The driver is isolated and his bus is taken out of service after a masked passenger began shouting threats:
Don’t mess with me, I have Ebola!
Metro officials and the LA County sheriff’s transit authorities are reviewing surveillance tapes from inside the bus to determine the identity of the passenger, who was accompanied by a woman.
Frieden says that a breach in safety protocols led to the infection of the nurse in Dallas, and warns of more infections:
We’re deeply concerned. Unfortunately, it is possible that in the coming days we will see additional cases of Ebola.
Brantly donates plasma to Pham, the third patient who has been given his blood in the hope that antibodies he developed in his recovery from the virus can cure others. Brantly is believed to have traveled to Texas Health Presbyterian Hospital to make the donation on Sunday night.
The Dallas nurse diagnosed with the virus is identified as 26-year-old Nina Pham. Her family confirm the identification. Pham graduated from Texas Christian University’s nursing program in 2010.
Director General Margaret Chan warns that 90% of the economic costs of any outbreak stem from…
irrational and disorganized efforts of the public to avoid infection.
She adds that the treatment of patients spotlights growing global inequalities:
The outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die.
The WHO warns that the virus is ‘the most severe acute health emergency in modern times.’ Director-General Margaret Chan:
I have never seen a health event threaten the very survival of societies and governments in already very poor countries. I have never seen an infectious disease contribute so strongly to potential state failure.
Health experts criticize CDC Director Frieden’s remark that a ‘protocol breach’ caused the Dallas nurse’s infection. They say that hospital staff need to be coached on each step of the process of dealing with Ebola patients, and that given the level of training needed to do the job safely, the government should consider designating a hospital in each region as the go-to facility for Ebola. National Nurses United disaster relief expert Bonnie Castillo:
You don’t scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct.
Brown causes a fury among his fans when he comments on the Ebola outbreak.
A passenger on a flight from JFK is investigated at LA International after showing Ebola-like symptoms. Officials say the cause is air sickness. Los Angeles Fire Captain Jamie Moore:
[It was] simple airline illness. If you were on a boat for a long time and you were going up and down, those are the same symptoms that this patient would have been exhibiting … Being in a confined space, not being able to get fresh air, not being able to see outside, just feeling general motion sickness.
State Attorney General Buddy Caldwell is seeking a temporary restraining order to block the disposal of incinerated waste from Duncan’s apartment at a Louisiana landfill:
We certainly share sadness and compassion for those who have lost their lives and loved ones to this terrible virus, but the health and safety of our Louisiana citizens is our top priority. There are too many unknowns at this point, and it is absurd to transport potentially hazardous Ebola waste across state lines.This situation is certainly unprecedented and we want to approach it with the utmost caution. We just can’t afford to take any risks when it comes to this deadly virus.
Health experts are rushing to determine how Pham contracted the virus. They propose several scenarios, including that she was infected while Duncan was being intubated or receiving kidney dialysis, both procedures with a high risk of contact with infected materials. Templeton University doctor Eileen Farnon, who formerly worked at the CDC and led teams investigating past Ebola outbreaks in Africa:
Removing the equipment can really be the highest risk. You have to be extremely careful and have somebody watching you to make sure you remember all the steps.
Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist:
I can have on the suit and be very careful, but I can pick up some secretions or body fluids on a surface
CDC director Frieden says the centre is considering several possibilities as to how the Dallas nurse became infected with the virus. One possibility is that the infection spread when protective equipment was removed or when Duncan received kidney dialysis or respiratory intubatution in last-ditch efforts to save his life:
Both of those procedures may spread contaminated materials and are considered high-risk procedures… When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material … touching you and being then on your clothes or face or skin … is not easy to do right.
Another possibility is out-of-protocol precautions taken by healthcare workers worried about safety, but which can actually increase risks, such as wearing three pairs of surgical gloves instead of two.
Liberia’s armed forces are leading anti-Ebola efforts including building 18 treatment centres across the country, and are working with U.S. Africa Command forces to rejuvenate their image after the country’s civil war. Joseph F. Johnson, a deputy minister at Liberia’s Defense Ministry:
We’re trying to rebrand the A.F.L. as a force for good. Piggyback on this.
Checks by Reuters show that state and city plans for handling Ebola are based on generic recommendations for disasters from measles to floods, hurricanes and dirty bombs. Health departments in Philadelphia, Boston, New York City, Minnesota, New Jersey, Maryland and Rhode Island are scrambling to adapt the generic plans. They must adapt hospital drills, 911 emergency operator guidelines, quarantine rules, and details such as checking that plastic body bags meet the minimal thickness of 150 micrometers recommended by the CDC. Rand Corp public health expert Chris Nelson:
It takes a certain amount of reverse engineering to get the plan to where it can respond to new, emerging threats.
Liberia bans journalists from Ebola treatment units due to concerns over privacy. Deputy information minister Isaac Jackson:
Journalists are no longer allowed to enter ETUs. These journalists enter the ETUs and cross red lines. They violate people’s privacy, take pictures that they will sell to international institutions. We are putting an end to that.
The NBC News crew including chief medical correspondent Nancy Snyderman that worked with Mukpo are placed in mandatory isolation in New Jersey after a 21-day voluntary isolation agreement was breached. The state Health Department says the crew remains symptom-free and there is no reason for concern of exposure to the virus to the community. It doesn’t give details on the breach of the voluntary agreement.
New York’s John F. Kennedy International Airport starts screening arriving passengers for the virus. The CDC has stated that not every incoming passenger will be screened. In fact, only about 150 people per day will be screened. The country of origin will be a factor in deciding whether or not a passenger will receive further attention. The CDC admits that even with these measures, it will not be impossible to prevent the virus from entering the United States:
No matter how many of these procedures are put into place, we can’t get the risk to zero.
John F. Kennedy International Airport begins Ebola screening. Inspectors will use special procedures to screen people traveling from Liberia, Sierra Leone or Guinea. CDC:
Our hope is that the screening will improve vigilance and increase awareness about the Ebola disease for those individuals traveling from the affected areas.
A 14-year-old boy from Colorado visiting Brooklyn is reported to have been placed in isolation at Brookdale University Hospital and Medical Center and treated according to Ebola protocols, after showing flu-like symptoms. The patient said that he had recently returned from a trip to Sudan, and reportedly lied to authorities so he could fly home. An official with the city’s Department of Health and Mental Hygiene tells 1010 WINS there are no patients currently suspected of having Ebola in New York City. WCBS 880 reports that New York City health officials also confirm he tested negative for Ebola. The boy’s uncle says the family did not think he had Ebola but sent him to hospital after he felt dizzy:
These are regular procedures that the officials needed to take just to make sure everything’s OK. I’m perfectly OK with it
Scientific American says that the outbreak highlights problems with procedures, equipment and training worldwide. It notes a Guardian report that the doctor who attended Spanish nurse Teresa Romero Ramos complained his hazmat suit’s sleeves were too short, while Romero herself told Spanish media she may have contracted the virus by accidentally touching her face with a gloved hand as she removed her protective gear. It says the cleanup team at Thomas Eric Duncan’s apartment wore full-face respirators and Level B Saranac suits. Cleaning Guys vice president Brad Smith:
We followed the recommendations of the [U.S. Centers for Disease Control and Prevention] but went one level above that as far as personal protective equipment
European countries are monitoring dozens of patients amid fears the outbreak could spread. 35 people in Macedonia have been placed in isolation after a British man died there and his friend was hospitalized. Lab samples are being tested in Frankfurt to determine if they had Ebola. In Prague, a Czech man is being tested for Ebola while in Spain, seven people turned themselves in voluntarily to an isolation unit, while six other people who had contact with nurse Teresa Romero are already being monitored. Romero’s condition remains serious but stable.
Mayor Bill de Blasio puts New York City on alert but says authorities have clear protocols to handle any potential Ebola cases.
There has not been a case in New York City. There is no cause for alarm… The city is particularly well prepared for any possible instance of Ebola because of our extraordinary health care system. Physicians, hospitals, emergency medical personnel are trained in how to identify this disease and how to quickly isolate anyone who may be afflicted.
The WHO warns that Ivory Coast, Guinea-Bissau, Mali and Senegal top a list of 13 countries urged to be prepared for Ebola cases. Other countries the agency is concerned may get Ebola cases are Benin, Cameroon, Central African Republic, Democratic Republic of the Congo, Gambia, Ghana, Mauritania, Nigeria and Togo. Daouda Coulibaly, head of the epidemiological monitoring service at the Ivory Coast’s National Institute of Public Health:
We are extremely at risk given the fact we share borders with two countries heavily affected
Dr. Aileen Marty talks to Jorge Ramos of Fusion after returning from a 31-day WHO mission to Nigeria, and says no checks were performed at Miami International Airport:
I get to the kiosk…mark the fact that I’ve been in Nigeria and nobody cares, nobody stopped me
She says this highlights a lack of preparation to handle travelers from Ebola-affected areas:
If we don’t change our entry method and this outbreak continues to get completely out of control…it’s likely to be seen in other countries.
The UN body says practices like rubbing a patient’s body with limes and onions or drinking saltwater are ineffective against the virus, and warns against fake vaccines and cures.
Decades of scientific research have failed to find a curative or preventive agent of proven safety and effectiveness in humans, though a number of promising products are currently under development. All rumours of any other effective products or practices are false. Their use can be dangerous. In Nigeria, for example, at least two people have died after drinking salt water, rumoured to be protective.
The British national who died in Macedonia may have had alcohol poisoning, not Ebola. Unnamed official:
We have serious indications from several places that he consumed large amounts of alcohol, so the theory that this might be the cause of death is very much in play.
Farrakhan claims the virus is a ‘race-targeting bioweapon’ created by the U.S. government:
There is a weapon that can be put in a room where there are Black and White people, and it will kill only the Black and spare the White, because it is a genotype weapon that is designed for your genes, for your race, for your kind … So, if you are poor and ignorant; if you are Black or Brown, you are being selected for destruction.
UN special envoy on Ebola David Nabarro tells the General Assembly that the number of cases is probably doubling every three to four weeks, and the response needs to be 20 times greater. He says that without a mass global mobilization:
the world will have to live with the Ebola virus forever
The UK introduces enhanced screening measures at Heathrow, Gatwick and Eurostar terminals for passengers arriving from Liberia, Guinea and Sierra Leone. Cameron:
Quite rightly, we’re taking all the steps we can to keep our own people safe here in the UK. What we do is we listen to the medical advice and we act on that advice and that’s why we’re introducing the screening processes at the appropriate ports and airports.
There are no direct flights to the UK from the affected areas but people can fly via Paris or Brussels.
Liberian lawmakers are debating whether to grant Sirleaf wider powers to restrict movement and public gatherings. A proposal would give authorities to seize property ‘without payment of any kind or any further judicial process’ to combat Ebola and allow Sirleaf to ‘limit the right to assembly for any reason.’
An additional 100 U.S. Marines arrive in Monrovia on four MV-22 Ospreys and two KC-130s, increasing the number of American troops in Liberia to just over 300. Sierra Leone President Ernest Bai Koroma:
Our people are dying
CDC Director Frieden tells a forum in Washington that includes the heads of the UN, World Bank, and IMF, that the spread of the virus is unseen since the AIDS epidemic:
I would say that in the 30 years I’ve been working in public health, the only thing like this has been AIDS … We have to work now so that it is not the world’s next AIDS.
Officials in hazmat suits board U.S. Airways passenger flight 85 out of Philadelphia on landing in the Dominican Republic, after a passenger apparently joked about having the virus. A passenger who recorded the incident:
Once we landed in Punta Cana we were told by the flight attendants that there was a situation and that a passenger may have been in Africa and had Ebola. She was certain it was a hoax but they did not take any chances and had a full hazmat crew board the plane and take the passenger off. It was later confirmed that the passenger was never in Africa and after 2hrs we were finally able to get off the plane.
Turnout for the Red River Showdown college football weekend in Dallas may be being affected by the news that Duncan contracted the virus. Jay Khan, General Manager of RJ Mexican Cuisine:
The buzz is definitely different. The West End is still going to have a lot going on… but, the decorations and the preparations that we usually do? It’s definitely not there this year. I think [Ebola] is affecting it. No doubt about that.
Another explanation is that both the University of Texas and University of Oklahoma college teams are coming off losing seasons and there is no championship at stake.
Obama appears to contradict CDC advice in a video message to residents of west Africa:
You cannot get it through casual contact like sitting next to someone on a bus.
CDC advice to travelers to west Africa worried about Ebola:
Limit your contact with other people when you travel to the doctor; avoid public transportation.
Health officials say the number of people expected to contract the virus from each person who has already contracted it – the ‘reproduction number’ – is currently at epidemic levels of 1.5-2, and the outbreak won’t decline until it falls below one. CDC Director Frieden:
The speed at which things are moving on the ground, it’s hard for people to get their minds around. People don’t understand the concept of exponential growth
WHO assistant director general Bruce Aylward describes the situation in west Africa:
The situation is worse than it was 12 days ago. It’s entrenched in the capitals. Seventy percent of the people [who become infected] are definitely dying from this disease, and it is accelerating in almost all settings
Federal officials announce that temperature screening of passengers arriving from Liberia, Sierra Leone and Guinea will start at New York’s Kennedy International as early as this weekend, and at Washington Dulles International, O’Hare International, Hartsfield-Jackson International and Newark Liberty International next week. About 90% of passengers from the three countries arrive via these five airports, with 43% flying via Kennedy alone. Of 36,000 passengers who left the three countries in the past two months, about a quarter came to the U.S., and 77 had Ebola-like symptoms but none had the virus.
A federal Customs and Border Protection agent who works on the front lines at Newark International says customs officers at the tri-state air hub don’t have proper training and equipment to handle potential Ebola cases. He says that there are no doctors or CDC personnel assigned to the airport.
They are assuring the public everything is being done, but it is not
A Dallas County sheriff’s deputy is possibly infected with the Ebola virus. Deputy Monnig had spent time in the apartment of the late Ebola patient Thomas Eric Duncan, although he did not have direct contact with him. His son thinks that the symptoms are not related to Ebola, and that his father will therefore not test positive for the virus:
He was in the apartment for 30 minutes, which we were told is no chance to contact the virus
Excalibur is taken from the Madrid apartment where Teresa Romero and her husband live, sedated, euthanized, and incinerated. Protesters tried to stop the dog being taken away in a van, but police with batons cleared a path. A petition to save the dog received nearly 350,000 signatures on change.org.
Africa Command commander Gen. David Rodriguez tells a Pentagon briefing that U.S. personnel will handle lab samples from Ebola patients. The majority of the 3,000-4,000 personnel deployed will not have direct contact with patients.
The health and safety of the team supporting this mission is our priority.
Rodriguez had previously said some U.S. personnel would have direct contact with patients, but later clarified the remark.
Duncan is pronounced dead at 7:51 a.m. at Texas Health Presbyterian Hospital Dallas, where he was admitted Sept. 28 and has been kept in isolation. Texas officials are monitoring 10 people who had direct contact with him while he was symptomatic, as well as 38 others who may have had contact. None have shown symptoms of the disease to this point. They will be monitored for 21 days, the normal incubation period for the disease. Hospital:
Mr. Duncan succumbed to an insidious disease, Ebola. He fought courageously in this battle. Our professionals, the doctors and nurses in the unit, as well as the entire Texas Health Presbyterian Hospital Dallas community, are also grieving his passing. We have offered the family our support and condolences at this difficult time.
Monnig, a sheriff’s deputy who served a quarantine order to the apartment where Thomas Eric Duncan was staying, is being examined at Texas Health Presbyterian Hospital for possible exposure to Ebola. Monnig, although not in direct contact with Duncan, exhibits symptoms and history that warrant testing. Dallas County Sheriff’s Office:
The deputy expressed concern and we directed that deputy to the Dallas County Health & Human Services for care. We now wait for further information as medical staff attends to the deputy.
CDC Director Tom Frieden, who is unofficially leading the U.S. response to Ebola says the virus becoming airborne is a possible but unlikely outcome in the current epidemic:
The rate of change [with Ebola] is slower than most viruses, and most viruses don’t change how they spread. That is not to say it’s impossible that it could change [to become airborne]. That would be the worst-case scenario. We would know that by looking at … what is happening in Africa. That is why we have scientists from the CDC on the ground tracking that.
The disease kills roughly half the people it infects, and lacking a vaccine or cure, its traceable chain of transmission through bodily fluids is one reason officials believe they can contain it.
WHO European director Zsuzsanna Jakab says that while more cases will spread in Europe, the continent should be well prepared to control the disease.
Such imported cases and similar events as have happened in Spain will happen also in the future, most likely. It is quite unavoidable … that such incidents will happen in the future because of the extensive travel both from Europe to the affected countries and the other way around. The most important thing in our view is that Europe is still at low risk and that the western part of the European region particularly is the best prepared in the world to respond to viral haemorrhagic fevers including Ebola.
A Spanish nurse is reported to be the first person contract the virus outside Africa. Health Minister Ana Mato says the woman treated Viejo at a Madrid hospital before he died of the virus. The woman went to the Alorcon hospital in the Madrid suburbs with a fever and was placed in isolation. The infection is confirmed by two tests and she was admitted Sunday. The fever was her only symptom. Madrid director of primary health care Antonio Alemany says authorities are drawing up a list of people she had contact with.
International aid workers recruit survivors to give courses to medical workers. Shevan Jacob, a WHO trainer who worked on previous Ebola outbreaks in Uganda and the DR Congo:
We tell the health workers that our role here is to protect and save lives … Many are afraid, they all have lost colleagues to the disease
Training takes two weeks including three days of theory classes, two days in a mock ETU, and working for five days in a real unit with a mentor.
Duncan has worsened and is in critical condition, Texas Health Presbyterian says. The hospital doesn’t provide other details.
CDC officials walk a man believed to be traveling from Liberia off United flight 998 at Newark after he falls ill. A source says the man had been vomiting. He is quarantined with his daughter, who appears to be about 10, at University Hospital.
CDC Director Frieden says a travel ban would make it harder to get supplies to west Africa. African Union aid workers experienced difficulty getting aid to Liberia:
Their ability to get there was delayed by about a week because their flight was canceled and they were stuck in a neighboring country