After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner

“The World Health Organisation (WHO) has raised the alarm that cases from the resurgent Ebola outbreak in the Democratic Republic of the Congo (DRC) are expected to rise in the coming days.
WHO’s Deputy Director General of Emergency Preparedness and Response, Peter Salama, said in Geneva that there had been around 20 deaths as a result of the Ebola virus.
Mr Salama also said protecting vulnerable people in eastern DRC from the latest Ebola Virus outbreak was going to be “very, very complex”, given the huge logistical challenges and ongoing conflict there.
The WHO emergency preparedness and response chief said: “We know for example that there have been around 20 deaths. We can’t at this stage confirm whether they are all confirmed or probable Ebola cases.
“We expect however that the overall case count will rise in coming days to weeks, based on the trajectory of epidemics at this stage in their development.”
Salama said that WHO was unaware of the public health emergency in North Kivu province when the UN agency a week ago declared the last Ebola episode over…
“It’s going to be a very, very complex operation,” he said, noting that the vast country is home to the UN’s largest peacekeeping operation, the UN Stabilisation Mission in the DRC.
One million of the province’s eight million inhabitants are displaced and getting access to some of those in danger of coming into contact with Ebola, will require an armed escort in some cases, the WHO official explained.
There is also the additional threat that those fleeing violence may also head into nearby Uganda, Tanzania and Burundi, taking the infection with them, Salama said, noting that additional surveillance measures are being implemented at crossing points.
“On the scale of difficulty, trying to extinguish a deadly outbreak pathogen in a war zone is at the top of the scale,” he added.” (A)

“In the outbreak earlier this year in DRC, health officials used a ring vaccination program, in which they tracked down the contacts of cases and the contacts of those contacts, and offered them all vaccine in a bid to halt spread. That approach might not be viable in North Kivu.
“The ring vaccination strategy is highly dependent on access, and really strong access to the population that’s being targeted,” Salama told STAT. “The ring vaccination is really the big question mark [here].”
Salama said consideration is being given to an “out-in strategy,” which would create a ring around an area where there had been cases, rather than trying to find and vaccinate specific individuals. The idea would be to start “with a protective buffer around a whole geographical zone,” and then moving inward, offering vaccine to everyone in the area.
A lot will depend on how freely the vaccine teams can travel. And that will be determined in negotiations with the United Nations peacekeeping operation in the region…
The fact that the Ebola Zaire virus is the cause of the outbreak also opens up the most options for experimental drugs to treat patients. In addition to the Merck vaccines, supplies of five potential therapeutics are already in the country, having been sent during the Bikoro outbreak.
None of the drugs was used during the previous outbreak. By the time DRC’s scientific and ethical committees reviewed the available scientific data and authorized the drugs for compassionate use, there were no more Ebola patients in care.” (B)

“Health workers are in the process of setting up a so-called cold chain, the series of measures needed to keep the vaccine well below zero in a tropical climate without reliable power supplies, the ministry said.” (C)

“”So, not only do you have the problem of tracking that internal displacement, but then you have the potential exportation of infection across borders,” Salama said. “And, that is why we are already working with the government of Uganda particularly, but also Rwanda, which shares a border as well with northern Kivu to be fully prepared for any eventualities across the border.”
The U.N. refugee agency is lending its expertise to this situation. It is preparing shelters for at least 1,000 vulnerable Internally Displaced Persons and other extremely vulnerable people in the Ebola-affected Beni area. It also is undertaking protection and monitoring activities.
UNHCR spokesman Andrej Mahecic says his agency’s staff in Uganda, Rwanda and Tanzania are on Ebola alert.
“Specifically, in Uganda, we have a continuous influx from the DRC. Our operation has intensified the awareness-raising among the refugee and host communities. We have also increased the infection control and outbreak preparedness measures,” Mahecic said. “And, we also are preparing for entry screening, that could be the temperature checks for arriving Congolese refugees at the borders.”
Mahecic says around 92,000 Congolese refugees have fled to Uganda so far this year. He says they are continuing to arrive at an average rate of between 100 and 200 a day.” (D)

“John F. Kennedy Memorial Hospital, Liberia’s biggest referral hospital, has denied reports of having on its ward a confirmed Ebola case…
The Hospital assured the public that any confirmed cases of Ebola at the Medical Center would be immediately communicated to the relevant authority.
In an interview with FPA last week, the head of the National Public Health Institute (NPHIL), Mr. Tolbert Nyenswah, said should be “no cause for alarm” despite the discovery of a new strain of the Ebola virus in neighboring Sierra Leone
The new strain of Ebola named ‘Bombali virus’ was discovered in fruits eating bats and has the potential to infect humans, researchers say.
So far, according to health officials in Freetown, there is no evidence that the new virus strain has infected any human.
“There is no need to panic about this situation; researchers are in control. It is not a new outbreak as it is being considered by people,” says Tolbert Nyenswah, NPHIL’s Director General.
Nyenswah, an expert health practitioner who worked successfully through the 2014 Ebola outbreak in Liberia, says more research is needed in order to establish the characteristics of the new strain found in Sierra Leone.
“The facts are, it can be transferred to human cells but what is not known is whether or not it can cause the [Ebola] disease as in the case of previous outbreaks,” he told FrontPage Africa on Wednesday.
There has been no human-to-human transfer of the new strain as in the case of the ‘Zaire strain’ which infected thousands of people leading to the deaths over 11,300 people in Liberia, Guinea and Sierra Leone.
Nyenswah, however, added that what is unknown about the new strain is whether it is virulent like the Zaire strain; adding, “This is why scientists are working overnight to determine”.
Experts have disclosed that it is difficult to put a timeline to gathering sufficient information about the new strain to determine if the virus can cause an outbreak.
“So, what we need to be caution about is playing with fruits bats or eating them. These kinds of things are very much warned against especially in the region of Sierra Leone that we are talking about,” he said.” (E)

“At least 34 people are reported to have died in a fresh outbreak of Ebola in the Democratic Republic of Congo, including one healthcare worker, the World Health Organization says, as officials scramble to contain the deadly virus in the restive eastern part of the country.
As of August 6, 43 Ebola cases have been reported primarily in North Kivu province, an area that has been beleaguered by decades of violence, with an additional 33 suspected cases currently undergoing laboratory tests.” (F)

“Colorado health officials scrambled to determine whether a man who recently worked with sick people in eastern Congo and became ill Sunday in Denver had contracted the deadly Ebola virus — and doctors also isolated an ambulance crew for testing and were looking for another person in metro Denver who may have had contact with the man.
Denver Health and Hospitals officials Sunday night were waiting for test results from a state health lab but said that, based on an initial test in a special isolated unit, they do not believe the man has Ebola. A Colorado Department of Public Health and Environment (CDPHE) bulletin late Sunday said testing “is negative for Ebola.”
The man had been working with sick and dead people in an area of eastern Congo where a recent outbreak of Ebola had largely dissipated with no new Ebola cases reported over the past 45 days. On Sunday morning, he reported sudden severe symptoms at his residence in Denver, Denver Health chief medical officer Connie Price said.
“We felt that, if he had Ebola, then he could be very communicable … We had no wiggle room to be wrong,” Price said.
The man “became ill very suddenly this morning,” she said, declining to specify his exact symptoms but saying they could mimic illnesses including flu and appendicitis. “He is getting better, so that is good.”
Three members of the ambulance crew that picked up the man — two of them paramedics, one a student — also were being held in isolation, and Denver public health officials were looking for a “significant other” who may have had contact with the man warranting testing as a precaution…
Hospital officials said they were “on normal operations” and that “there is no threat or concern for patient, staff or visitor safety.” Denver Department of Public Health and Environment officials couldn’t be reached late Sunday…
Denver Health staffers are trained and equipped to deal with situations involving infectious diseases. And the CDC has designated Denver’s hospital as one of 10 around the nation prepared to treat patients with Ebola.” (G)

“A man who fell ill after a recent trip to eastern Congo has been removed from isolation after tests came back negative for the deadly Ebola virus, health officials said on Monday.” (H)

“Denver Health officials’ ability to respond to potential public health threats was thrown into the spotlight late last month when a man’s illness spurred fears that he may have contracted the deadly Ebola virus.
And while officials say they followed protocols, there is one aspect of their response they would like to improve on: the amount of time it took Denver Health to inform the public.
It took about seven hours to get out the word that they were handling a case potentially involving an infectious disease…
“If I had to look back on it now, I would have liked to have sent the press release out a little earlier,” she said…
“We followed our established protocols and all Denver Health staff responded efficiently and effectively; however, we use every opportunity we can to learn and improve,” she said in a later statement. “We will have several debriefings to review every aspect of our response, and will certainly be open to finding new ways to refine it.” “ (I)

(A) Ebola cases in DR Congo ‘will rise in coming days’ – WHO, https://www.premiumtimesng.com/news/top-news/278867-ebola-cases-in-dr-congo-will-rise-in-coming-days-who.html
(B) Ebola outbreak in DRC sets up another test for experimental treatments, by Helen Branswell, https://www.statnews.com/2018/08/03/ebola-outbreak-in-drc-sets-up-another-test-for-experimental-treatments/?utm_source=STAT+Newsletters&utm_campaign=de1a372488-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-de1a372488-149527969
(C) Ebola vaccinations in eastern Congo due to begin on Wednesday, https://www.reuters.com/article/us-health-ebola-congo-vaccine/ebola-vaccinations-in-eastern-congo-due-to-begin-on-wednesday-idUSKBN1KQ0N0
(D) Can Ebola Spread From DRC to Neighboring Countries?, https://www.voanews.com/a/congolese-refugees-risk-infecting-neighboring-countries-with-ebola/4513607.html
(E) Liberia: John F. Kennedy Memorial Hospital Denies Having Confirmed Ebola Case on Ward, https://frontpageafricaonline.com/health/liberia-john-f-kennedy-memorial-hospital-denies-having-confirmed-ebola-case/
(F) Ebola death toll climbs to 34 as health workers struggle to contain latest outbreak in Congo, by Krista Mahr, https://www.telegraph.co.uk/news/2018/08/07/ebola-death-toll-climbs-34-health-workers-struggle-contain-latest/
(G) Denver man just back from Congo isolated for possible Ebola; CDPHE said testing “is negative”, by Bruce Finley, https://www.denverpost.com/2018/07/29/denver-health-ebola-virus-isolation/
(H) Denver man removed from isolation after tests prove negative for Ebola, by Kathryn Scott, https://www.denverpost.com/2018/07/30/denver-ebola-tests-negative/
(I) After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner, by Jessica Seaman, https://www.denverpost.com/2018/08/05/denver-health-ebola-scare-public-notice/
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