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


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.


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 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 : 2014 Outbreak Explained by Video

This video on the 2014 Ebola outbreak is a bit outdated as the disease continues to rapidly spread in West Africa.

Scientists working in a laboratory
Scientists working in a laboratory

Ebola experts all agree on one thing. The Ebola virus outbreak must be fought and contained in West Africa. The disease spreading to heavily populated cities around the world, largely through air travel, would be a nightmare.

Ebola virus is a favorite search over most search engines today. At our website, we tried to gather the best pieces of information for you. In case you liked the article above, we would recommend you to browse through our article gallery for more valuable take-away on the subject matter. Please remember the articles we present are collated from mainstream websites. Hopefully MSM is reporting accurate information as known today.

Ebola Disease Units Top Notch, But Short on Beds

The US has four top notch infectious disease units that are well suited for safely treating Ebola patients. The problem is each facility can only treat a few patients at one time.

The CDC has stepped up its protocol guidelines. Hospitals across the nation are scrambling to upgrade procedures for treating Ebola patients. Hopefully, with lessons learned, the Ebola disease will be contained. After the mishaps in Dallas everyone realizes the seriousness of treating Ebola. In treating the Ebola disease, there is no room for mistakes.

Ebola Disease Units Boast High-Level Tools, Few Rooms.

By Robert Langreth and Cynthia Koons Oct 17, 2014

The state-of-the-art infectious disease centers now treating Ebola patients in the U.S. have world-class doctors and nurses with years of training, hot pressure chambers that can sterilize more than a ton of contaminated waste, and a record of success handling some of the world’s most demonic pestilence.

Ebola disease
Ebola Lab Worker

What they don’t have is a lot of room for patients.

Only four hospitals in the country have high-level containment units specially designed for treating exotic infectious diseases such as Ebola, according to the U.S. Centers for Disease Control and Prevention. Each has the capacity to treat only a handful of Ebola patients at once.

“If there are any more mishaps we’re going to need more beds,” said Robert Glatter, an emergency room doctor at Lenox Hill Hospital in New York. “We need to significantly increase” the number of sophisticated containment units.

The debacle at Texas Health Presbyterian Hospital Dallas, where two health workers were infected with Ebola while treating Thomas Eric Duncan before he died, exposed the lack of preparedness for treating Ebola at many hospitals. While various major hospitals are now gearing up to treat Ebola, for now patients are being treated at just these handful of centers.

Emory University Hospital in Atlanta, which is treating Amber Vinson, the second Dallas health-care worker to be infected by Ebola, has capacity for three patients in its biocontainment unit, which was created in 2002, said Holly Korschun, an Emory spokeswoman, in an e-mail.

Over the years, its workers “were trained in the use of personal protective equipment like full-body suits, and they ran drills for a dozen different scenarios,” she said.

The National Institutes of Health Clinical Center, which is treating Nina Pham, the first Dallas health-care worker to be infected with Ebola, has capacity to take two patients, an NIH official told Congress on Thursday. The unit, in Bethesda, Maryland, is designed to provide high-level isolation capabilities, the NIH said in a statement.

The biocontainment facility at the Nebraska Medical Center, which is treating NBC cameraman Ashoka Mukpo, would most likely be able to handle two to three patients at a time, depending on the severity of the cases, said Christopher Kratochvil, associate vice-chancellor for clinical research at the University of Nebraska Medical Center, in a telephone interview.

Montana Facility

A fourth biocontainment facility in Montana, designed to treat workers from the NIH’s Rocky Mountain Laboratories in cases of accidental infection, has three patient rooms, according to a 2010 article in Emerging Infectious Diseases.

The high-level containment units weren’t necessarily designed with Ebola in mind, said Rick Davey, deputy clinical director of the National Institute of Allergy and Infectious Diseases division of clinical research, on a conference call with reporters. Instead, they were developed to safely treat workers from various national facilities who became infected with pathogens in accidents, he said. Among other features, the units have state-of-the-art air handling capabilities so microbes can’t get out.

“The staff training and drilling and re-training and re-drilling that all of these units have undertaken over a process of years has prepared them thoroughly for this current outbreak,” Davey said.

Ebola is challenging to treat safely because patients release large amounts of vomit, diarrhea or blood as the disease becomes more advanced, and the fluids can contain large amounts of infectious virus. Patients can lose as much as 5 to 10 liters of bodily fluids a day, according to a presentation by an Emory University infectious disease specialist, Bruce Ribner, at a medical conference in early October.

350 Boxes

At Emory, in just a three-week period after its first Ebola patient arrived, the hospital had to sterilize 350 boxes of medical waste weighing more than 3,000 pounds using a device called an autoclave, according to a webcast of Ribner’s presentation at idweek.org.

They filled several trailers sent off for incineration, according to the presentation.

Dealing with fluids “is a huge problem,” in treating Ebola patients, according to Sean Kaufman, a biosafety expert who was involved in infection control when the first two Ebola patients were treated at Emory in August. “The challenge of cleaning up large spills is substantial,” he said.

Kaufman has since left Emory and is now training doctors in Liberia.

‘Engineered Properly’

Emory “did a lot of things right,” Kaufman said. “They had a beautiful facility that was engineered properly. They had the best personal protective equipment. They had outstanding standard operating procedures. And they had great administrative control.”

For example, Emory used full-body suits and head gear, going beyond the minimum recommendations of the Atlanta-based CDC at the time, because nurses were more comfortable in them, according to Kaufman.

It also was important to have someone not involved in care watching over the caregivers to make sure they don’t inadvertently slip up and infect themselves, Kaufman said. At Emory, he said, “I sat in there with them for 15 hours a day for close to two weeks to make sure they did what they were supposed to do.”

The first two Ebola patients Emory treated — aid worker Nancy Writebol and doctor Kent Brantly — recovered and were released. A third patient who arrived at Emory on September 9 is recovering and expects to be released soon, according to a statement from the patient released by Emory on October 15.

Prior Training

The biocontainment facility at the Nebraska Medical Center, which successfully treated doctor Rick Sacra, has 40 employees from a variety of backgrounds. They include surgical nurses, respiratory therapists, nursing assistants and infectious disease doctors.

Five to seven staff members work on the unit at any one time treating a given Ebola patient, said Kratochvil, associate vice-chancellor for clinical research at the University of Nebraska Medical Center.

“To be able to perform at this level will really be based on the prior training of the hospital,” Kratochvil said by telephone. “The level of care required for the personal protective equipment with Ebola is higher than what most hospitals are used to.”

Nebraska’s unit has a dedicated individual who monitors the application and removal of protective equipment.

Less Time

Since receiving a second Ebola patient, the hospital has established a lab within the biocontainment unit to test blood and biological samples on site. That cuts down on the time it would take to sterilize the outside of a sample package before shipping it out for testing.

While the Nebraska facility has 10 beds distributed in five double rooms, Kratochvil said it would be difficult to put two Ebola patients in any one room given the equipment needed to treat them, and that the facility would most likely be able to handle two to three Ebola patients at a time, he said.

At the NIH Clinical Center in Maryland, Nina Pham is overseen by two nurses in her room at any one time, with other nurses outside watching to make sure procedures are followed.

Both Emory University and Nebraska had the advantage of knowing in advance that Ebola patients were coming, giving them time to prepare.

‘Advance Notification’

“They were fortunate that they had advance notification of that these patients were coming, versus the hospital in Texas where the patient just showed up,” said Mark Jarrett, chief quality officer at the North Shore-LIJ Health System, which has 17 hospitals in Long Island and New York. “It gave them a chance to make sure everything was put into place.”

Nurses and doctors need “ample training” in how to isolate and treat Ebola patients safely, including detailed training on how to take protective equipment off and observers who can help nurses and doctors do this, said Glatter, the emergency physician at Lenox Hill Hospital. Holding frequent drills or simulations is crucial for hospitals to be prepared for treating an Ebola patient in case one walks in the door.

Being able to treat an Ebola patient without spreading the disease “is direct proof of how well you are doing” in infection control, said Glatter.

See Emory Ebola Treatment Room Diagram: Ebola Treatment Room

Ebola virus is a favorite search over most search engines today. At our website, we tried to gather the best pieces of information for you. In case you liked the article above, we would recommend you to browse through our article gallery for more valuable take-away on the subject matter. Please remember the articles we present are collated from mainstream websites. Hopefully MSM is reporting accurate information as known today.

Ebola Virus: 5 CDC Mistakes

The CDC has come under attack for the way they have handled the Ebola crisis. The CDC is staffed by smart people, many brilliant, and overall serve the nation well. Their Ebola problem is one of inexperience. I’m sure the CDC underestimated the current strain of Ebola. Studying in a laboratory is far different from having field experience.

Ebola Protection
Ebola Protective Gear

Consulting with Doctors Without Borders before Ebola arrived in the US would have prevented a lot of grief. Perhaps a bit of hubris was involved. After all, DWB is a French organization. What could they possibly know? They’ve only fought Ebola in Africa since it was first discovered.

Ebola:Five ways the CDC got it wrong

By Elizabeth Cohen, Senior Medical Correspondent CNN

A nurse contracts Ebola. An urgent care center in Boston shuts down when a sick man recently returned from Liberia walks in. Health care workers complain they haven’t been properly trained to protect themselves against the deadly virus.

Public health experts are asking whether the U.S. Centers for Disease Control and Prevention is partly to blame.

Here are five things they say the CDC is getting wrong.

1. The CDC is telling possible Ebola patients to “call a doctor.”

When passengers arrive in the United States from Liberia, Sierra Leone or Guinea, they’re handed a flier instructing them to “call a doctor” if they feel ill.

Never mind how hard it is to get your doctor on the phone, but even if you could, it’s quite possible she’d tell you to go to the nearest emergency room or urgent care center.

We saw how well that worked at Texas Health Presbyterian Hospital in Dallas. On September 25, the hospital sent a feverish Thomas Eric Duncan home even though he had told them he’d recently been to Liberia.

And we’ve seen how well that worked in Massachusetts, where an ill man recently returned from Liberia walked into an urgent care center, which then evacuated its other patients and closed for several hours.

One way to do it differently: Set up a toll free number for returning passengers that would reach a centralized office, which would then dispatch a local ambulance to get the patient to a hospital.

The hospital would be warned that a possible Ebola patient is on the way, and the patient would not be brought through the main emergency room.

That’s the idea of Gavin Macgregor-Skinner, an assistant professor at Penn State’s Department of Public Health Sciences.

“Do you really want someone with Ebola hopping on a bus to get to the hospital? No,” he said. “And once they get there, do you want them sitting in the waiting room next to the kid with the broken arm? Again, no.”

CDC Director Tom Frieden faces rising tide of criticism

2. The CDC director says any hospital can care for Ebola patients.

Essentially any hospital in the country can safely take care of Ebola. You don’t need a special hospital to do it,” Dr. Thomas Frieden said Sunday at a press conference.

“I think it’s very unfortunate that he keeps re-stating that,” said Macgregor-Skinner, the global projects manager for the Elizabeth R. Griffin Foundation.

He said when it comes to handling Ebola, not all hospitals are created equally. As seen at Presbyterian, using protective gear can be tricky. Plus, it’s a challenge to handle infectious waste from Ebola patients, such as hospital gowns contaminated with blood or vomit.

Dr. Michael Osterholm, an infectious disease epidemiologist at the University of Minnesota, said some hospitals have more experience with infectious diseases and consistently do drills in how to deal with biohazards.

“If you were a burn unit patient, wouldn’t you want to go to a burn unit?” he said.

The CDC may already be moving in that direction.

Designating certain hospitals as Ebola treatment units “is something we’re exploring further,” said Tom Skinner, a spokesman for the agency.

CDC ‘doubling down’ on Ebola training efforts

3. The CDC didn’t encourage the “buddy system” for doctors and nurses.

Under this system, a doctor or nurse who is about to do a procedure on an Ebola patient has a “buddy,” another health care worker, who acts as a safety supervisor, monitoring the worker from the time he puts on the gear until the time he takes it off.

The “buddy system” has been effective in stopping other kinds of infections in hospitals.

Skinner said the CDC is considering recommending such a system to hospitals.

4. CDC didn’t encourage doctors to develop Ebola treatment guidelines.

Taking care of Ebola patients is tricky, because certain procedures might put doctors and nurses in contact with the patient’s infectious bodily fluids.

At Sunday’s press conference, Frieden hinted that Presbyterian might have performed two measures — inserting a breathing tube and giving kidney dialysis — that were unlikely to help Duncan. He described them as a “desperate measure” to save his life.

“Both of those procedures may spread contaminated materials and are considered high-risk procedures,” he said. “I’m not familiar with any prior patient with Ebola who has undergone either intubation or dialysis.”

Osterholm said CDC should coordinate with medical groups to come up with treatment guidelines.

“We could have and should have done it a few months ago,” he said.

5. The CDC put too much trust in protective gear.

Once Duncan was diagnosed, health authorities started making daily visits to 48 of his contacts.

But that didn’t include several dozen workers at Presbyterian who took care of Duncan after he was diagnosed. They weren’t followed because they were wearing protective gear when they had contact with Duncan. Instead, they monitored themselves.

Public health experts said that was a misstep, as the CDC should have realized that putting on and taking off protective gear is often done imperfectly and one of the workers might get an infection.

How did Dallas nurse contract Ebola?

“We have to recognize that our safety work tells us that breaches of protocol are the norm, not the exception in health care,” said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. “We routinely break precautions.”

Skinner said that in this case, self-monitoring worked, but that monitoring from health officials can be beneficial, too, and so health care workers who were involved in Duncan’s care will now get daily visits from health authorities.

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