World Bank president Kim says Ebola will have a major impact on West Africa economies:
For 2014 we estimate that the GDP losses to Liberia, Sierra Leone and Guinea from this crisis will be a combined $360 million, which is a huge portion of the overall GDPs of these small countries. We expect that the impact on government budgets to be $292 million.
Continued spread of the virus could multiply the effect:
Our findings indicate that if the virus continues to spread the economic cost to these countries could grow eight-fold by 2015. This would deal a potentially catastrophic blow
A fast and effective response could limit the economic damage in 2015 to $97 million but if rapid action isn’t taken it could be $800 million. The bank has released $117 million grant funding for an immediate humanitarian response to save lives and prevent new infections.
Virologist Heinz Feldmann says the Monrovia airport is the place he felt least safe:
They are checking your temperature three times before you get into the airport, but if you look at the people that do this kind of work, they don’t really know how to use the devices … They are writing down temperatures of 32°C, which everybody should know is impossible for a living person. All the checks they do are completely useless because they are done by people who are not well trained or overwhelmed by the number of passengers. It is just a disaster, and it needs to be fixed.
Obama is expected to announce the expansion of a $763 million U.S. plan to help West African nations combat the Ebola virus later Tuesday during his visit to the Centers for Disease Control and Prevention in Atlanta. Officials say the administration has asked Congress for an additional $88 million for the program. The Department of Defense, which is heading up the program, has requested the re-programming of $500 million. The expansion will include deploying 3,000 troops to the Liberian capital, according to a White House statement:
U.S. Africa Command will set up a Joint Force Command headquartered in Monrovia, Liberia, to provide regional command and control support to U.S. military activities and facilitate coordination with U.S. government and international relief efforts. A general from U.S. Army Africa, the Army component of U.S. Africa Command (AFRICOM), will lead this effort, which will involve an estimated 3,000 U.S. forces.
The White House says ‘many’ of the troops will be stationed at an ‘intermediate staging base’ where they will supervise movement of medical staff, supplies and heavy equipment.
Researchers from UK in Liberia say that each Ebola patient turned away by volunteers is infecting 1.5 other people. Prof Edmunds, Medecins Sans Frontieres.
The doubling time of this epidemic is about two weeks, so if we are overwhelmed with our resources right now, it’s going to be twice as bad in two weeks’ time.
Aid workers in Monrovia sing Liberian gospel tunes and encourage Ebola patients to join in in an effort to promote recovery. Nurse Mary Byepu:
They themselves will tell you they want to sing
Health staff have also added cornbread to the menu to encourage patients to eat. One health-care worker brought a woman a cucumber from the local market, while another promised a boy a bicycle if he recovered.
The disease detection technique of contact tracing cannot be done properly in Sierra Leone due to unreliable information. The UN says only 16 of 44 zones in west Africa have sufficient details on people who have come into contact with Ebola patients. U.S. Public Health Service Lt. Rebecca Levine describes the Health Ministry’s database:
Pretty much in shambles.
Contact tracing identifies people who have come into contact with an infected person and monitors them for 21 days. If they develop the disease, they are isolated and their contacts are tracked down. She says many contacts’ addresses are missing or vague, like ‘down by the farm road. In all, only 20% to 30% of the contacts in the database had a usable address.
The WHO says at least 600 more doctors are needed in west Africa. Director general Chan:
Our response is running short on nearly everything from personal protective equipment to bodybags, mobile laboratories and isolation wards. But the thing we need most of all is people: healthcare workers. The right people, the right specialists – and specialists who are appropriately trained and know how to keep themselves safe – are most important for stopping the transmission of Ebola. Money and materials are important, but those alone cannot stop Ebola transmission.
At least 1,000 other health workers are needed.
Medecins sans Frontieres worker Pierre Trbovic says the organization has only 200 beds in Monrovia and there are a total of only 240 in the city. MSF is turning away patients to avoid being overwhelmed:
In Monrovia, we estimate that there needs to be more than 1,000 beds to treat every Ebola patient. There are currently just 240 in total. Until that gap is closed by treatment centres with hundreds, rather than the small numbers pledged so far, the misery of turning people away at our gates will continue.
Dr. Rick Sacra is recovering after receiving a blood transfusion. According to his physicians he is doing very well. The blood came from Kent Brantly, another doctor who had been infected. Blood from a previously infected patient contains antibodies against the virus. Sacra’s wife is very pleased that Brantly was willing to donate blood:
It really meant a lot to us that he was willing to give that donation so soon after his own recovery.
The Foreign Office is investigating reports that a 57-year-old British man has died and a second man, aged 72, is ill in Skopje. Macedonian officials say the the patients had been staying at a hotel when they fell ill. The now-deceased man was admitted to the Clinic for Infectious Diseases around 3 p.m. (9 a.m. Eastern) and died around two hours later. His friend remains under observation at the hospital and medical staff are attempting to confirm whether they were infected with Ebola.
Defence Minister Brownie Samukai tells the UN Security Council that Ebola threatens the entire country’s security:
Liberia is facing a serious threat to its national existence [as it is] now spreading like wildfire, devouring everything in its path.
The Bill and Melinda Foundation pledged $50 million to help fight the Ebola outbreak in West Africa. The money will be used to help the government purchase supplies, “scale up emergency operations,” and enable international aid.
We are working urgently with our partners to identify the most effective ways to help them save lives now and stop transmission of this deadly disease. We also want to accelerate the development of treatments, vaccines and diagnostics that can help end this epidemic and prevent future outbreaks.
Pooley says he wants to return to west Africa following his recovery:
So while I’m happy to be recovered and alive, there’s a lot of stuff on my mind with what’s going on back there. It would be relatively safe for me to go back and work there, and it’s really the least I could do having received all this amazing care and have people look after me and potentially save my life. It’s the least I could do to go back and return the favour to some other people, even just for a little while. The more help they get the less chance there is they get sick. If they get sick they are just going to end up in a ward in Kenema with less chance than I had.
He says he has ‘huge gratitude’ for Cameron’s role in his recovery, but calls for more support from leaders:
It’s a global problem and it needs global level leadership so Obama and Cameron … need to show some more leadership on this issue … Sierra Leone needs lots of international health-care workers working with big NGOs like MSF and Red Cross. All of that needs to be increased.
The WHO says motorcycle taxis and regular taxis are not disinfected between passengers:
[They are] a hot source of potential virus transmission
The WHO says aid to Liberia needs to be scaled up by three to four times. It says new Ebola centres immediately overflow with patients, pointing to…
…a large but previously invisible caseload.
In Montserrado county, which includes Monrovia and is home to more than 1 million people, a WHO investigative team estimated that 1,000 beds are urgently needed:
The number of new cases is moving far faster than the capacity to manage them in Ebola-specific treatment centres.
Obama is likely to send US military resources to countries in West Africa affected by the Ebola virus outbreak. Obama stresses that action must be taken now to prevent the disease from spreading. Obama:
If we don’t make that effort now, and this spreads not just through Africa but other parts of the world, there’s the prospect then that the virus mutates. It becomes more easily transmittable. And then it could be a serious danger to the United States.
Sierra Leone plans a three-day nationwide lockdown in an effort to halt an Ebola outbreak that has killed hundreds. People will not be allowed to leave their homes for three days under the plan, set to start September 19. The lockdown is being billed as a predominantly social campaign rather than a medical one, in which volunteers will go door-to-door to talk to people. Sierra Leone’s minister Alhaji Alpha Kanu:
We believe this the best way for now to identify those who are sick and remove them from those who are well.
The U.S. Department of Health and Human Services signs a $24.9 million, 18-month contract with Mapp Biopharmaceutical to support the development, manufacture, and FDA approval of ZMapp. The deal can be extended up to a total of $42.3 million. HHS official:
While ZMapp has received a lot of attention, it is one of several treatments under development for Ebola, and we still have very limited data on its safety and efficacy. Developing drugs and vaccines to protect against Ebola as a biological threat has been a long-term goal of the U.S. government, and today’s agreement represents an important step forward.
Brantly is interviewed by Lauer for NBC Nightly News.
That morning. I just felt a little off. A little warm. A little under the weather. And I took my temperature and it was 100.0 I think.
I don’t think they ever said, ‘Ken I think you are about to die’. but I felt like I was about to die.
ZMapp is shown to cure 100% of monkeys in a Canadian study. Severe symptoms, rashes, bleeding, excessive liver enzymes and signs of liver failure had a reversal due to ZMapp injections and the monkeys continue to recover from a lethal dose of the virus, even five days after the infection. The anti-Ebola drug has yet to go through the official human testing phase. ZMapp takes several months to manufacture, which is why the dosages are currently not available.
Multiple mutations are complicating the diagnosis and treatment of the disease. Genetic sequencing the virus from 78 patients, consisting of 99 samples, since the inception of the outbreak leads to the discovery that the virus is mutating during the course of the “Zaire” strain outbreak. Researchers are gathering data to build a history of the particular strain, the disease possibly using bats as hosts since 2004. Gire:
We’ve uncovered more than 300 genetic clues about what sets this outbreak apart from previous outbreaks. Although we don’t know whether these differences are related to the severity of the current outbreak, by sharing these data with the research community, we hope to speed up our understanding of this epidemic and support global efforts to contain it.
Airlines suspend flights through the three nation crisis zone. Air France temporarily suspends services to Sierra Leone, leaving its capital Freetown and Monrovia in neighbouring Liberia with just one regular service, from Royal Air Morocco. Air France:
In light of the analysis of the situation and as requested by the French government, Air France confirms it is maintaining its program of flights to and from Guinea and Nigeria.
Not all authorities agree with more severe isolation. Nabarro:
By isolating the country, it makes it difficult for the UN to do its work.
WHO expresses their concern in regards to aggressive isolation. Fukuda:
Pilots and others, as well as passengers, generally have very low risk of Ebola infection.
Pooley is treated with the experimental ZMapp Ebola drug. Dr Michael Jacobs, clinical director of infectious diseases at the Royal Free hospital in Hampstead, north London:
We had the opportunity to give him the ZMapp treatment. It is an experimental medicine, we made that absolutely clear in our discussions with him.
A laboratory in Sierra Leone is shut down when a health worker is compromised by the Ebola virus. The World Health Organization is concerned the move may hinder efforts to combat the spread of the Ebola virus in the region. Up to this point, Ebola has infected 2,615 and killed a minimum of 1,427 people.
It’s a temporary measure to take care of the welfare of our remaining workers. After our assessment, they will return.
Rapid burials of possible Ebola victims lead to dogs digging up corpses and eating the remains. During the discovery, young men make efforts to contact the Healthy Ministry, which does not respond. The young men take matters into their own hands and try to kill the dogs, but some of the animals flee the scene. Resident:
We are very disappointed in the Health Ministry, especially the government that took an oath to defend and protect us; to see them act in such manner is unacceptable and we’ll never allow the government come to bury any longer. They will be resisted by us because I think the government has failed to protect us—why bring Ebola bodies and not bury them well?
Sierra Leone has voted to pass an amendment to its Health Act whereby people caught hiding Ebola patients could face possible jail time of up to two years. The amendment still needs to go for presidential approval. The country has been hit hard by the current outbreak with at least 392 deaths and 910 cases recorded.
Sierra Leone majority leader Ibrahim Bundu:
[Sierra Leone has suffered] abandonment and isolation from those we viewed to be our biggest friends in the region and beyond. These ugly developments are evidenced in the cancellations of flights, closing of borders, reduction of operational hours of banks and further isolation by shutting down businesses at the time of greatest need.
He said lawmakers would soon review the country’s partnerships “so as to form a permanent record of who are true friends are.”
Brantly is released from Hospital. He releases a statement (full text):
Today is a miraculous day. I am thrilled to be alive, to be well and to be reunited with my family. As a medical missionary, I never imagined myself in this position. When my family and I moved to Liberia last October to begin a two-year term working with Samaritan’s Purse, Ebola was not on the radar. We moved to Liberia because God called us to serve the people of Liberia.
After taking Amber and our children to the airport to return to the States on Sunday morning, July 20, I poured myself into my work even more than before—transferring patients to our new, bigger isolation unit; training and orienting new staff; and working with our Human Resources officer to fill our staffing needs. Three days later, on Wednesday, July 23, I woke up feeling under the weather, and then my life took an unexpected turn as I was diagnosed with Ebola Virus Disease. As I lay in my bed in Liberia for the following nine days, getting sicker and weaker each day, I prayed that God would help me to be faithful even in my illness, and I prayed that in my life or in my death, He would be glorified.
I did not know then, but I have learned since, that there were thousands, maybe even millions of people around the world praying for me throughout that week, and even still today. I cannot thank you enough for your prayers and your support. But what I can tell you is that I serve a faithful God who answers prayers.
Thank you to Emory University Hospital and especially to the medical staff in the isolation unit. You treated me with such expertise, yet with such tenderness and compassion. For the last three weeks you have been my friends and my family. And so many of you ministered to me not only physically, but also spiritually, which has been an important part of my recovery. I will never forget you and all that you have done for me. And thank you to my family, my friends, my church family and to all who lifted me up in prayer, asking for my healing and recovery. Please do not stop praying for the people of Liberia and West Africa, and for a quick end to this Ebola epidemic.
Kenya will be closing its borders on Wednesday August 20 to people travelling from Guinea, Sierra Leone and Liberia due to the spread of the virus. Kenya is at high risk as it is a major transport hub. Kenya’s health secretary said Kenyans and medical workers flying in from those states would still be allowed in. Kenyan Airways says it will stop flights to Liberia and Sierra Leone when the ban comes in. Kenyan Health Minister James Macharia said it was “in the interest of public health” and warned that Kenyans and health workers who had returned from the three west African states would face “strict checks” and would be quarantined if necessary.
After Khan’s death, it is discovered that he was not given ZMapp or asked to be a test case although an experimental dose was available. A Canadian team of scientists who had developed ZMapp were testing a dose for resistance to the African climate at a location within reach of the Sierra Leone field hospital where Khan was treated and offered to use it to treat him. However as the drug was untested and Khan’s immune system was fighting the virus, it was decided that the drug had a higher risk of killing him. His colleague, Dr. Daniel Bausch:
You had a person who was sick, and a drug never used on humans before, it wasn’t approved. There were lots of questions to be asked and no easy answers
He believes the final decision was with the field doctors at the hospital but says he disagrees with the refusal of the drug, especially as it was used on :
I do want it to be clear that these were difficult, delicate decisions that people in a stressful situation had to make. But I’m not going to deny that I disagree with the decision they made.
A health care facility in Monrovia, Liberia is attacked, causing a number of patients to flee the facility, all of them infected with Ebola. Some patients chose not to leave. The perpetrators made off with mattresses and equipment. No injuries have been reported. Liberian National Police:
It was an attack from people afraid of Ebola
The San Diego-based Mapp Biopharmaceutical develops ZMapp with the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) due to fears Ebola could be used as a bioweapon. ZMapp is made from two serums, MB-003 developed and ZMAb, made by Canadian company Defyrus Inc., and combined by Mapp Biopharmaceutical’s commercial arm LeafBio. MB-003 uses three chimera antibodies developed in mice, with human DNA spliced in, and grown in a genetically engineered indigenous Australian tobacco plant. ZMab was developed in a similar way.
Harvard Medical School associate professor of Global Health and Social Medicine Dr. Scott Podolsky writes in Annals of Internal Medicine that ZMapp is inspired by serology techniques developed in the 1890s after Louis Pasteur and Robert Koch began to identify the agents of diseases like anthrax, diptheria and pneumonia:
From the 1890s onward, this model of production – expose an animal (guinea pig, rabbit, cow, horse, etc.) to an identified microbial pathogen, generate antibodies (or use convalescent serum from former patients), and then ‘passively’ transfer the pre-formed antibodies to an exposed animal or person – could be expanded to such feared and prevalent diseases as pneumococcal pneumonia and meningococcal meningitis.
The supply of ZMApp, an experimental Ebola drug has been used to treat the two Americans as well as a Spanish Priest and two Doctors in West African countries is exhausted. Other countries have called ZMapp and they have complied with requests to the best of their ability. The drug has been provided at no cost.
It is our understanding that all patients offered treatment, treated, or expected to be treated were or are highly capable of providing informed consent for the use of an experimental drug not yet evaluated for safety in animals or people.
ZMapp along with their partners are working to increase production as quickly as possible. However, Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases says:
How can a couple of doses control an outbreak with hundreds and hundreds of people? You don’t control the epidemic with two or three doses.
A federal Customs and Border Protection agent says the arrival of a sick passenger believed to be from Liberia last Saturday caused confusion at Newark. The flight arrived at the gate and most passengers were allowed into the customs hall, while the sick passenger was taken to a hospital. For a low-level bomb scare, the plane is parked away from the airport.Airport managers went on the public address system and asked the passengers to separate themselves from people who had been on other flights and were not exposed to the vomiting patient.
A panic ensued. It was a disaster
Nigeria declares a State of Emergency after seven cases of Ebola are confirmed in the country after a man arriving from Liberia fell sick. Two of the confirmed cases die while several people who have come into contact with the man are under surveillance.
The World Health Organisation announces it is convening a special meeting next week to explore using experimental drugs in the West African outbreak, after two health workers from the US charity Samaritan’s Purse are treated with a drug called ZMapp. The decision to use an experimental drug to treat two Americans infected with Ebola, while nearly 1 000 Africans have already died from the deadly epidemic, has sparked controversy, but US experts say it is ethically justified.
The experimental drug is still in an extremely early phase of development and had only been tested previously on monkeys. It has never been produced on a large scale. There is no proven treatment or cure for Ebola. Samaritan’s Purse members Kent Brantly and Nancy Writebol, however, have shown improvements since taking the drug.
Writebol, the second American who contracted Ebola while working with a missionary group in Liberia, is airlifted to Emory hospital in Atlanta for treatment. The aid worker, 59, is the second American to be flown into the US for treatment. David Writebol:
Now we have a real reason to be hopeful.
The World Bank pledges $200m in emergency aid to Liberia, Guinea and Sierra-Leone, in a bid to counter further spread of the deadly virus. Jim Yong Kim, the president of the World Bank, says that he is ” deeply saddened” by the progress of the epidemic thus far. The funds will be used to undertake numerous relief activities including providing medical supplies, paying staff and driving a campaign that will contain the epidemic.Yong Kim:
I have been monitoring (Ebola’s) deadly impact around the clock and I’m deeply saddened at how it has ravaged health workers, families and communities, disrupted normal life and has led to a breakdown of already weak health systems in the three countries.
Both US patients appear to be responding well to experimental drugs provided by San Diego-based Mapp Biopharmaceutical. The Company is manufacturing more of the drug, while conducting clinical trials. Larry Zeitlin, the president of Mapp:
It’s absolutely overwhelming. We are discussing with the F.D.A. the right path to make the drug available to people as quickly and safely as possible.
Major decisions on how and where the drug will go are being discussed. Dr. Whaley:
We definitely would like to ramp up to have an impact on the Ebola epidemic. We’re not decision makers on many of these issues. There are regulatory and legal issues that have to be addressed.
The CDC is now concerned about the risk of Ebola spreading beyond Guinea, Nigeria, Sierra Leone and Liberia. Dr. Skinner, an infectious disease specialist from the organization, says that travelers could unknowingly transfer the deadly virus beyond more international borders. Dr. Rob Dretler, CDC:
We know what to do and can completely isolate them but someone coming home who doesn’t know they are sick and is here a few days and gets sick, that’s the risk.
Researchers consider using blood transfusions from Ebola survivors to pass antibodies into infected people, as no vaccines or drugs are approved yet. Dr. Peter Piot, director of London’s School of Hygiene and Tropical Medicine and co-discoverer of the virus:
This is something that’s fairly simple to do
WHO’s network of international blood regulators says there are thousands of survivors from past Ebola outbreaks in Africa. It says it has identified several patients as possible donors and the first batch of blood from survivors could be available later in the year, but adds:
[The] logistics of blood collection are an issue
Blood from donors must also be screened for other illnesses such as HIV and malaria before it can be used.
The CDC is planning, over the next month, to send 50 epidemiologists, experts of health communication and other service personnel to Sierra Leone and Guinea, which are the hardest hit countries, amid increasing fears of the spread of the deadly Ebola virus to other countries. Dr. Tom Friednen, CDC director:
These individuals will help countries establish emergency operations centers that can develop a structured and effective way of addressing the outbreak.
Health officials say local superstitions are turning away patients from seeking medical care, worsening the outbreak. In Liberia’s Lofa county, health workers trying to screen two communities were chased away with knives and cutlasses, while in other communities Ebola is seen as a ‘curse’ for things like sexual promiscuity. A Red Cross volunteer says some patients favour traditional remedies such as bathing in salt water at midnight. UNICEF Ebola coordinator Fabio Friscia:
What is actually creating the greatest problem is the behavior of the population … It is absolutely something we could expect. The population is being attacked by an absolutely new disease no one [in western Africa] has ever seen before.
The Ebola crisis in Liberia worsens after the evacuation of some international medics from Liberia following the infection of two US health workers with the Ebola virus. The overcrowded and understaffed Elwa hospital in the capital, Monrovia, where Kent Brantly and Nancy Writebol worked, has been forced to turn away some Ebola cases.
Brantly and Writebol are given ZMapp at the hospital in Liberia where they are being treated. After special permission is granted for the use of the untested medicine, the serum is sent from the U.S. stored at subzero temperatures, and must be allowed to thaw naturally for eight to 10 hours. They agree that Writebol will be given the first dose as Brantly is younger and expects to have a better chance of survival. However his condition worsens and he is intravenously administered Writebol’s thawed dose, after telling doctors that he thinks he is dying. Within an hour, his breathing eases and the red rash over his torso fades. Writebol is then given the medicine and requires a second dose, but also recovers.
Brantly receives a blood donation from a 14-year-old Ebola survivor in Liberia while awaiting ZMapp, the first person in the current Ebola outbreak to receive the treatment.
Brantly, one of the American victims of the Ebola Virus, is now receiving treatment at Grady Memorial Hospital in Atlanta. Brantly is the first ever patient to receive treatment for Ebola in the United States. Every precaution being taken in the care of the doctor who remains in isolation. His wife, Amber:
It was a relief to welcome Kent home today. I spoke with him, and he is glad to be back in the U.S. I am thankful to God for his safe transport and for giving him the strength to walk into the hospital.
Brantly and Writebol, a missionary, will fly back to US, as the Ebola outbreak is spreading too quickly. They will be flown on a jet which fitted with a tent designed for transporting patients with highly infectious diseases.
At a meeting in Guinea’s capital Conakry,WHO director-general Margaret Chan tells the presidents of Guinea, Liberia, Sierra Leone and Ivory Coast that the virus could be stopped, but cultural practices such as traditional burials were a significant cause of its spread. She also says that governments may need to restrict population movements and public gatherings, and use the police and civil defence forces to guarantee the security of response teams. She also says more than 60 medical workers have died, hampering efforts to tackle the disease.
This outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives, severe socioeconomic disruption and a high risk of spread to other countries.
The U.S. government will begin human testing on a Ebola vaccine as early as September, after seeing positive results from tests on primates, according to CNN and USA Today. The National Institutes of Health’s infectious disease unit is working with the U.S. Food and Drug Administration to put the vaccine into trial as quickly as possible.