A 5-year-old boy who arrived from Guinea showed a low-grade fever and would be tested for Ebola in New York, while a nurse held in quarantine in New Jersey will be allowed to go home, officials said on Monday.
Nurse Kaci Hickox, held at a New Jersey hospital under the state’s Ebola quarantine policy, didn’t present any symptoms and could complete her quarantine at home, state Governor Chris Christie said on Twitter.
Hickox arrived at Newark Liberty International Airport on Friday after treating Ebola patients in West Africa.
She had said she planned to challenge her quarantine in a lawsuit, saying it violated her constitutional rights.
However, with indications she will be released, a lawsuit is unlikely, her attorney said on Monday.
“She was quietly happy,” said attorney Steven Hyman, who said he had spoken to the nurse by telephone. “She wants this part of her ordeal to be over. She wants to return to her life.”
Hickox will be transported home to Maine, the New Jersey Department of Health said in a statement.
She remains subject to the state’s 21-day mandatory quarantine, the department said. She had no symptoms when she arrived in Newark on Friday, but developed a fever that prompted putting her in isolation, it said.
She is now symptom-free, it said.
In New York, a 5-year-boy who visited West Africa and has a low-grade fever will be tested for Ebola, City Health Commissioner Dr. Mary Travis said on MSNBC’s “Morning Joe” program. The results will be available later on Monday, she said.
The boy’s exposure history to the virus was unclear, she said.
“He has … traveled to one of the three affected countries and has a fever, and that’s what triggers an assessment,” she said.
Local media said the child lived in New York City’s Bronx borough.
Four people have been diagnosed with Ebola in the United States. The handling of the first case, a Liberian visitor to Texas in September who died, was riddled with missteps. Two nurses who treated the man contracted the disease but have recovered.
The only patient now being treated for Ebola in the United States is a New York doctor, Craig Spencer, who was diagnosed on Thursday. He had worked in Guinea treating Ebola patients with the humanitarian group Doctors Without Borders.
The mandatory quarantine policies put in place Friday by the governors of New York and New Jersey have been criticized amid concern they may discourage health care workers from traveling to West Africa to help in the fight against Ebola.
The virus has killed nearly 5,000 people in West Africa, where Sierra Leone, Liberia and Guinea have been hardest hit.
Medical professionals say Ebola is difficult to catch and is spread through direct contact with bodily fluids from an infected person and not transmitted by asymptomatic people.
New York Governor Andrew Cuomo struck a conciliatory tone on Sunday about the new quarantine policy after the White House said mandatory isolation could impede the Ebola fight.
Cuomo said New York wanted to encourage personnel to go to West Africa, lauding their “valor” and “compassion” while protecting public safety at home.
Health care workers and travelers exposed to people with Ebola and who live in New York may stay in their homes for the 21-day quarantine and be checked upon twice daily by healthcare professionals, Cuomo said, adding the state would provide financial assistance if needed.
Hickox, the first health worker isolated under the rules, was placed in 21-day quarantine in a New Jersey hospital after returning from treating Ebola patients in Sierra Leone.
She went public over the weekend, saying she underwent hours of questioning at Newark Liberty International Airport and had been transferred to a hospital isolation tent.
In response, the state health department said: “While in isolation, every effort was made to insure that she remained comfortable with access to a computer, cell phone, reading material and nourishment of choice.”
Christie said on Sunday that under New Jersey quarantine policy, a New Jersey resident who had contact with someone with Ebola would be quarantined at home. Non-residents would be transported home if feasible or quarantined in New Jersey.
JFK becomes first US airport to implement Ebola screening for passengers arriving from West Africa
New York’s JFK airport launched Ebola screening measures for passengers arriving from West Africa on Saturday, becoming the first US airport to implement procedures to combat the deadly virus.
Passengers from the worst affected countries, Liberia, Sierra Leone and Guinea, will have their temperatures taken using no-touch thermometers, and will have to answer a series of questions about their travel history.
Passengers will also be asked if they have come into contact with anyone infected with Ebola. If they answer yes to any of the questions or have a fever, a representative from the Centers for Disease Control and Prevention (CDC) will intervene to provide a public health assessment. Quarantine areas have also been set up at JFK to be used if necessary.
Gil Kerlikowske, commissioner of US Customs and Border Protection, said the new procedures would cover 94% of travellers from the affected region, and would provide the American public with extra assurance.
Over the next few days, checks will also be introduced at airports in Chicago, Newark, Washington and Atlanta.
There are currently no scheduled direct flights to the US from Liberia, Sierra Leone and Guinea, with most passengers from Africa travelling via Europe.
The measures come after Thomas Duncan, who travelled to the US from Liberia, became the first person to die of Ebola in Texas on Wednesday. Duncan was only diagnosed with the disease once he arrived in Dallas.
Recently elected New York mayor, Bill de Blasio, says the city is ready for Ebola appearing(Reuters)
Martin Cetron, director of the division of global migration and quarantine for the CDC, said at a press conference in New York on Saturday: “No matter how many procedures we have in place we cannot get the risk to zero.”
On Thursday, New York mayor Bill de Blasio chaired an “Ebola preparedness” meeting of city agencies, with representatives from hospitals, emergency services and coroners attending to discuss possible scenarios.
De Blasio stressed that as there has not been an Ebola case in New York, there is no cause for alarm.
“The city is particularly well prepared for any possible instance of Ebola because of our extraordinary health care system,” he said.
“Physicians, hospitals and emergency medical personnel are trained in how to identify this disease and how to quickly isolate anyone who may be afflicted.”
Dr Tom Frieden, director of the CDC, said in a press briefing earlier this week: “What we’re doing is putting in additional protections. I understand there have been calls to ban all travel to West Africa. The problem with that approach is that it makes it extremely difficult to respond to the outbreak.
CDC director Thomas Frieden (L) says that Ebola is ‘far ahead of us’(Jonathan Ernst/Reuters)
“It makes it hard to get health workers in because they can’t get out. If we make it harder to respond to the outbreak in West Africa, it will spread not only in those three countries but to other parts of Africa and will ultimately increase the risk here.”
According to the latest figures from the World Health Organization, the number of deaths attributed to haemorrhagic fever has risen to 4,033. The vast majority of fatalities (4,024) were in Liberia, Sierra Leone and Guinea.
Dr David Nabarro, the UN special envoy on Ebola, warned that the world may have to live with Ebola forever unless almost every country is fully prepared to combat it.
“The world has never seen anything like it,” he said. “Time is our enemy. The virus is far ahead of us.”
The use of ZMapp, an experimental drug previously used on two Americans with the virus, has opened up an ethical debate. The drug has shown promising results in the US but is still in an early phase of development.
Doctor who received experimental ZMapp treatment dies; two Ebola victims confirmed in Democratic Republic of Congo
A Liberian doctor who was among three Africans to receive an experimental Ebola drug has died, the country’s information minister said Monday.
Dr. Abraham Borbor, the deputy chief medical doctor at the country’s largest hospital, had been among three Liberians, and the first Africans, who received the drug, ZMapp. Two Americans received the untested drug and survived.
A Spaniard infected with Ebola received the treatment but died. There was no update given on the two other Liberians who took doses of the drug.
Borbor “was showing signs of improvement but yesterday he took a turn for the worse,” Information Minister Lewis Brown told The Associated Press. It wasn’t clear if he died late Sunday or on Monday.
The virus can only be transmitted through direct contact with the bodily fluids of the sick or from touching victims’ bodies, leaving doctors and other health care workers most vulnerable to contracting it.
Ebola-related deaths have been confirmed in the Democratic Republic of Congo in Djera, a remote area of the northern Equateur province, the country’s health minister said Sunday, though local officials believe the cases are unrelated to the outbreak in West Africa.
The World Health Organization (WHO) said on Monday it has sent protective equipment for medical staff there.
“The ministry of health has declared an outbreak and we are treating it as such,” WHO spokesman Tarik Jasarevic said in Geneva in response to a query.
The current Ebola epidemic has focused on Liberia, Guinea and Sierra Leone with several cases also in Nigeria.
Congolese authorities who went to the remote area found 24 cases of hemorrhagic fever of “unknown origin,” including 13 people that had died, Jasarevic said.
Of these, two have tested positive for Ebola, but other samples taken from suspect cases are being analyzed, he said.
This is the seventh outbreak of Ebola in Congo. The disease was first discovered there in 1976.
“The experience acquired during the six previous epidemics of Ebola will contribute to the containing of this illness,” said Health Minister Felix Kabange Numbi.
The WHO said last week those deaths were not Ebola-related, but WHO spokesman Gregory Hartl said by email Sunday that the information was the result of “miscommunication from the field.”
Hartl said on Twitter that samples tested at a national laboratory were positive for Ebola and that the results of confirmation tests from a laboratory in Gabon would likely come back Monday.
He said it was possible the outbreak could be unrelated to the outbreak in West Africa, where a total of 2,615 infections and 1,427 deaths have been recorded in four countries — Liberia, Guinea, Sierra Leone and Nigeria.
Djera, a collection of villages, is more than 745 miles from Congo’s capital, Kinshasa. It is more than 370 miles from the provincial capital, Mbandaka.
Kabange said Djera would be placed under quarantine.
Armed men claiming that “there’s no Ebola” in Liberia raided a quarantine centre for the deadly disease in Monrovia overnight, prompting at least 20 patients infected with the deadly virus to flee, a witness said Sunday.
“They broke down the door and looted the place. The patients have all gone,” said Rebecca Wesseh, who witnessed the attack and whose report was confirmed by residents and the head of Health Workers Association of Liberia, George Williams.
Williams said the unit housed 29 patients who were receiving preliminary treatment before being taken to hospital. It was unclear how many are now at large.
“They had all tested positive for Ebola,” he said, adding that nine had died, without elaborating.
Wesseh said she heard the assailants shouting that President Ellen Johnson Sirleaf “is broke”, adding: “She wants money. There’s no Ebola” in Liberia.
Wesseh said the mostly young men armed with clubs broke into the isolation unit set up in a highschool in a Monrovia suburb.
Nurses also fled the attack, Wesseh said.
The Ebola outbreak, the worst since the virus first appeared in 1976, has claimed 1,145 lives in five months, according to the UN World Health Organization’s latest figures as of August 13: 413 in Liberia, 380 in Guinea, 348 in Sierra Leone and four in Nigeria.
Patient Zero in the Ebola outbreak, researchers suspect, was a 2-year-old boy who died on Dec. 6, just a few days after falling ill in a village in Guéckédou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Guéckédou is at the intersection of three nations, where the disease found an easy entry point to the region.
A week later, it killed the boy’s mother, then his 3-year-old sister, then his grandmother. All had fever, vomiting and diarrhea, but no one knew what had sickened them.ű
Two mourners at the grandmother’s funeral took the virus home to their village. A health worker carried it to still another, where he died, as did his doctor. They both infected relatives from other towns. By the time Ebola was recognized, in March, dozens of people had died in eight Guinean communities, and suspected cases were popping up in Liberia and Sierra Leone — three of the world’s poorest countries, recovering from years of political dysfunction and civil war.
In Guéckédou, where it all began, “the feeling was fright,” said Dr. Kalissa N’fansoumane, the hospital director. He had to persuade his employees to come to work.
On March 31, Doctors Without Borders, which has intervened in many Ebola outbreaks, called this one “unprecedented,” and warned that the disease had erupted in so many locations that fighting it would be enormously difficult.
Now, with 1,779 cases, including 961 deaths and a small cluster inNigeria, the outbreak is out of control and still getting worse. Not only is it the largest ever, but it also seems likely to surpass all two dozen previous known Ebola outbreaks combined. Epidemiologists predict it will take months to control, perhaps many months, and a spokesman for the World Health Organization said thousands more health workers were needed to fight it.
Some experts warn that the outbreak could destabilize governments in the region. It is already causing widespread panic and disruption. On Saturday, Guinea announced that it had closed its borders with Sierra Leone and Liberia in a bid to halt the virus’s spread. Doctors worry that deaths from malaria, dysentery and other diseases could shoot up as Ebola drains resources from weak health systems. Health care workers, already in short supply, have been hit hard by the outbreak: 145 have been infected, and 80 of them have died.
Past Ebola outbreaks have been snuffed out, often within a few months. How, then, did this one spin so far out of control? It is partly a consequence of modernization in Africa, and perhaps a warning that future outbreaks, which are inevitable, will pose tougher challenges. Unlike most previous outbreaks, which occurred in remote, localized spots, this one began in a border region where roads have been improved and people travel a lot. In this case, the disease was on the move before health officials even knew it had struck.
Also, this part of Africa had never seen Ebola before. Health workers did not recognize it and had neither the training nor the equipment to avoid infecting themselves or other patients. Hospitals in the region often lack running water and gloves, and can be fertile ground for epidemics.
Public health experts acknowledge that the initial response, both locally and internationally, was inadequate.
He added, “A couple of months ago, there was a false sense of confidence that it was controlled, a stepping back, and then it flared up worse than before.”
Health experts have grown increasingly confident in recent years that they can control Ebola, Dr. Frieden said, based on success in places like Uganda.
But those successes hinged on huge education campaigns to teach people about the disease and persuade them to go to treatment centers. Much work also went into getting people to change funeral practices that involve touching corpses, which are highly infectious.
“Early on in the outbreak, we had at least 26 villages or little towns that would not cooperate with responders in terms of letting people into the village, even,” said Gregory Hartl, a spokesman for the World Health Organization.
The outbreak has occurred in three waves: The first two were relatively small, and the third, starting about a month ago, was much larger, Mr. Hartl said. “That third wave was a clarion call,” he said.
At a House subcommittee hearing on Thursday, Ken Isaacs, a vice president of Samaritan’s Purse, said his aid group and Doctors Without Borders were doing much of the work on the outbreak.
“That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries testifies to the lack of serious attention the epidemic was given,” he said.
Guinea’s Monumental Task
In mid-March, Guinea’s Ministry of Health asked Doctors Without Borders for help in Guéckédou.
At first, the group’s experts suspected Lassa fever, a viral disease endemic in West Africa. But this illness was worse. Isolation units were set up, and tests confirmed Ebola.
Like many African cities and towns, this region hums with motorcycle taxis and minivans crammed with passengers.
The mobility, and now the sheer numbers, make the basic work of containing the disease a monumental task. The only way to stop an outbreak is to isolate infected patients, trace all their contacts, isolate the ones who get sick and repeat the process until, finally, there are no more cases.
But how do you do that when there can easily be 500 names on the list of contacts who are supposed to be tracked down and checked for fever every day for 21 days?
“They go to the field to work their crops,” said Monia Sayah, a nurse sent in by Doctors Without Borders. “Some have phones, but the networks don’t always work. Some will say, ‘I’m fine; you don’t have to come,’ but we really have to see them and take their temperature. But if someone wants to lie and take Tylenol, they won’t have a temperature.”
At Donka Hospital in Guinea’s capital, Dr. Simon Mardel, a British emergency physician who has worked in seven previous hemorrhagic fever outbreaks and was sent to Guinea by the World Health Organization, realized this outbreak was the worst he had seen. A man had arrived late one night, panting and with abdominal pain. During the previous few days, he had been treated at two private clinics, given intravenous fluids and sent home. The staff did not suspect Ebola because he had no fever. But fever can diminish at the end stage of the disease.
The treatment room at Donka was poorly lit and had no sink. There were few buckets of chlorine solution, and the staff found it impossible to clean their hands between patients.
The man died two hours after arriving. Tests later showed he had been positive for Ebola. Untold numbers of health care workers and their subsequent patients had been exposed to the disease.
Gloves, in short supply at the hospitals, were selling for 50 cents a pair on the open market, a huge sum for people who often live on less than a dollar a day. At homes where families cared for patients, even plastic buckets to hold water and bleach for washing hands and disinfecting linens were lacking.
Workers were failing to trace all patients’ contacts. The resulting unsuspected cases, appearing at hospitals without standard infection control measures, worsened the spread in a “vicious circle,” Dr. Mardel said.
Tracing an Epidemic’s Origins
As is often the case in Ebola outbreaks, no one knows how the first person got the disease or how the virus found its way to the region. The virus infects monkeys and apes, and some previous epidemics are thought to have begun when someone was exposed to blood while killing or butchering an infected animal.
Cooking will destroy the virus, so the risk is not in eating the meat, but in handling it raw. Ebola is also thought to infect fruit bats without harming them, so the same risks apply to butchering bats. Some researchers also think that people might become infected by eating fruit or other uncooked foods contaminated by droppings from infected bats.
Once people become ill, their bodily fluids can infect others, and they become more infectious as the illness progresses. The disease does not spread through the air like the flu; contact with fluids is necessary, usually through the eyes, nose, mouth or cuts in the skin. One drop of blood can harbor millions of viruses, and corpses become like virus bombs.
A research team that studied the Guinea outbreak traced the disease back to the 2-year-old who died in Guéckédou and published a report in The New England Journal of Medicine. He and his relatives were never tested to confirm Ebola, but their symptoms matched it and they fit into a pattern of transmission that included other cases confirmed by blood tests.
But no one can explain how such a small child could have become the first person infected. Contaminated fruit is one possibility. An injection with a contaminated needle is another.
Sylvain Baize, part of the team that studied the Guinea outbreak and head of the national reference center for viral hemorrhagic fevers at the Pasteur Institute in Lyon, France, said there might have been an earlier case that went undiscovered, before the 2-year-old.
“We suppose that the first case was infected following contact with bats,” he said. “Maybe, but we are not sure.”
Roaring Back in Liberia
Dr. Fazlul Haque, deputy representative of Unicef in Liberia, said that after a few cases there in March and April, health workers thought the disease had gone away. But it came roaring back about a month later.
“It reappeared, and this time, it came in a very big way,” he said. “The rate of increase is very high now.”
From July 30 to Aug. 6, Liberia’s government reported more than 170 new cases and over 90 deaths.
“Currently, our efforts are not enough to stop the virus,” Dr. Haque said.
He added that most health agencies believed the true case numbers to be far higher, in part because locals were not coming forward when relatives fell ill, and because detection by the health authorities has been weak. Rukshan Ratnam, a spokesman for Unicef in Liberia, said some families had hidden their sick to avoid sending them to isolation wards, or out of shame stemming from traditional beliefs that illness is a punishment for doing something wrong.
Dr. Haque said that the tracing of cases, crucial for the containment of the disease, was moving too slowly to keep up with new infections. Seven counties have confirmed cases, and the government has deployed security forces in Lofa County, where Liberia’s first case was detected, he said. But the government has given leave to nonessential employees in those areas, so it is not clear how they will have the staffing to isolate the sick. Some hospitals have closed because so many health workers have fallen ill.
Liberia has closed markets and many border crossings. It has said testing and screening will be done at immigration checkpoints.
But on Thursday, at a checkpoint staffed by at least 30 soldiers in Klay, Bomi County, there was no screening — just a blockade and a line of trucks loaded with bags of charcoal, plantains and potato greens.
Hilary Wesseh, a truck driver who was sucking the last drops of juice out of a small lime, said he had been stuck there for two days.
“They are holding us hostage,” he said.
A Desperate Call for Help
By June and July, Sierra Leone was becoming the center of the outbreak. At the government hospital in Kenema, Dr. Sheik Umar Khan was leading the efforts to treat patients and control the epidemic.
But he was desperate for supplies: chlorine for disinfection, gloves, goggles, protective suits, rudimentary sugar and salt solutions to fight dehydration and give patients a chance to survive. Early in July, he emailed friends and former medical school classmates in the United States, asking for their help and sending a spreadsheet listing what he needed, and what he had. Many of the lines in the “available” column were empty. One of his requests was for body bags: 3,000 adult, 2,000 child.
Before his friends could send the supplies, Dr. Khan contracted Ebola himself. He died on July 29.
The Ebola outbreak in West Africa is spreading faster than efforts to control it, World Health Organization (WHO) head Margaret Chan has said.
She told a summit of regional leaders that failure to contain Ebola could be “catastrophic” in terms of lives lost.
But she said the virus, which has claimed 728 lives in Guinea, Liberia and Sierra Leone since February, could be stopped if well managed.
Ebola kills up to 90% of those infected.
It spreads by contact with infected blood, bodily fluids, organs – or contaminated environments. Patients have a better chance of survival if they receive early treatment.
Initial flu-like symptoms can lead to external haemorrhaging from the eyes and gums, and internal bleeding that can lead to organ failure.
A US relief agency says it will repatriate two of its American staff who have contracted the virus in Liberia.
They are believed to be the first Ebola patients ever to be treated in the US.
Hundreds of US Peace Corps volunteers have already been evacuated from the West African countries.
Separately, US President Barack Obama announced that delegates from affected countries attending a US-Africa conference in Washington next week would be screened.
“Folks who are coming from these countries that have even a marginal risk, or an infinitesimal risk of having been exposed in some fashion, we’re making sure we’re doing screening,” he said.
Offices are being sprayed with disinfectant in the Liberian capital Monrovia to prevent the spread of the Ebola virus
Analysis: David Shukman, BBC science editor
Friday’s summit should provide the kind of international co-operation needed to fight Ebola but the battle against the virus will be won or lost at the local level. An over-attentive family member, a careless moment while burying a victim, a slip-up by medical staff coping with stress and heat – a single small mistake in basic hygiene can allow the virus to slip from one human host to another.
The basic techniques for stopping Ebola are well known. The problem is applying them. Since the virus was first identified in 1976, there have been dozens of outbreaks and all of them have been contained. Experts point to these successes as evidence that this latest threat can be overcome too.
But working against them are suspicions among local people and the unavoidable fact that this is an extremely poor part of the world, much of it still reeling from conflict. Deploying the right equipment in properly trained hands is always going to be a struggle, one that is now extremely urgent.
Ebola since 1976
Dr Chan met the leaders of Guinea, Liberia and Sierra Leone to launch a new $100m (£59m) Ebola response plan.
The plan includes funding the deployment of hundreds more health care workers to affected countries.
“This meeting must mark a turning point in the outbreak response,” Dr Chan said at the summit in Guinea’s capital, Conakry.
“Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities.”
She said the outbreak was the deadliest and most widely spread, and had also demonstrated an ability to spread through air travel, unlike past outbreaks.
The spread of the virus is dominating the headlines in Liberia
Military vehicles in Liberia are displaying warnings and advice about Ebola to prevent panic over the spread of the virus
Separately, the Liberian government declared Friday a holiday to allow a huge sanitisation and chlorination exercise in government ministries and places of public gathering.
Information Minister Lewis Brown said “the intent is to let us come to the realisation that something is wrong and what is wrong is serious”.