The Big Ebola Update FAQ

Last week, I wrote the Gigantic Ebola Outbreak FAQ. This week in Ebola, more people get infected, more people die, and Ebola reaches Nigeria.

Wait, what ? You're writing another one of these?

Yeah, turns out disease outbreaks don't stop in their tracks just because I write about them. It's really annoying, but some of the facts on the ground have changed, and it is my duty as "some microbiologist guy on the internet" to inform people what's been happening. Make no mistake, it's been a pretty big week for Ebola.

I heard that it spread to some US citizens, what's the deal with that?

Hold your horses honey, Let's get the numbers out of the way first. The latest update from the WHO states that the 1,200 people have been infected, and that there have been 673 deaths.

Ebola has struck down a lot of notable medical workers this week. On July 22nd, a leading virologist, Dr. Sheik Umar Khan was struck down by the disease. He was in charge of the Ebola reaction unit in Kenema Government Hospital. Working in that unit is not for the faint hearted. Eight of the nurses who treated patients there have died in the past month.

He's currently being treated by Medecins sans Frontieres.

But wait, didn't he work in an Ebola Unit, why isn't he being treated there ?

Dr Khan kept that unit running by what appears to be sheer force of personality. It held together even through all of the problems Kenema Hospital faced. For a start, there was the controversial decision to move patients from the relatively remote medical centre in Kailahun province, into the busy city hospital of Kenema. The government was faced with the choice of either upgrading the facility in Kenema, or moving the patients to the nearest hospital with adequate facilities. Their choice has attracted some criticism from medical staff.

But even through this, Dr. Khan held his team together. His succumbing to this illness has been a massive blow to morale. Some reports dramatically state that the unit has collapsed, with nurses refusing to put themselves in any more danger and going on strike.

But then there were riots outside the unit three days after Dr. Khan took ill, Ebola denialists took to the streets in protest, fearful that doctors were killing people to harvest body parts. Does that sound familiar to you ?

All this happened as the Dr Khan, who had put his life at risk for his patients, was being treated in Kailahun province by Medecins Sans Frontieres. He died earlier today.

Oh, and did I mention ? It gets worse for Sierra Leone.

Really? What happened ?

It starts with a hairdresser named Saudata Koroma, who lived in Freetown, the capital of Sierra Leone. We don't know how she got the infection. It seemed like it had been confined to the eastern parts of the country, on the border with Guinea. She was the first recorded case in Freetown.

Luckily, she was admitted into hospital, so the medical workers could track down where she got the infection, and isolate the city from the outbreak. She would at least get some treatment. But then her family forcibly removed her from the hospital.

Immediately, the authorities scrambled to find her. She was a threat to anyone she made contact with, and could start an outbreak in Freetown all on her own.The police managed to finally find her in the house of a traditional healer. The family had taken there in the hope that the healer could help, and fought with the police when they attempted to retrieve her.

They managed to get her into an ambulance, only for her to die before she reached the hospital.

At the very same time, protesters rioted outside of the Freetown hospital. This lead to more clashes with riot police, who fired tear gas into the crowd, and shot a 9 year old in the leg.

The backlash against medical workers in Sierra Leone has been devastating. Many organisations run outreach to villages, to transport patients to hospitals and to help bury the dead. Now they are being met with rocks and machetes when they enter villages. For their own safety, they can no longer enter these communities.

Across Sierra Leone, there have been reports of families overwhelming hospital isolation rooms to spirit patients away to join the ranks of the invisible infected, who serve only to proliferate the outbreak and join the ranks of the unknown dead.

Okay, but what about the US citizens affected by this outbreak ?

Relax, I'll get to them soon. But first, we have to get around to Liberia. In the past week, they lost Dr Samuel Brisbane, the Chief Medical Doctor at the JFK medical centre in Monrovia.

He recognised his own symptoms as they began to emerge. At first, he refused to leave his own home, fearful that he could infect other people with the disease. As his condition worsened, he was taken to JFK medical centre, where he died last Saturday. He wasn't the only high ranking medical practitioner to succumb to the disease in Liberia.

Yes ?

Dr Melvin (Or Nelson according to some news sources) Korkor, the Lead doctor in Phebe also contracted this disease, but luckily survived. You'd think this means he'd be back at work soon? You'd be wrong, because Ebola survivors are stigmatised, and often barred from their communities. When he returned to the campus of Cuttington University, he was driven off campus by his friends and family, who were worried that he could still spread the disease.

I was expecting you to talk about the US medical staff...

Now we're getting to it. Kent Brantly was in Liberia working for a Charity called Samaritan's Purse. They have been working against the Ebola outbreak in Liberia, lifting some of the burden from Medecins Sans Frontieres by taking over some of their hospitals.

They are a religious organisation, with doctors serving a dual role as physicians and missionaries, committed to helping in regions with the most need.

Dr Brantly worked with his wife in Ebola isolation units in Monrovia. When he first noticed his symptoms, he checked himself into quarantine, and so far hasn't left it since then.

Samaritan's Purse risk losing another member to the disease. Nancy Whitebol, a hygienist reportedly working at the same institution also caught the disease.

You may ask why I've waited until the end of this article to tell their stories, and it's because you've probably heard more about them than I have. The media has been extremely good at capturing their stories.

Let's be clear, they are heroes. The kind of person who goes off and risk their lives in a country far from home just because they see people in need, is the kind of person we call a hero.

So is the person who keeps themselves and their staff going, even as they watch their colleagues succumb to the infection.

So are the people who keep on fighting, when all of the odds are stacked against them, in the face of riots and intimidation. They too are heroes, and their sacrifices also shouldn't be ignored.

There are still more people out there, whose stories we haven't heard, whose names we will never know, who are feverishly working to bring Ebola under control.

If you haven't already done it, send your donations to some of the organisations fighting to contain this outbreak. Medecins sans Frontieres, The International Federation for the Red Cross and Red Crescent, and Samaritans Purse could all do with more resources.

Okay okay, I've put some pennies in the collection tin, now tell me what happened in Nigeria ?

This is breaking news, that pretty much caught me on the back foot. It starts with another US citizen. Patrick Sawyer was working as a consultant for the Liberian Ministry of Finance, away from his wife in the US, but near to his family in Liberia.

It's reported that his sister recently died of the Ebola virus, and it's no big stretch to suggest that he caught the disease from her.

It was when he set out for Nigeria, that his symptoms emerged. I should note that it wasn't a direct flight either. It stopped off in Ghana, and he ha to change planes in Togo.

It was when he was on the plane to Lagos, that his symptoms emerged. He was reported to have already had a high fever, and vomited on the flight. It was when he collapsed on arrival at Lagos Airport that he got medical help.

He was transported to a private hospital, but died on the 25th. Officials are currently tracing and isolating everyone who he may have had contact with. Unfortunately, that number seems to currently about 30,000 people, including the ones who tried to help him when they saw that he'd collapsed in the airport. With an incubation period of up to 21 days, it may be too early to tell whether the outbreak has spread to Nigeria.

Nevertheless, I'm going to try to be optimistic, and say that we may have gotten lucky.

Lucky ? A man is dead, and a whole new outbreak could have started !

I know, I know, It's callous of me to say that, but it's true. We were very lucky that he showed symptoms on the plane. The authorities could rapidly quarantine him, and use the plane manifests to find all the other passengers who are at risk.

If his symptoms had appeared a day later, when he had already gotten lost in the most populous city in West Africa, we'd be dealing with a much larger outbreak. As it stands, the Nigerian officials have the chance to stop this outbreak before it starts.

What if his symptoms hadn't arisen until he was back home in the US ? Would his health insurance have covered Ebola ?

Asky Airlines, whose planes carried him to Lagos, have cut off all air travel to afflicted countries in response to his death.

Liberia has closed off all but three border crossings. Public gatherings are restricted and entire communities have been quarantined. This is in addition to all of the other infection control strategies in place.

So will it cause an outbreak outside West Africa ?

I guess we may have had a close call there, but its probably unlikely. The biggest weapon, in fact the only weapon, we have against Ebola is knowledge. Doctors around the world know the danger of this outbreak. They will be looking very carefully at people coming from West Africa.

What about these cases in the UK and Hong Kong?

The two people you are talking about fortunately have tested negative for the Ebola virus. The first passenger complained of feeling feverish when he landed in Birmingham, and was immediately put into quarantine. This case is the reason why the UK government recently went on high alert, and has taken steps to prepare the country for Ebola.

The woman in Hong Kong had travelled from Nigeria also complained of stomach pain and a fever. She was also immediately put into isolation.

Whilst they didn't turn out to have Ebola, the reaction to their symptoms could be a test of how prepared each of the governments are for the outbreak.

Sources.

NOTE: This is a developing story, and this time I'm drawing all of these facts from news articles. I cannot speak to the accuracy of these the same way I can with scientific journals, and given the chaotic nature of this outbreak, what we know of what's happening on the ground is prone to change. I had to drastically alter my article twice three times in response to information that emerged while I was writing it.

All Africa

News story focussing on the Story of Doctor Korkor, who even though he survived the outbreak, still faces stigma associated with it.

http://allafrica.com/stories/201407...

The Latest WHO report on the outbreak- Good for mortality statistics and a dry examination of the facts. They don't include Nigeria in their counts, but that may change.

http://www.who.int/csr/don/2014_0...

Awareness Times, a news site based in Sierra Leone has some articles that are chock full of information and local political commentary on the outbreak. It has a story about Dr Khan, and the action packed tale of another Ebola sufferer stolen from an isolation ward and spirited away into the rainy night on the back of a motorbike.

http://news.sl/drwebsite/publ...

http://news.sl/drwebsite/publ...

Reuters

Providing updates on the outbreak in Sierra Leone, and the Riot in Kenema.

http://uk.reuters.com/article/2014/0...

China Central Television

More details on the Nigerian response to the death of Patrick Sawyer

http://english.cntv.cn/2014/07/29/VID...

Quartz

Article on the two suspected Ebola victims from the UK and Hong Kong.

http://qz.com/242342/passeng...

Image source- Political Map of West Africa from the UN , hosted on Wikimedia Commons