Ebola

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Behind The Times: Pregnant Patient Asked About Travel To Ebola Region, But Not Zika

Jaqueline Vieira, left, watches as her 3-month-old son Daniel, who was born with microcephaly, undergoes physical therapy at the Altino Ventura foundation in Recife, Brazil. (AP Photo/Felipe Dana)

A baby born with microcephaly undergoes physical therapy at the Altino Ventura foundation in Recife, Brazil. (Felipe Dana/AP)

Dr. Shira Fischer is a RAND Corporation researcher whose interests include using electronic health records to improve care. She also happens to be pregnant, and she went in recently to the obstetrical urgent care unit at Brigham and Women’s Hospital.

She got “swift and appropriate” care, she writes on The Health Care Blog in a post headlined: Electronic Health Records: From Ebola To Zika, Fighting The Last War. Just one little problem: She was asked if she’d recently visited a country with Ebola, but not Zika.

Let me not get too snarky about health systems that don’t keep up with huge international health news. But something is clearly wrong here, in this latest example of how electronic medical records often lag. Fischer writes:

The existing system is too slow to respond and when it does, it finds itself chasing the past. Like security protocols at airports, where travelers are required to remove shoes because someone in 2001 hid explosives in his sneaker soles, instead of anticipating the next creative attack, the U.S. public health system finds itself asking about yesterday’s Ebola and not today’s Zika, because the gears of change move too slowly.

But the limitation is not the technology. Technology systems should be the first to respond, even more quickly than official government responses. They should be deployed more nimbly to support faster, more informed decisionmaking. Just as my iPhone automatically receives Amber Alerts as soon as they are issued by authorities, EHR could easily reflect the most relevant public health issues. It is shocking that health care providers are still asking about Ebola when Zika is already all over the news. The tools and the technology exist, but smarter ways to use them must be implemented.

Read her full post on The Health Care Blog here. And just a note of self-congratulation: She writes on Facebook that WBUR’s Narrating Medicine — a platform for first-person writing by people in health care, from doctors and nurses to patients and caregivers — motivated her to write up this experience. Want to get in on the narrative action? Just request to join here.

Opinion: Why The WHO Botched Ebola, And How Proposed Fixes Miss The Mark

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone last year. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone last year. (AP)

In the latest Lancet, a report from an independent panel of experts lambastes the World Health Organization for its handling of the Ebola outbreak. The panel makes 10 recommendations to help get the WHO in better shape for the next global epidemic alert.

I wish I could tell you not to worry, that the WHO will heed these recommendations and handle its next epidemic much better, so that the outbreak will never get as widespread and disturbing as Ebola was last year.

But I did my PhD dissertation on how the WHO plans for and responds to health problems like infectious diseases that don’t respect borders, and my sad conclusion is: Not gonna happen.

I agree wholeheartedly with many of the new recommendations — like that the WHO should focus on supporting countries with technical advice, and create a dedicated center for outbreak response. But if the WHO carries out even one of the 10, it will be a miracle.

Why should you care? Well, it’s widely thought that the WHO botched the Ebola outbreak: It was late in releasing information, and was even called out by Doctors Without Borders for its lackadaisical response.

And why did it botch the response? Because it is not built to rapidly balance politics with medicine, which is exactly what’s required in an epidemic. It can’t be helpful doctor and tough enforcer at the same time.

The independent panel, launched by the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine, includes world health experts and former high-level WHO officials, but it seems to forget how the WHO works. The experts have made pie-in-the-sky recommendations that the WHO is unlikely and probably even unable to implement, making it more likely that it will repeat its mistakes.

I spent close to four years working on my dissertation, which had the riveting title “Exit, Voice and (Trojan) Loyalty: The World Health Organization and the Dynamics of International Disease Control.” Luckily for you, you don’t need to read it (not even my mom has, to be honest). There are just two quotes you need to understand pretty much everything about my dissertation and how the WHO responds to infectious disease risks.

Quote No. 1: “Our clients are our member states.”

A WHO official told me this during my first week researching in the archives. You might think the WHO works for the health of the people. Unfortunately, that’s a common misunderstanding. The WHO’s first priority is to the governments of its member states. Understanding that allows you to make sense of the WHO’s actions (or lack thereof) during an epidemic.

It also makes many of the recommendations from the panel impractical. The panel is basically asking the WHO to go rogue and bite the hands that feed it, criticize sensitive and capricious governments that, if threatened, will simply throw the WHO and all of its officials out of the country. Continue reading

Mass. Doctor Who Beat Ebola To Return To Liberia

Former Ebola patient Dr. Richard Sacra at a September news conference in Nebraska. (Nati Harnik/AP)

Former Ebola patient Dr. Richard Sacra at a September news conference in Nebraska. (Nati Harnik/AP)

The Massachusetts doctor who beat Ebola plans to return to Liberia, where he contracted the deadly virus, in order to help overworked colleagues in the missionary hospital where he has worked for years.

Dr. Rick Sacra, 52, of Holden, said Monday he won’t be working directly with Ebola patients but might be asked to help from time to time, since doctors say he’s now immune. He departs Thursday.

“The medical staff is a little bit reduced. They’ve been working very hard and frankly they need a little bit of a breather,” he said at the University of Massachusetts Medical School, where he is an assistant professor. “I just feel the need to return to hopefully give them a break so they don’t burn out.”

But Sacra said he has no interest in testing his immunity and promised to follow all the necessary Ebola safety protocols.

Continue reading

Partners In Health: In Ebola-Stricken Nations, People Are Dying — But From Other Illnesses Too

In this Tuesday, Oct. 21, 2014 file photo, a man suffering from the Ebola virus lies on the floor outside a house in Port Loko Community, situated on the outskirts of Freetown, in Sierra Leone. (Michael Duff/AP)

In this Tuesday, Oct. 21, 2014 file photo, a man suffering from the Ebola virus lies on the floor outside a house in Port Loko Community, situated on the outskirts of Freetown, in Sierra Leone. (Michael Duff/AP)

Among the groups on the forefront in the international effort to address the Ebola crisis in West Africa is Boston-based Partners in Health (PIH). The group is promising to keep staff and volunteers in Liberia and Sierra Leone for several more years to fight Ebola and address other public health concerns in those countries.

Helping to lead the PIH initiative is chief nursing officer Sheila Davis, who returned to Boston earlier this month and remains largely confined to her home in Roslindale.

She joins Morning Edition Wednesday to talk about how the ongoing crisis reveals how vital public health infrastructures are.

Interview Highlights

Sheila Davis: Many times more people are dying, not because of Ebola, but because of this weakened health system. So even the facilities that have been open to provide care for other things — such as malaria, safe child birth — those in most counties are closed. So more people are dying, because they’re not being able to get health care for other, non-Ebola reasons.

A lot of the attention to both countries has been just treating the acute Ebola. But, if we don’t work at the same time to build up this system, we’re going to see these acute outbreaks or hotspots for quite a long time.

On whether PIH had any idea how serious the Ebola outbreak would become: 

SD: I don’t think we did. The first cases we heard about in probably March, April or May. Like all of the other previous Ebola outbreaks, the thought was it would show up and it would be quickly gone and a few hundred cases would be there worldwide, and we would stop hearing about it very quickly.

And then, during the summer, when we were hearing more and more about cases being found in Liberia, Sierra Leone, Guinea, we had two smaller nonprofits that we worked with in those areas, and we had been in contact with them. And they, as well as the governments of Liberia and Sierra Leone, asked us to come in and help.

Continue reading

Related:

Researchers Find First Ebola Case May Be Linked To Bat Play

A healthcare worker dons in protective gear before entering an Ebola treatment center in the west of Freetown, Sierra Leone.  (AP Photo/Michael Duff)

A healthcare worker dons in protective gear before entering an Ebola treatment center in the west of Freetown, Sierra Leone. (AP Photo/Michael Duff)

Scotland has confirmed its first Ebola case.

Nurse Pauline Cafferkey volunteered with Save the Children in Sierra Leone. She returned to Glasgow this past weekend with fifty other volunteers — fellow health professionals from the National Health Service (NHS).  She was transferred to a London Hospital on Tuesday.  Cafferkey is believed to be in the very early stages of the infection and health officials are scrambling to trace the 71 passengers on Cafferkey’s internal British Airways flight – BA1478 – from Heathrow to Glasgow.

This news comes as we learn more about little Emile Ouamouno, the two-year-old Ebola victim believed to be the first case in the current outbreak. Researchers report in EMBO Molecular Medicine that the boy may have contracted the disease from bats.

During a four-week field trip to Meliandou, the boy’s 31-house Guinean village, Dr. Fabian Leendertz and colleagues from Germany’s Robert Koch Institute found a hollowed out tree that was the source of play for many children.  Located about 50 meters away from the Emile’s home, the tree housed a colony of fruit bats that may have carried the virus.  Emile died in December 2013 and often played in the tree, according to his friends and family.

While bushmeat is believed to be a source of the virus, Dr. Leendertz doesn’t believe it played a role in Emile’s case.  Rather, he contracted the disease from rat droppings within the tree.

This particular tree caught on fire in March 2014 resulting in an exodus of bats. Continue reading

MGH Patient Monitored For Possible Ebola ‘Cleared Medically,’ Discharged

A patient who was being monitored for possible Ebola and then tested positive for malaria was “cleared medically” and discharged from Massachusetts General Hospital Friday morning, hospital officials announced in a statement.

The patient’s release and current condition are not a threat to anyone else, MGH officials said. The patient, who has not been identified, had been under the hospital’s care since Tuesday.

“As we noted previously this patient had been definitively diagnosed with malaria and is responding well to anti-malaria treatment,” hospital officials said in the statement. “The patient has had no fever or other symptoms for the past 24 hours.”

In a press conference Wednesday, Dr. David Hooper, the head of Mass General’s infection control unit, said the patient had traveled to Liberia in recent weeks, but worked in an administrative role.

Hooper said he did not have the patient’s permission to disclose where he worked while in Liberia, but said the patient “did not have direct contact with Ebola patients” and was tested “out of an abundance of caution.”

MGH officials also noted in the statement that screening the patient for Ebola afforded them the “opportunity to see firsthand the benefits of the extensive preparations that have been under way through the hospital for the past several months.”

Officials praised their response and said preparations included carefully following Centers for Disease Control and Prevention protocols for treating possible Ebola cases.

Related:

Another Suspected Ebola Case In Boston: 5 Reassuring Thoughts

(Adam Cole/NPR for the Goats and Soda blog)

(Adam Cole/NPR for the Goats and Soda blog)

This morning, my heart went out to WBUR’s Jack Lepiarz as he waited outside Massachusetts General Hospital in the pre-dawn rain, shivering despite his five layers of clothing, for possible word on a patient who may have Ebola.

But along with my sympathy, I felt an odd calm — very different from the alarm I felt in mid-October when we had an Ebola scare in Braintree.

What’s changed? Perhaps more than anything, the steady accumulation of time without another case contracted in the United States since two Dallas nurses caught the virus from Thomas Eric Duncan eight weeks ago. But also, it’s that this rare and terrifying virus, synonymous with “Hot Zone” nightmares, has become ever more familiar, and its limits more clear — even as it remains a major scourge in Africa.

The latest word from MGH is that the patient’s initial test for Ebola was negative. Good news, but these are the thoughts that most suppress my stress hormones:

1. Boston Hospital Strong

This is the medical mecca that became a model for the country in its handling of the marathon bombing injuries. It was prepared for that emergency, and, as Martha Bebinger reported, it has six hospitals prepped and ready for Ebola patients:

The six hospitals collaborating to provide care include Bay State Medical Center in Springfield and five Boston facilities: Boston Medical Center, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Tufts Medical Center and Massachusetts General Hospital.

“Hundreds of people at each hospital have spent incalculable hours in the necessary planning, training and practice efforts that are needed to respond to the challenges posed by this disease,” said Dr. Paul Biddinger, vice chair of emergency preparedness at Mass General.

Boston Children’s Hospital says it expects to join the Ebola treatment collaborative, and UMass Memorial in Worcester may as well. The other 59 acute care hospitals in Massachusetts would screen a patient, hold anyone who is at high risk or Ebola-positive in isolation, and then transfer the patient, says Public Health Commissioner Cheryl Bartlett.

2. Airborne? Not

Scientists don’t like to say “never,” so even though all indications are that Ebola spreads only through direct contact with bodily fluids, it initially scared me when there were even hints that it might spread more easily.

This interview with Boston University Ebola researcher Elke Muhlberger helped — Reality Check: How People Catch Ebola, And How They Don’t — but what helped even more was this great recent explainer from NPR: Ebola in the Air: What Science Says About How Ebola Spreads.

It includes the helpful graphic at the top of this post, and this wonderful little story, to be recalled when next you sit near a coughing passenger on the T:

Take the case of Patrick Sawyer. Back in July, the Liberian-American businessman boarded a plane from Monrovia to Lagos, Nigeria. He was clearly very sick — and very contagious — with Ebola. He even vomited while on the plane.
There were about 200 other passengers on the flight. None of them got infected.

3. Bedside Care Continue reading

Boston Nurse Records 'Desperately Sad' Experiences Treating Ebola Patients In Liberia

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

Workers are next to the body of a woman suspected of dying from Ebola, before they offload her at a gravesite near the Bomi County Ebola clinic, on the outskirts of Monrovia, Liberia. (Abbas Dulleh/AP)

A growing number of doctors, nurses and public health specialists across the U.S. are putting their lives on hold and heading to Ebola-ravaged regions of West Africa. Today, and in the months to come, we bring you the story of one man who is on the ground in Liberia.

John Welch, 33, is a nurse anesthetist at Boston Children’s Hospital, and works with Partners in Health (PIH) in Haiti. At least that was his life before he opened an email from the organization in late September. It was a call for volunteers and support as PIH moved into Liberia and Sierra Leone to try and stop Ebola’s spread. Welch told a supervisor he’d be happy to help if needed.

That decision, says Welch, “was about being on the right side of history. I think I would have trouble looking back, knowing that I had an opportunity, and had not stepped up.”

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he's going to Liberia. (Courtesy of John Welch)

Welch meets sister Heidi Christman and niece Lydia in Columbus, Ohio, to explain why he’s going to Liberia. (Courtesy of John Welch)

Calming worried friends and family members was not so easy.

“How does your mother feel?” asks Lindsay Waller, an old friend and fellow anesthetist, who helps Welch prepare to discuss the decision with his family.

She’s upset and worried, Welch says, but “I am who I am because she’s my mother. [My parents] taught me these feelings of altruism and taking care of the people around you and helping out.”

The next day, on a quick trip from Boston to Columbus, Ohio, Welch makes a pitch he knows will resonate with his mother, aunt and sister: 70 percent of deaths from Ebola are women, the caregivers.

He asks his family to sit with him and watch a “Frontline” episode on Ebola. Fear and pain in the faces of patients with Ebola made the point for Welch.

“At first, I wanted to just say, ‘No, don’t go, it’s too dangerous,’ ” says Heidi Christman, Welch’s sister. But then, in the video, Christman says she saw “the brothers and sisters, friends and family that have been lost because of Ebola. And it made me realize that it’s not about me or my fears. It’s about helping these people. They deserve people like my brother.”

Her brother flew to Alabama for a CDC Ebola treatment training and in mid-October, three weeks after Welch said, “I’m in,” he was on his way to Liberia.

It wasn’t an easy journey. There are very few flights in and out of Liberia these days. Welch had several cancellations, spent an extra day in Casablanca, and his luggage was lost in transit.

When he finally lands in Liberia, Welch must take his temperature and wash his hands in chlorine, something he’ll get used to doing at least a dozen times a day. On the drive into Monrovia, a building, all lit up, stands out from a distance. Welch realizes it’s the large Doctors Without Borders Ebola Treatment Unit that he’s read about and seen in pictures. Suddenly, his assignments feels real.

After a few hours sleep, Welch leaves Monrovia and heads inland to a clinic in rural Bong County run by the International Medical Core. Welch is here to learn what it will take for PIH to set up a similar Ebola Treatment Unit in another rural county with few roads, power lines and little running water.

Continue reading

6 Mass. Hospitals Collaborate On Ebola Response Plan

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

An entrance to Beth Israel Deaconess Medical Center in Boston. The hospital is one of six in the state that have formed a collaborative system to handle Ebola patients. (Steven Senne/AP)

Updated at 5 p.m.

BOSTON — Massachusetts public health leaders said Friday that while the risk of Ebola remains very low in the state, six hospitals are prepared to handle one patient each, meaning the state could treat six patients at any given time.

The announcement clears up some confusion around which hospitals are ready to care for an Ebola patient if there is a confirmed case in Massachusetts.

The six hospitals collaborating to provide care include Bay State Medical Center in Springfield and five Boston facilities: Boston Medical Center, Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Tufts Medical Center and Massachusetts General Hospital.

“Hundreds of people at each hospital have spent incalculable hours in the necessary planning, training and practice efforts that are needed to respond to the challenges posed by this disease,” said Dr. Paul Biddinger, vice chair of emergency preparedness at Mass General.

Boston Children’s Hospital says it expects to join the Ebola treatment collaborative, and UMass Memorial in Worcester may as well.

The other 59 acute care hospitals in Massachusetts would screen a patient, hold anyone who is at high risk or Ebola-positive in isolation, and then transfer the patient, says Public Health Commissioner Cheryl Bartlett.

“By creating this coordinated, collaborative system, we reduce the number of people who have to have that level of intensive training to care for an Ebola patient and this is one of the reasons for our announcement today,” Bartlett said.

Massachusetts hospitals do not expect to take Ebola patients from other states. Bartlett says the Centers for Disease Control has asked each state to be ready to care for its own.

All this costly planning is making some physicians, nurses and other hospital staff nervous.

“We’re fighting fear with facts and being direct with our staff members,” said Dr. Eric Goralnick, medical director of emergency preparedness at the Brigham. “Obviously there is a lot of anxiety around this issue. We’re being aggressive around communications, and listening and listening and listening, and educating, and focused on training, exercising and preparing for this.”

There is no uniform policy for staff who treat Ebola patients in Massachusetts hospitals, but several say personnel could come and go as they would on any shift. Each doctor, nurse or lab worker would monitor their temperature twice a day.

Hospitals that take Ebola patients expect a financial hit as patients avoid “the place that is treating Ebola.” In announcing the collaborative hospital effort Friday, the Department of Public Health stressed the work it has done to prepare for Ebola, but some hospitals say they need more help with equipment, training and the possible loss of business.

More Coverage:

Expert Opinion: Travel Bans And Quarantines For Ebola Could Backfire

New York Gov. Andrew Cuomo speaks during a news conference at Bellevue Hospital to discuss Craig Spencer, a Doctors Without Borders physician who tested positive for the Ebola virus last week in New York City. Along with New Jersey Gov. Chris Christie, Cuomo announced a mandatory Ebola quarantine for health workers returning from treating patients in West Africa. (John Minchillo/AP)

New York Gov. Andrew Cuomo speaks during a news conference at Bellevue Hospital to discuss Craig Spencer, a Doctors Without Borders physician who tested positive for the Ebola virus last week in New York City. Along with New Jersey Gov. Chris Christie, Cuomo announced a mandatory Ebola quarantine for health workers returning from treating patients in West Africa. (John Minchillo/AP)

By Richard Knox

The United States has entered a new phase in its response to Ebola. Call it “officially sanctioned panic.”

Governors from both parties — N.J. Gov. Chris Christie and N.Y. Gov. Andrew Cuomo — declared over the weekend that even symptom-free health care volunteers coming home from Ebola duty in West Africa will be considered infected (and infectious) until they prove otherwise — by not falling ill for three weeks after their return.

Three out of four Americans want to seal the nation’s borders against travelers from Ebola-affected countries in West Africa. Republican members of Congress are demanding it.

But experts say mandatory quarantine of health workers and travel bans are unnecessary and could cripple the global fight against Ebola.

“The only way to buy an insurance policy is to defeat the disease in West Africa.”

– Prof. Alessandro Vespignani

Against this backdrop, I had a long conversation this past weekend with Prof. Alessandro Vespignani. He’s a Northeastern University expert on how humans behave in the face of disease threats. The main takeaways: The key to defeating the outbreak is to get health care workers to West Africa and back, so to the extent a travel ban or quarantines impede that flow, they will be dangerously counter-productive. And travel is so hard to control fully that bans do little to stem the spread of disease anyway.

Vespignani is spending a lot of time these days consulting with the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the World Health Organization on how the Ebola situation could evolve over the coming months.

He’s thinking some ominous thoughts, which he says reflect the views of U.S. and international health officials that he talks to. But the scenarios they worry about are very different from those that preoccupy many politicians and voters. Politicians worry more about the small, containable immediate threat to Americans of occasional imported cases than the longer-term and potentially catastrophic Ebola scenario that could affect the whole world — in other words, an Ebola pandemic.

Here’s an edited version of our conversation:

RK: Your group published a paper the other day in the journal Eurosurveillance that would seem counter-intuitive to many Americans. You say that imposing a ban on travelers from Ebola-affected countries won’t do much to prevent importation of the virus to the United States. Why is that?

Vespignani: People think if you have a travel ban everybody from those countries will be kept out. It’s not like that.

It’s important to know that we don’t have direct flights from West Africa. So a travel ban has to be coordinated internationally. There are a lot of people with two passports (whose country of origin can’t be easily tracked). People would try to circumvent the travel ban, and they wouldn’t be trackable — that’s one of the most dangerous things.

You can stop 95 percent of travelers from a country, but it’s very difficult to do 100 percent. And even a 90 or 95 percent travel ban is going to delay the arrival of Ebola (in the U.S.) by only about two months. It’s only buying time.

Already there is almost an 80 percent reduction in travel to the U.S. from that region, so we have already bought some time — about four to five weeks.

So what’s the practical effect of that delay? How much would a travel ban reduce Americans’ risk? Continue reading