they worked at Bellevue -- being treated differently. We heard reports of people being unwilling to serve them food or treating their children differently. That is absolutely unacceptable."

But sometimes the snubbing is taking place inside their own workplace. Nurses treating CS were in tears at a meeting this week as they complained about being shunned by other staff members in the elevators, one health care worker who was there said. Workers in the isolation unit seem attuned to how their co-workers are viewing them. Some people who work in that unit are trying not to mingle with those who do not, several employees said. Even though the hospital administration has not explicitly ordered Ebola workers to stay away from others, employees said, the word has gone out through informal channels that it is better to lower the risk, and the anxiety quotient, of exposing other employees. Some nurses asked for arrangements to be made for them to sleep over at the hospital out of fears of passing the virus to their relatives and friends.

Even without the stigma, the work is both physically and psychologically taxing, and the dangers of burnout are high. Nurses have been going to group therapy at the hospital looking for support, and nurses from other public hospitals have been brought in for reinforcement. Some critical care patients have been transferred to Bellevue affiliated hospital, NYU Langone Medical Center, to free intensive care staff to treat CS, officials said.

One Bellevue health care worker said that nurses who had not completed their Ebola training were asked on Friday [24 Oct 2014] to relieve the nurse taking care of CS's fiancee. At 1st they refused, the worker said. Then one "gowned up" and was relieved to find the work consisted of making sure [CS's fiancee's] temperature was taken and entered into a log. The worker and other Bellevue employees quoted spoke on the condition of anonymity because they did not have permission to discuss hospital matters. [CS's fiancee], who has shown no symptoms, has since been discharged to home quarantine in the Hamilton Heights apartment she shares with CS.

Ana Marengo, a spokeswoman for Bellevue, said on Tuesday [28 Oct 2014] that everyone who worked with CS and [his fiancee] had been fully trained.

[Byline: Anenona Hartocollis & Nate Schweber]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[2] East Africa: tourism down
Date: Wed 29 Oct 2014
Source: Reuters [edited]
http://af.reuters.com/article/topNews/i ... G520141029


Ebola fears ripple across continent to hurt east African tourism
----------------------------------------------------------------
East Africa's Serengeti and Maasai Mara safari parks are as far if not further from the Ebola outbreak in the west of the continent than much of Europe which supplies the tourists, but you'd hardly guess that from the slump in bookings. In Tanzania and Kenya, tour operators say tented camps and luxury lodges where lion and elephant saunter past are surviving on visitors who have not yet written off the whole continent because of an outbreak that struck 5000 km away. "The probability of dying from a tree falling on your head is probably higher than going on a safari in the Serengeti and catching Ebola," said John Corse of Nomad Tanzania, one of whose camps overlooks plains where wildebeest make the annual Great Migration, often described as a natural Wonder of the World.

Tanzania -- which relies heavily on tourist dollars from visits to game reserves, Mount Kilimanjaro or Indian Ocean beaches -- was aiming for a record year to top the more than 1 million visitors who came in 2013. That now looks a pipedream. The Hotels Association of Tanzania, representing 195 sites nationwide, said business is down 30 to 40 percent on the year and advanced bookings, mostly for 2015, are 50 percent lower. Next door, Kenya has been hurt too. Its tourism industry was already reeling from a spate of attacks by Islamists, including last year's [2013] attack on the upscale Westgate mall and more recent incidents on the coast. Ebola has added to the pain, making dollars scarce in the foreign exchange market and weakening the [Kenya] shilling.

Safaris are vital to both nations, whose other main exports are agricultural produce, because they tend to draw wealthier visitors, ready to splash out on luxuries, like sundowners after a game drive at sites miles (kms) from the next settlement. "A safari holiday behaves like a form of luxury goods: people consume more of it when they're feeling safe and wealthy," said Corse, whose packages combining a week or so in the bush followed by a few days on Zanzibar's beaches cost USD 8000 to USD 15 000 a person. Particularly galling to some is that neither Kenya nor Tanzania, nor indeed any other east African nation, has had a single case of the Ebola virus.

The United States and Spain, meanwhile, have had cases of infection on their soil and also deaths from the disease. Madrid stands less than 4000 km [less than 2500 miles] from Liberia's capital Monrovia, a shorter distance than the game reserves of Kenya and Tanzania. Several east African nations have imposed restrictions on travellers coming from afflicted areas. Kenya Airways halted flights in August [2014] to Monrovia and Freetown after Kenya was declared a "high-risk" zone because Nairobi is one of Africa's transport hubs. However, some European airlines still fly to afflicted nations of West Africa. When 9 Kenyans returned to Nairobi from Liberia this week, they were isolated for hours and tested before being allowed to go home, even though they showed no fever or other Ebola symptoms.

"Our problems started with insecurity long before Ebola became an issue, but Ebola of course has worsened it," said Sam Ikwaye of the Kenya Association of Hotelkeepers and Caterers, referring to last year's deadly attack by Islamist gunmen on a Nairobi shopping mall followed by other assaults elsewhere. "Our members have reported that tourists are very concerned and have kept asking and seeking assurances that Kenya is Ebola-free," he said. The Serena Hotels, which run high-end safari lodges and beach resorts, said bookings were down by as much as 30 percent in 2014, from the last good year of 2012. In 2013, worries about election violence, which proved unfounded, also deterred visitors.

Knock-on effects on nearby Uganda and Rwanda
--------------------------------------------
Problems for Kenya and Tanzania have knock-on effects on nearby Uganda and Rwanda, which are also part of the East African Community bloc. Rwanda, whose tourist industry in particular relies on expensive treks to see rare mountain gorillas, denies entry to travellers who have been to the 3 West African nations in the previous 22 days. Ebola's incubation period is 3 weeks. Tanzania, where most visitors come from Britain, Germany, the United States and Italy, plans to launch a website in early November [2014] to educate visitors about Ebola and debunk any rumours. "We sympathise with our brothers and sisters in West Africa. But we don't have it and we are doing everything we can to ensure Tanzania remains Ebola-free," said Lathifa Sykes, chief executive of the Hotels Association of Tanzania. "Africa is not one country. Africa is a continent," she said, voicing the frustrations of many Africans who say people in the West often forget Africa's diversity and vast size.

Still, not all tourists are staying away. At the Sarova Whitesands Beach Resort, near Mombasa, 44-year-old Wilbur April from London shrugged off the worries."Of course we asked about Kenya before we came because there was bad publicity about the country back home and we wanted to be sure," he said from his sun-bed sipping a glass of red wine. "Recently it was terrorism," he said. "Now it is Ebola, and it is not even near Kenya.

[Byline: Edith Honan]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[One wonders whether tourism to the USA will start to decline, since it has seen 4 times as many cases as Senegal, including a fatality, and public anxiety and misinformation in the USA appear to be on a similar level to that in West Africa! - Mod.JW]


******
[3] USA: Opinion: How to make Ebola worse
Date: Wed 29 Oct 2014
Source: Humanosphere [edited]
http://www.humanosphere.org/basics/2014 ... bola-worse


Bill Foege on how to make Ebola worse
-------------------------------------
[Humanosphere Editor's note: Dr. William Foege is the physician-epidemiologist credited with devising the strategy that rid the world of smallpox, former head of the CDC (when AIDS 1st emerged) and, full disclosure, is also a good friend to Humanosphere. We asked him to offer perspective on all the finger-pointing attending the Ebola hysteria.]

It is easier to be a critic than a participant or helpful observer.

That goes for me as well, but I am concerned that the straight-forward, science-based approach taken by public health officials to limit Ebola's potential spread in this country has spawned such harsh criticism that the critics themselves may be a bigger risk to public safety than this virus.

It's important to realize Ebola is a living creature. Control of infectious diseases is a continuous evolutionary contest between microorganisms and humans fighting for turf. Science inches ahead as it gains more understanding of those organisms, which often leads to new medications and vaccines. Then we may find those very organisms evolving in response.

Chloroquine was once a wonder drug against malaria and we could almost see the inevitable defeat of that enemy. But the parasite found how to resist and essentially sideline that drug. Antibiotics seemed ready to make some infectious diseases obsolete. But gonorrhea defied penicillin; staph overcame many antibiotics; and tuberculosis learned to live with multiple drugs. All these organisms are too small to have a brain. Yet they figured out how to beat us.

Vaccines are better than drugs, in general, because organisms don't develop resistance. But even with these great tools, these organisms have co-opted some parents who refuse immunizations for their children. So measles and whooping cough are now able to rebound even in the face of great protective vaccines.

But humans are also ingenious. Working with the best information available, public health workers continue to change strategies. Smallpox workers evolved and suddenly a virus that had perfected its business plan for immortality was outflanked and it disappeared in a few years. Through a similar concerted global campaign, measles deaths have plummeted from over 3 million a year to less than 10 percent of that figure.

This same evolution is now occurring with Ebola. With the experience of 38 years and multiple outbreaks in Africa, the pattern seemed clear. Transmission between humans could be broken in fewer than 5 or 10 generations of the virus, a time frame of months. Humans would then remain free until the next transfer of the virus from bats to humans.

With another human case, the scenario would be repeated with intense human efforts to find cases, isolate them, treat them and avoid virus spread. Public health workers would find contacts, isolate them at the 1st sign of illness and help the community to dispose of the dead to stop viral transmission to others. Within months, the outbreak would cease.

But in 2014, the virus changed tactics and took advantage of a slow human response. The change in tactics led to a new phenomenon, spread of the virus to high population density areas. Control measures should have remained the same, mimicking the surveillance/containment strategies of smallpox eradication. But the greater volume of cases complicated isolation of patients.

The need to find, follow and refer for isolation large numbers of contacts overwhelmed an anemic public health response. Indeed, the need to find and follow all contacts of patients was not on the WHO "critical steps" list as late as October 2014. The result has been a disaster for West Africa. Half way measures are not sufficient and the public health community is now adapting and attempting to organize a large scale response.

Doctors Without Borders combined the experience of earlier outbreaks with the treatment of thousands of cases during this outbreak. They have done this under such difficult field conditions that it was assumed that most large hospitals in the United States could have done the same thing safely. That turned out not to be true and protocols quickly reflected this new information.

While the autonomy of state and local jurisdictions is a given in this country, the federal government has responded with assistance and personnel exceeding any previous investigation and control effort. Human evolution and response to unexpected problems will contain the virus in this country.

The screening of travelers is not simple and it is certainly not fool-proof. But again, public health recommendations have been tightened to improve the chances of finding people entering the country with the virus. Some of the same people critical of the public health approach seem very tolerant of politicians calling for a travel ban from affected countries or governors placing travelers in quarantine.

Past experience indicates that people are clever enough to travel to other countries 1st if they really want to come to this country. And they will hide their exposure to Ebola patients if it means being placed in quarantine. That simply increases our risk. There is no evidence that such quarantine would be better than finding contacts and taking their temperatures twice a day to detect the 1st evidence of illness.

When the governor of New York says he is instituting quarantine out of an abundance of caution, most can read the real reason as an "abundance of politics."

Will there be more cases in the United States? The chances are high that some will get past the travel-filter and that we have not as yet seen every possible error in blocking transmission in this country. But with steady and solid decisions based on past experience and new findings, the response will stop every chain of transmission promptly.

In fact, the public health response in this country has been far better than we could have expected, given the cutbacks in the public health infrastructure of recent years made worse by the private care system sometimes making decisions based on cost or insurance status rather than health needs.

Time will make clear the value of the wisdom of the advice given by the CDC and state health authorities. The hard work of thousands of health workers is not helped by media-generated panic or illogical political decisions.

Finally, as worrisome as Ebola is, it pales next to 1000 deaths a day due to tobacco, thanks to reluctant politicians over the decades, or to the more than 1000 deaths a week due to infections patients did not have when they entered the hospital, or the staggering toll of guns and influenza.

If only we, as a country, could show as much ingenuity in responding to our major health problems as we show with our criticism of the public health workers laboring to make the world safer.

[Byline: Bill Foege]

[Bill Foege, while working as a medical missionary in Africa and on assignment for the CDC, came up with the strategy known as "ring containment," which led to the eradication of smallpox. In 2012, President Obama honored Foege for his public health work with the Presidential Medal of Freedom. Foege is also on the board of directors for Humanosphere.]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Bill was Director of CDC when I was the director of the CDC San Juan Labs in Puerto Rico, and at my request waived federal regulations against purchasing foreign lab equipment to permit acquiring a British device that speeded up the lab diagnosis of dengue. - Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

Vielleicht steht's irgendwo in den eeeeewig langen Posts obendran schon geschrieben: Nordkorea hat wohl auch Angst vor Ebola und deshalb anscheinend beschlossen, dass alle Touristen, die ins Land kommen, zuerst 21 Tage in eine Quarantäne müssen - dies also bitte bei der Urlaubsplanung entsprechend berücksichtigen

EBOLA VIRUS DISEASE - ex AFRICA (29): UN CASE REPATRIATED, CANADA, NORTH KOREA, SUSPECTS
****************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] French UN employee repatriated
[2] Canada suspends visas for West Africa states
[3] North Korea: quarantine measures
[4] Suspected cases ex Africa

******
[1] French UN employee repatriated
Date: Sun 2 Nov 2014
Source: France 24 [edited]
http://www.france24.com/en/20141102-un- ... treatment/


UN worker with Ebola arrives in France for treatment
----------------------------------------------------
France is treating a UN employee who contracted Ebola while working with those infected in Sierra Leone, the French health ministry said on Sunday [2 Nov 2014]. The victim is in an isolation unit under high security at an army training hospital in Saint-Mande. France has 12 research hospitals ready to take in suspected Ebola cases. "The UN employee, who worked in Sierra Leone in the fight against Ebola, has undergone a secure medical evacuation by specialised aircraft," the French health ministry said in a statement.

A French nurse, who worked for Doctors Without Borders (MSF) in Liberia, was treated for Ebola at the same hospital in September [2014] and subsequently recovered.

Despite around 500 reports of [suspected] Ebola infections in France since June [2014], not one person has so far tested positive, the ministry said ... -- more

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[2] Canada suspends visas for West Africa states
Date: Sat 1 Nov 2014
Source: BBC News [edited]
http://www.bbc.com/news/world-us-canada-29861563


Ebola crisis: Canada suspends visas for West Africa states
----------------------------------------------------------
Canada is to suspend visa applications from residents and passport-holders from West African countries in the grip of the Ebola outbreak. The decision follows a similar decision by Australia, which drew criticism from the World Health Organization (WHO). The ban would apply to countries with "widespread and persistent-intense transmission", Canada said. Although Canada currently has no cases of Ebola, the country's federal citizenship ministry said "the introduction or spread of the disease would pose an imminent and severe risk to public health". A government spokesman said the move was less restrictive than Australia's plan, with the ability to grant visas on a case-by-case basis retained. The ban would also not apply to Canadians travelling from the Ebola zone -- allowing health workers and volunteers to return home....

WHO opposes travel bans
-----------------------
The WHO opposes travel bans as a method of containing Ebola. David Fidler, a professor at Indiana University in the USA, told Canadian media that the government's move undermined international regulations drawn up after the SARS outbreak of 2003. "The whole thing that so many years and so many efforts and so much money was spent on just seems to be disintegrating in this Ebola panic," he told CBC News ... -- more

--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>

******
[3] North Korea: quarantine measures
Date: Sun 2 Nov 2014
Source: The Guardian [edited]
http://www.theguardian.com/world/2014/n ... reat-ebola


In North Korea, fear takes hold over new foreign threat: Ebola
--------------------------------------------------------------
World's toughest measures against the disease have been imposed in a country far from west Africa, and with few tourists ...

The country announced it was banning all tour groups on 23 Oct [2014]. It also began refusing entry to citizens of countries that had had Ebola cases: a Beijing-based Spanish cameraman was told he could not make a scheduled trip; 2 individuals from African countries -- both far from the outbreak zone -- were ordered into quarantine after arrival in Pyongyang, though one has since been allowed to leave. An unknown number of North Korean citizens who have returned from abroad have also been quarantined, although it is not clear if the measure applies to all countries or specific ones. North Korea has diplomatic ties with Liberia, Guinea and Sierra Leone....

On Thursday [30 Oct 2014] the country tightened measures further, announcing that all foreigners entering the country would have to undergo a 3-week quarantine period. Foreign visitors who entered in the days before the quarantine announcement were told that daily temperature checks were compulsory....

Associated Press said on Friday [31 Oct 2014] that Chinese businesspeople on the border had said they were unaffected and China's state news agency, Xinhua, reported that no Chinese nationals had been quarantined. Already, officials have said that diplomats and the staff of international organisations -- who have to make regular trips to Beijing for cash and other supplies because of sanctions -- can serve their quarantine at home rather than at designated quarantine hotels ... -- more

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[4] Suspected cases ex Africa

Viet Nam ex Guinea suspected
----------------------------
1 Nov 2014: (Tuoi Tre News) A Vietnamese man who arrived from Guinea 5 days ago is suspected of having Ebola after showing a high fever and was quarantined in a hospital in central Vietnam's Da Nang City on Saturday [1 Nov 2014] ... -- more
http://tuoitrenews.vn/society/23738/pos ... al-vietnam

[NB: We are not posting any more suspected imported Ebola cases on ProMED because they have all been false alarms so far and only serve to put people off traveling "just in case the suspected Ebola case is confirmed." Travelers to countries that only have suspected cases are extremely unlikely to come into skin contact with anybody actually showing symptoms of Ebola infection. - Mod.JW]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[A HealthMap/ProMED-mail map of North Korea is available at http://healthmap.org/promed/p/196.]

EBOLA VIRUS DISEASE - ex AFRICA (30): USA SCARES, HOSPITAL PREPAREDNESS
***********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

[1] USA: Unhelpful scares from experts
[2] USA: Unnecessary precautions by school
[3] USA: Boston hospitals divide load

******
[1] USA: Unhelpful scares from experts
Date: Tue 4 Nov 2014
Source: Reuters [edited]
http://uk.reuters.com/article/2014/11/0 ... 1Q20141104


Even as government officials express confidence that researchers know the key facts about Ebola, many questions crucial to preventing an outbreak in the United States remain unanswered, scientists told a workshop at the National Academy's Institute of Medicine in Washington on Mon [3 Nov 2014]. Virtually all the unknowns have practical consequences, participants emphasized, making it foolish and perhaps dangerous to base policy on weak science... - more

[Byline: Sharon Begley]

--
Communicated by:
ProMED Rapporteur Kunihiko Iizuka
& Ryan McGinnis
<ryan@bigstormpicture.com>

[What the experts are reported to have said above about possibilities was quite correct, but they are just possibilities. There is only hard evidence at the moment for contact transmission between humans (and between bushmeat and humans), contact meaning contact with mucosal membranes (e.g. of the eye, nose or mouth) or broken skin with the blood or some body fluids of an infected person or animal. Note that the fact that Ebola virus has been found in sweat and saliva does not mean that it is there in sufficient quantity to infect anyone.

Pronouncements about possibilities do not help policy-makers make sound policy for proven threats, they merely feed the media hype that is resulting in paranoia in the USA & Europe, and leads for example to carabinieri wearing PPE to welcome US troops at arms length on their return from West Africa to their quarantine quarters in Italy, as if they were exhaling ebolavirus (see ProMED Ebola virus disease - ex Africa (26): USA quarantines, drug, vaccines, WHO 20141027.2906997), and to a US judge issuing a temporary ruling that a symptomless nurse who had a negative Ebola test had to stay at least 3 feet away from other people; see http://www.nbcnews.com/storyline/ebola- ... ng-n238326. The finding that Ebola was probably transmitted through the air between pigs and monkeys caged in a lab does not prove that the same could happen between people in crowded public spaces or transport; that's only another possibility, but policy is being based on it.

Yesterday [3 Nov 2014] was the 21st day since nurse Vinson flew back to Dallas from her pre-wedding shopping trip to Cleveland (ProMED Ebola virus disease - ex Africa (17): USA (TX) 2nd nurse update 20141015.2868385), and none of her 130 co-passengers have been reported to have had a significant fever. But good news of this sort does not make headlines. Meanwhile, in view of the concerns of people worried about unconfirmed possibilities (they are not even probabilities), unfortunately promulgated by experts, those responsible for public heath will continue to be guided by what the most vocal of the public demand, regardless of science but rather taking into account the effect on state and local voters and the impact on state and local hospitals, their health budgets, and the economy. - Mod.JW]

******
[2] USA: Unnecessary precautions by school
Date: 4 Nov 2014
Source: Courier-Journal [edited]
http://www.courier-journal.com/story/ne ... s/18417299


A teacher at St. Margaret Mary Catholic School who had recently returned from a mission trip to Kenya has resigned amidst swirling frustration and fears about Ebola. Susan Sherman was not immediately available Mon [3 Nov 2014] to comment on her resignation. Cecilia Hart Price, chief communications officer for the Archdiocese of Louisville, confirmed that Sherman resigned and that St. Margaret Mary's principal has already begun the process to try to fill the teaching position.

The school had asked Sherman to take a paid "precautionary leave" of absence of 21 days upon her return from her trip after "strong [school] parent concerns" about Ebola. It also asked Sherman, who is a registered nurse, to provide a doctor's note stating she was in good health. There have been no reported cases of Ebola in Kenya. Indeed, the archdiocese, in a statement released last month [September 2014] regarding Sherman's trip, noted that the Kenyan village where Sherman was working -- the remote village of Migori -- is "in Eastern Africa, thousands of miles from West Africa, where the main outbreak of the virus is located."...

Last week, Paul Sherman sent a letter to Archbishop Joseph Kurtz complaining that "unfounded fears" of some parents and parish staff "are triumphing over truth and reason." He said he and his wife offered to give an educational meeting about Ebola and about their medical mission trip, but they "were put off until our 'quarantine' is over." Steve James, founder of Kenya Relief, said he's only had one other mission trip participant experience a negative reaction upon returning home. He said all the other members of the team that went to Kenya have returned to their jobs with no problems... "We don't have Ebola in Kenya," James said. He said it's unfortunate when people making decisions "haven't paid attention to the facts."...

Last month [September 2014], a Dallas Certified Nursing Assistant claimed her employer sent her home because her daughter had visited from Kenya. A bridal shop in Akron, Ohio closed temporarily after it learned that a nurse who was later diagnosed with Ebola had shopped there...

--
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[It is a sad reflection on the state of geography education in Kentucky at the close of the 20th century (when those parents were in school). I hope today's teachers will point out to their pupils that Kenya does not have any cases of Ebola, and besides, Kenya is over 2500 miles further away by air from the Ebola-infected countries in West Africa as Louisville is from the closest Ebola case (in New York, 650 miles).

If the reason for parental concern is the possibility that an infected passenger might have arrived undetected in Kenya during her visit (Kenya has been designated a high risk country by WHO), will the school require 21-day leave for any staff member returning from travel to New York City, given the possibility that another asymptomatic infected health worker like CS -- or somebody else incubating Ebola -- might arrive back there any day now? - Mod.JW]

******
[3] USA: Boston hospitals divide load
Date: 29 Oct 2014
Source: Boston Globe [edited]
http://www.bostonglobe.com/metro/2014/1 ... story.html


Boston's top teaching hospitals are rejecting calls that one of them be designated as the state's primary Ebola treatment hub, saying that staff and space requirements would prove too burdensome, specialists from 3 institutions said Tue 29 Oct 2014. But the hospitals, among the most esteemed medical centers in the country, stressed that they would be willing to open their doors to small numbers of patients stricken with the viral disease. In a conference call last week, the state Department of Public Health floated the idea of having patients with Ebola symptoms transferred to a single regional center for treatment in Massachusetts, according to 2 people who were on the call. Instead, the hospitals suggested patients be spread among their facilities. The state health agency declined to comment on the call.

The fraught discussions over where to treat Ebola patients reflect the medical complexity of caring for those patients and the costs, in terms of finances and image, to hospitals. After a Texas hospital treated an Ebola patient from Liberia, other patients cancelled outpatient procedures, and business in the emergency room slowed, according to Dallas media reports.

"Each organization [in Massachusetts] was ready and prepared to serve their community," said Dr. Eric Goralnick, medical director of emergency preparedness at Brigham and Women's Hospital. "But we seem to come to agreement at this point that redundancy is important, and having multiple centers able to care for one or 2 patients is the right approach." The Brigham, Goralnick said, could treat one Ebola patient at a time. Massachusetts General Hospital said it could take up to 4. Boston Medical Center can handle 2-4. Our physical layout limits our capacity to a very small number of patients," said Dr. Stanley Hochberg, Boston Medical Center's senior vice president for quality, safety, and technology. "Wherever we place the patient, we would have to put that unit or parts of that unit out of service. We believe we can care for these patients," Hochberg added. "We are comfortable we can protect our staff. But it strains our ability to take care of all our other patients." Boston Medical Center is building a 3-bed biocontainment unit similar to those where Ebola patients have been treated in Omaha and Atlanta, but it will not be ready for at least 7 months, Hochberg said.

Dr. Paul Biddinger, medical director of emergency preparedness at Massachusetts General, said he also believes care should be divided among hospitals, given the burden on staff and finances in treating patients with the disease. "More than one hospital can do this in Boston," he said. "I am an emergency planning guy, and I believe in redundancy, so to have one place to be the receiving hospital doesn't make sense. To have a handful of tertiary hospitals that have the capacity to respond makes more sense."

Alternative approaches were suggested on the call with the Department of Public Health, Goralnick said, such as building a specialized unit at a military base or in a vacant hospital, or at a Veterans Administration hospital. These units could be staffed by different hospitals' medical workers, who would volunteer for such work.

Caring for an Ebola patient requires considerable space. In addition to the patient's room, there must be a "clean room" for donning protective equipment and a "dirty room" for taking it off, plus space for supplies and disposal of waste and possibly a laboratory nearby. All must be separated from other patients. Nebraska Medical Center, which has cared for 2 Ebola patients, required 40 to 60 staff members for each case; 5 medical workers tended to a single patient during each 12-hour shift, plus laboratory and other staff. Although the Omaha hospital's unit has 10 beds, officials said they would not handle more than 2 Ebola patients at a time. One room was taken up by the laboratory, which was moved closer to the patient to keep it separate from other samples, and 2 rooms were set aside for clean supplies and dirty supplies.

No patient with Ebola has been identified in Massachusetts, and the likelihood of it happening is considered remote, albeit possible. Logan Airport is not among the US airports designated for travelers arriving from West Africa. But every hospital has been investing in training and equipment to prepare for the possibility of an Ebola patient arriving, according to the Massachusetts Hospital Association. "At this time, all acute-care hospitals are ready to evaluate and determine treatment for patients exhibiting Ebola-like symptoms," a statement from the hospital association said.

[Byline: Felice J. Freyer]

--
Communicated by:
Roger Feldman <promedrf@gmail.com>

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.

EBOLA VIRUS DISEASE - ex AFRICA (31): UGANDAN CURED, TEXAS FREE, SAFETY, FUNDS
******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Ugandan doctor cured of Ebola in Germany
[2] USA: Texas Ebola-free
[3] Europe: EU funds for vaccine research
[4] USA: safety of lab equipment
[5] USA: remote diagnosis
[6] Japan: donates USD 140 million

******
[1] Ugandan doctor cured of Ebola in Germany
Date: Wed 5 Nov 2014
Source: Wall Street Journal [edited]
http://online.wsj.com/articles/ugandan- ... 1415204449


Patient is no longer infected but will remain in isolation for now
------------------------------------------------------------------
A Ugandan man being treated for Ebola in Germany is no longer infected and is headed toward a full recovery, officials at the University Hospital Frankfurt said on Wednesday [5 Nov 2014]. The patient, a doctor who contracted the disease while working in Sierra Leone for a nongovernmental organization, arrived in the country for treatment on 3 Oct [2014] He was in critical condition and suffered multiple organ failures. The patient is now free of the virus and able to move without pain. He will remain in isolation for the time being.

"We've really only known for a few days that he is out of the woods -- 10 days ago we weren't 100 percent sure," Dr. Timo Wolf, the lead physician for his treatment, said at a press briefing....

The doctors said Frankfurt medical staff weren't in danger, using optimal protective clothing, including 3 pairs of gloves, and a buddy system to prevent oversights. The team used around 50 protective suits a day. "Training is the decisive thing," said Prof. Hans-Reinhard Brodt, director of the clinic's HIV center. The cost of the Frankfurt patient's treatment is already around EUR 1 million (USD 1.25 million), Chairman and Medical Director of the University Hospital, Prof. Juergen Schoelmerich said. While both the hospital and the state of Hesse, where Frankfurt is located, have supported the treatment, the clinic is in discussions with the insurer of the NGO regarding payment.

In total, Germany has 7 special isolation wards with 47 beds available to treat patients, the federal health ministry said. The hospital will require 2-3 weeks to decontaminate the facilities and equipment used to treat the patient, but could accept additional patients within hours if required, Dr. Wolf said.... -- more

[Byline: Monica Houston-Waesch]

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******
[2] USA: Texas Ebola-free
Date: Fri 7 Nov 2014
Source: NBC News [edited]
http://www.nbcnews.com/storyline/ebola- ... ed-n242931


Texas' Ebola outbreak ends
--------------------------
As of midnight Friday [7 Nov 2014], it was 21 days since anyone got Ebola or was in contact with someone who got Ebola in Texas [USA]. "God willing, we are going to be Ebola-free Friday midnight," said Dallas County Judge Clay Jenkins, the elected official who oversaw the county's response to its 3-person outbreak, before the deadline passed.

It started when Thomas Eric Duncan, a Liberian citizen planning to settle in the United States, became sick and was at 1st mistakenly sent home from Texas Health Presbyterian Hospital in Dallas. He returned 2 days later by ambulance and was diagnosed with Ebola. Officials had to track as many as 50 people who may have been in contact with Duncan. But the real scare came when 2 nurses, Nina Pham and Amber Vinson, became infected while caring for him. Vinson had traveled to Ohio to make wedding plans and, even though she wasn't diagnosed until she came back to Dallas, her travels set off waves of anxiety.... -- more

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

******
[3] Europe: EU funds for vaccine research
Date: Thu 6 Nov 2014
Source: Reuters [edited]
http://www.reuters.com/article/2014/11/ ... 7J20141106


EU scheme commits USD 350 million for research on Ebola vaccines, tests
-----------------------------------------------------------------------
The Europe Union and drugmakers pledged on Thursday [6 Nov 2014] to invest 280 million euros (USD 350 million) in Ebola research, with the lion's share going to the testing and manufacture of potential vaccines. The funding will go to projects backed by the Innovative Medicines Initiative (IMI), a public-private scheme jointly paid for by the European Commission and the pharmaceuticals industry.

Reuters reported on 22 Oct [2014] that an IMI investment of around 200 million euros was pending. Since then, further discussions have been held about the resources needed for various projects and the amount has been increased. The final document setting out the plans commits the European Commission to giving as much as 140 million euros [about USD 175 million], with companies providing an equivalent amount in staff time, goods and services. "The EU is determined to help find a solution to Ebola. We are putting our money where our mouth is and boosting EU research on Ebola with an additional 280 million euros," said Carlos Moedas, European Commissioner for research.

The move shows how momentum is building to get medical intervention, especially vaccines, to West Africa as soon as possible, to try to control the world's worst Ebola outbreak, which has killed nearly 5000 people, according to official data. Many experts believe the true death toll is a lot higher.

The EU is also beginning its biggest single operation of transporting supplies to West Africa, with a Dutch ship sailing on Thursday [6 Nov 2014] from the Netherlands, loaded with ambulances, mobile hospitals, laboratories and other equipment provided by 9 European countries. With a total budget of 3.3 billion euros [about USD 4.1 billion] for the period 2014 to 2024, Europe's IMI scheme is the world's biggest public-private partnership in life sciences.... In the case of Ebola, 5 urgent projects have been identified involving the 3 stages of vaccine clinical trials:

- vaccine manufacturing;
- vaccine transport and storage;
- regimens for vaccination deployment;
- and rapid diagnostic tests.

The aim is to head off some of the technical obstacles that public health officials, governments and drugmakers face as they try to develop the world's 1st Ebola vaccines in record time. The challenges include finding enough vaccine manufacturing and filling capacity, getting accelerated clinical trial results, winning rapid regulatory approvals and building a supply chain in Africa for products that must be stored at ultra-low temperatures.

For diagnostics, the goal is to develop a simple test for Ebola infection that can generate results within 3 hours and preferably in less than 30 minutes.

2 leading vaccine candidates from GlaxoSmithKline and NewLink Genetics are already in human safety trials. Another 5 should begin testing in the 1st quarter of next year [2015]. One from Johnson & Johnson will start trials in January [2015]. The 3 leading companies hope to make millions of doses over the course of 2015.

[Byline: Ben Hirschler, Kate Kelland & Larry King]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[4] USA: safety of lab equipment
Date: Thu 6 Nov 2014
Source: USA Today [edited]
http://www.usatoday.com/story/news/nati ... /18546709/


Latest Ebola fear: Safety of lab equipment
------------------------------------------
When physicians at the Nebraska Medical Center got their 1st Ebola case in September [2014], they knew they'd rely heavily on sophisticated blood-test machines to monitor the man's condition. They didn't expect the virus might leave the machines incapacitated for longer than the patient.

Several leading manufacturers of high-tech diagnostic devices have alerted hospital laboratories that they will restrict service, support and warranties for equipment used to test blood and organ functions for Ebola patients. Fearing infections, some decline to have their technicians perform the tuning and maintenance the expensive devices often require. Others advise labs to quarantine the equipment after use on Ebola patients or even destroy it -- a policy that one company's own CEO calls "the dumbest" approach imaginable.

Hospital officials, including some involved in treating the few U.S. patients who have [caught] Ebola [virus disease], see many of the restrictions as irrational. They cite guidance from the Centers for Disease Control and Prevention [CDC], which advises that devices used to test biological samples from Ebola patients can be disinfected and reused safely. They note that the same equipment has been used for years to test blood from patients with other infectious diseases, such as HIV and hepatitis, and reused without problems.

"If this unfounded behavior continues, it could significantly impact the way hospitals care for these people," says Steven Hinrichs, chair of pathology and microbiology at the University of Nebraska and its affiliated hospital, which has treated 2 Ebola patients successfully. "These are good machines, we wanted to use them, but some (manufacturers) are saying you have to incinerate them if you do." ...

Concerns about the restrictive equipment policies were raised Thursday [6 Nov 2014] at a meeting of a CDC lab safety advisory committee, which includes officials from an array of hospitals. The agency's position is that "U.S. clinical laboratories can safely handle specimens from (Ebola) patients," but it reminds labs that "strict adherence" to safety protocols is especially important with those samples. Despite the CDC's reassurances, concerns about handling Ebola samples in lab environments are widespread. The nation's 4 big commercial diagnostic laboratories -- Quest Diagnostics, LabCorp, ARUP Laboratories and Mayo Medical Laboratories -- which do specialized tests on blood and tissue for thousands of hospitals and doctors across the country, announced that they will not accept blood or tissue samples from Ebola patients. Those policies aren't likely to have any immediate impact because the commercial labs aren't supposed to get Ebola samples at this point. The CDC and designated state public health labs handle all confirmatory tests for the virus. Any follow-up lab work on infected patients is done at the hospitals treating them....

"There's a generalized panic, and people in health care are not immune," says Amesh Adalja, a Pittsburgh [Pennsylvania] physician on the Public Health Committee of the Infectious Diseases Society of America. "We deal with a lot of blood-borne pathogens in lab settings, and there are adequate safety procedures (for Ebola).... But people are more comfortable making a decision that allows them to not actually make decisions, so they just say, 'We're not going to deal with this."

At Emory University Hospital in Atlanta [Georgia], doctors had 3 days' notice before getting the 1st U.S. Ebola cases -- a [male] doctor and a woman, both Americans, infected doing relief work in Liberia. They decided to do blood testing in a small lab in the isolation unit where the patients were treated, reasoning that it would limit the need to move infectious material through the hospital for analysis in its main lab -- and cut the risk of having to close the main lab for cleanup from a spill.

Several weeks later -- after both patients were cured and released -- an e-mail was circulated by Abaxis, the manufacturer of a portable blood-testing device, the "Piccolo," that Emory's doctors used to monitor the patients' blood in the isolation lab. The e-mail advised that Abaxis had finalized a new service and warranty policy for the USD 14 000 device: "The policy calls for the Piccolo to be incinerated after its use for testing Ebola patients." The directive "put us in a bit of a quandary," says James Ritchie, director of Emory Medical Laboratories. By the time it came out, the lab already had decided on a method for cleaning the Piccolos, and Ritchie and his staff were confident that their approach was effective. Besides, he adds, the Ebola virus doesn't live long outside the body, so if the device were just locked away for a few weeks, any live virus would be gone.

Ritchie compares the Ebola concerns to the fears surrounding HIV when it emerged in the 1980s. As with HIV, "we've had incidents where people have said things like, 'If those samples are coming into the lab, we're not coming to work,'" he says. "The fear factor is really great right now. I think you have to really just keep talking it down."

Clinton Severson, CEO of Abaxis, says he was unaware of the incineration policy issued for Piccolos until after it already had been sent to hospitals. "Technically, that is the policy, because somebody wanted a policy and if nobody has been given any guidelines, I guess the safest thing to say is to blow it up," he says. "But when people recommended that to me, I said, 'That's the dumbest thing I've ever heard in my life.'" Severson says the company decided to leave the policy in place while it investigated alternatives, and it has validated a cleaning protocol that will ensure Piccolos used to analyze Ebola samples can be reused for the general hospital population. A policy that outlines those cleaning protocols will be issued in the coming weeks, he says.

[Byline: Peter Eisler]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[Meanwhile, what are hospitals supposed to do about their machines? Even if they could be irradiated to kill any contamination, wrapped in sterile packaging, donated to West Africa -- where they could be really useful -- and sent by a UN, military or NGO airline (no other airline would touch them), they could not be serviced there. The world has obviously learned nothing from the HIV/AIDS experience. - Mod.JW]

******
[5] USA: remote diagnosis
Date: Sun Nov 3 2014
Source: National Geographic [excerpted, edited]
http://news.nationalgeographic.com/news ... technology


Treating Ebola: the Bluetooth method
------------------------------------
Keeping hands-off without abandoning the patient
------------------------------------------------
Before they set a toe into the concrete-walled isolation room, the doctors and nurses become fortresses unto themselves: face shields, of course, but respirators, too, plus 3 layers of gloves on each hand, duct-taped to their sleeves. Nurses watch over a webcam to keep them on protocol, and Bluetooth stethoscopes relay heart data directly to a remote location -- no ear canal exposure required.

Call it the no-touch approach to medicine. And it's the little-heralded reason that a hospital in Nebraska, of all places, has emerged as a leader in the stateside fight against Ebola. Already, it's brought 2 Ebola patients to recovery and prevented transmission to health care providers. The Centers for Disease Control and Prevention [CDC] has held up the hospital as a model for others....

The challenge is to harness technology's protective power without jettisoning the bedside manner, a key to healing, Nebraska health care practitioners acknowledge. They're navigating the trade-offs with computer screens that display "almost life-size" images, said Nebraska Medicine lead nurse Kathleen Boulter. And although providers remain hidden beneath layers of latex and paper, their patients have surprised them with an ability to recognize them by their eyes. "A lot of emotion is expressed by our eyes," she said.

So far, the hospital has a 100 percent success rate on Ebola. Its 1st Ebola patient, 51-year-old missionary Dr. Rick Sacra, stayed for nearly 3 weeks before his release. On 22 Oct 2014, the hospital discharged its 2nd patient, NBC freelance cameraman Ashoka Mukpo, 33, after a roughly 2-week stay, said Boulter.

So how does Nebraska Medicine work? It starts with a secured entrance. To limit traffic in and out of the isolation room -- and the risk of spreading disease -- it uses the Vidyo videoconferencing platform. The isolation room houses a webcam-equipped computer connected to the front desk, the biocontainment unit's conference rooms and providers' [medical staff] offices outside the unit. And inside the isolation room, providers can request a 2nd opinion or order supplies without ever leaving. "If something's going on, we know right away," Boulter said.

Traditional stethoscopes pose a huge contamination risk, medical professionals say, because they require practitioners to lodge earpieces into their ear canals. Technology, of course, has found a way around this. The 3M Littmann Electronic Stethoscope looks much like a regular stethoscope, but its Bluetooth capabilities allow Nebraska Medicine providers to take their ears out of the equation. Instead, a sensor goes onto the patient's chest. A USB dongle, connected to the computer in the isolation room, establishes a Bluetooth connection with a remote computer. Providers outside can listen to a patient's heart and lung sounds in real time. They can even tell health care workers inside the isolation room to reposition the sensor.

Another stethoscope used by Nebraska Medicine is the Thinklabs One Digital Stethoscope. Its high sound quality allows health care workers to wear earpieces over their surgical caps, eliminating ear-canal exposure. They slip them on just before entering the isolation room and plug them into a hockey puck-sized sensor -- equipped with a volume-control module -- that picks up sounds from the patient's chest. Providers chuck the earpieces into the hazardous waste bin when they doff their protective gear. [See comment below.]

Meanwhile, devices that monitor pulse and other vital signs upload measurements to the patient's electronic health record. And a wireless-capable X-ray allows nurses to send images directly to radiologists, skipping the step of transporting bulky film cassettes to the medical imaging department for processing....

And while other hospitals have embraced telehealth too, practitioners hope the healing touch is here to stay. "There are times when something as simple as holding a patient or family member's hand conveys calmness, caring, reduces fear.... I don't believe the effect of a human touch is something that can be replaced," Boulter said. Even the hospital's telehealth guru, Kyle Hall, agrees: "It's still about a human diagnosing the patient."

[Byline: Mellisa Pandika]

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

[Karl Johnson, who isolated and described Ebola virus in 1976, writes: "A stethoscope [is] important in helping manage fluid therapy where no modern tools are available. Wet lungs mean slow or stop IV fluids at peril of sudden fatal pulmonary edema." - Mod.JW]

******
[6] Japan: donates USD 140 million
Date: Fri 7 Nov 2014
Source: Japan Times [edited]
http://www.japantimes.co.jp/news/2014/1 ... st-africa/


Japanese government will provide up to USD 100 million in additional humanitarian assistance to Ebola-hit West Africa
--------------------------------------------------------------------------------
On Friday [7 Nov 2014] the Japanese government said it will provide up to USD 100 million in additional humanitarian assistance to Ebola-hit West Africa. The promised aid is in addition to the USD 40 million that Prime Minister Shinzo Abe pledged at the U.N. General Assembly in September [2014]. Abe will talk about Japan's efforts against the deadly virus during a series of upcoming international conferences. Abe is scheduled to attend meetings of the Asia-Pacific Economic Cooperation forum, the Association of Southeast Asian Nations and the Group of 20 this month [November 2014]. "The spread of Ebola has been a threat to international peace and security," Suga said. "The situation remains severe, so we have made the decision to accelerate assistance."

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

[A useful and highly relevant paper comparing the current outbreak with Zaire 1976 is:
Breman JG1, Johnson KM. Ebola then and now. N Engl J Med. 2014 Oct 30;371(18):1663-6. doi: 10.1056/NEJMp1410540. Epub 2014 Sep 10. http://www.nejm.org/doi/full/10.1056/NEJMp1410540.

(I declare my interest: I was a volunteer with Karl Johnson's Middle America Research Unit (MARU) field team in Bolivia during the 1963 outbreak of Bolivian hemorrhagic fever in the Bolivian Amazon at the time he made the 1st isolation of the rodent-borne Machupo virus and controlled it.)

For a geographical perspective on Ebola, these maps show how small the Ebola-infected part of Africa is compared with much of the rest of the world: http://kuow.org/post/twitter-snark-help ... ark-relief. - Mod.JW]

EBOLA VIRUS DISEASE - ex AFRICA (32): SPANISH NURSE RECOVERED, USA SEEKS PATENT
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Spain: nurse leaves Madrid hospital
[2] USA: government wants to patent the Ebola virus
[3] Worldwide: lack of ebolavirus samples for research
[4] USA: Ebola by the numbers

******
[1] Spain: nurse leaves Madrid hospital
Date: Wed 5 Nov 2014
Source: RTE Ireland [edited]
http://www.rte.ie/news/2014/1105/657129-ebola/


Nurse TR leaves Madrid, Spain, hospital after recovering from Ebola
------------------------------------------------------------------------------
A Spanish nurse who was the 1st person to catch Ebola outside Africa has left a Madrid hospital after recovering from her illness. TR was diagnosed with Ebola on 6 Oct 2014. She told reporters today [5 Nov 2014] that she thought she was going to die when she was 1st diagnosed and she paid tribute to the doctors and nurses who cared for her. "I was isolated and my only contact with the outside world was through the phone in my room [and the professionals on the staff]."

TR was treated with human serum containing antibodies from Ebola survivors and anti-virals. She was declared Ebola-free on 21 Oct 2014 although she remained in hospital until she became stronger. Doctors said they could not be sure if the medication which they gave TR had been responsible for her recovery. "In the absence of a control group, it is difficult to know what worked for our patient," said Marta Arsuaga, one of the doctors who have been working round the clock treating her.

Spain tightened its Ebola control measures after complaints that included inadequate training and protective suits that were too small for some medical workers. The changes include close monitoring of the people with whom TR came into contact and more thorough training. The government also lowered the temperature at which a fever serves as a red flag of possible Ebola virus [infection].

--
Communicated by:
Roger Feldman
<promedrf@gmail.com>

******
[2] USA: government wants to patent the Ebola virus
Date: Fri 7 Nov 2014
Source: International Business Times [edited]
http://www.ibtimes.com/us-government-wa ... ng-1719681


U.S. government researchers are embroiled in a 5-year fight with the US Patent and Trademark office for a patent on [an ebolavirus]. Though the effort sounds ominous, it could accelerate the pace of research into an Ebola vaccine by preventing pharmaceutical companies from monopolizing the field.

Through the Centers for Disease Control and Prevention [CDC], the U.S. government often seeks patents on viruses and their genetic material in an effort to research the diseases safely. If awarded a patent, the agency would make the material available for public use, which private companies aren't as likely to do. "If a company patents it, they could limit access," said Robert Stoll, former U.S. Patent and Trademark commissioner, currently an attorney at Drinker Biddle & Reath LLP. "[The government] could donate it to the public." It's happened before. The CDC holds a patent on the SARS virus from more than a decade ago. "The whole purpose of the patent is to prevent folks from controlling the technology," it said at the time. "This is being done to give the industry and other researchers reasonable access to the samples." ... -- more

[Byline: Kathleen Caulderwood]

--
Communicated by:
ProMED-mail
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[Indonesia's decision to withhold samples of avian influenza virus A (H5N1) from the World Health Organization for much of 2007 caused a crisis in global health -- see http://wwwnc.cdc.gov/eid/article/14/1/07-0700_article. The reason given was that Western pharmaceutical companies would patent drugs based on the viruses recovered that would be too expensive for developing countries to afford. This article goes into detail about all the legal arguments why no living thing can be patented. Not even a dead virus can be patented "because dead viruses exist in nature". - Mod.JW]

******
[3] Worldwide: lack of ebolavirus samples for research
Date: Wed 5 Nov 2014
Source: BetaWired [edited]
http://www.betawired.com/ebola-research ... es/1412716


Ebola researchers requesting access to virus samples
--------------------------------------------------------------
Ebola researchers from the USA are saying they are unable to obtain samples of Ebola virus making it harder for them to study and understand the virus. Without a sample, researchers are also saying that it would be harder to find a cure against it. Apparently, the lack of Ebola virus samples is due to growing caution by regulators and transport companies in handling Ebola specimens. The limited resource from West Africa is also another reason according to researchers.

Reuters have contacted 10 scientists that are currently working on Ebola and they all said they were unable to find any Ebola virus sample. According to the Centers for Disease Control and Prevention [CDC], transporting a live specimen of the Ebola virus is challenging. So far, only Tulane University has got a sample of the virus from the CDC.

As scientists try to understand this Ebola virus, they need to have constant supply of it. If there are any changes, they need to know so they can incorporate them with the vaccine or cure that they are trying to make. Apparently, with the short of supply of live specimens, it means delays on the development of vaccine and cure as well. One research institution that is in need of a live specimen of Ebola virus is microbiologists and infectious disease expert Dr. Charles Chiu. Dr. Chiu is currently trying to develop a new genetic test that aims to detect Ebola infection prior to the development of symptoms. Another individual working on developing a cure against Ebola is Erica Ollmann Saphire of the Scripps Research Institute in La Jolla, California. She is one of the developers of ZMapp. She is continuously working on finding a cure for Ebola and she has been requesting a special cell from Ebola survivors but hasn't received any response yet. The CDC promised that it will do its best to acquire live specimens in a matter of weeks according to CDC spokesman Tom Skinner.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[4] USA: Ebola by the numbers
Date: Sat 8 Nov 2014
Source: Politico [edited]
http://www.politico.com/story/2014/11/e ... 12699.html


Ebola in America: By the numbers
---------------------------------------
A snapshot of how Ebola has played out in the United States since 1 Aug 2014:

9 patients: 5 cases were diagnosed overseas. Of the 4 U.S.-diagnosed cases, 2 involved transmission [in the USA].

One death: Liberian national Thomas Eric Duncan, the "index case" in Dallas [Texas], died on 8 Oct 2014.

One current hospitalization: physician CS, who became ill after returning from volunteer medical duty in Guinea, continues to improve at Bellevue Hospital Center in New York.

4 quarantine orders: Officials in Texas, New York, New Jersey and Maine have executed orders to quarantine at least 7 individuals. Nurse KH went to court to overturn hers.

60 diagnostic tests: Of the untold number of people to show up at hospitals nationwide with symptoms of potential concern, CDC has run diagnostic tests on about 60. It has had 4 positive findings [Duncan, CS, and 2 nurses].

7 schools closed: Districts in Texas and Ohio closed 7 schools for at least a day in October [2014] because of concerns over potential exposure to Ebola -- in one case because a staff member might have ridden on the same Frontier Airlines plane, although not at the same time, as a Dallas nurse who subsequently became ill.

More than 1200 airport screenings: In the 1st 3 weeks of intensified traveler scrutiny at 5 U.S. airports, 1249 passengers were referred for enhanced screening. Of those, 62 underwent a CDC health assessment; 4 had elevated temperatures; 8 were taken to medical facilities for additional evaluation [including 4 who did not have elevated temperatures? Why? - Mod.JW].

Hundreds of travelers monitored: In New York alone, 357 people were under active monitoring as of Wednesday [5 Nov 2014]. "The vast majority of these individuals are travelers arriving in New York City within the past 21 days from the 3 Ebola-affected countries," according to the city's health department.

30 scientists missing: Nearly 3 dozen experts who were expected at the American Society of Tropical Medicine and Hygiene's meeting this week in New Orleans [Louisiana] were told not to come because they'd been in an Ebola-affected country within the past 21 days -- the full incubation period for the viral disease. Louisiana officials said the scientists would be confined to their hotel rooms if they tried to attend the meeting.

[Byline: Susan Levine]

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[A HealthMap/ProMED-mail map of the USA is available at http://healthmap.org/promed/p/106.]

EBOLA VIRUS DISEASE - ex AFRICA (33): CHINA, PHILIPPINES, SHIPPING, MOROCCO
***************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] China to build 100-bed treatment centre in Liberia
[2] Philippines: donating USD 1 million to UN Ebola fund
[3] Worldwide: social media
[4] West Africa: shipping problems, stowaways
[5] Morocco: refuses to host Africa football cup

******
[1] China to build 100-bed treatment centre in Liberia
Date: Fri 7 Oct 2014
Source: Reuters [edited]
http://mobile.reuters.com/article/idUSL ... 1?irpc=932>


China will dispatch an elite unit from the People's Liberation Army to help Ebola-hit Liberia, the Foreign Ministry said on Fri [7 Oct 2014], responding to U.N. calls for a greater global effort to fight the deadly virus in West Africa... Beijing has faced criticism for not doing enough.

The PLA squad, which has experience from a 2002 outbreak of severe acute respiratory syndrome (SARS), will build a 100-bed treatment centre in Liberia, the 1st such facility in the 3 countries most impacted by Ebola to be constructed and run by a foreign country, said Lin Songtian, director general of the ministry's Department of African Affairs. The centre will be open for operation in a month's time [December 2014], he told a briefing in Beijing. China will also dispatch 480 PLA medical staff to treat Ebola patients, he said. It's the 1st time China [will have] deployed a whole unit of epidemic prevention forces and military medical staff abroad, Lin said.

China is Africa's biggest trade partner, tapping the continent's rich vein of resources to fuel its own economic growth over the past couple of decades. Some critics have rounded on Beijing for not helping more in Africa's hour of need. China has so far donated 750 million yuan (USD 123 million) to 13 African countries and international organisations to combat Ebola, according to the government. "China's assistance will not stop until the Ebola epidemic is eradicated in West Africa," Lin said...

China said in July [2014] that more than half its foreign aid of over USD 14 billion went to Africa. In comparison, the United States spent about USD 46 billion in fiscal year 2015 on foreign aid programmes. China has also dispatched hundreds of aid workers to Africa to combat Ebola, including health experts and medical staff. Sihuan Pharmaceutical Holdings Group Ltd., a Chinese drug maker with military ties, has sent several thousand doses of an experimental Ebola drug to Africa and is planning clinical trials there [See Ebola virus disease - ex Africa (22): Canada, China, France, UK, USA, guidelines 20141022.2891397, item [2]].

Lin said several thousand Chinese nationals live in Guinea, Liberia and Sierra Leone, and about a million Chinese nationals live on the African continent... - more

[Byline: Megha Rajagopalan]

--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>

******
[2] Philippines: donating USD 1 million to UN Ebola fund
Date: Fri 7 Nov 2014
Source: Xinhua via Daily Times Pakistan [edited]
http://www.dailytimes.com.pk/foreign/07 ... ebola-fund


The Philippine government said on Fri [7 Nov 2014] that it will donate at least USD 1 million to the United Nations' trust fund to help fight the deadly Ebola virus disease. Philippine President Benigno Aquino III said that the presence of Filipinos abroad, estimated at 10 million, has made it imperative for the country to contribute to the UN's Ebola Response Multi-Partner Trust Fund. Aquino said that the Philippine government will exert all efforts to ensure that the country will remain Ebola-free. The Philippine government has allotted some 26 million pesos [USD 577 000] for the implementation of measures to prevent the entry and spread of Ebola in the country.

Measures put in place by the Philippine government to prevent the spread of the deadly disease include a 21-day quarantine for Filipinos coming from Ebola-stricken countries. Earlier, the Philippine government said that the 142 Filipino peacekeepers who will arrive on 11 Nov [2014] from Liberia will be brought to an island in the northern part of the country where they will be quarantined for 21 days.

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******
[3] Worldwide: social media
Date: Sat 8 Nov 2014
Source: Lancet [excerpted, edited]
http://www.thelancet.com/journals/lance ... X/fulltext


Analysis of social media traffic tells a story of unbalance. During October [2014], there were 21 [million] tweets about Ebola in the USA, compared with 13 480 about Ebola in Guinea, Liberia, and Sierra Leone combined. Yet around 5000 deaths and 14 000 cases in West Africa show that the epidemic continues to dominate at the source in these countries, contrary to the media footprint of Ebola...

We opened the [Lancet tweet] discussion by asking both Professors Heymann and Mabey to comment on the situation in West Africa right now, and subsequent questions focused on Africa's current needs, local challenges, cultural issues, and opportunities for treatment and prevention. Within the limit of 140 characters, we paraphrased our experts, who said that:

- "The absolute key is getting the community on board: there are dangers in parachuting western health workers into countries." And,
- "Local solutions to local problems need Africans training Africans, [for example] DRC supporting Guinea, good regional solidarity, a wealth of experience within Africa."

Twitter users echoed this sentiment: "co-operation and partnership between Africans," and "we need to help Africans strengthen their own capacity."
A call for anthropological empathy towards differences between cultures was voiced, triggered by David Heymann's observation that some

- "people in West Africa believe that bodies are full of evil spirits," a valuable and helpful belief if it leads to safer infection control and burial practices.

Our experts agreed that

- "it doesn't help to estimate trajectories. Watch what's happening now; deal with it now. Focus on present, not future."

Moving onto vaccines, David Mabey said,

- "On GSK vaccine: getting funding for Ebola research has been very difficult in the past. Traditionally, biodefense money used [sic] to fund [it]," which led Twitter to discuss the use of vaccines outside the framework of randomised trials.

Regarding the state of global health, and the robustness of country governance, we discussed and tweeted the need for stronger country governance, not only stronger global governance. The final question posed to our guests was

"Priorities for the next 60 days?"

- David Mabey said: "More beds in Freetown, train doctors, nurses, higher standard of supportive care. Promote positive African activities," and
- David Heymann added "and concentrate on community...while learning from local successes."

Social media during a health crisis has the potential to bring experts together in a transparent and democratic forum with global participation to generate a mass of new and potentially helpful ideas. Scaling up the positive and constructive discussion of an informed Twitter discussion could remove boundaries between scientists, health professionals, and policy makers, creating a new diverse community that gives everyone a voice and an opportunity to contribute. To create the conditions to defeat Ebola, we need more of that kind of global engagement, knowledge, and commitment.

[Ref: The Lancet, Volume 384, Issue 9955, Page 1641, 8 November 2014 doi:10.1016/S0140-6736(14)62016-X]

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******
[4] West Africa: shipping problems, stowaways
Date: Fri 17 Oct 2014 [this only reached ProMED on 8 Nov 2014]
Source: Lexology [excerpted, edited]
http://www.lexology.com/library/detail. ... 43b8f4eac9


Port closures and risks to crew safety: These are some of the consequences of the current Ebola outbreak for which the shipping industry is bracing itself... Several Danish ship owners have considered refusing to call at West African ports. While maintaining service, all Danish ship owners exercise great caution as regards the risk of infection. Together with a number of ship owners, the Danish Ship Owners' Association has set up a working group to provide advice and information to ship owners on how to avoid infection and how the disease develops.

Traditionally, case law has shown a tendency to focus on the safety of the vessel and not the safety of the crew. However, it cannot be excluded that the Ebola threat to the crew would in itself be sufficient to deem the port unsafe in legal terms. And in all circumstances, the shipowner is responsible for the safety of the crew.

So far, all ports in West Africa are still open. However, since most cargo from West Africa consists of general cargo, ship owners face the additional challenge that local stevedores are being used to a great extent, boarding the vessel in connection with loading and unloading. If a stevedore is a disease carrier, infection may at worst be transmitted to the crew. Consequently, there is a risk of the vessel being placed in quarantine, resulting in delays and off-hire. Unless it is possible under the charter party to refuse to call at the affected ports, it is, therefore, of paramount importance that the crew rigorously comply with the ISPS Code and generally do everything possible to avoid stowaways.

Reports of stowaways from West Africa during the current Ebola outbreak have already resulted in quarantine for several vessels, and a few countries have started to turn away vessels that have recently called at ports in the affected areas.

Consequently, ship owners are increasingly considering whether -- in future charter parties and fixtures -- they should insist on a trading limit (the right to refuse to call at specific harbours) for the countries affected, and whether it is possible to negotiate for the inclusion of such a trading limit in existing charter parties and fixtures.

--
Communicated by:
Bech-Bruun
Johannes Grove Nielsen, Denmark

******
[5] Morocco: refuses to host Africa football cup
Date: Sat 8 Nov 2014
Source: RT [edited]
http://rt.com/news/203595-african-cup-ebola-morocco


Morocco has rejected an ultimatum and refused to host the 2015 Africa Cup of Nations in January [2015] over the fear that Ebola virus may find its way into the country with the crowds of football fans and easily spread among them during the mass sporting event. "The decision is dictated by health reasons because of the serious threat of Ebola and the risk of its spreading," said a statement from Morocco's sports ministry on Sat [8 Nov 2014], the last day when the country was supposed to confirm the hosting of the championship.

The Moroccan government is concerned that a flow of football fans from West Africa could bring the disease to the Ebola-free country and has been asking the confederation to postpone the event until June [2015], and if the virus continues to spread, to January 2016. The fate of the 16-team tournament, scheduled on 17 Jan-8 Feb 2015, will be decided next week when Confederation of African Football (CAF) executives meet in Cairo on Tue [11 Nov 2014]. CAF could either move the event to another country or cancel it, as, so far, no country has volunteered as an emergency host. The Confederation accused Morocco of alarmism and exaggerating the Ebola threat, among other arguments, claiming that "there is unlikely to be a team from the worst affected area in the finals," according to Reuters.

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[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/158.]

EBOLA VIRUS DISEASE - ex AFRICA (34): US DOCTOR DISCHARGED, ROBOTS, WHO, GOOGLE
*******************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] WHO/UNWTO against travel & trade bans, quarantine
[2] USA: (New York) doctor now Ebola free, will be released from hospital
[3] USA: (California) some nurses plan strike over Ebola unpreparedness
[4] USA: robots, fighting Ebola with technology
[5] WHO: Ebola fraud warning
[6] USA: Google will double gifts for Ebola campaign

******
[1] WHO/UNWTO against travel & trade bans, quarantine
Date: Mon 10 Nov 2014
Source: UNTWO (UN World Tourism Organization) press release [edited]
http://media.unwto.org/press-release/20 ... break-west


Statement from the Travel and Transport Task Force on Ebola virus disease outbreak in West Africa
-----------------------------------------------------------------
Leading international organizations and associations from the transport, trade, and tourism sector stand firmly with the World Health Organization (WHO) against general bans on travel and trade, as well as restrictions that include general quarantine of travellers from Ebola-affected countries.

The Travel and Transport Task Force, established in August 2014, calls for international cooperation of governments and the transport sector in following the recommendations of the International Health Regulations Emergency Committee on Ebola, convened by WHO. WHO does not recommend general bans on travel or trade, or general quarantine of travellers arriving from Ebola-affected countries, as measures to contain the outbreak. Such measures can create a false impression of control and may have a detrimental impact on the number of health care workers volunteering to assist Ebola control or prevention efforts in the affected countries. Such measures may also adversely reduce essential trade, including supplies of food, fuel and medical equipment to the affected countries, contributing to their humanitarian and economic hardship.

Screening for Ebola
-------------------
Current exit screening of all persons departing affected countries through international airports, seaports and major land crossings is recommended by WHO and can reduce the numbers of people with symptoms from travelling from the countries with high levels of Ebola transmission. While screening upon entry into non-affected countries may provide an opportunity to further increase public awareness about Ebola, such screening also can require significant resources including staff, facilities and systems to care for ill travellers who might be suspected of having Ebola.

Preparedness for non-affected countries
---------------------------------------
The best protective measures for non-affected countries are adequate levels of preparedness, including heightened surveillance to detect and diagnose cases early and well prepared staff and operational planning to ensure that suspect cases of Ebola are managed safely and in ways to minimize further spread. Communication campaigns should be conducted to inform travellers, airlines, shipping crews, staff working at points of entry, and health workers everywhere about the symptoms of Ebola virus disease and what to do if a person has symptoms. Data on the efficiency of exit screening should be made available.

Advice to travellers
--------------------
People who have travelled to one of the 3 West African countries currently affected by Ebola virus disease (Guinea, Liberia, and Sierra Leone) should take the following precautions for 21 days after returning:
- stay within reach of a good quality health care facility
- be aware of the symptoms of infection (sudden fever, intense weakness, muscle pain, headache, vomiting, diarrhoea, rash, and sometimes bleeding)
- immediately report a fever of 38 deg C [100.4 deg F] or higher to their local medical emergency service (ideally by phone) [that is, not by going there personally, especially not by public transport - Mod.JW]
- and mention their travel history.

Note:
- early treatment improves the chance of recovery
- to catch Ebola requires direct contact with the body fluid of an Ebola-infected person
- asymptomatic individuals are not infectious, even if they are incubating the disease.

Attending international meetings
--------------------------------
The IHR Emergency Committee agreed that there should not be a general ban on participation of people from countries with transmission of Ebola from attending international meetings and events. The decision of participation must be made on a case by case basis by the host country. This country may request additional health monitoring of participants.

The Travel and Transport Task Force, which includes WHO, is working together to:
- develop guidance on exit screening recommendations for affected countries
- provide a set of considerations and steps for planning entry screening at point of entry for countries that wish to introduce this as part of their preparedness plan
- inform the aviation and maritime sectors on procedures for caring safely for travellers who are suspected to be infected with Ebola on board an aircraft or ship, or at arrival points
- provide information on Ebola to travellers arriving at or leaving airports, ports, or other transit points
- develop protocols for the passenger shipping sector
- collect data and work with authorities to reduce restrictions to port arrivals and ship and aeroplane movements.
The Task Force is concerned about reports of denial of medical care for ill seafarers on board ships that had previously called at ports in the Ebola-affected region.

About the Travel and Transport Task Force... -- more

Contacts
--------
UNWTO
senior media officer: Marcelo Risi
<mrisi@UNWTO.org>
WHO
communications officer: Tarik Jasarevic
<jasarevict@who.int>

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******
[2] USA: (New York) doctor now Ebola free, will be released from hospital
Date: Mon 10 Nov 2014
Source: CNN [edited]
http://edition.cnn.com/2014/11/10/healt ... ebola-free


The doctor who was diagnosed with Ebola in New York City last month [October 2014], is now free of the virus and will be released from the hospital Tue [11 Nov 2014], city officials said. "[The doctor] poses no public health risk and will be discharged from the hospital tomorrow," the New York City Health and Hospitals Corporation said in a statement on Mon [10 Nov 2014].

The Doctors Without Borders [Medecins sand Frontieres; MSF] physician, became the 1st person to test positive for the deadly virus in the city after returning from treating patients in Guinea. Officials said [the 33 year old physician] was hospitalized after developing a fever, nausea, pain, and fatigue. He has been in isolation at New York's Bellevue Hospital, where he was undergoing treatment... -- more

[byline: Shimon Prokupecz, Catherine E Shoichet]

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[See also: Why US Ebola patients seem to be recovering faster http://edition.cnn.com/2014/10/29/healt ... s-recovery. - Mod.JW]

******
[3] USA: (California) some nurses plan strike over Ebola unpreparedness
Date: Sun 9 Nov 2014
Source: The Washington Times [edited]
http://www.washingtontimes.com/news/201 ... la-unprepa


Some 18 000 Kaiser Permanente nurses in Northern California are planning a 2-day strike this week against what they say is unpreparedness in fighting the deadly Ebola virus. The walkout scheduled for Tuesday and Wednesday [11-12 Nov 2014] would affect 21 hospitals and 65 clinics owned by Kaiser Permanente, said Charles Idelson, a spokesman for National Nurses United, Bloomberg reported. The union said in a statement Thu [6 Nov 2014] that Kaiser "continued to stonewall on dozens of proposals to improve patient care standards, as well as refusing to address the concern of Kaiser RNs [registered nurses] about Ebola safety protocols and protective equipment, refusing to even answer questions by the RNs."

Kaiser spokesman John Nelson denied allegations that health workers aren't being trained adequately. "We are training our staff on how to use the right protective gear, to make sure they know how to use it," he told Bloomberg. "We have repeatedly asked union leadership to work with us on our Ebola strategy. They have refused. Instead, they continue to hold press conferences claiming hospitals are unprepared for Ebola." Mr Nelson said Kaiser hospitals are preparing for the walkout next week by rescheduling elective procedures and non urgent appointments.

[byline: Jessica Chasmar]

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[It's not a state-wide strike. California has about 350 hospitals, of which Kaiser Permanente owns or operates only 37, so no need for anyone to panic. We understand that normal shifts will be on duty, with off-duty nurses demonstrating outside -- not a work stoppage inside. But this might not be the best way to promote public confidence in those hospitals' preparedness for the importation of an Ebola case. - Mod.JW]

******
[4] USA: robots, fighting Ebola with technology
Date: Mon 10 Nov 2014
Sources: see below


6 reports on robotics in Ebola care, each from a different angle
----------------------------------------------------------------
1. Here are some robots we could use to fight Ebola
http://www.defenseone.com/technology/20 ... rica/97100
2. Researchers, medical workers seek tech answers to Ebola outbreak
http://www.computerworld.com/article/28 ... break.html
3. Ebola-tackling robots to be discussed by the White House
http://www.bbc.com/news/technology-29942392
4. Worcester Polytechnic Institute (WPI) explores using robots to treat Ebola
http://www.telegram.com/article/2014110 ... 89829/1116
5. Local researchers testing remote control Ebola care
http://www.wcvb.com/health/local-resear ... e/29586104
Local researchers testing remote control Ebola care
6. Doc eyes high-tech ways to fight Ebola
https://www.bostonherald.com/news_opini ... ight_ebola

--
communicated by:
ProMED-mail rapporteur Mary Marshall

[Of course, robots operating in a contaminated environment will themselves have to be decontaminated after each shift. They are only likely to be used in developed countries because of the problem of expert maintenance, which would likely be frequently necessary in a tropical country. And even in the USA, would manufacturers be any less reluctant to repair robots than those that are refusing to perform routine maintenance on blood analysis machines used in Ebola labs? - see ProMED-mail: Ebola virus disease - ex Africa (31): Ugandan cured, Texas free, safety, funds 20141107.2938140 item [4]. - Mod.JW]

*******
[5] WHO: Ebola fraud warning
Date: Sun 9 Nov 2014
Source: Sacramento Bee [edited]
http://www.sacbee.com/news/local/health ... 78251.html


The World Health Organization, master planner of the planet's battle against the deadly Ebola virus, is warning of various fraudulent schemes claiming to be raising funds for the eradication effort. "Beware of scams implying association with the WHO," organization leaders said in a news release urging the public to spurn the deceptive requests for money. "Many of these scams request detailed information and/or money from individuals, businesses, or non-profit organizations with the promise that they will receive funds or other benefits in return," the WHO release said. Most of the phony solicitations are sent as emails from rogue websites. In many cases, somebody will call or fax to try to collect money unlawfully. Some schemes display the WHO logo, and refer to email addresses made to look like WHO or the United Nations' addresses.

"In particular, WHO suggests that recipients do not send money or personal information in response to invitations from anyone who claims to be awarding jobs, funds, grants, scholarships, certificates, lottery winnings, or prizes, and/or who requests payment for registration fees and hotel room reservations in the name of WHO," the release said.

At the same time, WHO officials said they calculate it will take about USD 260 million to stamp out the current outbreak, the worst ever since the virus was discovered along the Ebola River, from which it got its name, in 1960. As of last week, the WHO had received only half of that. Another 15 percent has been pledged, leaving a shortfall of 36 percent of funds needed. For decades, the organization has warned its worldwide member states that poor countries in Africa just recovering from civil strife were ripe for rapid outbreaks because of a lack of sufficient public health facilities... -- more

[byline: Cynthia H Craft]

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******
[6] USA: Google will double gifts for Ebola campaign
Date: Mon 10 Nov 2014
Source: Google [edited]
http://googleblog.blogspot.co.uk/2014/1 ... tions.html


Today [10 Nov 2014], Google is launching a public giving campaign to fight Ebola. For every US dollar you give, Google will donate US 2 dollars. In addition, we're donating USD 10 million right away to support nonprofits such as InSTEDD [Innovative Support to Emergencies, Diseases, and Disasters], International Rescue Committee, Medecins Sans Frontieres, NetHope, Partners in Health, Save the Children, and US Fund for UNICEF. These organizations are doing remarkable work in very difficult circumstances to help contain this outbreak, and we hope our contribution will help them have an even greater impact. Separately, our family foundation will also be giving USD 15 million. Our hearts go out to everyone whose lives have been touched by this tragedy.

[posted by: Larry Page, CEO Google]

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[You can donate in US dollars at the source URL above. - Mod.JW]

[A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/106.]

EBOLA VIRUS DISEASE - ex AFRICA (35): SUSPECTED EBOLA CASES, QUARANTINE
***********************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] AP policy on reporting suspected cases of Ebola in USA & Europe
[2] Worldwide: suspected imported cases of Ebola and quarantines since 1 Nov 2014

******
[1] AP policy on reporting suspected cases of Ebola in USA & Europe
Date: Fri 17 Oct 2014 [note date]
Source: Associated Press (AP) [edited]
http://blog.ap.org/2014/10/17/advisory- ... a-coverage


Advisory on Ebola coverage
--------------------------
Editors:

We're increasingly hearing reports of "suspected" cases of Ebola in the United States and Europe. The AP has exercised caution in reporting these cases and will continue to do so.

Most of these suspected cases turn out to be negative. Our bureaus monitor them, but we have not been moving stories or imagery simply because a doctor suspects Ebola and routine precautions are taken while the patient is tested. To report such a case, we look for a solid source saying Ebola is suspected and some sense the case has caused serious disruption or reaction. Are buildings being closed and substantial numbers of people being evacuated or isolated? Is a plane being diverted? Is the suspected case closely related to another, confirmed Ebola case?

When we do report a suspected case, we will seek to keep our stories brief and in perspective.

The AP

[byline: Erin Madigan White]

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******
[2] Worldwide: suspected imported cases of Ebola and quarantines since 1 Nov 2014

12 Nov 2014 Denmark: (Copenhagen) Dane observed for suspected Ebola infection after visit to West Africa
http://www.shanghaidaily.com/article/ar ... ?id=252028

12 Nov 2014 Mali: (Bamako) Mali quarantines dozens after Ebola kills 2nd victim
http://uk.reuters.com/article/2014/11/1 ... 3820141112

10 Nov 2014 Liberia: What difference does 21 days make? MSF
http://blogs.msf.org/en/staff/blogs/msf ... om-the-usa

10 Nov 2014 Malawi: Government denies reports of suspected Ebola case
http://www.nyasatimes.com/2014/11/10/ma ... ebola-case

10 Nov 2014 South Africa: CBS' Lara Logan quarantined after Ebola report
http://www.msn.com/en-us/tv/news/cbs-lo ... ar-AA7tRIE

10 Nov 2014 UK (N Ireland): Ebola: 'Negative test result' on Belfast patient
http://www.bbc.com/news/uk-northern-ireland-29984150

3 Nov 2014 UK (Wales): Negative test for suspected Ebola case at Glangwili (Wales)
http://www.bbc.com/news/uk-wales-south- ... s-29880419

10 Nov 2014 UN WHO/UNWTO against travel & trade bans, quarantine
http://media.unwto.org/press-release/20 ... break-west

8 Nov 2014 Japan: Suspected case of Ebola ruled out in Japan
http://www.shanghaidaily.com/article/ar ... ?id=251473

7 Nov 2014 Philippines: 21-day quarantine for Filipinos coming from Ebola-stricken countries.
http://www.dailytimes.com.pk/foreign/07 ... ebola-fund

2 Nov 2014 North Korea: Fear takes hold over new foreign threat: Ebola (quarantine on all entering from abroad)
http://www.theguardian.com/world/2014/n ... reat-ebola

11 Nov 2014 USA (MD): Maryland Health Department: no more details on suspected Ebola cases
http://www.wboc.com/story/27348544/md-h ... bola-cases

10 Nov 2014 USA (NC): Missionary quarantined in Charlotte connected to 3 other Ebola cases
http://www.walb.com/story/27335476/miss ... bola-cases

10 Nov 2014 USA (IL): Dozen in Illinois being monitored, but not quarantined, for Ebola
http://www.chicagotribune.com/lifestyle ... story.html

9 Nov 2014 USA (SC): Pilot with 'flu-like' symptoms is 'no risk' for Ebola (never left the plane)
http://www.live5news.com/story/27323882 ... bola-virus

8 Nov 2014 USA (NYC): Ebola 'active monitoring': 357 active cases
http://healthmap.org/ln.php?2940084&u3392

8 Nov 2014 USA (IA): Iowa Department of Public Health says that 13 travelers who were in West African countries are being monitored in for Ebola
http://www.siouxlandmatters.com/story/d ... INl7bjKhVQ

6 Nov 2014 USA (NC): Duke patient tested negative for Ebola, discharged
http://www.news-record.com/news/duke-pa ... f6878.html

6 Nov 2014 USA (TX): It's over -- Texas' Ebola outbreak has ended
http://www.nbcnews.com/storyline/ebola- ... ed-n242931

4 Nov 2014 USA (IN): Teacher leaves Catholic school amid Ebola fears (after trip to Kenya)
http://www.courier-journal.com/story/ne ... s/18417299

--
communicated by:
Celeste Whitlow
<whitlow.celeste@gmail.com>

[Note that the Associated Press (AP) did not refer to suspected cases in Africa. ProMED-mail has been independently following a similar editorial policy in recent weeks. However, in response to a plea to post all unconfirmed reports of suspected Ebola cases and quarantines, in order for readers to be able to make up their own minds as to the severity of the potential threat worldwide, we are posting those that have come to our notice since the beginning of November 2014, and will continue to post similar updates. - Mod.JW]

EBOLA VIRUS DISEASE - ex AFRICA (36): USA MEDEVAC, STRIKE, AUSTRALIA, SAFETY
****************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] USA: new case medevaced to Nebraska
[2] New strategy for Liberia
[3] USA: nurses strike
[4] Australia to screen all arrivals
[5] Worldwide: safety video free to mariners

******
[1] USA: new case medevaced to Nebraska
Date: Fri 14 Nov 2014
Source: USA Today [edited]
http://www.usatoday.com/story/news/nati ... t/18995987


3rd Ebola patient headed to Nebraska Medical Center
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The patient is a Sierra Leonean national who is a permanent resident of the United States and lives in Maryland, AP reported, citing an anonymous source. He reportedly was working at Kissy United Methodist Hospital in Freetown, Sierra Leone, when he came down with Ebola symptoms on 6 Nov 2014. He tested negative for the virus at that time, AP reported. When he was tested again on Monday [10 Nov 2014], the results came back positive. The patient will arrive on Saturday [15 Nov 2014] at the University of Nebraska facility, the Omaha World-Herald reported, citing an unidentified person "with knowledge of the patient's impending arrival". He is in a stable condition at an Ebola treatment center in Freetown, AP reported.... -- more

[byline: Michael Winter]

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[There has been a debate within the US administration about whether to bring Ebola-infected non-US citizens to the USA for treatment. This particular case has a US citizen wife and children. - Mod.JW

A HealthMap/ProMED-mail map of the USA is available at http://healthmap.org/promed/p/106.]

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[2] New strategy for Liberia
Date: Wed 12 Nov 2014
Source: New York Times [edited]
http://www.nytimes.com/2014/11/13/world ... beria.html


Health officials reassess strategy to combat Ebola in Liberia
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As the rate of new Ebola infections in Liberia has slowed, American and Liberian officials are debating whether to build all 17 planned Ebola treatment centers in the country or to shift money from the Obama administration that was planned for the centers into other programs to combat future outbreaks. The United States announced on Monday that it had completed the 1st of the 100-bed centers, some 40 miles outside Monrovia, in Tubmanburg, and turned over its operation to the International Organization for Migration, which will staff and run the center. 2 other treatment units, in Sinje, to the north of Monrovia, and Buchanan, to the south, will be completed by the end of November [2014], American military officials said. 7 additional treatment units across the country are in various stages of construction.

A 25-bed hospital recently opened outside Monrovia, and American and Liberian military officials are clearing the land for 2 more units. If all of them go ahead as planned, that would bring the total units built by the American and Liberian militaries working together on the project to 13, or 4 short of the units promised by President Obama on 16 Sep 2014.

But Mr Obama's promise came at the height of the epidemic, when new cases were increasing at a brisk rate. Since then, the rate of new infections in Liberia has come down and several treatment units around the country have reported empty beds for more than a month.

[byline: Helene Cooper and Sabrina Tavernise]

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[3] USA: nurses strike
Date: Wed 12 Nov 2014
Source: Time [edited]
http://time.com/3580028/california-nurs ... permanente


The 2-day strike is organized by National Nurses United and will affect 88 hospitals in the Golden State [California], 86 of which are owned by Kaiser Permanente, Reuters reports. [ProMED found only 37 listed on Kaiser Permanente's website -- see ProMED-mail post: Ebola virus disease - ex Africa (34): US doctor discharged, robots, WHO, Google 20141111.2946186. - Mod.JW]. The larger national strike will involve 100 000 nurses in 15 US states and the District of Columbia.

"Inadequate preparedness for Ebola symbolizes the erosion of patient care standards generally," a spokesman for National Nurses United told Reuters, adding that numerous other patient care issues, including under-staffing, have been "stonewalled and ignored." National Nurses United is in the midst of contract talks. In rebuttal to the union, an ad published in the Sacramento Bee by Kaiser over the weekend called the strikes counterproductive to making sure that US hospitals are ready for any future Ebola cases. "There is never a good time for a strike," it read. "Calling one now, just as we are entering the flu season, and when the nation and our members are concerned about the risk of Ebola, seems particularly irresponsible." ... -- more

[byline: Chelsea Rice and Jack Pickell]

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[4] Australia to screen all arrivals
Date: Fri 14 Nov 2014
Source: Central Queensland News [edited]
http://www.cqnews.com.au/news/ebola-che ... s/2453506/


Ebola check at Australian airports
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Travellers arriving at Australian airports now have to complete a travel history check to see if they have visited countries with an Ebola outbreak. The increased checks at airports will be part of overall screening methods, and it will also involve temperature checks of those posing a higher risk. Fever is a symptom of the virus.

Agriculture minister Barnaby Joyce said the measures began on Friday [14 Nov 2014, and would mean every one of the 45 000 people arriving in Australia through airports would be checked. He said while the risk of an Ebola outbreak was still low in Australia, the extra screening could help identify at-risk passengers.

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[5] Worldwide: safety video free to mariners
Date: Wed 12 Nov 2014
Source: KVH Industries [edited]
http://www.kvh.com/Press-Room/Press-Rel ... Video.aspx


KVH offering Videotel's new Ebola safety video free to mariners
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"Ebola -- Staying Safe", produced by maritime e-Learning leader Videotel, explains the dangers of Ebola and its impact on ships and seafarers.

KVH Industries, Inc, (Nasdaq: KVHI) is offering Videotel's new video about Ebola safety free to all mariners worldwide in an effort to increase awareness of the vitally important prevention measures that can keep seafarers safe. Ebola, a severe and often fatal illness for which there is no vaccine [true, so far] or cure [not true, unless you write "no specific cure". - Mod.JW], has been ravaging parts of West Africa since March [2014] in the largest outbreak ever known. The World Health Organization has declared the current outbreak a public health emergency, and it is critically important that anyone working in the global maritime industry understand the steps they can take to prevent the further spread of the disease.

KVH has created a website, http://www.kvh.com/EbolaSafety, for all mariners to download the XXXXXXX and an accompanying workbook. In addition, KVH delivered the entire video program today to its IP-MobileCast customers on vessels across the globe, who will automatically receive the video for immediate viewing onboard. "This is a perfect example of why it is sometimes necessary to send out urgent training updates without delay and not wait for the annual update process," says Nigel Cleave, Videotel chief executive officer.... -- more

Contact:
Jill Connors
Media & Communications Manager
KVH Industries, Inc.
401-851-3824
<jconnors@kvh.com>

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