Local reports on the Ebola epidemic

ebola-quarantine

I’ve been scanning the Internet nightly for any reputable eyewitness accounts on the ebola epidemic. Sadly, nearly everything appears to be repostings of the same soundbytes recycled in the 24/7 news echo chamber. These are the noteworthy exceptions – first hand accounts and important developments about the ebola epidemic:

School

Today: Nigerian government postponed the resumption of primary and secondary schools across the country a month, until October 22nd, instead of September 22nd. This announcement came just hours before claiming that officially, ebola is contained and exactly one patient has it in the whole country.

Vectors: Are Bats Spreading Ebola Across Sub-Saharan Africa?

“We have no idea how it’s moved from Central Africa to Guinea,” says primatologist Christophe Boesch of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany. A leading suspect is fruit bats. In Central African rainforests, several species have shown evidence of infection with Ebola without getting sick. And at least one of the species, the little collared fruit bat, Myonycteris torquata, has a range that stretches as far west as Guinea. “We’ve always been very suspicious of bats,” says William Karesh of EcoHealth Alliance in New York City, who studies the interactions among humans, animals, and infectious diseases.

Source: http://www.sciencemag.org/content/344/6180/140.summary

Conflicting info:

There has never been an Ebola outbreak in West Africa before.

The EBOV strain from Guinea has evolved in parallel with the strains from the Democratic Republic of Congo. It came from a recent ancestor and has not been introduced from the latter countries into Guinea.

Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.

It would seem that even though outbreaks are rare, they happen in multiple parts of the world simultaneously. This suggests to me a migratory vector – like locusts that swarm once every 30 years with imperfect precision. (I’m not saying “locusts” but something that carries the disease and has the same chaotic rise and fall).

Source: bush meat:

The rise of this epidemic comes from a tradition of buying “bush”meat, specifically monkey meat in Liberia back in January of 2014.

EBOLA: Ghana To Place Blanket Ban On Buying & Selling Of Bushmeat

NIGERIA: The women under the aegis of Bushmeat Sellers Association protested that since the announcement that the deadly disease could be caused by eating bush meat, spell had been cast on their sales.

Senegal and Gambia – August 12, 2014

Right now I just returned from Dakar, as I was visiting my brother who came from the USA with his colleagues from Purdue to implement a grain storage set up in Senegal, on flying out all officers where in gloves immigration to customs etc, flying in you arrive at the terminal, you have a sanitiser at the entrance to watch your hand prior to going straight to medical clearance where you get your passport checked by the medical officer to see country of departure and if you stay in Gambia when you left, after thast you get a sensor temperature meter pointed at your eyes to get your temperature if its good, you cleared to go to immigration, this also applies at all Gambia border post.

West Point slum in Monrovia Liberia

The policy implications of this next item are what started me researching everything Ebola-related as fodder for a fiction novel:

The army has moved in and surrounded a slum of over 50,000 Liberians with orders of “shoot to kill” in order to contain the possible spread of Ebola. This act is in effect isolates a 99.99% healthy population inside a zone with known Ebola carriers. …

Liberia said a ban on travel to the region imposed by neighboring countries was complicating the fight against Ebola and leading to shortages of basic goods.

“Isolating Liberia, Sierra Leone and Guinea is not in any way contributing to the fight against this disease,” Information Minister Lewis Brown said. “How do we get in the kinds of supplies that we need? How do we get experts to come to our country? Is that African solidarity?”

At least 1,427 people have died and 2,615 have been infected since the disease was detected deep in the forests of southeastern Guinea in March. A separate outbreak was confirmed in Democratic Republic of Congo on Sunday.

***

The characters in this next story are fictional, but the events occurred on Saturday, 8/16/14, and are tragically true…

Charles Smith had been afraid when he first heard of Ebola. Rumors had been swirling for weeks, but he had not believed them until men from the government rode through West Point with loudspeakers telling them that Ebola was in West Point. They warned to watch for people with fevers and vomiting.

That was also when his doubts about Ebola began. Fever, vomiting? Malaria causes those symptoms too. After 14 years of civil war, he had been lied to by the government before and this did not ring true. His doubts were increased when “health workers” came to West Point wearing suits that we all white and covered them head to toe. He had seen things like this in American films.

West Point, a peninsula in Western Monrovia, was known for its poverty and squalid conditions. 50,000 people share two groups of public toilets (that most can’t afford). The beaches are littered with human waste waiting for the tides to come in and wash it away.

When he heard from friends that even doctors were saying there was no such thing as Ebola, he knew this was a coverup for something else. Something evil. Rumors were spreading that white men were eating people in the white tents and at the ELWA hospital. The posting of signs throughout Monrovia did not impress Charles. Like 75% of Liberians, he couldn’t read them, but signs told more lies that truths in his mind.

Charles took comfort that the Ebola liars were mostly on the other side of Monrovia. The JFK Hospital is uncomfortably close, but still far enough away. West Point had its problems, but the Ebola liars were not one of them.

He was awakened Sunday morning by his friend Thomas. The Ebola liars had come to West Point. A clinic had been opened in West Point itself!

“How can this happen? How can we let them eat our own children,” asked Charle
He went to visit several friends to discuss this new clinic. Many could die if they don’t act quickly. The small crowd around him swelled to about ten as he discussed fervently how they must stop the clinic. Joseph, an old friend ran up.

“Charles, they have taken Jimmy into the clinic.”

Jimmy, one of Charles’ nephews, had been sick for a few days with Malaria. Now they had brought him into that death trap.

“Come with me friend. Come, let’s stop this madness” cried Charles. The crowd of ten swelling to over one hundred within minutes. Fueled by a smoldering anger at the lies about Ebola, burst into an angry trot.

The clinic was a converted school which was now going to hold patients who had been identified as having Ebola. The plan was for these patients to then go to a hospital when a bed became available.

The shanty gates to the clinic were easily ripped off their posts. The small clinic compound was quickly filled with several hundred people.

“The President says you have Ebola. You don’t have Ebola, you have malaria” Charles yelled, “Get up and get out.”

Many of the patients in the clinic left, including several children. Charles was quite relieved when he saw Jimmy. He had not been sent away to those hospitals to be eaten. Jimmy, clearly weak but able to walk, stood gingerly. Charles walked over and grabbed him under the arm and assisted him out of the compound. Jimmy was safe.

The others did not have such charitable motives. The mass of humanity quickly stripped the clinic bare of all food, mattresses, sheets, and gloves. Charles was indignant with the mob. He was here to save his nephew, not to steal from the clinic. He knew right from wrong and this was wrong.

With his nephew in tow, Charles was in no position to stop the mass looting. Within minutes, it was done. There was nothing left in the clinic except about ten patients who refused to leave and some desperate nurses who wondered what to do next.

Charles took Jimmy back to his small home. Jimmy was feverish and clearly needed Charles’ care. He brought him food and water. Jimmy was shivering despite his fever. Charles laid next to him on the mattress and pulled him close to warm him. As they both fell asleep, Charles took great comfort that those he loved were close.

They were safe.

***

(Another first hand account from West Point slum via local newspaper)

 http://thegistpartner.com/2014/08/20/liberias-effort-to-contain-ebola-turns-violent-as-people-try-to-escape-quarantine/

Youths angrily threw stones and tried to tear down the the barb wired barricades created to prevent the people from leaving the area which was written off by Government. soldiers were used to control the rebellious crowd, driving hundreds of young men back into the neighbourhood, a slum of tens of thousands in Monrovia known as West Point.

“This is messed up, They injured one of my police officers. That’s not cool. It’s a group of criminals that did this. Look at this child. God in heaven help us.”

LIBERIA: This boy suspected of having Ebola. Residents in Monrovia dressed him and then left him in the streets before he was transported to a hospital.

Screen Shot 2014-08-20 at 11.08.03 AM

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John Moore / Getty Images / Published by The New York Times

Notes

Ebola has definitely changed the way we do things…and this will probably have to keep evolving until we kick this bug. The catholic churches have suspended ‘offering each other the sign of peace’ which involved handshakes with people all around you. In the same way, I see people becoming more orderly as they try to reduce body contact with other people in the market and outside of the market.

Procedure

(This post was writer’s gold for actual details on the medical side.)

From http://ebolastories.wordpress.com/2014/08/28/ebola-accounts-sierra-leone/

I have been here for 7 weeks, working as a nurse and emergency coordinator for the Médecins sans Frontières (MSF) Ebola response. Today we’re lucky: it’s raining, so we won’t be too hot in the personal protective equipment (PPE) we must wear. We control who goes into the isolation area, how often, and for how long. No one should wear the PPE for longer than 40 minutes; it’s unbearable for any longer than that, but it’s easy to lose track of time, so we have to monitor our colleagues. The process starts in the dressing room, where getting into the PPE takes about 5 minutes. We have a designated dresser, responsible solely for making sure that we are wearing our equipment properly and that not a square millimeter of skin is exposed. In case one layer is accidently perforated, we wear two pairs of gloves, two masks, and a heavy apron on top of the full-body overalls. When we exit the isolation area, we are sprayed down with chlorine solution and peel off the PPE layer by layer. Some of the equipment — goggles, apron, boots, thick gloves — can be sterilized and used again. Everything else — overalls, masks, headcover — is burned.

In the suspected-case tents most patients look well, but the probable-case area is a different story. Patients here have fever, pain, anorexia — but these symptoms could indicate malaria. A polymerase-chain-reaction (PCR) test determines if a patient has Ebola. When results comes in, the patient is either moved to the confirmed-case tents or discharged. Knowing what it means to be moved to these tents, patients are understandably frightened. We have a psychologist, a counselor, and health promoters to help and support patients, but there are just too many of them.

Standard treatment for Ebola is limited to supportive therapy: hydrating patients, maintaining their oxygen status and blood pressure, providing high-quality nutrition, and treating any complicating infections with antibiotics. Supportive treatment can help patients survive longer, and that extra time may be what their immune system needs to start fighting the virus.

There’s also a tent for the most severely ill patients. I try to spend more time there than in the other tents, if only to hold patients’ hands, give them painkillers, and sit on the edge of their beds so that they know they’re not alone. But spending time is always difficult — there are so many patients waiting for help.

Evading the quarantine

A doctor, who secretly treated a diplomat who had contact with the index case, Liberian-American Patrick Sawyer, has died of Ebola in Nigeria.

The doctor, who has yet to be named, died on Friday. His wife has also taken ill and has been quarantined in Port Harcourt. Interestingly, the diplomat the doctor treated is still alive.

The diplomat, who was part of the team who met with Patrick Sawyer in Lagos, flew to Port Harcourt, Rivers State for treatment, evading Nigerian federal government surveillance for the disease. The late doctor then took him to a hotel for treatment.

As a result of this, 70 people have been quarantined. The doctor’s hospital, Good Heart Hospital in Rivers State, has been shut down. The unnamed hotel, where the secret treatment took place, has also been shut down.

History and ebola facts

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus comprises 5 distinct species:

Bundibugyo ebolavirus (BDBV)
Zaire ebolavirus (EBOV)
Reston ebolavirus (RESTV)
Sudan ebolavirus (SUDV)
Taï Forest ebolavirus (TAFV).

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

***

An Ebola treatment clinic in Monrovia was attacked by a group of youngsters claiming that the disease was made up by the West. In the process, many sick patients have just disappeared into thin air. The marauders looted the clinic (how smart is that?) and made off with mattresses and other items that were soiled by the body fluids of the sick. It’s worth mentioning that the virus is spread by contact with body fluids of those showing symptoms of being sick. In other words, those idiots just screwed themselves and anyone else that came in contact with the items from the clinic.

At the same time, there are sick people crossing from Liberia into Guinea, even though the Guinea border was supposedly closed around two weeks ago. It seems as though many people there don’t believe this stuff is real. I can’t grasp that given that there are reports that the government is very slow about picking up the dead bodies. It seems that leaving the bodies around will lead to the spread of this instead of trying to limit the exposure by picking up and placing the bodies in quarantine as quickly as possible.

There’s also the thinking that the current counts are underrepresented of the true number of cases. That may have some validity since patient zero was determined to have gotten sick in December of 2013. That’s eight months plus of this virus being spread around. I’m amazed that it didn’t jump the borders of the three original countries until Patrick Sawyer landed in Nigeria.

 

Introducing my other blog: ebolastories.wordpress.com

This blog aggregates anything worthwhile from google alerts, two google groups, globalgiving updates, wordpress ‘ebola’ or ‘liberia’ tagged stories, and other useful sources, since none of these feeds is more than 10% wheat to 90% chaff.

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