The biggest Ebola crisis in history continues to spread, confirmed cases as well as increased precautions. The last official numbers from the World Health Organization were reported Friday at 1427 deaths of over 2600 possible cases.
One concerning point of news has been reported in the interim by the WHO. About half of more than 240 health workers have died as a result of treating the outbreak, representing a change in the pattern of infection. This has been attributed to a change in the circumstances of administering care.
The outbreak of Ebola virus disease in west Africa is unprecedented in many ways, including the high proportion of doctors, nurses, and other health care workers who have been infected.
To date, more than 240 health care workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died.
Ebola has taken the lives of prominent doctors in Sierra Leone and Liberia, depriving these countries not only of experienced and dedicated medical care but also of inspiring national heroes.
Several factors help explain the high proportion of infected medical staff. These factors include shortages of personal protective equipment or its improper use, far too few medical staff for such a large outbreak, and the compassion that causes medical staff to work in isolation wards far beyond the number of hours recommended as safe.
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The current outbreak is different. Capital cities as well as remote rural areas are affected, vastly increasing opportunities for undiagnosed cases to have contact with hospital staff. Neither doctors nor the public are familiar with the disease. Intense fear rules entire villages and cities.
Several infectious diseases endemic in the region, like malaria, typhoid fever, and Lassa fever, mimic the initial symptoms of Ebola virus disease. Patients infected with these diseases will often need emergency care. Their doctors and nurses may see no reason to suspect Ebola and see no need to take protective measures.
Some documented infections have occurred when unprotected doctors rushed to aid a waiting patient who was visibly very ill. This is the first instinct of most doctors and nurses: aid the ailing.
In many cases, medical staff are at risk because no protective equipment is available – not even gloves and face masks. Even in dedicated Ebola wards, personal protective equipment is often scarce or not being properly used.
Indian officials coordinated the precautionary quarantine processing over over 100 nationals returning from Africa in an attempt to keep orderly control over the tense situation.
Times of India
The enormity of the Ebola outbreak hit home on Tuesday as 112 Indians and four Nepalese arrived in the country on different flights from Liberia. This West African country has seen over 600 deaths so far and is the worst affected. Till late in the night, 88 people had arrived – 71 in Mumbai and 17 in Delhi. More were on their way on different commercial flights.
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Sources said the 112 Indian nationals and four Nepalese were brought back by International SOS (ISOS) on the request of infrastructure company Afcons. These persons belong to Delhi(4), Maharashtra (54), West Bengal (12), Bihar (10), Uttar Pradesh (7), Tamil Nadu (5), Andhra Pradesh (4), Kerala (3), Odisha (3), Gujarat (3), Karnataka (2), Haryana (2), Punjab (2), Jharkhand (1), Madhya Pradesh (1), Uttarakhand (1), Rajasthan (1) and Himachal Pradesh (1).
The medical director, International SOS, said these persons have been screened at the time of exit from Liberia and none of the passengers had any symptoms prior to travel.
On Tuesday, IGI airport witnessed hectic activity with passengers being rushed out of the airport and an APHO ambulance making several rounds from their office at the airport and T-3′s arrival terminal. The first flight from Liberia, routed via Doha, QR564, landed at IGI at 7.40 am. The next flight – Ethiopian Airlines – came almost an hour later. Three passengers from it were rushed to APHO in an ambulance.
The Ebola suspects were wearing a suit and face mask. Officials at the airport said the aircraft carrying the passengers was being sequestered and fumigated. “The luggage of the Ebola suspects is also being isolated,” an official said.
The scare this disease has caused was palpable inside and outside the airport. All staff inside the airport wore face masks to prevent contamination since hundreds of foreign visitors were arriving at the international terminal by the hour.
Even between the arrivals of the flights from Liberia, there was a sense of caution at the airport. Several foreign tourists were also spotted with face masks along with some visitors who had come to receive their guests.
The densely populated country scrambled to set up more isolation capacity to receive the quarantine candidates.
Civic authorities, meanwhile, are busy creating an isolation facility in a suburban hospital.
According to a spokesperson for the Chhatrapati Shivaji International Airport (CSIA), the seven flights are carrying Indians evacuated from Liberia by the Indian embassy. Liberia is one of the four countries in West Africa affected by the Ebola virus.
While three flights will be diverted via Delhi, the remaining four will reach Mumbai directly at different times on Tuesday. All the flights are originating from Johannesburg.
The Brihanmumbai Municipal Corporation (BMC) is preparing 120 beds after it received an alert from the CSIA. According to acting executive health officer (EHO) at BMC, Dr Shreedhar Kubal, an action plan has been drawn up. “We are isolating 120 beds. We have been told that more than 100 passengers are suspected to have been exposed to Ebola,” Kubal said.
BMC’s additional municipal commissioner Sanjay Deshmukh said, “While a facility for 120 passengers is being mobilised, we expect that around 20 would need to be quarantined.”
An emergency meeting was called by the civic health department Monday. Currently, the civic body has only 20 isolation beds for infectious diseases — 10 in Kasturba hospital at Chinchpokli and 10 in Jogeshwari trauma care hospital.
Preparations are also being made at the airport in Mumbai. South African flight 284 with 20 passengers is expected to be the first to arrive at 12.50 am Tuesday. More passengers are scheduled to be flown in by Ethiopian Airlines, Etihad Airways, Qatar Airways, Emirates and South African Airways.
The medical team at CSIA has planned a five-step process for the safety of passengers, including parking the aircraft at an isolated bay. “The passengers will be screened at the step ladder itself. Those without symptoms will be cleared,” said an airport spokesperson.
CDC worker returns to US
An American CDC worker was flown home and is being “monitored” for symptoms.
A CDC staff member was recently flown home to the United States on a private charter after spending time in close proximity with another health care worker who tested positive for Ebola in Sierra Leone.
The CDC worker is reportedly healthy and has shown no symptoms of the deadly virus. He or she is simply rotating back to the United States as previously scheduled, according to the CDC. It is CDC policy that people who have been exposed to Ebola and are traveling long distances do so on a private plane in the three weeks after exposure to lower the risk of spreading the infection.
“We think it’s the right thing to do, to bring them home,” CDC spokesman Tom Skinner said. “They want to come home. Their tour of duty was up, and we’ve made it crystal clear that if they go over there and have something like this happen and want to go home, we’re going to bring them home.”
The staff member will be monitored for 21 days — the longest known incubation period — for Ebola symptoms, but he or she currently “poses no Ebola-related risk to friends, family, co-workers, or the public,” the CDC said in a statement.
Compare the international precautions to this American worker basically being asked to keep a watch on body temperature. Canada has decided to pull its workers out of the country after the lab they were working in was closed as a result of a Senegalese doctor contracting the virus.
The American CDC staff worker was said to being working “within 3 feet” of another worker confirmed to be infected with the virus. Watch the incredible explanation by CNN.
Wolf Blitzer: “What are you hearing from the CDC?”
Elizabeth Cohen: “What I’m hearing is that this employee was working in Sierra Leone, and ended up, they were working next to, within 3 feet, of an international health worker who was sick, had symptoms and later turned out that that person had Ebola.
So the CDC employee is completely fine, has no symptoms at all… but it was time for this person to come home.
So they put the CDC employee on a private chartered flight from Sierra Leone to Atlanta, this employee landed here in Atlanta this morning.
This employee has to take their temperature twice a day, just to make sure that they don’t get sick. But it’s interesting, while they’re here in Atlanta, there’s no restrictions, this employee can go to work, can go out, can do whatever they want.
Wolf: Is that *stutters* Shouldn’t they err on the side of caution maybe uh because sometimes it takes a while for symptoms to develop, right?
EC: You know Wolf, I think that’s a question that a lot of people will be asking, but here’s the reasoning behind it.
“You’re not contagious with Ebola until you’re actively sick. This person is not sick and had what is considered to be a very low risk exposure. They were just working near the person, they didn’t have it, they weren’t taking care of them or anything like that.
So if this person starts to get sick, if this person spikes a temperature, then yes, I am sure immediately this person will be quarantined and they’ll be very vigilant about that, but at the moment this person isn’t sick so there’s no reason to think this person has Ebola, and certainly this person isn’t contagious because they’re not sick.
World Health Organization
On 26 August 2014, the Ministry of Health, Democratic Republic of Congo (DRC) notified the World Health Organization (WHO) of an outbreak of Ebola virus disease (EVD) in Equateur Province.
The index case was a pregnant woman from Ikanamongo Village who butchered a bush animal that had been killed and given to her by her husband. She became ill with symptoms of EVD and reported to a private clinic in Isaka Village. On 11 August 2014, she died of a then-unidentified haemorrhagic fever. Local customs and rituals associated with death meant that several health-care workers were exposed and presented with similar symptoms in the following week.
Between 28 July and 18 August 2014, a total of 24 suspected cases of haemorrhagic fever, including 13 deaths, have been identified. Human-to-human transmission has been established and includes the health-care personnel who were exposed to the deceased pregnant woman during surgery (one doctor and two nurses) in addition to the hygienist and a ward boy, all of whom developed symptoms and died. Other deaths have been recorded among the relatives who attended the index case, individuals who were in contact with the clinic staff, and those who handled the bodies of the deceased during funerals. The other 11 cases are currently being treated in isolation centres.
Samples have been sent to laboratories in Kinshasa and in Gabon for confirmation of EVD and to identify the strain. The index case and the 80 contacts have no history of travel to the EVD-affected countries in West Africa (Guinea, Liberia, Nigeria, or Sierra Leone) or history of contact with individuals from the affected areas. At this time, it is believed that the outbreak in DRC is unrelated to the ongoing outbreak in west Africa.
Expect something to change soon as not only are economies of West Africa suffering losses, but the diamond industry is running into problems also.
As transport companies suspend services, cutting off the region, governments and economists have warned that the epidemic could crush the fragile economic gains made in Sierra Leone and Liberia following a decade of civil war in the 1990s.
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African Development Bank (AfDB) chief Donald Kaberuka said on a visit to Sierra Leone he had seen estimates of a reduction of up to 4 percent in gross domestic product due to Ebola.
“Revenues are down, foreign exchange levels are down, markets are not functioning, airlines are not coming in, projects are being cancelled, business people have left – that is very, very damaging,” he told Reuters late on Tuesday.
Liberia has already said it would have to lower its 2014 growth forecast, without giving a new one.
Sierra Leone Deputy Minister of Mineral Resources Abdul Ignosis Koroma said the government would miss its target of exporting $200 million in diamonds this year because of the Ebola outbreak. It exported $186 million of diamonds in 2013.
He said miners were too afraid to go to alluvial diamonds pits in the Ebola-stricken east and tough border controls to curb the spread of the virus were also hurting the trade.
Several international companies in the region have pulled out expatriate staff in recent weeks. Iron ore miner London Mining, whose only operating mine is in Sierra Leone, said recently that Ebola could hurt its production this year.
The Senegalese doctor has been flown to Germany to receive treatment. His condition may be an interesting one to watch as the clinic suggested conventional treatment options would be used as opposed to possible experimental treatments. The lab he was working in, with the evacuated Canadians, has been closed as a result.
- A Senegalese doctor who contracted Ebola while working for the World Health Organisation (WHO)in Sierra Leone arrived in Hamburg on Wednesday for treatment at a tropical medicine unit, becoming Germany’s first patient with the disease.
At a news conference on Wednesday the clinic’s tropical medicine specialist said the man would not be given new experimental drugs such as ZMapp but that his treatment would at first focus on managing his symptoms.
The Senegalese doctor arrived in Germany on a specialist plane and was transferred to the university clinic Hamburg-Eppendorf in a special isolation ambulance, accompanied by a police guard.
The WHO had approached the clinic on Saturday to ask if they would accept the patient, Rico Schmidt, health spokesman for Hamburg city senate told reporters.
Doctors at the clinic declined to give details about the man’s condition due to patient confidentiality, but said the fact he was able to enter the aeroplane himself suggested he was well enough to benefit from treatment.
The patient, who has not been named, had worked in a laboratory in Sierra Leone that was testing for Ebola, the WHO has said. It shut the laboratory on Tuesday after he became infected.
Hamburg-based tropical medicine specialist Stefan Schmiedel said they would not be using drugs such as ZMapp, which has been given to some Ebola patients including a British volunteer nurse recently repatriated to London.
Treatment would at first consist of managing the patient’s vital functions, pain and fever levels. “We believe through these simple measures the threat of Ebola can be reduced,” Schmiedel said.
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