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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15 Responses to “Ebola Update: WHO raises alert level, as travel restrictions begin”

  1. Jassey Smith says:

    Ebola is dangerous disease now a day. Before going anywhere you have to survey for this. For Istanbul tourist attractions visit at http://www.triphobo.com/istanbul-turkey

  2. Mark_in_MN says:

    Franklin Graham is vile. That’s for certain. Many medical partitioners who go through religious organizations just do medical stuff. But the point is quite simply that going to help others is hardly a silly reason, nor one that should be judged wanting in its own right. The other activities or the way particular organizations go about it, on the other hand, may rightly be subject to significant and heavy criticism.

  3. MJ says:

    (Until the homophobia you unwittingly helped your boss spread around creates another Uganda…)

  4. Mark_in_MN says:

    Physicians and nurses go to the developing world to provide medical care with all sorts of organizations, from secular to religious. They may go with religious motivations or with simply human ones. Personal motivations may not necessarily align with the nature of the organization they work with. Even those who dress them in religious language may really be going simply because it is the human thing to do, to provide care to people who are in need of it and may have limited access or resources for it. Going to help others is hardly a silly reason.

  5. MJ says:

    I disagree on missionary egos (especially these ones with homophobe Franklin Graham’s outfit) but I understand what you’re saying from the medical side of it, even though I disagree with you there too, in a way. If someone catches a, debatably, contagious disease for a reason as silly as God-called-me-to-that infested-place, then I don’t want him bringing it home to me. (But, again, I understand the medical point you make).

  6. Mark_in_MN says:

    Medical evacuation and repatriation is the right thing to do. Better medical facilities and access to family is worthwhile and important. The chances of transmission to others, especially when precautions are taken and observed, is fairly small. I don’t think it really has anything to do with “missionary ego,” whatever that is (although the missionary connection might help with the financial side of the medical evacuation). I’d want those working with Doctors Without Borders or those who have just been living and working there to be brought home for treatment too.

  7. MJ says:

    BTW : The odd thing about gays is that, although they’ve always been critical of western missionaries spreading homophobia throughout Africa, they actually defend and support Franklin Graham and Kent Brantly doing just that, ONLY because Ann Coulter criticized Brantly herself. Since they hate Ann Coulter, their brains can only conclude that Graham and Brantly must be the good guys. Gays used to be men like Alan Turing and Francis Bacon, and now…..most have as much mental capacity as Sponge Bob.

  8. MJ says:

    And as soon as they catch anything they come rushing back to the U.S. for treatment, not even considering what danger they could be bringing to areas not yet affected. Talk about the missionary ego.

  9. lynchie says:

    we also have the religious who believe that god will look after them because they (the church) are christian as well as the thousands waiting for doomsday to be called to heaven. they prefer a stupid uninformed public who line up to hear what god told their pastor or minister because they talk every night. the spread in remote areas by these ministries is about brainwashing and converting more to the flock. the same happens here with Swaggert, Popov, Osteen, Graham and the host of televangilists who scare, wind up the viewers. It happened during the early settling of North America with the Indians and Eskimos and converting people is their goal. this ensures vast amounts of money flowing to their coffers.

  10. GarySFBCN says:

    Thanks for that link.

    FYI, the response activities I described above are used for other purposes – there are ‘sentinel events’ such as one anthrax event where we would be part of the response – manage or monitor the decontamination efforts and the care/treatment of the infected, or small-scale efforts such as a bacterial meningitis outbreak in a high school, where we would provide prophylaxis to 2,000 students. Once we implemented the Department Operations Center as our response ‘decision center’, it was part of exercises twice a year and was deployed about to respond to an even about twice a year.

    And we used a wonderful org/command structure called the Incident Command System, which is part of the National Incident Management System. This great tool allows for near seamless coordination between otherwise disparate agencies and multiple levels of government.

    There is so much work that goes on ‘behind the scenes’ and it would only be in the press if we made a mistake.

  11. docsterx says:

    Interesting. I didn’t realize the scope of the preparations that the health department does for alerts.

    As you mentioned, communicating with the public is very important and social media can play a huge role. Unfortunately, in the Liberia, Sierra Leone and Guinea, social media, as we know it, isn’t available. The government is hanging up signs and posters, canvassing neighborhoods, etc. to try to get information out. Not very effective.

    BTW, the CDC used Twitter for a news conference about Ebola, answer questions, etc. It’s available on Twitter #CDCChat or here https://storify.com/HHSGov/august-4-2014-cdcchat-on-ebola

  12. GarySFBCN says:

    I used to work in a county public health department so I’d like to provide a perspective of what happens when these alerts are issued. In 2009 when news of H1N1 first broke (in Mexico) and the CDC issued an alert, I was called at 10pm on a Saturday night (I was at a dinner party) to report to work. We activated our emergency/outbreak ‘Department Operations Center’, and set-up the facility. All of the department leads met and we were informed about the outbreak. Then, using our pandemic flu response plans (plans that most departments have but never use), we determined what our response and ‘ready state’ efforts should be based upon the information available.

    We were responsible for planning for patient surge should everyone get sick, isolation, quarantine, vaccine administration and distribution, establishing personal protective gear standards, working with other agencies to ensure that if 60% of the population was sick that critical parts of the infrastructure (water, electricity, etc.) would still be in place. Data collection and disseminating diagnostic and treatment guidelines, guidelines may change more than one realizes, was also part of our responsibilities. The CDC (via the state) would ship us large quantities of needed vaccines, meds, equipment from the Strategic National Stockpile, for us to distribute to clinics, hospitals, etc. We had to ensure that first responders would be protected via vaccines and protective gear.

    One of the biggest challenges is communications. We had to be the source of all info for the county and having relationships with members of the press before an outbreak is important. We would often establish a call-center because we would get hundreds, sometimes thousands of calls from ‘worried well.’ Crafting press releases and getting them out quickly is key to staying ahead of rumors. And rumor control is also important. Ideally, the department is already good at Twitter. During the Boston Marathon bombing, BPD was on-top of the communications, expertly using Twitter to inform, squelch rumors and engaging the public’s help to finally capture the bomber.

    We also set up flu vaccine clinics – some in the most used transit stations, others in big parking lots for ‘drive by shootings’ vaccinations.

    There is a lot I’m leaving out but it is a huge effort and it is usually very well coordinated among several agencies within a county, the state, the US and sometimes foreign countries. Plans are great but they aren’t everything. Once the pilot of a full jet radioed that they had two people that may have SARS on it and they were landing in our jurisdiction. There was nothing in the plan for that. After our response to that (setting up a clinic at the airport, screening passengers, isolation, etc), we documented everything in an ‘after action report’ and added an addendum to the emergency response plan.

    Anyway, this is just a few things that happen when alerts are issued.

  13. goulo says:

    “(Probably the best sign that she may be feeling better, is that she asked for, and received, coffee from Starbucks.)”

    (Insert obligatory snark that, rather than being a good sign, this shows that she is suffering from advanced delirium…) :)

  14. bkmn says:

    American fundamentalist missionaries are some of the outsiders in these areas so don’t be surprised at the willful ignorance. These areas are chronically poor and in much of Africa corruption in government is the norm.

  15. HeartlandLiberal says:

    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.

    While reading this, I had to struggle to grasp why this was very different from the militant ignorance and disinformation cesspool that America has become for a large percentage of the population. Some of it sounds like it could come right out of the Tea Party playbook. Or the vaccine disbelievers playbook. Or just the general stew of insane conspiracy theories that have infected and destroyed rational discourse in this nation.

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