September 26, 2020

Ebola crisis: WHO focuses on preventing regional spread


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_78250921_amber_vinson From BBC

The World Health Organization is to “ramp up” efforts to prevent Ebola spreading beyond the three countries most affected by the deadly virus.

Fifteen African countries are being prioritised, top WHO official Isabelle Nuttall told a Geneva news conference.

They will receive more help in areas including prevention and protection.

public health officials are being questioned at a congressional hearing on perceived failings in how the has dealt with cases.


The transmission of the Ebola virus remains intense in , and Guinea, the WHO’s Dr Nuttall said.

There was a “spike” in the Guinean capital, Conakry, said Dr Nuttall, and “intense transmission” in Freetown, the capital of Sierra Leone.

In the Liberian capital, Monrovia, she spoke of “significant underreporting” and problems with data-gathering making it hard to reach firm conclusions. But there was a drop in the number of cases in Lofa district.

Farmers in Sierra Leone have deserted their land during the Ebola outbreak

Overall, cases were doubling every four weeks, said Dr Nuttall, the WHO’s Director of Global Capacities Alerts and Response, and the death toll was expected to go above 4,500 this week.

Countries in the region_78290951_ebola_pledges_v2 must be prepared, she said, listing Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of Congo, Gambia, Ghana, Mauritania, Nigeria, South Sudan, and Togo.

She highlighted four nations directly bordering the worst affected area – Ivory Coast, Guinea Bissau, Mali and Senegal.

“We will ramp up our support to the countries. We will work with them on a plan. But a plan needs to be changed into action.”

Action will include:

Rapid response teams

   Engaging at community level

   Training in infection prevention and protection

   Having laboratories in place

Earlier, the WHO said the introduction of Ebola in the US and elsewhere was a matter of concern, but a major outbreak was unlikely given the strength of health systems in the West.

In another development, the European Union is to examine whether exit screening at West African airports is effective.

EU health ministers also agreed to try to co-ordinate measures taken at EU airports. Some countries, such as the UK, have introduced screening.

Texas nurse

In the United States, questions are being asked about why two nurses who treated an Ebola patient from Africa have themselves become infected.

Thomas Eric Duncan died at the Texas Health Presbyterian Hospital after arriving in the US from Liberia.

Nurses Nina Pham and Amber Vinson both contracted Ebola after treating him.

Both wore face shields, hazardous materials suits and protective footwear as they drew blood and dealt with Mr Duncan’s body fluids and it remains unclear how they were infected, officials say.

Amber Vinson was allowed to take a commercial flight after treating him and officials are trying to the trace the 132 people who flew with her.

In testimony prepared for the congressional hearing, Daniel Varga, the chief clinical officer for the company that runs the hospital, apologises for mistakes made in treating Mr Duncan.

“We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry,” he says.

“A lot is being said about what may or may not have occurred to cause Ms Pham to contract Ebola,” he says.

“She is known as an extremely skilled nurse, and she was using full protective measures under the CDC protocols, so we don’t yet know precisely how or when she was infected.”

Opening the hearing, Chairman of the House Subcommittee on Oversight and Investigations Tim Murphy accused the Centers for Disease Control of “changing course” on measures that would have strengthened quarantining.

He also cast doubt on airport screening, saying those with a fever could avoid it.

But in his opening statement, Centers for Disease Control Director Tom Frieden said everything was being done to prevent transmission of Ebola.

“There are no shortcuts. Everyone has to do their part. We are there to support. We are there with world-class expertise to protect Americans.”

New US Ebola control measures

   A “site manager” will supervise how workers at the Texas Health Presbyterian Hospital put on and take off protective clothing

   Two nurses from Emory University Hospital in Atlanta will offer “enhanced training” in Dallas

   An immediate response team will travel to the site of any future Ebola diagnoses to hit the ground “within hours”

   New guidelines for testing at hospitals throughout the US, with special emphasis on asking questions about travel history

In other developments on Thursday:

Another Spanish healthcare worker, who came into contact with a nurse already infected, is being tested for the virus

   An Air France passenger with a high fever, reportedly from Nigeria, is to be examined in hospital for Ebola symptoms after arriving in Madrid from Paris

   A patient with “Ebola-like” symptoms is being monitored in the US state of Connecticut

How not to catch Ebola:

Avoid direct contact with sick patients as the virus is spread through contaminated body fluids

   Wear goggles to protect eyes

   Clothing and clinical waste should be incinerated and any medical equipment that needs to be kept should be decontaminated

   People who recover from Ebola should abstain from sex or use condoms for three months


Ebola victim in Liberia, 15 Oct The disease has killed about 4,500 people so far, mostly in Liberia, Guinea and Sierra Leone

Graphic showing pledges in fight against Ebola

Amber Vinson -undated photo Amber Vinson was not supposed to travel on an aeroplane, health officials said.

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Related story:

Ebola spreads through droplets in the airFrom Newsmax

The Centers for Disease Control and Prevention confirmed Sunday that a nurse at a Dallas hospital who cared for Thomas Eric Duncan, who died from Ebola last week, was the first person to become infected with the virus on U. S. soil. The nurse reportedly wore a gown, gloves, a mask and a face shield while caring for the Liberian national at Texas Health Presbyterian Hospital. Many, including CDC Director Tom Frieden, are questioning how the nurse became infected despite wearing the appropriate personal protective equipment, which should have shielded her from direct contact with Duncan and his bodily fluids.

Once again, the specter of airborne Ebola is being raised.

No virus that causes disease in humans has ever been known to mutate to change its mode of transmission. This means it is highly unlikely that Ebola has mutated to become airborne. It is, however, droplet-borne — and the distinction between the two is crucial.

Doctors mean something different from the public when they talk about a disease being airborne. To them, it means that the disease-causing germs are so small they can live dry, floating in the air for extended periods, thus capable of traveling from person to person at a distance. When inhaled, airborne germs make their way deep into the lungs.

Chickenpox, measles and tuberculosis are airborne diseases. Droplets of mucus and other secretions from the nose, mouth and respiratory tract transmit other diseases, including influenza and smallpox.

When someone coughs, sneezes or, in the case of Ebola, vomits, he releases a spray of secretions into the air. This makes the infection droplet-borne. Some hospital procedures, like placing a breathing tube down a patient’s air passage to help him breathe, may do the same thing.

Droplet-borne germs can travel in these secretions to infect someone a few feet away, often through the eyes, nose or mouth. This may not seem like an important difference, but it has a big impact on how easily a germ spreads. Airborne diseases are far more transmittable than droplet-borne ones.

Richard Preston‘s remarkable book, “The Hot Zone,” chronicled an Ebola Reston virus outbreak at a primate quarantine facility just outside Washington. The monkeys didn’t have direct contact with each other. CDC and military experts had to consider the possibility that Ebola Reston virus might be airborne. But feces thrown about the room, aerosols used in pressure washing the monkey cages or contaminated gloves used to handle the animals could also have transmitted the virus.

It is important to emphasize that Ebola Reston virus does not cause disease in humans. It also survives longer than — the species responsible for the West African epidemic — when aerosolized in the lab. But even can remain infectious when aerosolized for at least 90 minutes. What happens in the lab, however, doesn’t always represent the real world.

Since the Reston scare, scientists have learned more about Ebola transmission from other outbreaks.

In 1995, more than 300 people became sick with Ebola in Kikwit, Democratic Republic of the Congo. Disease detectives were unable to determine how 12 of the patients were exposed — again raising questions about the possibility of airborne transmission. But if Ebola could be transmitted through the air, at least some family members of Ebola patients should have gotten sick even without direct contact. That didn’t happen.

Ebola struck again in 2000, this time affecting more than 400 people in Gulu, Uganda. Not all had direct contact with another Ebola patient. Bedding and mattresses seemed to be one source of infection. So did sharing a meal with an Ebola patient — which often meant using fingers to eat from the same plate. Each had in common likely exposure to infected bodily fluids.

In the lab, scientists studied how Ebola virus infects different species and causes disease. In humans and primates, Ebola Zaire spreads from the cells of the immune system to the lymph nodes, blood, liver and spleen. It causes minimal disease in the lungs. But in pigs, Ebola Zaire causes severe lung disease.

Researchers infected pigs with Ebola Zaire and then placed them near but not in direct contact with primates. The primates became infected. Because Ebola Zaire causes severe lung disease in pigs, their respiratory secretions are laden with the virus. With all their snorting and snuffling, pigs are very good at generating aerosols. The infected monkeys, however, didn’t transmit the virus onward.

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For Ebola Zaire to become airborne in humans, it would need to cause lung disease significant enough to release lots of virus into respiratory secretions. The virus would then need to survive outside the body, dried and in sunlight for a prolonged time. And it would need to be able to infect another person more than a couple feet away.

There’s no evidence from previous epidemics or laboratory experiments that Ebola Zaire behaves in this way. Although the virus is mutating as the Ebola epidemic continues to grow in West Africa, it has multiple hurdles to overcome in order to become airborne.

As we rule out Ebola being airborne, the droplet-borne risk of Ebola must be addressed. Most important, those on the frontlines — especially nurses and doctors — should be provided with the necessary training and personal protective equipment to ensure that there are no more transmissions within hospitals.

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