Obama is likely to send US military resources to countries in West Africa affected by the Ebola virus outbreak. Obama stresses that action must be taken now to prevent the disease from spreading. Obama:
If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates. It becomes more easily transmittable. And then it could be a serious danger to the United States.
The WHO says aid to Liberia needs to be scaled up by three to four times. It says new Ebola centres immediately overflow with patients, pointing to…
…a large but previously invisible caseload.
In Montserrado county, which includes Monrovia and is home to more than 1 million people, a WHO investigative team estimated that 1,000 beds are urgently needed:
The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centres.
The WHO says motorcycle taxis and regular taxis are not disinfected between passengers:
[They are] a hot source of potential virus transmission
Pooley says he wants to return to west Africa following his recovery:
So while I’m happy to be recovered and alive, there’s a lot of stuff on my mind with what’s going on back there. It would be relatively safe for me to go back and work there, and it’s really the least I could do having received all this amazing care and have people look after me and potentially save my life. It’s the least I could do to go back and return the favour to some other people, even just for a little while. The more help they get the less chance there is they get sick. If they get sick they are just going to end up in a ward in Kenema with less chance than I had.
He says he has ‘huge gratitude’ for Cameron’s role in his recovery, but calls for more support from leaders:
It’s a global problem and it needs global level leadership so Obama and Cameron … need to show some more leadership on this issue … Sierra Leone needs lots of international health-care workers working with big NGOs like MSF and Red Cross. All of that needs to be increased.
The Bill and Melinda Foundation pledged $50 million to help fight the Ebola outbreak in West Africa. The money will be used to help the government purchase supplies, “scale up emergency operations,” and enable international aid.
We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease. We also want to accelerate the development of treatments, vaccines and diagnostics that can help end this epidemic and prevent future outbreaks.
Defence Minister Brownie Samukai tells the UN Security Council that Ebola threatens the entire country’s security:
Liberia is facing a serious threat to its national existence [as it is] now spreading like wildfire, devouring everything in its path.
The Foreign Office is investigating reports that a 57-year-old British man has died and a second man, aged 72, is ill in Skopje. Macedonian officials say the the patients had been staying at a hotel when they fell ill. The now-deceased man was admitted to the Clinic for Infectious Diseases around 3 p.m. (9 a.m. Eastern) and died around two hours later. His friend remains under observation at the hospital and medical staff are attempting to confirm whether they were infected with Ebola.
Dr. Rick Sacra is recovering after receiving a blood transfusion. According to his physicians he is doing very well. The blood came from Kent Brantly, another doctor who had been infected. Blood from a previously infected patient contains antibodies against the virus. Sacra’s wife is very pleased that Brantly was willing to donate blood:
It really meant a lot to us that he was willing to give that donation so soon after his own recovery.
Medecins sans Frontieres worker Pierre Trbovic says the organization has only 200 beds in Monrovia and there are a total of only 240 in the city. MSF is turning away patients to avoid being overwhelmed:
In Monrovia, we estimate that there needs to be more than 1,000 beds to treat every Ebola patient. There are currently just 240 in total. Until that gap is closed by treatment centres with hundreds, rather than the small numbers pledged so far, the misery of turning people away at our gates will continue.
The WHO says at least 600 more doctors are needed in west Africa. Director general Chan:
Our response is running short on nearly everything from personal protective equipment to bodybags, mobile laboratories and isolation wards. But the thing we need most of all is people: healthcare workers. The right people, the right specialists – and specialists who are appropriately trained and know how to keep themselves safe – are most important for stopping the transmission of Ebola. Money and materials are important, but those alone cannot stop Ebola transmission.
At least 1,000 other health workers are needed.
Aid workers in Monrovia sing Liberian gospel tunes and encourage Ebola patients to join in in an effort to promote recovery. Nurse Mary Byepu:
They themselves will tell you they want to sing
Health staff have also added cornbread to the menu to encourage patients to eat. One health-care worker brought a woman a cucumber from the local market, while another promised a boy a bicycle if he recovered.
The disease detection technique of contact tracing cannot be done properly in Sierra Leone due to unreliable information. The UN says only 16 of 44 zones in west Africa have sufficient details on people who have come into contact with Ebola patients. U.S. Public Health Service Lt. Rebecca Levine describes the Health Ministry’s database:
Pretty much in shambles.
Contact tracing identifies people who have come into contact with an infected person and monitors them for 21 days. If they develop the disease, they are isolated and their contacts are tracked down. She says many contacts’ addresses are missing or vague, like ‘down by the farm road. In all, only 20% to 30% of the contacts in the database had a usable address.
Researchers from UK in Liberia say that each Ebola patient turned away by volunteers is infecting 1.5 other people. Prof Edmunds, Medecins Sans Frontieres.
The doubling time of this epidemic is about two weeks, so if we are overwhelmed with our resources right now, it’s going to be twice as bad in two weeks’ time.
Obama is expected to announce the expansion of a $763 million U.S. plan to help West African nations combat the Ebola virus later Tuesday during his visit to the Centers for Disease Control and Prevention in Atlanta. Officials say the administration has asked Congress for an additional $88 million for the program. The Department of Defense, which is heading up the program, has requested the re-programming of $500 million. The expansion will include deploying 3,000 troops to the Liberian capital, according to a White House statement:
U.S. Africa Command will set up a Joint Force Command headquartered in Monrovia, Liberia, to provide regional command and control support to U.S. military activities and facilitate coordination with U.S. government and international relief efforts. A general from U.S. Army Africa, the Army component of U.S. Africa Command (AFRICOM), will lead this effort, which will involve an estimated 3,000 U.S. forces.
The White House says ‘many’ of the troops will be stationed at an ‘intermediate staging base’ where they will supervise movement of medical staff, supplies and heavy equipment.
Virologist Heinz Feldmann says the Monrovia airport is the place he felt least safe:
They are checking your temperature three times before you get into the airport, but if you look at the people that do this kind of work, they don’t really know how to use the devices … They are writing down temperatures of 32°C, which everybody should know is impossible for a living person. All the checks they do are completely useless because they are done by people who are not well trained or overwhelmed by the number of passengers. It is just a disaster, and it needs to be fixed.
World Bank president Kim says Ebola will have a major impact on West Africa economies:
For 2014 we estimate that the GDP losses to Liberia, Sierra Leone and Guinea from this crisis will be a combined $360 million, which is a huge portion of the overall GDPs of these small countries. We expect that the impact on government budgets to be $292 million.
Continued spread of the virus could multiply the effect:
Our findings indicate that if the virus continues to spread the economic cost to these countries could grow eight-fold by 2015. This would deal a potentially catastrophic blow
A fast and effective response could limit the economic damage in 2015 to $97 million but if rapid action isn’t taken it could be $800 million. The bank has released $117 million grant funding for an immediate humanitarian response to save lives and prevent new infections.
Ashoka posts on Facebook about the situation in Liberia;
Man oh man I have seen some bad things in the last two weeks of my life. how unpredictable and fraught with danger life can be. how in some parts of the world, basic levels of help and assistance that we take for granted completely don’t exist for many people. the raw coldness of deprivation and the potential for true darkness that exists in the human experience. I hope that humanity can figure out how we can take care of each other and our world. simple, soft aspiration for all my brothers and sisters on this earth who suffer the elements and the cold. may we all be free, loved, and tended to…
Duncan is tested at Roberts International Airport, 35 miles east of Monrovia before boarding his flight to the U.S. via Belgium. He does not have high fever, sweating, vomiting or weakness. Jay Nagbe Sloh, the director-general of the state-run Liberia News Agency:
He showed no Ebola signs.
Duncan leaves Liberia for the U.S. He boards an SN Brussels Airlines flight to Brussels. He then boards United Airlines Flight 951 to Washington Dulles and Flight 822 to Dallas-Fort Worth.
Red Cross Society volunteer Daniel James says his group bury six bodies a day and take blood samples from the corpses in Kailahun, Sierra Leone:
Our personal protective equipment and a chlorine solution are our protection; they are our medication and they are our doctors. We maintain the ABC Rule: Avoid Body Contact.
He says his team have suffered no medical problems.
One current projection by the CDC for a worse case scenario places the number of Ebola infections at 550,000. The estimate does not consider intervention and aid from governments and relief organizations mobilizing to contain the virus. The figures stretch all the way to the end of January.
CDC is working on a dynamic modeling tool that allows for recalculations of projected Ebola cases over time. CDC expects to release this interactive tool and a description of its use soon.
The CDC releases a report on predicting as many as 550,000 to 1.4 million cases of the Ebola virus in Sierra Leone and Liberia alone, by the end of January. CDC scientists also say that there may be as many as 21,000 reported and unreported cases of Ebola in just those two countries as soon as the end of this month.
“he model shows — and I don’t think this has been shown by other modeling tools out there — that a surge now can break the back of the epidemic. It also shows that there are severe costs of delay,” CDC Director Dr. Thomas Frieden said in a press conference Tuesday.
CDC director Frieden says Duncan developed symptoms ‘four or five days” after traveling to the U.S. The incubation period is two to 21 days.
Duncan comes into contact with 12 to 18 people in Dallas over a period of several days after he starts developing symptoms. Five of them are his girlfriend’s children. An ambulance crew that takes him to hospital are also among those identified.
Blair says Africa needs support to get through the initial crisis:
If we don’t get this thing under control in the next six to eight weeks, it could become the biggest humanitarian disaster in a generation.
Rebuilding efforts are needed to reinforce strained government resources:
This means stopping the knock-on effects of Ebola. Hunger is a huge risk. The price of basic goods in parts of Liberia’s capital, Monrovia, is up 8% since the virus got a foothold, and in some rural areas the cost of staple foods has doubled.
Governments need support against future crises:
Aid has been successful at slashing the number of people succumbing to preventable disease and lifting the number of kids in school, but too often it has managed this by working around governments. In a crisis you need governments with the capability to respond
Doctors at the Nebraska Medical Centre biocontainment unit say Sacra has been treated with the experimental TKM-Ebola, manufactured by Canadian company Tekmira, which is designed to stop the virus replicating. Doctors had previously declined to identify the drug. Dr. Angela Hewett:
We don’t know if it was Dr. Sacra’s own immune system, the supportive therapy we provided, the blood transfusion from Dr. Brantly, TKM-Ebola or a combination of all these factors that helped Dr. Sacra recover
Duncan presents at Texas Health Presbyterian after 10 p.m. local time. He undergoes basic blood tests but isn’t screened for Ebola, and is given antibiotics and a pain killer. Dr. Edward Goodman:
His condition did not warrant admission. He also was not exhibiting symptoms specific to Ebola.
Although Duncan informs a nurse that he has traveled from Liberia. Staff say this is not ‘fully communicated’ to the hospital’s medical team.
The FDA sends warning letters to three companies the government agency says are selling products over the Internet that claim to treat, prevent or even cure the deadly disease. The letters are issued after an alert warning consumers about fraudulent Ebola products being hawked online went out last month. Howard Sklamberg, the FDA’s deputy commissioner for global regulatory operations and policy:
We have a program at FDA that monitors the Internet to look for health fraud products, products not approved by FDA that claim to cure or treat disease. We noticed that when there is a public health issue that really comes to the fore(front) — for example H1N1 a few years ago, and now Ebola — there tends to be an increase in health fraud products, which are products that claim to prevent, treat or cure disease and the product has not been approved by FDA.
22-year-old Liberian nursing student Kekula invents her own equipment to protect against Ebola. She puts trash bags over her socks and ties them in a knot over her calves, wears rubber boots and another set of trash bags over them, wraps her hair in stockings and places a trash bag over it, wears a raincoat and four pairs of gloves on each hand, followed by a mask. She is able to treat her father, Moses, mother, Victoria, sister, Vivian, and 14-year-old cousin, Alfred Winnie, without becoming infected herself. Moses:
I’m sure she’ll be a great giant of Liberia/
A doctor says he has good results with a treatment he is trying out of sheer desperation: an HIV drug. Dr. Gobee Logan gives the drug, lamivudine, to 15 Ebola patients, and all but two survive. That’s a 7% mortality rate. One of the patients says:
My stomach was hurting; I was feeling weak; I was vomiting. They gave me medicine, and I’m feeling fine. We take it, and we can eat — we’re feeling fine in our bodies.
Duncan arrives at Texas Health Presbyterian by ambulance and is admitted. A friend says that he called the CDC after Duncan was sent home from the hospital, who told him to call the Texas Board of Health and the message eventually got to the hospital. Health Presbyterian says by the time Duncan arrived:
EMS had already identified potential need for isolation. The hospital followed all suggested CDC protocols at that time.
For the first time, the UN opens a health mission headquarters. UNMEER, or United Nations Mission for Ebola Emergency Response, provides coordinating international efforts to combat the Ebola virus. Team lead Anthony Banbury with crew members arrive on Monday in Accra, the capital of Ghana. Speaking to the Security Council, Ki-Moon:
This international mission, to be known as the United Nations Mission for Ebola Emergency Response, or UNMEER, will have five priorities: stopping the outbreak, treating the infected, ensuring essential services, preserving stability and preventing further outbreaks. Under the leadership of a Special Representative of the Secretary-General, the Mission will bring together the full range of UN actors and expertise in support of national efforts. Our best estimate is that we need a 20-fold increase in assistance.
Texas Health Presbyterian Hospital in Dallas becomes the first hospital in the US to diagnose a patient with Ebola. The patient, and unnamed man, is in isolation. CDC Director Tom Frieden said the patient had been traveling in Liberia, where he may have contracted the disease. He returned to the US on September 20, after which he sought care. Frieden:
It is certainly possible that someone who had contact with this individual…could develop Ebola in the coming weeks…there is no doubt in my mind that we will stop it here.
Frieden also said that “a handful” of people, including family members, may have been exposed to the patient prior to his seeking treatment.
The CDC says Ebola spreads through saliva, semen, blood, feces and mucus from people who are already showing symptoms, unlike the airborne transmission of other viruses. Frieden:
Ebola doesn’t spread before someone gets sick. Ebola does not spread … from someone who doesn’t have fever and other symptoms.
Symptoms generally occur abruptly eight to 10 days after infection, though it can range from two to 21 days. The virus can continue to spread after a patient dies. CDC’s Division of Global Migration and Quarantine director Dr. Marty Cetron:
There needs to be direct contact frequently with body fluids or blood.
Texas Presbyterian Health officials say Duncan wasn’t diagnosed with Ebola because of incomplete information. Infectious disease specialist Dr. Edward Goodman says the medical team thought it was a low-grade viral infection as he was not vomiting and did not have diarrhea:
All the information wasn’t present as they made their clinical decision
Dr. Mark Lester confirms Duncan told staff on his first visit he had been in an area affected by Ebola:
A checklist was in place for Ebola in this hospital for several weeks. That checklist was utilized by the nurse, who did ask [the] question [if the patient had been to Africa.] Regretfully, that information [was not shared] with the full team.
Dallas Independent School District Superintendent Mike Miles says five children from four of the district’s campuses were possibly exposed to the virus:
- Conrad High School
- Tasby Middle School
- Hotchkiss Elementary School
- Dan D. Rogers Elementary School
Tasby Middle School shares a campus with Jack Lowe Sr. Elementary School, but DISD officials say no students at Lowe Elementary were directly exposed. The students who may have had contact with Thomas Eric Duncan attended classes earlier in the week, but none have exhibited symptoms. Miles:
So, the odds of them passing on any sort of virus is very low
The children are at home and being monitored by Dallas County Health and Human Services, while the schools have been staffed with additional health employees and more sanitation staff.
The first person to develop Ebola symptoms in the U.S. is identified as Thomas Edward Duncan. His sister, Mai Wureh, says he was treated with antibiotics but then sent home from Texas Health Presbyterian despite telling a nurse that he was visiting from Liberia. CDC Center for Global Health director Dr. Tom Kenyon:
There were no signs of any disease when the gentleman boarded the flight. This was not a failure of the screening process at the airport.
Dr. Mark Gendreau of Peabody’s Lahey Medical Center says U.S. hospitals have protocols in place:
Every hospital in the commonwealth has been working on this since June. I would say that all of the hospitals in Massachusetts are very capable of handling a patient who presents with Ebola.
Doctors and nurses have been trained to ask patients with possible symptoms if they have traveled to Africa in the last 21 days. If the answer is yes, the medical staff would ‘gown up’ and the patient would be immediately isolated and tested. If the test is positive the CDC and state Department of Public Health will be notified. The patient will also be asked for the names of people he or she had been in contact with and contacts would be instructed to isolate themselves at home, check their temperature twice a day and immediately report any symptoms or fever to the local health department.
The WHO says that 3,338 people in West Africa have died of confirmed, suspected or probable Ebola through Sept. 28. A total of 7,178 cases have been reported. It says the situation in Guinea appears to have stabilized somewhat, but the epidemic is growing in Sierra Leone and likely also in Liberia.
Health officials are closely monitoring a second person in Dallas County who had close contact with the first Ebola patient confirmed in the U.S. Zachary Thompson, director of Dallas County Health and Human Services:
The fact that we have one confirmed case, there may be another case that is a close associate with this particular patient. So this is real. There should be a concern, but it’s contained to the specific family members and close friends at this moment.
Duncan helped transport Ebola patient Marthalene Williams to hospital in Monrovia on Sept. 15, four days before traveling to the U.S. Marthalene’s family took her by taxi to a hospital with Duncan’s help after failing to get an ambulance as she was convulsing and seven months pregnant, according to her parents, Emmanuel and Amie Williams. Duncan, who was the family’s friend and tenant, rode in the taxi in the front passenger seat while Marthalene, Emmanuel and her brother, Sonny Boy, shared the back seat. A neighbour says Duncan then helped carry Ms. Williams, who was no longer able to walk, back to the family home that evening:
He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back.
Sonny Boy developed Ebola symptoms around the same time as Duncan, and died on the way to hospital in an ambulance.
Medical officials say a patient is being treated at The Queens Medical Centre in Honolulu. Dr. Melissa Viray, deputy state epidemiologist:
We are early in the investigation of a patient — very, very early — who we’re investigating that might have Ebola. It’s very possible that they do and they have Ebola. I think it’s also more likely that they have another condition that presents with similar symptoms.
She says the patient could have a number of illnesses including Ebola, flu, malaria and typhoid. The public should not be concerned:
Like I said, this is a possible case we’re investigating. We don’t know if this is Ebola or a number of other conditions.
A friend who speaks with Duncan says he is ‘all right’ but hasn’t eaten in a week:
He is in pain.
Health Presbyterian says he remains in serious condition.
Duncan won’t be given ZMapp, as all the dosages currently in existence have already been used. ZMapp is manufacturing more supplies, but the drug takes months to produce.
American freelance cameraman Ashoka Mukpo tests positive for Ebola in Liberia. Mukpo, working as second cameraman for NBC News Chief Medical Editor and Correspondent Dr. Nancy Snyderman, will return to the U.S. for treatment. Mukpo is the fifth American diagnosed with Ebola in West Africa. NBC News President Deborah Turness’ note to NBC staff:
As you know, Dr. Nancy Snyderman and our news team are in Liberia covering the Ebola outbreak. One of the members of their crew is an American freelance cameraman who has worked in Liberia for the past three years and has recently been covering the epidemic for US media outlets. On Tuesday he began working with our team. Today, he tested positive for Ebola.
We are doing everything we can to get him the best care possible. He will be flown back to the United States for treatment at a medical center that is equipped to handle Ebola patients. We are consulting with the CDC, Medicins Sans Frontieres and others. And we are working with Dr. Nancy on the ground in Liberia.
We are also taking all possible measures to protect our employees and the general public. The rest of the crew, including Dr. Nancy, are being closely monitored and show no symptoms or warning signs. However, in an abundance of caution, we will fly them back on a private charter flight and then they will place themselves under quarantine in the United States for 21 days – which is at the most conservative end of the spectrum of medical guidance.
We know you share our concern for our colleagues and we will continue to keep you up to date and informed. Please don’t hesitate to reach out to me or David Verdi with any questions.
The CDC has issued a nationwide alert to hospitals updating them on how to appropriately respond to possible Ebola cases after Duncan was sent home after contracting the virus. CDC director Frieden:
It’s a teachable moment.
The guidance includes a poster with quick rules for evaluating returned travelers and a checklist.
National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci tells CNN’s The Lead with Jake Tapper that Texas Health Presbyterian made a mistake by releasing Duncan:
A travel history was taken, but it wasn’t communicated to the people who were making the decision. … It was a mistake. They dropped the ball. You don’t want to pile on them, but hopefully this will never happen again. … The CDC has been vigorously emphasizing the need for a travel history.
Liberia will prosecute Duncan for allegedly lying on an airport questionnaire about not having any contact with an infected person. He filled out a series of questions about his health and activities on Sept. 19, answering no to all of them. The form asked whether he had cared for an Ebola patient or touched the body of anyone who had died in an area affected by Ebola.Binyah Kesselly, chairman of the board of directors of the Liberia Airport Authority in Monrovia:
We expect people to do the honorable thing.
The agency obtained permission from the Ministry of Justice to pursue the matter.
The number of people being screened in Dallas increases to around 100. CDC Director Frieden says only a ‘handful’ of people who had contact with Duncan have been identified. Most of the 100 people haven’t been ordered to stay home however officials say they ordered four of Duncan’s family members to remain in their home as the family disobeyed their request to stay there. The family was examined Thursday and hadn’t developed symptoms. A law enforcement official is stationed outside their apartment to make sure they don’t leave.
United is contacting passengers who flew in and out of Dulles with Duncan and telling them how to contact health officials. United officials decline to say how many passengers were on the flights. The Brussels-to-Dulles flight used a Boeing 777 with 266 seats and the flight to Dallas used an Airbus A320 with 138 seats. United did a routine overnight ‘thorough cleaning’ after the flights:
Including cleaning of lavatories and galleys with heavy-duty all-purpose cleaners and wiping tray tables and armrests with disinfectant … We continue to clean and route the planes throughout our network as usual.