Tuesday, August 12, 2014

Ebola Updates ( August 12 , 2014 ) Examining where things stand today , a look at the curious case of Patrick Sawyer - and the strange manner in which he carried Ebola to Nigeria , what could happen if Ebola arrives in the US


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The One Question About Ebola That Nobody Can Seem To Answer

How in the world is it possible that more than 170 health workers have been infected by the Ebola virus? That is the one question about Ebola that nobody can seem to answer. The World Health Organization is reporting this as a fact, but no explanation is given as to why this is happening. We are just assured that Ebola “is not airborne” and that getting infected “requires close contact with the bodily fluids of an infected person”. If this is true, then how have more than 170 health workers caught the disease? These workers are dressed head to toe in suits that are specifically designed to prevent the spread of the virus. So how is this happening?



Canada will donate up to 1,000 experimental Ebola vaccine doses to WHO

Published time: August 12, 2014 23:31
A file photo taken on June 28, 2014 shows a member of Doctors Without Borders (MSF) putting on protective gear at the isolation ward of the Donka Hospital in Conakry, where people infected with the Ebola virus are being treated. (AFP Photo / Cellou Binani)
A file photo taken on June 28, 2014 shows a member of Doctors Without Borders (MSF) putting on protective gear at the isolation ward of the Donka Hospital in Conakry, where people infected with the Ebola virus are being treated. (AFP Photo / Cellou Binani)
​Canada has offered to donate its experimental Ebola virus vaccine to West African States after the WHO said it would be ethical to use untested vaccines to try and contain the outbreak that has already claimed the lives of more than 1,000 people.
According to the Public Health Agency of Canada (PHA) the country sees the vaccine as a global resource and is in talks with the US and the World Health Organization to coordinate the best application of a limited number of doses in its possession.
The deputy head of PHA Dr. Gregory Taylor estimates that Canada has about 1,500 doses of the vaccine, which has not yet been tested on people, saying that 1,000 doses of vaccine could be sent abroad for use, Canadian Press reports.
Taylor also warned that since the drug is yet to be tested on humans, it’s not clear what dosage is needed to protect a person, so those numbers could change.
Earlier on Tuesday, the WHO announced that experimental drugs can be used to treat patients but the scarcity of supplies raises questions who gets saved first.
“There was unanimous agreement among the experts that in the special circumstances of this Ebola outbreak it is ethical to offer unregistered interventions as potential treatments or prevention,” the WHO's assistant director general Marie-Paule Kieny said after an ethics panel published its guidance.
Ugandan medical staff disinfect a desk bearing a poster reading ''Ebola'' at the Entebbe International Airport on August 8, 2014. (AFP Photo / Isaac Kasamani)
Ugandan medical staff disinfect a desk bearing a poster reading ''Ebola'' at the Entebbe International Airport on August 8, 2014. (AFP Photo / Isaac Kasamani)

The WHO adjourned a meeting after Zmapp an experimental drug previously tested on humans by US biotech company Mapp Biopharmaceutical, was offered as a treatment to two US aid workers infected in Liberia. The WHO said only around 10 to 12 doses of the drug have been made.
Overall the WHO believes that the first tests of the experimental drugs in humans would be done over the next two to four months.
Meanwhile the US department of State has issued “Response to the Ebola Virus” a fact sheet outlining Washington’s efforts to contain the outbreak of the Ebola virus.
The US efforts to battle the deadly virus is based on conglomerate response of a number of US federal agencies, including the Department of Defense and Centers for Disease Control and Prevention (CDC), to offer “every possible form of assistance to the affected countries, their citizens and international organizations responding to the outbreak, ” State department said.
US authorities have approved a request from Liberia's government to send sample doses of the experimental ZMapp drug to treat those infected with Ebola, after on Friday, the FDA lifted its hold on one of those drugs being tested in the United States. Also on Friday, US health authorities announced that they are sending extra personnel and resources to Nigeria.
On the home-front the statement reads that US “has a range of steps in place to prevent the introduction, transmission and spread of suspected communicable diseases across the US border.”
US authorities concentrate their efforts on “appropriate procedures are in place for screening both in the region and here in the United States", as “there is no significant risk to the United States from Ebola.”
Health officials said Sunday that missionaries retuning to the United States after working with patients infected with Ebola will be put in quarantine and monitored, after USA aid worker Nancy Writebol is still in hospital in after contracting Ebola while in West Africa.
A picture taken on July 24, 2014 shows staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA hospital in the Liberian capital Monrovia. (AFP Photo / Zoom Dosso)
A picture taken on July 24, 2014 shows staff of the Christian charity Samaritan's Purse putting on protective gear in the ELWA hospital in the Liberian capital Monrovia. (AFP Photo / Zoom Dosso)

There is no treatment or vaccine for Ebola, which has a mortality rate of up to 90 percent. Currently it can be contained if those exposed are swiftly isolated. According to CDC guidelines, medical workers treating Ebola patients should wear protective gowns, goggles, face masks and gloves.
Companies working against the clock to provide treatments include Tekmira Pharmaceuticals, Biocryst Pharmaceuticals and Siga Technologies.
As soon as next month GlaxoSmithKline and American scientists at the National Institute of Allergy and Infectious Diseases want to conduct a clinical trial after promising test results in primates.
An experimental vaccine from Johnson & Johnson is expected to enter Phase I clinical trials as early as late 2015, while Profectus Biosciences is also working on preclinical vaccine.
A total of 1,848 suspected cases with 1,013 deaths have been reported by the World Health Organization in West Africa, of which 1,176 cases and 660 deaths have been confirmed to be Ebola.


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Priest With Ebola Dies In Spanish Hospital As Eight Chinese Workers Quarantined

Sadly, the Spanish missionary priest who became infected with Ebola treating patients in Liberia has died in hospital in Madrid. As AP reports, Father Miguel Pajares died despite receiving the experimental drug ZMapp, and is one of 3 patients to receive it (the American doctors in Atlanta being the other 2). This morning the WHO confirmed the use of "experimental, unproven" Ebola drugs such as ZMapp was ethical in this situation, as the death toll tops 1000 in what WHO called the "most severe and most complex outbreak of Ebola virus disease in history." Perhaps most concerning of all this morning is news that China is quarantining 8 of its West African nurses (as the death toll among health workers surges).


The Economic Community of West African States, ECOWAS, announced today the death of Jatto Abdulqudir, a member of its staff, from the Ebola virus. Abdulqudir is the third person in Nigeria to die of the disease, following the initial Liberian case, Patrick Sawyer, and a nurse who attended to him after he collapsed in Lagos.
Ebola Health Workers in NigeriaEbola Health Workers in NigeriaIn the below statement, released by ECOWAS today, the commission expressed gratitude to Nigerian government authorities and paid tribute to Mr. Abdulqudir, a protocol assistant, who was one of the principal staff members who worked with Patrick Sawyer. Abdulqudir was one of the 40 people under quaratantine in Lagos following Sawyer's death. The Nigerian government claims there are ten cases of Ebola in Lagos, and 70 people, acccording to the Ministry of Health, are said to be under quarantine.
SEE ALSOHow Liberian Govt Cleared Patrick Sawyer To Travel To Nigeria With Ebola"The ECOWAS Commission announces with deep regret the passing of a staff member of its Lagos Liaison Office, Mr. Jatto Asihu Abdulqudir, aged 36. 
Mr. Abdulqudir, a Protocol Assistant, was among those who assisted the Liberian delegate to a regional meeting Mr. Patrick Sawyer, who died from the Ebola Virus Disease at a Lagos hospital on 25th July 2014.
Mr. Abdulqudir had been under quarantine following that sad incident.
The Commission wishes to use this opportunity to express its gratitude to Nigerian government authorities and others who contributed to managing the late official while under quarantine. The Management of the Commission wishes to commiserate with Mr. Abdulqudir’s family and colleagues and prays for the repose of his soul.
Before this sad event, the Commission working in collaboration with Nigerian health authorities, had disinfected all the facilities of the ECOWAS Lagos Liaison Office as part of precautionary measures to safeguard the health, safety and security of staff members, and will continue to monitor the situation.
Management has also intensified awareness campaign among staff on the deadly virus and uses this opportunity to invoke the spirit of solidarity and mutual assistance. “The Commission wishes to reassure staff of all Community Institutions all over the entire region that it is taking all necessary steps to guarantee their health and safety.
Furthermore, Management enjoins all staff members and community citizens in general to intensify the observance of personal hygiene. They should also report any suspected case to health facilities and seek medical advice or attention for the effective containment and defeat of the Ebola disease.
On the directive of regional leaders, ECOWAS has already set up a Solidarity Fund to fight the disease and has solicited the support contribution of Member States and development partners to the Fund to rid the region of the virus.
The ECOWAS Commission wishes to reiterate its continued commitment to support Member States in confronting this deadly virus."


The Liberian Government was aware that Patrick Sawyer, its citizen who brought the Ebola virus into Nigeria, had possibly contracted the virus from his late sister, yet cleared him to travel to Nigeria for a conference organised by the Economic Community of West African States [ECOWAS], PREMIUM TIMES can authoritatively report today.
Documents obtained by this newspaper showed that Mr. Sawyer’s employers, ArcelorMittal, an iron mining company, suspended him from work and isolated him after it became aware that he had contact with his sister who died of the virus on July 8.
The company also issued an internal memo to staff of the company informing them that Mr. Sawyer had been referred to the Liberian Health ministry for testing and close observation.
“A family member of an ArcelorMittal Liberia employee died on Tuesday, July 8th, in Monrovia due to a confirmed case of the Ebola virus,” the July 11 edition of Satellite, an internal newsletter of ArcelorMittal Liberia, said. “The employee had minimal contact with the victim, at the state where the virus was infectious.
“Doctors say the risk of potential transfer to any member of the ArcelorMittal staff or contractors is very low. The employee has submitted to the Ministry of Health for a medical examination for possible Ebola infection, and has also requested the Ministry of Health to make the result available to ArcelorMittal Liberia and its close affiliates.
“There is no evidence to suggest that the employee has been infected. Under the Ministry of Health guidelines, the employee is being monitored on a daily basis and will continue to do so for a period of 21 days. During this time the employee will be absent from work.”
The July 25 edition of the Satellite, which announced Mr. Sawyer’s death, reads:
“Patrick was last at the Buchanan site (of AncelorMittal) on 9th July when he informed us about the death of his sister. Having informed us of this news, Patrick was submitted to the Ministry of Health for a medical observation and isolation and requested not to return to work until he had passed through the incubation period. He has not been at the Buchanan site or in any ArcelorMittal office since that time.”
But despite being under isolation and observation for the deadly disease, the Liberian Government, through its Deputy Finance Minister For Fiscal Affairs, Sebastian Muah, cleared Mr. Sawyer to travel to Nigeria for an ECOWAS convention in Calabar.
The deputy minister personally admitted approving the trip in an online discussion forum, where some Liberian citizens raised questions about his action and competence.
Mr. Muah could not be reached for comments on Monday. His mobile telephone was switched off the numerous times PREMIUM TIMES called.
But the Liberian Minister of Information, Lewis Brown, admitted to this newspaper that his government knew Mr. Sawyer was possibly infected by the virus before he travelled to Nigeria.
“I can confirm to you that he was advised by the Chief Medical Officer at the Ministry of Health not to leave the country because he was under observation,” Mr. Brown said by telephone from Monrovia, the Liberian capital. “It was regrettable that he left the country while being observed.
“We felt he had a duty to his colleagues to tell them that he was under observation for the disease. We also felt he had a duty to our country and yours (Nigeria) not to leave Liberia so as not to endanger the lives of others.”
Asked why a Liberian government official approved Mr. Sawyer’s trip to Nigeria even when the administration was watching him for Ebola, Mr. Brown said he had no information that the Deputy Minister, Mr. Muah, okayed the journey.
He however explained that such an administrative slip was possible at the time Mr. Sawyer left Liberia for Nigeria because at that time, inter-agency cooperation among government departments was low.
“It’s possible the health ministry was monitoring him (Mr. Sawyer) but the finance ministry did not know,” Mr. Brown said. “It was a slip and we have learned from it regrettably.”
He said the Patrick Sawyer incidence had now compelled Liberia to rework its procedures.
“Now the practice is to share the names of everyone under observation with all other agencies, including the airport, so they cannot leave the country,” the minister said.
“Before the Patrick Sawyer incidence, we did not have that kind of cooperation. We were not locking people under observation down. We were only bringing them to the isolation centre after they showed signs of the disease.”
Liberian newspaper, The New Dawn, which saw the CCTV footage recorded at the James Spriggs Payne’s Airport, Monrovia, moments before Mr. Sawyer boarded an Asky Airline plane to Lagos on July 20, reported that he looked “terribly ill” and wore a “sad countenance“ like someone in severe pain.
Apparently overtaken by “excruciating pain,” he, at a point, laid flat on his stomach on the floor in the corridor of the airport.
The paper also reported the footage as capturing Mr. Sawyer sitting alone and avoiding bodily contacts with other passengers who came close to him at the boarding gate of the airport as he awaited his flight to Lagos.
Mr. Sawyer became severely ill on the plane and was taken to First Consultant Hospital, Obalende, from the Murtala Mohammed Airport in Lagos.
Reports of events before he travelled to Nigeria and soon after his death have now shown that top Liberian government officials were aware of his trip to Nigeria and appeared to have done nothing to stop him.
The reports have also shown that Mr. Sawyer did not escape from where he was quarantined as reported by some newspapers.
In fact, the actions of some Liberian officials suggested that they were more concerned with getting Mr. Sawyer to the convention venue in Calabar and cared very little about the health risk he posed.
After he died, First Consultant Hospital issued a statement saying it resisted immense pressure from Liberian officials to discharge Mr. Sawyer from the hospital to enable him to attend the convention in Calabar, with diplomats saying he had a key role to play at the convention.
Nigeria was free of Ebola until July 20 when Mr. Sawyer arrived.
He became terribly ill on his flight and was rushed to the First Consultant Hospital Obalende, Lagos, where he died on July 24.


Given the scope of the Ebola outbreak unfolding in Western Africa, it seems possible that a case will eventually emerge in the U.S. We could even see an isolated cluster of infections in an American city.
Considering the nature of the Ebola virus, and the medical infrastructure we have to combat its spread, the diagnosis of some cases on American soil shouldn’t be reason to panic. We have a plethora of tools and public health practices to readily combat its spread. Yet because the virus is so dangerous, and feared, its arrival in America would likely to trigger a robust response from our public health establishment.
For most Americans, it may be the first time they glimpse the tools that our government has staked out over the last decade, as preparation for public health emergencies like a pandemic flu, or even bioterrorism. Some of these authorities are wholly necessary. Others will prove controversial and worthy of closer scrutiny.
Chief among them are authority maintained by the Centers for Disease Control to quarantine Americans suspected of having a dangerous, communicable disease. In some cases, this includes the power to isolate people, and hold a healthy person against his will. The CDC’s quarantine authority has been strengthened in recent years. But we haven’t had sufficient debate about how to balance individual rights against public health in these circumstances. And when quarantine is even effective. We should revisit these issues before we find ourselves invoking these tools.
What will happen if Ebola arrives in America?

Yet given the deadly nature of the Ebola virus, and the popular worry it’s likely to engender, one can expect the CDC and health authorities to pull out all the stops. The response could include invocation of the CDC’s evolving quarantine authorities.
These federal powers comprise a set of rules that gives CDC sweeping authority to hold and isolate Americans in a public health emergency. These authorities haven’t been fully updated in decades. They’ve only been amended in piecemeal fashion to deal with modern threats like SARS and MERS. In advance of what may be a very public test of these powers, the collected scheme deserves closer scrutiny.

Updated quarantine regulations were first proposed in 2005 during the Bush Administration amid fears of pandemic flu. The regulations spelled out in detail how CDC would exercise its sweeping powers to involuntarily confine sick individuals and those believed to be exposed to certain deadly and contagious diseases. The rules also focused efforts on quarantine at airports. Among other things, it held airlines responsible for keeping records to help health officials track down people coming off flights, in the event they would need to be located later for quarantine.
The set of regulations also included a new “provisional quarantine” rule that would have allowed CDC to detain people involuntarily for up to three days, with no mechanism for appeal. CDC had to believe a person was infected with certain pathogens. Among the diseases included were pandemic flu, infectious tuberculosis, plague, cholera, SARS, diphtheria, and viral hemorrhagic fevers such as Ebola.
The regulations were an attempt to provide clarity to how quarantine would be implemented. But in spelling out its proposed procedures, the rule raised concerns that the feds were assuming too much jurisdiction to detain people involuntarily. In short, CDC got itself into political trouble by merely clarifying how it proposed to implement federal authorities that the agency long held, and still maintains.
While the rule was never fully implemented, in its absence, one can assume that CDC would implement quarantine in keeping with these general constructs.
President Obama withdrew the Bush quarantine rule in 2010 because the provisions, when spelled out in regulation, proved controversial. Airlines, in particular, balked. Yet in its place the Obama Administration implemented a series of Executive Orders, and fell back on the CDC’s original quarantine provisions. The status quo could be just as troubling as the controversial regulation that it displaced.


In the presence of a suspect case of Ebola, the officialCDC website details ‘Specific Laws and Regulations Governing the Control of Communicable Diseases’, under which even healthy citizens who show no symptoms of the virus could be forcibly quarantined at the behest of medical authorities. The existing regulations stipulate, “Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill.”
In other words, you don’t have to be sick to be detained. Just suspected by health officials of having been in contact with someone who might have had the disease.
The regulations say a person “may be detained for such time and in such manner as may be reasonably necessary.” Is that three days or thirty? There are no rules.


Those provisions have been laid out largely in piecemeal. One of those pieces came just a week ago. In a move that raised some eyebrows, President Obama amended a 2003 Executive Order that gives the Federal government authority to quarantine people showing signs of severe respiratory illness. While the original provision pertained largely to SARS, the Obama revision was meant to apply the quarantine authority to a broader range of respiratory illnesses.
The timing of the revision struck many as odd, since it didn’t appear to pertain directly to the unfolding Ebola outbreak. Some speculated it was done in response to concerns about respiratory diseases that are being spread as a result of recent immigration trends across our Southern border.