Ebola Virus Disease Electron Micrograph

71% Back Mandatory Quarantines for Ebola Workers: Poll

This article was originally published on this site

By Carrie Dann

More than seven in 10 Americans support mandatory quarantines for health professionals who have treated Ebola patients in West Africa, even if they have no symptoms, according to a new NBC News/Wall Street Journal poll.

The survey shows that 71 percent of those surveyed say the health workers should be subject to a 21-day quarantine, while 24 percent disagree.

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The question of mandatory quarantines exploded into the public debate after nurse Kaci Hickox battled with the governors of New Jersey and Maine over the mandated isolation, arguing that she has exhibited no symptoms and tested negative for the virus. Those who oppose the practice – including top health officials and White House administration officials — say that it is unnecessary and discourages health workers from fighting the Ebola outbreak at its source.

Support for the quarantines varies by political party, age and education level.

Eighty-five percent of self-described Republicans say they think the quarantines should be enforced, versus 65 percent of Democrats and 60 percent of independents. Ninety-one percent of Tea Party backers also believe the quarantines are necessary.

Older Americans are also more likely to back mandatory isolation for the health workers. A third of those 18-34 years old oppose the requirements, compared with just one in 10 seniors.

And those with lower levels of education are more likely to support quarantines (80 percent of those with a high school education or less are in favor) than those with college or post-graduate educations (63 percent are in favor.)

The poll was conducted October 30 through November 1, 2014. The margin of error for the poll question regarding Ebola quarantines was 5.73 percent.

First published November 2 2014, 3:29 PM

Carrie Dann

Carrie Dann is a national political writer for NBCNews.com. She has worked for NBC and NBCNews.com since 2006. Dann writes about politics and Congress. Dann rejoined the web team after 18 months as a campaign reporter for NBC News, covering presidential and vice presidential candidates during the 2012 election. She also covered the 2007-2008 presidential campaign for NBC, including extensive reporting on the Iowa caucuses.

Prior to her work at NBCNews.com, Dann was a staff reporter at CongressDaily, where she covered lobbying and government reform.

A Virginia native, she now lives in Washington, D.C.

… Expand Bio

Ebola Virus Disease Electron Micrograph

Maine nurse sees Ebola quarantines as ‘abundance of politics’

This article was originally published on this site
Nurse Kaci Hickox (L) joined by her boyfriend Ted Wilbur speak with the media outside of their home in Fort Kent, Maine October 31, 2014. REUTERS/Joel Page

 

 

(Reuters) – A U.S. nurse who challenged quarantines of health care workers returning from treating West African Ebola patients said on Sunday she thought “an abundance of politics” lurked behind them.

 

Kaci Hickox has fought a heated public battle over what she considers draconian measures to isolate her for 21 days after her return from Sierra Leone, in a case that highlights the dilemma over how to balance public health needs and personal liberty.

 

In some U.S. states officials such as New Jersey Governor Chris Christie have imposed strict quarantines on health workers returning from three Ebola-ravaged West African countries, but the U.S. federal government opposes such measures.

 

“When Governor Christie stated that it was an abundance of caution, which is his reasoning for putting health care workers in a sort of quarantine for three weeks, it was really an abundance of politics,” Hickox said in an interview with NBC’s “Meet the Press”.

 

“And I think all of the scientific and medical and public health community agrees with me on that statement,” she said.

 

Christie has defended his decision to impose a mandatory three-week quarantine, saying that counting on a voluntary system may or may not work and that protecting health and safety is the government’s job.

 

The most deadly outbreak of Ebola on record has killed nearly 5,000 people, all but a handful of them in Liberia, Guinea and Sierra Leone.

 

ISOLATION TENT

 

Hickox tested negative for Ebola after returning recently from working for Doctors Without Borders in Sierra Leone. But she was placed in an isolation tent in New Jersey when she returned before being allowed to leave for Maine, which also sought to quarantine her at home.

 

A judge in Maine on Friday rejected that state’s bid to quarantine Hickox, instead imposing limited restrictions on her. The judge said that Hickox must continue direct monitoring of her health, coordinate travel plans with health officials and report any symptoms.

 

“We know a lot about Ebola,” Hickox told Meet the Press. “We know that it’s not transmitted from someone who is asymptomatic, as I am and many other aid workers will be when they return.”

 

Speaking to NBC from Fort Kent, Maine, Hickox indicated she would continue to stay away from crowds in her community, but that her partner, Ted Wilbur, should be allowed to go back to nursing school on Monday.

 

“I understand that the community has been through a lot in the past week and I do, you know, apologize to them for that,” she told NBC.

 

“I will not go into town, into crowded public places … But on the other hand, you know, my partner is currently in nursing school and there is definitely zero scientific evidence that says he shouldn’t be allowed to return to his campus on Monday.”

 

Only one person in the United States is currently being treated for Ebola, a New York doctor, Craig Spencer, who cared for patients in West Africa. His condition was upgraded by New York City health officials on Saturday to “stable” from “serious but stable” at Bellevue Hospital.

 

In Oregon, test results were awaited for a woman with a fever who was hospitalized in an isolation unit on Friday after returning from West Africa, Oregon health officials said.

 

She had not come into known contact with Ebola patients while in Africa, the officials added.

 

(Reporting by Susan Cornwall in Washington; Editing by Gareth Jones)

 

Ebola Virus Disease Electron Micrograph

Ebola-carrying bats may be heroes as well as villains

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Fruit bats are seen for sale at a food market in Brazzavile, Republic of Congo, in this file photograph dated December 15, 2005. REUTERS/Jiro Ose/Files

Fruit bats are seen for sale at a food market in Brazzavile, Republic of Congo, in this file photograph dated December 15, 2005.

Credit: Reuters/Jiro Ose/Files

 

 

(Reuters) – Bats are living up to their frightening reputation in the world’s worst Ebola outbreak as prime suspects for spreading the deadly virus to humans, but scientists believe they may also shed valuable light on fighting infection.

 

Bats can carry more than 100 different viruses, including Ebola, rabies and severe acute respiratory syndrome (SARS), without becoming sick themselves.

 

While that makes them a fearsome reservoir of disease, especially in the forests of Africa where they migrate vast distances, it also opens the intriguing possibility that scientists might learn their trick in keeping killers like Ebola at bay.

 

“If we can understand how they do it then that could lead to better ways to treat infections that are highly lethal in people and other mammals,” said Olivier Restif, a researcher at the University of Cambridge in Britain.

 

Clues are starting to emerge following gene analysis, which suggest bats’ capacity to evade Ebola could be linked with their other stand-out ability — the power of flight.

 

Flying requires the bat metabolism to run at a very high rate, causing stress and potential cell damage, and experts think bats may have developed a mechanism to limit this damage by having parts of their immune system permanently switched on.

 

The threat to humans from bats comes en route to the dinner plate. Bushmeat — from bats to antelopes, squirrels, porcupines and monkeys — has long held pride of place on menus in West and Central Africa. The danger of contracting Ebola lies in exposure to infected blood in the killing and preparation of animals.

 

NATURAL HOSTS

 

Scientists studying Ebola since its discovery in 1976 in Democratic Republic of Congo, then Zaire, have long suspected fruit bats as being the natural hosts, though the link to humans is sometimes indirect as fruit dropped by infected bats can easily be picked up by other species, spreading the virus to animals such as monkeys.

 

This nexus of infection in wildlife leads to sporadic Ebola outbreaks following human contact with blood or other infected animal fluids.

 

This no doubt happened in the current outbreak, although the scale of the crisis now gripping Liberia, Sierra Leone and Guinea, which has killed around 5,000 people, reflects subsequent public health failures.

 

“What is happening now is a public health disaster rather than a problem of wildlife management,” said Marcus Rowcliffe at the Zoological Society of London (ZSL), which runs London Zoo.

 

Bats’ role in spreading Ebola is probably a function both of their huge numbers, where they rank second only to rodents among mammals in the world, as well as their unusual immune system, according to Michelle Baker of the Commonwealth Scientific and Industrial Research Organisation, Australia’s national science agency.

 

Baker, who is intrigued by bats’ ability to live in “equilibrium” with viruses, published a paper with colleagues in the journal Nature last year looking at bat genomes. They found an unexpected concentration of genes for repairing DNA damage, hinting at a link between flying and immunity.

 

“(This) raises the interesting possibility that flight-induced adaptations have had inadvertent effects on bat immune function and possibly also life expectancy,” they wrote.

 

UNDERSTANDING BATS

 

As well as tolerating viruses, bats are also amazingly long-lived. The tiny Brandt’s bat, a resident of Europe and Asia, has been recorded living for more than 40 years, even though it is barely the size of a mouse. Bats also rarely get cancer.

 

“We are just at the beginning,” Baker said in a telephone interview. “But if we can understand how bats are dealing with these viruses and if we can redirect the immune system of other species to react in the same way, then that could be a potential therapeutic approach.”

 

It won’t be easy. Turning on components of the immune system can bring its own health problems, but the idea — which has yet to get beyond the basic research stage — is to turn up certain elements to achieve a better balance.

 

One reason why Ebola is so deadly to people is that the virus attacks the immune system and when the system finally comes back it goes into over-drive, causing extra damage.

 

Ebola works in part by blocking interferon, an anti-virus molecule, which Baker has found to be “up-regulated”, meaning it is found in higher levels, in bats.

 

VENISON, WITH WINGS

 

The bat immune system may or may not lead to new drugs one day. Still, experts argue there are plenty of other reasons to cherish bats, which also play a vital role in pollination and controlling insect pests.

 

They are also a traditional source of protein in West Africa, often served in a spicy stew, and restrictions on bushmeat consumption are now contributing to food shortages in parts of West Africa, according to the International Food Policy Research Institute.

 

Hunting and butchering bats may be risky but cooking is thought to make them safe. The World Health Organization advises animals should be handled with “gloves and other appropriate protective clothing” and meat should be “thoroughly cooked”.

 

“In the long run it would be sensible to see people moving away from hunting bats but in the short term they provide an important source of food,” said Rowcliffe of ZSL.

 

“Essentially, wild meat is a good, healthy product. People in Britain eat venison and rabbit, and in many ways it’s no different to that.”

 

(Editing by Peter Millership and Giles Elgood)

 

Ebola Virus Disease Electron Micrograph

U.N. health worker flown to France for Ebola treatment

This article was originally published on this site

(Reuters) – A United Nations health worker suffering from Ebola has been flown to France from Sierra Leone for treatment, the French health ministry said in a statement overnight.

 

The UN worker, whose name and nationality have not been disclosed, was transported to France aboard a specially equipped jet and placed in isolation at the Begin military hospital in the eastern Paris suburb of Saint-Mandé, the statement said.

 

The UN worker is the second Ebola sufferer to have received treatment in France since the start of the epidemic ravaging West Africa. A French nurse repatriated in September has since made a full recovery from the virus, which has killed almost 5,000 people.

The worker is being treated at the request of the World Health Organization, the ministry said, adding that there were currently no other confirmed Ebola cases in France.

 

(Reporting by Laurence Frost; editing by Jane Baird)

 

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Scientists try to predict number of US Ebola cases

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STANFORD, Calif. (AP) — Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year’s end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease.

But how many cases?

No one knows for sure how many infections will emerge in the U.S. or anywhere else, but scientists have made educated guesses based on data models that weigh hundreds of variables, including daily new infections in West Africa, airline traffic worldwide and transmission possibilities.

This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130.

“I don’t think there’s going to be a huge outbreak here, no,” said Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University’s medical school. “However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases.”

Relman is a founding member of the U.S. Department of Health and Human Services advisory board for biosecurity and chairs the National Academy of Sciences forum on microbial threats.

Until now, projections published in top medical journals by the World Health Organization and the Centers for Disease Control have focused on worst-case scenarios for West Africa, concluding that cases in the U.S. will be episodic, but minimal. But they have declined to specify actual numbers.

The projections are complicated, but Ebola has been a fairly predictable virus — extremely infectious, contagious only through contact with body fluids, requiring no more than 21 days for symptoms to emerge. Human behavior is far less predictable — people get on airplanes, shake hands, misdiagnose, even lie.

Pandemic risk expert Dominic Smith, a senior manager for life risks at Newark, California-based RMS, a leading catastrophe-modeling firm, ran a U.S. simulation this week that projected 15 to 130 cases between now and the end of December. That’s less than one case per 2 million people.

Smith’s method assumes that most cases imported to the U.S. will be American medical professionals who worked in West Africa and returned home.

Smith said the high end may be a bit of an overestimate as it does not include the automatic quarantining measures that some areas in the U.S. are implementing.

Those quarantines “could both reduce the number of contacts for imported cases, as well as increase the travel burden on — and perhaps reduce the number of — U.S. volunteers planning to support the effort in West Africa,” he said.

In a second simulation, Northeastern University professor Alessandro Vespignani projected between one case — the most likely scenario — and a slim chance of as many as eight cases though the end of November.

“I’m always trying to tell people to keep calm and keep thinking rationally,” said Vespignani, who projects the spread of infectious diseases at the university’s Laboratory for the Modeling of Biological and Socio-Technical Systems.

In an article in the journal PLOS ONE, Vespignani and a team of colleagues said the probability of international spread outside the African region is small, but not negligible. Longer term, they say international dissemination will depend on what happens in West Africa in the next few months.

Their first analysis, published Sept. 2, proved to be accurate when it included the U.S. among 30 countries likely to see some Ebola cases. They projected one or two infections in the U.S., but there could be as many as 10.

So far, nine Ebola patients have been treated in the U.S., and one has died. Seven became infected in West Africa, including Thomas Eric Duncan, the first to arrive undiagnosed and the first to die. He was cared for at a Dallas hospital, where two of his nurses were also infected.

Duncan, who was initially misdiagnosed and sent home from the emergency room, is Vespignani’s worst-case scenario for the U.S.

A similar situation, if left unchecked, could lead to a local cluster that could infect, on the outside, as many as 20, he said.

The foreseeable future extends only for the next few months. After that, projections depend entirely on what happens in West Africa. One scenario is that the surge in assistance to the region brings the epidemic under control and cases peter out in the U.S. A second scenario involves Ebola spreading unchecked across international borders.

“My worry is that the epidemic might spill into other countries in Africa or the Middle East, and then India or China. That could be a totally different story for everybody,” Vespignani said.

Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute, said he’s not worried about a handful of new cases in the U.S. His greatest worry is if the disease goes from West Africa to India.

“If the infection starts spreading in Delhi or Mumbai, what are we going to do?”

Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, pegs the range of cases in the U.S. between five and 100.

The Centers for Disease Control and Prevention prefers not to focus on a particular number. But spokeswoman Barbara Reynolds said Ebola will not be a widespread threat as some outside the agency have warned.

“We’re talking about clusters in some places but not outbreaks,” she said.

The CDC is using modeling tools to work on projections in West Africa, but “there isn’t enough data available in the U.S. to make it worthwhile to go through the exercise.”

University of Texas integrative biology professor Lauren Ancel Meyers said there are inherent inconsistencies in forecasting “because the course of action we’re taking today will impact what happens in the future.”

Her laboratory is running projections of Ebola’s spread in West Africa.

The U.S. simulations run for the AP had fairly consistent results with each other, she said. And they are “consistent with what we know about the disease.”

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Nurse free to move about as restrictions eased

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FORT KENT, Maine (AP) — A nurse who treated Ebola patients in Sierra Leone can move about as she pleases after a Maine judge eased state-imposed restrictions on her, handing officials in Maine a defeat in the nation’s biggest court case yet over how to balance personal liberty, public safety and fear of Ebola.

Judge Charles C. LaVerdiere ruled Friday that Kaci Hickox must continue daily monitoring of her health but said there is no need to isolate her or restrict her movements because she has no symptoms and is therefore not contagious.

The judge also decried the “misconceptions, misinformation, bad science and bad information” circulating about the lethal disease in the U.S.

After the ruling, a state police cruiser that had been posted outside Hickox’s home left, and she and her boyfriend stepped outside to thank the judge.

Hickox, 33, called it “a good day” and said her “thoughts, prayers and gratitude” remain with those who are still battling Ebola in West Africa.

She said she had no immediate plans other than to watch a scary movie at home on Halloween in this town of 4,300 people on the remote northern edge of Maine, near the Canadian border.

Maine health officials had gone to court on Thursday in an attempt to bar her from crowded public places and require her to stay at least 3 feet from others until the 21-day incubation period for Ebola was up on Nov. 10. She would have been free to jog or ride a bike.

But the judge turned the state down.

Gov. Paul LePage said he disagreed with the ruling but will abide by it. Officials said there are no plans to appeal.

“As governor, I have done everything I can to protect the health and safety of Mainers. The judge has eased restrictions with this ruling, and I believe it is unfortunate,” LePage said.

Later in the day, the governor lashed out at Hickox, saying: “She has violated every promise she has made so far, so I can’t trust her. I don’t trust her. And I don’t trust that we know enough about this disease to be so callous.”

Hickox was thrust into the center of a national debate after she returned to the U.S. last week from treating Ebola victims in West Africa as a volunteer for Doctors Without Borders.

She contended that the state’s confining her to her home in what it called a voluntary quarantine violated her rights and was unsupported by science. She defied the restrictions twice, once to go on a bike ride and once to talk to the media and shake a reporter’s hand.

In his ruling, the judge thanked Hickox for her service in Africa and acknowledged the gravity of restricting someone’s constitutional rights without solid science to back it up.

“The court is fully aware of the misconceptions, misinformation, bad science and bad information being spread from shore to shore in our country with respect to Ebola,” he wrote. “The court is fully aware that people are acting out of fear and that this fear is not entirely rational.”

Hickox’s quarantine in Maine — and, before that, in New Jersey, upon her arrival back in the U.S. — led humanitarian groups, the White House and many scientists to warn that automatically quarantining medical workers could discourage volunteers from going to West Africa, where more than 13,500 people have been sickened and nearly 5,000 have died from Ebola.

Hickox has been vilified by some and hailed by others. She has been getting a similarly mixed reaction from her health care colleagues.

On a popular nursing website, allnurses.com, some nurses felt the 21-day quarantine was a sensible precaution for those returning from a high-risk area, while others were more critical, accusing her of giving nurses everywhere a bad name.

Hickox has said she is following the federal Centers for Disease Control and Prevention recommendation of daily monitoring for fever and other signs of the disease. She tested negative for Ebola last weekend, but it can take days for the virus to reach detectable levels.

Her boyfriend, Ted Wilbur, said Friday that the two of them weren’t planning to go into town in the immediate future.

“I’m just happy that Kaci is able to go outside, exercise. It’s not healthy to be inside for 21 days,” he said.

___

Associated Press writers David Sharp and Patrick Whittle in Portland contributed to this story.

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Spanish woman cured of Ebola moves to normal room

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MADRID (AP) — A Spanish nursing assistant who recovered from an Ebola virus infection has left the isolation unit where she was being monitored and moved to a normal room, a hospital statement said Saturday.

Teresa Romero tested positive on Oct 6, but was declared cured of the virus 15 days later. She was the first known person to contract the disease outside of West Africa in the latest outbreak.

Madrid’s Carlos III hospital said that Romero, 44, was now being attended by hospital staff that no longer needed to wear protective outfits.

Romero was able to reunite with her husband, Javier Limon, and other staff members at the hospital.

The statement said tests confirmed Romero was free from all traces of the virus in her body fluids.

Romero had treated two Spanish missionaries who died of Ebola in August and September after they were flown back to Spain from West Africa.

She still needs to recover fully from the after-effects of the serious infection.

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New York doctor infected with Ebola is improving

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The New York doctor infected with Ebola is getting better, health officials said Saturday.

Dr. Craig Spencer’s condition was upgraded to “stable” after he received a plasma transfusion from Ebola survivor and missionary Nancy Writebol, along with the experimental drug Brincidofovir, at Bellevue Hospital, according to officials.

Before yesterday, Spencer, 33, was listed as “serious but stable.”

“The patient will remain in isolation and continue to receive full treatment,” the NYC Health and Hospitals Corp. said in a statement. The corporation runs Bellevue Hospital.

Spencer, of Harlem, was diagnosed with the deadly virus Oct. 23 after he returning from a stint in Guinea working for Doctors Without Borders.

Also Saturday, officials said one of Spencer’s two home-quarantined pals can leave home, but will continue to be assessed twice daily.

Spencer is the only confirmed Ebola patient in New York.

His case prompted New York and New Jersey governors to set mandatory quarantine periods for travelers exposed to Ebola in West Africa.

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Scientists try to predict number of US Ebola cases

This article was originally published on this site

STANFORD, Calif. (AP) — Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year’s end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease.

But how many cases?

No one knows for sure how many infections will emerge in the U.S. or anywhere else, but scientists have made educated guesses based on data models that weigh hundreds of variables, including daily new infections in West Africa, airline traffic worldwide and transmission possibilities.

This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130.

“I don’t think there’s going to be a huge outbreak here, no,” said Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University’s medical school. “However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases.”

Relman is a founding member of the U.S. Department of Health and Human Services advisory board for biosecurity and chairs the National Academy of Sciences forum on microbial threats.

Until now, projections published in top medical journals by the World Health Organization and the Centers for Disease Control have focused on worst-case scenarios for West Africa, concluding that cases in the U.S. will be episodic, but minimal. But they have declined to specify actual numbers.

The projections are complicated, but Ebola has been a fairly predictable virus — extremely infectious, contagious only through contact with body fluids, requiring no more than 21 days for symptoms to emerge. Human behavior is far less predictable — people get on airplanes, shake hands, misdiagnose, even lie.

Pandemic risk expert Dominic Smith, a senior manager for life risks at Newark, California-based RMS, a leading catastrophe-modeling firm, ran a U.S. simulation this week that projected 15 to 130 cases between now and the end of December. That’s less than one case per 2 million people.

Smith’s method assumes that most cases imported to the U.S. will be American medical professionals who worked in West Africa and returned home.

Smith said the high end may be a bit of an overestimate as it does not include the automatic quarantining measures that some areas in the U.S. are implementing.

Those quarantines “could both reduce the number of contacts for imported cases, as well as increase the travel burden on — and perhaps reduce the number of — U.S. volunteers planning to support the effort in West Africa,” he said.

In a second simulation, Northeastern University professor Alessandro Vespignani projected between one case — the most likely scenario — and a slim chance of as many as eight cases though the end of November.

“I’m always trying to tell people to keep calm and keep thinking rationally,” said Vespignani, who projects the spread of infectious diseases at the university’s Laboratory for the Modeling of Biological and Socio-Technical Systems.

In an article in the journal PLOS ONE, Vespignani and a team of colleagues said the probability of international spread outside the African region is small, but not negligible. Longer term, they say international dissemination will depend on what happens in West Africa in the next few months.

Their first analysis, published Sept. 2, proved to be accurate when it included the U.S. among 30 countries likely to see some Ebola cases. They projected one or two infections in the U.S., but there could be as many as 10.

So far, nine Ebola patients have been treated in the U.S., and one has died. Seven became infected in West Africa, including Thomas Eric Duncan, the first to arrive undiagnosed and the first to die. He was cared for at a Dallas hospital, where two of his nurses were also infected.

Duncan, who was initially misdiagnosed and sent home from the emergency room, is Vespignani’s worst-case scenario for the U.S.

A similar situation, if left unchecked, could lead to a local cluster that could infect, on the outside, as many as 20, he said.

The foreseeable future extends only for the next few months. After that, projections depend entirely on what happens in West Africa. One scenario is that the surge in assistance to the region brings the epidemic under control and cases peter out in the U.S. A second scenario involves Ebola spreading unchecked across international borders.

“My worry is that the epidemic might spill into other countries in Africa or the Middle East, and then India or China. That could be a totally different story for everybody,” Vespignani said.

Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute, said he’s not worried about a handful of new cases in the U.S. His greatest worry is if the disease goes from West Africa to India.

“If the infection starts spreading in Delhi or Mumbai, what are we going to do?”

Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, pegs the range of cases in the U.S. between five and 100.

The Centers for Disease Control and Prevention prefers not to focus on a particular number. But spokeswoman Barbara Reynolds said Ebola will not be a widespread threat as some outside the agency have warned.

“We’re talking about clusters in some places but not outbreaks,” she said.

The CDC is using modeling tools to work on projections in West Africa, but “there isn’t enough data available in the U.S. to make it worthwhile to go through the exercise.”

University of Texas integrative biology professor Lauren Ancel Meyers said there are inherent inconsistencies in forecasting “because the course of action we’re taking today will impact what happens in the future.”

Her laboratory is running projections of Ebola’s spread in West Africa.

The U.S. simulations run for the AP had fairly consistent results with each other, she said. And they are “consistent with what we know about the disease.”

Ebola Virus Disease Electron Micrograph

Scientists try to predict number of US Ebola cases

This article was originally published on this site

STANFORD, Calif. (AP) — Top medical experts studying the spread of Ebola say the public should expect more cases to emerge in the United States by year’s end as infected people arrive here from West Africa, including American doctors and nurses returning from the hot zone and people fleeing from the deadly disease.

But how many cases?

No one knows for sure how many infections will emerge in the U.S. or anywhere else, but scientists have made educated guesses based on data models that weigh hundreds of variables, including daily new infections in West Africa, airline traffic worldwide and transmission possibilities.

This week, several top infectious disease experts ran simulations for The Associated Press that predicted as few as one or two additional infections by the end of 2014 to a worst-case scenario of 130.

“I don’t think there’s going to be a huge outbreak here, no,” said Dr. David Relman, a professor of infectious disease, microbiology and immunology at Stanford University’s medical school. “However, as best we can tell right now, it is quite possible that every major city will see at least a handful of cases.”

Relman is a founding member of the U.S. Department of Health and Human Services advisory board for biosecurity and chairs the National Academy of Sciences forum on microbial threats.

Until now, projections published in top medical journals by the World Health Organization and the Centers for Disease Control have focused on worst-case scenarios for West Africa, concluding that cases in the U.S. will be episodic, but minimal. But they have declined to specify actual numbers.

The projections are complicated, but Ebola has been a fairly predictable virus — extremely infectious, contagious only through contact with body fluids, requiring no more than 21 days for symptoms to emerge. Human behavior is far less predictable — people get on airplanes, shake hands, misdiagnose, even lie.

Pandemic risk expert Dominic Smith, a senior manager for life risks at Newark, California-based RMS, a leading catastrophe-modeling firm, ran a U.S. simulation this week that projected 15 to 130 cases between now and the end of December. That’s less than one case per 2 million people.

Smith’s method assumes that most cases imported to the U.S. will be American medical professionals who worked in West Africa and returned home.

Smith said the high end may be a bit of an overestimate as it does not include the automatic quarantining measures that some areas in the U.S. are implementing.

Those quarantines “could both reduce the number of contacts for imported cases, as well as increase the travel burden on — and perhaps reduce the number of — U.S. volunteers planning to support the effort in West Africa,” he said.

In a second simulation, Northeastern University professor Alessandro Vespignani projected between one case — the most likely scenario — and a slim chance of as many as eight cases though the end of November.

“I’m always trying to tell people to keep calm and keep thinking rationally,” said Vespignani, who projects the spread of infectious diseases at the university’s Laboratory for the Modeling of Biological and Socio-Technical Systems.

In an article in the journal PLOS ONE, Vespignani and a team of colleagues said the probability of international spread outside the African region is small, but not negligible. Longer term, they say international dissemination will depend on what happens in West Africa in the next few months.

Their first analysis, published Sept. 2, proved to be accurate when it included the U.S. among 30 countries likely to see some Ebola cases. They projected one or two infections in the U.S., but there could be as many as 10.

So far, nine Ebola patients have been treated in the U.S., and one has died. Seven became infected in West Africa, including Thomas Eric Duncan, the first to arrive undiagnosed and the first to die. He was cared for at a Dallas hospital, where two of his nurses were also infected.

Duncan, who was initially misdiagnosed and sent home from the emergency room, is Vespignani’s worst-case scenario for the U.S.

A similar situation, if left unchecked, could lead to a local cluster that could infect, on the outside, as many as 20, he said.

The foreseeable future extends only for the next few months. After that, projections depend entirely on what happens in West Africa. One scenario is that the surge in assistance to the region brings the epidemic under control and cases peter out in the U.S. A second scenario involves Ebola spreading unchecked across international borders.

“My worry is that the epidemic might spill into other countries in Africa or the Middle East, and then India or China. That could be a totally different story for everybody,” Vespignani said.

Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute, said he’s not worried about a handful of new cases in the U.S. His greatest worry is if the disease goes from West Africa to India.

“If the infection starts spreading in Delhi or Mumbai, what are we going to do?”

Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine and director of the Texas Children’s Hospital Center for Vaccine Development, pegs the range of cases in the U.S. between five and 100.

The Centers for Disease Control and Prevention prefers not to focus on a particular number. But spokeswoman Barbara Reynolds said Ebola will not be a widespread threat as some outside the agency have warned.

“We’re talking about clusters in some places but not outbreaks,” she said.

The CDC is using modeling tools to work on projections in West Africa, but “there isn’t enough data available in the U.S. to make it worthwhile to go through the exercise.”

University of Texas integrative biology professor Lauren Ancel Meyers said there are inherent inconsistencies in forecasting “because the course of action we’re taking today will impact what happens in the future.”

Her laboratory is running projections of Ebola’s spread in West Africa.

The U.S. simulations run for the AP had fairly consistent results with each other, she said. And they are “consistent with what we know about the disease.”