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.
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.
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.
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.
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 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.
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.
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.
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.
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 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
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.
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 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.
Friends and relatives of Ebola patients say many people have vanished after being admitted to Liberia’s hospital system. Some people passed through the health system without a paper trail, others were transferred between clinics without notice, and hundreds have been cremated before their families are informed that they have died. A hygienist who says he has reassured people that patients are okay, although he wasn’t sure himself:
I don’t want to be the one to tell them that bad news
Klain is reported to be excused from a Republican-led congressional panel on Ebola due Friday. He will officially start work on Wednesday. A White House official confirms that he did not attend two previous meetings in the 48 hours after he was appointed as response coordinator:
It is not that long of a lapse
The DHS says that four passengers were taken from Dulles to a local hospital after enhanced screening raised alarms. DHS and the CDC don’t give further details. The two Northern Virginia hospitals closest to Dulles say they didn’t receive the patients. DHS and CDC aren’t able to explain the discrepancy. A person familiar with the screenings says a 13-year-old boy and his mother were taken to a hospital last Thursday after the CDC became concerned about their symptoms, and two other passengers were taken to a hospital over the weekend. The person was unable to name the hospital, and said that all four passengers apparently were released after further testing.
The World Health Organization announces the true Ebola death toll may be three times more. Higher numbers place Guinea with a factor of 1.5, Sierra Leone at 2.0 and Liberia at 2.5. This suggests a true total of approximately 15,000 deaths versus a minimum of 4,877. At least 9,936 cases report infection. Of the thousands of cases, 443 health workers contract the disease resulting in 244 deaths. Official:
Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care.
Klain meets with Obama and senior White House staff members to discuss strategies for preparedness and containment on his first day as “Ebola czar”. White House official:
He will attend meetings with other senior White House staff, as well as with the White House teams that are coordinating and operationalising the comprehensive strategy to enhance our domestic preparedness and contain the epidemic in West Africa.
Mukpo discusses the effects of his battle with Ebola and his travels to Liberia in an interview with NBC News after being declared free of the virus.
I mean, there’s definitely some physical effects of this that I think are gonna last a while. But I can feel my strength coming back every day. And, I mean, there was a period of time that I was quite sick. And, you know, I was laying in a hospital bed and had no strength. Had various pains. And — and just all kinds of fun stuff going on in my body. I mean, I think it’s important in life to take risks for things that you believe in. But it’s also important to keep yourself safe. So, I mean, it’s hard to call Ebola a learning experience. But I think that I’m gonna walk away from this with some important lessons for the future.
The CDC announces that it will monitor all passengers from west Africa – even Americans – for a mandatory 21 days. The screenings will begin Monday in New York, Pennsylvania, Maryland, Virginia, and Georgia. Travelers will be given information cards and a thermometer and be required to make daily checkins with state or local health officials in person, by phone, Skype or Facetime, or through employers. CDC director Frieden:
The bottom line is that we have to keep our guard against Ebola.
The official WHO death toll from the virus stands at 4,877 as of Oct. 19, while at least 9,936 cases of the disease had been recorded, but the organization says the real figures may be three times as high. The real numbers are higher by a factor of 1.5 in Guinea, 2 in Sierra Leone and 2.5 in Liberia, while the death rate is thought to be about 70 percent of all cases. WHO on why so many have caught the disease:
Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care
U.S. and British insurers are writing exclusions into standard policies to cover hospitals, event organizers and other businesses vulnerable to local disruptions. That means new policies and renewals will become costlier for companies that insure business travel to west Africa or to cover the risk of losses from quarantine shutdowns at home. Gary Flynn, an event cancellation broker at Jardine Lloyd Thompson Group Plc in London:
What underwriters are doing at the moment is they’re generally providing quotes either excluding or including Ebola – and it’s much more expensive if Ebola is included
Vinson’s mother says that she has tested negative for the disease.
Amber and our family are ecstatic to receive this latest report on her condition. We all know that further treatment will be necessary as Amber continues to regain strength, but these latest developments have truly answered prayers and bring our family one step closer to reuniting with her at home.
Officials from at least three hospital systems interviewed by Reuters say they are considering whether to withhold individual procedures or leave it up to individual doctors to determine whether interventions will be performed, while ethics experts are fielding calls from doctors asking what their professional obligations are to patients if healthcare workers could be at risk. One issue is that there are no data on whether an Ebola patient is beyond help, or whether procedures like dialysis or CPR can be performed safely and effectively. Medical historian Dr. Howard Markel:
This is another example of how this 21st century viral threat has pulled us back into the 19th century
Schaffner tells PBS that other illnesses are a bigger risk than Ebola. Questioned about the 600 measles cases this year:
Yes. Can you imagine that? And that’s because there’s still measles out in the world, but our parents, many of them, are withholding their children from vaccination. And so when someone from — with measles comes into this country, it can spread among our own children, causing a whole lot of illness, illness that we thought was long gone.
He says whooping cough, antibiotic-resistant bacteria, and flu are also more dangerous.
Ebola is new, mysterious, fierce. It has a very high mortality rate. And people feel a lack of control. There’s nothing they can do about it. They can get vaccinated against flu, but they feel put upon. I have even spoken to some people who seem indignant that something like Ebola could even come to the United States in the 21st century.
Cybercriminals are using an email that appears to be an informative message from the World Health Organization to hack computers. Cybersecurity firm Trustwave says it appears that several hundred organizations have been targeted. Karl Sigler, threat intelligence manager at Trustwave:
It follows the standard, successful formula for most phishing campaigns.
Spencer tests positive for the Ebola virus at Bellevue Hospital in New York City. Spencer is the only diagnosed case in New York City, the fourth case diagnosed in the United States. New York City Mayor Bill de Blasio:
There is no reason for New Yorkers to be alarmed. New Yorkers who have not been exposed to an infected person’s bodily fluids are not at all at risk.
Mukpo returns home to Providence, RI on a chartered jet after being declared free of the Ebola virus. Mukpo is now requesting privacy. Dr. Mitchell Levy, Mukpo’s father:
He has said he will begin to write and speak about his ordeal, including with the press, but he wants to do it on his own time.
Spencer is rushed to Bellevue Hospital in New York City with Ebola-like symptoms. Spencer tells authorities he began to feel sluggish on Tuesday but did not develop a fever until this morning. At 11 a.m., the doctor found that he had a 103-degree temperature and alerts the staff of Doctors Without Borders, who calls the New York health department, which in turn called the Fire Department. Emergency medical workers, wearing full personal protective gear, rush to Spencer’s apartment, on West 147th Street, and he is transported to Bellevue and arrived shortly after 1 p.m. He is placed in a special isolation unit and is being seen by the pre-designated medical critical care team. They are in personal protective equipment with undergarment air ventilation systems. Health Department:
After consulting with the hospital and the CDC, DOHMH has decided to conduct a test for the Ebola virus because of this patient’s recent travel history, pattern of symptoms, and past work.
Sources say Morrison is suggesting implementing mandatory quarantine for anyone arriving in Australia from Ebola-affected west Africa. He has said that a hard-line quarantine approach could be best run by being absorbed under his immigration portfolio and handled by the Operation Sovereign Borders team, which is in place to stop people smuggling into the country. A minister tells ABC radio:
[Morrison is] annoying everyone on the National Security Committee because he’s not across all the facts on Ebola. He doesn’t have access to what the chief medical officer is advising the Health Minister.
New York state officials are monitoring four people who had contact with Spencer. His fiancee and two friends are healthy but have been quarantined. The fourth person is who is in contact with the state is the driver of an Uber car that Spencer took when he bowling Wednesday night in Williamsburg. The driver had no direct contact with Spencer, and is not believed to be in any danger.
Forty-three Liberians in quarantine after four people died of Ebola in Jenewonda, a town in an impoverished corner of Grand Cape Mount County near the Sierra Leone border, threaten to break out of isolation as they have no food. The World Food Program has not previously been supplying the area but will begin doing so. The WFP’s logistics unit is delivering the food Thursday, but it must be driven in from Monrovia as there are no trucks in the area. WFP spokesman:
WFP in Liberia heard about this community being isolated only two days ago via the radio and staff immediately began organizing a mission to bring food to the quarantined people.
The workers at University of Texas Southwestern Medical Center use the sauce to practice taking hazmat gear on and off. If the sauce touches their skin, they have been ‘contaminated’. Capsicum frutescens, the peppers used in Tabasco, contain capsaicin, which has previously been used in medical settings including dermatology and neurology for pain and itch relief. Dr. Bruce Meyer:
In a way, it gives feedback immediately
Schools in states states such as Louisiana, Maryland and Georgia are taking precautions that include rules allowing superintendents to close schools, Ebola risk assessments for all children registering for school, and measures to ensure quarantined students are provided homework and instruction. In one instance, DeKalb County School District in Georgia notified principals and administrators that no new students from Liberia, Sierra Leone or Guinea—as well as affected areas in the U.S.—would be enrolled or allowed to attend classes without medical documentation and approval. University of California public health professor:
I can understand wanting to be prepared. But most of these school districts will never encounter a student with contact with the three countries. It’s a legitimate concern but an overreaction.
The slum, which is Liberia’s biggest and is home to 50,000 people, introduces measures like avoiding contact with the sick and hand-washing using a bleach solution, and avoiding eating ‘bush meat,’ meat from monkeys and rodents. Aid worker Mechie Seih tells charcoal seller Mamie Kollie how to lower infection risk if a family member falls ill:
You put clean plastic bags on your hands. You wear a thick jacket with long trousers. You put shoes and socks on your feet.
Pharmacist Doris Nyenkan says she now tells customers complaining of fever to get tested for Ebola. She also sells hand sanitizer, and uses it herself:
People clean their homes every day now. Now they are washing their hands, buying this gel. Before Ebola you didn’t see people doing such things.
Spencer tests positive for the virus at Bellevue Hospital. Spencer recently returned from treating Ebola patients in West Africa. He is the fourth confirmed case in the U.S. and the first in the city. He is being treated in a special isolation ward. City officials say the doctor’s symptoms developed Wednesday, prompting him to isolate himself in his apartment.
The CDC has dispatched an Ebola response team to New York, and the city’s disease detectives have been tracing the doctor’s contacts to identify anyone who may be at risk. His Harlem apartment has been cordoned off, and his fiance, who is not showing symptoms, is being watched in a quarantine ward at Bellevue.
Mayor Bill de Blasio said proper protocols were followed every step of the way and it didn’t appear the doctor had been showing symptoms for very long.
The patient is in good shape and has gone into a great deal of detail with our personnel as to his actions the last few days so we have a lot to work with. We have a patient who has been very communicative and precise and who has only been back a very short time and has been quite clear about individuals he had close contact with.
A study in Lancet Infectious Diseases warns of 171,000 cases of the virus in Montserrado county by Dec. 15, 12% of the country’s population, with over 90,000 fatalities. The study depends on the assumptions that every person with Ebola will infect 2.49 other people, and that health measures in Montserrado will remain unchanged. It says that if 4,800 beds are installed at treatment centres in November and health workers speed up fivefold the detection rate of Ebola cases, 77,312 cases could be averted. Health experts say the situation on the ground is changing. Doctor:
It’s too early to say whether the ongoing and intense control efforts in Monrovia have yet achieved control or merely slowed the epidemic, but what is being seen on the ground is clearly incompatible with the results in this paper.
Canadian and U.S. scientists developed a vaccine almost 10 years that was 100% effective in protecting monkeys against the virus, publishing their results in Nature and saying a product could be ready for licensing by 2010 or 2011, but the vaccine was shelved due to the lack of market opportunities. It is now undergoing basic safety tests in humans after falling into what an expert calls a ‘biotech valley of death’, where no drug company would help bring it to production. One of the vaccine developers:
There’s never been a big market for Ebola vaccines. So big pharma, who are they going to sell it to? It takes a crisis sometimes to get people talking. ‘O.K. We’ve got to do something here.’
Microsoft co-founder Allen quadruples an earlier donation pledge of $26 million to non-profits and government organizations including the CDC. Allen:
Everybody feels called sometimes to really pursue a certain thing that resonates with them, and this has resonated with me
Health and New York City officials are tracing the steps of Spencer, who travelled the city for three days before being diagnosed with the Ebola virus. They determine Spencer rode the subway, rode in a taxi and visited ‘The Gutter’, a Williamsburg bowling alley. The Gutter, shuttered after hearing the news, issues the statement:
We’ve been in constant contact with the Health Department and they have determined that there was no risk to our customers.
Mayor Bill de Blasio:
Being on the same subway car or living near someone with Ebola does not in itself put someone at risk.
Spencer follows guidelines set by Médecins Sans Frontières/Doctors Without Borders that say he does not need to self-quarantine upon returning from Guinea. MSF guidelines ask that those returning from Ebola infected areas self-monitor their health for 21 days. MSF statement:
‘Our colleague in New York followed the MSF protocols and guidelines since returning from West Africa.
Twitter users post angry tweets after learning Spencer travelled around New York City for three days while at risk for Ebola. Many tweets revolve around his visit to the Williamsbug bowling alley, The Gutter.
Spencer’s live in fiancée, Morgan Dixon, is quarantined at Bellevue Hospital. Two of Spencer’s friends voluntarily quarantine themselves in their homes. New York Governor Andrew Cuomo:
We are as ready as one can be for this circumstance.
Spencer’s family defends him against the critics who are upset that he did not quarantine himself upon his return to the United States. Arnie Spencer, Spencer’s uncle to Mail Online:
‘As far as I’m concerned he did nothing wrong. I’m angry that he is getting trashed. I don’t like what’s being said at all. ‘He’s a hero to me,’ said his uncle. He’s a fantastic humanitarian and that is how people should think of him. He wanted to be a doctor without borders from when he was a kid. It’s all he wanted to do.
Seattle Seahawks owner Allen donates 100 million to the effort to fight Ebola. Allen sets up a website, TackleEbola.com, where people can make donations.
Everybody feels called sometimes to really pursue a certain thing that resonates with them, and this has resonated with me. The exponential nature of the growth of this disease is really a challenge — we’ve already seen in the U.S. where one case quickly became two.
A two-year-old girl brought into Mali from Guinea is taken to the hospital in Kayes after showing symptoms, and tests positive. Her father had died of the virus. Health Ministry spokeswoman:
The girl is still in the hospital in Kayes together with members of her family who might have been exposed to the virus
Aid groups in west Africa say they have enough money to fight the virus but need more people. The WHO estimates that 1,000 foreign medical workers and 20,000 locals are needed to man the 50 Ebola treatment units due to be rolled out across the three worst effected nations, but so far there are firm commitments from foreign teams for only 30 of the units. Manuel Fontaine, head of UNICEF in west Africa:
The big gap is still in human resources. Money is necessary. It is an expensive operation. But we need people.