EBOLA: The 2014 Outbreak
EBOLA: “It’s even worse than I’d feared.” Taken from Jacque Wilson's article on CNN published on August 27, 2014
“It’s even worse than I’d feared,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said Wednesday of the Ebola outbreak rampaging through West Africa. “Every day this outbreak goes on, it increases the risk for another export to another country. “The sooner the world comes together to help Liberia and West Africans, the safer we will all be.” Frieden spoke to CNN’s Nima Elbagir in Monrovia, Liberia, where fear and anger over the largest Ebola outbreak on record has grown as health officials put up quarantines around some of the capital city’s poorest areas.
Dec. 18, 2013 Emile, a 2-year-old boy in Guinean village of Meliandou, dies of a mysterious sickness, becoming West Africa’s first Ebola victim.
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EBOLA VIRUS:
9
Things To Know About The Killer Disease
An article originally posted by CNN on August 25, 2014 Written by: Susannah Cullinane and Masison Park
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Why does Ebola generate such fear?
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What is Ebola?
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What are Ebola’s symptoms?
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How is it treated?
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What drugs exist to combat the disease?
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How does Ebola virus spread?
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C an plane passengers become infected?
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W hat should flight crew do if Ebola infection is suspected?
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How many cases have there been?
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Why
1.
Does Ebola Generate Such Fear?
1. M edecins Sans Frontieres (MSF) describes Ebola as “one of the world’s most deadly diseases.” 2. “ It is a highly infectious virus that can kill up to 90% of the people who catch it, causing terror among infected communities,” it says. 3. There is also no vaccination against it. 4. O f Ebola’s five subtypes, the Zaire strain—the first to be identified—is considered the most deadly.The WHO said preliminary tests on the Ebola virus in Guinea in March suggested that the outbreak there was this strain, though that has not been confirmed. 9
Is Ebola?
What
2.
The Ebola virus causes viral hemorrhagic fever, which according to the U.S. Centers for Disease Control and Prevention (C.D.C.), refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding. The virus is named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first outbreaks occurred in 1976. The same year there was another outbreak in Sudan. The W.H.O. says there are five different strains of the virus—named after the areas they originated in. Three of these have been associated with large outbreaks of hemorrhagic fever in Africa. These are the Bundibugyo—an area of Uganda where the virus was discovered in 2007—Sudan and Zaire sub-types. There has been a solitary case of Ivory Coast Ebola. This subtype was discovered when a researcher studying wild chimpanzees became ill in 1994 after an autopsy on one of the animals. The researcher recovered. Finally, Reston Ebola is named after Reston in the U.S. state of Virginia, where this fifth strain of the Ebola virus was identified in monkeys imported from the Philippines. The CDC says while humans have been infected with Ebola Reston, there have been no cases of human illness or death from this sub-type.
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Symptoms
3. What Are Ebola’s
Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection. The WHO says these nonspecific early symptoms can be mistaken for signs of diseases such as malaria, typhoid fever, meningitis or even the plague. MSF says some patients may also develop a rash, red eyes, hiccups, chest pains and difficulty breathing and swallowing. The early symptoms progress to vomiting, diarrhea, impaired kidney and liver function and sometimes internal and external bleeding. Ebola can only be definitively confirmed by five different laboratory tests.
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How
4.
Is It Treated?
There are no specific treatments for Ebola. MSF says patients are isolated and then supported by health care workers. “This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections,” it says. There have been cases of health care workers contracting the virus from patients, and the WHO has issued guidance for dealing with confirmed or suspected cases of the virus. Caregivers are advised to wear impermeable gowns and gloves and to wear facial protection such as goggles or a medical mask to prevent splashes to the nose, mouth and eyes. MSF says it contained a 2012 outbreak in Uganda by placing a control area around its treatment center. An outbreak is considered over once 42 days—double the incubation period of the disease—have passed without any new cases.
March 23, 2014
March 30, 2014
The World Health Organization publishes notification of a “rapidly evolving” Ebola outbreak in Guinea involving 49 patients and 29 deaths. Suspected cases in Sierra Leone and Liberia are being investigated.
The WHO reports that two Liberians tested positive for the Ebola virus after traveling to Guinea, including a 35-year-old woman who died March 21.
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5.
Drugs
What
Exist To Combat The Disease?
Two American missionary workers infected with Ebola were given an experimental drug called ZMapp, which seems to have saved their lives. The drug, developed by a San Diego firm, had never been tried before on humans, but it showed promise in small experiments on monkeys. But rolling out an untested drug during a massive outbreak would also be very difficult, according to MSF. Experimental drugs are typically not massproduced, and tracking the success of such a drug if used would require extra medical staff where resources are already scarce. ZMapp’s maker says it has very few doses ready for patient use. There are other experimental drugs. Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information. At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced that a safety trial of another Ebola vaccine will start as early as September. And in March, the U.S. National Institutes of Health awarded a five-year, $28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola. “A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why,� a news release about the grant said.
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How
6.
Does Ebola Virus Spread?
The WHO says it is believed that fruit bats may be the natural host of the Ebola virus in Africa, passing on the virus to other animals. Humans contract Ebola through contact with the bodily fluids of infected animals or the bodily fluids of infected humans. MSF says that while the virus is believed to be able to survive for some days in liquid outside an infected organism, chlorine disinfection, heat, direct sunlight, soaps and detergents can kill it. MSF epidemiologist Kamiliny Kalahne said outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water. “People who become sick with it almost always know how they got sick: because they looked after someone in their family who was very sick—who had diarrhea, vomiting and bleeding—or because they were health staff who had a lot of contact with a sick patient,” she said.
May 10, 2014 Dozens of mourners attend the funeral of a traditional healer who contracted Ebola while treating patients. The funeral, in Koindu, Sierra Leone, helps the virus spread and may be linked to 365 Ebola deaths, local health authorities say.
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Can Plane Passengers Become
Infected?
7.
While the CDC acknowledges it’s possible a person infected with Ebola in West Africa could get on a plane and arrive in another country, the chances of the virus spreading during the journey are low. “It’s very unlikely that they would be able to spread the disease to fellow passengers,” said Stephen Monroe, deputy director of CDC’s National Center for Emerging Zoonotic and Infectious Diseases. “The Ebola virus spreads through direct contact with the blood, secretions, or other body fluids of ill people, and indirect contact—for example with needles and other things that may be contaminated with these fluids.” He added that most people who have become infected with Ebola lived with or cared for an ill patient. “This is not an airborne transmission,” said Dr. Marty Cetron, director of CDC’s Division of Global Migration and Quarantine. “There needs to be direct contact frequently with body fluids or blood.” Travelers should take precautions by avoiding areas experiencing outbreaks and avoid contact with Ebola patients. “It is highly unlikely that someone suffering such symptoms would feel well enough to travel,” IATA said in a statement. “In the rare event that a person infected with the Ebola virus was unknowingly transported by air, WHO advises that the risks to other passengers are low. Nonetheless, WHO does advise public health authorities to carry out contact tracing in such instances.” This means determining who had contact with the affected person.
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What Should Flight Crew Do If Ebola Infection Is
Suspected?
8.
The CDC has issued guidance for airline crews on Ebola virus infections. “As with many other global infectious disease outbreaks, airline carriers, crew members, airports can be very important partners in that front line,” said Cetron. “Being educated, knowing the symptoms, recognizing what to do, having a response protocol, knowing who to call, those are really, really important parts of the global containment strategy to deal with threats like this.” The CDC advises that when flight crew members encounter a passenger with symptoms that they suspect could be Ebola, such as fever and bleeding, that they keep the sick person away from other passengers. They’ve been instructed to wear disposable gloves and to provide the sickened person with a surgical mask to prevent fluids from spreading through talking, sneezing or coughing. The airline cleaning crew are also instructed to wear disposable gloves, wipe down surfaces including armrests, seat backs, trays and light switches. The CDC says that packages and cargo should not pose a risk, unless the items have been soiled with blood or bodily fluids. When someone becomes ill on a flight, the captain is required by aviation regulations to report the suspected case to air traffic control,according to IATA.
Mid June An international research team sequences the genome of the Zaire strain of the Ebola virus. Researchers around the world begin studying it for clues about how to treat patients or develop drugs.
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June 23, 2014 Doctors Without Borders says the epidemic is “out of control.� The group says it has reached the limit of what it can do to fight the outbreak.
June 24, 2014 The U.S. Centers for Disease Control and Prevention reports that the outbreak appeared to be running out of steam in Liberia and Guinea in late April, only to resurge in late May and spread to Sierra Leone.
Cases
9.
How Many
Have There Been?
The CDC estimates there have been more than 3,000 cases of Ebola and more than 2,000 deaths since 1976. The last recorded outbreaks before the current one in Guinea were in 2012—in Uganda and Democratic Republic of Congo. The Uganda outbreak involved a total of 24 probable and confirmed cases, and 17 deaths, according to the WHO, which declared it had ended in October 2012. MSF said the Uganda outbreak had been the Sudan strain, while the virus found in DRC was the Bundibugyo sub-type. Before 2014, the most deadly outbreak was the 1976 outbreak in then Zaire, when 280 of 318 infected people died, according to the CDC. In 2000, there were 425 cases of Ebola Sudan in Uganda, which resulted in 224 fatalities.
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Inside the Ebola outbreak with the An Article originally posted by CNN on August 13, 2014 Written by: David Daigle
July 20, 2014 Liberian American Patrick Sawyer ignores the advice of medical officials and flies from Monrovia to Lagos, spreading Ebola to Nigeria. He dies five days later, and the virus goes on to sicken 19 and kill eight, the WHO says.
August 1, 2014 Reviving a practice common during the medieval Black Death, the leaders of Guinea, Liberia and Sierra Leone announce plans to set up a cordon sanitaire. Troops are deployed to seal off the area where the three countries meet, a region that accounts for about 70% of the Ebola cases so far.
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Inside the Ebola outbreak with the CDC
person to die of Ebola here was an American named Patrick Sawyer, who arrived from Liberia. Now WHO suspects Nigeria has had 12 cases and three deaths. Our team in Lagos is a small part of the CDC’s effort to fight Ebola, with work going on in several African countries, and back in the United States at our headquarters in Atlanta. There, the CDC’s Emergency Operations Center has activated its highest level to main-
There are nine of us from the Centers of Disease Control and Prevention in Lagos, Nigeria. We arrived from different U.S.
agency’s efforts. We are five hours ahead of Atlanta, a fact my family has yet to grasp as I
states, or from the CDC’s polio team
receive texts during odd hours asking,
already in Nigeria, and possess varying
“What’s Lagos like?” and “What are
skill sets, including infection control,
you doing?”
global migration and quarantine,
Good questions.
data management, epidemiology and
A typical day for our team begins at
communications. We’re here to work with colleagues Aid workers from the Liberian Medical Renaissance League stage an Ebola awareness event October 15 in Monrovia, Liberia. The group performs street dramas throughout Monrovia to educate the public on Ebola symptoms and how to handle people who are infected with the virus.
tain 24/7 operations to coordinate the
a hotel—one big advantage of an urban outbreak. After breakfast we move to
and partners from Nigeria’s Ministry
one of several locations, including the
of Health, UNICEF, Doctors Without
hospital, U.S. Consulate or a training
Borders and the World Health Organiza-
site, depending on the work to be done
tion to stop the largest Ebola outbreak
that day.
in history—the first in a densely populated, urban environment. Nigeria is the latest country to become affected by the outbreak. The first
Health workers transport the body of a person suspected to have died of Ebola in Port Loko, Sierra Leone, on Tuesday, October 21. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 4,500 people have died there, according to the World Health Organization.
Team Lagos is working as part of a much larger team in Nigeria to find and isolate all possible patients, tracking down everyone who could have been
August 2, 2014
August 5, 2014
August 12, 2014
Dr. Kent Brantly, a 33-year-old American who contracted Ebola while working in Liberia, is taken to Emory University Hospital in Atlanta. He becomes the first patient with Ebola to be treated on U.S. soil.
Nancy Writebol, a 59-year-old American missionary who contracted the virus while working in Liberia, arrives at Emory University Hospital. Both Writebol and Brantly make full recoveries after being treated with the experimental drug ZMapp, though it is unclear whether the drug was helpful.
A WHO panel sanctions the use of experimental drugs to fight the epidemic, though supplies are extremely limited.
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exposed to Ebola, and educating the
accurate information to the public and
public about the risks.
health care workers. Health care work-
A great deal has been accomplished
lines of this battle; WHO says 10% of the
operations center is up and running
deaths during this epidemic have been
now, and we are about to move Ebola
health care workers.
patients into a newly, remodeled treatHickox sent CNN this image of the tent where she was initially being isolated for Ebola monitoring Sunday, October 26, in New Jersey. Hospital officials told CNN the indoor tent was in a climate-controlled extendedcare facility adjacent to a hospital.
ers are critical as they are on the front
in a short time. A Nigerian emergency
ment facility. There are 60 folks on the contact
Our infection control experts have been training workers on proper infection control and teaching them how
tracing team, which has been tracking
to don Personal Protective Equipment
more than 200 people thought to have
properly, a critical task given this virus.
come in contact with the virus. These
I was taking pictures of this train-
teams visit the contacts daily to take
ing near the Ebola ward when one of
their temperatures and check to see if
the trainers came out of the “hot zone”
they have developed any symptoms. On
and asked if anybody had a paperback
Tuesday, 147 of the 152 contacts were
to give one of the patients. I donated
visited and assessed. When difficulties
a weathered copy of Shakespeare’s
arise locating contacts, additional teams
“Henry the IV, Part 1.” (I always carry a
are employed and efforts ramped up to
book on deployments). So the Bard has
conduct the tracing.
entered the Ebola ward in Lagos.
The Ebola response team in Nige-
A newspaper headline shows the
ria recently saw 30 people finish the
dangers of false information being
21-day risk period—the longest time
spread in Nigeria about Ebola treat-
period during which Ebola symptoms
ments.
have been known to be present. These
One interesting aspect of this out-
30 people were able to leave the contact
break has been the rumors and misin-
tracing list, which is a hopeful sign.
formation spurred by Ebola. Last week,
There is a great deal of fear in Lagos
Garteh Korkoryah, center, is comforted during a memorial service for her son, Thomas Eric Duncan, on Saturday, October 18, in Salisbury, North Carolina. Duncan, a 42-year-old Liberian citizen, died October 8 in a Dallas hospital. He was in the country to visit his son and his son’s mother, and he was the first person in the United States to be diagnosed with Ebola.
communicators were working quickly
as many worry about a virus of which
to respond to a rumor that bathing in
they know precious little. CDC com-
or drinking salt water would prevent
municators like myself work to provide
Ebola. I have seen local press coverage
August 20, 2014
August 28, 2014
A 21-year-old man who was being monitored by health authorities in Guinea flees to Dakar in neighboring Senegal, becoming that country’s first and only Ebola case. He is released from a hospital Sept. 19.
The WHO warns that the Ebola outbreak is accelerating and could infect more than 20,000 people before it is brought under control. The National Institute of Allergy and Infectious Diseases says it will begin human tests of a vaccine developed by the U.S. military and GlaxoSmithKline.
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that notes two people may have died from attempting this treatment. As I write this, we are in a
The work is long, hard, challenging but worthwhile. The CDC team in Lagos is amazing, one of the best I have been
temporary emergency operations center
on. And the larger response team that
at a psychiatric hospital, waiting for
includes all our partners and our col-
remodeling to be complete on our own
leagues from Nigeria is doing important
center. We made the change with some
work to break the Ebola infection cycle.
grumbling but did not miss a beat— Health workers bury the body of a woman who is suspected of having died of the Ebola virus on the outskirts of Monrovia, Liberia, on Monday, October 20.
flexibility is essential in an evolving outbreak situation. Our work is made more difficult by traffic in the city, a lack of Internet connectivity and security, which is a concern. We typically make it back to the 41
hotel late, anywhere between 9 and 11 p.m. local time and try to eat together. Team members who gather are tired, and the outbreak dominates the conversation. But we also try to distract ourselves: On my third night, a team member asked, “Has anyone else noticed that the background music is all Celine Dione?� It was true. Turns out she has quite a few songs, and I am pretty sure we have heard them all. I am not afraid of catching the Ebola virus. I know how Ebola is transmitted and will not put myself in jeopardy, thinking of my wife and four children at home.
September 2, 2014
September 5, 2014
The National Institutes of Health unveils plan to speed development and regulatory approval of ZMapp.
The WHO endorses the use of blood transfusions from recovered patients to boost antibodies for the sick.
September 9, 2014 Another patient with Ebola is admitted to Emory University Hospital. No details are released, but on Oct. 15 the patient says in a statement that he or she is recovering and anticipates being released soon.
Ebola Panic
ENCOURAGED 43
By Social Media An article originally posted in Rutgers University's Daily Targum Written by: Sergio Rojas on October 13, 2014
September 16, 2014 A team dispatched by the Guinean government to educate people about Ebola is attacked with clubs and stones in the village of Womme. Eight officials and journalists are killed.
September 24, 2014 U.N. Secretary-General Ban Ki-moon calls for a “twentyfold surge in care, tracking, transport and equipment� to curb the epidemic, which is doubling in size about every three weeks.
Teresa Romero Ramos tests positive for Ebola in Spain, becoming the first person known to have contracted the virus outside West Africa in the current outbreak. The nursing assistant had treated two infected missionaries.
October 6, 2014
reached New Jersey — despite the fact that the New Jersey State Health Department has done an adequate job in quarantining an NBC news crew that recently returned from Liberia.
assigned part of the blame on the media for hyping up these fears, which it certainly is doing. I believe mainly young people in their late teens and college years further perpetuate this atmosphere of fear on
in the editorial “We Got 99 Problems, Ebola Ain’t One,” the chances of an Ebola outbreak in the U.S. are slim to none due to our country’s health care and disease prevention infrastructures. This is the general consensus of American professionals in health and medicine, with the Center for Disease Control calling the likelihood of
are only concerned with the health of whites and are leaving the black population to their own devices. Posts like these — which are re-Tweeted, shared and re-shared countless times — only distort reality of the situation in America and obscure and ignore the actual crisis in Western Africa.
these posts are meant to be humorous, some are intended to be serious, and others lay in an uncertain middle ground. Aside from posts shared from official health organizations and governmental agencies, it seems almost nothing on social media in regards to Ebola does anything to a.) Calm the growing panic of the fear of an Ebola outbreak in the
conspiracy theory that misinforms and distorts the views of many young social media users. “Proof that Ebola is airborne” and “I heard the Ebola vaccine only works on white people” are some examples. The first statement is plainly false, but to the impressionable this leads to the belief that breathing “contaminated
find more posts that stoke the flames of some sort of
recent outbreak of the D68 strain of the enterovirus — it has already killed one boy in Mercer County, and there are confirmed cases in children in our very own Middlesex County.
true, it could be in Jersey for all we know,” is just part of
true, it should not be an excuse. Do not re-post, share or write insensitive or sensationalist things about Ebola on the Internet. It is perpetuating irrational fear among youth and spreading
While this is unfortunately
or cure has been found yet)
should pay attention to the
Rutgers students in particular
the clutter. subject imaginable, right?
Ebola can be helpful as well. all day, every day on every vaccine (no effective vaccine
falsehoods and break through creators of the supposed
should use this tool to dispel on health risks that are not and posted on social media
African populations. Focusing opinions are already shared that divide, suggesting the
sible members of society, we
the grave risk it has for West the second Tweet furthers
interactively. But as respon-
why. Raise awareness about So what’s the big deal? Offensive and uninformed
already exist in this country,
ions instantaneously and
Ebola poses in the U.S. and tion. While racial tensions
nicate knowledge and opin-
statistics about the low risk
is a powerful tool to commu-
spread the truth. Share actual air” can lead to contamina-
As we all know, social media
your voice on social media to
misinformation. Instead, use
term “Ebola” on Twitter to
“Not everything you hear is
One need only search the
fact an Ebola outbreak has
last week’s Targum editorial
section of this paper last week
references to Ebola. Some of
social media.
governments are hiding the
spiratorial tone, suggesting
spite so many assurances, is
the U.S. and possibly state
language has a kind of con-
a “minute risk.” Why then, de-
the U.S. so prevalent? Again,
going on in West Africa.
dia news feeds, you can see
feed regarding Ebola. This
CEO of Project HOPE, calling it
the fear of Ebola spreading in
astating pandemic currently
outbreak. All over social me-
came up on my Instagram
Dr. John Howe, president and
As expressed in the opinions
to the very real and very dev-
regarding the current Ebola
ridiculous statements and
awareness and a call to action
tivity abound on social media
a long warning of a post that
an outbreak “very low” and
original and shared posts with
United States or b.) Help raise
Both ignorance and insensi-
By Sergio Rojas | 10/13/14
Ebola panic encouraged by social media
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2020
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