EBOLA. PART 13. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.

In 2016 The World Health Organization identified the top 8 emerging diseases that were likely to cause severe outbreaks in the near future: Crimean-Congo haemorrhagic fever; Ebola; Marburg; Lassa Fever; MERS; SARS;  Nipah; and Rift Valley fever. (Q)

The Ebola epidemic in the Democratic Republic of Congo is breaching its contiguous borders with South Sudan, Uganda, and Tanzinia; it also borders four other countries.

 “…If the purse strings tighten, however, and the WHO cannot continue its work, the outbreak will almost certainly pick up speed. It’s only a matter of time until the virus crosses borders…

There are a few possible explanations for this (funding) shortcoming. The first is unspoken, but (is) true of the world’s largest outbreak of the disease in West Africa — Ebola has not yet spread to rich countries…”

Are we ready?

ASSIGNMENT: As Ebola spreads from Congo to contiguous countries In Africa, is the United States prepared for Ebola and other known and unknown emerging viruses?

“It sounds like an improbable fiction: a virulent flu pandemic, source unknown, spreads across the world in 36 hours, killing up to 80 million people, sparking panic, destabilising national security and slicing chunks off the world’s economy.

But a group of prominent international experts has issued a stark warning: such a scenario is entirely plausible and efforts by governments to prepare for it are “grossly insufficient”.

The first annual report by the Global Preparedness Monitoring Board, an independent group of 15 experts convened by the World Bank and WHO after the first Ebola crisis, describes the threat of a pandemic spreading around the world, potentially killing tens of millions of people, as “a real one”.

There are “increasingly dire risks” of epidemics, yet the world remained unprepared, the report said. It warned epidemic-prone diseases such as Ebola, influenza and Sars are increasingly difficult to manage in the face of increasing conflict, fragile states and rising migration…

 “Ebola, cholera, measles – the most severe disease outbreaks usually occur in the places with the weakest health systems,”.. “As leaders of nations, communities and international agencies, we must take responsibility for emergency preparedness, and heed the lessons these outbreaks are teaching us. We have to ‘fix the roof before the rain comes.’” (A)

“On Wednesday (July 17), the World Health Organization declared the Ebola outbreak in Democratic Republic of Congo a global health emergency…

A WHO committee that decided the outbreak would be a PHEIC lays out specific recommendations in a statement, including keeping borders open and not placing restrictions on trade and travel. The members call for a “coordinated international response” and for neighboring countries to work with partners to prepare for detecting and managing imported cases.

The emergency committee writes that, nearly a year into the outbreak, “there are worrying signs of possible extension of the epidemic.” Robert Steffen, who chaired the group, tells STAT that WHO is now declaring a PHEIC in part because disease transmission in the DRC city of Beni has increased, there is a risk to response workers’ safety, and that the disease is still actively transmitted in large geographical areas of the country.” (B)

“South Sudan has stepped up surveillance along its porous southern border after an Ebola case was detected just inside DR Congo, an health official in Juba told AFP Wednesday…

It is the closest Ebola is known to have come to South Sudan since a major outbreak began in Congo last August.

Dr Pinyi Nyimol, the director general of South Sudan’s Disease Control and Emergency Response Centre, said a team of reinforcements had been sent to the region to bolster surveillance after the case was confirmed.

“We are very worried because it is coming nearer, and people are on the move so contact (with Ebola) could cross to South Sudan,” he told AFP.”  (C)

“Uganda’s ministry of health announced late on Thursday a second Ebola outbreak in the western district of Kasese, about 472 km from the capital Kampala, following an imported case from the neighboring Democratic Republic of the Congo (DRC).

Joyce Moriku Kaducu, minister of state for primary health care, said in a statement that a 9 year-old female Congolese who entered the country with her mother on Wednesday through the Mpondwe border to seek medical care at Bwera Hospital has tested positive of the deadly virus.

The minister said the child was identified by the point of entry screening team with symptoms of high fever, body weakness, rash, and unexplained mouth bleeding…

“Since the child was identified in Uganda at the point of entry, there are no contacts in Uganda,” she said…

In June, Uganda confirmed three index cases of the highly contagious disease who visited the neighboring DRC. The outbreak was declared finished after 42 days of close monitoring.” (D)

“A  nine-year-old Congolese girl who tested positive for Ebola in neighbouring Uganda has died of the disease, as the World Health Organisation (WHO) warned that the current outbreak was approaching the grim milestone of 3,000 cases and 2,000 deaths.

Her death makes her the fourth case to cross into Uganda amid the continuing struggle to contain the deadly outbreak.” (E)

The World Health Organization issued an extraordinary statement Saturday raising concerns about possible unreported Ebola cases in Tanzania and urging the country to provide patient samples for testing at an outside laboratory.

The statement relates to a Tanzanian doctor who died Sept. 8 after returning to her country from Uganda; she reportedly had Ebola-like symptoms. Several contacts of the woman became sick, though Tanzanian authorities have insisted they tested negative for Ebola.

But the country has not shared the tests so they can be validated at an outside laboratory, as suggested under the International Health Regulations, a treaty designed to protect the world from spread of infectious diseases.

It is highly unusual for the WHO, which normally operates through more diplomatic means, to publicly reveal that a member country is stymying an important disease investigation.

 “The presumption is that if all the tests really have been negative, then there is no reason for Tanzania not to submit those samples for secondary testing and verification,” Dr. Ashish Jha, director of the Harvard Global Health Institute, told STAT…” (F)

“The statement comes hard on the heels of similar remarks by the US health secretary, Alex Azar, last week amid mounting concern that Tanzania may be in breach of its international commitments to share critical data relating to global health security.

Although Tanzania has insisted that its own tests showed negative for the Ebola virus, international health organisations have raised the alarm about not being given access to samples.

According to unconfirmed reports, the woman, in her mid-30s, had been conducting health research and had visited several health facilities in central Uganda before her death, after showing symptoms of a serious febrile illness.

The patient, who died on 8 September, had not been to the Democratic Republic of the Congo or had contact with Ebola cases, leading international health monitoring organisations to initially rule out the Ebola virus.

However, as several more reported cases emerged, including the initial patient’s sister, Tanzania’s response to the issue has prompted alarm about the country’s willingness to share either its test results or allow secondary testing of samples.

Azar voiced his own criticism during a visit to Uganda, telling reporters that he and others are “very concerned” as he urged Tanzania’s government to share laboratory results regarding the case.” (G)

A team of specialists at Emory University will never forget Aug. 2, 2014. That’s the day Kent Brantley, an American missionary based in Liberia, became the first of four patients with the Ebola virus to arrive at its Atlanta facility.

The eyes of the world watched as the Serious Communicable Diseases Unit ⁠— in hazmat suits, successfully treated Brantley and three other patients with the highly infectious disease.

The team at Emory is innovating on what they learned five years ago to help treat the disease now. “ (H)

“This fall, the University of Nebraska Medical Center is scheduled to open a cutting-edge center for training, simulation and quarantine to prepare federal workers to address highly infectious diseases. Creation of the National Center for Health Security and Biopreparedness is timely and important, given the troubling new Ebola outbreak in Africa.

As a result, the infectious disease initiative at UNMC and clinical partner Nebraska Medicine is taking on particular importance. UNMC received a $19.8 million federal grant for creation of the new biopreparedness center. A team of infectious disease experts from UNMC and Nebraska Medicine was in Uganda last year to train local health care workers in infection response and control…

During 2014-15, the med center treated three Ebola patients and monitored several others who were exposed but did not develop the disease. On Dec. 29 last year, an American doctor who had been treating patients in the Democratic Republic of Congo arrived in Omaha, where he completed the last 14 days of a 21-day monitoring period in UNMC’s biocontainment unit.” (I)

“During the outbreak five years ago, 56 hospitals across the U.S. were designated Ebola treatment centers, or ETCs. The idea was to increase national capacity to care for patients who contracted this highly infectious disease. These hospitals are mostly clustered around major airports where travelers from West Africa are likely to arrive, including Chicago’s O’Hare International Airport. They were initially equipped with dedicated clinical care resources, specialized infrastructure and trained staff to safely manage and treat patients suspected or confirmed to have Ebola. Since its inception in 2014, fewer resources have been allocated to this hospital network. As a result, the ETCs are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S., and other infectious diseases that may follow.

Outbreaks are costly. Public health responses to Ebola, Zika, MERS, SARS and other diseases cost tens of billions of dollars, much of which can be avoided by taking preventive action. Congress can wait until Ebola or some equally deadly infectious disease arrives in our country, overwhelms state, local, tribal and territorial health care and public health capacity, and threatens lives and then provide billions in emergency supplemental funding. Or Congress can now recognize that these significant disease events will continue to occur and proactively take steps to ensure we can respond by creating a standing response fund.” (J)

“… In the past two years, the Trump administration has dissolved the federal government’s biosecurity directorate, scaled back its infectious disease prevention efforts, restricted development aid for countries like Congo, made several attempts to rescind foreign aid, including for global health, and pulled C.D.C. workers from Congo’s outbreak zones without a clear plan to send them back.

The administration has also announced policies meant to scare legal immigrants off public assistance programs, including for health care, to which they are legally entitled. Such policies imperil everyone: The more people who don’t have access to vaccines or antibiotics, the greater the risk that an infectious disease will spread. That applies to diseases like Ebola that might arrive on American shores from other countries, but it also applies to diseases that are already here, like flu and measles. The only reliable way for a country to protect itself from these threats is for it to help other countries do the same.

The new medications for Ebola and tuberculosis are the product of years of investment and careful work. That investment could continue to pay off, but only if the United States and its partners around the world increase their global health efforts, instead of shrinking away from them.” (K)

“As the Ebola epidemic in the DRC has become a global health emergency, we must not relent in our efforts to fight back. There are Ebola vaccines available today (pending licensing) thanks to the research and development and vaccine trials conducted during the West Africa Ebola epidemic. But the public health community needs a greater supply of those vaccines, and we need coordinated action on behalf of the public, philanthropic and private sectors to arrest the outbreak in the DRC. Stopping outbreaks at the source protects America. Infectious, deadly diseases such as Ebola do not recognize or respect borders.” (L)

“I’m not a social scientist. I have zero data on which to lean here. Someone who actually does this sort of research may conclude that donor fatigue, or the financial straits some countries and most media outlets currently face, or the turning inward that has accompanied the rise of populism can explain why this Ebola outbreak isn’t as front burner an issue as it would have been a decade ago, why organizations struggling to stop it are finding fewer donors writing smaller checks.

But in the meantime I am left wondering if we have learned to fear this virus less. And in the process, if we have let Ebola drift toward the column of bad diseases — things like cholera and yellow fever, Guinea worm and malaria — that we’re not so concerned about. Sure, they sicken and kill lots of people. But they don’t do it here.” (M)

“…If the purse strings tighten, however, and the WHO cannot continue its work, the outbreak will almost certainly pick up speed. It’s only a matter of time until the virus crosses borders…

There are a few possible explanations for this shortcoming. The first is unspoken, but was true of the world’s largest outbreak of the disease in West Africa — Ebola has not yet spread to rich countries…

At last month’s G20 summit in Japan, high-income countries, including the United States, declared their full support for the Ebola response. They must now make good on that promise to the WHO. If countries procrastinate, the world risks a repeat of the 2014–16 Ebola outbreak, in which a slow response contributed to the loss of more than 11,300 lives in Africa and a cost to taxpayers of more than $3 billion. The WHO needs just a fraction of this to prevent a horrific repeat of history.” (N)

“A dispute between two major players in the epidemic response — Doctors Without Borders and the W.H.O. — erupted on Monday, just as the W.H.O. announced that a new vaccine, the second to be deployed, would be introduced into the region.

On Monday, Doctors Without Borders accused the World Health Organization of “rationing Ebola vaccines and hampering efforts to make them quickly available to all who are at risk of infection.”

The W.H.O. quickly fired back, saying it was “not limiting access to vaccine but rather implementing a strategy recommended by an independent advisory body of experts and as agreed with the government of the D.R.C. and partners.”..

The approach so far has relied on a traditional strategy called ring vaccination that has been used successfully against other diseases. It involves vaccinating everyone who has had contact with an infected person, and all the contacts of those people, as well.

Officials from Doctors Without Borders say the strategy has not worked in Congo, in part because it has not been possible to track down every person who has come into contact with someone infected with Ebola, and because some contacts have refused to cooperate. The group has urged more widespread vaccination in regions where the disease is spreading, whether people are known contacts or not.

But it says that instead the W.H.O. has doled out limited amounts of vaccine. About 225,000 people have been vaccinated, but Doctors Without Borders says 450,000 to 600,000 should have received the vaccine by now.” (O)

“The United States has warned its citizens to take extra care when visiting Tanzania amid concerns over Ebola, adding to calls for the East African country to share information about suspected cases of the deadly disease there…

U.S. travelers should “exercise increased caution”, the State Department said on Friday in an updated travel advisory that cited reports of “a probable Ebola-related death in Dar es Salaam”.” (P)

“The medical response to an Ebola infection is markedly more challenging than many other diseases. It is one of the most deadly viruses with a 60% – 90% mortality rate compared to 2% for measles.

The Ebola virus is extremely infectious and highly communicable. Treating the disease is resource intensive. Patients must be kept in isolation in specialised, well-designed treatment centres. Health care workers are at high risk of exposure and must take extreme precautions to examine patients. Breakdown in personal protection and infrastructure can be fatal. In fact, approximately 6% of the victims have been involved in looking after patients.” (R)

“Today (June 12, 2019) the U.S. Centers for Disease Control and Prevention (CDC) is announcing activation of its Emergency Operations Center (EOC) on Thursday, June 13, 2019, to support the inter-agency response to the current Ebola outbreak in eastern Democratic Republic of the Congo (DRC). The DRC outbreak is the second largest outbreak of Ebola ever recorded and the largest outbreak in DRC’s history. The confirmation this week of three travel-associated cases in Uganda further emphasizes the ongoing threat of this outbreak. As part of the Administration’s whole-of-government effort, CDC subject matter experts are working with the USAID Disaster Assistance Response Team (DART) on the ground in the DRC and the American Embassy in Kinshasa to support the Congolese and international response. The CDC’s EOC staff will further enhance this effort.

CDC’s activation of the EOC at Level 3, the lowest level of activation, allows the agency to provide increased operational support for the response to meet the outbreak’s evolving challenges. CDC subject matter experts will continue to lead the CDC response with enhanced support from other CDC and EOC staff.” (S)

“…if we want to prevent Ebola cases evolving into wider outbreaks, then we’ll need to move beyond reactionary responses and address the factors that pave the way for epidemics.”..

To prevent future outbreaks, and to support the health of local communities in the poorest parts of the world, we need to invest in strengthening primary care and medical education. Otherwise, we will be here again in another five years, once again having failed to learn from our mistakes.” (T)

________________

May 15, 2017

Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.

2. REVRCs should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and emerging viruses “reading” expertise).

3. National leadership in clinical trials.

4. A track record of successful, large scale clinical Rapid Response.

5. Organizational wherewithal to address intensive resource absorption.

  • Faculty might want to scan the following unabridged Ebola chronology

PART 1. May 15, 2017. EBOLA is back in Africa. Is ZIKA next? Are we prepared?

PART 2. May 9, 2018. New Ebola outbreak declared in Democratic Republic of the Congo

PART 3. May 18, 2018 . As ZIKA and EBOLA reemerge, Trump administration cuts funding to halt international epidemics

PART 4. June 11, 2018 . “With an outbreak like this, it’s a race against time, as one Ebola patient with symptoms can infect several people every day.”

PART 5. June 16, 2018. EBOLA, ZIKA. EMERGING VIRUSES. ” All too often with infectious diseases, it is only when people start to die that necessary action is taken.”

PART 6. June 17, 2018. ANDEMIC PREPAREDNESS. “It’s like a chain-one weak link and the whole thing falls apart. You need no weak links.”

PART 7. June 21, 2018. Democratic Republic of Congo’s Ebola outbreak has been “largely contained”…

PART 8. June 24, 2018. “Slightly over a month into the response, further spread of [Ebola Virus Disease] has largely been contained,” WHO announced on June 20.

PART 9. August 10, 2018. After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner

PART 10. August 20, 2018. At least 10 health-care workers have been infected with the deadly Ebola virus as they battle an outbreak in an eastern province of Congo

PART 11. August 30, 2018. “…(WHO) reports the next seven to 10 days are critical in controlling the spread of the Ebola virus in eastern Democratic Republic of Congo.” http://doctordidyouwashyourhands.com/2018/08/who-reports-the-next-seven-to-10-days-are-critical-in-controlling-the-spread-of-the-ebola-virus-in-eastern-democratic-republic-of-congo/

PART 12. June17, 2019. “Three cases of EBOLA have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.” http://doctordidyouwashyourhands.com/2019/06/part-12-june17-2019-three-cases-of-ebola-have-emerged-in-uganda-a-neighboring-country-to-the-democratic-republic-of-the-congo/

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