Rewire the Web : Ebola Key Facts: 2014

Thursday, October 23, 2014

Ebola provides timely lesson for HeLa students

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Hospital of Ebola patient posts poor ER benchmarks

DALLAS (AP) — Diplomas from outstanding medical schools. Records free of discipline. A team trusted by a president.

For all the strengths of Texas Health Presbyterian Hospital Dallas, the first U.S.-diagnosed Ebola patient walked through its seemingly weakest link: the emergency room.

Presbyterian met or exceeded 75 percent of 138 specific measures of care, according to its most recent data. But its emergency department failed to meet all five national patient safety and quality benchmarks the hospital reported. Those measure how long it takes for patients to be seen, admitted, or otherwise cared for in the ER.

"When wait times get longer, it creates an environment where people are more likely to make mistakes," said Dr. Ashish Jha, a Harvard University professor and director of the Harvard Global Health Institute. "It's a recipe for things not going well."

The hospital itself says emergency wait times may indicate understaffing or overcrowding that "can result in treatment delays and more stress for patients."

Thomas Eric Duncan first entered Presbyterian's ER on Sept. 25, complaining of abdominal pain, severe headache, dizziness and nausea. He was discharged after a few hours, but returned two days later and eventually died of Ebola. Two of his nurses became infected.

For the year ending March 31, patients in Presbyterian's emergency department waited 44 minutes on average before their first contact with a health care professional, 50 percent longer than state and national waits. They spent more than five hours in the emergency department, on average, before being admitted, more than an hour longer than state and national averages. Presbyterian reported meeting one of six emergency department benchmarks in 2012-13.

Hospital spokesman Wendell Watson said, "Wait time is only one component of patient care and patient experience." Others insist longer wait times can reflect a workflow problem, with lags for X-rays, tests or admissions.

"To miss your benchmarks in emergency room waiting times is probably the greatest indication that your ER is not up to snuff," said Jamie Court, president of the nonprofit Consumer Watchdog.

In other areas where Presbyterian reported data and for which federal benchmarks exist, the hospital largely met or exceeded national averages.

Presbyterian — where former President George W. Bush underwent a heart procedure last year — exceeded seven national benchmarks for strokes, earned perfect scores on a number of surgical measures and met six of 10 criteria on heart attacks, according to its data. It had nearly no infections from IV insertions, about 75 percent fewer than national benchmarks.

Those infections had been a problem for Presbyterian in 2011, when increasing cases prompted a hospital task force. This summer, a Presbyterian infection prevention specialist published a study describing how the hospital dramatically decreased infections by strictly enforcing rules about how long to scrub the hubs of catheters before inserting them.

Health safety consultant Michael Millenson, a visiting scholar at Northwestern University, says it's laudable that Presbyterian addressed the problem, but added that federal standards are weak and it took years to do what should have taken weeks.

Texas Health Resources began posting detailed data online — from heart attack mortality rates to post-surgical infections — for each of its 17 hospitals this summer. U.S. hospitals are required to send such indicators to the U.S. Centers for Medicare & Medicaid Services, but do not generally post them on their websites.

"We've committed to show it all, both the good and the bad," said now-retired Texas Health CEO Douglas Hawthorne.

___

When Duncan initially appeared in Presbyterian's ER, several potential warning signs apparently went unnoticed.

"He had symptoms that could be Ebola but could be any number of things when he showed up at his first visit," said Dr. Greg Moran, an emergency and infectious disease specialist at UCLA who reviewed Duncan's medical records. "The miss was basically a simple question that the physician didn't ask: Had he traveled? I don't see documentation that the physician asked that question."

Duncan had recently arrived from West Africa, where the largest outbreak of Ebola ever recorded is occurring. But the only reference to Africa came in a brief nurse's note.

Two medical specialists reviewed hospital records detailing Duncan's ER treatment for The Associated Press, which received the documents from his family. They noted that Duncan had somewhat abnormal blood and urine test results that could have raised questions, particularly about his kidney function. Along with a fever that spiked at 103, that might have indicated an infection, mild dehydration, the onset of diabetes, or nothing at all, they said.

But combined with Duncan's travel information, the results would have prompted them to consider the possibility of Ebola, they said.

Instead, Duncan was sent home after four hours with a prescription for antibiotics and a handout about sinus infections. Four hours later, a specialist reviewed his CT scan and ruled out a sinus infection. The records don't indicate that information was passed on.

"Diagnosing Ebola is very different from treating Ebola," said Watson, who added Presbyterian has changed the screening process in its ER to obtain a patient's travel history immediately and make it more easily visible in its electronic records system.

Jha, who also serves on a federal commission studying ER mistakes, said 5 percent of all emergency room visits are misdiagnosed — "a very high error rate."

___

At Presbyterian, ER doctors don't actually work for the hospital.

Texas, like some other states, bars most hospitals from employing physicians directly, said Allison Winnike, a University of Houston health law professor.

"The idea is to keep the physicians independent from the hospital so they could act on what's best for the patient and not what's best for the hospital," said Dr. William Durkin, a former president of the American Academy of Emergency Medicine.

Presbyterian's ER doctors are private contractors who work with Texas Medicine Resources LLP, which has had the contract to provide them for 38 years, according to Dr. Ralph Baine, the president of Emergency Medicine Consultants, a related company that handles many administrative functions for the doctors. Those two companies operate out of the same Fort Worth office.

Supplies, support staff and other emergency department needs are provided directly by Presbyterian. The setup has no impact on care, Baine said, adding, "Our physicians are held to the same standard of care regardless of the legal structure under which they operate."

But Daniel Zingale, who pioneered California health reform plans, said having non-staff physicians creates a certain amount of risk. Even under ordinary circumstances, he said, it's a challenge to maintain coordination and flow of information in a system divided between health plans, hospitals and providers.

"In a public health emergency, there are clear advantages to a more integrated and seamless system," he said.

Consumer Watchdog says having physicians working in independent groups rather than directly for the hospital can lead to weaker care.

"If you have doctors who are not salaried and on staff, you're less likely to hit public health benchmarks as you are about the business goals of that contract," said Court, the group's president.

The AP has attempted to contact dozens of individuals directly involved in Duncan's care. None has been willing to speak. Messages left for the ER doctor who first treated and released Duncan, as well as his attorney, have gone unanswered.

Texas Medical Board records show that none of Duncan's 20 doctors have ever been disciplined, investigated by the board for malpractice, had restrictions placed on their licenses or been linked to any criminal history. Dallas County court records show relatively few malpractice cases filed against them.

Some earned medical degrees from schools including Harvard and New York University. On average, they have about 14 years of experience. Among 32 nurses involved in Duncan's care whose records could be located, none had a disciplinary record. They averaged about six years of experience in Texas.

Presbyterian has conceded its Ebola training was not fully deployed, and apologized for Duncan's initial misdiagnosis. A public-relations push has included posting videos of nurses praising the facility and a "PresbyProud" Twitter campaign. Watson says Presbyterian wants to move forward: "We are determined to be an agent for change across the U.S. health care system by helping our peers benefit from our experience."

But the mistakes are baffling, said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Tennessee.

"I would have thought that literally every hospital would have said, 'Hmmm, one of those patients could walk into my emergency room and so we had better start reviewing our infection control program, make sure it includes these Ebola-specific issues, make sure we have the personal protective equipment and make sure that our staff is prepared,'" he said.

Gay community under attack in Liberia over Ebola outbreak

By Misha Hussain and Maria Caspani

Thu Oct 23, 2014 1:40pm BST

DAKAR/NEW YORK (Thomson Reuters Foundation) - Leroy Ponpon doesn't know whether to lock himself in his flat in Monrovia because of the deadly Ebola virus, or because he is gay. Christian churches' recent linking of the two have made life hell for him and hundreds of other gays.

Ponpon, an LGBT campaigner in the Liberian capital, says gays have been harassed, physically attacked and a few have had their cars smashed by people blaming them for the hemorrhagic fever, after religious leaders in Liberia said Ebola was a punishment from God for homosexuality.

"Since church ministers declared Ebola was a plague sent by God to punish sodomy in Liberia, the violence toward gays has escalated. They're even asking for the death penalty. We're living in fear," Ponpon told the Thomson Reuters Foundation by telephone from Monrovia.

Ebola has infected almost 10,000 people in West Africa since March, killing around half its victims. Liberia is the worst hit country where poverty, corruption and civil war have left a weak health system unable to cope with the exponential spread of the disease.

Some religious leaders have their own interpretation of the causes of Ebola.

Earlier this year, the Liberian Council of Churches said in a statement that God was angry with Liberians "over corruption and immoral acts" such as homosexuality, and that Ebola was a punishment.

In May, Archbishop Lewis Zeigler of the Catholic Church of Liberia said that "one of the major transgressions against God for which He may be punishing Liberia is the act of homosexuality," local media reported.

Francois Patuel, Amnesty International's representative in West Africa, said there had been reports of threats and violence against the LGBTI community in Monrovia since the incendiary remarks made by the local Christian leaders.

"Amnesty has received pictures of cars that reportedly belong to gays with their windows smashed as well as reports that gays have been forced from their homes and had to go into hiding," Patuel told the Thomson Reuters Foundation.

Neither the Catholic Church nor the Liberian Council of Churches could be reached in Monrovia. Representatives of the U.S. Conference of Catholic Bishops and the Episcopal Church did not immediately respond to a request for comment.

COVER OF DARKNESS

Ponpon prefers to move at night. He is scared to be identified in daylight after the local press splashed his picture and phone number across the front pages. But the Ebola curfew, running from 11 p.m. to 6 a.m., has complicated things.

"In the day, we move around wearing sunglasses and disguises. The problem with moving at night is that it is not safe in Monrovia in the dark, and also, if you violate the Ebola curfew, it is punishable by imprisonment," he said.

The curfew has affected the LGBT community in another way. When activists contact the police for protection, they reply that because of the Ebola emergency and the curfew put in place to combat the disease, they cannot help, Ponpon said.

Violence against the LGBT community was already common in West Africa before the Ebola outbreak, and same-sex relationships are still largely taboo in many African countries. A recent Gallup poll showed Africa as the worst continent for gay people.

National laws in West Africa are in line with public sentiment. In Liberia, 'voluntary sodomy' is a first-degree misdemeanor with a penalty of up to one year in jail, according to the International Lesbian Gay Bisexual Trans and Intersex Association (ILGA).

Patuel said Amnesty had received no reports of similar incidents in other Ebola-stricken countries in the region, and urged African states to stand up for minorities.

"In August this year the African Union passed a resolution for the protection of LGBTi rights. The authorities must adopt this into their national law and take action against homophobic statements to protect its citizens," Patuel said.

In Liberia, Ponpon's demands are simple: "Right now, all we want is protection. We want the government to come forward and say that this is a minority group and they deserve the same rights as anyone else and then people will stop attacking us."

(Reporting By Misha Hussain in Dakar and Maria Caspani in New York, editing by Tim Pearce)

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EU leaders seek more Ebola funding at summit

BRUSSELS (AP) — The European Union has contributed another 24.4 million euros ($31 million) to the fight against Ebola, as the bloc's leaders try to close in on a 1 billion-euro ($1.26 billion) fund to fight the deadly virus.

British Prime Minister David Cameron set that high target last week. Going into Thursday's start of a two-day EU leaders' summit, the bloc's total anti-Ebola commitments stood over halfway to that goal.

EU Commission President Jose Manuel Barroso on Thursday added 24.4 million euros more for medical research on an Ebola vaccine.

Britain says it has committed 125 million pounds ($200 million) toward fighting Ebola, more than any other of the bloc's 28 nations.

Ebola
European Union

How warnings from Ebola case spawned Richardson treatment unit

When the first Ebola patient showed up at Texas Health Presbyterian Hospital Dallas, a warning sounded that other hospitals needed to prepare space for a possible influx of new cases.

Methodist Health System quickly identified a place that might work — a small intensive-care unit in its Methodist Campus for Continuing Care in Richardson. The unit had been empty since April but needed only minor alterations to give medical staffers room to change in and out of the protective gear required for treating Ebola patients.

“Initially, we thought it would be just for us,” said Dr. Sam Bagchi, Methodist’s senior vice president and chief quality officer.

Then came telephone calls from the Centers for Disease Control and Prevention, Dallas County and the Texas health department. Officials wanted to see what Methodist was planning and find out how quickly an Ebola treatment center could be set up.

The idea was to meet the needs of all local hospitals in one location.

The nation’s first patient diagnosed with Ebola, Thomas Eric Duncan, had died Oct. 8 at Presbyterian. Two nurses who became infected while caring for him were airlifted to specialty treatment sites in other states.

And the clock was ticking for more than 125 people locally who had been isolated because of possible exposure to the deadly disease. If any of them started showing symptoms, there had to be a treatment center ready to provide immediate care.

“All of the hospitals were working on plans to take care of an extended stay by an Ebola patient,” Bagchi said. “Why not combine those efforts? It’s meant to take the pressure off the community.”

It took only a few days for Methodist to revamp its plan into a 10-bed Ebola treatment center. Parkland Memorial Hospital agreed to supply protective gear along with a team of nurses, lab technicians and other support staff. UT Southwestern Medical Center at Dallas would provide doctors.

Dr. David Lakey, the state health commissioner, toured the Richardson facility with CDC officials, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

On Wednesday, the first two beds were ready for Ebola patients, allowing Methodist to officially activate the unit.

The facility has two negative-pressure rooms — rooms equipped to prevent the escape of contaminated air.

‘Nice collaboration’

If anyone is confirmed to have Ebola, it would take 12 hours to activate the facility and get it fully staffed. In all likelihood, an Ebola patient would have gone first to a hospital emergency room and been isolated and tested before being transferred to the Richardson facility, Bagchi said.

“This unit is for patients who test positive for Ebola,” he said. “Any patient would go through diagnostic screening before being transferred here.”

The state’s second Ebola treatment facility, at the University of Texas Medical Branch in Galveston, is expected to be ready for patients as early as Thursday. The hospital is home to the Galveston National Laboratory, a federal biocontainment facility that has extensively researched Ebola and other infectious diseases.

The Methodist Ebola center is on the third floor of the 51-year-old Methodist Richardson Medical Center at 401 W. Campbell Road. The hospital was replaced last spring by a new facility at Renner Road and the Bush Turnpike.

“We couldn’t have done it without the CDC’s involvement,” Bagchi said of the quick turnaround at the Methodist center. “It’s a really nice collaboration, where everybody is bringing something.”

Some experts outside Dallas questioned having UT Southwestern and Parkland involved together with the new Ebola treatment facility. The two came under federal scrutiny three years ago over lapses in infection prevention and other care.

“This track record of problems is, of course, concerning,’’ said Dr. Ashish Jha, an associate professor at Harvard University’s School of Public Health. “Have they really put these problems behind them, and do they understand what caused them?”

Parkland and UTSW declined Wednesday to answer questions about their past collaborations. In a joint statement, they spoke of their “70-year history of working as partners and a productive and constructive relationship.”

Meeting of neighbors

Wednesday evening, Richardson Mayor Laura Maczka addressed about 100 people at a regular meeting of the Canyon Creek Homeowners Association, where residents of the neighborhood just north of the hospital were agreeable to news of its designation as a treatment site.

“As a community, you hope and pray something like this never happens in your community,” Maczka said. “But if it does, you also hope and pray that you are prepared for it, and so I think we as a community should be really proud.”

Diane Jacobs, who lives near the Richardson facility, said she supported using it to care for Ebola patients.

“We’re excited that the city of Richardson can participate in this fight, because that’s what it is,” said Jacobs, who directs a church preschool.

Susan Yost, who also lives nearby, said she was “very proud” that the Richardson facility was chosen. “It makes our city more proactive and prepared. It makes me feel safer,” she said.

Rex Kathcart, another resident, said he had no concerns about the center being used as an Ebola treatment site because officials have been transparent about plans for the facility.

“I think the hospitals have learned from their mistakes,” Kathcart said. “If this was two weeks ago you may have seen some concern, but they have explained it really well.”

Texas officials said the Richardson and Galveston facilities would be available to handle outbreaks of other diseases beyond Ebola.

“Ebola is the current threat, but there are other infectious diseases that pose a risk,” said Goodman, the state Health and Human Services Commission spokeswoman. “These new centers will make sure Texas is well-prepared for whatever comes our way.”

The treatment centers aren’t costing the state any money, she said. “These hospitals already get state and federal funding, and they’re able to support the centers within their current budgets,” she said.

Treatment costs also could be billed to private insurers or Medicaid, she added.

Staff writers Leslie Barker, Julie Fancher, Wendy Hundley and Miles Moffeit contributed to this report.

sjacobson@dallasnews.com;

rloftis@dallasnews.com

Tuesday, October 21, 2014

Ebola ‘czar’ to skip House hearing, aide says

America's newly appointed Ebola ‘czar’ is not yet in the House — at least not the ones on Pennsylvania Avenue or Capitol Hill.

Ron Klain, appointed last Friday by President Obama to direct the nation's response to the Ebola crisis, sent his regrets Monday to the House Oversight and Government Reform Committee, which had invited him to testify this Friday, a committee aide told Fox News.

Klain was invited to join Defense and Health and Human Services department officials also slated to testify at the hearing.

“The White House has informed us that he has not yet officially started and will not be able to attend Friday,” the committee aide told Fox News.

Klain, a former chief of staff to vice presidents Al Gore and Joe Biden, has yet to formally start his new assignment — though he was spotted on the White House campus on Saturday. Fox News was told, however, that he did not meet with the president – and was not part of an all-hands-on-deck Ebola meeting that same day.

He is expected to start sometime this week.

Despite bipartisan calls for an Ebola czar, however, the selection of Klain angered some Republicans, who complained he has no health care experience. Klain, after leaving Biden's staff, went into the private sector, serving as president of Case Holdings and general counsel for venture-capital firm Revolution LLC.

“That the president chose a political operative rather than a health care expert to head up his administration’s response to an outbreak of a deadly disease says a lot – and nothing positive – about the White House’s line of thinking,” Rep. Tom Price, R-Ga., said in a statement on Friday.

Health officials, though, have defended Klain as someone who brings needed managerial experience to a complex task.

“He's a highly experienced, highly talented manager. He's been chief of staff for Vice President Gore, for Vice President Biden, has had experience in the Congress,” Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said Monday at a town hall-style meeting. “He will be coordinating the interactions among a multi-agency endeavor that are involved, each of which have their own responsibility.”

Fauci also stressed that Klain is not a “czar.”

“It's an Ebola response coordinator is the title for Ron Klain,” Fauci said.

Fox News’ Mike Emanuel contributed to this report.

Ebola is a fear factor for stock market

NEW YORK (CNNMoney)

Fear has returned to Wall Street this fall and at least some of the heightened nervousness can be pinned on Ebola.

That's not to say the deadly virus is the number one thing keeping investors awake at night. There's concern about the global economy, deflation in Europe, China's slowing growth and Federal Reserve policy.

But Ebola has contributed to the negative psychology that has sent stock prices reeling this month.

Need proof? The chart below shows how the VIX volatility index has spiked since the summer. At the same time, the number of searches on Bloomberg terminals (a key resource for many investors) for news related to the Ebola outbreak has also skyrocketed. Of course, correlation doesn't imply causality, but it's worth noting.

Ebola is "not by itself directly responsible for everything, but it's obviously making things work," said Dan Greenhaus, chief global strategist at BTIG.

The VIX volatility index has clearly been on the rise since July 1. So have searches on Bloomberg terminals for news surrounding the Ebola crisis.

Greenhaus, who published a similar chart in a note to clients Sunday night, said he's noticed a change in how his investor clients have reacted to the Ebola issue.

"I saw the progression from curiosity and sideshow to something a little more paramount," he said. "In the context of everything else going on from European weakness to Fed tapering, if you layer on top of that whatever minor chance of a pandemic, you obviously have the recipe for additional volatility."

Turbulence hits stocks: That volatility was on full display last week. The Dow plummeted as much as 460 points on October 15 amid a plethora of concerns, including Ebola, before rebounding sharply.

Two days later the Dow surged 263 points -- its second best day of the entire year -- as Wall Street cheered strong corporate report cards.

A sense of calm returned to Wall Street on Monday, with most major U.S. markets climbing cautiously higher. The VIX dropped 11%, putting it on track for a third consecutive down day. There was positive news on the Ebola front as 43 people who were in contact with Ebola patient Thomas Eric Duncan were officially cleared.

The Ebola concerns are not universal among investors.

Greenhaus said he's noticed that clients who believe there's a reason to be worried about Ebola are very concerned. But he said those that aren't concerned believe it's a "sideshow, a convenient excuse and stupid it would get brought up at all."

Volatile travel stocks: There's far less debate over what kind of impact Ebola is having on certain corners of the travel and pharmaceutical sectors of the stock market.

Just look at the bumpy ride airline investors are experiencing. Shares of Delta Air Lines (DAL) and American Airlines (AAL) have retreated more than 15% from their 52-week highs amid fears a wider Ebola crisis will scare people away from flying.

Cruise operators like Carnival (CCL) and Royal Caribbean (RCL) have also been hit, with their shares tumbling 12% a piece over the past month.

On the other hand, investors are betting on which companies will be able to capitalize on Ebola. Shares of Tekmira Pharmaceuticals (TKMR) and other drug makers working on Ebola treatments have shot up in recent months.

Lakeland Industries (LAKE), which makes Hazmat suits, has skyrocketed 100% since mid-September.

First Published: October 20, 2014: 2:49 PM ET

Doctors Without Borders Hits Ebola Breaking Point

Contact tracing—tracking down an Ebola patient’s immediate circle—is doable in the West. But in West Africa, with limited transportation, fuel, and health workers, it’s daunting.

“Contact tracing” sounds like something that would excite only the grimmest of healthcare operations implementation scientists.

But actually, contact tracing is the core principle of all public health endeavors. It is the very thing that separates the men from the boys—or in this instance, the resource-plentiful from the resource-strapped countries. And though you wouldn’t know it from the trail of lamentations and mea culpas that have followed the Dallas hospital leaders and the even more beleaguered Centers for Disease Control and Prevention (CDC), we just saw a perfect execution of contact tracing right there in Metroplex, Texas (and the attendant venues on the cruise ship and the Frontier airlines flights).

What they did—and what humanitarian aid organization Doctors Without Borders/Médecins Sans Frontières (MSF) says Liberia no longer can do—is simple: they traced people.

So when the late Thomas Eric Duncan was diagnosed, an immediate circle was drawn around his contacts—they were traced (ergo, contact tracing). And because the transmission of Ebola is pretty well understood, this group of people was watched carefully for 21 days—graduating just yesterday—until they proved themselves to be Ebola free. Had a secondary case (Duncan is the primary case; anyone catching it from him, such as the two nurses, are secondary cases) been diagnosed from his home contacts, that person would have been caught early in the pre-contagious stage, and a circle drawn around his or her contacts. They would then start the meter at 21 days and wait it out.

After the rudiments were in place for the home contacts to be contact traced, the healthcare workers who tended him were then watched—and it worked, too. There have been no further cases and most importantly of all, no cases transmitted by the secondary cases (Nurses Pham and Vinson) have been identified. In other words, contact tracing with appropriate surveillance of those at risk has worked exactly according to plan. And because of contact tracing, Dallas and the greater U.S. remain safe.

Compare this triumph and similar ones in Senegal and Nigeria to the still-deteriorating disaster of the three West African nations where Ebola still rages. There, the person who shared the house with the latest case can’t be traced; ditto the nurse or doctor who treated the patient is lost in the shuffle; so too the various people involved in a burial or, as happened in Duncan’s case, who helped a dying patient to the hospital. In other words, the systematic rational way to control the outbreak, by defining its outer borders and letting the pyre of cases inside burn to completion, cannot be used to stop Ebola 2014.

With the World Health Organization reporting over 9,000 cases and 4,500 deaths in West Africa, contract tracing has become a luxury the region can no longer afford. But if these major organizations have abandoned this practice, it isn’t for lack of trying to implement it. In September, the World Health Organization (WHO) released a painstakingly detailed report on the process, which it described as an “integral component” of the overall strategy for controlling an outbreak. “It is critical that all potential contacts of suspect, probable and confirmed Ebola cases are systemically identified,” writes WHO.

In a country with a fully functioning health system populated with able and willing medical professionals, this is doable. In West Africa, where Ebola patients are dying at the gates of hospitals too full to let them in, it’s not.

The CDC too, has been emphatic in their promotion of the technique. In a press briefing on October 4, Director Thomas Frieden repeated a line he’s used in nearly every call since July. “We know how to stop outbreaks of Ebola,” he said. “The core of that, the way to stop Ebola in its tracks is contact tracing, and follow-up.” In case those daily reminders aren’t enough, the CDC has issued a colorful turquoise and orange poster that reads like a children’s book. “Contact tracing can stop Ebola in its tracks,” the poster begins, before flowing onto stick figures of varying shades (red is a victim, black is not). “Even one missed contact can keep the outbreak going,” it continues.

The process, as both the CDC and WHO have echoed for months, isn’t easy. The first step, contact identification, involves obtaining meticulous details from each Ebola patient about who they may have come in contact with since exhibiting symptoms (a step that poses many problems, including how one figures out when they were symptomatic). Contact listing, next up, involves taking copious notes about each potential new victim—where they live, how old they are, when they came in contact with the victim, in what way. Since the virus can stay incubated in the human body for up to 21-days the third step, follow-up, is key. Home visits necessitate a phone, car, fuel, and someone who can drive.

In a country with a fully functioning health system populated with able and willing medical professionals, this is doable. In West Africa, where Ebola patients are dying at the gates of hospitals too full to let them in, it’s not. The already-tiny group of volunteers and health care workers in West Africa is shrinking. According to an October 18^th situation report from the Liberian Ministry of Health, 228 health care workers have been infected with the virus in that country; 103 of them have died. Overall, says WHO, 423 have contracted it, 239 have died.

An article in Nature three weeks ago brought up the devastation that could result if contact tracing were to be stopped. “Rapid 'contact tracing' will be key to containing the disease in West Africa,” it reads. Noting that the region was already strapped by insufficient resources and staff, the author explained under what conditions contact tracing would be able to continue: “Only if the international community can massively increase the number of trained health workers there.”

Contact tracing is not an exciting, experimental treatment or an expensive, innovative vaccine. It is a basic necessity.

Contact tracing is not an exciting, experimental treatment or an expensive, innovative vaccine. It is a basic necessity—the bare bones of an already-anemic effort to fight this in West Africa that is growing smaller every day. MSF’s inability to perform a task so integral to halting this epidemic proves just how inadequate the “surge” in international support has been.

“This is where, unless the international response ramps up considerably and immediately, the math is against dampening this outbreak down very soon,” Dr. Terry O’Sullivan, director of the Center for Emergency Management and Homeland Security Policy Research says. “One cannot do outbreak control of this sort without significant contact tracing abilities.”

O’Sullivan, who spent three years volunteering as a doctor in Sierra Leone, joins the choir of voices applauding Nigeria’s containment effort. “[They] reportedly conducted almost 19,000 interviews in order to stamp out a very small Ebola outbreak there,” says O’Sullivan. “Without significant infusion of outside resources and manpower to do the contact tracing, the outbreak will continue to get worse in those areas where MSF has reached its limit.”

CDC releases revised Ebola gear guidelines

ATLANTA (AP) — Federal officials are going on the road with new guidelines to promote head-to-toe protection for health workers treating Ebola patients.

Officials on Monday night released the advice, which health workers had pushed hard for after two Dallas nurses became infected while caring for the first person diagnosed with the virus in the United States.

Centers for Disease Control and Prevention officials will be demonstrating the recommended techniques Tuesday at a massive training at New York City's Javits Center, with an expected attendance of thousands.

The president of a group representing 3 million registered nurses said she's glad to finally see better federal advice. Health care workers said the CDC's old guidance was confusing and inadequate, and left them fearfully unprepared for how to deal with an Ebola patient.

"Today's guidance moves us forward," said Pamela Cipriano, president of the American Nurses Association, in a statement Monday night.

Demand for new guidance was spurred by the unexpected infections this month of the two nurses at Texas Health Presbyterian Hospital. It's not clear exactly how they became infected, but clearly there was some kind of problem, CDC Director Dr. Tom Frieden said.

"The bottom line is the guidelines didn't work for that hospital," Frieden said, in announcing the revised guidelines Monday evening.

Earlier CDC guidelines had been modeled on how Ebola patients in Africa were treated, though that tends to be less intensive care done in rougher settings — like tents. They also allowed hospitals some flexibility to use available covering when dealing with suspected Ebola patients.

The new guidelines set a firmer standard, calling for full-body garb and hoods that protect worker's necks; setting rigorous rules for removal of equipment and disinfection of hands; and calling for a "site manager" to supervise the putting on and taking off of equipment.

They also call for health workers who may be involved in an Ebola patient's care to repeatedly practice and demonstrate proficiency in donning and doffing gear — before ever being allowed near a patient.

And they ask hospitals to establish designated areas for putting on and taking off equipment, whether it's a room adjacent to an Ebola patient's room or a hallway area cordoned off with a plastic sheet.

The CDC cannot require hospitals to follow the guidance; it's merely official advice. But these are the rules hospitals are following as they face the possibility of encountering patients with a deadly infectious disease that a few months ago had never been seen in this country.

The CDC guidance was expected as early as Saturday, but its release has been pushed back while it continues to go through review by experts and government officials.

All this stems from the case of Thomas Eric Duncan, a Liberian man who came down with Ebola symptoms last month while visiting Dallas.

Duncan went to the hospital Sept. 25 but was not tested for, or diagnosed with, Ebola. He returned to the hospital three days later and on Sept. 30 tested positive. He died Oct. 8.

Duncan's case led to the monitoring of about 50 people who came in contact with him before his second trip to the hospital, and dozens of health care workers who cared for him after his admission.

Some good news this week: The 50 in the initial contact group have passed a 21-day observation period and no longer are deemed at risk for coming down with the dreaded disease.

Youngor Jallah spent the past three weeks confined to her small apartment with her children and boyfriend, fearing they had contracted the deadly Ebola virus from Duncan, who was her mother's fiance.

But with the household emerging symptom-free from the incubation period, Jallah's family members are now trying to resume their lives - replacing the personal belongings incinerated in a cleanup at her mother's home, and overcoming the stigma of the Ebola scare that has gripped Dallas.

"If they see me at the store, they run away," Jallah told The Associated Press on Monday.

There are now about 120 people in Texas being monitored for symptoms, with their wait period ending Nov. 7, said Dallas Mayor Mike Rawlings. He said the number may fluctuate.

There are also about 140 people being monitored in Ohio because of contact or potential contact with nurse Amber Vinson, Ohio officials said. Vinson, who cared for Duncan in Texas, flew from Dallas to Cleveland on Oct. 10 and flew back Oct. 13.

Schmall reported from Dallas. Associated Press writers Jamie Stengle, Nomaan Merchant and Marilynn Marchione in Dallas contributed to this report.

Doctor on sister's Ebola death in Freetown, Sierra Leone

Dr Albert Benjamin's sister, Dr Olivet Buck, was treating Ebola patients in Freetown, Sierra Leone. Last month she died after contracting the deadly virus.

Dr Benjamin spoke to the BBC about the horrific conditions in which his sister and other primary care workers in Freetown have been forced to operate.

Monday, October 20, 2014

Nigeria Officially Declared Ebola-Free

The World Health Organization declared Nigeria to be officially free of the Ebola virus. Nigeria has not had a confirmed case of the disease for 42 days, or two incubation periods of 21 days. WHO also declared Senegal to be free of Ebola on Friday. Nigeria’s success is drawing attention from many fighting the spreading virus who are impressed that the country’s efforts to contain the disease with an underfunded and ill-equipped health system. “It’s possible to control Ebola. It’s possible to defeat Ebola. We’ve seen it here in Nigeria,” said Onyebuchi Chukwu, the country’s health minister. The country experienced 20 cases of Ebola, and the virus ultimately killed eight people. Liberia, Guinea, and Sierra Leone continue to struggle with thousands of cases and deaths.

Thomas Eric Duncan's fiancee set to complete Ebola quarantine on Monday

STORY HIGHLIGHTS

Louise Troh releases statement as her quarantine is set to end

General already working to form Ebola "quick-strike team," Pentagon says

Texas Health Resources CEO admits to mistakes, says hospital is sorry

Cruise ship involved in contagion scare arrives back in Texas on Sunday

Are you on the front lines of Ebola? We'd like to hear your story.

(CNN) -- For nearly 20 days, Louise Troh has had to endure tremendous fear, grief and isolation.

When told of the death of her fiancee, Thomas Eric Duncan -- the first person diagnosed with Ebola in the United States -- she fell to the ground.

The man giving her the news couldn't even console her with a hug.

But day 21 is Monday: The day the quarantine period is expected to come to an end for Troh, her son and two nephews. If the four do not develop symptoms by Monday, they will have managed to not contract Ebola despite being in close proximity to Duncan.

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"We are so happy this is coming to an end, and we are so grateful that none of us has shown any sign of illness," Troh said in a statement on Sunday. "We have lost so much, but we have our lives and we have our faith in God, which always gives us hope."

Mark Wingfield, an associate pastor at Wilshire Baptist Church, told CNN that Troh will not be doing interviews at this time, but plans to write a book about her experience.

"They feel like this is a tremendous miracle that's happened," Wingfield said. "This is a long-awaited day of celebration."

Tears shed for Duncan

On Saturday, loved ones honored Duncan's memory in North Carolina, where his mother lives.

In a memorial service at Rowan International Church in Salisbury, his nephew Josephus Weeks and others eulogized Duncan as a kind, compassionate man.

Weeks said he wished Duncan would be remembered for his acts of kindness "as opposed to the person who brought this disease to America, because he didn't know he was sick."

Duncan's willingness to help others may have led to his death at age 42.

Former neighbors in Monrovia, Liberia, have said he may have contracted Ebola while rushing to the aid of a woman who collapsed under duress from the disease. She was pregnant, and Duncan did not know she was sick, they said.

"We continue to mourn his loss and grieve the circumstances that led to his death, just at the time we thought we were facing a happy future together," Troh said. "Even though the quarantine is over, our time of mourning is not over."

A quick-strike team

The U.S. military is forming a 30-person "quick-strike team" equipped to provide direct treatment to Ebola patients inside the United States, a Defense Department official told CNN's Barbara Starr on Sunday.

A Pentagon spokesman later confirmed portions of the official's information.

The team will be under orders to deploy within 72 hours at any time over the next month, the official said.

The Department of Health and Human Services requested the military team, and the Pentagon has given verbal approval, the official said.

The team will include five doctors, 20 nurses and five trainers, Pentagon press secretary Rear Adm. John Kirby said in a statement.

The Pentagon has been working to determine what assistance it could offer the civilian health care sector following a White House meeting last week during which President Barack Obama said he wanted a more aggressive response, according to two Defense officials.

Defense Secretary Chuck Hagel ordered chief of the Northern Command, Gen. Chuck Jacoby, "to prepare and train a 30-person expeditionary medical support team that could, if required, provide short-notice assistance to civilian medical professionals in the United States," Kirby said.

Jacoby is already working with the military on the joint team, Kirby said, and once formed, it will head to Fort Sam Houston in Texas for up to seven days of training in infection control and personal protective equipment. The training, provided by the U.S. Army Medical Research Institute of Infectious Diseases, will begin "within the next week or so," Kirby said.

The team will remain in "prepare-to-deploy" status for 30 days, he said. It will be able to respond anywhere in the U.S. if "deemed prudent by our public health professionals," he said.

Cruise passenger cleared

Sunday's news out of the Pentagon came as a cruise ship plowed through the waters of a Texas port with precious cargo on board -- the end of a small Ebola scare. A passenger had been loosely linked to the only patient to die from the disease in the United States, but health authorities cleared her after an odyssey at sea.

After voluntarily isolating herself in her cabin, she remained symptom-free, and her lab tests looked good, the Galveston County Health Authority said. She and a travel partner were allowed to disembark.

The drama goes back to the woman's work as a lab supervisor at Texas Health Presbyterian Hospital in Dallas, the center of a maelstrom of Ebola fears in the United States.

It's where Liberian patient Duncan was misdiagnosed and later died, and where two nurses became the first people to contract Ebola in America.

Seventy-five health workers and 48 people in the community are under monitoring after coming into contact with Duncan.

There are hopeful signs that some of the Ebola contagion scare in the United States could be winding down. Of the four patients being treated, at least two appear to be making a recovery.

And the monitoring period for the 48 community members ends at midnight Sunday night, according to Dallas County Judge Clay Jenkins, who is overseeing response efforts in Dallas.

"Thankfully they are all asymptomatic, and it looks like none of them will get Ebola," Jenkins said, expressing hope that they would be welcomed home with no issues. "The community needs to reach out and envelop them in compassion and acceptance because we cannot have the community stigmatizing people. ... They have been through a terrible ordeal."

As for the other 75 people, they are in Day 11 of 21 since Duncan's death and Jenkins said, "Today is a crucial day for them because is one of the last high-likelihood days that we will see more cases."

The cruise ship incident and a second travel scare came about in a bureaucratic loophole.

In an abundance of caution to avoid any possible spread of the Ebola virus, about 50 people associated with Texas Health Presbyterian have signed a document legally restricting where they can go until they are cleared of Ebola.

But before the voluntary travel ban existed, the lab supervisor and a nurse, who later came down with Ebola, went on trips and triggered hefty responses.

The lab worker had had no direct contact with Duncan but may have handled one of his lab specimens. A doctor on board the ship observed her to make sure she was symptom-free as the incubation period within which the disease would manifest itself approached its end.

The other travel scare was set off by one of the nurses who contracted Ebola after treating Duncan. Before her illness was apparent, Amber Vinson took a Frontier Airlines flight to Cleveland, then a flight back to Dallas.

There were 132 people on Vinson's flight. After her contagion became known, the air carrier reached out to some 800 passengers out of an abundance of caution, advising them to contact the CDC.

Frontier Airlines also took the plane out of service temporarily.

Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told CNN on Sunday that he didn't know much about Vinson's condition, but he said Nina Pham, the other Dallas nurse who contracted the illness, was in fair condition and doing "fine."

Can you catch Ebola on a plane?

Hospital apologizes

On Sunday, Texas Health Presbyterian took out a full-page newspaper ad, once again offering an apology.

The open letter from Texas Health Resources CEO Barclay Berdan appeared in the Sunday editions of the Dallas Morning News and Fort Worth Star-Telegram.

"As an institution, we made mistakes in handling this very difficult challenge," Berdan wrote. The hospital is analyzing the errors and will make changes, he said.

The turmoil started in September, when Duncan went to the hospital with Ebola symptoms, and health care workers initially sent him home with antibiotics.

They recorded his travel history to West Africa, where a raging Ebola outbreak has killed more than 4,500 people. But they didn't give that detail the necessary attention, the hospital said.

WHO to review Ebola response amid criticism

CNN's Ben Brumfield, Tom Dunlavey and Nick Valencia contributed to this report.

Clinics recommend hospitals for Ebola testing

When a Dallas County sheriff's deputy who had entered the apartment of the first patient to die from Ebola in the U.S. started feeling ill himself, he didn't rush to the nearest hospital. He chose an urgent care clinic.So did a man who recently traveled to West Africa and was complaining of flu-like symptoms, prompting the suburban Boston urgent care practice where he went to briefly shut down last week.The deadly virus' arrival in the U.S. has put the spotlight on weak spots in American hospitals, but those facilities are not the only ones who have suddenly found themselves on the front lines against Ebola.Urgent-care clinics for many people have become de-facto emergency rooms. They are not, however, equipped like hospitals to treat serious illnesses, such as Ebola, nor do they have isolation units.Clinics are urging potential patients to get checked for the highly contagious virus at a hospital.Given the problems at the Texas hospital, where Thomas Eric Duncan died and two nurses have been diagnosed with the virus, an Ebola case could have posed even greater problems at a clinic or smaller hospital, experts say."That would be an even less controlled situation," said Dr. David Weber, an epidemiologist at the University of North Carolina's hospital. "The likelihood for that is so remote that they may never have thought about that."Still, clinics are preparing staff in case someone with Ebola does walk in. They are distributing protective gear and quickly trying to get up to speed on the best protocols to teach their health providers.Dr. William Gluckman of the Urgent Care Association of America, which represents more than 2,600 clinics, said the facilities want anyone who suspects they may have contracted Ebola to go to a hospital emergency department.The Urgent Care Association of America sent emails to its roughly 6,400 members asking them to spread that message.One of the fastest growing segments of the U.S. health care industry with more than 9,000 clinics, urgent care is designed to treat as many patients as quickly as possible for minor illnesses, like the flu or a sliced finger.But people are increasingly using them for any emergency to avoid the costs, long waits and crowds at hospitals."I think patients have a difficult time deciding where they need to go for care so sometimes we'll see someone come in suffering from an acute heart attack or stroke, but urgent care shouldn't be the place to go for that," said Gluckman, who owns FastER urgent care clinic in Morris Plains, New Jersey.MedExpress - which runs 130 clinics in 10 states - said its employees have been told to encourage patients with flu-like symptoms who have been in West Africa or in contact with someone infected with Ebola to go to a hospital.The Centers for Disease Control and Prevention says Ebola isn't contagious until symptoms appear. Ebola isn't spread through the air like the flu; people catch it by direct contact with a sick person's bodily fluids, such as blood or vomit.The urgent care association recommends front desk staff ask for specifics on symptoms from patients and recent travel history.If that the person has a fever, headache or other flu-like symptoms and has been in an Ebola hot spot, clinics have been told to isolate them in a single room, Gluckman said. The clinic should call public health officials and contact a hospital to transport them there as quickly as possible, per CDC guidelines.Patients at the urgent care clinic in Frisco, a suburb north of Dallas, were held briefly after Dallas County sheriff's deputy Sgt. Michael Monning went there with flu-like symptoms. Monning had entered Duncan's apartment but had no direct contact with him.Monning was transported to a hospital where it was determined that he did not have the virus.Patients at the practice in Braintree, about 12 miles south of Boston, were also held briefly on Oct. 12, while the man was taken to a hospital, where it was determined he did not have Ebola. The car that he drove to the office in was decontaminated by crews in hazmat suits.CDC Director Tom Frieden said the agency is bolstering training nationwide on how to respond to an Ebola case.U.S. health care has become more complex with retail clinics, urgent care centers, work-site clinics and even on-line clinics, so ensuring that everyone strictly follows protocol is going to continue to be a challenge.But that's not necessarily a bad thing, said Dr. Tom Zweng of Novant Health, a four-state system based in Winston Salem NC."This is not an exercise in futility," he said of the measures being taken to protect against Ebola. "This is preparing staff in safe practices. It may be Ebola today, but tomorrow there may be another communicable disease that we don't even know about. This is about taking health care in this country to the next level."

Is this the meat behind Ebola outbreak?

In December 2013 a two-year old child from the village of Gueckedou in south-eastern Guinea became the first victim of this Ebola outbreak, having contracted the disease from a fruit bat his family had hunted as bushmeat.

Since then Ebola has passed from person-to-person, claiming the lives of thousands and travelling half way around the world.

The severity of this outbreak has led to calls to ban the hunting, selling and eating of bushmeat.

Bushmeat is wild animal meat, and often refers to chimpanzees, gorilla, and other monkeys, as well as fruit bats, that are killed so that they can be eaten.

Previous outbreaks of Ebola are also credited to the bushmeat trade, particularly the capturing and butchering of infected animals.

It is even thought one or more HIV strains originated from bushmeat hunters in central and western Africa.

The World Health Organisation has said: "It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts."

Bats, which can carry a whole range of viruses, are the likely source of Ebola to humans because unlike moneys, the disease doesn't often kill them.

Often there's a non-human intermediary, but virologist Professor Jonathan Ball told the BBC that the virus can make the species jump directly from bats to humans by gaining "access to the cells in which it can replicate" through contact with blood.

A study from Cambridge University found that blood is sometimes spilled when bushmeat hunters are bitten and scratched by bats.

But the solution isn't as simple as banning bushmeat, as the practice will likely just be pushed underground. It's just too big.

According to the Centre of International Forestry Research, five million tonnes of bushmeat are eaten every year in Africa's Congo Basin.

Africa doesn't have a livestock infrastructure like the west, and as a meat-eating culture turn to bushmeat as it is available and affordable.

Curbing the bushmeat trade is ideal, but it should be stressed that these species-to-species disease transmission are rare; it's when infected humans come in contact that the real damage is done.

The Cambridge scientists advocate for educating hunters, having found that most of the 600 surveyed Ghanaians were unaware of the dangers in their bushmeat practices.

Dr Marcus Rowcliffe from the Zoological Society of London, who was involved with the study, said: "Although many programmes suggest economic opportunity as the major motivation behind livelihood choices and success of alternatives, it may not be enough on its own.

"We found people in Ghana to be responsive to education pieces about the disease risk from bushmeat but also the ecological role of bats in pollination and seed dispersal.

"Working with local communities to help them find effective and sustainable solutions in line with their economic needs must be a long-term commitment."

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Nigeria declared Ebola-free after containing virus

ABUJA Mon Oct 20, 2014 12:31pm BST

A school official takes a Goverment Secondary School Garki pupil's temperature using an infrared digital laser thermometer, as school resumes in Abuja September 22, 2014.

Credit: Reuters/Stringer

Saturday, October 18, 2014

Ebola is one of many lethal infections threatening U.S. hospitals

Long before Ebola created anxiety about the preparedness of U.S. hospitals to handle serious contagious diseases, infections contracted in hospitals were a leading killer in America, and remain so.

Although Colorado compares well to other states, hospitals here have run into problems with their infection-prevention efforts, The Denver Post found.

Inspectors cited one hospital for potentially reusing an intravenous bag and reusing oxygen tubing. Others were rapped for unsafe practices during a blood transfusion and poor communication after a staph infection outbreak.

The issue of infections in hospitals took on new urgency last week after a Texas hospital botched the treatment and isolation of the first U.S. Ebola case, which resulted in two nurses contracting the disease.

"We have a good medical system. We have the knowledge, the equipment to contain Ebola and other infections," said University of Denver professor Phil Danielson, a specialist in infectious diseases. "But the risk of spreading them is always going to be there. It is never zero. There is always the human factor."

In 2011, there were about 722,000 hospital-acquired infections nationally, according to the Centers for Disease Control and Prevention. About 75,000 of these patients died, the CDC reports.

"On any given day," the CDC says, "about 1 in every 25 hospital patients has at least one health-care-associated infection."

Infection rates associated with health care at Colorado's hospitals and dialysis centers were lower than or equal to rates for hospitals across the nation in all but one of 15 categories measured between August 2012 and July 2013, according to data collected and reported to the Colorado Department of Public Health and Environment.

Overall, Colorado hospitals and dialysis centers reported 1,108 health-care-associated infections during that time frame. Deaths associated with those infections were not included in the health department's report. Outpatient-surgery figures also were not included.

The only area in which Colorado had a worse rate of surgical-site infections than the national average was in patients who underwent breast surgery.

Some data conflict. Numbers from the Centers for Medicare & Medicaid Services, or CMS, this year showed that Colorado ranked seventh-highest in the country for the percentage of facilities facing potential fines for hospital-acquired conditions. That includes infections in patients with catheters in major veins and their bladders as well as eight other patient problems, including blood clots, bed sores and accidental falls.

Sixteen of 46 Colorado hospitals in the data faced potential fines. Final data haven't been released.

Texas Health Presbyterian Hospital in Dallas, where the Ebola patient was treated, faced a potential fine, according to the preliminary data. Hospital officials didn't respond to a request for more information.

CMS records of hospital inspections from 2011 to 2013 found problems at Colorado hospitals.

At Sterling Regional MedCenter in June 2012, inspectors found a half-used intravenous solution bag dangling from a pole available — improperly — for use for another patient, reuse of sections of oxygen tubing by more than one patient and nebulizers that were not adequately disinfected.

"The incidents were addressed immediately, and the corrective actions were reported to the appropriate agencies," said Sara Quale, a public relations director for Sterling's parent company, Banner Health. "We are confident that processes put in place following these findings have resolved this concern."

After a June 2013 outbreak of MRSA infections hit patients at North Suburban Medical Center in Thornton, the hospital's top leaders failed to ensure that medical staffers were told of the outbreak or given recommendations that would prevent such outbreaks in the future, an inspector found.

"The state inspection report noted we could improve how we communicate with our physicians regarding infectious-disease trends in the area," said Dan Welch, director of marketing for North Suburban. "We adjusted our processes to accomplish that objective and a follow-up review with state inspectors in January 2014 found that we were in compliance."

At Englewood's Swedish Medical Center in September 2012, an inspector saw a registered nurse with no gloves administering a blood transfusion to a patient — a breach in the hospital's protocol.

The nurse got flustered while the inspector was reviewing her and made a one-time mistake, said Nicole Williams, the assistant vice president of marketing and public relations for Swedish.

"This isn't a rampant issue and in no way, shape or form would reflect on our abilities to handle an infectious patient," Williams said.

Inspections also found unsafe food preparation at several Colorado hospitals and operating-room temperatures at one facility that were high enough to promote infections.

Colorado's health department is one of 10 state health departments in the country participating in the CDC's Emerging Infections Program, which allows for extra monitoring and research of hospital-acquired infections.

Of the 50 or more Colorado hospitals reporting to the CDC for 2012, the most recent year for which data is available, the state composite score was "significantly better" than the national infection rate in two high-risk areas, central-line-associated bloodstream infections and catheter-associated urinary-tract infections.

The public reporting of hospital-acquired infections in Colorado was enabled by a 2006 state law, but that law also gave hospitals protection from disclosure in specific patient cases. The law designates all patient information compiled for the reports, and any related materials, as confidential, not subject to disclosure.

"It means you can't find out from hospitals anything regarding an infection," said Denver medical malpractice attorney Daniel Sloane, who represented a man whose spinal fusion resulted in a surgical-site infection.

Sloane said a recorded conversation the man had with his physician about the infection could not be used in court because of the absolute privilege the law grants hospitals.

Nationally, infections directly related to surgical procedures are projected to cost consumers and health-care payers from $3 billion to $10 billion, studies suggest.

The watchdog group Committee to Reduce Infection Deaths, or RID, reports there are 2 million patient-contracted infections each year in the United States, with 103,000 resulting in death.

RID estimates that all hospital infections could add an estimated $30.5 billion to hospital costs each year.

There are signs of improvement. Tracking by the CDC showed that from 2008 to 2012, infections stemming from surgical sites declined by 20 percent. Infections due to central lines placed in the veins of necks or chests of patients declined by 40 percent during the period. Yet catheter-associated urinary-tract infections have risen by about 3 percent.

Dr. Anthony Harris, an infectious-disease physician at the University of Maryland School of Medicine, is also president-elect of the Society for Healthcare Epidemiology of America.

"The public is afraid about Ebola. But if you ask the public about what epidemiologists do, they would have no idea," Harris said. "That's exactly the problem this country has at this time."

Hospital epidemiologists and infection-prevention specialists work to drive down infection rates by monitoring, intervening in specific cases, training, education and forming policies and protocols, he said. There are too few of them. They aren't given enough time or resources. And they're up against antibiotic-resistant super bugs bred in hospitals.

In other words, he said, the country chronically ignores proven methods to prevent and control infections.

Health care workers often pay the price. They are exposed to a wide range of workplace hazards, from needle sticks and back injuries to exposure to violence and contagions.

Cases among heath care workers of nonfatal occupational injury and illness are among the highest of any industry sector, the CDC reports.

The two nurses who treated the first Ebola fatality in the U.S., Thomas Eric Duncan, reported following hospital procedures and CDC guidelines, which have been something of a moving target with regard to protective equipment. travel restrictions, warning symptoms and so on.

"I'm sure (Texas) health care workers think that they followed all the procedures correctly, but it is so easy to make a wrong move — the inadvertent rubbing of an eye or touching a lip without even knowing it," said Danielson, who teaches courses in infectious diseases at DU and has trained law enforcement in containment of bioterrorism agents, including Ebola.

Danielson said the CDC's missteps have been harder to understand.

"The CDC has amazing resources and immense talent," Danielson said, "but I am somewhat dismayed by the breakdown in common sense."

At Presbyterian/St. Luke's Hospital in Denver, chief medical officer Steve Quach was leaving nothing to chance or the CDC, as his staff practices in pairs and refines, over and over, the protocol for health care workers' donning and doffing of protective clothing and equipment.

"I do believe with the proper precautions, Ebola patients can be taken care of safely without health care workers being infected," Quach said. "But there are more bodily secretions with this disease than health workers expect."

When one staff member asked whether he has to scrub his eyeglasses with bleach afterward, Quach wryly tells him he could always incinerate them instead.

Three Denver-area hospitals Friday were designated by the state to handle Ebola cases if they surface in Colorado. They are Denver Health, University of Colorado Hospital and Children's Hospital Colorado. More hospitals could be added to the list.

Electa Draper: 303-954-1276 or edraper@denverpost.com

Ebola lapses persisted for days at Dallas hospital, medical records show

Scores of staffers at Texas Health Presbyterian Hospital in Dallas were put at risk by lapses in the treatment of the first Ebola patient diagnosed in the U.S., the patient's medical records show.

The medical records of Thomas Eric Duncan, given to the Associated Press by his family, provide a window of the span of exposure to the hospital's workers in the early days of Duncan's treatment.

The records show that because of a lag in implementing preventative measures or because of insufficient measures, multiple hospital staffers were put at risk.

The hospital's protective protocol was "insufficient," said Dr. Joseph McCormick of the University of Texas School of Public Health, who was part of the CDC team that investigated the first recorded Ebola outbreak in 1976. "The gear was inadequate. The procedures in the room were inadequate."

The Centers for Disease Control and Prevention had previously pointed to lapses by the hospital in the initial days after Duncan arrived at the hospital, and the records show heightened protective measures as his illness advanced.

The records show Nina Pham, the first Texas nurse to be diagnosed with Ebola, first encountered the patient after he was moved to intensive care at 4:40 p.m. on Sept. 29, more than 30 hours after he came to the ER. Nearly 27 hours later, Amber Joy Vinson, a second nurse who contracted the disease, first appears in Duncan's charts.

Because doctors and nurses are focused on logging the patient's care, they may not always note their own safeguards in the medical records. In Pham's first entry, she makes no mention of protective gear. When she logs again the following morning, she specifically mentions wearing a double gown, face shield and protective footwear, equipment she mentions again in later entries.

In the first apparent mention of Vinson -- identified by just her first name in another nurse's notes -- she is said to have worn personal protection, including a hazardous-materials suit and face shield.

It's unclear whether those initial interactions with Duncan represent the time at which a breakdown in protection led to the infections, or whether such lapses persisted during the remainder of the patient's 11-day stay. At least 70 workers are named in the records as being involved with Duncan's care in that period.

Dr. Tom Frieden, the CDC director, told lawmakers during a congressional hearing Thursday that he did not know how the nurses got infected, only that "possible causes" had been identified.

In comments a day earlier, he gave a clue: "For the first several days of the patient's stay, before he was diagnosed, we see a lot of variability in the use of personal protective equipment."

Because Ebola has an incubation period of up to 21 days, those who cared for Duncan at the start of his second hospital stay will not be considered safe from infection until Monday. Those with him at the time of his death will not emerge from monitoring until Oct. 30.

Duncan first arrived at Presbyterian on Sept. 25 but was sent home. When he returned by ambulance at 10:07 a.m. on Sept. 28, he was sicker and probably more contagious. Staff noted immediately upon his intake that he had recently arrived from Liberia.

Five minutes later, a nurse notes that he is in a room and had "put on airborne precautions." Nine minutes after that, Duncan is seen by a doctor who writes that Ebola is a possibility and notes that he "followed strict CDC protocol" by being "masked, fully gowned and gloved" when treating Duncan.

The doctor makes no mention of eye protection such as goggles or a face shield, which are considered basic equipment in Ebola guidelines issued by the CDC. There is also no initial mention of foot coverings, which are suggested when such patients have diarrhea or vomiting, as Duncan did, according to the records.

It is also not clear when Duncan was safely isolated, though the records refer to him being in an "isolation room" in the ER on Sept. 29.

Numerous entries in the records of Duncan's stay at the hospital -- both in the ER and later in intensive care -- make note of precautionary measures. Many other entries are silent on the issue, and the mention of hazardous-material suits does not appear in Duncan's records until after his diagnosis is confirmed on Sept. 30.

Hospital officials say Duncan was immediately put in isolation in a private room and that staff adhered to CDC guidelines on protective gear, even though those guidelines changed during the course of Duncan's stay.

"The CDC guidelines changed frequently, and those changes were frustrating," hospital spokesman Wendell Watson said.

Dr. Victoria Sutton, a member of Texas Gov. Rick Perry's newly appointed infectious-disease task force, said the issue was not protocols, but preparation.

"I think the problem is there wasn't enough time to do training," she said.

The hospital has denied the allegations of several of its nurses who anonymously aired concerns through a statement issued by the National Nurses United union. Among their complaints: that Duncan was kept for hours in an area of the emergency department where seven other patients could have been exposed; that a nurse supervisor faced resistance from higher-ups when she said he should be moved to an isolation unit; and that even after the patient was isolated, hospital workers came and went from his bedside without proper protection, then walked through halls that were not properly cleaned.

"If any of those allegations -- let alone more than one -- are correct, if they are valid, then obviously his whole hospitalization put health care workers at risk," said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center.

A half-dozen doctors and nurses made notes in Duncan's chart during the first 24 hours of his stay in the ER. As his first night at the hospital faded into the following morning, his condition worsened. A doctor noted he is suffering and deteriorating. At one point, he asked for a diaper because he was too exhausted to get up.

The records do not reveal what happened once hospital staffers left Duncan's bedside. Walking through the hallways, interacting with other staff and patients, removing protective gear and any other physical motions -- even as seemingly minor as rubbing an eye or scratching an itch -- before being properly sanitized could have led to further infections.

The Associated Press contributed to this report.

MORE FUNDS, TROOPS, DOCS NEEDED | Ebola could become 'disaster of our generation'

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LONDON - Aid agency Oxfam said Ebola could become the "definitive humanitarian disaster of our generation," as US President Barack Obama urged against "hysteria" in the face of the growing crisis.

Oxfam, which works in the two worst-hit countries -- Liberia and Sierra Leone -- on Saturday called for more troops, funding and medical staff to be sent to tackle the west African epicentre of the epidemic.

Chief executive Mark Goldring warned that the world was "in the eye of a storm".

"We cannot allow Ebola to immobilise us in fear, but... countries that have failed to commit troops, doctors and enough funding are in danger of costing lives," he said.

The worst-ever outbreak of the deadly virus has so far killed more than 4,500 people, mainly in Guinea, Liberia and Sierra Leone, but isolated cases have now begun to appear in Europe and the United States.

"The Ebola crisis could become the definitive humanitarian disaster of our generation," a spokesperson for the British-based charity said as it appealed for EU foreign ministers meeting in Luxembourg on Monday to do more.

Obama's warning about hysteria came a day after the World Bank said the battle against the disease was being lost and as the US president named an "Ebola czar" to coordinate Washington's response.

In Sierra Leone, Defence Minister Alfred Paolo Conteh was put in charge of the fight against the disease as the death toll there rose to 1,200.

In a statement, President Ernest Bai Koroma said the defence minister would "with immediate effect" head a new national Ebola response centre.

A global UN appeal for nearly $1 billion (785 billion euros) to fight the spread of the disease has so far fallen short, but a spokesman told AFP more money was coming in daily.

Out of $988 million requested a month ago, the UN said Saturday $385.9 million had already been given by a slew of governments and agencies, with a further $225.8 million promised.

"It has been encouraging to see the amount and the speed with which these amounts have been committed," said Jens Laerke, spokesman for the UN's humanitarian office (OCHA).

But the total was still some way off, Laerke said. "Nobody's smiling in this crisis, so I'm not going to go out and clap my hands and say everything is going fine, because it's not," he told AFP.

- Panic growing -

As panic and Ebola scares spread worldwide, Obama called for patience and perspective.

"This is a serious disease, but we can't give in to hysteria or fear -- because that only makes it harder to get people the accurate information they need. We have to be guided by the science," Obama said.

Friday saw a number of false alarms in the United States as fears grew, including at the Pentagon, where an entrance was closed after a woman vomited in a parking lot. US authorities later found no evidence that she had contracted Ebola.

Meanwhile, US media reported on overzealous action taken by some worried communities, including a group of Mississippi parents who pulled their kids from school because the principal had recently travelled to Zambia -- a southern African country far from the Ebola crisis in west Africa.

The United States -- where a Liberian man died from Ebola on October 8 and two American nurses who treated him have tested positive -- was not seeing an "outbreak" or "epidemic", Obama stressed.

More "isolated" cases in the country were possible, he conceded. "But we know how to wage this fight."

The US president played down the idea of a travel ban from west Africa.

"Trying to seal off an entire region of the world -- if that were even possible -- could actually make the situation worse."

- 'Losing the battle' -

Obama's call for calm was in stark contrast to World Bank chief Jim Yong Kim, who warned Friday that "we are losing the battle".

He blamed a lack of international solidarity in efforts to stem the epidemic.

"Certain countries are only worried about their own borders," he told reporters in Paris, as leaders in Washington and beyond grapple for a coordinated response to the outbreak.

Airports in several countries were taking passengers' temperatures in a bid to detect Ebola carriers, although experts have expressed doubts about the effectiveness of the checks.

France on Saturday started carrying out health checks on Air France passengers arriving from Guinea, where the epidemic began in December, while a cabin crew union called for a halt to flights from Conakry altogether.

One 40-year-old passenger was taken to a Paris hospital with a suspected fever but officials later said she was not suffering from vomiting or diarrhoea.

Meanwhile, a woman was taken to a military hospital close to Paris on Saturday suffering from abdominal pain and fever, but there was no confirmation of her condition.

The United States, Britain and Canada have already launched screenings at airports for passengers from Ebola-hit zones. The EU is reviewing the matter.

As of October 14, 4,555 people have died from Ebola out of a total of 9,216 cases registered in seven countries, the World Health Organization said.

Americans 'can't give in to hysteria or fear' over Ebola - Obama

By Roberta Rampton

WASHINGTON Sun Oct 19, 2014 8:13am IST

A member of the CG Environmental HazMat team disinfects the entrance to the residence of a health worker at the Texas Health Presbyterian Hospital who has contracted Ebola in Dallas, Texas, October 12, 2014.

Credit: Reuters/Jaime R. Carrero

WASHINGTON (Reuters) - With three cases of Ebola diagnosed in the United States but more than 100 people being monitored in case they contract the disease, President Barack Obama urged Americans on Saturday not to give in to "hysteria" about the spread of the virus.

As though to illustrate his point, a Dallas bus and train station was closed on Saturday afternoon over concern about a woman who fell ill. The woman was first reported to be on the checklist for possible Ebola exposure, but then turned out not to be on any such list.

Obama made plain he is not currently planning to give in to demands from some lawmakers for a ban on travelers from the worst-hit countries.

"We can't just cut ourselves off from West Africa," Obama said in his weekly radio address. "Trying to seal off an entire region of the world - if that were even possible - could actually make the situation worse," he said.

The worst Ebola outbreak on record has killed more than 4,500 people, most of them in the West African countries of Liberia, Sierra Leone and Guinea.

Obama, whose approval rating is already low, has been criticized over his administration's handling of Ebola. He held a flurry of meetings on the issue in the past week and on Friday appointed Ron Klain, a lawyer with long Washington experience, to oversee the effort to contain the disease.

Republicans questioned why he did not pick a medical expert.

"I hope he (Klain) is successful in this. I think it's a step in the right direction, but I just question picking someone without any background in public health," Republican Representative Ed Royce, chairman of the House Foreign Affairs Committee, told CNN on Saturday.

The Obama administration is not alone in facing criticism. The World Health Organization has been faulted for failing to do enough to halt the spread since the outbreak was detected in March.

The agency promised it would publish a full review of its handling of the crisis once the outbreak was under control, in response to a leaked document that appeared to acknowledge that it had failed to do enough.

There is no cure or approved vaccine yet for Ebola but pharmaceutical companies have been working on experimental drugs. The virus is transmitted through an infected person's bodily fluids and it is not airborne.

Canada said on Saturday it would ship 800 vials of its experimental Ebola vaccine, undergoing clinical trials, to the WHO in Geneva, starting on Monday. Iowa-based NewLink Genetics Corp holds the commercial license for the Canadian vaccine.

Britain's biggest drugmaker GlaxoSmithKline said on Saturday that work to develop a vaccine was moving at an "unprecedented rate" and the next phase - if successful - involving vaccinating frontline healthcare workers, would begin early 2015.

RASH OF SCARES

Obama sought to put the extent of the disease in the United States in perspective. "What we're seeing now is not an 'outbreak' or an 'epidemic' of Ebola in America," he said. "This is a serious disease, but we can't give in to hysteria or fear."

A rash of Ebola scares has hit the country since late September when a Liberian visitor to Dallas, Texas, became the first person to be diagnosed in the United States. Americans' faith in the medical system and in authorities' ability to prevent the disease from spreading was jolted by a series of mis-steps when the Liberian was initially not diagnosed by a Dallas hospital.

The man, Thomas Eric Duncan, was admitted to Texas Health Presbyterian Hospital days later and diagnosed with Ebola. Two nurses who were part of the team caring for Duncan, who died on Oct. 8, contracted Ebola. Amber Vinson is being cared for at Atlanta's Emory University Hospital, while Nina Pham is being treated at the National Institutes of Health (NIH) just outside Washington.

A chain of people who had contact with either Duncan or the sick nurses are being monitored in case they develop the disease, which has an incubation period of up to 21 days.

The Texas Department of State Health Services said in a statement on its website dated Saturday that it was working to monitor people who had contact with the Ebola patients, specimens, or potentially contaminated surfaces. A total of 145 "contacts and possible contacts" were being monitored for symptoms, while 14 people had completed surveillance, it said.

Some 800 passengers who took the same planes as Vinson on a trip she made to Ohio before being diagnosed, and passengers on subsequent flights using the same planes, have been contacted by the airline, Frontier Airlines, the carrier said on Saturday.

The airline said in a letter to employees that it had been informed by the U.S. Centers for Disease Control and Prevention (CDC) that the Dallas nurse may have been in a more advanced stage of the illness than previously thought, when she traveled back to Dallas from Cleveland on Oct. 13.

The White House said late on Friday it would send senior personnel to Dallas to help federal, state and local officials there trying to identify and monitor people who came in contact with the three people who fell sick with Ebola.

Those being monitored include a lab worker at the Dallas hospital, who is not ill but is in isolation at sea: in her cabin on the Carnival Magic cruise ship. The lab worker did not have contact with Duncan, but may have come in contact with test samples.

Her presence on the ship caused Mexican authorities to deny docking at the Mexican port of Cozumel on Friday. The Carnival Magic, owned by Carnival Corp unit Carnival Cruise Lines, was en route back to Galveston on Sunday.

At Dallas' White Rock station, a woman was taken to the hospital for evaluation on Saturday, the city's transit authority said. Local media reported the station was closed as she was being monitored for possible Ebola exposure, but the Dallas Area Rapid Transit system said she was not on a watchlist.

Obama has stressed that containing Ebola should include help for the worst-hit countries and Washington plans to deploy up to 4,000 military personnel to the region by late October. Obama is preparing to ask for additional funds from Congress to beat Ebola, and could make the request next week, according to a Bloomberg report.

British Prime Minister David Cameron said on Saturday European Union leaders should raise the amount of money pledged to fight Ebola to 1 billion euros ($1.3 billion) and mobilize at least 2,000 workers to head to West Africa.

He made the appeal in a letter to the President of the European Council Herman Van Rompuy. A spokeswoman at Cameron's office said the EU commission and 28 member states had pledged a total of 500 million euros so far to fight Ebola.

Combatting the disease was also among the subjects of talks being held on Friday and Saturday between American and Chinese top diplomats.

(Additional reporting by Mohammad Zargham and Eric Beech in Washington, Frank McGurty in New York, Anna Driver in Dallas, Tom Miles in Geneva, and Costas Pitas in London; Writing by Frances Kerry and Megan Davies; Editing by David Clarke and Grant McCool)

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Thursday, October 23, 2014

Tuesday, October 21, 2014

Fear has returned to Wall Street this fall and at least some of the heightened nervousness can be pinned on Ebola.

Monday, October 20, 2014

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Saturday, October 18, 2014