Ebola Update: WHO raises alert level, as travel restrictions begin

Ebola patients in the news

The Saudi Arabian, who was thought to be infected with Ebola, tested negative for that disease.  His illness was caused by something else.  Perhaps another hemorrhagic fever.

Just a general note.  Possible cases of Ebola have been reported in a number of locations: Mexico City, Greece, Benin, London and other places.  Physicians and hospitals have been alerted about the Ebola epidemic and are using an abundance of caution.  Probably almost all of those thought to have Ebola will eventually test negative.

Dr. Kent Brantly, the Ebola patient John mentioned earlier, wrote, from his isolation room at Emory,  that he is getting stronger every day.

The husband of the other patient, Nancy Writbol, says that she is still very weak, but he says that he’s been told that she’s “making progress.”  (Probably the best sign that she may be feeling better, is that she asked for, and received, coffee from Starbucks.)  Her husband was in close contact with her in Liberia; he is waiting out a 21-day quarantine period.  As of today, he has no fever or other symptoms.

As far as I can tell, the Nigerian cases of suspected Ebola have not been confirmed.  One reason may be that many couriers in the affected countries are refusing to transport any specimens that may contain Ebola for testing.  Also, there is only one lab in each country that can do Ebola testing.

Another physician from Sierra Leone has been diagnosed with Ebola.  He had been treating patients, some of whom were later identified of having Ebola.

West Africa Ebola update

Guinea has closed its borders with Sierra Leone and Liberia.  The country is trying to stop the spread of Ebola by limiting people from neighboring countries who may be infected.

A woman stands in front of her roadside stall where she sells grains in Monrovia, Liberia. MickyWiswedel / Shutterstock.com

A woman stands in front of her roadside stall where she sells grains in Monrovia, Liberia. MickyWiswedel / Shutterstock.com

One doctor, who periodically goes to Liberia to treat patients, says that this is the rainy season in that area of Africa.  Often, at this time, clinics close because transportation may become almost impossible.  Since almost no clinics outside of Monrovia have electricity, they rely on frequent deliveries of perishables to remain open.  He says that typhoid increases during this period as drinking water supplies become contaminated with human waste.  He anticipates that there will be many more deaths from typhoid, than there will be from Ebola, at least, in the immediate future.  As the epidemic continues, supplies, already limited, are running low.  With quarantines in place in some areas and the unwillingness of drivers to transport supplies, things will continue to get worse.

The Liberia, Sierra Leone and Guinea have other problems in dealing with the epidemic, as well.  The governments don’t have a lot of capital to spend on public health in the best of times.  They are really strapped now.  The majority of the population is also extremely poor and under educated.  Some don’t believe that Ebola is even a real disease.  Some prefer to go to native healers.  A portion believe that the clinics and doctors are actively trying to kill them.  Police and military troops have been called in, at times, to protect healthcare workers and facilities such as hospitals, clinics and government offices.  Because of the outbreak, food prices are rising.

As this continues, it will doubtless contribute to increasing unrest and fear.  The Nigerian finance minister has said that the government needs to contain Ebola quickly to prevent economic damage to the area.  Unfortunately, most epidemiologists familiar with Ebola and the area involved, say that this outbreak will probably continue for a minimum of six months.  There seems to be disconnect between government officials and health officials in some cases.  The overall impression is that things will get worse in the affected areas for quite some time, before there is any improvement.

The Liberian government has apologized to health care workers for its lack of preparedness, equipment and supplies to cope with the outbreak.  All four involved nations are asking for help in the form of medical supplies, money and volunteers.

WHO raises its alert level over Ebola

The World Health Organization yesterday, said that the Ebola outbreak meets the criteria to be classified as a “Public Health Emergency of International Concern.”  As such, the WHO is recommending that all countries that are affected with Ebola adopt the following measures.  These are supposed to be carried out at international airports, seaports and major border crossings.

— At a minimum, conduct a questionnaire, measure temperature;
— If fever, assess whether caused by Ebola. Prevent travel of persons whose illness is consistent with Ebola, unless authorized for medical evacuation;
— Prevent international travel of Ebola contacts or cases, unless authorized for medical evacuation;
— If confirmed Ebola case, individual should be isolated and treated at an Ebola Treatment Center with no international travel until 2 Ebola-specific diagnostic tests conducted at least 48 hours apart are negative;
— If Ebola contact, monitor daily with no international travel and restricted national travel until 21 days after exposure;
— If probable or suspected Ebola case, individual should be isolated and travel restricted according to whether deemed a confirmed case or contact.
— Countries should ensure appropriate medical care is available to airline crews and staff operating in affected countries and establish communication procedures for tracing passenger locator records.

Of course, these are simply recommendations.  It is up to the involved nations whether to enforce them.  But all three of the countries most severely affected are following some screening procedures.  However, these would not prevent infected patients by crossing borders via secondary roads, on foot, by small water craft, etc.  People may also attempt to avoid screenings by deceit or bribery.

Other countries are starting screening procedures directed at arrivals from the affected countries  Some have prohibited flights to or from Sierra Leone, Guinea and Liberia.  Or they have restricted what can enter their countries from those areas.  For example, Nigeria is prohibiting transport of bodies of people who have died from Ebola.  Others, like Zambia, are restricting the entry of travelers from the affected countries and are prohibiting Zambians from traveling to the stricken areas.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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