The National Ebola Response Center (NERC) says 49 confirmed cases emerged in a single day Monday in two Ebola zones in and around the capital, while lawmaker Claude Kamanda, who represents a western area, says more than 20 deaths are being reported daily. The uncontrolled movement of people from the interior to Waterloo, which is the gateway to the capital Freetown, has fueled the increase of cases in the west. There is a strong feeling that people are violating quarantines elsewhere and coming to Freetown through Waterloo. There are 851 total confirmed Ebola cases in the two zones, called Western Area Urban and Western Area Rural.
A study published in Lancet indicates that up to three Ebola-infected people could embark on overseas flights every month from Sierra Leono, Liberia, and Guinea. Kamran Khan, lead author:
[The study shows] that controlling the outbreak at the source is the most important thing that needs to happen
The restriction is imposed in the eastern town of Koidu after a dispute between youth and police over a suspected case of Ebola degenerated into gunfire and rioting. A local civil society leader says he has seen at least two bodies with gunshot wounds, while the head of the local police unit says youth had fired at officers with shotguns but denies anyone has been shot dead. The police unit commander says rioting began when a former youth leader refused health authorities permission to take her 90-year old grandmother for an Ebola test.
The CDC releases guidelines recommending full-body protective suits and hoods that protect worker’s necks; setting rigorous rules for removal of equipment and disinfection of hands; and calling for a ‘site manager’ to supervise the putting on and taking off of equipment. Health workers who may be involved in an Ebola patient’s care must repeatedly practice and demonstrate proficiency in donning and doffing gear before being allowed near patients. CDC officials will demonstrate the techniques at New York’s Javits Center Tuesday to several thousand people. American Nurses Association president Pamela Cipriano:
Today’s guidance moves us forward
U.S. officials are hopeful that the virus has been contained after no new cases are reported in five days. Dallas Mayor Mike Rawlings:
We are breathing a little bit easier, but we are still holding our breath
The United States restricts travel from West Africa by funneling incoming passengers through five airports consisting of John F. Kennedy in New York, Newark in New Jersey and O’Hare international airports in Atlanta, Chicago and Washington Dulles. The airports essentially account for 94 percent of passengers traveling to the United States from the three hot spot countries in West Africa. Johnson:
We are working closely with the airlines to implement these restrictions with minimal travel disruption. If not already handled by the airlines, the few impacted travelers should contact the airlines for rebooking, as needed. We currently have in place measures to identify and screen anyone at all land, sea and air ports of entry into the United States who we have reason to believe has been present in Liberia, Sierra Leone or Guinea in the preceding 21 days.
As soon as January, two vaccines may be ready to deploy for the heavy hitting Ebola areas of Guinea, Liberia and Sierra Leone. The vaccines must pass human safety trials where twenty human subjects receive injections in the United States. Researchers hope to know about safety results by late November or early December. WHO especially expresses interest in one of the vaccines from GlaxoSmithKline. Fauci:
I don’t know if that’s going to be the best one, but that’s the one farthest along in terms of development.
A Canadian company ships 800 vials for testing in the hopes that WHO approves. Kieny:
These data are absolutely crucial to allow decision-making on what dose level should go in the efficacy testing in Africa. We expect, we hope, to have a go-ahead by the end of the month.
Both of these vaccines are the top choices for availability and production. They’re not ready for prime time if it wasn’t an emergency situation, but they are the ones the World Health Organization is supporting.
Rwanda requires visitors who have been in the United States or Spain in the previous 22 days to be screened upon arrival in the country. Visitors are examined upon entry and those with temperatures are asked to leave. Visitors without temperatures are required to report their health conditions daily. Dr. Agnes Binagwaho, Rwanda’s health minister:
It is definitely extra work for us. We have to ensure that all citizens or any other travelers arriving from the above mentioned countries including the U.S have to be screened in an extra careful manner and follow up on them during their stay.
Baylor Medical Center in Frisco, Tx., restricts its ER with a locked sliding glass door and a sign telling people to knock. KLIF-AM radio announcer Dave Williams says he and another person were questioned before being allowed to enter:
Have either of you been in contact with anyone who has had Ebola?’ … ‘Have either of you been to West Africa recently?’
Another sign posted on the door tells those who have traveled internationally recently and who show a variety of symptoms, not to enter patient-care areas. The hospital says the system is designed to protect staff, and that it will not turn people away from the ER.
Jindal orders Louisiana officials to track travel to countries affected by the virus. Executive order:
[State officials] are authorized and directed to develop policies and reporting mechanisms for public employees and students, faculty, and staff of institutions of higher learning to report travel to the countries identified by the Centers for Disease Control [and Prevention] as having a threat of contracting the Ebola Virus Disease.
It could require some to disclose travel to affected countries.
The Texas state health department says 43 people who had contact with Duncan are cleared of twice-daily monitoring after 21 days of showing no symptoms. Another 120 are still on watchlists.
The WHO says 42 days have passed since the last case tested negative. Coun try director Rui Gama Vaz:
The outbreak in Nigeria has been contained
The Harvard Crimson reports that affiliates of the school need permission from Provost Alan M. Garber and their School dean before traveling to west Africa. In a separate policy, it says any Harvard affiliate returning from Sierra Leone, Guinea, and Liberia must complete medical screening with Harvard University Health Services before arriving on campus. Travelers could also be asked to stay away from campus for 21 days, the length of the incubation period.
Hagel orders the 30-member team to prepare in line with a Department of Health and Human Services request. Pentagon spokesman Rear Adm. John Kirby:
[The team is] an added, prudent measure to ensure our nation is ready to respond quickly, effectively and safely in the event of additional Ebola cases.
The team’s members will be selected and led by Northern Command Commander Gen. Chuck Jacoby.
Researchers say the virus is not as easy to catch as people think, and that people who have come into indirect contact with potential patients have a relatively low risk. They also say the virus may mutate, but that it remains difficult to contract. CDC medical epidemiologist Michael Kinzer, who spent five weeks in Guinea fighting the outbreak:
There’s a reason it’s not everywhere. It’s just not as easy to transmit as people think.
Top U.S. government health officials from the CDC issue an update of strict guidelines informing American health workers to cover both skin and hair when caring for Ebola patients. The guidelines are a reaction to previous incidents where some health workers also became Ebola patients themselves. Fauci:
I don’t want to officially comment on what is being developed, but pretty soon we are going to be seeing new guidelines that, at least I can tell you, they are going to be much more stringent.
The old guidelines derive from the World Health Organization having skin exposure problems. Fauci:
We want to make sure that that’s no longer the case. That you have essentially everything covered.
The teacher at Strong Elementary is placed on a 21-day paid leave of absence after parents tell the board they are concerned that she might have been exposed to Ebola during a trip to Dallas for an educational conference. School district:
At this time, we have no information to suggest that this staff member has been in contact with anyone who has been exposed to Ebola. However, the district and the staff member understand the parents’ concerns. Therefore, after several discussions with the staff member, out of an abundance of caution, this staff member has been placed on a paid leave of absence for up to 21 days.
Matt Dexter, who first raised the concerns:
What the parents were saying last night is that, you sent (this teacher) to a potentially harmful area for exposure, and then to come back and jump into the classroom on Monday seemed a little bit reckless. I’m really tired of people telling everyone, on the news, starting at the national level, ‘zero risk, low risk.’ The bottom line is that there is risk.
Officials say monitoring of the virus’s potential spread has been inconsistent. In one example, Dallas County chief executive Judge Jenkins told Texas Health Presbyterian to change its system so that workers who had treated Duncan were to stop seeing any patients other than Pham. The next day, the CDC allowed Vinson to fly on a commercial airliner. Rep. Michael Burgess, R-Texas, a doctor who did his residency in Dallas:
I don’t think the directions provided to people at first were as clear as they needed to be, and there have been changes in the instructions given to people over time.
Obama says in his weekly address that the virus must be kept in perspective, saying that ‘what we are seeing is not an outbreak or an epidemic in America.’ He notes that there have been three cases in a nation of 300 million, and says that he has met with a recovered patient. The U.S. knows how to fight the disease and knows the protocols, and has safely treated the five Americans who contracted the disease, while the CDC is stepping up efforts, and screening measures are in place. The U.S. can’t ‘cut itself off’ from west Africa but must stop the virus at its source. He says avoid panic:
All of us – citizens, leaders, the media – have a responsibility and a role to play. This is a serious disease, but we can’t give in to hysteria or fear-because that only makes it harder to get people the accurate information they need. We have to be guided by the science. We have to remember the basic facts
The British-based charity, which is working in Liberia and Sierra Leone, is calling for more troops and funding in the worst-hit areas. Chief executive Mark Goldring:
We cannot allow Ebola to immobilise us in fear, but… countries that have failed to commit troops, doctors and enough funding are in danger of costing lives.
Oxfam spokesman at a meeting of EU foreign ministers in Luxembourg:
The Ebola crisis could become the definitive humanitarian disaster of our generation
The Carnival Magic is returning to Texas after being refused permission to dock in Mexico and Belize. The worker from Texas Health Presbyterian remains in self-quarantine and is not ill. Carnival Cruise Lines spokesperson:
Regular debarkation will take place. The lab worker continues to show no symptoms.
AfriCom commander Gen. David Rodriguez says at a Pentagon briefing that troops with the division, known for its role on D-Day and fighting the Iraq War under Gen. Petraeus, will only need gloves and masks.
They don’t need the whole suit – as such – because they’re not going to be in contact with any of the people.
Rodriguez says the 101st Airborne will primarily be building hospitals, ultimately leading what could be a contingent of 4,000 American service members. They’ll be housed either in tent cities at military airfields or in Liberian Ministry of Defense facilities. Their health will be monitored through surveys and taking their temperature on their way in and out of camps. If a service member does get sick, they will be flown home immediately for treatment.
U.S. hospitals are preparing for flu season and a rush of panic by people with flu thinking they have Ebola, as the two have similar symptoms. At least one panic case has already been reported, as a woman who had traveled to South Africa presented at a hospital with what she thought were potential Ebola symptoms, but was found to be pregnant. Dr. Bruce Hirsch, an infectious diseases specialist at North Shore University Hospital in Manhasset, NY:
It tells you how ready for panic we can get ourselves. There’s a lot of anxiety and the answer to anxiety is information and training.
Dr. Sampson Davis, an emergency medicine physician at Meadowlands Hospital Center in Secaucus, NJ:
I think there will be an increase of people who want to get checked out just because of the fear factor, especially if we start to see more of a spread of Ebola
Medical staffing agency Angel Staffing Inc. is hiring people with basic EMT or paramedic training to assist Customs and Border Protection officers and the CDC in identifying possible victims at JFK’s Terminal 4 as part of heightened screening. EMTs will earn only st $19 an hour while paramedics will earn $29. Applicants must be registered with the National Registry of Emergency Medical Technicians. It is also selecting screeners to work at Washington Dulles, Newark Liberty, Chicago O’Hare, and Hartsfield-Jackson Atlanta.
The Better Business Bureau is warning that major websites are budding and posing as fundraisers and charities that help Ebola victims. For example, one website that has these possible scams is GoFundMe that claims to be taking donations for the nurse Amber Vinson, but the family is unable to verify the veracity of the specific fundraiser. Though GoFundMe is a legitimate crowd sourcing fund raising site, scam artists can use such sites to pose as a legitimate operation. The BBB shut down the specific sub site. However, there are as many as 100 such websites to claim funds for various Ebola campaigns, with the first set of scams showing up when Thomas Duncan made entrance to the US with infection. Even telephone scandals posing as well-known chapters are cropping up.
Panic occurs when people on board the Carnival Magic cruise ship hears about a woman passenger who worked in an Ebola laboratory. After days pass, the captain acknowledges that a current passenger is a lab supervisor at the Texas Health Presbyterian Hospital in Dallas. The suspect passenger and her husband volunteer to remain in their room during travel. Up to 40 workers wear masks and clean the ship with fluids. Passenger Malone:
People are scared. I’ve seen people crying. You’re using the same buffet line as someone else, the same waiters, the folks that clean the state rooms. If someone was cleaning their state room and cleaned yours right after, the exposure that you have there to elevators…it’s very tight quarters and a lot of interaction. It’s really difficult to control any type of virus that’s on a cruise ship. It’s like a floating petri dish. It spreads very rapidly. They’re cleaning elevators. I’ve seen people with pink liquid cleaning the bar area and the handrails.
Earnest explains that Klain will lead a response effort that incorporates many government agencies and says Pres. Obama wanted a person in charge of the response who focused solely on the virus:
By bringing on Mr. Klain he will dedicate 100% of his time to coordinating this whole-of-government approach…The president recognized that the response would benefit from having someone that could devote 100% of their time to coordinating the response, and somebody like Mr. Klain, who has a strong management track record both inside government and outside has the right track record…This is much bigger than a medical response…there is a significant medical component, but it’s not solely a medical response
Press secretary Josh Earnest says the White House was looking for an ‘implementation expert’, not necessarily someone qualified in Ebola treatment. He tells CBS that Klain is responsible for coordinating the approach to the virus between the various agencies such as USAID and AfriCom overseas and the DHS and CDC domestically:
This administration, under the direction of the President, is pursuing a whole-of-government approach…it is the responsibility of Mr Klain to coordinate those efforts across agencies to make sure we are maximizing this whole-of-government approach.
Klain was selected for his experience in private- and public-sector management:
The president wanted someone who could working in a coordinating function…what we were looking for is not an Ebola expert but an implementation expert.
Some Republicans and political commentators have referred to Klain as a ‘czar’:
They’re certainly welcome to do that. We describe him as the Ebola response coordinator.
He is reporting to Rice and Monaco, but Pres. Obama remains in ultimate charge of the Ebola response.
The Russian government has placed all students arriving from west Africa – more than 1,000 people – under monitoring. Deputy education minister Kaganov:
I’m sure there is no real danger of Ebola getting into [Russia].
Syracuse is reported to disinvite Washington Post photographer du Cille, a Pulitzer Prize winner, from a journalism workshop as he had been in Liberia three weeks earlier, more than the 21-day Ebola incubation period. A student is reported to have researched du Cille and discovered the trip and raised concerns, after which provost Eric Spina consulted with health officials and made the call. Du Cille:
It’s a disappointment to me. I’m pissed off and embarrassed and completely weirded out that a journalism institution that should be seeking out facts and details is basically pandering to hysteria.
Travel agents in the U.S. say that individual customers have canceled trips due to concerns over Ebola, although the travel market remains mostly unaffected overall. Tim Husted, a traveler-services executive for Carlson Wagonlit Travel, says fewer than 1% of the company’s leisure travelers have changed a booking and there is even less of a reaction among business travelers, although a few have requested routes that avoid Dallas. Maryann Cook, a travel agent in New York, says a Florida doctor who booked a $197,000 family safari trip to South Africa for 30 people next year wants to rebook it for 2016, even if it means losing a $60,000 deposit.
He didn’t feel a real urgency because South Africa is so far away from the problem spot, but he got a lot of stress from his children and his children’s children.
New York travel agent Blake Fleetwood says a client who booked travel to India is worried about a stopover in London, where there could be a greater chance of exposure to travelers from west Africa.
We’re hearing from everyone. Even people flying domestically are very nervous.
He says he understands the anxiety:
I wouldn’t fly on Frontier Airlines. I know that’s a crazy thing to say, but I just wouldn’t want my mind to be bothered. I would take another airline.
Texas Health Presbyterian workers who treated Duncan have been restricted from going out to restaurants, grocery stores, and movie theaters as well as traveling by plane, ship, long-distance bus, and other types of transportation during the 21-day observation period. (Restriction documents here.) Dallas County Judge Jenkins:
These are hometown health care heroes. They want to do this. They’re going to follow these agreements.
The New York Times reports that only a handful of U.S. hospitals are equipped to handle the large amounts of waste produced by cases of Ebola. Aside from Emory University and the University of Nebraska, most facilities don’t have incinerators or autoclaves (steam sterilizers) and specially trained staff. Texas Health Presbyterian had to pack and ship 55-gallon drums of waste including body fluids, linens, hazmat suits and an entire hospital bed, to a Port Arthur, Tx., incinerator. Debra Sharpe, a Birmingham, Ala., biosafety expert:
It would take me anywhere from four to six weeks to train an employee to work in a high containment lab in a safe manner. It’s ludicrous to expect doctors and nurses to figure that out with a day’s worth of training. None of the science is new; none of the protection components are new. It’s just new in a health care setting. Hospitals and the C.D.C. should have been reaching out to the biosafety community before now, to try to adjust to this.
The Biomedical Advanced Research and Development Authority (BARDA) has issued a task order for three U.S. biotech labs to submit plans to produce ZMapp. One of the labs is housed at Texas A&M Health Science Center and works with GlaxoSmithKlein Plc, and was established in 2012 2by U.S. officials as a Center for Innovation in Advanced Development and Manufacturing, with $440 million in seed money. two other U.S. emergency drug manufacturing centers are a facility led by Emergent Biosolutions in Baltimore and a second in Holly Springs, North Carolina, led by Swiss drug company Novartis AG. Once proposals are submitted on Nov. 10, BARDA will choose one or more of the labs to produce the drug. Official at the Texas facility:
We are prepared to take action immediately to ramp up production on this promising experimental drug for those in need of Ebola therapies
60-year-old retired municipal worker Emanuel Smith is arrested and part of the Horseshoe Casino is shut down after Smith says he is there to avoid his ex-wife, who he jokes has Ebola. Records show the comment:
[…] Caused panic [and] a large financial loss
Perry comes under scrutiny from both Republicans and Democrats for traveling to Europe during the Ebola scare on a foreign policy trip, ahead of an expected presidential run, that meant he was away when the infections of Pham and Vinson happened. Republican strategist Mark McKinnon:
Crisis management is actually something Perry has done pretty well in the past. But, in this case when the national spotlight was on Texas, Perry was missing in action. And based on pure politics, this is a situation where he could have taken command and control and looked presidential. He’s trying to jump back on stage now, but at the very least, he missed the first act because he was in Europe.
Democratic strategist Paul Begala:
Of course, Gov. Perry should have canceled his trip or come back from Europe — just as President Obama should have gone to the border. As George H.W. Bush said, ‘90 percent of life is just showing up.’ Now, will that hurt Perry two years from now? No way.
U.S. soldiers are reported to receive four hours of training about Ebola before deploying to west Africa, and are having to invent some protocols and procedures on the fly. The first 500 personnel to arrive are also waiting for longer-term infrastructure to be set up, and have been housed in government buildings and hotels, it says. U. S. Army Medical Research Institute of Infectious Diseases spokesman:
All training is tiered to the level of risk each person may encounter
Frontier is now seeking to contact 800 passengers who flew on plane number N220FR, an Airbus A320, after Vinson’s flight. The plane made five flights before the CDC informed the airline that she may have been contagious and it was removed from service, flying to Atlanta and Fort Lauderdale, then back to Cleveland. Passengers on the Oct. 10 Frontier Flight 1142 from Dallas/Fort Worth to Cleveland and passengers on Monday’s Flight 1143 from Cleveland to Dallas/Fort Worth have been asked to call the CDC and monitor themselves for symptoms.
The Washington Examiner reports that the Obama government may be planning to bring foreign Ebola patients to the U.S. for treatment. The report cites the conservative group Judicial Watch, which is representing the paper in a Freedom Of Information Act suit, as saying:
Specifically, the goal of the administration is to bring Ebola patients into the United States for treatment within the first days of diagnosis
A report says that Klain was involved in President Obama’s decision to visit the solar power company in 2011 despite questions over its finances. As Ebola ‘czar,’ Klain will report to National Security Advisor Susan Rice and homeland security adviser Lisa Monaco, it says.
The Carnival Magic heads back to the U.S. after Mexican authorities declined to grant permission to dock off the Cozumel coast. The ship is headed back to Galveston, Tx., after Mexican authorities failed to grant permission by midday, due to the presence onboard of the Texas Health Presbyterian lab worker.
CBS reports that Obama-appointed Ebola ‘czar’ Klain has no medical or health care background. A Democratic senator praises the choice of Biden’s former chief of staff while a Republican senator criticizes it. Charles Schumer, D-N.Y.:
I’ve known Ron Klain for over twenty years. He is smart, aggressive, and levelheaded; exactly the qualities we need in a czar to steer our response to Ebola. He is an excellent choice.
Worst ebola epidemic in world history and Pres. Obama puts a government bureaucrat with no healthcare experience in charge. Is he serious?
— Rep. Andy Harris, MD (@RepAndyHarrisMD) October 17, 2014
Arlington and Fairfax hazmat and medical teams are sent to the Pentagon and pedestrian and vehicle traffic is shut down at the Pentagon Memorial, while a large area o the Pentagon south parking lot is sealed to the public after a woman was taken ill on a bus tour of the monument. The woman is reported to have recently arrived from Sierra Leone, and began vomiting during the tour.
— Brad Freitas (@NewsChopperBrad) October 17, 2014
CBS reports that Klain is appointed partly in response to confusion over who is in charge of the anti-Ebola effort. In a segment of a White House press question-and-answer a reporter asks Earnest:
[You are] reluctant to say who’s in charge of the federal response to Ebola
It interviews medical expert Dr. David Agus who says while states are in charge of their own medical response, the federal government needs to coordinate the approach:
We’re getting such mixed messages
Perry’s office confirms that he wants a travel ban. He has previously called for stepped-up screening at entry points but has stopped short of an outright restriction. Communications director:
Gov. Perry believes it is the right policy to ban air travel from countries hit hardest by Ebola … provided there is an exception for aid workers
— Office of Gov Perry (@TexGov) October 17, 2014
A Texas Health Presbyterian employee who may have handled fluid samples from Duncan has been placed in quarantine on a Carnival cruise ship in the Caribbean. State Department’s Jen Psaki:
The employee … may have had contact with clinical specimens collected from him. The individual was out of the country before being notified of CDC’s updated requirements for active monitoring. At the time the hospital employee left the country, CDC was requiring only self-monitoring.
A doctor on the cruise ship has declared the woman symptom-free and in good health. She handled the fluid samples 19 days ago, and has two more days until passing the 21-day threshold for Ebola incubation. The ship is being held off the coast of Belize until she can be removed and returned to the U.S.
A Dallas lab worker, thought to have handled specimens from Thomas Eric Duncan, is quarantined aboard a cruise ship off the coast of Belize. The Belize coast guard refuses to allow the ship to dock or passengers to disembark. Carnival Cruise Lines:
At no point in time has the individual exhibited any symptoms or signs of infection and it has been 19 days since she was in the lab with the testing samples. She is deemed by CDC to be very low risk. At this time, the guest remains in isolation on board the ship and is not deemed to be a risk to any guests or crew. It is important to reiterate that the individual has no symptoms and has been isolated in an extreme abundance of caution. We are in close contact with the CDC and at this time it has been determined that the appropriate course of action is to simply keep the guest in isolation on board.
The government of Belize reassures the public that the passenger never set foot in Belize and while we remain in close contact with U.S. officials we have maintained the position that when even the smallest doubt remains, we will ensure the health and safety of the Belizean people.
An entrance to the Pentagon and South parking lot are closed due to an Ebola scare. A woman who claims she recently returned from western Africa is found ill and vomiting in the South parking lot by police. The woman is transported to Inova Fairfax Hospital in Falls Church, Va. Lt. Col. Tom Crosson, a Pentagon spokesman:
Out of an abundance of caution, all pedestrian and vehicular traffic was suspended around the South Parking lot, while Arlington County responded to the scene.
A report says that Texas Health Presbyterian had a machine that the U.S. military is using to screen for the virus in west Africa, but was prevented by government guidelines from using it to screen Duncan. The toaster-sized box called Film Array, which retails for $39,000 and is produced by bioMérieux subsidiary BioFire, is capable of detecting Ebola with a high degree of confidence in under an hour. The FDA rules that it must be used only to screen patients for research purposes, not to treat patients.
The Independent reports that 4,000 children in west Africa have been orphaned by the virus, and that number could rise as the UN predicts 10,000 new cases per week. It reports that last month, two children orphaned by the virus starved to death, as aid workers weren’t able to reach them. The newspaper interviews the head of the Street Child charity, who says food prices have risen by up to 100% in Ebola-affected areas of the country, and people are afraid to go out to the fields or to market. Especially in places under quarantine, this leaves people vulnerable:
Life in those districts – it’s like holding your breath: you can do it for a while, but you can’t do it for huge periods. It’s the most vulnerable that reach the sharp end first.