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Fighting Ebola, and the Mud

NEW YORK TIMES                         Oct. 21, 2014

Op-ed in Today's New York Times by Karen Huster, a nurse working in Liberia for Last Mile Health says that Liberia’s dysfunctional transportation system is standing in the way of fighting the Ebola epidemic and suggests some solutions
 

"Patients have died on grueling journeys to treatment units. Blood samples have sat waiting for days, eventually becoming invalid....

 "The best solution is removing the need to travel altogether by building more easily accessible treatment centers all over the country, where patients with confirmed or suspected cases of Ebola can be housed and treated. The United States military is building these structures, but it is taking time. Nimbler nongovernmental organizations must also step in. Save the Children has already done so and is also building smaller community care centers — sort of homes away from home, where families can continue to care for their sick loved ones safely removed from the community. A makeshift center with tents instead of permanent structures could be set up within a week.

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DHS requires West Africa travelers to arrive at five airports

USA TODAY                                                                                     Oct. 21, 2914By Bart Jansen

WASHINGTON — The Department of Homeland Security announced Tuesday that all travelers from Ebola outbreak countries in West Africa will be funneled through one of five U.S. airports with enhanced screening starting Wednesday.

                                                                       (Photo: Melissa Maraj, AP)

Customs and Border Protection within the department began enhanced screening — checking the traveler's temperature and asking about possible exposure to Ebola — at New York's John F. Kennedy International Airport on Oct. 11.

Enhanced screening for travelers from Liberia, Sierra Leone and Guinea was expanded Oct. 16 to Washington's Dulles, Chicago's O'Hare, New Jersey's Newark and Atlanta's Hartsfield-Jackson international airports.

Those airports were supposed to screen 94% of the average 150 people per day arriving from the three countries. But lawmakers from other states asked for enhanced screening at their airports, too.

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Special Report - A Primer on Ebola for Clinicians

journals.cambridge.org -  Eric Toner, Amesh Adalja and Thomas Inglesby. A Primer on Ebola for Clinicians.
Disaster Medicine and Public Health Preparedness, available on CJO2014. doi:10.1017/dmp.2014.115.

Abstract

The size of the world’s largest Ebola outbreak now ongoing in West Africa makes clear that further exportation of Ebola virus disease to other parts of the world will remain a real possibility for the indefinite future. Clinicians outside of West Africa, particularly those who work in emergency medicine, critical care, infectious diseases, and infection control, should be familiar with the fundamentals of Ebola virus disease, including its diagnosis, treatment, and control. In this article we provide basic information on the Ebola virus and its epidemiology and microbiology. We also describe previous outbreaks and draw comparisons to the current outbreak with a focus on the public health measures that have controlled past outbreaks. We review the pathophysiology and clinical features of the disease, highlighting diagnosis, treatment, and hospital infection control issues that are relevant to practicing clinicians. We reference official guidance and point out where important uncertainty or controversy exists. (Disaster Med Public Health Preparedness. 2014;0:1-5)

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Ebola Doctors at Breaking Point: 'This Constant Feeling That the Boat's Sinking'

      

A doctor outside the JFK Ebola treatment center speaks to journalists on Oct. 13, 2014 in Monrovia, Liberia.  Photographer: John Moore/Getty Images
 
bloomberg.com - by Makiko Kitamura and Naomi Kresge - October 20, 2014

At 3:30 a.m. in the world’s biggest Ebola treatment center, Daniel Lucey found the outbreak reduced to its essentials: patients lying on mattresses on the floor and vomiting in the dark, visible only by the wavering flashlight beam of a single volunteer doctor.

“I don’t see a light at the end of the tunnel,” said Lucey, a physician and professor from Georgetown University who is halfway through a five-week tour in Liberia with Medecins Sans Frontieres, the medical charity known in English as Doctors Without Borders. “The epidemic is still getting worse,” he said by phone between shifts.

(READ COMPLETE ARTICLE)

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Review of Human-to-Human Transmission of Ebola Virus

CDC                                                              Posted Oct. 20, 2014 from  CDC  Oct. 17 document

This document is a concise summary of published information on the current science about human-to-human transmission of Ebola virus. It is developed for use by healthcare personnel and public health professionals to use. It is a complement to the many guidance documents that CDC has issued already online at

www.cdc.gov/ebola.

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Liberia president describes heavy cost of Ebola

Liberia's president calls for more investment in health systems, news article, op-ed

ASSOCIATED PRESS                               Oct. 20, 2014

by Jonathan Paye-Layleh

Monrovia, Liberia — Liberian President Ellen Johnson Sirleaf said Ebola has killed more than 2,000 people in her country and has brought it to “a standstill,” noting that Liberia and two other badly hit countries were already weakened by years of war.

Appealing for more international help, Sirleaf described the devastating effects of Ebola in a “Letter to the World” that was broadcast Sunday by the BBC.   https://soundcloud.com/bbc-world-service/a-letter-to-the-world-on-ebola-from-liberian-president-ellen-johnson-sirleaf?ocid=socialflow_twitter

“Across West Africa, a generation of young people risk being lost to an economic catastrophe as harvests are missed, markets are shut and borders are closed,” the Nobel Peace Prize laureate said. “The virus has been able to spread so rapidly because of the insufficient strength of the emergency, medical and military services that remain under-resourced....”

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Nigeria Is Ebola-Free: Here’s What They Did Right

It's been 42 days since the last new case

TIME MAGAZINE                                                      OCT. 20, 2014

Alexandra Sifferlin

 The World Health Organization declared Nigeria free of Ebola on Monday, a containment victory in an outbreak that has stymied other countries’ response efforts....

 

A school official takes a pupil's temperature using an infrared digital laser thermometer in front of the school premises, at the resumption of private schools, in Lagos, Sept. 22, 2014. Akintunde Akinleye—Reuters

“It’s possible to control Ebola. It’s possible to defeat Ebola. We’ve seen it here in Nigeria,” Nigerian Minister of Health Onyebuchi Chukwu told TIME. “If any cases emerge in the future, it will be considered—by international standards—a separate outbreak. If that happens, Nigeria will be ready and able to confront it exactly as we have done with this outbreak.”

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The Bigger Picture: Ebola - Dr. Michael D. McDonald

RT – Thom Hartmann - The Bigger Picture: Ebola – October 17-18, 2014

Dr. Michael D. McDonald, Robert Walker and DeAnn McEwen – A Discussion on Ebola

To stop Ebola from spreading in West Africa, Dr. Michael D. McDonald, Executive Director of Health Initiatives Foundation Inc. and the Global Resilience System talks about the need to have community strategies where we set up Resilience Capacity Zones to reduce the transmission and the translocation of Ebola. He states we need to create behavioral and social immunity around Ebola-affected areas to reduce the transmission and translocation. We need to create Ebola-resistant, and Ebola-free zones in ring-like fashion.

CLICK HERE - The Bigger Picture: Ebola

http://www.youtube.com/watch?v=FZlUp_aVgxc

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Long Quest for Ebola Vaccine Slowed by Science, Ethics, Politics

An experimental Ebola vaccine has been developed by the U.S. National Institutes of Health and pharmaceutical company GlaxoSmithKline. Photograph by Steve Parsons, AP

Image: An experimental Ebola vaccine has been developed by the U.S. National Institutes of Health and pharmaceutical company GlaxoSmithKline. Photograph by Steve Parsons, AP

news.nationalgeographic.com - October 14th, 2014 - Karen Weintraub

Ebola vaccines are so effective in monkeys that macaques can be protected or rescued even if they're injected with a hundred times the lethal dose of the Ebola virus after vaccination. But no one knows for certain whether the vaccines will work in humans; the vaccines haven't yet been rigorously tested in people.

Just developing the vaccines to test in monkeys was a grueling, decades-long process that has killed scores of macaques since the 1990s.

(VIEW COMPLETE ARTICLE)

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NEJM - Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections

nejm.org - WHO Ebola Response Team

N Engl J Med 2014; 371:1481-1495 - October 16, 2014 - DOI: 10.1056/NEJMoa1411100

Conclusions

These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.

(SEE COMPLETE NEJM ARTICLE HERE)

NEJM - Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections (15 page .PDF file)

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