Ebola Virus Still Rages in Sierra Leone

While the spread of the Ebola virus has dropped off the front pages of American media the disease still rages in Sierra Leone. The following story shows how difficult Ebola is to control in remote rural areas.

Ebola virus
Ebola virus biopharmaceutical drug research in biochemical lab

The video below honors Ebola fighters that were named Time magazine’s Person of Year.

Horror in Sierra Leone: A Single Spark Gives Ebola New Life

BY MAGGIE FOX, NBC News

An especially deadly outbreak of Ebola burned unseen in a remote part of Sierra Leone for several weeks, giving public health experts a reality check. It’s also a perfect embodiment of the warning that they’ve been giving for months: that a single spark can set off a conflagration of disease and death.

It happened in Kono, a remote district bordering Guinea. World Health Organization workers heard rumors of deaths and traveled there to find scenes out of a horror movie. At least 87 people had died and been hastily buried, often without the precautions needed to stop the corpses from infecting the living.

“When we got there the staff at the hospital were exhausted,” said Winnie Romeril, a spokeswoman from WHO. “They had been working nonstop, trying to manage the large numbers of patients who came in.”

Romeril, who was with one of the WHO teams in Kono, said the sick and dying were flooding the small facility.

“Everybody was at wit’s endThere weren’t enough vehicles to safely transport the sick, and local residents were so far from any cities or towns that they had not gotten word about Ebola. They didn’t know to seek treatment right away, they didn’t know they should stay away from other people, and they didn’t even know that a fever might mean something far worse than malaria.

“In this case, because people were so remote, by the time they got to the hospital it was five days out. They were dehydrated. It was too late,” Romeril said. Death rates, she said, were 85 percent.

WHO, the Sierra Leonean government and non-profit groups had been focused on the other hot spots and especially the cities. “It’s easy to get distracted when it gets into an urban area,” Romeril said. They were just feeling defeated,” she told NBC News.

“It would have been better if we had seen it earlier.”

Sierra Leone has overtaken Liberia as the country where the Ebola epidemic is the worst, with hundreds of new cases reported every week.

It’s still bad — WHO reports more than 18,000 cases and more than 6,500 deaths in Sierra Leone, Liberia and Guinea. Experts now say it’ll be the middle of next year in the best-case scenario for getting the epidemic under control.

Read More: Ebola in Sierra Loene

TransCom Buys Ebola Isolation Units

With US military units operating in West Africa the Pentagon’s Transportation Command recently ordered Ebola Isolation Units. With over 4,000 troops deployed it is best to be ready. With only a short time to train troops could easily make a mistake in an Ebola virus zone.

Phoenix  Air Ebola isolation-unit
Phoenix Air Ebola isolation unit

If highly trained doctors and nurses come down with Ebola the ordering of isolation units by the Pentagon seems like a good move. Just in case.

TransCom Rushes Buy Of Ebola Isolation Units; 60 Days From Idea To Test

WASHINGTON: The Pentagon’s Transportation Command — the folks who move most everything for the military from Point A to Point B — are testing a new isolation unit to fit in a C-17 or C-130 aircraft, just 60 days after issuing the requirement.

The head of TransCom, Gen. Paul Selva, told reporters this morning at a Defense Writers Group breakfast that the command realized it needed the units in case anyone in the military was exposed to or came down with Ebola and needed evacuation. Obviously, these units can be used for everything from tuberculosis to the Marburg virus (a relative of Ebola’s) but they were built in response to the Ebola crisis afflicting West Africa.

Selva issued a Joint Urgent Operational Need (known as a JUON) for the units, 12 of which are planned. So far, the one company that built the larger system now being used by the State Department on contract, a firm with the unlikely name of Production Products of St. Louis, has been working on the system. The photo above shows the single unit, which is larger than the new units and can handle only one patient at a time.

The systems are standardized for us with pallets so they can easily be moved and secured on aircraft.

Interestingly, Selva said TransCom worked with the Defense Threat Reduction Agency, which handles biological warfare issues, and the Department of Health and Human Services as it developed the requirements.

“We have the capacity to isolate a single person and that capacity was designed exclusively to handle a SARS patient,” the general said. Believe it or not, the entire US military only had one unit capable of something similar, but it was designed to carry one person suffering from Severe Acute Respiratory Syndromes (SARS).

The new units can carry two patients on a stretcher and four in chairs. They can be linked to allow access for a care giver — properly suited and otherwise protected, of course.

Read More: Read More: Ebola Isolation Units

Ebola Virus Rages in Sierra Leone

Over the past few weeks the spread of the Ebola virus has stopped being front page news in US mainstream media. That doesn’t mean the threat is over. The following story indicates to control the disease, there is still much to be done in West Africa.

Ebola Rages in Sierra Leone as UN Misses Goals for Curbing Cases

By Simeon Bennett and Makiko Kitamura Nov 30, 2014

The United Nations has probably missed targets it set for curbing West Africa’s Ebola epidemic, as new infections surge in Sierra Leone.

Craig Spencer
Ebola Protective Gear

Only 23 percent of cases are being isolated in Liberia, and 40 percent in Sierra Leone, short of a goal set in October to isolate seven-in-ten cases by tomorrow. Neither country has enough burial teams to achieve a target of safely burying 70 percent of Ebola-related deaths, according to the World Health Organization. Still, unreliable data make it difficult to know conclusively whether the goals have been met, the Geneva-based WHO said.

While new infections are declining in Liberia and stable in Guinea, they’re rising in Sierra Leone, particularly in the country’s north and west, including the capital Freetown, according to the WHO. Burial rites in which mourners touch the corpse of a dead person are continuing to contribute to the spread of Ebola in Sierra Leone, Alpha Kanu, the nation’s information minister, said in a Nov. 27 briefing.

“Getting your people who for centuries have been steeped in those cultural practices to abandon those practices overnight is one of the challenges we have been facing,” Kanu said. “The culture of continuing with traditional practices is still very much a challenge. It’s a very touchy-feely African culture.”

Worst Outbreak

The outbreak began on Dec. 6 last year in the remote Guinean village of Meliandou, where a two-year-old boy, Emile Ouamouno died. It’s since raced through Guinea, Sierra Leone and Liberia, infecting 16,000 people and killing 5,689, making it the worst Ebola outbreak on record. Cases have also been reported in Mali, Nigeria, Senegal, the U.S. and Spain.

The epidemic may wipe as much as $33 billion from the region’s economy in a worst-case scenario, according to the World Bank, which is mobilizing $1 billion for the response.

More than 1,300 people have been infected in Sierra Leone in the past three weeks, and the country’s total number of infections will soon eclipse those in Liberia, the worst-affected country, according to the WHO.

Doctors Without Borders is building a new treatment center in Freetown that will open within the next 2 weeks, according to Francien Huizing, a spokeswoman for the medical charity in the Sierra Leonean capital.

In Liberia, only 67 cases were reported in the week to Nov. 23, and the northern district of Lofa has reported no cases for four weeks, the WHO said. Successful community outreach programs to educate people at risk and get them to adopt new burial practices have helped to curb infections in Liberia, said Dorian Job, deputy emergency program manager for Doctors Without Borders in Geneva.

The charity’s 240-bed ELWA3 treatment center in Monrovia only had 23 patients as of Nov. 17. Still, in some areas community outreach teams still lack fuel for their cars, preventing them from getting to remote communities, Job said.

“In general, Liberia is better supplied and has more resources than other countries,” he said. “What is important is that we don’t relax the effort. It’s not over.”

Read More Related News: Ebola Virus

Preliminary Studies Indicate Under Certain Conditions Ebola is Aerostable

Is the government telling us all it knows about the Ebola virus? Does it really understand the disease? A PDF published by the DEFENSE THREAT REDUCTION AGENCY indicates much remains to be known  about the current strain of Ebola. The information below comes from a.gov website. In public announcements it looks like information is being withheld from the public. The reasons are understandable. The government wants to avoid panic and wants to appear to have Ebola under control. This may have short term benefits but could have disastrous long term consequences. The more we understand about Ebola the better we can take steps to avoid infection.

DEFENSE THREAT REDUCTION AGENCY
BROAD AGENCY ANNOUNCEMENT
HDTRA1-15-EBOLA-BAA

Under item 2.2.4. “Ebola is aerostable in an enclosed controlled system in the dark and can
survive for long periods in different liquid media and can also be recovered from plastic and
glass surfaces at low temperatures for over 3 weeks.”

Source: Ebola Characterization  (Once on page download PDF file HDTRA1-15-Ebola-BAA at top right)

2.2.4. Ebola Characterization
The means by which Ebola virus is maintained in nature remains unclear. One reservoir of this zoonotic pathogen is believed to be in bats, but it is unknown what other natural reservoirs exist. Distinct Ebola viral sequences have been identified in infected but healthy mice and shrews. (Pourrut et al., 2005) indicating there may be other unknown reservoirs.

Ebola
Ebola Virus

A better understanding of Ebola persistence under a variety of environmental conditions may help us identify other possible reservoirs and hosts to research reservoirs and other modes of transmission.

While current science indicates the disease can only be transmitted by contact with contaminated body
fluids, it remains unclear if other transmission modes are feasible. Filoviruses are able to infect
via the respiratory route and are lethal at very low doses in experimental animal models, however
the infectious dose is unknown. There is minimal information on how well filoviruses survive
within aerosolized particles, and in certain media like the biofilm of sewage systems.

Preliminary studies indicate that Ebola is aerostable in an enclosed controlled system in the dark and can survive for long periods in different liquid media and can also be recovered from plastic and glass surfaces at low temperatures for over 3 weeks (Piercy, et al., 2010).

21 Day Quarantine For US Troops Returning From West Africa

President Obama says it’s a “different situation” for military troops than for returning health workers. He is right about that. Health workers that’ve been in close contact with Ebola virus infected patients will not be quarantined by federal law (Some states will require quarantine), while US troops involved with the construction of hospital facilities and clients will be quarantined. Make sense?

We seem to be getting a confused message about quarantine. Ebola medical experts say a quarantine will be counterproductive, while Chuck Hagel has ordered a quarantine for the military  and politicians are divided.

Ebola healthcare workers
Ebola Healthcare Workers in PPE

Hagel orders quarantine for US troops returning from W. Africa

Pentagon chief Chuck Hagel on Wednesday ordered a 21-day quarantine for all US troops returning from West Africa, calling it a “prudent” measure to prevent the spread of the Ebola virus.

The move means the military is adopting much stricter measures than those in place for civilian health workers sent by the US government to Liberia and Senegal, and the order came amid a debate about how to treat Americans who may have come in contact with those suffering from the deadly disease.

“The secretary believes these initial steps are prudent, given the large number of military personnel transiting from their home base and West Africa, and the unique logistical demands and impact this deployment has on the force,” his spokesman Rear Admiral John Kirby said in a statement.

The quarantine was being introduced even though officials say the soldiers will be focused on building medical clinics and will have no contact with those infected with the virus.

But Hagel said the decision was taken partly because military families urged the quarantine.

“This is also a policy that was discussed in great detail by the communities, by the families of our military men and women, and they very much wanted a safety valve on this,” Hagel said at an event in the US capital, the “Washington Ideas Forum.”

The US Army had already ordered a 21-day quarantine for its troops coming back from Liberia and Senegal. Hagel’s order extended the measure to all branches of the military.

Under the decision, Hagel asked the chiefs of the armed services to deliver a detailed plan within 15 days on how to carry out the quarantine. And he directed the chiefs to review the new regimen within 45 days and advise whether to continue with the measures.

Medical experts have sharply criticized recent strict quarantine orders adopted in New York and New Jersey as based on politics rather than science.

President Barack Obama on Tuesday urged Americans to respond to the virus with “facts” rather than “fear.”

But Obama endorsed the military’s approach, saying the armed forces presented a “different situation” than civilian health workers.

Read More: Ebola Quarantine

Ebola Virus Outbreak. Is It a Black Swan?

The 2014 Ebola outbreak is far worse than previous outbreaks dating back to 1976. One look at the chart below shows you have unprecedented the current outbreak is. While the chart is already outdated the difference between Ebola 2014 and every other outbreak is clear. We must make every effort to contain the outbreak to West Africa. An outbreak in developed countries would overwhelm even advanced medical facilities.

Ebola outbreaks
All Ebola Outbreaks Since 1976

The Ebola Outbreak — A Black Swan

A friend recently asked us whether the massive Ebola outbreak in West Africa could be regarded as a “black swan” in the sense of Nassim Taleb’s definition of the term. After thinking it over, we concluded that yes, it can definitely be characterized as one. Evidently, something is very different about this year’s outbreak compared to previous ones, and a number of unexpected developments have occurred. Chief among them is that a hitherto firmly held belief had to be abandoned. It was thought that the very thing that that makes the illness rather terrifying, namely its high mortality rate, helped in containing outbreaks.

We can definitely state that the current outbreak is anything but “well contained”. Below is a statistical table that shows all Ebola outbreaks since the discovery of the disease in 1976. Note that this graphic is already dated by now — the 2014 event has literally “gone off the chart” in the meantime. Even so, this graphic gives a good impression of how small the previous incidences of Ebola outbreaks were by comparison.

From a statistical viewpoint, the 2014 outbreak definitely must be regarded as a “black swan” — it was hitherto held to be impossible for the illness to propagate in such fashion (source: news.au.com)
Another way of looking at the “black swan” quality of the current outbreak is its geographical spread. All previous Ebola outbreaks were confined to a few isolated locations at most, mainly because they occurred in remote villages in the bush. As a result sick (and therefore infectious) people simply didn’t manage to reach any other villages to spread the virus further. Moreover, since also many of those who catch the illness quickly die, the virus was thought not to propagate very easily. Death is obviously the ultimate impediment to mobility (the dead do however remain infectious for quite some time).
The fact that the outbreak already has “black swan” qualities makes it more likely that a few other strongly held beliefs could also turn out to be wrong. There is already an intense debate over how the virus actually moves from person to person. Given that it is present in sputum, a number of virologists have stated that if one were for instance bathed in a gentle spray of saliva emitted by a coughing and sneezing person that has been infected, one will probably catch it. In fact, a recent warning issued by the Center for Infectious Disease Research and Policy is mainly noteworthy for its admission regarding the uncertainties about possible transmission vectors.

It recommends that health care workers be fitted out with proper respirators to ward off infection via aerosol particles.
Before hearing about this, we remarked as follows in a recent email conversation: Even considering the low standards of hygiene and certain cultural idosyncracies that make it more likely for the disease to spread in African countries, it seems not as difficult to get infected as was generally held. One must also keep in mind that the official numbers almost certainly understate the number of infected people by a fairly big margin — many people reportedly get infected and simply die without ever making it into the statistics.

The progression of the outbreak shows that many hitherto widely accepted nostrums about Ebola and the likelihood of it spreading beyond a fairly small group of people have proved wrong. There is therefore possibly one more article of faith that may prove wrong as well, namely that there is no reason to worry that it could spread in developed countries.
What if it did?..

More Information and Charts: Ebola Outbreak

Troops Quarantined After Ebola Aid Trip

The Pentagon has decided, at least for now, to quarantine troops returning from West Africa. This goes against the wishes of many medical experts, but is in line with New York, New Jersey, and Illinois requiring quarantines for returning health workers, or for anyone having contact with Ebola victims in West Africa. What do you think? Should everyone be quarantined or allowed to return and self monitor?

One factor that may have aided the Pentagon’s decision. The first returning troops are returning to base in Italy. The host nation may have insisted on a quarantine.

Army major general, troops quarantined after Ebola aid trip

By Barbara Starr, CNN Pentagon Correspondent

Army Major General Darryl A. Williams, commander of U.S. Army Africa, and approximately 10 other personnel are now in “controlled monitoring” in Italy after returning there from West Africa over the weekend, according to multiple U.S. military officials.

The American personnel are effectively under quarantine, but Pentagon officials declined to use that terminology.

William’s plane was met on the ground by Italian authorities “in full CDC gear,” the official said referring to the type of protective equipment warn by U.S. health care workers.

There is no indication at this time any of the team have symptoms of Ebola.

They will be monitored for 21 days at a “separate location” at the U.S. military installation at Vicenza Italy, according to U.S. military officials. Senior Pentagon officials say it is not a “quarantine,” but rather “controlled monitoring.” However, the troops are being housed in an access controlled location on base, and are not allowed to go home for the 21 day period while they undergo twice daily temperature checks.

It is not clear yet if they will be allowed visits from family members.

Williams and his team have been in West Africa for 30 days, to set up the initial U.S. military assistance there and have traveled extensively around Liberia. The team was in treatment and testing areas during their travels.

Speaking to reporters two weeks ago while he was still overseas in Liberia, Williams spoke of the extensive monitoring that he was given.

“We measure, while we’re here — twice a day, are monitoring as required by the recent guidance that was put out while we’re here in Liberia. I — yesterday, I had my temperature taken, I think, eight times, before I got on and off aircraft, before I went in and out of the embassy, before I went out of my place where I’m staying,” William said during the October 16 press conference.

“As long as you exercise basic sanitation and cleanliness sort of protocols using the chlorine wash on your hands and your feet, get your temperature taken, limiting the exposure, the — no handshaking, those sorts of protocols, I think the risk is relatively low.”

Officials could not explain why the group was being put under into controlled monitoring, which is counter to the Pentagon policy. The current DOD policy on monitoring returning troops says “as long as individuals remain asymptomatic, they may return to work and routine daily activities with family members.”

White House Press Secretary Josh Earnest said Monday that the Defense Department “has not issued a policy related to their workers that have spent time in West Africa.”

“I know that there was this decision that was made by one commanding officer in the Department of Defense, but it does not reflect a department-wide policy that I understand is still under development,” Earnest said.

The Pentagon has, though, published plans that detail how it will handle troops who are deployed to the region — including potential quarantines.

Jessica L. Wright, the undersecretary of Defense for personnel and readiness, issued an Oct. 10 memo that said troops who have faced an elevated risk of exposure to Ebola will be quarantined for 21 days — and that those who haven’t faced any known exposure will be monitored for three weeks.

Wright’s memo also lays out the Pentagon’s plans to train troops before they’re sent to West Africa and to monitor them during their deployment to the epicenter of the Ebola outbreak.

Read More: Ebola Quarantine

CDC Info on Ebola (Ebola Virus Disease)

The following is from the CDC website, where extensive information on the Ebola Virus Disease is presented. Note the use of the word “aerosol” rather than “airborne”.

Be sure to scroll down the page to the section titled: Key Components of Standard, Contact, and Droplet Precautions Recommended for Prevention of EVD Transmission in U.S. Hospitals.

Note the use of the word “droplet” instead of “airborne”.

As I understand it aerosol and droplet refer to the suspension of viruses for a short distance, while airborne would mean transmission over longer distances. Perhaps a medical professional could clarify this by leaving a comment. Your help, and the help of all healthcare workers, in dealing with the Ebola virus is appreciated.

Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals.

CDC Headquarters
CDC Headquarters, Atlanta

Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease (EVD) (See Table below). Note that this guidance outlines only those measures that are specific for EVD; additional infection control measures might be warranted if an EVD patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).

Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures.

HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. This guidance is not intended to apply to persons outside of healthcare settings.

As information becomes available, these recommendations will be re-evaluated and updated as needed. These recommendations are based upon available information (as of July 30, 2014) and the following considerations:

High rate of morbidity and mortality among infected patients
Risk of human-to-human transmission
Lack of FDA-approved vaccine and therapeutics

More at CDC website:
CDC Website

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