Tuesday, October 7, 2014

All These Countries Are One Flight Away From Ebola Pandemic

Many people are asking why flights from known Ebola affected countries are not banned. As you will see below many countries have taken it upon themselves to do just that. Please note the calender below of current Ebola Affected areas during the month of October and their relationship to the flight map I have included above. 

Flights out of major airports in the affected countries arrive in 39 airports in 35 other countries. There are seven in Europe, in the UK, Belgium, Germany, France, Spain and the Netherlands; four in the Middle East; and three in the US (Houston, Atlanta and New York).

So far, the World Health Organization hasn’t endorsed any travel restrictions. “We would have to consider any travel recommendations very carefully, but the best way to stop this outbreak is to put the necessary measures in place at the source of infection,” Gregory Hartl, a WHO spokesperson, told CBC. Closing borders “might help, but it won’t be exhaustive or foolproof,” he said.]

Legitimate public health concerns remain. Aside from coming into contact with open cuts, Ebola likely enters a person’s body through mucus membranes, such as the surface of the eye or by clinging to cells in their throat. Because the virus is bloodborne—it grows only in an animal’s bloodstream—it’s not as easily transmitted as something like, say, the flu. Still, it can survive in liquid or dried materials for a number of days outside a human host. 

It also is an STD of sorts, having been found in semen 61 days after its onset, with transmission occurring seven weeks after the patient recovered. Otherwise, the incubation period—meaning, between exposure and when a person begins to show symptoms—is between two and 21 days.

Below is a calender of case by case Ebola affected countries as reported by International SOS.

Imported cases
Many locations are testing people who have traveled to Ebola-affected countries and returned with a fever and other symptoms. Senegal and the United States have confirmed imported cases of Ebola. International SOS is monitoring these closely. Click here for more details.

7 October

A new training program has been launched for the healthcare workers on Ebola patient care at Monrovia. At least six survivors will play a very important role in this training and share their experiences of Ebola infection. It is an initiative by World Health Organization (WHO) and Ministry of Health and a mock Ebola treatment unit has been constructed for the two-week long course. Over 400 health workers in batches of fifty will be attending the sessions. On successful completion the trainees will be eligible for employment in Ebola treatment centres across the country.

In the latest situation report, the Ministry of Health has confirmed additional cases and deaths.

Spain: Media sources have reported that a second healthcare worker has been isolated at a hospital in Madrid. Test results for Ebola and further details are awaited. Read more...

WHO: The World Health Organization has released a situation assessment regarding the mode of transmission of the Ebola virus. They refute claims that the virus spreads through air and the speculations that the virus may mutate into an airborne disease. The Ebola virus spreads thought direct physical contact with infected bodily fluids or contaminated surfaces and objects.

Uganda: A 30-year-old man died from Marburg haemorrhagic fever in Kampala on 28 September. Dozens of people are being monitored after having had contact with the man with several developing symptoms. It is unknown how the first case contracted the disease, investigations into this outbreak continue. Marburg virus belongs to the same family of viruses as Ebola virus and is also transmitted through contact with bodily fluids. Marburg disease has no vaccine or cure, and can cause similar symptoms to Ebola such as fever, headache, vomiting, diarrhoea and bleeding. Public health measures will be needed to prevent this outbreak spreading.

This outbreak is independent to the Ebola epidemic ongoing in West Africa.

Aid: Norway is extending support to control the Ebola outbreak in the affected countries in the form of funds, personnel and equipment.

US: Media sources are reporting that the Dallas patient is being treated with an experimental drug. An antiviral medication, bricidofovir is being used. The drug is manufactured by a North Carolina-based company, Chimerix. Officials are yet to confirm this news.

6 October

Spain: A nurse who cared for two Ebola patients evacuated from Liberia and Sierra Leone in August and September has been confirmed infected with the virus. This is the first know instance of a person being infected with Ebola outside Africa. Read more...

MSF: Another Medecins Sans Frontieres health worker has been infected with Ebola. The Norwegian doctor has been working in Bo, Sierra Leone, and developed a fever on 5 October. She will be evacuated to Oslo for treatment. Norway has designated the Oslo University Hospital as the country's Ebola treatment centre.  An investigation into how she was infected is underway.
United States: Media sources have reported that the American patient, a photojournalist infected with Ebola in Liberia, will be arriving in the country today and admitted to Nebraska Medical Centre.

In other news, media sources report that there are seven healthcare workers among the 10 close contacts of the Dallas case. Read more...

Sierra Leone: The Ministry of Health has reported new confirmed cases. Read more...

Liberia: US Navy mobile Ebola laboratories are operating at the Island clinic, Monrovia and in Bong County.
In other news, the Ministry of Information Culture Affairs and Tourism has introduced a new media access policy. Journalists must secure written permission if they want to take photographs or conduct interviews at Ebola healthcare facilities. According to the Minister, this policy protects the privacy of patients and healthcare workers and to protects the health and safety of both Liberians and international journalists. Read more...

Ethiopia: New sources are reporting that a 24-hour Ebola testing service has been launched at Bole International Airport, Addis Ababa, specifically to monitor and test passengers from 21 West African destinations.

5 October

Sierra Leone:
The Public Health Agency of Canada has deployed a second field laboratory and staff to join an existing PHAC team working in Kailahun, eastern Sierra Leone. The laboratories will contribute to efforts to rapidly diagnose Ebola. The team will monitor the effectiveness of measures designed to prevent infection in the local communities.

Treatment: The World Health Organization has issued a position paper on the use of convalescent blood or plasma in treating Ebola outbreaks. This interim guidance for national health authorities and blood transfusion services covers guidelines on selecting donors; screening and handling blood; transfusion processes and other topics. Read more...

 4 October

The Public Health Agency of Canada has clarified their position on donated vaccines. The Agency has confirmed that the 800-1000 vaccine doses are ready to be transported once "WHO requests that they be transferred or deployed." This shipment is dependent on safety and ethical considerations which are yet to be resolved by WHO and the global community.

Aid: The German government has delivered medical supplies to Liberia in the first mission involving the German Air Force. The NGO-led German Liberia clinic (GERLIB) has established a 48-bed isolation centre for Ebola cases in Paynesville, Monrovia.

US: The number of contacts under close monitoring in Dallas has been reduced from 100 to around 50, with 10 labelled as "high risk" contacts. CDC officials met a flight landing in Newark, New Jersey from Brussels, Belgium on 4 October following reports that a passenger from Liberia was ill on board. Read more...

France: The French nurse who was medically evacuated to France for treatment on 19 September has recovered and been discharged from hospital. The nurse was infected while working as a volunteer with MSF in Liberia. A health ministry statement confirmed the nurse received a number of new antiviral medications, including Avigan (favipiravir).

Germany: The doctor from Senegal who was evacuated to Hamburg has recovered and been discharged from hospital. The doctor had contracted Ebola whilst working for the World Health Organization in Sierra Leone.

Nigeria: The Federal Ministry of Health has finalised plans to carry out "Train the Trainer" sessions across all states as part of enhanced preparedness for Ebola. These sessions will be directed at both health workers and state health educators to ensure the response is coordinated and that health workers are appropriately knowledgeable and protected. Training has also been offered to health workers from Guinea, Sierra Leone and Liberia.

Europe: In an open letter to European governments published in The Lancet, over 40 signatories have called on government leaders to "mobilise all possible resources to assist West Africa." This includes the need to free up medical staff to volunteer, establish field laboratories and support the epidemiological surveillance. The authors also call for critical infrastructure to be built up, including telecommunications, clean water and fuel. They highlight the critical shortage of appropriate personal protective equipment (PPE) and urge local groups in West Africa to be empowered to bridge the gap between the international responders and the local communities.

Outlook: Two authors have called into question the apparently low case fatality rate in the current Ebola outbreak in West Africa. The report published in The Lancet states that the current values do not take into account the interval between confirming a case and knowing whether the case died or survived. They conclude, "The widely cited 2014 CFR of around 50% is therefore likely to be a substantial underestimate of the true value, and so the number could apparently rise over the course of the outbreak."

3 October

 The United Nations Mission for Ebola Emergency Response (UNMEER) has responded to recent media speculation that the Ebola virus could mutate or become airborne (PDF). The organisation states that there is no evidence that the Ebola virus is mutating to become airborne. UNMEER does not anticipate such a mutation and calls for Ebola response efforts to focus on the real needs in affected communities.

UNMEER has also released a statement (PDF) detailing the recent developments and international pledges of support following the "Defeating Ebola in Sierra Leone" conference held in London. The report also draws attention to the potential food crisis, given the impact Ebola has had on local and international trade in affected nations. Harvests are also threatened, further eroding food security in the region.

Liberia: A fifth American citizen working in West Africa is reported to have contracted Ebola. The 33-year-old man was working in Liberia as a freelance camera operator. He developed symptoms on 1 October and immediately isolated himself. Tests performed at an MSF treatment centre in Monrovia were reported to be positive on 2 October. It is unknown how he contracted the virus. The man will be medically evacuated back to the United States for treatment.

In other news, media sources have reported that, in the event the confirmed case in Dallas returns to Liberia, authorities there may prosecute him.  He may have made a false declaration on the screening questionnaire before departing Liberia, stating he had no contact with Ebola patients.

Yet it is believed that, before leaving Liberia for the US, he helped care for an infected pregnant woman in Monrovia who later died of the disease. It is not clear whether the man knew the woman died of Ebola.

United States: Health officials in Texas have legally ordered four close family members of the Dallas Ebola patient to stay home until at least 19 October. This is a precautionary measure. At this time, none of the family members have symptoms. The family have also been asked not to have any visitors without approval from the local or state health departments. The order will remain in place until after one 21-day incubation period passes. (The incubation period is the time between when someone is exposed to the Ebola virus and when they begin to have symptoms.)

Three healthcare workers who survived infection with Ebola have been interviewed. In the journal Science, the survivors recall their stringent precautions taken against Ebola and all wonder how they were infected. The call patients whose Ebola status is unknown a "hidden danger"; people who have symptoms but do not disclose them or patients who may withhold information about contacts.

Germany: A Ugandan doctor, who was working in Sierra Leone, has been medically evacuated to Frankfurt suffering from Ebola. The patient will be treated in isolation at the Frankfurt University hospital. He is the second Ebola case to be treated in Germany following medical evacuation from West Africa.

Sierra Leone: New cases have been reported.

WHO: In their latest Ebola Response Roadmap Update, 7,470 total cases and 3,431 deaths have been reported up to 1 October in Guinea, Liberia and Sierra Leone. Exposure of healthcare worker has resulted in more than 380 of them becoming infected and at least 216 have died since the start of the outbreak. Nigeria and Senegal have completed at least 30 days since the last confirmed case in both nations and all contacts have completed the 21-day monitoring period in isolation with no new cases. The WHO update also includes confirmation of the patient in Dallas, Texas which is detailed on the United States page.

2 October

United States:
The man who has Ebola in Texas first sought medical care on 25 September, several days before he was tested for Ebola and admitted to a hospital. He visited an emergency department on 25 September with abdominal pain and a low-grade fever. He reportedly told a nurse he had been in Liberia recently, but he was not screened for Ebola. His symptoms worsened and he returned to the hospital (via ambulance) on 28 September, when he was admitted into isolation and tested for Ebola.

Authorities will monitor around 100 people who may have had contact with this man, including ambulance staff and several school children. This is a conservative approach which casts a 'wide net' and includes people who are likely not at risk but will be screened anyway. None of them have any symptoms. Public health officials stated it was unnecessary to contact trace fellow passengers on this man's commercial flights since he felt well while travelling. Ebola is contagious only after the patient develops symptoms. Nevertheless, one airline has made an announcement about the flights they think he was on. Read more...

WHO: The World Health Organization organised an expert consultation on Ebola vaccines. More than 70 experts attended the meeting to assess the status of testing and to licensing two candidate Ebola vaccines. Experts from both affected and neighbouring countries in West Africa also attended the event. All participants agreed that the main immediate goal is"to have a fully tested and licensed product that can be scaled up for use in mass vaccination campaigns."

ECDC: The European Centre for Disease Control and Prevention has updated their Rapid Risk Assessment (RRA) for the Ebola outbreak in West Africa. A dramatic increase in trend in Guinea, Liberia and Sierra Leone in the coming months is indicated by projections published by different models. It further quoted "These projections should be regarded as indicative of possible trends and not as exact predictions.

Yet, all models point to a substantial increase in the number of cases if control efforts remain unchanged." The RRA also assesses the risk to Europe and outlines what European Union (EU) member states can do to reduce these risks. The RRA explores the risk of infection for EU residents who may visit affected countries, and the risk of spread following importation into Europe, either as a planned medical evacuation or following commercial flight of an infected traveller.

1 October

WHO: In their latest Roadmap Situation Report #6, the World Health Organization says there have been 7,178 cases and 3,338 deaths up to 28 September. The situation in Guinea appears stable, there has been a slight fall in the number of new cases reported, mainly due to a drop in the number of new cases reported from Macenta. Liberia has also reported a fall in cases, it is likely that this is due to delays matching laboratory results with clinical surveillance data. The situation in Sierra Leone continues to deteriorate, as case numbers continue to increase. Port Loko, Bombali and Moyamba districts have been quarantined after a surge in cases over the past four weeks.
In Guinea, Liberia and Sierra Leone, the WHO is monitoring response efforts in the following 5 domains:

  • Case management: Ebola treatment centres, referral, and infection prevention and control.
  • Case confirmation
  • Surveillance
  • Safe and dignified burials
  • Socialisation
Liberia: Media sources report that soldiers at the Edward Beyan Kesselley Barrack have been quarantined and the facility has been closed for 21 days. The step was initiated after at least seven soldiers from the Liberian army were infected with Ebola. The soldiers have been admitted to John F Kennedy Ebola Treatment Centre. It is reported that one of the soldier’s may have acquired the infection from his spouse, which then spread to his close contacts at the barrack.

Sierra Leone: Ministry of Health and Sanitation has reported more new cases. Read more...

Nigeria: All contacts have completed 21 days monitoring with no further cases identified. Read more...

The World Health Organization reported last week that more than 3,400 people have died from among a total of nearly 7,500 people infected with Ebola in West Africa, with casualties increasing rapidly.

Pestilence : CDC Director warns against restricting entry to the US over Ebola crisis (Oct 04, 2014)   

President Obama already has authority under the law to deny entry to diseased applicants from entering the U.S Yet he chooses not too. As 6000 people fly from Ebola ravaged West Africa to America each week, it seems inevitable that it’s just a matter of time before more people infected with Ebola make it to American cities.

The countries listed below have already taken measures to ban travel from the Ebola infected countries of West Africa. These countries are protecting their citizens from Ebola entering their country as Obama should be doing. It's not impossible. 

   Countries that have implemented Ebola-related travel restrictions:

  • Gambia has banned the entry of flights from Guinea, Liberia, Nigeria and Sierra Leone.
  • Gabon has banned the entry of flights and ships from countries affected by Ebola.
  • Senegal has banned flights from Guinea, Liberia and Sierra Leone.
  • Cameroon has banned flights to and from Nigeria.
  • Chad has suspended all flights from Nigeria.
  • Côte d'Ivoire has banned all passenger flights from Guinea, Liberia and Sierra Leone.
  • Nigeria has suspended flights to the country operated by Gambian national carrier Gambia Bird.
Details of airlines that have restricted flights to Ebola-affected countries:

  • Air France suspended flights to Sierra Leone from 28 August.
  • The Togo-based carrier Asky Airlines has suspended flights to and from Guinea, Liberia and Sierra Leone.
  • Arik Air (Nigeria),Gambia Bird and Kenya Airways have suspended services to Liberia and Sierra Leone.
  • British Airways has extended their suspension of flights to Liberia and Sierra Leone until 31 December.
  • Ceiba Intercontinental, the national airline of Equatorial Guinea, has reportedly suspended flights to West African countries. In addition, the airline has suspended flights to Cameroon's capital Douala from 1 September.
  • Emirates Airlines has suspended flights to Guinea.
  • Korean Air suspended flights to and from Kenya from 20 August.
  • Senegal Airlines has suspended flights to and from Conakry (Guinea) until further notice.
Other airlines have modified their routes but are still operating regular scheduled services. These include:

  • Royal Air Maroc
  • Brussels Airlines.
Medical screening
Entry and exit health screening is now in place in numerous countries in the region and elsewhere; related measures can include the partial closure of land borders, ports and river crossings in an effort to restrict cross-border travel. Members should allow additional time to pass through medical screening and not travel if they are sick. Staff should continue to monitor local media and this website for developments.
Travel Advice Summary
  • Defer non-essential travel to Guinea, Liberia and Sierra Leone.
  • Travelers flying from countries affected by Ebola should enquire with the relevant embassies or health ministries about any requirements conditioning entry at their destination, and prepare accordingly.
  • Reconfirm bookings on all regional routes as increased demand is likely. We do not hold information on specific flights.
  • Allow additional time during arrival and departure to pass through enhanced medical screening.
  • Do not travel if you are sick. Persons with fever or other Ebola-like symptoms may be taken to designated centres or have entry/exit denied.

On October 6, 2014, President Obama was briefed on the Ebola outbreak in the U.S. and abroad, and provided an update on the U.S. preparedness and response to the epidemic. Ebama claims he is doing everything he can. What does this sound like to you? 

Does President Obama's response make you feel safer? 

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