Ebola survivor reunited with dog

Nov. 1: Ebola survivor Nina Pham is reunited with her dog Bentley at the Dallas Animal Services Center in Dallas. (Reuters)

A Dallas nurse who recovered from Ebola was reunited with her dog Bentley, after it was quarantined when she was sick with the virus.

Nina Pham and Bentley were rejoined privately Satuday in a vacant residence where officers once lived at a decommissioned naval base. The King Charles Spaniel was quarantined for 21 days as veterinarians in full protective gear checked on it daily.

“I’d like to take a moment to thank people from all around the world who have sent their best wishes and prayers to me and Mr. Bentley,” said Pham, who read a statement at a news conference Saturday. Bentley, whom she called “one of my best friends,” was there on a leash.

Pham was diagnosed with Ebola last month after caring for Thomas Eric Duncan in a Dallas hospital. Duncan died of the disease Oct. 8.

Pham recovered and was released Oct. 24 from a Washington, D.C.-area hospital.

“Bentley is alive and well in the city of Dallas,” Mayor Mike Rawlings said, adding that he even kissed the dog Saturday. “There were a lot of human beings that spent a lot of time making sure this dog was safe.”

The Associated Press contributed to this report

Ebola Virus Disease Electron Micrograph

Eluding Ebola: Gear Matters, But Technique Matters More

New guidelines for the personal protective equipment that health workers should have on when treating Ebola patients make clear that what you wear counts — but even more important is how you put it on and take it off.

And the guidelines that the World Health Organization updated Friday suggest only highly trained medical professionals should be taking on the dangerous job of caring for Ebola patients, say the country’s leading doctors at the National Institutes of Health.

“Anybody could do this, but the training process is something that takes a lot of time,” Dr. Francis Collins, who heads the National Institutes of Health, told NBC News in an interview.

Treating Ebola patients does not have to be dangerous, Collins said. “But it takes a lot of time to make it safe.”

That was obvious in a demonstration given this week at the NIH clinical center, where Dallas nurse Nina Pham was cared for until she was released earlier this month. It took a full 10 minutes to gear up Kevin Barrett, a specialist nurse who helped care for Pham.

“One of the most dangerous times is when someone is doffing or taking off their gear.”

“First Kevin, please don the belt,” says Dr. Tara Palmore, hospital epidemiologist for the NIH Clinical Center. She’s spotting Barrett. Ebola veterans say having someone watch you put on — and, more importantly, take off — Ebola gear can make the difference between safely treating a patient and getting infected yourself.

“Then don the shoe covers,” Palmore adds, reading from a checklist. Barrett systematically puts on a white Tyvek full-body suit, two pairs of shoe covers, a helmet called a powered air purifying respirator (PAPR or “papper” for short), a “shroud” over his PAPR and head, a two-way radio that’s hooked to his belt, two pairs of gloves, taped on using a special trick so the tape can be pulled off easily later, and a yellow gown.

Doffing the gear takes even longer. “One of the most dangerous times is when someone is doffing or taking off their gear,” said Dr. Anthony Fauci, head of the NIH’s National Institute for Allergy and Infectious Diseases.

Palmore spots Barrett every step of the way, instructing him step by step. In a real patient care situation, she’d be suited up too, just in case something splashed off onto her.

The goal is to get all these layers off without ripping them and without carrying any possible contamination outside the room where the patient is. Experience led to the trick with the tape, said Fauci — just folding the end over itself leaves a non-sticky length that can be pulled without ripping the sleeve of the suit.

That’s one of the flaws that Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, saw at the Texas Health Presbyterian hospital in Dallas, where Pham and her fellow nurse Amber Vinson became infected. They layered on too many pairs of gloves and rolled on so much tape they had trouble getting the gear off safely.

The CDC released its own instructional video Friday.

Health care workers often get infected even while wearing personal protective equipment, or PPE. Hundreds have become infected and have died at the front lines in Liberia, Sierra Leone and Guinea, and Pham and Vinson were infected while taking care of Thomas Eric Duncan, the only person so far to die of Ebola in the United States.

Most experts think infection was due to a gear malfunction of some type — perhaps a small mistake made when taking off contaminated PPE.

The new WHO guidelines don’t specify any particular piece of equipment. They make clear what needs to be protected — and in treating Ebola, that is every part of the body, from the top of the head to the bottom of the feet.

Ebola isn’t as contagious as influenza, measles or even the common cold. It doesn’t float in the air or live on surfaces. To get it, people have to be in close contact with someone who is actively sick or with the person’s bodily fluids, such as on a sheet covered with vomit or diarrhea. But doctors, nurses and technicians fall squarely into this risk group.

The WHO guidelines emphasize that PPE must keep virus out of the eyes, nose and mouth, as well as off the hands. It’s also important to keep it off any part of the body that someone might touch later, because the hands can carry it to eyes, nose and mouth. That’s why skin must be covered — not because the virus can infect through the skin, but because you might touch it later.

“Paramount to the guidelines’ effectiveness is the inclusion of mandatory training on the putting on, taking off and decontaminating of PPE, followed by mentoring for all users before engaging in any clinical care,” said Edward Kelley, WHO’s director for service delivery and safety.

It might seem like you can never have too many layers, but the gear is hot and hard to move around in.

“I would say categorically that unless you have rehearsed, you should not do it.”

And a hot, tired worker makes mistakes. “This process is not an easy process, and you are the most fatigued when you are taking off your material,” Fauci said. “That’s a time when you are very vulnerable.”

Fauci agrees with Collins — caring for Ebola patients is not work for amateurs. “I would say categorically that unless you have rehearsed, you should not do it,” Fauci told NBC News.

In July, Frieden said any U.S. hospital should be able to care for an Ebola patient. Fauci disagrees. “You don’t expect every single hospital in the country to be able to fully take care of an Ebola patient, but you expect the clinics and emergency rooms to be able to recognize when an Ebola patient comes through the door or is carried through the door,” Fauci said. The right thing to do is then get the patient to an appropriate facility, where staff have rehearsed how to safely care for such a patient.

“When the outbreak came we were well-trained and suited to do this,” Fauci said. The NIH clinical center, Emory University Hospital and the Nebraska Medical Center all have special biocontainment units where staff are trained to care for patients with dangerous illnesses.

Bellevue Hospital in New York is caring for Dr. Craig Spencer, a doctor infected in Guinea while treating Ebola patients. Bellevue is one of dozens of hospitals that have drilled recently in the care of such patients.

First published November 1 2014, 3:00 AM

Ebola Virus Disease Electron Micrograph

Days after waving to U.S. envoy, Liberian boys are Ebola free

Boys Solomon (C, rear) and Joe (R, rear) stand in the ''red zone'' where they are being treated for Ebola at the Bong County Ebola Treatment Unit about 200 km (120 miles) east of the capital, Monrovia, October 28, 2014.  REUTERS/Michelle Nichols

Boys Solomon (C, rear) and Joe (R, rear) stand in the ”red zone” where they are being treated for Ebola at the Bong County Ebola Treatment Unit about 200 km (120 miles) east of the capital, Monrovia, October 28, 2014.

Credit: Reuters/Michelle Nichols

 

 

(Reuters) – Just a few days after Solomon, 14, and Joe, 11, stood in t-shirts and pyjama pants waving as U.S. envoy Samantha Power visited an Ebola treatment unit in Liberia, their recovery was complete — they tested negative for the hemorrhagic fever.

 

“Solomon and Joe went home,” said U.S. nurse Bridget Mulrooney on Saturday, who works with the unit run by International Medical Corps in Bong County, about 200 km (120 miles) east of Liberia’s capital Monrovia.

 

Power, accompanied by U.S. public health experts, visited the treatment unit on Tuesday but did not enter the facility. She traveled to Liberia, Sierra Leone and Guinea to assess the global response to the worst outbreak of Ebola in history.

 

From a distance, Joe and Solomon watched and waved at Power’s delegation from behind a neon orange fence at the “red zone” of the treatment unit.

 

U.S. Navy Lieutenant Commander Benjamin Espinosa delivered the news to the boys on Friday that they were better, said International Medical Corps communications officer in Liberia Stuart Sia. Both Joe and Solomon went home to their villages on Saturday afternoon to be cared for by family, Sia said.

 

Espinosa, himself a father-of-four, is the officer-in-charge of a mobile laboratory set up in Bong County a few weeks ago that has cut sample testing times to five hours from five days.

 

But Solomon’s 7-year-old ‘social sister’ Christine, who’s mother raised Solomon as her own, is still fighting the virus that has gripped Liberia, Sierra Leone and Guinea, killing some 5,000 people and infecting thousands more.

 

“Christine is up and down. Ebola and children is harsh. We want her to pull through, but her tiny body is ravaged. She is eating and walking, and she hasn’t done much of either in weeks,” Mulrooney told Reuters in an email.

 

These improvements though in the past few days left the nurses confident that Christine will recover, said Sia in an email. Solomon and Christine both arrived at the treatment unit about two weeks ago from Joblo in Margibi County, he said.

 

However, Christine’s 10-year-old biological brother Rancy, who was admitted three days earlier than Christine and Solomon, died from Ebola within a week of being admitted for treatment.

 

“Their mother contracted Ebola from a friend in another village. She went to (the village of) Kakata to be taken cared of by family and later died,” Sia said. Their father then contracted Ebola from his wife, but after three weeks of treatment at a hospital in Monrovia he recovered.

 

In total, Sia said 14 members of their family had been infected. Joe, who comes from Weala in Margibi County, had also been in the treatment unit nearly two weeks.

 

After Power’s brief visit to West Africa, she told Reuters on Thursday that she had found some “hope and possibility” that the global response to the Ebola outbreak is working, but more resources are needed.

 

(Reporting by Michelle Nichols; Editing by Bernard Orr)

 

Dallas nurse who survived Ebola reunited with dog

Nov. 1: Ebola survivor Nina Pham is reunited with her dog Bentley at the Dallas Animal Services Center in Dallas. (Reuters)

DALLAS –  A Dallas nurse who recovered from Ebola has been reunited with her dog named Bentley, who has been quarantined since she fell ill.

Nina Pham and the King Charles Spaniel were reunited privately on Saturday in a vacant residence where officers once lived at a decommissioned naval air base, where he was quarantined for 21 days. Veterinarians in full personal protective gear checked on him daily.

 “I’d like to take a moment to thank people from all around the world who have sent their best wishes and prayers to me and Mr. Bentley,” said Pham, who read a statement at a news conference Saturday. Bentley, whom she called “one of my best friends,” was there on a leash.

Pham was diagnosed with Ebola last month. She contracted the virus while caring for a Liberian man, Thomas Eric Duncan, who died Oct. 8.

Judge rejects Ebola quarantine for Maine nurse

Pham recovered and was released Oct. 24 from a Washington, D.C.-area hospital.

Earlier this year, authorities in Madrid, Spain, caused a public uproar when they euthanized a dog belonging to a nursing assistant sickened by Ebola.

“Bentley is alive and well in the city of Dallas,” Mayor Mike Rawlings said, adding that he even kissed the dog Saturday. “There were a lot of human beings that spent a lot of time making sure this dog was safe.”

Rawlings thanked city staff and Texas A&M University veterinarians.

Ebola Virus Disease Electron Micrograph

Ebola-free Texas nurse, pet dog reunited after long quarantine

Ebola survivor Nina Pham is reunited with her dog Bentley at the Dallas Animal Services Center in Dallas, November 1, 2014.  REUTERS/Lisa Maria Garza

 

 

(Reuters) – The Dallas nurse treated for Ebola had an emotional reunion on Saturday with her “best friend”, a King Charles Spaniel, after the pet spent the last three weeks in quarantine being monitored for the deadly virus.

 

The dog named Bentley showered Nina Pham with licks at a handover ceremony near the Dallas shelter where he had been kept in isolation and cared for by kennel workers in protective suits.

 

Pham, 26, became the first person in the United States to be infected with Ebola after treating an infected man. She was released from a National Institutes of Health hospital in Maryland on Oct. 24 after being declared free of the virus.

 

“After I was diagnosed with Ebola, I didn’t know what would happen to Bentley and if he would have the virus,” Pham told reporters. “I was frightened that I might not know what happened to my best friend.”

 

Bentley has been under the spotlight after officials in Madrid put down the dog of a Spanish nurse who contacted Ebola while also caring for a patient.

 

Wearing a maroon handkerchief around his neck and a silver bone charm on his collar, Bentley licked Pham’s face and wagged his tail as he was cradled by the nurse in front of the cameras.

 

The dog was fed by decontamination crews working to clean Pham’s apartment shortly after she was diagnosed with the virus and later evacuated by a small team wearing protective gear.

 

Bentley became a minor Internet star as picture and videos of him running around his isolation call and playing with workers in space suits were released by the city – after they had first been shown to Pham.

 

Bentley was declared Ebola-free at the end of October after clearing several tests.

 

Pham said the two were now going to celebrate.

 

“Right now, I’m just excited to take Bentley home so we can start picking out his gifts for his 2 year birthday party this month,” Pham said.

 

(Writing by Jon Herskovitz; Editing by Gareth Jones)

 

Ebola Virus Disease Electron Micrograph

Ebola: Windfall for Military-Industrial Complex

On October 31, Profectus BioSciences, Inc. announced it has received millions of dollars to develop an Ebola vaccine.

The Pentagon awarded the contract through its Medical Countermeasure Systems-Joint Vaccine Acquisition Program, a program that develops and stockpiles vaccines to be used on soldiers.

“The $9.5 million award has been made with Battelle Memorial Institute through the Chemical, Biological, Radiological, & Nuclear Defense Information Analysis Center,” a PRNewswire released on Friday states.

CBRNIAC is part of the Pentagon’s Defense Technical Information Center. DTIC provides a “suite of services” to defense contractors and academic institutions. It also provides services of the Homeland Security “community.”

“We are continuing to develop a trivalent vaccine that will protect our service members and DoD civilians against the major filovirus threats: Ebola Zaire, Ebola Sudan, and Marburg viruses,” said the manager of the Pentagon’s Medical Countermeasure Systems-Joint Vaccine Acquisition Program. “The DoD is optimistic that its long-term commitment to identifying and supporting safe and effective trivalent filovirus vaccines is coming to fruition and remains supportive to advancing the Profectus BioSciences trivalent Ebola/Marburg vaccine into human clinical trials as rapidly as possible.”

Earlier in the week, the Medical Countermeasure Systems-Joint Vaccine Acquisition Program awarded Colorado State University’s Biopharmaceutical Manufacturing and Academic Resource Center $2 million to work on an Ebola and Marburg vaccine. “Among MCS-JVAP’s requirements is to develop a vaccine to protect soldiers from exposure to filoviruses, which cause several types of hemorrhagic fever,” Global Biodefense reports.

From Military Guinea Pigs to Civilians

The move by the Pentagon represents the militarization of Ebola vaccine effort. “While the primary purpose of the Ebola vaccine would be to protect U.S. soldiers, it is possible that such a vaccine could be used for endemic outbreaks of filovirus infection,” the website notes.

Soldiers will become guinea pigs for a vaccine destined for public application. On October 27, USA Today reported the center at CSU “develops and stockpiles vaccines and countermeasures that can be used to protect soldiers, but the research ultimately will benefit civilians.”

The link between the Pentagon and defense contractors raises serious questions, writes Julie Lévesque. “This link between the U.S. military and pharmaceutical companies in the production of flu vaccines raises serious questions, especially since the H1N1 pandemic has been exposed as a multibillion dollar fraud instigated by Big Pharma and the World Health Organization (WHO),” Lévesque wrote after Medicago, a corporation owned by Mitsubishi Tanabe Pharma Corp. and Philip Morris, began work on an Ebola antibody. In 2012, Medicago partnered with the Pentagon on the development of an influenza vaccine.

On October 1 Infowars.com reported on the Pentagon’s funding of an Ebola vaccine under a $140 million project with Tekmira Pharmaceuticals, a Canadian company.

“It is clear that the US government has been keeping tabs on Ebola for a while now,” writes Dave Mihalovic for Prevent Disease. “It holds the patents on a strain of the Ebola virus known as Bundibugyo (EboBun) that was found in Uganda. It is although not clear whether it is the same strain that has created the current epidemic. The patent, awarded in October 2012 to five scientists led by Jonathan S Towner, is now deposited with the US Centers for Disease Control and Prevention.”

Many Believe Ebola Released to Benefit Big Pharma and Military Industrial Complex

Many Africans believe Ebola was unleashed on West Africa in order to create a pandemic that would require a vaccine.

“Reports narrate stories of the US Department of Defense (DoD) funding Ebola trials on humans, trials which started just weeks before the Ebola outbreak in Guinea and Sierra Leone. The reports continue and state that the DoD gave a contract worth $140 million dollars to Tekmira, a Canadian pharmaceutical company, to conduct Ebola research. This research work involved injecting and infusing healthy humans with the deadly Ebola virus,” writes Dr. Cyril Broderick, a former professor of Plant Pathology at the University of Liberia’s College of Agriculture and Forestry.

Broderick claims Ebola is a genetically modified organism designed by the “American Military-Medical-Industry that conducts biological weapons tests under the guise of administering vaccinations to control diseases” in Africa and other third world countries. Broderick also claims the World Health Organization and other United Nations agencies “have been implicated in selecting and enticing African countries to participate in the testing events” and are “promoting vaccinations.”

M. Durga Prasad of India’s Defense Research & Development Organization recently raised the hackles of the establishment media when he said the Ebola outbreak could be part of a biological warfare program.

As noted by Infowars.com, the Pentagon and the CIA have a long track record of releasing deadly viruses on the public.

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Ebola Virus Disease Electron Micrograph

Ebola costs encourage budget flexibility among U.S. Republicans

(Reuters) – Worries about Ebola are chipping away at some congressional Republicans’ support for maintaining across-the-board spending caps on U.S. government agencies and the military.

 

An increasing number of Republicans are speaking out in favor of Ebola “emergency” funds, which would be passed outside of the normal budget process, and would not require offsetting spending cuts or explicit sources of revenue.

 

“I think we’re going to give the money that’s needed,” Republican Representative Blake Farenthold of Texas told Reuters, when asked about emergency funds. “If they need more, they need to ask for it.”

 

Farenthold and others open to special measures for Ebola generally insisted that any broad increase in spending would need to be paid for with cuts. And the pre-election pledges to fight Ebola from rank and file Republicans and some party leadership could still have strings attached.

 

But concerns about the disease are adding to pressures on the 20-month-old “sequester” spending caps. These include the growing costs of fighting Islamic State militants in Iraq and Syria, maintaining U.S. military superiority over a more aggressive Russia and addressing a surge of child migrants from Central America. Some see concern over Ebola paving the way for other action.

 

Lawmakers and aides now expect an emergency funding request from the Obama administration within days to provide more money for the Centers for Disease Control and other agencies to stop the virus from spreading in West Africa and in the United States. A White House spokeswoman declined to comment on any Ebola request.

 

“Whatever the CDC thinks they need, we’ll give it to them,” Senate Republican leader Mitch McConnell said in a recent MSNBC interview, referring to Ebola funding.

 

Congress’ deficit-cutting fervor has cooled somewhat as an economic rebound and tax increases have more than halved the government’s deficits to $483 billion last fiscal year from the recession-driven $1 trillion-plus that were prevalent when the controls were enacted in 2011.

 

Approving emergency funds is probably the easiest way for Congress to circumvent the budget caps. Congress did this in August when it approved $16 billion to speed medical care to veterans languishing on long waiting lists at Veterans Affairs Department clinics and hospitals.

 

Lawmakers could also raise caps through a one-or-two year budget agreement like one crafted last year.

 

The most difficult change would be a comprehensive budget deal in Congress that ends seven future years of caps.

 

Many Republican lawmakers, including Farenthold, a member of the conservative Tea Party faction, have been chafing at the spending controls on the military and are talking more openly about easing the sequester outright. Farenthold said he hoped to be able to work with Democrats to target alternative cuts.

 

“I think there’s a good chance it gets replaced at some level,” Republican Representative Tom Cole said of the sequester. He said the building pressures from Ebola and other “international imperatives,” along with lower deficits, mean that Congress has a better chance of reaching an agreement to change sequester.

 

“The stars are beginning to align so that we can achieve something, but it will have to be a compromise,” the ally of House Speaker John Boehner told Reuters.

 

Although he supports offsetting savings, he said Republicans may be more open to allowing higher tax revenue to be an offset to spending if it is part of a broader tax reform plan that boosts economic growth. Previously, he has ruled out any tax increases after the “fiscal cliff” tax hikes were passed in January 2013.

 

There is still broad resistance to anything that could be interpreted as a tax increase among the party’s most conservative wing, but more conservatives are talking about the need for a sequester replacement. The relatively modest size of Ebola funding makes it less controversial. International Medical Corps, a non-profit group working in West Africa, estimates that it will cost $1.6 billion over the next six months to bring the disease under control.

 

“I didn’t vote for sequestration, I’m for ending it,” Representative Jim Jordan said. Jordan, one of the most conservative Republicans in Congress, told Reuters the “pressing” issues from Ebola to Islamic State represent emergencies that need funding, though he added that he will insist on spending reductions elsewhere in the budget to offset increases in spending for Ebola and the military.

 

“Let’s hope (Ebola) forces the hand to increase military spending and make savings and reductions other places so that we actually are treating taxpayers with the respect that they deserve,” he said. A year ago, he vowed that Republicans would stay united in defending the spending caps.

 

(Reporting By David Lawder, editing by Caren Bohan and Peter Henderson)

 

Nurse free to move about as restrictions eased

Oct. 31, 2014: Nurse Kaci Hickox speaks to reporters outside their home. (AP)

FORT KENT, Maine –  A nurse in who treated Ebola patients in Sierra Leone can move about as she pleases after a 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 go bike riding.

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.

Ebola Virus Disease Electron Micrograph

Judge rejects isolation for U.S. nurse who treated Ebola patients

(Reuters) – A Maine judge ruled on Friday that a U.S. nurse who treated victims of Ebola in West Africa does not need to be confined to her home, declaring Ebola fears in the United States “not entirely rational.”

 

Nurse Kaci Hickox’s challenge of Maine’s 21-day isolation regime became a key battle in the dispute between some U.S. states and the federal government. A handful of states have imposed mandatory quarantines on health workers returning from three Ebola-ravaged West African countries while the federal government is wary of discouraging potential medical volunteers.

 

While she may travel freely in public, the judge decided that Hickox must continue direct monitoring of her health, coordinate travel plans with health officials and report any symptoms.

 

“I’m happy with the decision the judge made today,” Hickox told reporters via a live video feed from her house in Maine to her lawyer’s New York City office. “I think we are on the right track. I think now we’re discussing as a nation and individual communities about this disease.”

 

Public concern about the spread of the virus is high in both the United States and Canada. Canada became the second developed nation after Australia to bar entry for citizens from the three West African nations where Ebola is widespread.

 

Some U.S. politicians have called for a similar travel ban, making Ebola as much of a political issue as a public health question.

 

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

 

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.

 

Maine Governor Paul LePage, a Republican in a tough re-election battle that culminates in Tuesday’s elections, said he was disappointed that restrictions confining the nurse to her home were lifted. His office did not respond to questions about whether the governor would appeal the ruling.

 

The issue is not yet legally closed.

 

A hearing is scheduled for Tuesday that will give lawyers for the state another opportunity to plead their case for more restrictions on Hickox before Charles LaVerdiere, the chief judge of Maine District Court.

 

In Friday’s order, LaVerdiere said, “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.

 

“The court is fully aware that people are acting out of fear and that this fear is not entirely rational. However, whether that fear is rational or not, it is present and it is real,” the judge added, saying Hickox is “not infectious.”

 

On Thursday, the 33-year-old nurse defied the state’s quarantine order and went on a bike ride with her boyfriend. Following the ruling, state troopers who had been stationed outside Hickox’s home departed.

 

Speaking to reporters alongside boyfriend Ted Wilbur outside her two-story clapboard house in the small town of Fort Kent along the Canadian border, Hickox said she would comply.

 

“It’s just a good day,” Hickox said. “I am taking things minute by minute. Tonight, I am going to try to convince Ted to make me my favorite Japanese meal. And I think we’re going to watch scary movies since it’s Halloween.”

 

Hickox tested negative for Ebola after returning from working for Doctors Without Borders in Sierra Leone. She also objected when the state of New Jersey put her into isolation when she arrived at Newark airport.

 

She said he hoped to be able to return for more work in West Africa. “I love working overseas. It’s been a large part of my life since 2006,” Hickox said.

 

“I know that Ebola is a scary disease. I have seen it face-to-face and I know that we are nowhere near winning this battle,” she added.

 

Medical professionals say Ebola is difficult to catch and is spread through direct contact with bodily fluids from an infected person and is not transmitted by asymptomatic people. Ebola is not airborne.

 

An Oregon resident was hospitalized on Friday for a possible Ebola infection after traveling to West Africa, according to state health officials. The woman registered a high temperature and is in isolation and not a danger to the public, Oregon Health Authority said.

 

The woman had not come into known contact with Ebola patients while in Africa, and had not been quarantined after arriving in Portland because there was no medical need, Dr. Paul Lewis, a public health officer in the Portland area, told a news conference.

 

Public health experts, the United Nations, federal officials and even President Barack Obama have expressed concern that state quarantines for returning doctors and nurses could discourage potential medical volunteers from fighting the outbreak at its source in West Africa.

 

In New York on Friday, U.S. Ambassador to the United Nations Samantha Power defended federal guidelines for monitoring healthcare workers returning from the three Ebola-stricken countries.

 

Power spoke at a Reuters Newsmaker event hours after returning from a four-day trip to Liberia, Guinea and Sierra Leone. She said she believed current federal guidelines for returning healthcare workers balanced “the need to respond to the fears that this has generated” in the United States with the known science on the disease.

 

The U.S. Department of Defense trod that line carefully on Friday. According to the Pentagon, civilian U.S. defense employees returning from Ebola relief work in West Africa must undergo monitoring to ensure they are free of disease but can choose between following civil health guidelines or the stricter military regimen, which requires troops to be isolated for 21 days after returning to their home station.

 

Another potential flashpoint was resolved when Louisiana reached an agreement on Friday to prevent Veolia Environmental Services, which is in possession of the incinerated personal items of Ebola victim Thomas Eric Duncan and is holding them in Port Arthur, Texas, from sending them to a Louisiana landfill.

 

Louisiana Attorney General Buddy Caldwell had sued and obtained a temporary restraining order to block the transfer of the material collected from Duncan and the Dallas apartment where he was staying to a hazardous waste landfill in Louisiana.

 

(Additional reporting by Joseph Ax, Jonathan Allen, Courtney Sherwood, David Ljunggren, Jeffrey Hodgson, Brendan O’Brien, David Alexander and Jonathan Kaminsky; Writing by Will Dunham and Bill Rigby; Editing by Jonathan Oatis, Grant McCool and Lisa Shumaker)

 

Better Staffing Seen as Crucial to Ebola Treatment in Africa

By DENISE GRADY
October 31, 2014

Dr. Rick Sacra, a missionary who contracted Ebola in Liberia this August, was first treated there. Each nurse on the ward cared for 15 or 20 patients, and none could work for more than an hour at a time because the protective gear was so suffocatingly hot. They never drew his blood for lab tests. There was no lab.

“A nurse makes rounds maybe once every eight hours,” Dr. Sacra said. A doctor came by once a day. “The staff is so few.”

After he was evacuated to Nebraska Medical Center, a nurse stayed in his room all the time, and dozens of people were involved in his care. He had daily blood tests to monitor his electrolytes, blood count, liver and kidneys, and doctors used the results to adjust what went into his intravenous lines.

The stark difference in the care available in West Africa and the United States is reflected in the outcomes, as well. In West Africa, 70 percent of people with Ebola are dying, while seven of the first eight Ebola patients treated in the United States have walked out of the hospital in good health. Only one died: Thomas Eric Duncan, a Liberian, whose treatment was delayed when a Dallas hospital initially misdiagnosed his illness.The survival gap can and should be narrowed, experts say, and they agreed that the single most important missing element is enough trained health workers to provide the kind of meticulous intensive care that saved Dr. Sacra and the others treated here. West Africa is starved of doctors, nurses, hospitals and equipment, so more outside help is urgently needed, they said.

Former Ebola patient Nina Pham, a nurse who was infected while treating an Ebola patient in Dallas.

“There is no reason we can’t turn this around,” said Dr. Paul Farmer, a Harvard professor and co-founder of the aid group Partners in Health, which is setting up treatment centers in Liberia and Sierra Leone for 500 patients each. “You need the four S’s,” he said. “Staff, stuff, space, systems.”

Doctors say the key to surviving Ebola, and what has saved the patients in the United States, has been a higher level of “supportive care” to treat deadly symptoms like severe fluid loss and organ failure. That means the patients received intravenous fluids and salts to replace what they lost through vomiting and diarrhea, a fluid loss that can reach five to 10 quarts a day during the worst phase of the disease. Without the fluids, blood pressure can crash, and the patient can quickly go into shock and die.

Most of the patients in the United States also received experimental drugs or plasma transfusions, but doctors say rehydration played a major role in saving them.

“It’s not rocket science,” said Dr. Daniel Bausch, an infectious disease expert from Tulane University who has treated Ebola patients in Guinea and Sierra Leone. Fluid replacement is done routinely for all sorts of illnesses in the United States, he said. But he added, “It’s much more challenging in Africa.”

Dr. Rick Sacra, a missionary who was infected with Ebola in Liberia.

The greatest need, he said, is for a larger staff. “Biggest impediment to this outbreak,” he said. “We need people to do the work.”

Dr. Bausch and Dr. Pierre Rollin of the Centers for Disease Control and Prevention, both veterans of multiple Ebola outbreaks, said they could not be sure yet, but thought this new strain of Ebola was causing more severe and copious diarrhea than earlier strains, increasing the need to monitor and replace fluids and electrolytes.

Dr. Bruce S. Ribner, who directed the care of patients evacuated to Emory University Hospital in Atlanta, said his medical team was surprised at the amount of fluid and potassium lost, and alerted doctors at treatment centers in Africa that patients there might need more replenishment than expected.

Dr. Armand Sprecher, a public health specialist for Doctors Without Borders, echoed the need for more pairs of hands: “If somebody said, what would I love to be able to bring to bear? Dialysis machines? Ventilators? Infusion pumps? No, I would want more person-hours of skilled nursing for patients.”

Nancy Writebol, who contracted the virus while doing missionary work in Liberia.

Ebola wards need an unusually high level of staffing, Dr. Sprecher said. Not only does each patient require a lot of care, but the protective gear causes health workers to overheat so quickly and severely, especially in wards that lack air-conditioning in bare-bones facilities, that they cannot work for more than an hour without coming out to cool down. Extra workers are needed so that they can spell each other.

Doctors and nurses working in the Ebola zone are disturbed by the limited care they can provide and the high death rates. Indeed, if they become infected, they leave if they can: at least 10 volunteers from developed countries have been flown to Europe or the United States for treatment rather than remain in the West African hospitals where they worked.

One volunteer, Dr. Craig Spencer, who returned to the United States from treating Ebola patients in Guinea and fell ill on Oct. 23, is being treated for the virus in New York.

Like most of the aid workers treated in the United States, those evacuated to Europe have generally fared better than patients in Africa. Two of three sent to Germany survived, as did one in Britain. Two priests repatriated to Spain died, but a health worker infected while caring for one of them survived.

Although the level of intensive care is important, doctors also say it is not the whole story. Dr Ribner suggested that two nurses infected in Dallas may have recovered quickly because they are young, in their 20s.

“We know from a lot of data coming out of Africa that younger patients do much better,” he told reporters on Tuesday. He also suggested that the gear they wore, though it obviously did not prevent infection, may have spared them a worse infection by minimizing the amount of the virus to which they were exposed.

“The higher the viral load that you get infected with, the more severe your disease is likely to be,” Dr. Ribner said.

He also mentioned that some of the sickest patients in the United States were saved by ventilators and kidney dialysis. Those treatments are not available in the field hospitals in West Africa where Ebola is being treated.

Dr. Sprecher said that most patients in West Africa were not well nourished, and that Ebola quickly sapped what little reserves they had and then made them too sick to eat. He said Doctors Without Borders was considering different options for feeding. Nasal tubes have failed: Ebola patients tend to rip them out, he said. Intravenous nutrient solutions may be needed, he said, but they are not simple to administer, and the obstacle once again is staffing.

He said Doctors Without Borders was also trying to find ways to do the routine monitoring of electrolytes that can help fine-tune treatment for severe fluid loss. At present, the only lab work done on a typical patient is a single test to see whether the person has Ebola.

Short-staffed and overwhelmed with severely ill patients, the group has judged that drawing and handling blood posed too much of a risk to its workers from spills or being stuck with needles. In addition, there simply have not been enough medical workers to follow up on those blood tests by doing things like adjusting the electrolyte levels in intravenous fluids.

But now, Dr. Sprecher said, the possibility of testing patients’ blood chemistry every other day was being investigated.

He said that over all, the death rate was about 60 percent at Doctors Without Borders’ six treatment centers in West Africa, and dropping somewhat. A similar pattern of improving survival has occurred in other Ebola outbreaks, probably because early on, the first patients to seek treatment tend to be the sickest, and many are too far gone to be saved. Gradually, people show up in earlier stages of the disease, when their odds of surviving are higher.

But Dr. Sprecher said he did not expect big drops in the death rate. “I think we could do better,” he said. “But this is not like cholera or dengue, where you can get it down to 1 percent. I could be wrong. There are people who have a lot of hope for supportive care, for doing it better. I’ll be happy to be proven wrong.”

Dr. Farmer of Partners in Health said that too often, aid workers in Africa become “socialized to scarcity”— resigned to shortages of help and supplies, and to accepting that there is only so much they can do. He challenged that idea, arguing that the standard of care should be the same everywhere.

“Let’s have a medical moon shot,” he said.

Alan Blinder contributed reporting from Atlanta, and Donald G. McNeil Jr. from New York.