The medical situation in Monrovia blemish "catastrophic" and fears the worst is yet to come

They get sick and die in taxi door center "

José Naranjo Dakar 26 AGO 2014 - 19:43 CEST1
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Lindis Hurum with Brett Adamson, MSF. / John Moore (Getty Images)


"The situation in Monrovia is totally out of control, it is very serious, catastrophic," says Hurum Lindis, coordinator of Doctors Without Borders (MSF) in Liberia. "Every day gets worse every day the news is worse and sincerely believe that the worst is yet to come true," he adds. "We are facing an epidemic of a scale never seen before and in this city of one million people the disease is everywhere, in every neighborhood. This requires implementing a strategy that does not know, requires coordination and means that we have not seen anywhere. "
more

     "Do not give them food or clothing; leave them there to die "
     The quarantine Ebola Liberia plunges into chaos
     Fear of Ebola goes global

It takes two months to face the Ebola outbreak and has extensive emergency experience in the field, but what he saw excels all. "We have launched the largest center of isolation for sick Ebola that has ever been created, with capacity for one hundred patients, but we are overwhelmed. We see people get sick and die in a taxi at the door of our hospital, "says Hurum. "We need to address this problem like a tsunami or an earthquake, we only run after an epidemic that goes faster than us and do not see the resources anywhere. The government does what he can, he tries, but his health system is very fragile, unable to respond. "

Admits to feeling exhausted after 60 days fighting a giant and is waiting to return to his native Norway, but virtually all companies have canceled their flights. "We're seeing the reaction of the international community has been panic, trying to isolate this part of the world to prevent Ebola reach Europe or the USA. That is not the solution, we should use that energy to come here and help isolate completely because if this area is going to be even worse. At MSF we have crossed alarmist, but I'm being realistic. "

     We can not isolate these people and let die

A serious problem is that it is not by tracking cases and contacts. There is not even reliable figures. "We are absolutely certain that there are more cases and more deaths than the official figures say," he says. And we must add the problem of public safety: keep thousands of people in quarantine, and the neighborhood of West Point, where 70,000 people have been left within a cordon sanitaire. "This is not just a problem of Ebola is a real humanitarian crisis. We are in a big city where in normal times there is some crime, but now the risk of violence is high. Prices rise, schools are closed, there are areas where people can not move. We will see terrible things we've never seen before, "Hurum forward.

"There must be an answer and international agencies, are almost alone against this," he concludes. "We need doctors, nurses, skilled people, this is Ebola and there is a risk, but it is affordable, you can afford. We can not isolate these people and let die. It takes coordination that has not existed until now. I am very glad that David Nabarro [UN coordinator to the epidemic] is come this weekend, but we need all these resources are already talking implement now without further delay. "  http://sociedad.elpais.com/sociedad/2014/08/26/actualidad/1409074987_694884.html

Liberia: Quarantined & Homeless

By Samuel G. Dweh
Rampaging sea tide from the Atlantic Ocean evicted hundreds of residents of quarantined West Point Township from their homes from the early hours of yesterday, August 25.
On Tuesday, August 19, Liberia's President, Mrs. Ellen Sirleaf, gave order for barring of all residents of West Point to other parts of the Country.
The President's order came six days after some residents of the Town evaded a quarantine center in the community and escaped with mattresses, googles, nose-masks and other things in the Ebola quarantine center.
The order has is causing hunger in majority of the Township residents because the government has provided food only once (Thursday, August 21) and majority of outside relatives and friends unable to deliver food, water and money to the trapped persons. The visitation from the government is short (6am-3pm) and the bureaucracy to pass through the five check points is time-consuming. Some have spent days near the first check point, on Mechlin Street, to find a way. Perishable goods have got damaged.
By 7pm of Saturday, August 23, message of halt of food or money delivery came out from the leadership of the joint task force of the Police and Army. This message caused hopelessness in all with something to deliver to a hungry relative or a friend behind the barricades.

"If I didn't deliver the food with me, how will my eleven children and my husband survive today?" cried Madam Mary Seon, who later told the New Republic's reporter beyond the first Check Point that she lives in West Point, but was away in Salala, Bong County, when the quarantine order was issued. "I left West Point Monday to this food and arrived in Monrovia in the afternoon of Thursday."
Madam Ethel Pleh, another resident of West Point, a travel companion of Madam Seon, told the New Republic Saturday she has seven children and a grandchild. "I, too, was away out of Town buying this food for my family," she directed this writer's attention to two full rice bags besides her on the Side Walk.
"My brother, please tell me how the government is doing with this Ebola business in West Point," a lady, who gave Saybah Kamara as her name, and said she lives in West Point identified herself with formation, some people who had brought food or money went back to come another day. But some stay on with a hope the task force's decision would be rescinded later.

The government has not provided food for three days in row (Friday, August 22-Monday, August 26). Representative Saah Joseph of District # 13 and few humanitarian organizations have been filling the hunger gap created by the government's failure to provide food for the quarantined people, but the foods often come late.

The sea kicked down all the homes along the shoreline and created a plain where some of the houses had been before it struck.
"I lost all my six bed-room house to the sea water," Madam Cynthia Wlue, a resident of the Township, explained to journalists at the beachside yesterday, August 24. "I and my children and grandchildren are just sitting with our neighbor, and waiting on God to provide a sleeping place through somebody."
Another resident, Mr. Mohammed Carew, told journalists at the beachside that his four-room apart was destroyed by the erosion. "This thing is coming upon us when we are already going through a heart-breaking situation--quarantine by the government," lamented to some of the journalists observing the sea erosion's damage along the shoreline. rent t
Yesterday's was the second in this year for this annual destructive climate condition to occur. Similar thing happened four months ago.
"From report received by my office, the number of homes destroyed is two hundred and fifty," the Township Commissioner, Madam Miatta Flowers, told journalists at the Township yesterday.
Madam Flowers, however, told the Press people she didn't know the actual number of persons in each of the homes.
Representatives of the World Food Program and the Liberian National Red Cross donated food ration to residents of the Township yesterday.
Later in the day, President Ellen Sirleaf visited the Township to acquaint herself with unfolding events. http://allafrica.com/stories/201408261589.html

The Struggle to Contain Sierra Leone's Ebola Epidemic

Liberia: Dogs Feed On Ebola Victims

By E. J. Nathaniel Daygbor
The residents of the Mount Barclay Community within the Johnsonville Township, outside of Monrovia woke up on last Friday morning in total dismay when the remains of dead Ebola victims were reportedly seen, eaten by dogs, something reminiscent of the brutal civil war here, when dogs ate dead bodies on the streets.
The Liberian Government, through the Ministry of Health and Social Welfare, buried some unaccounted-for corpses, suspected to have died from the Ebola Virus in that township few weeks ago.
The burial was done in a hurry at night following a standoff in the day between residence and the Ministry of Health burial team. The former had refused to grant the authority a piece of land to carry out the burial. The dogs, in their numbers, were seen pulling the bodies out of the shadowed grave and hastily eating them.

A resident, who spoke to the NewDawn, said that the action of the dogs has posed a serious health hazard to the entire Mount Barclay Community. Mr. Alfred Wiah noted that the dogs could easily spread the virus through further interactions with community dwellers.
According to Mr. Wiah, upon discovery of the dogs' behavior, some young men immediately contacted the Health Ministry, but to no avail. The young men also attempted to kill all of the dogs, but some escaped the scene, making the terrain very scaring for the residents.
He then expressed his disappointment in the manner and form the Liberian Government has treated the township. "We are very disappointed in the Health Ministry, especially the government that took an oath to defend and protect us; to see them act in such manner is unacceptable and we'll never allow the government come to bury any longer. They will be resisted by us because I think the government has failed to protect us- why bring Ebola bodies and mot bury them well,"? He explained in this paper.
According to him, some residents were deciding to leave the township in order to save their respective families, noting that since the incident occurred last Friday, the government has failed to clean the "mess" by reburying the dead properly. When the Commissioner of the Johnsonville Township, Mr. Melvin Bettie, was contacted yesterday, he confirmed the information, but added that his leadership was working with the community leadership to find a solution to the situation.
"I received the information already through the community chairman and I've sent a delegation there to see how we can revise the situation because it is embarrassing and it poses serious hazard to the community's dwellers," he said.  http://allafrica.com/stories/201408260125.html?viewall=1

WHO pulls staff from Sierra Leone Ebola lab after doctor infected

FREETOWN (Reuters) - The World Health Organization has withdrawn staff from a laboratory testing for Ebola at Kailahun in eastern Sierra Leone after one of its medical workers there was infected during the worst ever outbreak of the disease, a WHO spokesperson said.

"It's a temporary measure to take care of the welfare of our remaining workers," WHO spokesperson Christy Feig told Reuters. "After our assessment, they will return."

The WHO has sent nearly 400 people from its own staff and partner organisations to fight the outbreak in West Africa. It said on Sunday that a foreign health worker it had deployed in Sierra Leone had been infected. http://news.yahoo.com/pulls-staff-sierra-leone-ebola-lab-doctor-infected-140605262.html

Zambia-State strengthens Ebola watch

By KABANDA CHULU
Government has strengthened surveillance and increased the level of alertness by installing fever-detecting equipment at all border entry points with the Democratic Republic of Congo (DRC) where Ebola has reportedly broken out.

Deputy Minister of Health Chitalu Chilufya said Zambia was taking precautionary measures following the confirmed outbreak of the epidemic in northern DRC with symptoms similar to that of Ebola.
“We have started raising the level of alertness in our systems and strengthening surveillance, especially at those entry points we share with the DRC where there is an outbreak of an epidemic similar to Ebola,” Dr Chilufya said yesterday.
Yesterday afternoon, teams were dispatched to install equipment at these borders which include infra-red thermometers to detect fever and screen people entering the country.
Dr Chilufya said: “Health workers have also been equipped with protective clothing and we are going to install scanners with network systems that detect fever in a crowd of people and pick out infected people. This system is highly efficient and we shall put it at all airports and other points of entry.”
According to the Daily Mail of the UK, a medical team was earlier yesterday dispatched to DRC’s Equateur Province to investigate whether the Ebola virus has re-emerged in the area.
The latest outbreak of Ebola in West Africa - the worst ever - has already killed more than 1,200 people in Guinea, Liberia, Sierra Leone and Nigeria, and experts warn it is not yet under control.
DRC does not share a border with any of the countries already known to be affected by the epidemic, but reports of a potential outbreak there are a serious cause for concern.
And JIMMY CHIBUYE in Chavuma reports that the district is vulnerable and can easily contract the deadly Ebola virus, which has claimed over 1,000 lives in West Africa, if it breaks out in Angola, district commissioner Laurence Kayumba has said.
Mr Kayumba said here yesterday that Chavuma is close to Angola and has only two officials manning the Chiingi border post and the district has no capacity to handle the Ebola virus if it breaks out.
The highly-contagious Ebola virus can kill up to 90 percent of its victims. There is no known vaccine for the disease.  http://www.daily-mail.co.zm/index.php/local-news/item/8256-state-strengthens-ebola-watch

112 Indians Arriving from Ebola-Hit Liberia; Mumbai, Delhi Airports Gear Up

Updated: August 26, 2014 01:35 IST

File Photo: Mumbai Airport (Press Trust of India)

Mumbai:  Elaborate precautionary arrangements have been put in place at the Delhi and Mumbai airports to screen 112 stranded Indians who will arrive today by various flights from and around Ebola-hit Liberia, authorities have said.

Some of these passengers, traveling by a South African Airways flight, arrived at the Mumbai Airport a few minutes after midnight.

"As part of the tentative plan, the aircraft will be first taken to a remote bay and all passengers will be screened at the step-ladder exit after the arrival of flights at the Chhatrapati Shivaji International Airport (CSIA)," the Mumbai International Airport Limited or MIAL earlier said in a statement.

While the passengers without any symptoms will be cleared and shifted to the terminal for immigration and customs clearance, those with symptoms suggestive of Ebola Virus Disease or EVD will be directly shifted to the designated hospital in ambulances from the bay, it said.

These passengers would have been screened in at least three countries - Liberia, South Africa and United Arab Emirates or Ethiopia, where the flights would have halted on their way - before they land in India, said sources.

They added that the screening was precautionary, as the passengers would have been stopped and quarantined in the other countries if they had exhibited any symptoms of the disease.

According to the MIAL, Ethiopian Airline, Emirates, Etihad, Qatar Airways, Jet Airways and South African Airways are flying these passengers to Delhi and Mumbai.

MIAL also said the baggage of the flights need to be kept separate by the concerned airline in their custody, adding disinfection of the flight will be carried out after all the passengers alight from the plane.

Flights will be allowed to board the next passengers only after thirty minutes of disinfection, the statement added.

Story First Published: August 25, 2014 22:57 IST

http://www.ndtv.com/article/cities/112-indians-arriving-from-ebola-hit-liberia-mumbai-delhi-airports-gear-up-581624?curl=1409008359

Doctor: Ebola Fatality Rate Running At 70 Percent

August 23, 2014 7:32 AM ET

4 min 28 sec

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Dr. Gabriel Fitzpatrick has been treating Ebola patients in Sierra Leone with Doctors Without Borders. He spoke with NPR's Scott Simon about what the news of two cured Americans means for his efforts. http://www.npr.org/2014/08/23/342652020/doctor-ebola-fatality-rate-running-at-70-percent?utm_content=buffer165fb&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Bodies Of Ebola Victims Cremated In Lagos

Monday, 25 August 2014

Bodies Of Ebola Victims Cremated In Lagos

Bodies of the four Nigerians, who died of Ebola Virus Disease, EVD, have been cremated in line with World Health Organisation, WHO, requirements for disposal of such corpses. The body of the index (first) case, Patrick Sawyer was the first to be cremated on July 25, 2014.

A health official at the Emergency Operation Centre, EOC, of the Mainland Hospital, Lagos, who confirmed the development, said

“All the bodies of those who died of Ebola from this centre have been cremated. None was allowed to undergo traditional burial because extreme care is being taken to prevent further infections,” the official noted.

The WHO in recommending that people who die from Ebola should be promptly and safely buried, notes that cremation, which is the application of high temperature to reduce bodies to basic chemical components (ashes), is ideal for safe disposal of bodies of such persons in order to minimise further transmission.

While the ECOWAS Commission stated that the remains of its Protocol Assistant at the Lagos Liaison Office, Mr. Salihu Abdulqudir Jatto, who succumbed to the Ebola Virus Disease, EVD, on August 12, 2014, had been laid to rest in a private ceremony in Ikorodu, Lagos state.

The Commission had earlier paid a condolence visit to the deceased’s widow and other members of his family.

Jatto was among persons that assisted the American-Liberian Mr. Patrick Sawyer, and contracted the disease from the late Sawyer who took ill on arrival in Nigeria on July 20, 2014 on his way to a regional conference in Calabar, and later died in a Lagos hospital of the EVD. http://abdulkuku.blogspot.com/2014/08/bodies-of-ebola-victims-cremated-in.html

Rwanda bans travel from Ebola-hit countries

• August 26, 2014
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KIGALI: Rwanda has announced restrictions on travel from Ebola-hit West African countries, the ministry of health said in a statement on Monday.
The move follows confirmed cases of Ebola in the neighboring DR Congo, and the escalating spread of the Ebola virus in West Africa.
“The Ministry of Health strongly recommends that all passengers coming from the Republics of Guinea-Conakry, Liberia and Sierra Leone or anyone who has travelled to those countries within the last 22 days be stopped from boarding flights to Rwanda or to enter Rwanda by any means of transport. An exception is only provided for passengers with special authorization signed by the Minister of Health of the Republic of Rwanda,” the ministry said in a statement.
“Any passenger with a fever of 37.5 degrees Celsius and above will not be allowed to enter Rwanda. Rwanda returning passengers will be requested to stay at an isolation facility at the border posts for further medical checks and consistent follow up by health professionals accredited by the Ministry of Health, up to clearance as per the Ministry of Health Protocol,” the statement said.
The Ministry of Health reassured said surveillance has been strengthened within the community and at all points of entry including all border posts in the country as well as airports. “Referral hospitals, district hospitals and other health facilities are well equipped and staff have been trained to handle any cases,” it said.
Over the weekend, DR Congo government confirmed two Ebola cases, the first outside West Africa since the outbreak.
The UN condemns travel bans on affected areas, but several countries including the Ivory Coast, Gabon, Senegal, Cameroon and South Africa have ordered travel bans to the affected countries.  http://www.dailytimes.com.pk/foreign/26-Aug-2014/rwanda-bans-travel-from-ebola-hit-countries

Dr Adadevoh's Sister Tests Positive To Ebola

   http://www.news360ng.com/2014/08/dr-adadevohs-sister-tests-positive-to.html

Insiders at the Ministry of health report that Dr Stella Ameyo's sister whose tests was conducted last week has tested positive to the Ebola virus.
The sister was one of the people to have had contact with Dr Ameyo before she passed on via Ebola virus.
Dr Ameyo's sister is allegedly presently under quarantine at Lasuth.

Ebola outbreak: Foreign Correspondent reports from behind the roadblocks on Sierra Leone's health crisis

Updated 26 August 2014, 7:12 AEST

By Suzanne Smith and Adam Bailes

ABC Foreign Correspondent reveals how its team covered the Ebola crisis in Sierra Leone before a media lockout was enforced.

A health worker offers water to a woman with Ebola at Kenema Government Hospital. (Credit: Reuters) 

The reports indicated the Ebola outbreak was getting worse. Not only had it taken hold in Liberia, Sierra Leone and Guinea in West Africa, but it had started to spread to Nigeria and Kenya as well.
The World Health Organisation had declared it an international public health emergency. This was a big and important story. But dispatching a crew from Australia was risky and problematic.
We couldn't be sure borders would be shut down en route, but even if they did get into one of the hotspots, the safety and security of the crew was paramount.

Snapshot of life in the Ebola 'hot zone'

The victims of the Ebola outbreak are not just those who have died, but entire communities left behind to try and rebuild.

We undertake strict and sophisticated risk assessments before our assignments, but this was particularly challenging. It became clear that local knowledge and experience was needed. We needed someone on the ground, who knew the conditions, had been to the epicentre before, and would know in a detailed way how to conduct themselves to ensure no risk of infection.
It was a big ask but we found the right person.
Adam Bailes has been working in Sierra Leone for some time and had visited the key towns at the epicentre of the outbreak – Kailahun and Kenema.
He is a young video journalist originally from England. He also speaks the local lingo.
We had been in constant contact with key NGOs on the ground in Sierra Leone, and, with the expertise of the World Health Organisation, the Red Cross and Médecins Sans Frontières, had developed an assignment that would deliver this important story with minimal risk to our team.
Adam was comfortable with the plan and the precautions in place and he was also keen to participate in the effort to get this important story out to an international audience.
The journey begin in Freetown, as Adam set off in a Red Cross 4x4 with Patrick Massaquoi, the communications director of the agency in Sierra Leone. It was the wet season, so after many hours of rough slippery roads, Adam and his crew arrived at the journey's midway point, Kenema.

Video: Red Cross workers handle a dead body in the town of Dodo, Sierra Leone (ABC News)

Kenema is the site of a terrible tragedy. Twenty nursing staff have died of Ebola in the local government hospital. Now the International Red Cross (IRC) is there building a new field hospital and training the local health workers in how to protect themselves from infection.
"I have been to Kenema a number of times over the past few months and seen many very hard-hit families in many districts as well as the chaos of the Kenema Government Hospital at the worst time," Adam said.
He said it was around July when he realised many of the staff he had been interviewing over the past months were now sick or had died, including Sheik Umar Khan, the Kenema hospital's head matron, and a lab technician called Hassan.

The race to the Ebola outbreak epicentre

As Adam arrived with our team, the head of the IRC response, Australian Amanda McClelland, told our crew they would need to leave immediately if they were to get through the roadblocks.
The government had announced a media lockout and also a lockout for all non-essential personnel.
Adam and the team quickly ran to the car and continued their journey to the epicentre of the Ebola outbreak at Kailahun.

Compared to the last few months, this time, travelling to Kailahun did not feel very high risk. I felt very comfortable.

Adam Bailes

Our crew travelled for many hours, again on wet bumpy roads. Twelve hours later, they reached Kailahun.
This is the site of the crisis coordination centre set up by Médecins Sans Frontières with help from the IRC and the World Health Organisation.
"Walking through the gates to the compound of MSF and Red Cross headquarters and seeing maybe 60 white 4x4's with MSF or Red Cross on the side, flags flying and big radio transmitters on front, I remember thinking 'this is an army'," Adam said.
"Compared to the rest of the country, Kailahun has the most specialised and prepared team I have seen. This is the kind of response that is needed all over the country.
"Compared to the last few months, this time, travelling to Kailahun did not feel very high risk. I felt very comfortable."

'Ebola may just keep slowly burning through the country'

Adam and the team arrived back safely in the capital Freetown several days later, but some of the fear of working in an Ebola-affected area remained.

Photo: Adam Bailes, an English video journalist, joined the ABC's Foreign Correspondent team in Sierra Leone.

"There is definitely a whole mental process you go through covering an outbreak like this," Adam said.
"You become hyper-aware, thinking about every surface you touch or a tiny bit of sweat dripping on your lip. You become paranoid every time you feel a bit tired, or have a small temperature change. Straight away I would start counting backwards how many days it had been, to see if you fall in the contagion time of three to 21 days.
"It feels now like perceptions of people in Sierra Leone are beginning to change which will make a massive difference. If people accept Ebola is real, is it a lot easier to treat.
"I fear though Ebola may just keep slowly burning through the country. Now rainy season is really kicking in, traveling is becoming even harder and resources in the fight are already low."v   http://www.radioaustralia.net.au/international/2014-08-26/ebola-outbreak-foreign-correspondent-reports-from-behind-the-roadblocks-on-sierra-leones-health-cris/1360786

The Federal Government’s Inconsistent Ebola Story

• By Jonathan Easley
• •   August 15, 2014

The federal government denies having any significant involvement in helping two sick American aid workers in West Africa obtain an unapproved Ebola drug from a U.S. company, but the stories coming from the relevant agencies are murky and inconsistent.
Experts say the non-transparent, strained telling of the government’s involvement, and the passive, anything-goes approach to treating the outbreak, is evidence the U.S. needs to review its experimental drug laws. They also say it’s evidence the country is unprepared to deal with potentially more dangerous contagions at home or abroad.

@jflier @JonEasley it’s clear now we don’t have any such emergency plan or point people in general whether CDC or FDA.
— Ford Vox, MD (@fordvox) August 7, 2014

In late July, two Americans in Liberia – Kent Brantley, a doctor with Samaritan’s Purse, and Nancy Writebol, a missionary for another charitable organization, SIM – were diagnosed with Ebola and received treatments of ZMapp, a highly experimental medication made by tiny San Diego-based Mapp Biopharmaceutical, Inc. The drug was designed with the support of the U.S. military. It’s expensive, difficult to transport, exists only in a limited supply, and before it’s arrival in Liberia, had only been tested on a handful of monkeys.
Brantley and Writebol arrived back in the U.S. in early August. Their return and steady improvement attracted a media frenzy, which in part forced the federal government to detail how the patients obtained the rare, early-stage drug while overseas.
But the government’s explanation has at every point been murky, and at times, conflicted with the stories coming from the private companies involved. All three federal agencies —the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), and National Institutes of Health (NIH) —say they played little or no role in the decision-making or drug procurement process.
This seems unlikely, according to Ford Vox, a physician at Atlanta’s Shepherd Center hospital who has written critically about the government’s Ebola response “If [Mapp] did this on their own, they must have had unbelievable confidence in the product and lawyers who know this up and down,” Vox said. “If they went this alone, their investors should be worried, because that’s reckless. A team of scientists could get in a lot of trouble doing that, and I can’t imagine they run their company that way, especially considering they have support from the Department of Defense.”
According to the CDC, it was Samaritan’s Purse, the private humanitarian organization that employs Dr. Brantley, who reached out to them in an attempt to find an experimental Ebola drug. The CDC says it passed Samaritan’s Purse along to NIH, who referred them to contacts within Mapp.
“This experimental treatment was arranged privately by Samaritan’s Purse,” the CDC said. “Samaritan’s Purse contacted the Centers for Disease Control and Prevention (CDC), who referred them to the National Institutes of Health (NIH). NIH was able to provide the organization with the appropriate contacts at the private company developing this treatment. The NIH was not involved with procuring, transporting, approving, or administering the experimental treatments.”
The New York Times first reported this version of events on Aug. 6, and the statement was posted on the CDC’s website a few days later, where it remains.
But the NIH told Morning Consult one of its scientists on the ground in West Africa approached the charity before the group had even decided to pursue an experimental alternative.
“The NIH scientist who was in West Africa referred Samaritan’s Purse to company contacts because they were best equipped to answer questions about the status of their experimental treatment,” the agency said in an email to Morning Consult. “This occurred before Samaritan’s Purse decided to pursue an experimental therapy.”
A statement from Samaritan’s Purse also conflicts with the CDC’s telling of events, and indicates the NIH and other government agencies may have played an active role in procuring the drugs.
“The experimental medication given to Dr. Brantley was recommended to us,” the group said. “We didn’t seek it out, but worked with the National Institutes of Health and other government agencies to obtain this medication.”

In emergency use of Ebola sero- therapy, still unclear from news reports who approved use? FDA or not? Unprecedented. http://t.co/0DSBAhmtmu — Jeffrey Flier (@jflier) August 7, 2014

NIH did not answer repeated questions on how the agency decides it is appropriate to refer sick patients directly to a private company, how often it does so, and what criteria is considered. In an interview, Dr. Arthur Caplan, the head of bioethics division at New York University, said such referrals are an “ethical call” that he deals with frequently and occasionally struggles with.
The CDC also did not respond to multiple requests for clarification, and when presented with this confusing string of events, the NIH merely reiterated the CDC statement.
The Food and Drug Administration has also sought to diminish its involvement in the transaction.
“In some cases, when a U.S.-based drug company may be pursuing approval of a drug and that drug will be shipped from the United States for investigational use prior to its approval, that shipment will be covered by an Investigational New Drug (IND) [approval pathway],” the agency said in an email. “FDA has procedures in place to permit, in appropriate circumstances, emergency use in individual patients under an emergency IND. In other cases, exports of investigational drugs may be permitted without an IND as long as they meet the export requirements under the law.”
“However, FDA was not involved in the shipment of this experimental treatment to West Africa or the administration of the experimental treatment there,” they added.
But a statement from drugmaker Mapp implies that the process followed FDA guidelines.
“Any decision to use an experimental drug in a patient would be a decision made by the treating physician under the regulatory guidelines of the FDA,” the company says in a statement posted on its website.
The FDA’s jurisdiction here is difficult to decipher. The agency doesn’t govern non-commercial transactions and has limited international influence. And while the IND approval process is one way a patient could obtain an experimental drug, private individuals and companies sometimes operate outside of the regulatory process – and it’s not necessarily illegal to do so. But in these cases, drugmakers usually have little reason to comply with patient’s request. That’s because they take on enormous liability in giving out an unapproved drug, and most patients can’t pay for those drugs out of pocket anyway. In general, it’s safer for the drugmaker to go through the clinical trials process, rather than to openly test its product on a random patient.
In this case, it seems the stars aligned in favor of the American aid workers.

@JonEasley @fordvox Likely because it was administered outside USA. Right or wrong, FDA would never have approved under these circumstances.
— Jeffrey Flier (@jflier) August 7, 2014

The FDA did not respond to a follow-up question from Morning Consult requesting clarification about how the transaction could be described as having taken place in accordance with their guidelines, and Mapp did not return a phone call or email requesting comment.
In addition to these inconsistencies, many questions remain unanswered because the events transpired hidden from public view. For instance, it’s unclear how the ZMapp, which requires delicate handling in a cold environment, was delivered to Africa.
While nobody is arguing the sick Americans should have been denied the treatment they received, and indeed, everyone Morning Consult spoke with agreed that getting the aid workers ZMapp was the right thing to do, experts say that by claiming to have not been involved, the government set a real-world precedent that raises questions about how the U.S. might handle another, more serious threat.
They also say the disorganized and secretive nature of the endeavor, in which no federal agency has stepped forward to claim responsibility, is a concern.
“An ethical case can surely be made for an organization that puts health-care workers in harm’s way to acquire access to experimental drugs and bring staff home to get the best possible care,” Caplan wrote in a recent Washington Post op-ed. “But that is neither a fair nor just policy for deciding what to do when an emergency arises and rationing is the only option.”
It also raises questions about U.S. compassionate use laws. In June, Morning Consult reported on so-called ‘right-to-try’ laws, which a number of states have passed in an effort to make it easier for dying patients to obtain experimental early-stage medications. The idea is that the federal government shouldn’t tell a dying patient what to do. Despite the inherent conflicts with federal law, the state laws have gained traction on the strength of this emotionally compelling argument.
At the time of that story, medical experts and the federal government stood in almost unanimous opposition to the laws, arguing, among other things, that they’d turn the U.S. drug market into the Wild West. However, it’s difficult now to distinguish between the way in which the American aid workers obtained the drug, and how a private citizen or group in the U.S. might obtain an unapproved medication under right-to-try laws.
“It looks like we haven’t done any planning whatsoever,” Vox said. “There’s no consistency here – it’s left to the market, what connections you have, whether you have money and the media behind you, whether you know who to call…there’s been no planning, despite the fact we’ve been working with these outbreaks for decades…there’s apparently no process and no person tasked with making these decisions.”
Caplan is a fierce critic of right-to-try laws – like many, he believes the laws are thinly written to appeal to emotional, not scientific reasoning, and he argues they do nothing to help patients connect with private companies or pay for the drugs that may be able to help them. But he also acknowledges that the Ebola outbreak exposed the present system as inadequate.
“I think it alerts us to the need for a transparent public policy debate about compassionate use that goes beyond the window dressing of right-to-try laws,” he said. “It would be good if that debate were convened by the FDA, because this comes up in all sorts of situations.”
Vox noted that ZMapp was developed with the military, making it taxpayer property. He left the conversation with a simple matter of concern.
“Who are we going to leave these questions up to?” he asked. http://themorningconsult.com/2014/08/federal-governments-ebola-story-rife-inconsistencies/?utm_content=buffer230ad&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Ebola outbreak: Why Liberia's quarantine in West Point slum will fail

Monday, August 25, 2014

Ebola outbreak: Why Liberia's quarantine in West Point slum will fail

Last week, military personnel set up a barricade around the West Point slum in Liberia, but medical experts say there's no proof the medieval measure is effective. (Abbas Dulleh/The Associated Press)

Medical experts say that mass quarantine is rarely if ever effective in stemming the spread of a contagion like Ebola, and the move by Liberia to cordon off a sprawling slum is likely to do more harm than good.

"It's a measure that basically goes back to the Middle Ages. It's a reflection really of ignorance and panic," said Dr. Richard Schabas, formerly chief medical officer for Ontario and now in that role in Hastings and Prince Edward counties.

"Mass quarantine of this kind really has no place at all in disease control."

The concept of quarantine "has an intuitive appeal to a layperson, and leaders of these countries are lay people," adds Dr. William Schaffner, a Vanderbilt University professor of preventive medicine.

"But the practical aspects of implementation are very substantial and there aren't any data that would tell you securely that this works."

What's more, he suggests, the measure will also likely foment further public mistrust of the government.

Liberia is already struggling with fallout over its move to try to contain the spread of Ebola with a barricade around the West Point slum, located near the capital city of Monrovia.  

Clashes broke out in West Point after Liberia's military set up the barricade late Tuesday using scrap wood and barbed wire. Officials patrolled the expansive coastline to prevent the more than 70,000 residents from fleeing in canoes.

Several residents were shot during the unrest, including a 15-year-old boy who later died. Food prices in the crowded peninsula have skyrocketed.

Liberia — one of the poorest countries in the world and long wracked by civil war — has been the hardest hit of the four West African nations suffering under the five-month-long Ebola epidemic. As of Friday, the country had incurred 624 of the 1,427 deaths.

Desperate to control the spreading epidemic, the government has quarantined both remote villages in the northern Lofa County as well as the West Point slum, creating what some humanitarian workers dubbed "plague villages."

Sierra Leone and Guinea have also set up quarantine zones in areas severely affected by Ebola to try to reduce the chance of people spreading the virus outside their borders.

Quarantine during SARS 'damaging'

Dr. Schabas stresses that isolation — the act of segregating a person showing symptoms of the disease — is key to containing infections.

But he argues that there is no scientific proof that a quarantine — separating an entire category of people on the assumption they may be incubating the disease — is effective in zoonotic diseases (that can be transmitted between species) like Ebola.

Ebola can only be transmitted when a patient is showing symptoms of the disease. That's why some say patient isolation is a better way to control the spread of the disease. (Michael Duff/Associated Press)

As the World Health Organization has noted, a person infected with Ebola can only spread the virus once he or she starts to show symptoms. Transmission comes from contact with the bodily fluids of an infected person, whether dead or alive, or from animals.

It's believed that fruit bats are the carriers of Ebola, and that residents of the region may have caught the disease while handling the animals to cook the bush meat.

Schabas notes that a mass quarantine was tried during the 2003 outbreak of SARS in Toronto, with about 30,000 people ordered to stay home. But the measure failed.

"It involved a huge disruption and huge investment of public health resources," said Dr. Schabas. "It created the perception that SARS was more dangerous and more widespread than it was. It triggered things like travel advisories, which were economically damaging."

Dr. Schabas argues that for a quarantine to be useful, it has to make sure people comply with quarantine conditions, and the infectious disease must be transmissible when patients don't yet show symptoms. Neither SARS nor Ebola is transmissible when a patient is asymptomatic.

Medieval measure

Cordoning off a community to protect it or the outside world from the spread of an infectious disease is a Medieval measure dating back to the Black Death pandemic that killed up to 200 million people in the 14th century.

There have been other attempts to close off towns and villages in following centuries, including a rare instance in the British village of Eyam in the 1660s when villagers voted to voluntarily quarantine themselves.

They circled the town with piles of stones to prevent the spread of the plague beyond its border. Three-quarters of the 350 townspeople died.

But, as Joseph Byrne, a historian at Nashville's Belmont University, notes "most of the cordoning off [in history] occurred before germs were understood to be the cause."

"There were other more effective ways of dealing with disease from the late-1800s on, rather than simply saying, 'Well, let's seal off an area'," said Byrne. "I think that's why there aren't many contemporary attempts to do that."

There is also little research pointing to the effectiveness of quarantines, and many questions about not only infringing on individuals' human rights but physically harming them and spreading mistrust in the authorities. 

Keeping West Point — a densely packed stretch of land largely bordered by the Atlantic Ocean — secure over a lengthy period of time, perhaps weeks, will pose a major challenge.

Among them will be trying to stop townspeople from trying to bribe their way out.

As well, the 24-hour security will stretch government coffers and those inside the barricades may suffer. Some work outside the township and so will lose income while food costs are soaring and general frustration is rising. 

Distrust and misunderstanding of the disease is already hindering attempts to get the outbreak under control. Families are hiding relatives suspected of being infected, fearful of the stigma attached to Ebola.

Some believe the virus is a hoax, and many infections are happening because family members touch bodies during funeral rites. 

Dr. Keith Martin, a former Liberal MP who now heads the Washington-based Consortium of Universities for Global Health, says isolating a small group of unhealthy people with a large group of healthy residents can cause more harm than good if they don't get access to food, water and medical care — all of which are in increasingly short supply as groups like Doctors Without Borders have pointed out.

"Quarantining a large area like West Point in the way that it's done can contribute to the death rate because you're essentially isolating healthy and unhealthy people, and not implementing what's more important — good public health measures," said Martin.

'Biggest bang for buck'

The World Health Organization said that such "extraordinary" measures as quarantine should only be taken when "considered necessary," but countries must take human rights into account if they resort to quarantines and give residents the necessities of life.

Liberia's the hardest hit West African country, accounting for more than 40 per cent of the deaths from Ebola. (Luc Gnago/Reuters)

The UN World Food Program is planning to distribute food to an estimated one million people living in quarantine zones in West Africa. But residents have already complained that there's not sufficient food or water, creating the potential for a humanitarian crisis. 

Ultimately, the WHO stresses that the primary way to control a disease is "quality clinical care." Though it is advising countries on the health crisis, WHO notes "national authorities take decisions based on their assessment of local conditions."

Dr. Schaffner notes that the oil-rich nation of Nigeria has been successful in containing Ebola by using "standard public health practices." There, medical officials have focused on isolating cases of suspected Ebola, then tracking down and monitoring their contacts with daily temperature checks for the disease. 

Though clean water, food, education and good medical care give the "biggest bang for the buck," it's those basic necessities that the poorest countries lack, says Dr. Martin.

That's led them to desperately try to stem the contagion through other means.

"In Liberia, at the present time, they have more soldiers than they have doctors," observes Dr. Schaffner. "So they're using the resources that they have in the hopes that it will do some good."

Aid Workers In Short Supply As Ebola Grips Liberia

by Nurith Aizenman

August 24, 201411:44 AM ET

4 min 35 sec

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After arriving by ambulance, people with suspected Ebola virus lie on the ground before being admitted to the Doctors Without Borders Ebola treatment center in Monrovia, Liberia, last week. The 120 beds in the center were filled almost immediately.

John Moore/Getty Images

Sheldon Yett is UNICEF's lead man in Liberia. Over a long career he's been in the thick of all sorts of crises — wars, earthquakes, epidemics. He's seen firsthand how, when disaster strikes a poor country, aid workers and experts from all over the world flood the zone.
But with the Ebola epidemic, almost no one is answering the call.
"I'm astounded by how difficult it has been to get the partners we need," Yett says. "People are afraid. I can't convince my own staff to come. It's extremely, extremely difficult. We need skilled, qualified people here."
With the number of Ebola cases in Liberia now topping 1,000 and many more cases thought to be unreported, the need for international support has become acute. Liberian officials and aid groups say they desperately need health workers and experts in disease management.
"The effects of this outbreak will be with us for many, many, many months to come, and we need qualified people here, and we need the funds to address it," Yett says. "The needs are enormous."
But something about this virus — maybe the fact that it's so deadly, or maybe it's the images of health workers putting on full-body protective suits to avoid getting infected — seems to have unnerved the sort of experts Liberia needs.
Hunting For Doctors
One of biggest shortages has been in care centers for people with Ebola. Last weekend the aid group Doctors Without Borders opened a new center in Monrovia with 120 beds. They were filled almost immediately. The United Nations is promising to help add another 500 beds — but not for another six weeks, and it's still on a hunt for doctors.
"The biggest concern has been, as long as I've been here, is to get international staff with Ebola experience," says Lindis Hurum, Doctors Without Borders emergency coordinator for Monrovia. "That's what's been stopping us."
She says they've already brought in every available person they can. But they don't actually need that many more international experts to expand the treatment centers, just enough to train the Liberians who would do most of the work.
Even though working with Ebola patients is extremely dangerous, Brett Adamson, coordinator of the new Doctors Without Borders center, says he's had no problem finding Liberians willing to step up.
"It was quite surprising, considering the number of health workers that have died, and so they've been amazing," Adamson says. "We recruited 50, 60, 70 staff in a day."
'We Need Brave People'
One of the new hires, Amos Togba, helps disinfect gear and equipment at the center. He says he knows the risks.
"Well, yes, I have some fear, but I have to be brave to do it," Togba says. "That's the only way we can attack the virus. We need brave people to do it."
Then there are the jobs that aren't hazardous, but are nonetheless essential.

Liberia's government recently set up an Ebola hotline for people to call with questions or ask for help. Barkue Tubman, who runs a public relations firm, helped set up the center with a Facebook call-out for workers.
On hiring day, Tubman says, "We walked out the gates and we saw about 1,000 people in pouring rain," she says.
It's rainy season here, and when it comes down, it really comes down. Tubman says they had to turn hundreds of people away.
Liberians are also at forefront of the work that experts say is the real key to quashing the outbreak: going door-to-door through every community to find out who is sick, help them get tested, and encourage those who came in contact with a sick person to stay away from others during the 21 days it takes to find out if they've been infected.
Barely Making A Difference
Joyce Kilpo does this by delivering supplies such as rice, salt, cooking oil and sanitary pads to people under quarantine. Kilpo makes these runs every day in partnership with an NGO called Action Aid. But she feels like she's barely making a difference.
"We say, 'Sorry for everything that happened,' " Kilpo says. "There are a lot of people that are not getting food, and what we are doing is just a drop in the ocean."
Experts also say the information being gathered by people like Kilpo is of limited use, unless it's fed to people with direct experience coordinating disease emergencies. That expertise is missing, too.
Hurum says she thinks experts don't step forward because they fear they would be putting themselves in immediate danger, which is not necessarily true. The reality, she says, is that working in Liberia during this outbreak is a lot like working in any other disaster.
"There's a lot of things you can do in this response that [are] not high-risk," she says. "You do not have to put on that astronaut equipment that you see in all the pictures to respond to this crisis." http://www.npr.org/blogs/goatsandsoda/2014/08/24/342477258/aid-workers-in-short-supply-as-ebola-grips-liberia?utm_content=buffer1468a&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Equateur province. Ebola confirmed Djera. Kinshasa and Mbandaka not concerned

Monday, August 25, 2014

* Kinshasa and Mbandaka are not infected with the Ebola virus, reassured the Minister of Public Health, Felix Kabange Numbi, at the end of the third crisis meeting yesterday at the Government House. The Government of the Republic has taken all measures to contain and limit the disease in the area Djera, Boende territory in the province of Ecuador
 
* At present, the Government is focused on active case detection and monitoring, secure confirmed cases of unexplained deaths and funerals, the isolation of confirmed cases, staffing of essential drugs, etc. In short, nothing is overlooked by the Government Matata holding with the President of the Republic. However, the DRC is open to any assistance to stop this scourge, which the WHO had declared "global priority" in terms of data recorded in the countries of Western Africa consequences
The epidemic which some believed to be far from the ground floor to affect its population, has indeed been confirmed by the Government of the Republic. Ebola dreaded disease internationally and has claimed several lives in West Africa, has been located in the area of ​​Djera, Boende territory in the province of Ecuador.
 
It is the Government, at the end of the third crisis meeting held yesterday the Prime Minister, who announced to the press. Indeed, of the eight samples taken and examined by the National Institute of Biomedical Research (INRB), two were positive to Ebola, announced the Minister of Public Health, Felix Kabange Numbi at the end of the meeting of crisis at Government House.
Note that contingency measures were Pises by the Government to stop the spread of the virus. Asked by the press yesterday, the Minister of Public Health noted that first, the Head of State asked that steps be taken to ensure that the outbreak is managed at sector Djera, that is ie, erect a camp at Lokolia, that coordination is achieved at the center of the epidemic.
"The Head of State emphasized that the protection of personnel and the protection of the population extends to the entire province of Ecuador, that is to say, measures will be taken Governor have to protect all travelers and the people of Ecuador, "said he said, adding that the President of the Republic wants a wide communication.
In this regard, the Minister of Public Health found that the DRC has managed this epidemic with all the transparency that we are known in the management of epidemics. For him, it is the seventh outbreak in DRC, for disease Ebola. And this is not the first. At the same time, the Government has resolved to mobilize health workers who worked in six previous epidemics, to be deployed. And all this with the support of the security services.
For Felix Kabange, when it comes to the management of epidemics, there must have finance. In this regard, the Government is prepared. Being also a matter of national security, the interior ministry will work closely with the Ministry of Health. In addition, there is a toll free number and information will be accessible to everyone. But the prime minister also wants green people, those responsible for providing information to those who need it.
The people called for calm
Actions are already underway. The Government of the DRC calls on the population to remain calm and respect the precautions or hygiene. The quarantine was also decided Djera. The establishment of a center in Lokolia will also manage communication challenges related to this outbreak. A camp will be built to allow dispatched teams to manage any suspected or confirmed cases.
To achieve this, the government mobilized the services responsible for the installation of a mobile laboratory to ensure real-time diagnostics and support emergency actions. Staffing all ports and airports in the province of Ecuador lazer thermometer. The Government has also decided to ban hunting in the perimeter where are recorded cases of Ebola.
Active case finding and monitoring, secure confirmed cases of unexplained deaths and funerals, the isolation of confirmed cases, the provision of essential drugs, nothing is overlooked by the Government Matata holding with the President of the Republic. The DRC also remains open to any assistance in order to stop this scourge, which the WHO had declared "global priority" under registered in the countries of western Africa consequences.
An Information Point will be open from Monday, August 25, 2014 that the Ministry of Health to address all concerns about the virus. A hotline will also be communicated in the coming hours for any need of information.
"Ebola is neither nor Mbandaka to Kinshasa. The outbreak is confined to Djera and the Government has taken all measures to contain and limit the disease in this part of the Republic, "said the Minister of Health when he read the Declaration on the antennae of the Congolese National Radio and Television (TRNC).
The Future  https://translate.googleusercontent.com/translate_c?depth=1&hl=en&ie=UTF8&prev=_t&rurl=translate.google.com&sl=auto&tl=en&u=http://www.groupelavenir.org/spip.php%3Farticle1478&usg=ALkJrhheFBG1j8H8GYraBQSEPGBm8rrURg

Uganda has heightened its surveillance along the border with the Democratic Republic of Congo (DRC) after an Ebola outbreak was Sunday declared in the Central African country.
The Director General of Health Services, Dr. Jane Ruth Aceng, said so far, 13 people have died of the highly contagious Viral Hemorrhagic Fever in the DRC.
The new outbreak follows another one that is currently ravaging West African countries and has so far killed 1,427 people.
Ministry of Health in its routine National Taskforce meeting today developed new strategies to control the Ebola spread into Uganda.
“It is important to note however that confirmed cases of Ebola in DRC are reported in an isolated remote area in north western region of the country which is over 1,870 kilometres from the Uganda border,” said Dr Aceng.
http://chimpreports.com/?p=3765

$430 million needed to contain Ebola outbreak

http://thehill.com/policy/healthcare/215870-430-million-needed-to-contain-ebola-outbreak#.U_tOZNNmksA.twitter

By Ferdous Al-Faruque - 08/25/14 10:49 AM EDT

The World Health Organization says it needs more than $430 million to bring the deadly Ebola outbreak in West Africa under control.
The price tag is included in a draft document prepared by the WHO that lays out their plans for stopping the outbreak within six to nine months.

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The document, obtained by Bloomberg News, requires investment from governments, development banks and private donations. Half of the $430 million would be used to create patient referral centers, and to treat and isolate patients with Ebola.The Ebola outbreak in West Africa has killed more than 1,400 people in Sierra Leone, Liberia, Guinea and Nigeria. On Sunday, the Congo became the latest country to declare an outbreak of the disease, and its government confirmed at least 13 people have died.
Governments around the world are already scrambling to develop treatments for the disease, which has no known cure or vaccine.
While the National Institutes of Health has been ramping up efforts to develop treatments, the Centers for Disease Control and Prevention has sent dozens of specialists to the region to help local health officials bring the outbreak under control.