Ebola Facts Are Scary Enough

N.Y. TIMES, MICHIKO KAKUTANI

Ebola has come to be described in horror-movie terms as an affliction, in the words of the journalist David Quammen, that “seems to kill like the 10th plague of Egypt in Exodus — the one inflicted by an angel of death.” With a mortality rate as high as 90 percent, it kills painfully and swiftly, with a seemingly remorseless calculus. There is even an article on the website of the Centers for Disease Control and Prevention that compares Ebola to the ghastly scourge in “The Masque of the Red Death,” the Edgar Allan Poe story that begins: “The ‘Red Death’ had long devastated the country. No pestilence had ever been so fatal, or so hideous.”

In “Ebola: The Natural and Human History of a Deadly Virus,” Mr. Quammen puts the frightening reality of Ebola — and the heightened language and hyperbole surrounding it — into perspective. This slender book is an expanded extract from his 2012 book “Spillover: Animal Infections and the Next Human Pandemic,” and it does a nimble job of situating this year’s unnerving events in historical context, going back to the first recorded occurrence of the virus in 1976 and chronicling the scientific and medical efforts to understand it since.

 

Mr. Quammen combines on-the-ground reporting with research and interviews to give the reader a sharp-edge understanding of the subject at hand: what is known, what is not known and what may be in dispute. His book, like most writing about Ebola, is deeply unsettling, but it’s also sober minded, and in this respect, a standout in the floodlet of Ebola books, many of them quickie scare guides and medical thrillers (with portentous titles like “Ebola: The Final Plague,” “Ebola: Be Afraid, Be Very Afraid,” “Ebola: The Preppers Guide to Surviving Ebola,” “The Trojan Virus: An Ebola Bioterrorism Thriller” and “The Ebola Conspiracy”), which seem intended to exploit public fears.

In these pages, Mr. Quammen takes Richard Preston — the author of the 1994 best seller “The Hot Zone” — to task for his melodramatic approach to the subject, writing that readers should not take Mr. Preston’s lurid descriptions of Ebola’s consequences literally — liquefying organs until “people were dissolving in their beds” or causing victims to “weep blood.” (In a recent interview with The New York Times, Mr. Preston said he now wants to update his book and make “the clinical picture of the virus more clear and accurate.”)

Mr. Quammen — like the journalist Laurie Garrett in her illuminating and encyclopedic book “The Coming Plague” — shows in these pages that the reality of the virus is horrifying without any apocalyptic embellishment. He writes that experts “aren’t sure exactly how the virus typically causes death”; rather, multiple causes — including liver failure, kidney failure, breathing difficulties, diarrhea — seem to converge in “an unstoppable cascade.” The “idea of immune suppression by ebolaviruses has also appeared lately in the literature,” he says, “along with speculation that it might allow catastrophic overgrowth of a patient’s natural populations of bacteria, normally resident in the gut and elsewhere, as well as unhindered replication of the virus itself.”

 

Much of this book reads like a detective story, tracing the intrepid efforts of microbe hunters to understand how this dangerous virus works — the dynamics of transmission, the geographical pattern of outbreaks — and possible approaches to treatment. There are some harrowing accounts of forays by scientists into disease-ridden (and cobra-infested) bat caves in Uganda, and an equally chilling story about an infectious-disease research scientist who accidentally stuck herself with a syringe that she’d been using to inject Ebola-ridden mice.

Over the years, considerable attention has been devoted by scientists to unraveling the mystery of where the virus lurks when it is not infecting humans, i.e., an animal host or reservoir, where it can exist more or less benignly. The chief suspected reservoirs, Mr. Quammen says, are certain types of fruit bat, which are present in parts of Central and West Africa. The diversity of bats (“one in every four species of mammal is a bat,” he writes), “their ancientness” (they evolved “to roughly their present form about 50 million years ago”) and their abundance in large, intimate communities, he argues, might have contributed to their capacity to host a wide variety of viruses, just as their migratory habits (some journey as much as 800 miles between their summer and winter roosts) might have increased “the likelihood that they, or the viruses they carry, will come in contact with humans.”

Why do “zoonoses” (animal infections that jump over into humans, like Ebola, SARS, AIDS, Lyme disease, West Nile fever, swine flu, bird flu) seem to be more and more common? Mr. Quammen suggests that when humans “encroach upon the host populations” of a pathogen — “hunting them for meat, dragging or pushing them out of their ecosystems, disrupting or destroying those ecosystems” — “our action increases the level of risk.” As a veterinary disease ecologist named Jon Epstein observes, “It increases the opportunity for these pathogens to jump from their natural host into a new host.”

In some cases, the microbe remains benign in the new host as it was in the old one. In other cases (like HIV), the pathogen — especially RNA viruses given to high rates of mutation and replication — not only gets a foothold in the new host, but also adapts and evolves and causes serious illness.

An important study published by the journal Science in August, Mr. Quammen says, addressed the Ebola virus variant involved in this year’s outbreak, which is the worst in the history of the disease. The study, he writes, indicated that “the virus was mutating prolifically and accumulating a fair degree of genetic variation as it replicated within each human case and passed from one human to another.”

The high rate of mutations in the virus suggest “that continued progression of this epidemic could afford an opportunity for viral adaptation,” it said, “underscoring the need for rapid containment.” Or, in Mr. Quammen’s words, “The higher the case count goes, the greater the likelihood that Ebola virus as we know it might evolve into something better adapted to pass from human to human, something that presently exists only in our nightmares.”

As for our still highly provisional scientific understanding of ebolaviruses, Mr. Quammen reminds us that it “constitutes pin pricks of light against a dark background.”

EBOLA

The Natural and Human History of a Deadly Virus

By David Quammen

119 pages. W. W. Norton & Company. $13.95.

Cuomo and Christie Order Strict Ebola Quarantines.

Katie Orlinsky for The New York Times        

N.Y. TIMES

The governors of New York and New Jersey on Friday ordered quarantines for all people entering the country through two area airports if they had direct contact with Ebola patients in Guinea, Liberia and Sierra Leone.

The announcement signaled an immediate shift in mood, since public officials had gone to great lengths to ease public anxiety after a New York City doctor received a diagnosis of Ebola on Thursday.

A few hours later, New Jersey health officials said a nurse who had recently worked with Ebola patients in Africa and landed in Newark on Friday had developed a fever and was being placed in isolation at a hospital. The nurse, who was not identified, had been quarantined earlier in the day under the new policy, even before she had symptoms. Officials did not know Friday night whether or not she had the virus.

The new measures go beyond what federal guidelines require and what infectious disease experts recommend. They were also taken without consulting the city’s health department, according to a senior city official

A passenger on the No. 1 train, one of three trains that Dr. Craig Spencer, New York City’s first Ebola patient, rode on Wednesday. Credit Todd Heisler/The New York Times        

In New York City, disease investigators continued their search for anyone who had come into contact with the city’s first Ebola patient, Dr. Craig Spencer, since Tuesday morning. Three people who had contact with Dr. Spencer, 33, have been quarantined, and investigators have compiled a detailed accounting of his movements in the days before he was placed in isolation at Bellevue Hospital Center on Thursday.

He remained in stable condition on Friday, and doctors were discussing the use of various experimental treatments. He was able to talk on his cellphone and was even well enough to do yoga in his room, according to friends.

Officials from New York and New Jersey said they were still working out many details, including where people would be quarantined, how the quarantine would be enforced and how they would handle travelers who do not live in either of those states.

The mandatory quarantine for nonsymptomatic travelers will last 21 days, the longest documented period it has taken for an infected person to show symptoms of the disease.

On Friday, the White House sidestepped questions about whether a nationwide quarantine of returning health care workers was being considered. Instead, officials defended the procedures the administration has put in place, including enhanced airport screenings and the monitoring of people arriving from Ebola-afflicted countries.

In New York City, health officials said that initial reports were incorrect when they indicated that Dr. Spencer had a 103-degree fever when he notified the authorities of his ill health. He actually had only a 100.3 fever. Officials attributed the mistake to a transcription error and said the lower temperature made it highly unlikely that he could have spread the disease before going to the hospital. Still, out of caution, they were tracing his contacts back to Tuesday, the day he began feeling fatigued. Dr. Spencer had been working with Doctors Without Borders in Guinea, treating Ebola patients, before leaving Africa on Oct. 14 and returning to New York on Oct. 17.

Much of the public’s concern focused on the movements of Dr. Spencer the night before he reported feeling ill.

On Friday, officials added some new details about those movements. He traveled on the A and L subway lines to Brooklyn, where he went bowling in Williamsburg and took a taxi back to Manhattan on Wednesday evening. He assured officials that he did not have symptoms at the time.

Earlier in the day, he went for a three-mile jog along Riverside Drive. On Tuesday, the day Dr. Spencer first began to feel sluggish, he visited the High Line and ate at the Meatball Shop in the West Village.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, said Dr. Spencer probably should have stayed home beginning on Tuesday.

“At that point I would have locked myself in, and I would have started checking my temperature hourly,” he said.

Dr. Schaffner also said he saw no need for an automatic 21-day quarantine or isolation period for people arriving from West Africa, not even health workers. There is no medical reason for it, he said, because people are not contagious until they develop symptoms.

Officials both national and local conspicuously conveyed the idea that the public should not overreact. President Obama was photographed in the Oval Office hugging Nina Pham, the Dallas nurse who was just declared Ebola-free after being in isolation since Oct. 16. Mayor de Blasio rode the subway, to demonstrate that the virus could not be spread through casual contact, like holding a subway pole.

The Ebola virus can be transmitted to other people only through bodily fluids when an infected individual begins to show symptoms. At the onset of illness, the amount of virus in the body is generally low, so the risk of infection is also considered small.

As the disease progresses, the amount of virus in the body multiplies and so does the risk of contagion.

Dr. Spencer’s fiancée, Morgan Dixon, has been quarantined at Bellevue Hospital Center. Officials said she would be allowed to return to the apartment she shared with Dr. Spencer, which has been cleaned, and carry out the rest of her quarantine there.

“There is the pure science and the protocols that must be put in place based on that science, in terms of what we know and what can come from that,” said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University and a special adviser to Mayor de Blasio. “On the other end of the spectrum, there is the world of abundance of caution. Public officials are constantly trying to find the right balance.”

A special locked isolation ward at Bellevue Hospital Center is being used to treat New York’s first Ebola patient. Credit Benjamin Norman for The New York Times        

Doctor in New York City Is Sick With Ebola

Dr. Craig Spencer (right) and fiancee Morgan Dixon    Photo: Instagram

 A doctor in New York City who recently returned from treating Ebola patients in Guinea became the first person in the city to test positive for the virus Thursday, setting off a search for anyone who might have come into contact with him.

The doctor, Craig Spencer, was rushed to Bellevue Hospital Center and placed in isolation at the same time as investigators sought to retrace every step he had taken over the past several days.

At least three people he had contact with in recent days have been placed in isolation. The federal Centers for Disease Control and Prevention, which dispatched a team to New York, is conducting its own test to confirm the positive test on Thursday, which was performed by a city lab.

Dr. Spencer, 33, had traveled on the A and L subway lines Wednesday night, visited a bowling alley in Williamsburg, and then took a taxi back to Manhattan. People infected with Ebola cannot spread the disease until they begin to display symptoms, and it cannot be spread through the air. As people become sicker, the viral load in the body builds, and they become increasingly contagious.

The driver of the taxi, arranged through the online service Uber, did not have direct contact with Dr. Spencer and was not considered to be at risk, officials said.

The Meatball Shop on Friday in Greenwich Village, where Dr. Craig Spencer had visited. Credit Todd Heisler/The New York Times        

Speaking at the news conference, city officials said that while they were still investigating, they did not believe Dr. Spencer was symptomatic while he traveled around the city on Wednesday and therefore had not posed a risk to the public.

“He did not have a stage of disease that creates a risk of contagiousness on the subway,” Dr. Mary Bassett, the city health commissioner, said. “We consider it extremely unlikely, the probability being close to nil, that there will be any problem related to his taking the subway system.”

Mayor Bill de Blasio, speaking at a news conference at Bellevue on Thursday night, sought to reassure New Yorkers that there was no reason to be alarmed.

“Being on the same subway car or living near a person with Ebola does not in itself put someone at risk,” he said.

Still, out of an abundance of caution, officials said, the bowling alley in Williamsburg that he visited, the Gutter, was closed on Thursday night, and a scheduled concert there, part of the CMJ music festival, was canceled. Health workers were scheduled to visit the alley on Friday.

At Dr. Spencer’s apartment building, his home was sealed off and workers distributed informational fliers about the disease.

Since returning, he had been taking his temperature twice a day, Dr. Bassett said.

He told the authorities that he did not believe the protective gear he wore while working with Ebola patients had been breached but had been monitoring his own health.

Doctors Without Borders, in a statement, said it provides guidelines for its staff members to follow when they return from Ebola assignments, but did not elaborate on the protocols.

Emergency medical workers, wearing full personal protective gear, rushed to Dr. Spencer’s apartment, on West 147th Street. He was transported to Bellevue and arrived shortly after 1 p.m.

He was placed in a special isolation unit and is being seen by the designated medical critical care team. Team members wear personal protective equipment with undergarment air ventilation systems.

Ebola is transmitted through bodily fluids and secretions, including blood, mucus, feces and vomit.

Because of its high mortality rate — Ebola kills more than half the people it infects — the disease spreads fear along with infection.

At least two Doctors Without Borders workers have contracted the disease so far this year.
Norwegian physician Silje Lehne Michalsen was infected in Sierra Leone and recovered this month, according to the Nordic Page website.
A French nurse was also diagnosed with Ebola on Sept. 16 while working in Monrovia, Liberia, and recovered in France.

N.Y. TIMES

Can You Get Ebola From a Bowling Ball?

Although the surface of a shared bowling ball is a likely place to find germs — and some people avoid bowling for this very reason — it is extremely unlikely that Ebola could be passed that way. There is no evidence that it has been passed, as colds or flu sometimes are, by touching surfaces that someone else touched after sneezing into their hand. Ebola is normally passed through contact with blood, vomit or diarrhea.

If someone left blood, vomit or feces on a bowling ball, and the next person to touch it did not even notice, and then put his fingers into his eyes, nose or mouth, it might be possible. But, the Ebola virus does not not normally build up to high levels in saliva or mucus until very late in the disease — several days after the initial fever sets in — and it is unlikely that someone that ill would have just gone bowling. Also, the Ebola virus is fragile and susceptible to drying out. It does not normally survive for more than a few hours on a hard, dry surface.

N.Y. TIMES

Can Pets Get Ebola?

Bentley, the one-year-old King Charles Spaniel belonging to Nina Pham, a nurse who contracted Ebola.Credit Courtesy of Sana Syed/PIO, City of Dallas, via Associated Press

Ebola is primarily an animal disease. Its natural reservoir is probably fruit bats, which can live with the virus without getting ill. Gorillas, chimpanzees and humans all die rapidly after getting infected.

Ebola is found in some hunted African animals, including forest antelopes and rodents. Pigs, guinea pigs, horses and goats have been infected experimentally and either had no symptoms or mild ones. Ebola has not been found in any African felines, such as lions, so cats may be immune.

Dogs living with humans apparently can get infected. Although the virus itself has not been found in dogs, antibodies have been detected in their blood, suggesting the dogs had survived infections.

Gabon has had several Ebola outbreaks, and in 2005 French scientists tested 337 dogs for antibodies. Many were village strays that lived on what they caught and scraps that hunters threw them.

Villages in which there were both human deaths and hunters returning with infected bush meat — which often started the outbreaks — had the most dogs testing positive.

The most likely explanation, the scientists said, was that the dogs were infected with the virus from meat scraps and from licking human vomit. They were not known to get ill.

Whether dogs can pass the virus to humans or to other dogs is unknown. Many diseases — including polio and typhoid — have silent human carriers who never get sick but pass fatal infections to others.

Ebola is not known to exist in any North American animal species, including bats. But many species clearly could become carriers.

Since dogs interact intermittently with humans and with animals in city parks and rural forests, they could be a vector for transmitting Ebola from humans into wildlife, where it could, in theory, establish a permanent American reservoir.

While an infected dog could be quarantined, it would have to be caged indefinitely, since it is unknown how long it might remain infectious.

Ebola Test Is Positive in Second Texas Health Worker

An ambulance on Wednesday took Amber Joy Vinson to the Dallas airport for transport to Emory University Hospital in Atlanta. Credit Jaime R. Carrero/Reuters       

N.Y. TIMES

New shortcomings emerged Wednesday in the nation’s response to the Ebola virus after it was revealed that a second nurse was infected with Ebola at a hospital here and that she had traveled on a commercial flight the day before she showed symptoms of the disease.

The nurse, Amber Joy Vinson, 29, was on the medical team that cared for the Ebola victim Thomas Eric Duncan after he was admitted to the hospital on Sept. 28 and put in isolation. Ms. Vinson should not have traveled on a commercial flight, the director of the federal Centers for Disease Control and Prevention said after learning that she was a passenger on Frontier Airlines Flight 1143 on Monday, flying from Cleveland to Dallas-Fort Worth.

But hours after the director, Dr. Thomas R. Frieden, made that statement, one official said that Ms. Vinson had indeed called the C.D.C. before boarding the plane, but was allowed to fly because she barely had a fever.

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1. The CDC is now trying to reach 132 passengers who were on the plane with her as a matter of urgency. 

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New York’s premier public hospital will become a center for treatment of the Ebola virus in the city, hospital and city officials said on Tuesday, amid widespread concerns that the disease may not be so easily contained by every hospital that has an isolation unit.

Bellevue Hospital Center, the country’s oldest public hospital, would receive any confirmed Ebola cases within the 11-member public hospital system, a Bellevue spokesman said. It would also be available to receive transfers from private hospitals in the city.

Five myths about Ebola



A health worker takes the temperatures of U.S. Marines arriving to help combat the Ebola outbreak in Liberia. (John Moore/Getty Images)

WASHINGTON POST

 Laurie Garrett October 10

Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations. Her latest book is “I Heard the Sirens Scream: How Americans Responded to the 9/11 and Anthrax Attacks.”

 

The Ebola outbreak in West Africa has reportedly claimed close to 4,000 lives, and World Health Organization officials believe the true death toll could be far higher. An international response — including U.S. military personnel, as well as assistance from several other countries and nongovernmental organizations — has begun, yet global concern about the virus is spreading. How worried should we be? What are the risks? Let’s separate fact from fiction in this crisis.

1. Ebola won’t spread in rich countries.

Until nurse Teresa Romero Ramos contracted Ebola in Madrid, the wealthy countries of Europe, North America and Asia seemed confident that the virus could be contained in advanced medical facilities. As Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, put it after the first U.S. Ebola case was confirmed in Dallas: “We’re stopping it in its tracks in this country.” Such assurances help calm people’s nerves but may be overstated. No system of protection is 100 percent. The Spanish government has concluded that Ramos got infected as she was removing her protective suit, touching her face before disinfecting her hands.

Like Ebola, the SARS virus spreads in hospitals, primarily through physical contact with contaminated fluids. As SARS spread across Asia in 2003, some hospitals, including in Hong Kong, had large numbers of health workers infected, while nearby facilities with similar populations of SARS patients had no employee infections.

Hubris is the greatest danger in wealthy countries — a sort of smug assumption that advanced technologies and emergency-preparedness plans guarantee that Ebola and other germs will not spread. It was hubris that left Toronto’s top hospitals battling SARS in 2003, long after the virus was conquered in poorer Vietnam. It was hubris that led the World Health Assembly in 2013 to cut the WHO’s outbreak-response budget in favor of more programs to treat cancer and heart disease. And it is hubris that causes politicians to routinely slash public health budgets every time the microbes seem under control, only to cry out in desperation when a new epidemic appears.

2. Post-9/11 emergency preparedness has the United States ready to fight Ebola.

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But most of the training — both military and civilian — imagined the biological equivalent of an attack, in which something evil is found; responders from police, fire and health departments swoop in wearing hazmat suits; and boom: The infected people are identified, isolated and treated, and the danger to the community is gone. Even in 2005, when the White House feared that a highly virulent pandemic strain of bird flu would sweep across America, preparedness plans focused on isolating a germ and its carriers the way a bomb or chemical weapon might be isolated and defused. Missing was preparation for a long haul of contagious patient treatment, with health workers repeatedly exposed to possible contamination.
Today, in the face of requests for help in West Africa, the answer from the U.S. Agency for International Development is: “There isn’t an existing cadre of people who have experience in treating this epidemic.”

3. It could go airborne.

Yes, the virus is mutating — a recent paper in Science shows that more than 300 mutations have occurred. But what is now a virus that latches onto receptors outside endothelial cells lining the circulatory system won’t change into one that can attach to the alveolar cells of the lungs. That’s a genetic leap in the realm of science fiction.
Viruses mutate for two reasons: random error and natural selection. Random transformation from a virus solely adapted to infect cells that line blood vessels into one that can attach to entirely different classes of proteins found in the lungs borders on the impossible. Natural selection can overcome the impossible if great pressure is put on a viral population, forcing it to alter or die out. But in Liberia, Sierra Leone and Guinea, there is no such pressure on Ebola: The virus is spreading readily and infecting thousands of people without any need to change into a radically new form.
Far more realistic and perhaps equally worrisome is that the outer coat of the virus — the parts that are recognized by the human immune system and trigger production of antibodies and killer cells that devour viruses — might respond to immune system attack by mutating their outer proteins. If Ebola made such an adaptation, it might mean that people who have survived the disease could be reinfected, and vaccines now in the pipeline could prove ineffective.

 Travel bans would keep Ebola from spreading in the United States.

 The only evidence that any travel ban in the 21st century slowed down viral spread occurred right after the 9/11 attacks, when airports in the eastern United States were shut down for days, and few Americans traveled far from home for several weeks. Possibly as a result, the influenza season was delayed about two weeks in 2001. But the flu eventually came.

Many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 “swine flu.” None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures governments took to keep them out.

The days of Ellis and Angel islands screening out diseases effectively disappeared with the jet age.

A vaccine is around the corner.

There are several vaccine candidates in development right now, two of which recently got green lights from a special WHO scientific panel. That go-ahead means the potential vaccines are now being tested on human volunteers. If after a few weeks of such testing the vaccines are shown to cause no undue side effects, the next phase of trials will be carried out, probably in the epidemic countries, to see if the vaccines can protect people from the virus. If it’s obvious in that phase that the vaccine is protecting people from Ebola, the products move to the final, and most difficult, phase — a clinical trial comparing vaccine vs. placebo in hundreds of people, also in the epidemic area.

The No. 1 question I hear privately from vaccine manufacturers regarding Ebola is: How will people dressed like space aliens in their protective gear get terrified, healthy people in Liberia or Sierra Leone to stand still for a poke in the arm?
At best, a vaccine might be ready for final testing by spring 2015 — and that question of trust will still remain.

Man With Ebola in Dallas is Dead As US Plans Airport Screening

The first person to be diagnosed with Ebola within the US has died, Texas hospital officials have said.

Travelers from Ebola-affected countries will face increased security scrutiny at five major US airports.
Passengers from Liberia, Sierra Leone and Guinea will have their temperatures taken and have to answer questions.
The new measures at O'Hare in Chicago, JFK and Newark in the New York area, Washington's Dulles, and Atlanta's airport will begin in the coming day

Thomas Eric Duncan, 42, who caught the virus in his native Liberia, was being treated with an experimental drug in isolation in a Dallas hospital.

A police officer who visited Mr Duncan's home is now reported to have Ebola-like symptoms and has been taken to hospital as a precaution.

Frisco Mayor Maher Maso described the risk as "minimal", but officials were taking "an abundance of caution"

Earlier the US announced new screening measures at entry points to check travelers for symptoms of the virus.

It has killed 3,865 people, mostly in Liberia, Sierra Leone and Guinea, in the worst Ebola outbreak yet.

US Ebola patient 'fighting for his life'

Thomas Eric Duncan, who is being treated for Ebola in Dallas, is shown at a wedding in Ghana in a 2011 photo provided by Wilmot Chayee. Photograph: Wilmot Chayee/AP

THE GUARDIAN     10/6/14

US Ebola patient 'fighting for his life' as authorities find homeless man

• Unidentified man may have had contact with Thomas Duncan
• Victim is not receiving experimental treatments for Ebola
• CDC chief to give a briefing to Barack Obama on Monday
• NBC cameraman with Ebola reported on way to Nebraska

Thomas Duncan, the first person to have been diagnosed with Ebola in the US, is fighting for his life in hospital in Dallas.
On Sunday, Thomas Frieden, director of the federal Centers for Disease Control and Prevention (CDC), said Duncan had “taken a turn for the worse” and was “fighting for his life”. On Saturday, Duncan’s condition worsened from “serious” to “critical”.
Frieden also told reporters that he was scheduled to brief President Barack Obama on Monday as health officials attempt to ensure that the virus others do not contract the virus.
The authorities in Dallas said on Sunday they had located a homeless man who may have had contact with Duncan.
A few hours after officials told a conference call with media the man was missing, a Dallas city spokeswoman, Sana Syed, said he had been located. Officials said the man was not one of 10 people who have definitely had contact with Duncan.
The homeless man, who officials said was in a group of 38 people who may have had contact with Duncan, was said to have shown no signs of Ebola when he was tested on Saturday. Officials say the policy is to monitor the condition people who may have come into contact with an Ebola sufferer for 21 days.

Duncan, who is from Liberia, which with Guinea and Sierra Leone is one of the principal centres of the outbreak – has been in isolation at Texas Health Presbyterian hospital in Dallas since last Sunday.
Frieden said it appeared that Duncan was not receiving any of the experimental medicines for the virus.
Doses of the experimental medicine ZMapp were “all gone”, Frieden said, and that the drug, produced by San Diego-based Mapp Biopharmaceutical, is “not going to be available anytime soon”.
Asked about a second experimental drug, made by Canada’s Tekmira Pharmaceuticals Corp, he said it “can be quite difficult for patients to take.”
Frieden said the doctor and the patient’s family would decide whether to use the drug, but if “they wanted to, they would have access to it.”
“As far as we understand, experimental medicine is not being used,” Frieden said. “It’s really up to his treating physicians, himself, his family what treatment to take.”

Jobless Rate in U.S. Falls Below 6% as Hiring Picks Up . Also Another Beheading and Ebola in Dallas.

Students attend a career fair at the University of Illinois in Springfield, Ill. Credit Seth Perlman/Associated Press        

Read it at Bloomberg News

The U.S. economy added 248,000 jobs in September, bringing the unemployment rate down to 5.9 percent. Job growth was higher than projected and it brought the unemployment rate down to its lowest level since July 2008. Growth was seen mostly at grocery stores, factories, and restaurants. It was a significant gain over the 180,000 jobs added in August.

N.Y. TIMES

But the surprisingly rosy jobs report released by the government on Friday appeared to be too little, too late to bolster the prospects of Democratic candidates facing voters in struggling campaigns for next month’s midterm elections in the face of rising disenchantment with President Obama’s performance.

And the signs of improvement were tempered by evidence that wage gains remained meager and that millions of Americans were still so discouraged by their job prospects that they had lost contact with the regular employment system.

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Read it at BBC News

 

ISIS released a new video Friday showing the beheading of British aid worker Alan Henning. The jihadists warned that American Peter Kassig, a medic and ex-U.S. Army Ranger who was working in central Syria as of last October, will be killed next.
Henning, 47, was an aid convoy volunteer who was captured by ISIS in Syria nine months ago and is thought to have been held with 20 other Western hostages. Members of the convoy Henning was helping when he was captured have described armed men surrounding a warehouse where the convoy was delivering medical equipment. Gunmen claimed they were suspicious of Henning because he was not Muslim and separated him from the group. In the video showing his beheading, Henning's executioner, in a London accent, says, "If you, Cameron, persist in fighting the Islamic State, then you, like your master Obama, will have the blood of your people on your hands."
The other ISIS hostage is Peter Kassig, a 25-year-old native of Indiana. Kassig founded an emergency aid group for Syrian refugees in Lebanon and Syria called Special Emergency Response and Assistance (SERA). The organization provided medical assistance, medical supplies, clothing, food, and cooking stoves, and fuel to refugees.

N.Y. TIMES

Health officials’ handling of the first Ebola patient diagnosed in the United States continued to raise questions Friday, after the hospital that is treating the patient and that mistakenly sent him home when he first came to its emergency room acknowledged that both the nurses and the doctors in that initial visit had access to the fact that he had arrived from Liberia.

For reasons that remain unclear, nurses and doctors failed to act on that information, and released the patient under the erroneous belief that he had a low-grade fever from a viral infection, allowing him to put others at risk of contracting Ebola. Those exposed included several schoolchildren, and the exposure has the potential to spread a disease in Dallas that has already killed more than 3,000 people in Africa.

 

Health officials narrowed down to 10 the number of people considered most at risk of contracting Ebola after coming into contact with Mr. Duncan. They also moved the four people who had shared an apartment with him from their potentially contaminated quarters, as local and federal officials tried to assure the public that the disease was contained despite initial missteps here.

The four people, a girlfriend of Mr. Duncan and three of her relatives, had been under orders not to leave their home, and Texas officials apologized to them for not moving faster to have the apartment cleaned of potentially infectious materials.

The cleanup began Friday afternoon — more than a week after Mr. Duncan first went to the hospital — as television-news helicopters swirled in the skies above and workers in yellow protective suits scoured the apartment, whose entryway and balcony were covered with a tarp.

 

Around the country, anxiety spread Friday as two hospitals in the Washington area each reported a possible case of Ebola, and a television journalist working in Liberia prepared to return to the United States after being told that he had the virus. Besides the 10 people considered most at risk in Dallas, another 40 people are being monitored in the city but are considered at relatively low risk, officials said. No one has developed any symptoms. The first signs of the illness often appear within eight to 10 days, but can take as long as 21 days.

 

Images from Monrovia, Liberia and Dallas in the last few days have raised new questions about the adequacy of the American effort on both continents.

In Liberia, the help Mr. Obama promised several weeks ago has been slow to arrive, and logistical glitches have prevented the United States military from being able to quickly set up the hospitals and treatment centers needed to halt the virus. Gen. David M. Rodriguez, commander of the Africa Command, told reporters in Washington that the military was working quickly, but that it could take “several weeks” to get the hospitals built and the medical personnel trained.

And in Dallas, the misstep at Texas Health Presbyterian Hospital, where Mr. Duncan is in serious condition, came after the acknowledgment Thursday by other health officials that the apartment where he had stayed had not been sanitized, with the sheets and towels that he had used while sick still there.

 

Dr. Ashish Jha, a professor at Harvard University’s School of Public Health, said there appeared to be “literally multiple failures” that led to Mr. Duncan’s release on Sept. 25, only to be hospitalized three days later when his symptoms worsened. Among them, he said, are that the nurse who learned Mr. Duncan had just come from Liberia failed to tell a doctor directly.

“In a well-functioning emergency department, doctors and nurses talk to each other,” Dr. Jha said. “Also, why didn’t the physician think to ask the question separately? Anyone who comes in with a febrile illness, a travel history, that’s a fundamental part of understanding what might be going on.”

He added, “For me, the most disappointing thing isn’t that the system didn’t work, but in the aftermath, instead of helping every other hospital in the country understand where their system failed and learn from it, they have thrown out a whole lot of distractions.”

 

“The United States is prepared to deal with this crisis, both at home and in the region,” Ms. Monaco said. “Every Ebola outbreak over the past 40 years has been stopped. We know how to do this, and we will do it again.”

Ebola: How Much Do You Know About The Outbreak?

Sierra Leone is one of the countries affected by the current epidemic. Downtown Freetown still bustles despite the outbreak. Tommy Trenchard for NPR

NPR:

Back in early December, a little boy in southern Guinea caught a mysterious disease. He had a fever, was vomiting and had blood in his stool.
The boy died a few days later. Before he did, he passed the disease to his 3-year-old sister, his mother, his grandmother and a midwife. The latter was eventually hospitalized in Gueckedou, a nearby city of 200,000 people.

By March, the disease spread to four cities. And international health officials realized they had an Ebola outbreak on their hands. The virus quickly spilled over into Sierra Leone, Liberia and Nigeria. Now more 1,400 have died in the outbreak, the World Health Organization says.
The disease is named for the river near the town of Yambuku in Zaire (now the Democratic Republic of Congo), where some of the first documented cases of the disease were identified in 1976.



Body collectors come to the home of four children in Monrovia who lost both parents to Ebola. Tommy Trenchard for NPR hide caption itoggle caption Tommy Trenchard for NPR

The entire outbreak in West Africa likely started with only one person, who caught the virus from a sick animal. Maybe a bat. Or another animal that had been infected by a bat.

Pierre Rollin, an infectious disease doctor with the Centers for Disease Control and Prevention. says. "We think that there was only one introduction [from animals] and then from that it went from human to human to human to human,"
Scientists figured this out in two ways. First, every person they know who has been infected with Ebola, so far, has had contact with somebody else with the disease.
"We always find a link with someone else who had been sick," Rollin says. "You always find this chain," he added. So the virus isn't just popping up seemingly randomly.

Joseph Fair, an infectious disease doctor who works in Sierra Leone, says. "What was interesting is we did find two individuals — and that was up to five years ago — with recent exposure to Ebola Zaire," 
That's the type of Ebola causing the outbreak right now. The team found only two patients with signs of a previous Ebola Zaire infection. But with the recent outbreak in region, that finding likely means that Ebola has been hiding out in animals in West Africa for years now.
And it was waiting for just the right moment — and the right person — to launch an outbreak.


There is no evidence that the disease can spread through the air, nor do mosquitoes carry it. But blood and indeed any bodily fluid can transmit it from person to person. According to the Centers for Disease Control and Prevention, the individual will be contagious only after symptoms appear.

The only way others could be infected is by direct contact with the bodily fluids of the infected person. And the virus would need to enter the other person via a cut on the skin or by contact with eyes, nose, mouth or ears.

Dead bodies are highly contagious because of the high levels of virus in body fluids.

Traces of the virus linger in semen and breast milk; a patient who survives Ebola is released but told to use condoms or wean her children upon returning home, for a period of several weeks.

In 1989, the Reston species of the virus was discovered in a blood sample from crab-eating macaques from the Philippines that had been brought to Hazleton Laboratories in Reston, Va. A year later, there were four reported cases in the U.S. of humans infected with Ebola Reston, but all were asymptomatic. Monkeys and humans can be infected by this species but CDC notes that compared with other Ebola viruses, this one appears to be "less capable, and possibly incapable" of causing disease in humans.

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Street vendors sell water on a street of Gueckedou — the city in Guinea where the Ebola outbreak began. Bordering Sierra Leone and Liberia, Gueckedou is a bustling city of more than 200,000 people.                 SEYLLOU/AFP/Getty Images

After 10 days in Liberia, NPR producer Nicole Beemsterboer has just landed in London. "You don't realize how much has been hanging over your head until you're out," she says.
She's talking about Ebola, the virus raging in Liberia as well as Sierra Leone and Guinea. "It was silent and invisible," she says. "So you're always on edge, always careful."

How did you protect yourself?
I got used to not touching anyone, no handshakes. And there are buckets of chlorine solution everywhere — outside every office building, police station, government office, hotel, store. Everywhere. I washed my hands dozens of times a day, and was careful never to touch my face.
At government buildings, officials watch you wash your hands and then take your temperature with an ear-gun thermometer. They write your temperature on a piece of paper and actually staple it to your lapel so it's visible to everyone inside. You can't get in the building if you have a temperature, and it sends a message: We're being vigilant; you need to be vigilant, too. Hold yourself and others accountable.

And you were careful right down to the soles of your boots?
We were concerned that if anything was contaminated, it was the bottom of our boots, so we were constantly rinsing them in the chlorine solution.
I don't know that we started a trend, but on the last day we were there, our hotel added a shoe wash — a box with a big foam pad inside, soaked in chlorine so you didn't have to soak your shoes but were getting enough chlorine on [the soles] to decontaminate them. We started seeing this more and more, at Redemption Hospital and other places around the city.


Headlines emphasize how hard it is to keep up with the outbreak.
For people in Monrovia, if they do show symptoms, there are still limited options for where they can go. The MSF (Doctors Without Borders) facility is expanding, but as soon as they have more beds, they are immediately filled. There simply isn't enough room for all the people who are sick, and until there are, people who get sick will stay home, get sicker and put those around them at risk.

When we landed in Casablanca, instead of someone taking your temperature with the ear gun, they had us stand about 20 feet away from a staff person in nurses scrubs in front of an infrared camera. If anyone does have a fever, the airport staff doesn't have to be anywhere near you.