Chicago-based LifeSecure supply shop owner David Scott says he has shipped about 50 Extended Infection Protection kits worth $149.95 packages in the last two weeks with sales spiking in the three days since Duncan was diagnosed with Ebola. The kits include respirators, eye protection, gloves and biohazard bags. Scott:
People don’t tend to think about these things until they’re in the headlines, then they panic-buy.
Sales of $124.89 disposable DuPont Co. (DD) Tyvek suits surged 233% in 24 hours to 2:19 p.m. New York time on Amazon.com and DuPont, based in Wilmington, Delaware, says it has tripled production of some items used for Ebola protection and has
worked hard to shift products geographically and made a available a broader range of styles suitable for various treatment levels.
Sales of 3M Co.’s (MMM) particulate respirators, starting at $22, were up 4,004% according to Amazon’s data. Soap.com, a site owned by Amazon, said hand sanitizer sales jumped 20% this week.
Five schools in Dallas are set to install Wello Inc.-made WelloStation temperature monitoring devices to detect fluctuations in students’s body temperatures. Wello Inc.:
The WelloStation measures your body’s core temperature using a patented, non-contact and non-invasive process. An elevated body temperature is the number one indicator of infection. WelloStation quickly screens for fevered individuals so you can either prevent them from entering or perform additional medical checks.
Hospitals around the U.S. have reported 100 cases of Ebola-like symptoms since July. A CDC official says many hospitals remain unsure about how they are supposed to react when a suspected patient shows up. Atlanta’s Emory University Hospital, which has treated several Ebola patients from West Africa, has provided information and advice to hospitals, many of which are struggling with a lack of awareness about safety protocols and fear among some workers who feel ill-prepared. Washington-area health officials say they are trying to identify gaps in preparedness plans.
Mukpo’s mother, Diana, says his virus is in the ‘early stages’ and she is optimistic he will be cured.
At one point he was trying to help decontaminate a car. He had most of the protective gear on, but he thinks something might have splashed on his body at that point. That’s one possibility, but really, one doesn’t know fully.
NBC says 33-year-old American freelance cameraman Ashoka Mukpo has contracted a ‘low amount’ of the virus and is quarantined in Liberia and will be flown back to the U.S. Mukpo had been on assignment in Monrovia with Chief Medical Editor and Correspondent Dr. Nancy Snyderman and three other NBC News employees. His prognosis is good. Staff note from NBC News President Deborah Turness:
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 also taking all possible measures to protect our employees and the general public.
The rest of the crew, including Dr. Snyder, are ‘being closely monitored and show no symptoms or warning signs’ but will be flown to the U.S. and quarantined for 21 days.
62 doctors and 103 nurses from Cuba arrive in Sierra Leone after more than two weeks of training with international experts at a Havana hospital specializing in tropical diseases. Another 296 Cuban doctors and nurses will go to Liberia and Guinea after training. Deputy Health Minister Madina Rahman:
We have 165 medical officers, qualified health professionals that are here to help us in the fight against Ebola. As we know we need as much healthcare and professionals as possible. This will make a dent in the fight, we need more if we can get more
Liberia requires journalists to obtain official permission to cover many aspects of the outbreak under new rules aimed at protecting patient privacy. Journalists can be arrested and prosecuted if they fail to get written permission from the health ministry before contacting Ebola patients, conducting interviews or filming or photographing healthcare facilities. Tolbert Nyenswah, assistant minister of health and head of Liberia’s Ebola Incident Management System:
We have noted with great concern that photographs have been taken in treatment centers while patients are going in to be attended by doctors. That is invasion of the dignity, privacy and respect of patients. Ebola patients are no different from any other patients. We should do that (report) under permission so that we don’t just take pictures or send out stories of naked people (in a way) that does not respect their privacy.
The office of Dallas County DA Craig Watkins is considering state charges of aggravated assault against Duncan:
We’re dealing with the issue that he may have knowingly exposed individuals in Dallas County to the Ebola virus. We’ve prosecuted individuals, for knowingly exposing individuals to HIV – which is aggravated assault.
Initial Ebola tests of a prisoner at Cobb County Jail in Atlanta return negative. The area where the inmate was quarantined has been cleaned and the jail has lifted a ban on local agencies bringing in new inmates. Prison authorities are waiting for further test results, and the prisoner has been transfered to another medical facility.
Shady Grove Adventist Hospital in Rockville, Maryland, says a patient is in isolation with ‘flu-like symptoms and a travel history that matches criteria for possible Ebola.’ Lab results indicate the patient has another illness.
We are working closely with the Montgomery County Health Department and State Department of Health and Mental Hygiene (DHMH) as well as the CDC to manage this case and to ensure we continue to be prepared to care for patients with Ebola symptoms.
An inmate at Cobb County Jail in Atlanta is being tested for the virus. The person was arrested for a DUI overnight and told officials he had recently traveled to Africa after he developed a fever while in custody.
The D.C. Department of Health says there are no confirmed Ebola cases in D.C. It is working with the CDC and Howard University Hospital to monitor ‘any patients displaying symptoms associated with the Ebola virus.’
Mukpo’s father confirms that he will be transported to the isolation unit at the Nebraska Medical Center in Omaha on Sunday, the same facility where Rick Sacra was treated. His mother, Diana Mukpo:
[He is] very, very frightened, but his spirits are relatively good. We intend to go wherever he ends up.
A person who traveled to the U.S. from Nigeria is hospitalized at Howard University Hospital in Washington with possible Ebola symptoms. Hospital spokesperson:
We can confirm that a patient has been admitted to Howard University Hospital in stable condition, following travel to Nigeria and presenting with symptoms that could be associated with Ebola. In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient. Our medical team continues to evaluate and monitor progress in close collaboration with the CDC and the Department of Health.
The hospital is unable to reveal more due to privacy reasons.
A Hazmat team from the private company Cleaning Guys arrives at the apartment where Duncan was staying. Louise Troh, her son Timothy Wayne, 13, nephew Oliver Smallwood, 21, and his friend Jeffrey Cole, are among 10 people legally ordered to stay inside. The team plans to dispose of bedsheets, a mattress, and clothes that Duncan brought from Liberia to prevent his bodily fluids from contacting other people in the apartment. Dallas County Fire Marshall Robert De Los Santos:
The family is in good spirits and they are being closely monitored. Our ultimate aim is to move those people out of this apartment but we don’t know when
Health officials say it’s likely more people will travel to the U.S. carrying Ebola. Georgetown University Medical Center infectious disease specialist Jesse L. Goodman:
I would expect that so long as there is such a widespread epidemic in Africa, that even with good screening at the airports, etc., it’s possible there will be additional cases. This is a global public health emergency, and I think this indicates that.
The man identified as the first Ebola patient in the U.S. was incubating the disease when he traveled from Liberia to Dallas on Sept. 19-20, but he showed no symptoms while he was traveling, so his fellow travelers are not at risk.
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.
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.
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.
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.
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.
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.
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 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.
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 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.
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 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.
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.
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.
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 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.
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.
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.
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.
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/
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.
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.
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 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.
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.
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.
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.
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.
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.
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…