Patient Zero, a two-year-old boy dies a few days after falling ill in a village in Guéckédou, a village in southeastern Guinea that borders Sierra Leone and Liberia. A week later, the virus kils the boy’s mother, then his three-year-old sister, then his grandmother. All have symptoms of the virus, including fever, vomiting and diarrhea, but at the time, no one knew what had made them ill. Two mourners at the grandmother’s funeral take the virus home to their village. A health worker carries it to another village, where he dies, as does his doctor. They both infect relatives from other towns. WHO releases the chart of infection in August 2014.
Reuters reports that an outbreak of hemorrhagic fever has killed at least 23 people in Guinea’s southeastern forest region since February when the first case was reported. Sakoba Keita, the doctor in charge of the prevention of epidemics in Guinea’s Health Ministry says at least 35 cases have been recorded by local health officials:
Symptoms appear as diarrhea and vomiting, with a very high fever. Some cases showed relatively heavy bleeding. We thought it was Lassa fever or another form of cholera but this disease seems to strike like lightning. We are looking at all possibilities, including Ebola, because bushmeat is consumed in that region and Guinea is in the Ebola belt.
No cases of the highly contagious Ebola fever have ever been recorded in the country. Most of the victims had been in contact with the deceased or had handled the bodies.
A total of 75 Ebola cases and 41 deaths are reported. There are 49 cases and 29 deaths in Guinea, eight cases and six deaths in Liberia, 16 cases and five deaths in Sierra Leone, one death in Nigeria and one case in Senegal.
A total of 112 suspected Ebola cases and 71 deaths from the virus are reported in West Africa. Guinea’s Health Ministry confirms that the virus has killed 59 people, four of them health workers, and there are 86 cases including three suspected in the capital, Conakry.
An angry crowd attacks an Ebola treatment center in Macenta, around 425 km (265 miles) southeast of Guinea’s capital Conakry. The crowd accused staff of bringing the disease to the town. Medecins Sans Frontieres spokesman:
We have evacuated all our staff and closed the treatment center. We have the full support of the local leaders and we’re working with the authorities to try and resolve this problem as quickly as possible so we can start treating people again.
A total of 248 suspected cases and 148 deaths due to the virus are reported in West Africa. Guinea reports 197 clinical cases, including 122 deaths, with a growing amount in Conakry. Of 24 health workers infected, 13 have died. In Sierra Leone, 15 people are under surveillance but no confirmed cases are found. Tests are negative in several deaths in Mali feared to have been caused by the disease.
The outbreak appears to have stabilised. In Guinea, five of the six prefectures where the outbreak occurred have no reported any more cases for almost a month while in Liberia no new cases have been reported since April 9. No confirmed cases are reported in Sierra Leone.
Sierra Leone declares a 4-day lockdown from the 18th to the 21st of September 2014. This is in a bid to tackle the Ebola outbreak in the country. The aim of the move is to allow health care workers to isolate new cases and prevent the disease from spreading further. Health workers will be given vaccines in November, after safety checks have been completed.
WHO calls for “drastic action” to fight the deadliest Ebola breakout on record and is convening an 11-nation meeting to address the crisis. 635 cases of haemorrhagic fever (most confirmed to be Ebola), including 399 deaths, have been reported across Guinea, Liberia and Sierra Leone, making this the larges breakout ever reported. Doctors Without Borders (MSF) said that the deadly outbreak of the virus is “out of control”.
Khan develops symptoms that he believes are a common cold.
Khan contracts Ebola and is admitted to a Medecins Sans Frontieres treatment ward in Kailahun, Sierra Leone. Health Minister Miatta Kargbo:
[I will do] anything and everything in my power to ensure he survives.
Khan tells the BBC that he fears for his life as he treats Ebola patients:
Health workers are prone to the disease because we are the first port of call for those with the disease. Even with the full kit we put on we’re at risk. I’m afraid for my life, because I cherish my life. And if you are afraid then you must take the maximum precautions, stay vigilant and stay on your guard.
Brantly diagnoses himself with Ebola virus while working with Ebola patients in Liberia. Brantly has body aches, pains and fever but is in a stable condition, says Ken Isaacs of North Carolina Samaritan’s Purse:
[The doctor] is not out of the woods yet, but we remain optimistic that he will survive.
The disease has killed at least 672 people in four West African countries since the outbreak began earlier this year in Guinea and spread to Liberia and Sierra Leone.
Liberian president, Ellen Johnson Sirleaf, closes most of the country’s borders. Ebola testing centers have been opened in the few points of entry that still remain. Public gatherings and hotels have been also ordered to play a 5-minute video on Ebola safety. Sirleaf:
No doubt the Ebola virus is a national health problem. It attacks our way of life, with serious economic and social consequences. As such we are compelled to bring the totality of our national resolve to fight this scourge.
Khan dies after contracting Ebola. Chief medical officer Dr Brima Kargbo:
It is a big and irreparable loss to Sierra Leone as he was the only specialist the country had in viral haemorrhagic fevers.
Doctors without Borders:
His work and dedication have been greatly appreciated by the medical community in Sierra Leone for many years. He will be remembered and missed by many, especially by the doctors and nurses that worked with him. MSF’s sincere thoughts and condolences are with Dr. Khan’s family, friends and colleagues.
King’s Sierra Leone Partnership program director Dr Oliver Johnson of Connaught Hospital Freetown says Khan’s death is a national tragedy:
Dr Khan was widely known and respected for a long career and in leading the fight against Lassa fever. He’d become a real figurehead for the Ebola response so there’s a sense of deep sadness in what’s a very small community here in Freetown.
Dr Khan was friends with many of the senior doctors and nurses at Connaught Hospital, and was well known as a teacher for the medical students who were very sad yesterday, as well as the general public.
When the news first broke that he was sick, I think it added to fears amongst the many doctors and nurses about treating Ebola patients. People thought, if even Dr Khan can get sick, then any of us can get sick.
The U.S. government will begin human testing on a Ebola vaccine as early as September, after seeing positive results from tests on primates, according to CNN and USA Today. The National Institutes of Health’s infectious disease unit is working with the U.S. Food and Drug Administration to put the vaccine into trial as quickly as possible.
At a meeting in Guinea’s capital Conakry,WHO director-general Margaret Chan tells the presidents of Guinea, Liberia, Sierra Leone and Ivory Coast that the virus could be stopped, but cultural practices such as traditional burials were a significant cause of its spread. She also says that governments may need to restrict population movements and public gatherings, and use the police and civil defence forces to guarantee the security of response teams. She also says more than 60 medical workers have died, hampering efforts to tackle the disease.
This outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives, severe socioeconomic disruption and a high risk of spread to other countries.
Brantly and Writebol, a missionary, will fly back to US, as the Ebola outbreak is spreading too quickly. They will be flown on a jet which fitted with a tent designed for transporting patients with highly infectious diseases.
Brantly, one of the American victims of the Ebola Virus, is now receiving treatment at Grady Memorial Hospital in Atlanta. Brantly is the first ever patient to receive treatment for Ebola in the United States. Every precaution being taken in the care of the doctor who remains in isolation. His wife, Amber:
It was a relief to welcome Kent home today. I spoke with him, and he is glad to be back in the U.S. I am thankful to God for his safe transport and for giving him the strength to walk into the hospital.
Brantly receives a blood donation from a 14-year-old Ebola survivor in Liberia while awaiting ZMapp, the first person in the current Ebola outbreak to receive the treatment.
Brantly and Writebol are given ZMapp at the hospital in Liberia where they are being treated. After special permission is granted for the use of the untested medicine, the serum is sent from the U.S. stored at subzero temperatures, and must be allowed to thaw naturally for eight to 10 hours. They agree that Writebol will be given the first dose as Brantly is younger and expects to have a better chance of survival. However his condition worsens and he is intravenously administered Writebol’s thawed dose, after telling doctors that he thinks he is dying. Within an hour, his breathing eases and the red rash over his torso fades. Writebol is then given the medicine and requires a second dose, but also recovers.
The Ebola crisis in Liberia worsens after the evacuation of some international medics from Liberia following the infection of two US health workers with the Ebola virus. The overcrowded and understaffed Elwa hospital in the capital, Monrovia, where Kent Brantly and Nancy Writebol worked, has been forced to turn away some Ebola cases.
Health officials say local superstitions are turning away patients from seeking medical care, worsening the outbreak. In Liberia’s Lofa county, health workers trying to screen two communities were chased away with knives and cutlasses, while in other communities Ebola is seen as a ‘curse’ for things like sexual promiscuity. A Red Cross volunteer says some patients favour traditional remedies such as bathing in salt water at midnight. UNICEF Ebola coordinator Fabio Friscia:
What is actually creating the greatest problem is the behavior of the population … It is absolutely something we could expect. The population is being attacked by an absolutely new disease no one [in western Africa] has ever seen before.
The CDC is planning, over the next month, to send 50 epidemiologists, experts of health communication and other service personnel to Sierra Leone and Guinea, which are the hardest hit countries, amid increasing fears of the spread of the deadly Ebola virus to other countries. Dr. Tom Friednen, CDC director:
These individuals will help countries establish emergency operations centers that can develop a structured and effective way of addressing the outbreak.
Researchers consider using blood transfusions from Ebola survivors to pass antibodies into infected people, as no vaccines or drugs are approved yet. Dr. Peter Piot, director of London’s School of Hygiene and Tropical Medicine and co-discoverer of the virus:
This is something that’s fairly simple to do
WHO’s network of international blood regulators says there are thousands of survivors from past Ebola outbreaks in Africa. It says it has identified several patients as possible donors and the first batch of blood from survivors could be available later in the year, but adds:
[The] logistics of blood collection are an issue
Blood from donors must also be screened for other illnesses such as HIV and malaria before it can be used.
The CDC is now concerned about the risk of Ebola spreading beyond Guinea, Nigeria, Sierra Leone and Liberia. Dr. Skinner, an infectious disease specialist from the organization, says that travelers could unknowingly transfer the deadly virus beyond more international borders. Dr. Rob Dretler, CDC:
We know what to do and can completely isolate them but someone coming home who doesn’t know they are sick and is here a few days and gets sick, that’s the risk.
Both US patients appear to be responding well to experimental drugs provided by San Diego-based Mapp Biopharmaceutical. The Company is manufacturing more of the drug, while conducting clinical trials. Larry Zeitlin, the president of Mapp:
It’s absolutely overwhelming. We are discussing with the F.D.A. the right path to make the drug available to people as quickly and safely as possible.
Major decisions on how and where the drug will go are being discussed. Dr. Whaley:
We definitely would like to ramp up to have an impact on the Ebola epidemic. We’re not decision makers on many of these issues. There are regulatory and legal issues that have to be addressed.
The World Bank pledges $200m in emergency aid to Liberia, Guinea and Sierra-Leone, in a bid to counter further spread of the deadly virus. Jim Yong Kim, the president of the World Bank, says that he is ” deeply saddened” by the progress of the epidemic thus far. The funds will be used to undertake numerous relief activities including providing medical supplies, paying staff and driving a campaign that will contain the epidemic.Yong Kim:
I have been monitoring (Ebola’s) deadly impact around the clock and I’m deeply saddened at how it has ravaged health workers, families and communities, disrupted normal life and has led to a breakdown of already weak health systems in the three countries.
Writebol, the second American who contracted Ebola while working with a missionary group in Liberia, is airlifted to Emory hospital in Atlanta for treatment. The aid worker, 59, is the second American to be flown into the US for treatment. David Writebol:
Now we have a real reason to be hopeful.
The World Health Organisation announces it is convening a special meeting next week to explore using experimental drugs in the West African outbreak, after two health workers from the US charity Samaritan’s Purse are treated with a drug called ZMapp. The decision to use an experimental drug to treat two Americans infected with Ebola, while nearly 1 000 Africans have already died from the deadly epidemic, has sparked controversy, but US experts say it is ethically justified.
The experimental drug is still in an extremely early phase of development and had only been tested previously on monkeys. It has never been produced on a large scale. There is no proven treatment or cure for Ebola. Samaritan’s Purse members Kent Brantly and Nancy Writebol, however, have shown improvements since taking the drug.
Nigeria declares a State of Emergency after seven cases of Ebola are confirmed in the country after a man arriving from Liberia fell sick. Two of the confirmed cases die while several people who have come into contact with the man are under surveillance.
A federal Customs and Border Protection agent says the arrival of a sick passenger believed to be from Liberia last Saturday caused confusion at Newark. The flight arrived at the gate and most passengers were allowed into the customs hall, while the sick passenger was taken to a hospital. For a low-level bomb scare, the plane is parked away from the airport.Airport managers went on the public address system and asked the passengers to separate themselves from people who had been on other flights and were not exposed to the vomiting patient.
A panic ensued. It was a disaster
The supply of ZMApp, an experimental Ebola drug has been used to treat the two Americans as well as a Spanish Priest and two Doctors in West African countries is exhausted. Other countries have called ZMapp and they have complied with requests to the best of their ability. The drug has been provided at no cost.
It is our understanding that all patients offered treatment, treated, or expected to be treated were or are highly capable of providing informed consent for the use of an experimental drug not yet evaluated for safety in animals or people.
ZMapp along with their partners are working to increase production as quickly as possible. However, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases says:
How can a couple of doses control an outbreak with hundreds and hundreds of people? You don’t control the epidemic with two or three doses.
Harvard Medical School associate professor of Global Health and Social Medicine Dr. Scott Podolsky writes in Annals of Internal Medicine that ZMapp is inspired by serology techniques developed in the 1890s after Louis Pasteur and Robert Koch began to identify the agents of diseases like anthrax, diptheria and pneumonia:
From the 1890s onward, this model of production – expose an animal (guinea pig, rabbit, cow, horse, etc.) to an identified microbial pathogen, generate antibodies (or use convalescent serum from former patients), and then ‘passively’ transfer the pre-formed antibodies to an exposed animal or person – could be expanded to such feared and prevalent diseases as pneumococcal pneumonia and meningococcal meningitis.
The San Diego-based Mapp Biopharmaceutical develops ZMapp with the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) due to fears Ebola could be used as a bioweapon. ZMapp is made from two serums, MB-003 developed and ZMAb, made by Canadian company Defyrus Inc., and combined by Mapp Biopharmaceutical’s commercial arm LeafBio. MB-003 uses three chimera antibodies developed in mice, with human DNA spliced in, and grown in a genetically engineered indigenous Australian tobacco plant. ZMab was developed in a similar way.
A health care facility in Monrovia, Liberia is attacked, causing a number of patients to flee the facility, all of them infected with Ebola. Some patients chose not to leave. The perpetrators made off with mattresses and equipment. No injuries have been reported. Liberian National Police:
It was an attack from people afraid of Ebola
After Khan’s death, it is discovered that he was not given ZMapp or asked to be a test case although an experimental dose was available. A Canadian team of scientists who had developed ZMapp were testing a dose for resistance to the African climate at a location within reach of the Sierra Leone field hospital where Khan was treated and offered to use it to treat him. However as the drug was untested and Khan’s immune system was fighting the virus, it was decided that the drug had a higher risk of killing him. His colleague, Dr. Daniel Bausch:
You had a person who was sick, and a drug never used on humans before, it wasn’t approved. There were lots of questions to be asked and no easy answers
He believes the final decision was with the field doctors at the hospital but says he disagrees with the refusal of the drug, especially as it was used on :
I do want it to be clear that these were difficult, delicate decisions that people in a stressful situation had to make. But I’m not going to deny that I disagree with the decision they made.
Kenya will be closing its borders on Wednesday August 20 to people travelling from Guinea, Sierra Leone and Liberia due to the spread of the virus. Kenya is at high risk as it is a major transport hub. Kenya’s health secretary said Kenyans and medical workers flying in from those states would still be allowed in. Kenyan Airways says it will stop flights to Liberia and Sierra Leone when the ban comes in. Kenyan Health Minister James Macharia said it was “in the interest of public health” and warned that Kenyans and health workers who had returned from the three west African states would face “strict checks” and would be quarantined if necessary.
Brantly is released from Hospital. He releases a statement (full text):
Today is a miraculous day. I am thrilled to be alive, to be well and to be reunited with my family. As a medical missionary, I never imagined myself in this position. When my family and I moved to Liberia last October to begin a two-year term working with Samaritan’s Purse, Ebola was not on the radar. We moved to Liberia because God called us to serve the people of Liberia.
After taking Amber and our children to the airport to return to the States on Sunday morning, July 20, I poured myself into my work even more than before—transferring patients to our new, bigger isolation unit; training and orienting new staff; and working with our Human Resources officer to fill our staffing needs. Three days later, on Wednesday, July 23, I woke up feeling under the weather, and then my life took an unexpected turn as I was diagnosed with Ebola Virus Disease. As I lay in my bed in Liberia for the following nine days, getting sicker and weaker each day, I prayed that God would help me to be faithful even in my illness, and I prayed that in my life or in my death, He would be glorified.
I did not know then, but I have learned since, that there were thousands, maybe even millions of people around the world praying for me throughout that week, and even still today. I cannot thank you enough for your prayers and your support. But what I can tell you is that I serve a faithful God who answers prayers.
Thank you to Emory University Hospital and especially to the medical staff in the isolation unit. You treated me with such expertise, yet with such tenderness and compassion. For the last three weeks you have been my friends and my family. And so many of you ministered to me not only physically, but also spiritually, which has been an important part of my recovery. I will never forget you and all that you have done for me. And thank you to my family, my friends, my church family and to all who lifted me up in prayer, asking for my healing and recovery. Please do not stop praying for the people of Liberia and West Africa, and for a quick end to this Ebola epidemic.
Sierra Leone has voted to pass an amendment to its Health Act whereby people caught hiding Ebola patients could face possible jail time of up to two years. The amendment still needs to go for presidential approval. The country has been hit hard by the current outbreak with at least 392 deaths and 910 cases recorded.
Sierra Leone majority leader Ibrahim Bundu:
[Sierra Leone has suffered] abandonment and isolation from those we viewed to be our biggest friends in the region and beyond. These ugly developments are evidenced in the cancellations of flights, closing of borders, reduction of operational hours of banks and further isolation by shutting down businesses at the time of greatest need.
He said lawmakers would soon review the country’s partnerships “so as to form a permanent record of who are true friends are.”
A laboratory in Sierra Leone is shut down when a health worker is compromised by the Ebola virus. The World Health Organization is concerned the move may hinder efforts to combat the spread of the Ebola virus in the region. Up to this point, Ebola has infected 2,615 and killed a minimum of 1,427 people.
It’s a temporary measure to take care of the welfare of our remaining workers. After our assessment, they will return.
Rapid burials of possible Ebola victims lead to dogs digging up corpses and eating the remains. During the discovery, young men make efforts to contact the Healthy Ministry, which does not respond. The young men take matters into their own hands and try to kill the dogs, but some of the animals flee the scene. Resident:
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 not bury them well?
Pooley is treated with the experimental ZMapp Ebola drug. Dr Michael Jacobs, clinical director of infectious diseases at the Royal Free hospital in Hampstead, north London:
We had the opportunity to give him the ZMapp treatment. It is an experimental medicine, we made that absolutely clear in our discussions with him.
Airlines suspend flights through the three nation crisis zone. Air France temporarily suspends services to Sierra Leone, leaving its capital Freetown and Monrovia in neighbouring Liberia with just one regular service, from Royal Air Morocco. Air France:
In light of the analysis of the situation and as requested by the French government, Air France confirms it is maintaining its program of flights to and from Guinea and Nigeria.
Not all authorities agree with more severe isolation. Nabarro:
By isolating the country, it makes it difficult for the UN to do its work.
WHO expresses their concern in regards to aggressive isolation. Fukuda:
Pilots and others, as well as passengers, generally have very low risk of Ebola infection.
Multiple mutations are complicating the diagnosis and treatment of the disease. Genetic sequencing the virus from 78 patients, consisting of 99 samples, since the inception of the outbreak leads to the discovery that the virus is mutating during the course of the “Zaire” strain outbreak. Researchers are gathering data to build a history of the particular strain, the disease possibly using bats as hosts since 2004. Gire:
We’ve uncovered more than 300 genetic clues about what sets this outbreak apart from previous outbreaks. Although we don’t know whether these differences are related to the severity of the current outbreak, by sharing these data with the research community, we hope to speed up our understanding of this epidemic and support global efforts to contain it.
ZMapp is shown to cure 100% of monkeys in a Canadian study. Severe symptoms, rashes, bleeding, excessive liver enzymes and signs of liver failure had a reversal due to ZMapp injections and the monkeys continue to recover from a lethal dose of the virus, even five days after the infection. The anti-Ebola drug has yet to go through the official human testing phase. ZMapp takes several months to manufacture, which is why the dosages are currently not available.
Brantly is interviewed by Lauer for NBC Nightly News.
That morning. I just felt a little off. A little warm. A little under the weather. And I took my temperature and it was 100.0 I think.
I don’t think they ever said, ‘Ken I think you are about to die’. but I felt like I was about to die.
The U.S. Department of Health and Human Services signs a $24.9 million, 18-month contract with Mapp Biopharmaceutical to support the development, manufacture, and FDA approval of ZMapp. The deal can be extended up to a total of $42.3 million. HHS official:
While ZMapp has received a lot of attention, it is one of several treatments under development for Ebola, and we still have very limited data on its safety and efficacy. Developing drugs and vaccines to protect against Ebola as a biological threat has been a long-term goal of the U.S. government, and today’s agreement represents an important step forward.
Sierra Leone plans a three-day nationwide lockdown in an effort to halt an Ebola outbreak that has killed hundreds. People will not be allowed to leave their homes for three days under the plan, set to start September 19. The lockdown is being billed as a predominantly social campaign rather than a medical one, in which volunteers will go door-to-door to talk to people. Sierra Leone’s minister Alhaji Alpha Kanu:
We believe this the best way for now to identify those who are sick and remove them from those who are well.
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