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Ebola Virus Disease (EVD) in the United States


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Myself . By T.V. Antony Raj

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Great Seal of the United States

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Today, Ebola virus disease (EVD) represents a major public health issue, not only in sub-Saharan Africa, where it originated, but also to the whole world.

Researchers believe that the index case of the current EVD epidemic was the death of a 2-year-old boy in the village of Meliandou, Guéckédou Prefecture, in the West African nation of Guinea.

Guinea’s local health officials reported the first cases of fever in February 2014. They diagnosed the early cases as other diseases more common to the area and not as Ebola.

On March 19, 2014, Reuters reported an outbreak of an undetermined haemorrhagic fever in Guinea.

On March 22, 2014, Guinea confirmed that the viral hemorrhagic fever that killed more than 50 people is Ebola. On the same day, Liberia reported two EVD cases.

On March 30, 2014, Sierra Leone reported suspected cases.

On April 4, 2014, a mob attacked the Ebola treatment center in Guinea. In Sierra Leone and Liberia healthcare workers faced hostility from fearful, suspicious people.

On June 17, 2014, Liberia’s capital Monrovia reported the first case of Ebola.

On July 27, 2014, Liberia closed its borders with neighbouring countries. Three days later, Liberia shut down all schools. It quarantined worse-affected communities using troops.

On August 2, 2014, a U.S. missionary physician infected with Ebola in Liberia was flown to Atlanta in the United States for treatment.

On August 5, 2014, a second U.S. missionary infected with Ebola was flown from Liberia to Atlanta for treatment.

On August 8, 2014, World Health Organization (WHO) declared Ebola as “international public health emergency.”

On August 15, 2014, Médecins Sans Frontières (MSF) or Doctors Without Borders said it would take about six months to control the epidemic.

On August 19, 2014, one of the two U.S. missionaries treated in Atlanta declared free of the virus was released from the hospital.

On August 21, 2014, the second U.S. missionary treated in Atlanta declared free of the virus was released from the hospital.

By September the epidemic accelerated in sub-Saharan Africa.

On September 3, 2014, a third U.S. missionary doctor infected with Ebola was flown from Liberia for treatment in Omaha, Nebraska.

On September 7, 2014, President Barack Obama said the United States needs to do more to help prevent Ebola from becoming a global crisis.

On September 8, 2014, a fourth Ebola patient was flown to Atlanta.

On September 9, 2014, WHO said at least 2,296 died out of 4,293 cases recorded in five countries.

On September 13, 2014, Liberia appealed to Obama for help fight Ebola.

On September 16, 2014, President Obama promised to send 3,000 military engineers and medical personnel to West Africa to build clinics and train healthcare workers.

Thomas Eric Duncan (Source: abcnews.go.com)
Thomas Eric Duncan (Source: abcnews.go.com)

On September 20, 2014, Thomas Eric Duncan, a Liberian, flew to the United States after trying to help a woman with Ebola in his home county. He flew from Liberia to Dallas in the United States via Brussels and Washington.

On September 25, 2014, Duncan went to the Texas Health Presbyterian Hospital Dallas with fever and abdominal pain. Despite telling a nurse that he travelled from West Africa, the hospital sent him back to the apartment where he was staying with antibiotics.

On September 28, 2014, Duncan returned to Dallas hospital by ambulance.

On September 30, 2014, U.S. Centers for Disease Control and Prevention (CDC) confirmed Duncan afflicted with Ebola. This was the first case diagnosed in the United States.

On October 2, 2014, NBC News said that Ashoka Mukpo, the American freelance cameraman in its employ, afflicted with Ebola will be flown to the United States for treatment.

On October 8, 2014, Duncan, the first person diagnosed with Ebola in the United States, died in Texas Health Presbyterian Hospital Dallas.

The United States government ordered five major airports to screen passengers from West Africa for fever.

On October 9, 2014, WHO said there is no evidence of the epidemic being brought under control in West Africa. Some lawmakers in the United States called for the ban of travelers from the West African countries hit hardest by Ebola.

On October 10, 2014, WHO raised the death toll to 4,033 out of 8,399 cases in seven countries. Most fatalities were in Liberia, Sierra Leone and Guinea.

On October 11, 2014, Medical teams at New York’s John F. Kennedy International airport began screening travelers for Ebola symptoms from three West African countries.

Ebola survivor Nina Pham appears at a press conference after she was discharged from the hospital on ct. 24, 2014. (Source: abcnews.go.com)
Ebola survivor Nina Pham appears at a press conference after she was discharged from the hospital on October 24, 2014. (Source: abcnews.go.com)

On October 12, 2014, Nina Pham the nurse who took care of Liberian, Thomas Eric Duncan, at Texas Health Presbyterian Hospital Dallas tested positive for Ebola. She became the first person to contract the virus in the United States. U.S. National Institutes of Health said nurse Pham will be moved from Dallas to a National Institutes of Health (NIH) isolation unit in Bethesda, Maryland.

Nurse Amber Vinson (Source: nbcnews.com)
Nurse Amber Vinson (Source: nbcnews.com)

On October 15, 2014, officials said that Amber Vinson, a second Texas nurse who treated Duncan had contracted Ebola. She was treated at Emory University Hospital in Atlanta. Authorities said Vinson took a flight from Cleveland to Dallas/Fort Worth International Airport while running a slight fever.

On October 16, 2014, a U.S. congressional subcommittee sharply questioned health officials about the response to Ebola in the United States.

Dr. Craig Spencer (Source - nbcnews.com)
Dr. Craig Spencer (Source – nbcnews.com)

On October 17, 2014, The 33-year-old Dr. Craig Spencer, a New York doctor returned from Ebola-hit Guinea. Spencer, treated Ebola patients while working for MSF. After completing his work on October 12, 2014, he left Guinea two days later via Brussels, Belgium. He arrived at John F. Kennedy International Airport in New York City, on October 17, 2014. On his arrival, he did not exhibit any symptoms of the virus. The physician, who worked at Columbia Presbyterian Hospital, was checking his temperature twice a day. He had not seen any patients since his return.

On October 20, 2014, Emory University Hospital in Atlanta released an unidentified American who had contracted Ebola in Sierra Leone.

In Texas, 43 people were taken off Ebola watch lists. About 260 people were still being monitored in Texas and Ohio. United States issued stricter guidelines for health workers treating Ebola victims. Not to expose skin or hair.

On Tuesday, October 21, 2014, Dr. Spencer started feeling fatigued and sluggish though without a fever. That day, he visited a coffee stand and a meatball restaurant in Manhattan. The next day, he ran for three miles in his neighborhood, and took the subway to a bowling alley in Brooklyn. He was not symptomatic then.

On October 23, 2014, Spencer developed a fever, nausea, pain and fatigue in the morning. His fever spiked to 100.3 degrees Fahrenheit (about 38 Celsius). He tested positive for Ebola. He is the first case of the deadly virus in New York City and the fourth diagnosed in the United States.

Health officials cleared both the coffee stand and the bowling alley after assessing them. After closing the bowling alley on Thursday, they had the bar cleaned and sanitized as a precaution.

Spencer’s Manhattan apartment has been isolated and locked.

Spencer was in contact with a few people after he started exhibiting symptoms. Ebola is not contagious until someone has symptoms. Health officials said that three people – his fiancée and two friends – are on quarantine and monitored,

“They are all well at this time; none of them is sick,” said Dr. Mary Travis Bassett, New York City’s health commissioner.

Spencer also travelled on three subway lines. “At the time that the doctor was on the subway, he did not have fever… He was not symptomatic,” Bassett said. The chances of anyone contracting the virus from contact him are “close to nil,” she said.

Ebola spreads by direct contact with the body fluids of an infected person. The time between exposure to the virus and the development of symptoms of the disease is usually two to 21 days. Estimates based on mathematical models predict around 5% of cases might take greater than 21 days to develop the symptoms.

Dr. Craig Spencer is now lodged at New York’s Bellevue Hospital Center. He has been in isolation since emergency personnel took him there. It is one of the eight hospitals statewide designated by New York Governor Andrew Cuomo as part of an Ebola preparedness plan.

“We are as ready as one could be,” Cuomo said. New York state will be different from Texas he said.

“We had the advantage of learning from the Dallas experience,” he said, recalling the death of Liberian Thomas Eric Duncan on October 8, 2014, diagnosed with Ebola.

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Fatu Kekula: the Brave Ebola Lifesaver


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Myself . By T.V. Antony Raj

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The rampant spreading of the Ebola Virus Disease (EVD) in Liberia, has created a chaos in that country. As on October 18, 2014, out of the 4,665 patients diagnosed for Ebola in Liberia, 2,705 died. In the past week alone Monrovia reported 305 new EVD cases. Out of the 15 counties in Liberia 14 have reported cases of Ebola. Only Grand Gedeh county has yet to report an EVD case.

Even before the outbreak of the Ebola virus, Liberia faced a health crisis. It had only 50 physicians in the entire country – one for every 70,000 citizens. In September 2014, the US Centers for Disease Control and Prevention (CDC) reported that some hospitals in Liberia had been abandoned, and the hospitals which were still functioning lacked basic facilities. They did not have running water, rubber gloves, and sanitizing supplies.

At the end of August 2014, the World Health Organization (WHO) stated that Liberia fell short of 1,550 beds to treat EVD patients. In September, a new 150-bed treatment clinic opened in the capital, Monrovia. At the time of the opening ceremony six ambulances were already waiting with potential Ebola patients. More patients were waiting by the clinic after making their way on foot with the help of relatives.

The treatment of EVD in other parts of the country is more pathetic. To add to the woes, on October 12, 2014, Liberian nurses threatened a strike over wages.

Fatu Kekula, 22-year-old Liberian student nurse (Source: edition.cnn.com)
Fatu Kekula, 22-year-old Liberian student nurse (Source: edition.cnn.com)

Amidst this chaos comes the story of Fatu Kekula, a brave 22-year-old Liberian nursing student.  She took care of four relatives affected by the Ebola virus by herself. She managed to save three out of the four patients, she cared for. That is a whopping 25% death rate, far better than the estimated average Ebola death rate of 58% in Liberia. Now, her unique methods for survival are being taught all over West Africa.

In July 2014, Fatu’s father, Moses Kekula, experienced high blood pressure. She took him to the local hospital in Kakata. After admitting Moses, the crowded hospital provided a bed that had become free. At that time, none of Fatu’s family members knew that the previous occupant of the bed had died from EVD. Soon after, Moses showed symptoms of EVD. He developed a fever. He started vomiting and had diarrhoea. A few days later the authorities shut down the hospital because nurses started dying of EVD.

Fatu then took her father to Monrovia. Three hospitals turned him away because they were already filled over capacity. So, Fatu took her father back to Kakata and got him admitted in another hospital. There they said he had typhoid fever and did little for him. Frustrated, Fatu returned home with her father.

At home Moses infected three other family members: his wife Victoria (57), elder daughter Vivian (28), and nephew Alfred Winnie (14). Fatu was the only unaffected family member.

Fatu contacted their family doctor. But he refused to come to their home, fearing the possibility of getting infected. Taking the next best option, Fatu requested the doctor to for directions. She got the medicines and fluids prescribed by the doctor from a local clinic. Her training at the nursing school helped her create her own intravenous lines.

Fatu Kekula, 22-year-old Liberian student nurse  saved her father's life in this makeshift isolation ward in a spare unfinished room at home. - MCT
Fatu Kekula, 22-year-old Liberian student nurse saved her father’s life in this makeshift isolation ward in a spare unfinished room at home. – MCT

Fatu then began to take care of her father, mother, sister, and cousin, all by herself. She put her three patients – father, mother and cousin in makeshift isolation ward in a spare unfinished room at home.

Fatu Kekula, 22-year-old Liberian student nurse. She took all the precautions for avoiding contact by using layers of trash bags on her feet and hair. She wore rubber boots, four pairs of gloves, and a face mask. (Source: edition.cnn.com)
Fatu Kekula, 22-year-old Liberian student nurse. She took all the precautions for avoiding contact by using layers of trash bags on her feet and hair. She wore rubber boots, four pairs of gloves, and a face mask. (Source: edition.cnn.com)

She did not have personal protection equipment such as those white space suits and goggles used in Ebola treatment units. She invented her own protective gear. She came up with the trash bag method. She took all the precautions for avoiding contact by using layers of trash bags on her feet and hair. She wore rubber boots, four pairs of gloves, and a face mask.

She fed her patients, gave them medicines, and cleaned them, all by herself day in and day out. It is a miracle that Fatu herself was not infected in the two weeks she was taking care of her family though she was in close contact with them.

On August 17, 2014, space became available at John F. Kennedy Medical Center, the national medical center of Liberia, located in the Sinkor district of Monrovia. Fatu’s father, mother, and sister recovered, but her cousin Alfred Winnie succumbed to the disease at the hospital the following day.

Fatu Kekula’s father is trying to find a scholarship for her that so she can finish her final year of nursing school. He has no doubt his daughter will go on to save more lives in the future.

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Ebola Virus Disease (EVD) in Liberia


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Myself . By T.V. Antony Raj

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Coat of arms of Liberia

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On December 6, 2013, a 2-year-old boy died in the village of Meliandou, Guéckédou Prefecture, Guinea. Researchers believe the boy’s death was the index case of the current Ebola virus disease epidemic.

Hammer-headed bat (Hypsignathus monstrosus), also known as the big-lipped bat, is a megabat widely distributed in equatorial Africa. (Credit - Shyamal - Wikipedia)
Hammer-headed bat (Hypsignathus monstrosus), also known as the big-lipped bat, is a megabat widely distributed in equatorial Africa. (Credit – Shyamal – Wikipedia)

Bushmeat refers to meat from non-domesticated mammals, reptiles, amphibians, and birds hunted for food in tropical forests. The dead boy’s family were hunters of bats for bushmeat. They hunted the Ebola-harbouring species Hypsignathus monstrous and Epomops franqueti. This may have been the original source of the infection. The dead boy’s mother, sister, and grandmother fell ill with similar symptoms and died. People infected by those victims spread the disease to other villages.

Now, Ebola represents a major public health issue in sub-Saharan Africa. But in early 2014, West Africa did not report any no cases of Ebola. The early cases of Ebola were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.

On Wednesday, March 19, 2014,  Reuters reported an outbreak of an undetermined viral haemorrhagic fever in the West African nation of Guinea. According to Guinea’s local health officials, the first case of the fever was reported in February 2014 that sickened at least 35 people and killed 23.

Dr. Sakoba Keita, the doctor in charge of the prevention of epidemics in Guinea’s Health Ministry said:

“Symptoms appear as diarrhoea and vomiting, with a very high fever. Some cases showed relatively heavy bleeding… We thought it was Lassa fever or another form of cholera, but this disease seems to strike like lightning. We are looking at all possibilities, including Ebola, because bushmeat is consumed in that region and Guinea is in the Ebola belt.”

Keita also said that most of the victims had been in contact with the deceased or had handled the dead bodies. He said those infected had been isolated, and they had sent samples to Senegal and France for further tests.

By March 24, 2014, Médecins Sans Frontières (MSF) or Doctors Without Borders had set up an isolation facility in Guéckédou.

By late May 2014, the outbreak had spread to Guinea’s capital, Conakry, a city of about two million inhabitants. On May 28, 2014, the total number of cases reported had reached 281 with 186 deaths.

In late March 2014, Liberia, reported the spread of Ebola in Lofa and Nimba counties. In mid-April 2014, the Liberia’s Ministry of Health and Social Welfare recorded possible cases of Ebola in Margibi and Montserrado counties. In mid-June 2014, Liberia’s capital Monrovia reported the first cases of Ebola. On July 27, 2014, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its borders with neighbouring countries. In August, he declared a national state of emergency, with the “suspensions of certain rights and privileges”.

Liberia faced a health crisis even before the outbreak of the Ebola virus. It had only 50 physicians in the entire country — one for every 70,000 Liberians. In September 2014, the US Centers for Disease Control and Prevention (CDC) reported that some hospitals in Liberia had been abandoned. The report also said the hospitals which were still functioning lacked basic facilities such as running water, rubber gloves, and sanitizing supplies.

At the end of August, the World Health Organization (WHO) stated that Liberia’s capacity to treat Ebola Virus Disease (EVD) cases fell short of 1,550 beds. In September, a new 150-bed treatment clinic was opened in Monrovia. At the time of the opening ceremony six ambulances were already waiting with potential Ebola patients. More patients were waiting by the clinic after making their way on foot with the help of relatives.

2014 ebola virus epidemic in West Africa (Author: Mikael Häggström)
2014 Ebola virus epidemic in West Africa (Author: Mikael Häggström)

As on October 19, 2014, out of the 4,665 patients diagnosed for Ebola in Liberia, 2,705 had died. In the past week alone Monrovia reported 305 new EVD cases. Out of the 15 counties in Liberia 14 have reported cases of Ebola. Only Grand Gedeh has yet to report an EVD case.

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