04 August 2014 (Primary Source) Ebola Drug Made From Tobacco Plant Saves U.S. Aid Workers

A tiny San Diego-based company provided an experimental Ebola treatment for two Americans infected with the deadly virus in Liberia. The biotechnology drug, produced with tobacco plants, appears to be working.

In an unusual twist of expedited drug access, Mapp Biopharmaceutical Inc., which has nine employees, released its experimental ZMapp drug, until now only tested on infected animals, for the two health workers. Kentucky BioProcessing LLC, a subsidiary of tobacco giant Reynolds American Inc. (RAI), manufactures the treatment for Mapp from tobacco plants.

The first patient, Kent Brantly, a doctor, was flown from Liberia to Atlanta on Aug. 2, and is receiving treatment at Emory University Hospital. Nancy Writebol, an aid worker, is scheduled to arrive in Atlanta today and will be treated at the same hospital, according to the charity group she works with. Both are improving, according to relatives and supporters.

Each patient received at least one dose of ZMapp in Liberia before coming to the U.S., according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

“There’s a very scarce number of doses,” and it’s not clear how many each patient needs for treatment, Fauci said. “I’m not sure how many doses they’ll get.”

Citing unnamed sources, CNN yesterday reported that the drug used for the treatment is Mapp’s.

Ebola Outbreak

Ebola, spread through direct contact with body fluids such as blood and urine, has sickened 1,603 people in West Africa, killing 887, according to the World Health Organization. The disease, first reported in what is now the Democratic Republic of Congo in 1976, can cause bleeding from the eyes, ears and nose.

The Deadliest Disease on Earth

The virus has historically killed as many as 90 percent of those who contract it. The current outbreak has a fatality rate of about 60 percent, probably because of early treatment efforts, officials have said.

There is no cure for Ebola, although several companies -- including Mapp -- are working on drug candidates that are undergoing animal testing. Normally, patients are given fluids, blood transfusions and antibiotics with the hope their immune systems can fight off Ebola’s onslaught.

The two scientists behind Mapp, President Larry Zeitlin and Chief Executive Officer Kevin Whaley, “are both brilliant,” said Charles Arntzen, a plant biotechnology expert at Arizona State University who collaborated with the two researchers years ago. “They are very, very bright guys and free spirits.”

The antibody work came out of research projects funded more than a decade ago by the U.S. Army to develop treatments and vaccines against potential bio-warfare agents, such as the Ebola virus, Arntzen said in a telephone interview.

Tobacco Plant

The tobacco plant production system was developed because it was a method that could produce antibodies rapidly in the event of an emergency, he said.

To produce therapeutic proteins inside a tobacco plant, genes for the desired antibodies are fused to genes for a natural tobacco virus, said Arntzen. The tobacco plants are then infected with this new artificial virus, he said.

“The infection results in the production of antibodies inside the plant,” Arntzen said. The plant is eventually ground up and the antibody is extracted, he said. The whole process takes a matter of weeks.

When confronted by reporters about the Ebola infections in Liberia and subsequent treatments, Whaley said he needed to get up to speed on the developing events.

“This is all new to me,” said Whaley, who was dressed in shorts, a well-worn T-shirt and flip-flops while addressing reporters’ questions outside the company’s offices in a San Diego business park. “I just don’t want to give out any inaccurate information, that’s all.”

Antibody Cocktail

Mapp’s drug is being developed with Toronto-based Defyrus Inc., which has six employees, according to Defyrus CEO Jeff Turner. ZMapp is a “cocktail” of monoclonal antibodies that help the immune system attack the virus.

Monoclonal antibodies designed to fight and block specific proteins can stop the virus from latching onto and entering cells, said Heinz Feldmann, chief of the National Institute of Allergy and Infectious Diseases’ Laboratory of Virology in Hamilton, Montana.

The key is to find antibodies that can prevent viral infection, and to attack several points on the virus so that mutants won’t “escape” treatment, he said.

“What you want is a cocktail of antibodies that target different domains on the virus so escape is less likely in treatment,” he said in a telephone interview. Feldmann said he hasn’t been involved in developing treatments.

ZMapp’s predecessor, MB-003, protected three of seven rhesus macaques in a study run in 2013 by Mapp and the U.S. Army Medical Research Institute of Infectious Diseases.

Ethical Questions

Ebola and virology experts believe the use of the Mapp drug for Brantly and Writebol is unusual in the annals of emergency drug treatments. While potentially saving lives, the cases raise questions about who should have the right to receive experimental drugs years before they gain FDA approval.

“There are a lot of Africans that are also dying,” Robert Garry, a virologist at Tulane University, said in a telephone interview. “If we are going to do it for the Americans then we should certainly step up our game for the Africans.”

Although no drugs to treat Ebola are approved by U.S. regulators, the Food and Drug Administration can approve an emergency application to provide access to unapproved drugs, Stephanie Yao, an FDA spokeswoman, said in an e-mail.

Emergency Approval

Approval for emergency drug use outside of a clinical trial can be made within 24 hours, Yao wrote. Shipment and treatment with the drug could begin even before completed written forms are submitted to the FDA, which can approve the use of an experimental treatment by telephone in an emergency.

“The FDA stands ready to work with companies and investigators treating these patients who are in dire need of treatment,” Yao said. She declined to say whether the FDA had allowed any drug to be used in the Ebola outbreak.

Erica Ollmann Saphire, a molecular biologist at the Scripps Research Institute in San Diego, worked with Mapp and the other biotechnology companies to develop models of the Ebola virus and potential antibodies.

She directs a global consortium given the job of modeling the virus and the mixture of antibodies needed to defeat it. She said the drug was approved for the two American medical workers in Liberia under a compassionate-use doctrine, because it’s not even scheduled for clinical trials until next year.

Informed Consent

“I’d take it myself,” she said in an interview in her laboratory, near La Jolla. “Absolutely. I wouldn’t think twice.”

She said the American medical aid workers were in a better position to give consent to the treatment than African disease victims.

“Do you put an untested therapy in a human or do you just watch them die?” Saphire asked. “Certainly these two Americans are medically trained individuals who knew what they were getting into. They are able to give informed consent.”

Medical care of the two U.S. citizens may take two to three weeks if all goes well, Bruce Ribner, an infectious disease specialist at Emory, said in an Aug. 1 news conference.

The Atlanta-based Centers for Disease Control and Prevention, which confirmed that Brantly and Writebol are the first Ebola patients on U.S. soil, is working with the hospital and transport company to make sure evacuation of the two patients goes safely, said Barbara Reynolds, an agency spokeswoman.

“We’re here to make sure the transportation process and the care here in the U.S. ensures there’s no spread,” Reynolds said. “It’s important to remember this is not an airborne virus, it requires close contact with body fluids. It’s minimal risk as long as the people caring for the patient use meticulous procedures.”

04 August 2014 (Primary Source) Patients’ Symptoms Raise Concern About Ebola in New York

Heightened concern about the Ebola virus has led to alarms being raised at three hospitals in New York City. But so far, no Ebola cases have turned up.

The latest episode involved a man who had recently been to West Africa, and who went to the emergency room at Mount Sinai Hospital in Manhattan late Sunday with a high fever and gastrointestinal problems, the hospital reported on Monday. He is being kept in isolation at the hospital while tests are being done for Ebola, a deadly disease, but also for other illnesses that could have caused his symptoms.

But the city’s health department issued a statement on Monday saying that after consulting with Mount Sinai and the Centers for Disease Control and Prevention in Atlanta, “the health department has concluded that the patient is unlikely to have Ebola. Specimens are being tested for common causes of illness and to definitively exclude Ebola. Testing results will be made available by C.D.C. as soon as they are available.”

At NYU Langone Medical Center last week, a patient who went to the emergency room with a fever and who mentioned a recent visit to West Africa was given a mask and moved to a secluded area, said Dr. Michael Phillips, the hospital’s director of Infection Prevention and Control. But further questioning revealed that the patient had not visited any of the affected countries, “so we stopped right there,” Dr. Phillips said.

At Bellevue Hospital Center last week, a patient was placed in isolation, but it quickly became clear that he did not have Ebola.

An Ebola outbreak centered mainly in three West African countries — Sierra Leone, Guinea and Liberia — has infected more than 1,300 people and killed more than 700 of them. American health officials have advised against nonessential travel to the three countries, and have urged doctors to be on high alert for people who return from the region with symptoms like fever, diarrhea and vomiting.

A Mount Sinai spokeswoman, Dorie Klissas, said that to protect the patient’s privacy, the hospital was not making public his occupation, which country he had been in, whether he had been exposed to a patient with Ebola there, or whether he had close contacts like family members, friends or co-workers who were also at risk. Officials said they expected the results of the tests for Ebola in 24 to 48 hours.

In a statement to employees, hospital officials said that Ebola was spread only by direct contact with bodily fluids, and that infection control measures were being employed to protect patients and staff members.

In the Bellevue Hospital Center case, Dr. Ross Wilson, the chief medical officer at the New York City Health and Hospitals Corporation, said that the man had symptoms also found in Ebola patients. He had arrived at Kennedy International Airport from West Africa and was being detained by security personnel at the airport for an unrelated matter when he fell ill.

“He developed a headache and fever,” Dr. Wilson said. He was transported to Bellevue, but the people who brought him there did not suspect Ebola.

“We immediately put the dots together,” Dr. Wilson said.

Following the guidance of the Centers for Disease Control and Prevention, every patient entering one of the city’s hospitals who has fever, headache and other symptoms associated with Ebola (as well as countless other ailments), is asked two new questions.

“Have you traveled to or from West African countries in the last 10 days? Have you been in contact with an Ebola patient or with anyone who has been in contact with an Ebola patient?”

04 August 2014 (Primary Source) Contagion Screenwriter: Ebola Isn’t the Pandemic. Fear Is

What we should really be afraid of: our inability to assess risk

There is an animal somewhere in Africa — most likely a bat — that has worked out an arrangement with a microscopic agent. The deal is this: the agent won’t kill the bat if the bat will transport it to other warm-blooded animals and give it a chance do its gruesome work. All the bat had to do to enter this arrangement was build up a resistance to the agent over generations and become a good hiding place — and then continue about its business of being a bat.

We identified such an agent in 1976 and named it Ebola for a nearby river. Unfortunately, we didn’t find it in a bat but as a virus in the blood of a dead man.

A virus that kills quickly does not take full advantage of the social behavior of humans and tends to burn itself out. That behavior includes the profound compassion of health care workers who are always among the secondary infections; funereal practices that bring the healthy in contact with the infected dead; and illiteracy, which keeps the local population from understanding what is afoot. The very lethality of Ebola — killing up to 90% of its victims — becomes a self-limiting proposition. It will never become a pandemic, according to public-health experts, unless we help it along.

And how would we do that?

Public health is a kind of math class we seem to fail year after year. Its most basic equation addresses the following question: for every infected person today, how many more infected people can we anticipate? The numerical answer to this question is called the R-nought of the disease. Smallpox has an R-nought of between 3 and 7, depending on population density. The Spanish flu of 1918 had an R-nought between 3 and 4 and killed an estimated 100 million people. Ebola has an R-nought of 1.5.

The people who are infected with Ebola develop a screenwriter’s list of symptoms: bleeding from the mouth, nail beds and eyes as their capillaries disintegrate inside them. Their brains, awash in the blood of hemorrhagic fever, become deranged. There is no vaccine and there is no cure approved for use.

It is a terrifying prospect.

And there is no more effective contagion than fear. Rest assured, it has an R-nought far greater than Ebola. To contract it you do not need to have contact with bodily fluids, only limited exposure to sensationalizing media or a water-cooler conversation embellished with misinformation. And fear has a tendency to shut down the parts of our brain we need most in these moments and leave us at the mercy of our most primitive urges.

There is an equation used in the security world that would help inoculate us against the paralysis and bad judgment symptomatic of fear. It goes like this: risk = threat x vulnerability x consequences. In the case of Ebola, the threat is isolated to West Africa. If you have not traveled to any of the countries involved, your level of threat is zero. Even if you have visited these countries, you would still need direct contact with a sick person or animal — or the American doctor or missionary being treated in isolation at Emory University Hospital in Atlanta. But they are isolated and being treated by people who understand the equation above. Furthermore, your vulnerability is next to nil given our relatively robust public-health system that protects us from such an outbreak and, given the advanced medicine that exists in the U.S., even the consequences of such an infection are much lower.

Contrast this with places like Sierra Leone, Liberia and Guinea. The threat is clear and present, and there couldn’t be a more vulnerable population. These are countries struggling to emerge from years of civil war and violence, poor places with little to spend on public health. Pulitzer Prize–winning journalist Laurie Garrett has pointed out that Liberia spends $18 per capita on public health, Sierra Leone spends $13 per capita and Guinea a mere $7 per capita on the health of their people. (By contrast Hawaii spends $155 per capita on public health.) In addition, their cultural practices and distrust of outside aid make the consequences that much more dire. The death toll from the current Ebola outbreak tops 800. Yet 1.5 million people will die of malaria this year without the proportional coverage to the threat it poses, many of them dying in the same cash-strapped hospitals treating the current victims of Ebola.

So what should we be afraid of?

On the heels of 9/11, five deadly cases of anthrax shut down the government. And yet when 200,000 died from last year’s influenza, less than 37% of the population opted for a flu shot. It is our inability to assess risk that should scare us into action. The threat of influenza is high: we are all vulnerable regardless of geography, and the consequences can be extreme. The notion that vaccines can cause autism has long been discredited, but many of us still suffer from this fear that prevents us from protecting ourselves, our children and our neighbors.

The monster we can see — the nuclear bomb, the fanatic with the suicide vest, the swirl of hurricane in the satellite photo — leads us to build shelters, change security policy or head for high ground. But the monster in the microscope seems to sneak up on us every time. There is, without a doubt, another bat in another tree harboring another agent. But maybe this bat is in Southeast Asia or South America or in another war-torn country that can’t provide medical care for its people. And there are migratory birds crisscrossing our borders and differing standards of health care that are consorting with livestock and bringing with them novel viruses that will play genetic roulette with our collective futures. These are the real risks. This is the math exam the future holds for us.

The author would like to thank Dr. Larry Brilliant, president of the Skoll Global Threats Fund, and Dr. Alex Garza, former assistant secretary and chief medical officer of the U.S. Department of Homeland Security, for their guidance on this piece.

Burns is a screenwriter, director, producer and playwright. He wrote the screenplay for Contagion, directed by Steven Soderbergh, and produced the Academy Award–winning documentary An Inconvenient Truth.

3 August 2014 (Primary Source) Sunday Show Round Up: CDC downplays threat of Ebola outbreak on U.S. soil as American patient arrives in Atlanta

The Director of the Centers for Disease Control (CDC), Dr. Tom Frieden, appeared on four Sunday programs to quell fears that the United States may be at risk for an Ebola outbreak.

“We know that there are travelers from places where there’s Ebola. We know it’s possible that someone will come in. If they go to a hospital and that hospital doesn’t recognize it’s Ebola there could be additional cases or their family members could have cases. That’s all possible, but I don’t think it’s in the cards that we would have an outbreak in this country,” Frieden said on CBS’ “Face the Nation.”

“The way it spreads in Africa is really two things. First, in hospitals where there isn’t really infection control and second in burial practices where people are touching the bodies of people who have died from Ebola. So it’s not going to spread widely in the U.S. Could we have another people here, could we have a case or two, not impossible … but we know how to stop it here.”

The outbreak began in Guinea, before spreading to Liberia and Sierra Leone. As of July 30, 826 people have been killed by the illness that has a fatality rate of up to 90 percent.

Two American aid workers, Dr. Kent Brantly and Nancy Writebol, have contracted the disease.

Concern in the United States escalated after it was announced that both patients would be brought back to America. Brantly arrived in Atlanta, Ga., on Saturday and Writebol is expected to follow shortly.

Medical experts echoed Frieden’s position and downplayed the threat of an outbreak in the United States.

“This disease is spread by direct contact or body fluid contact, and inside these containment areas there’s negative pressure so any air going, would go into rather than come out of that facility. The workers are protected by complete covering of their face and all of their body, and they are isolated,” said Dr. Toby Cosgrove, President and CEO, of the Cleveland Clinic.

“Interestingly, this is not as highly contagious as many other diseases,” Cosgrove told NBC. “You have to understand that we’ve gone to a globalized world now, and disease are globalized as well. … With transportation, this is something we must learn to deal with.”

“There’s a humanitarian reason for stopping this in West Africa,” noted Dr. Richard Besser, “but the conversation we’ve been having also shows we have a self interest in doing that. The conversation really has to look at what will it take to beef up the health system to control this where it is.”

While officials understood the public’s concerns, they insisted there was no reason to worry.

“I can understand why people are scared of Ebola,” Frieden said on Fox News Sunday. “It’s deadly, it’s a gruesome death … but I hope and I’m confident that our fears are not going to overwhelm our compassion. We care for our own. We bring people home if they need to come home.”

The decision to bring Brantly back to America was made by the organization that sent him to Africa, Frieden said, and the role of CDC is to ensure the process of it is safe, by “isolat[ing] the patient so that it doesn’t spread during transit or when he’s in the hospital.”

Less than a month ago, Frieden appeared before a congressional committee to explain why researchers at the CDC “mishandled live anthrax and other deadly pathogens” on four different occasions. That history, which officials characterize as “lapses,” has resulted in skepticism over the safety of the transportation process.

There is currently no cure for the disease, but a vaccine is being developed and should be ready for human testing in early September.

“We would love an Ebola vaccine,” Frieden said, “but even in the best case, it’s a long way away and it’s uncertain.”

“Really, the tried and true public health mechanisms work. You find the patients. You isolate them. You find out who their contacts were. You trace the contacts. You track them everyday for 21 days. If they get fever you start that process again. You make sure there’s good infection control and you educate the community in Africa about safe burial practices. When you do those simple things, Ebola stops.”

Previous Ebola outbreaks were stopped through the process, Frieden noted, but the current outbreak is “out of control in West Africa and it may well spread further in that region.”

In the meantime, CDC is “surging their response,” sending more researchers to Africa in an effort to control it and “put out the embers.”

The U.S.-Africa Leaders Summit will be held in Washington, D.C., this week and the outbreak, while not the summit’s focus, will likely be addressed.

01 August 2014 (Primary Source) What we need to fight Ebola

Ebola outbreaks have occurred in Africa on more than two dozen occasions over the past 40 years, and they were brought under control every time. This was possible thanks to reliable techniques, such as preventing direct contact with infected persons and monitoring all people who did come into contact with an infected person. Anyone showing early symptoms was put in isolation. Despite no effective treatment or vaccine, these standard approaches worked.

Unfortunately, today’s outbreak is very different. And unless we invest more resources in fighting it — and coordinate the response across countries — the outbreak will spread further. If that happens, economic and political chaos could follow.

What’s different about this outbreak? The Ebola virus hasn’t changed; Africa has changed. First, residents of the affected countries — Guinea, Liberia and Sierra Leone — travel much farther and have many more contacts than they did in previous decades. Following up on all contacts who live a few miles from a case is much easier than tracking down people who may live far away. With modern transportation, family members may travel hundreds of miles to be with sick loved ones. And more of this outbreak area, in West Africa, is urbanized than where many of the previous outbreaks occurred in Central Africa, so the virus spreads faster.

Relatives may have extensive contact with an infected person before he or she dies, or they may help prepare the body for burial. Funeral traditions in Africa frequently involve washing the body before it is buried, which can mean contact with blood and other infectious bodily fluids. Public health workers haven’t been able to curtail this traditional practice; it’s a challenge that puts religious and cultural beliefs in direct conflict with infection control. Moreover, this is the first time that this part of Africa has experienced an Ebola outbreak, so there is no collective memory of what to do to stop the virus.

Second, local populations have been increasingly unwilling to cooperate with medical personnel and public health workers, in part because they believe that such workers are spreading the virus. While this is not a new phenomenon, faith in traditional medicine and public health measures alike has declined since previous outbreaks. As a result, cases are not being identified, and follow-up with contacts isn’t adequate enough to thwart transmission. This is happening much more frequently than it did during previous outbreaks.

For the past two months, the nongovernmental organizations providing the primary response to the Ebola outbreak have realized that the response from regional governments and international public agencies was inadequate. Their call for additional resources, including personnel and supplies, went unaddressed. Now, ending this outbreak will require a much more extensive public health response than has been needed in the past.

In addition, some people are hiding potential cases because they fear that their loved ones will be moved to a clinic or a hospital and placed in isolation, where they will die alone. These concerns are fueled by a lack of education about how the Ebola virus is spread and the difficulty in treating it. People see that their loved ones are alive when they are taken away — but are returned in body bags.

Since the first Ebola cases were reported in March from forested areas in southeastern Guinea, the outbreak has grown steadily in terms of people infected and geography covered. The virus has infected more than 1,300 people; more than 700 have died. This is nowhere near the tolls of other infectious diseases, such as HIV/AIDS, malaria, diarrheal disease and tuberculosis, which occur every day in this same region. But the Ebola virus strikes a chord of fear unlike other infectious diseases because of the quick, horrible deaths it causes.

The front-line providers of medical care for this outbreak have been dedicated and heroic, but there just aren’t enough of them. Doctors Without Borders is the primary treatment and community-intervention organization in the three affected countries, in addition to the International Federation of Red Cross and Red Crescent Societies, public health agencies organized under the World Health Organization (WHO), and in-country health-care providers and community educators.

These groups know how to fight this disease — they helped develop the interventions that stopped Ebola outbreaks in the past — but the nongovernmental organizations are “dangerously close to being completely tapped out,” a Doctors Without Borders spokesman told me this past week. “It will be impossible to implement an effective control strategy for this outbreak due to a severe shortage of medical professionals on the ground and the geographic spread of the disease.”

The Centers for Disease Control and Prevention announced Thursday that it will send 50 additional specialists to West Africa to help combat the outbreak, supplementing the 12 CDC professionals already there. For an outbreak involving three countries with about 22 million people and 165,000 square miles, that’s hardly enough boots on the ground. But the CDC is just one piece of the international response; the WHO and other G-7 nations need to act, too.

The WHO does not have the resources to stop this outbreak alone. With a deep respect for the sovereignty of the affected countries, the G-7 nations — the United States, Canada, Germany, Britain, France, Italy and Japan — must immediately mobilize and deploy hundreds of infectious-disease experts, along with medical and technical assets to map the epidemic. Hundreds more personnel will be needed to establish treatment centers and to work with local leaders and educators to help people learn how to stop virus transmission.

In addition to these outside resources, the affected countries must step up their commitment to stopping the outbreak. This past week, Ernest Bai Koroma, president of Sierra Leone, declared an Ebola-related public emergency. He called on the army to quarantine Ebola-stricken neighborhoods and to help conduct house-to-house searches for people who may have been exposed to the virus. Such moves acknowledge that this outbreak will not be stopped using the approaches that have worked before. But it is unclear how these efforts are being coordinated with the WHO and NGOs in Sierra Leone. And since this is a regional problem that requires every involved country to halt virus transmission, regional governmental coordination is crucial.

What happens if the response to and management of this outbreak don’t shift? The fear and panic are growing each day, with new areas reporting cases and more health-care workers dying. If it continues, West Africa could become politically and economically destabilized. Already, crops are not being harvested because of unrest surrounding the outbreak. Schools in Liberia have closed, and the Peace Corps has removed 340 volunteers from the affected countries. Borders are being closed, too, which can have political and economic impacts.

This coming week’s U.S.-Africa Leaders Summit in Washington must put the Ebola crisis front and center. If the presidents of Guinea, Liberia and Sierra Leone decide to stay home, it will be virtually impossible to do so. Other African countries must also pledge quick and effective responses if cases occur within their borders. We are at a critical point, and the response by the international community and the affected countries will determine if this outbreak is just a chapter in the region’s story — or a dramatic and dangerous shift in West Africa’s future.

03 August 2014 (Primary Source) 'Training for this': Atlanta hospital ready for opportunity to treat Ebola patients

Atlanta (CNN) -- Ebola is brutal. Those afflicted often bleed uncontrollably, vomit profusely, lose function of their kidneys and other organs, and -- in over half the cases recently in West Africa -- die.

So faced with the prospect of coming face-to-face with this terrible illness at their Atlanta hospital, where its first documented Ebola cases ever are soon set to arrive, what did two nurses do?

They canceled their vacation.

"They said, 'We have been training for this,'" Dr. Bruce Ribner, who heads the Emory University Hospital unit where the two Americans with Ebola will be treated, told CNN chief medical correspondent Dr. Sanjay Gupta -- himself a neurosurgery professor at Emory. "'We are not going to miss this opportunity to care for this patient."

Online and on street corners, in homes and in businesses, the idea of purposefully bringing Ebola into the United States has rattled the nerves of many.

Ebola coming to U.S. for first time
There is lots of evidence of this sentiment on Twitter, where some opined that "we're being very foolish" -- and that's one of the kinder remarks.

"Why willingly bring infected ebola victims to this country?" wrote one woman. "Why purposely spread the infection?"

But you won't hear that kind of thing at Emory University Hospital. According to Ribner, it's been just the opposite.

"As I came in this morning, I had people congratulating us for accepting these patients."

They know how the virus spreads

Yes, Ebola in the United States is unprecedented. But that doesn't mean experts don't know anything about it.

Talking to reporters Friday, Ribner said that Ebola spreads much like HIV, Hepatitis B or C -- through the transmission of bodily fluids, not by simply being in the same room as someone infected.

It's not like someone is contagious the second they are infected. The virus doesn't spread until that person shows symptoms, which typically takes two to 21 days, according to the World Health Organization.

Those working at Emory also can take comfort in that they have a unique place -- one of only four such facilities in the United States, according to Ribner -- to treat such a contagious disease.

What you need to know

The isolation unit was created 12 years ago in conjunction with experts from the U.S. Centers for Disease Control and Prevention, which is based down the street. It features "special air handling," strict protocols on everything and everyone who goes in and out of a patient's room, and other measures to ensure that any potential dangers are contained.

Everything is thought out, right down to how visitors can interact with patients. They can be within 1 to 2 inches of each other, looking through a plate-glass window and talking through an intercom.
It's a unique facility that's rarely used.

Ribner said it was last activated a couple of years ago, when someone came from Angola amid a Marburg virus outbreak.

"It's kind of like an insurance policy," the Emory physician said. "You can complain about the fact that you didn't collect on your ... policy or you can say -- as in this case -- 'Boy, we're lucky we've been supporting you all these years because now we really need you.' And it would be really challenging to develop this on the fly."

Giving the body a chance to fight back

The renowned hospital's wide variety of tools will be put to ample use given how Ebola -- without the existence of any FDA-approved treatments -- will be addressed at Emory: using what Ribner calls "supportive care." That means carefully tracking a patient's symptoms, vital signs and organ function and taking measures, such as blood transfusions and dialysis, to keep him or her as stable as possible.
"We just have to keep the patient alive long enough in order for the body to control this infection," Ribner explained.

What the Emory doctor doesn't have, as American patients Nancy Writebol and Dr. Kent Brantly arrive for treatment at his hospital, is hesitation or trepidation. Ribner told reporters he has "no concerns" about his health or that of his colleagues.

Another person who also didn't express any worry was Ribner's wife.

"My wife knew when she was getting into when she married an infectious disease doctor... It went fine," he said of his conversation with his wife. "She said, 'Great, that's what you've been dreaming for 12 years.'"

1 August 2014 (Primary Source) Ebola patient coming to U.S. as aid workers' health worsens

(Reuters) - A U.S. aid worker who was infected with the deadly Ebola virus while working in West Africa will be flown to the United States to be treated in a high-security ward at Emory University Hospital in Atlanta, hospital officials said on Thursday.


The aid worker, whose name has not been released, will be moved in the next several days to a special isolation unit at Emory. The unit was set up in collaboration with the U.S. Centers for Disease Control and Prevention.


CDC spokeswoman Barbara Reynolds said her agency was working with the U.S. State Department to facilitate the transfer.


Reynolds said the CDC was not aware of any Ebola patient ever being treated in the United States, but five people in the past decade have entered the country with either Lassa Fever or Marburg Fever, hemorrhagic fevers similar to Ebola.


News of the transfer follows reports of the declining health of two infected U.S. aid workers, Dr. Kent Brantly and missionary Nancy Writebol, who contracted Ebola while working in Liberia on behalf of North Carolina-based Christian relief groups Samaritan's Purse and SIM.


CNN and ABC News reported that a second American infected with Ebola was to be flown to the United States. CNN identified the U.S.-bound patients as Brantly and Writebol. Reuters could not independently confirm the reports.


Amber Brantly, the wife of Dr. Brantly, said in a statement: "I remain hopeful and believing that Kent will be healed from this dreadful disease."


Earlier on Thursday, White House spokesman Josh Earnest said the State Department was working with the CDC on medical evacuations of infected American humanitarian aid workers.


The outbreak in West Africa is the worst in history, having killed more than 700 people since February. On Thursday, the CDC issued a travel advisory urging people to avoid all non-essential travel to Guinea, Liberia and Sierra Leone, the epicenter of the outbreak.


Brantly and Writebol "were in stable but grave" condition as of early Thursday morning, the relief organizations said. A spokeswoman for the groups could not confirm whether the patient being transferred to Emory was one of their aid workers.


CDC Director Dr. Thomas Frieden said in a conference call that transferring gravely ill patients has the potential to do more harm than good.


Meanwhile, the National Institutes of Health plans in mid-September to begin testing an experimental Ebola vaccine on people after seeing encouraging results in pre-clinical trials on monkeys, Dr. Anthony Fauci, director of the NIH's allergy and infectious diseases unit, said in an email.
In its final stages, Ebola causes external and internal bleeding, vomiting and diarrhea. About 60 percent of people infected in the current outbreak are dying from the illness.


Writebol, 59, received an experimental drug doctors hope will improve her health, SIM said. Brantly, 33, received a unit of blood from a 14-year-old boy who survived Ebola with the help of Brantly's medical care, said Franklin Graham, president of Samaritan's Purse.


Frieden could not comment on the specifics of either treatment but said: "We have reviewed the evidence of the treatments out there and don't find any treatment that has proven effectiveness against Ebola."

(Additional reporting by Alex Dobuzinskis in Los Angeles and Eric M. Johnson in Seattle; Editing by Will Dunham, Sandra Maler and Lisa Shumaker)

30 July 2014 (Primary Source) Liberia shuts schools as Ebola spreads, Peace Corps leaves three countries

(Reuters) - Liberia will close schools and consider quarantining some communities, it said on Wednesday, rolling out the toughest measures yet imposed by a West African government to halt the worst outbreak on record of the deadly Ebola virus.

"This is a major public health emergency. It's fierce, deadly and many of our countrymen are dying and we need to act to stop the spread," Lewis Brown, Liberia's information minister, told Reuters. "We need the support of the international community now more than ever. We desperately need all the help we can get."

Security forces in Liberia were ordered to enforce the action plan, which includes placing all non-essential government workers on 30-day compulsory leave.

Highly infectious Ebola has been blamed for 672 deaths in the West Africa nations of Liberia, Guinea and Sierra Leone, according to the World Health Organization. Liberia accounted for just under one-fifth of those deaths. The first cases of this outbreak were confirmed in Guinea's remote southeast early this year. It then spread to the capital, Conakry, and into neighboring Liberia and Sierra Leone.

The fatality rate of the current outbreak is around 60 percent although the disease can kill up to 90 percent of those who catch it. The illness, called viral hemorrhagic fever, has symptoms that include external bleeding, massive internal bleeding, vomiting, and diarrhea.

The U.S. Peace Corps said on Wednesday it was temporarily withdrawing 340 volunteers from Liberia, Sierra Leone and Guinea and that two of its volunteers had been isolated and were under observation after coming in contact with a person who later died of the Ebola virus.

The Peace Corp has 102 volunteers in Guinea, 108 in Liberia and 130 in Sierra Leone working in education, health and agriculture.

The State Department has confirmed that one U.S. citizen died from Ebola in Nigeria after being infected in Liberia. Two other American aid workers infected with Ebola, Dr. Kent Brantly and missionary Nancy Writebol, are in serious condition, but they have shown slight improvement. They were part of a team in Liberia from North Carolina-based Christian relief groups Samaritan's Purse and SIM.

'ONLY HEALTHCARE WORKERS WILL BE PERMITTED'

Liberian President Ellen Johnson Sirleaf said in a speech posted on the presidency's website that the government was considering quarantining several communities based on the recommendation of the health ministry. www.emansion.gov.lr/

An earlier draft of the measures sent to Reuters specified communities to be quarantined.

"When these measures are instituted, only healthcare workers will be permitted to move in and out of those areas. Food and other medical support will be provided to those communities and affected individuals," she said, adding that all markets in border areas are to be closed.

White House spokesman Eric Schultz told reporters that President Barack Obama had been briefed on Tuesday by his homeland security adviser, Lisa Monaco, and that the White House was monitoring the deadly outbreak.

“The CDC (U.S. Centers for Disease Control and Prevention) has said this is not a risk to the United States at this time,” Schultz told reporters traveling with the president back to Washington from Kansas City, Missouri. He said the U.S. government had increased assistance to countries battling Ebola.

Schultz said the White House would proceed with a planned U.S.-Africa Leaders Summit in Washington Aug. 4-6 that about 50 Africa leaders are expected to attend to discuss trade and investment between the United States and Africa.

Liberia's President Surleaf said she would not be attending the summit but that Vice President Joseph Nyuma Boakai and a few cabinet ministers "whose presence are absolutely necessary" would attend.

“We have no plans to change any elements of the U.S.-Africa Leaders Summit as we believe all air travel continues to be safe,” Schultz said.

Last week, 40-year-old Liberian-American Patrick Sawyer, a consultant for the Liberianfinance ministry, died from Ebola in Nigeria after having traveled from Liberia. Authorities in Nigeria, as well as Ghana and Togo, through which he passed en route to Lagos, are trying to trace passengers who were on the same plane as he was.

On Wednesday, Britain held a top-level government meeting to discuss the spread of Ebola in West Africa, saying the outbreak was a threat it needed to respond to.

OVERWHELMED

Mike Noyes, head of humanitarian response at Action Aid UK, said people affected by Ebola should be treated with compassion and not criminalized.

"Enforced isolation of a whole community is a medieval approach to controlling the spread of disease," he said.

Some airlines in the region have cut routes to countries affected by Ebola, even as the WHO is saying it does not recommend travel restrictions as a step to control outbreaks.

On Wednesday, Liberian health officials said an isolation unit for Ebola victims in Liberia's capital, Monrovia, was overrun with cases and health workers were being forced to treat up to 20 new patients in their homes.

Protests by the local community against construction of an isolation unit at Elwa Hospital have ended, said Tolbert Nyenswah, an assistant minister of health, but patients with Ebola symptoms will have to wait at home until work is finished.

"The staff here are overwhelmed. This is a humanitarian crisis in Liberia," Nyenswah told Reuters by telephone.

Nyenswah said the suspected patients were being treated by trained medical staff with full protective gear, but it would take at least 24 to 36 hours to build the new unit.

Initial resistance to building a new isolation unit highlighted the fear and mistrust health workers have faced across West Africa as they battle the outbreak, which has strained the region's weak health systems.

Dozens of local health workers, including Sierra Leone and Liberia's leading two Ebola doctors, have died treating patients.

Samaritans Purse said on Wednesday it would stop running case-management centers in Liberia after an attack on employees over the weekend and resistance from the local community to the expansion of their unit in Monrovia. The organization said it was withdrawing non-essential staff from the country.

(Reporting by David Lewis and Emma Farge; Additional reporting by Kwasi Kpodo in Ghana, Clair MacDougall in Monrovia, Misha Hussain for the Thomson Reuters Foundation in Dakar, Lesley Wroughton and Roberta Rampton in Washington, Colleen Jenkins in North Carolina; Writing by Toni Reinhold; Editing by Steve Orlofsky)

26 July 2014 (Primary Source) Ebola center in Sierra Leona under guard after protest march

Police were guarding an Ebola treatment center in Sierra Leone on Saturday, the day after thousands marched on the clinic following allegations by a former nurse the deadly virus was invented to conceal "cannibalistic rituals" there, a regional police chief said.

Across Guinea, Liberia and Sierra Leone, at least 660 people have died from the illness, according to the World Health Organisation, placing great strain on the health systems of some of Africa's poorest countries.

The virus is still spreading. A Liberian man who died in Nigeria's commercial capital, Lagos, tested positive for the virus on Friday, Nigeria's health minister said.

Sierra Leone now has the highest number of cases, at 454, surpassing neighboring Guinea where the outbreak originated in February.

Angry crowds gathered on Friday outside the country's main Ebola hospital in Kenema in the West African country's remote east where dozens are receiving treatment for the virus, and threatened to burn it down and remove the patients.

Residents said police fired tear gas to disperse the crowds and that a 9-year-old boy was shot in the leg by a police bullet.

Assistant Inspector General Alfred Karrow-Kamara said on Saturday the protest was sparked by a former nurse who had told a crowd at a nearby fish market that "Ebola was unreal and a gimmick aimed at carrying out cannibalistic rituals".

He said calm had been restored to Kenema on Saturday, adding that a strong armed police presence was in place around the clinic and the local police station.

Some health workers from the clinic have been reported absent from work because of "misconceptions by some members of the community," according to a local doctor.

RUNAWAY FOUND

Ebola can kill up to 90 percent of those who catch it, although the fatality rate of the current outbreak is around 60 percent. Highly contagious, especially in the late stages, its symptoms include vomiting and diarrhea as well as internal and external bleeding.

President Ernest Bai Koroma said on Saturday the government planned to "intensify activities and interventions in containing the disease and stopping it spread" with a view to ending the disease within 60 to 90 days.

The new strategy will focus on contact tracing, surveillance, communications and social mobilization, social services, logistics and supplies, according to the president's statement.

The WHO said previously that poor health infrastructure and a lack of manpower were hindering efforts to contain the outbreak in Sierra Leone. Another problem is fear and mistrust of health workers among the local population, many of whom have more faith in traditional medicine.

Sierra Leone officials appealed for help on Friday to trace the first known resident in the capital with Ebola whose family forcibly removed her from a Freetown hospital after she tested positive for the deadly disease. [ID:L6N0Q03FK]

Amadu Sisi, senior doctor at King Harman hospital, from which the patient was removed, said on Saturday she had been turned in after seeking refuge in the house of a traditional healer. She died in the ambulance on the way to another hospital, he added later.

Health workers are now setting up a new Ebola treatment center in Lakka village, about 20 km (12 miles) south of Freetown, to prepare for future cases near the capital.

26 July 2014 (Primary Source) Nigeria: Government Confirms a Death From Ebola

West Africa’s current Ebola outbreak has spread to a fourth country, as Nigeria on Friday confirmed a death caused by the disease. Officials said a 40-year-old Liberian government official died of Ebola in a Lagos hospital on Friday after arriving in the country on Tuesday. It is the first case of Ebola to be confirmed in Nigeria since the outbreak began in West Africa this year, said Nigeria’s health minister, Onyebuchi Chukwu. The Liberian was attending an international conference in Lagos and died early Friday. The Lagos University Teaching Hospital said the man’s blood tested positive for Ebola. One of the world’s most deadly and contagious diseases, Ebola has killed at least 660 and infected 1,093 in Sierra Leone, Liberia, Guinea, and now Nigeria, according to the World Health Organization.