Ten Additional HCWs Being Evacuated From Sierra Leone After Potential Ebola Exposure

 

 

 

# 9830

 

Yesterday, in CDC Statement: Investigating Additional Potential Ebola Exposures To American Citizens In West Africa, we learned than an American HCW who contracted Ebola in Sierra Leone was evacuated to the NIH hospital in Bethesda, and a second healthcare worker who was exposed (but not symptomatic) was being transported to Emory.

 

Last night it was revealed that at least 10 other Americans who were potentially exposed – but are not currently ill – are being transported back to this country for isolation, observation, and possible treatment.  

 

This move seems predicated upon an `abundance of caution’ rather than expectations that these individuals are infected.

 

All ten appear to be associated with the non-profit group Partners in Health, which has roughly 2,000 staff members in Africa. First a statement from Partners in Health, followed by an update from the CDC, and then lastly a report by NBC’s Maggie Fox.

 

Update on Ebola Response Clinicians Returning from Sierra Leone

Posted on March 14, 2015

 

FOR IMMEDIATE RELEASE
Contact: Jeff Marvin, Media Relations Manager
jmarvin@pih.org

BOSTON (Mar. 14, 2015)—On Wednesday, March 11, a clinician working with Partners In Health’s Ebola response in Sierra Leone tested positive for the Ebola virus disease. The clinician was evacuated from West Africa and is currently receiving treatment at the National Institutes of Health Special Clinical Studies Unit in Bethesda, Maryland.

Ten clinicians who came to the aid of their ailing colleague were subsequently identified as contacts of the evacuated clinician. These individuals remain asymptomatic for Ebola virus disease. Out of an abundance of caution, and in collaboration with the U.S. Centers For Disease Control and Prevention, these clinicians are being transported to the United States via non-commercial aircraft. They will remain in isolation near designated U.S. Ebola treatment facilities to ensure access to rapid testing and treatment in the unlikely instance that any become symptomatic. The clinicians have agreed to be monitored, and will voluntarily self-isolate during the remainder of the 21-day incubation period, in accordance with CDC guidelines.

Meanwhile, PIH is working with the CDC, the WHO, and the Ministry of Health and Sanitation of Sierra Leone to conduct a thorough assessment of safety and clinical protocols to ensure that we continue providing the best possible care for our patients, and safe workplaces for our staff.

PIH remains fully committed to the Ebola response in West Africa and, in the months and years to follow, working shoulder-to-shoulder with the governments of Sierra Leone and Liberia toward rebuilding the health systems in both countries.

Media Statement

For Immediate Release: Saturday, March 14, 2015
Contact: CDC Media Relations
404-639-3286

CDC continues to investigate potential Ebola exposure among individuals in Sierra Leone, including several American citizens, following the identification of an American volunteer healthcare worker in Sierra Leone who tested positive for Ebola virus.  That healthcare worker returned to the U.S. by medevac and was admitted to the NIH Clinical Center on March 13th for care and treatment. 

As a result of CDC's ongoing investigation, CDC and the State Department are facilitating the return of additional American citizens who had potential exposure to the index patient or exposures similar to those that resulted in the infection of the index patient. Currently, none of these individuals have been identified as having Ebola virus disease.

Individuals will be transported to the U.S. by non-commercial air transport and will be near the University of Nebraska Medical Center, the National Institutes of Health, or Emory University Hospital.

Individuals will follow CDC’s recommended monitoring and movement guidelines, including direct active monitoring and, as appropriate, voluntary self isolation during the 21-day incubation period.  In the event an individual shows symptoms, they will be transported following protocol to an Ebola treatment center for evaluation and care.

Ten Americans Evacuated From Sierra Leone After Ebola Scare

By Maggie Fox

 

Ten Americans who helped treat a medical worker infected with the Ebola virus are being evacuated from Sierra Leone and will be quarantined near special isolation units, the charity they work for said Saturday.

Partners in Health, a nonprofit group with 2,000 staff in West Africa, said the Americans are being evacuated and quarantined out of an abundance of caution. Earlier Saturday the Centers for Disease Control and Prevention said several people would be flown to the U.S. by private jet.

"Ten clinicians who came to the aid of their ailing colleague were subsequently identified as contacts of the evacuated clinician," Partners in Health said in a statement on its website.

None has any symptoms.

(Continue. . . )

Sierra Leone Bans Holiday Festivities, Begins House-to-House Search For Ebola Cases

Credit CDC

 

# 9453

 

While there are some encouraging signs of progress in Guinea and Liberia, the Ebola situation in Sierra Leone continues to deteriorate with a sharp jump in cases over the past 30 days.  Roughly 800 cases have been reported out of just Sierra Leone during the first 15 days of December.

 

Today the country will begin the previously announced (see Sierra Leone To Impose 2-Week Regional `Lockdown’)  14 day campaign dubbed `Operation Western Area Surge’ that will see teams go from house-to-house in the hard hit capital looking for those who may be infected.

 

The President of the country – in a radio announcement today – also announced that all Christmas and New Year's Eve festivities, including church services and New Year's Day outings, have been prohibited.  You may recall that last September the country held a similar nationwide 3-day lockdown , and while initially declared a `success’ by authorities (see BBC Report) – the virus has continued to spread.

 

Two reports, the first from the AP.

 

House searches for Ebola in Sierra Leone capital

By Associated Press December 17 at 8:36 AM

FREETOWN, Sierra Leone — Ebola surveillance teams fanned out Wednesday in Sierra Leone’s capital to search every house for sick people, as the president imposed new restrictions on movement and gatherings in a bid to stop the disease’s spread.

President Ernest Bai Koroma launched the 14-day “Operation Western Area Surge” in a national broadcast, promising that treatment beds, labs and ambulances are ready to handle any new cases. He reiterated that Christmas and New Year’s celebrations are canceled and also banned all public gatherings during the holidays and movement between districts.

(Continue . . . )

 

This report from the Anadolu News Agency.

 

All New Year's Eve festivities, including church services and New Year's Day outings, have been prohibited

By Cinnatus Dumbuya

FREETOWN

President Ernest Bai Koroma of Sierra Leone on Wednesday unveiled a raft of measures aimed at containing the spread of the Ebola virus, including house-to-house searches in capital Freetown and a ban on New Year festivities.

"Our country is at war with a vicious enemy that is still taking the lives of our brothers, sisters, mothers, fathers, children and friends," Koroma said in an address to the nation.

The house-to-house search exercise, codenamed "Operation Western Area Surge," was put together by the state-run National Ebola Response Center as a result of increased day-to-day transmission of the virus in Freetown.

"This exercise is to encourage people to come forward if they have a fever or other symptoms of Ebola and to call [hotline number] 117 for help at an early stage," Koroma said.

"The National Ebola Response Center has positioned beds, laboratories, ambulances, personnel and other logistics required to successfully implement this two-week exercise," he added.

(Continue . . . )

Sierra Leone To Impose 2-Week Regional `Lockdown’

Credit CDC

# 9432

 

 

Two months ago the `official’ WHO tallies showed Sierra Leone trailing far behind Liberia (2304 to 3696) in total Ebola cases, but since then we’ve seen Sierra Leone catch up and pull ahead in the case count.

 

From the most recent WHO assessment:

Sierra Leone

EVD transmission remains intense in Sierra Leone, with 397 new confirmed cases reported in the week to 7 December (3 times as many as Guinea and Liberia combined). The worst affected area remains the capital, Freetown, which reported one-third (133) of all new confirmed cases (figure 3).

 

December 10th WHO Roadmap

 

These numbers are routinely acknowledged to be undercounts, given the limits of surveillance and reporting in the region, and the reluctance of many to come forward for treatment.

 

Yesterday the AP reported on a grisly find at Sierra Leone’s latest Ebola hotspot in the Kono District in the eastern interior of the country, which has resulted in the declaration of a `lockdown’ of the area – no travel in or out – until December 23rd.

 

Sierra Leone area to hold 2-week Ebola ‘lockdown’

Published December 11, 2014

Health workers sent to Sierra Leone to investigate an alarming spike in deaths from Ebola have uncovered a grim scene: piles of bodies, overwhelmed medical personnel and exhausted burial teams.

The World Health Organization says the health workers from several local and international agencies are racing to the latest Ebola hotspot, a diamond-mining area that Sierra Leone put on "lockdown" Wednesday.

"In 11 days, two teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor who had been drafted into removing bodies piled up at the only area hospital," the WHO said in a statement Wednesday night.

(Continue . . .)

 

Last September Sierra Leone held a nationwide 3-day lockdown in a bid to identify those who were infected and contain the outbreak.  While initially declared a `success’ by authorities (see BBC Report) – and mistakenly believed by many residents to have ended the epidemic – the continued spread of the virus has proved otherwise.

 

Despite some of the progress against the virus that has been made in the more populated regions of the country, there appears to be a good deal of activity in remote areas where there is little reporting, and even less control.

Sierra Leone Reports 5th Doctor To Succumb To Ebola

 

# 9280

 

As I pointed out yesterday in French MOH Statement On UN Employee Evacuated From Sierra Leone With Ebola, as of Friday’s WHO Ebola Response Situation Report:

 

A total of 523 health-care workers (HCWs) are known to have been infected with EVD up to the end of 29 October: 82 in Guinea; 299 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and three in the United States of America (two were infected in the USA and one in Guinea). A total of 269 HCWs have died.

The vast majority of these losses have come among local nurses, and healthcare workers, whose names we rarely hear, and whose personal sacrifice or struggle is only known to their families and co-workers.  More visible to the media are cases where  doctors, or international volunteers, are infected.

 

Today multiple media sources are reporting that Dr. Godfrey George, medical superintendent of Kambia Government Hospital in northern Sierra Leone, has died from the Ebola virus.   

 

Sierra Leone Says Another Doctor Dies of Ebola

FREETOWN, Sierra Leone — Nov 3, 2014, 7:46 AM ET

By CLARENCE ROY-MACAULAY Associated Press

A doctor in Sierra Leone has died of Ebola — the fifth local doctor in the West African nation to die of the disease, authorities said Monday.

(Continue . . .)

 

 

 

While field reports are difficult to evaluate, we continue to see stories suggesting the outbreak in Sierra Leone may be far worse than previously reported (see UK Independent Report Ebola outbreak: Virus 'spreading quickly' in Sierra Leone ).

French MOH Statement On UN Employee Evacuated From Sierra Leone With Ebola

 

# 9278

 

As of Friday’s WHO Ebola Response Situation Report:

 

A total of 523 health-care workers (HCWs) are known to have been infected with EVD up to the end of 29 October: 82 in Guinea; 299 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and three in the United States of America (two were infected in the USA and one in Guinea). A total of 269 HCWs have died.

 

While a number of these infections are believed to have been acquired from community contact – or in settings where the HCW did not know they were dealing with a possible Ebola case – this illustrates just how dangerous working in the Ebola hot zone can be for healthcare workers. 

 

Overnight the French Ministry of Health has confirmed that they have accepted for treatment an unidentified UN worker from Sierra Leone with the Ebola virus.  This is the second such evacuation to France since the outbreak began, the first being a French nurse who was successfully treated in September.

 

 

(Machine translation)

France hosts a confirmed Ebola cases after medical evacuation

November 2, 2014

The French authorities have agreed to respond positively to the request of the World Health Organization (WHO) and welcome in France a person employed by an agency of the United Nations and victim of Ebola virus.

This person, who works in Sierra Leone in the fight against Ebola has been medicalized and secure a medical evacuation by special plane. The entire circuit support was secured from the off Freetown and the plane ride to the hospital in isolation in high-security room dedicated to the Army Instruction Bégin (St. Hospital mended), where she receives medical attention.

There are no other confirmed cases of Ebola in the area.

Marisol Touraine, Minister of Social Affairs, Health and Women's Rights, said that France is fully committed to the fight against the terrible epidemic of Ebola strikes the West Africa and takes its international commitments taken medical care for humanitarian workers mobilized by non-governmental organizations and UN agencies to fight the virus in affected countries.

WHO Issues Ebola Home Care Advice For Sierra Leone

# 9187

 

Given the need to isolate patients in order to reduce the spread of the Ebola virus, the news on Saturday that due to badly overburdened Ebola treatment centers - Sierra Leone’s Ebola Battle Shifts To Facilitating Home Care - is considered to be a major (although hopefully, temporary) setback.

 

While more assets are being sent to the region, the number of patients continues to rise faster than beds can be set up and staffed, which has led today to the  World Health Organization issuing a statement  regarding the home care of Ebola cases.

 

The ramifications of this are far from certain, but the CDC’s MMWR report Estimating the Future Number of Cases in the Ebola Epidemic — Liberia and Sierra Leone, 2014–2015 offered up a couple of hypothetical's.

 

In a hypothetical scenario, the epidemic begins to decrease and eventually end if approximately 70% of persons with Ebola are in medical care facilities or Ebola treatment units (ETUs) or, when these settings are at capacity, in a non-ETU setting such that there is a reduced risk for disease transmission (including safe burial when needed).

In another hypothetical scenario, every 30-day delay in increasing the percentage of patients in ETUs to 70% was associated with an approximate tripling in the number of daily cases that occur at the peak of the epidemic (however, the epidemic still eventually ends).

 

The goal of treating 70% of persons with Ebola in Sierra Leone in medical care facilities or (ETUs), at least for now, seems a distant one.

 

This update was emailed out by the WHO earlier today.

 

Staying safe : advice for households with Ebola virus disease in Sierra Leone

Freetown – 11 October 2014 - The Ebola virus disease outbreak in Sierra Leone is continuing to accelerate with a total of 2950 cases reported by October 8, and hundreds of new infections identified each week. With so many critically ill people to care for, treatment centres are currently overwhelmed and struggling to meet demand.

The goal shared by the Government of Sierra Leone and partners working to overcome Ebola is to increase the number of beds in Ebola treatment units as rapidly but also as safely as possible. This takes time as facilities must be constructed or redesigned to reduce the risk of health care worker infection and increase patient safety. Already 123 health care workers have developed Ebola virus disease and, tragically, 97 of them have died.

To shorten waiting times and provide care closer to home, community Ebola care units are now being put in place in the communities most heavily affected. These have an average of eight beds per centre and are staffed by health care workers and members of the community trained in infection control. They give Ebola care such as oral rehydration salts and medicines to relieve symptoms and treat other common causes of fever such as malaria. Current plans for building Ebola care units will add an extra 1000 beds for people ill with Ebola virus disease.

Anyone with Ebola virus disease needs access to good care as quickly as possible. However, while waiting for the ambulance or for a bed to be free in the nearest treatment unit, it is essential that family members and others caring for the sick person understand how to protect themselves from infection.

To enable household members to stay safe while waiting, “interim recommendations for protection of households” have been developed and approved by the Sierra Leone Emergency Operations Committee (EOC)

In summary these state that:

• Taking care of the patient suspected to have EVD at home is NOT recommended; all efforts should be made to safely transport patients to an appropriate Ebola care facility.
• To reduce risk of infection of other family members, the following general recommendations should be followed:

1. The patient should be asked to restrict movement to one room or area in the house and should avoid leaving it, if possible.
2. Where possible, the patient should be asked to use one toilet that other household members do not use. If a separate toilet is not available, the patient can use a separate waste bucket, followed by proper decontamination with strong chlorine solution. Avoid direct contact with other family members.
3. If care must be given to the patient, only one family member should be designated to provide the care.
4. Caregivers should wear gloves or use towels soaked in weak chlorine solution whenever they touch the patient, personal items belonging to the patient (e.g., clothing, bedding, eating and drinking utensils,  mobile phones, etc.) or their body fluids (e.g., vomit, stool, urine, etc.).
5. Caregivers should avoid contact with the patient’s body fluids by staying behind or beside the patient while giving care, and never facing the patient.
6. Hands should be washed very well with soap and water or weak chlorine solution before and after entering the patient’s room/area and after removing gloves.
7. A mask or a dry towel wrapped around the face can be used to protect the nose and mouth when entering the patient’s room/area.

Sierra Leone’s Ebola Battle Shifts To Facilitating Home Care

 

# 9179

 

In some of the bleaker flu pandemic scenarios that floated around during the middle of the last decade – with 30% (or more) of the population expected to fall ill with a comparable-to-1918  flu – at some point hospitals would be overrun, healthcare worker infections (and defections) would degrade their ability to provide services, and 90% of those infected would end up being treated in their homes by family and friends (see Alabama Pandemic Drill & Home Alone).

 

This graphic is from the State of Florida Pandemic plan

With roughly 50,000 hospital beds in the State of Florida – 80%-90% of which are occupied at any given time - finding a way to treat an additional 640,000 cases during a pandemic would be an extreme challenge.  But at least in the United States, with more than 1 million hospital beds, there is a fair amount of surge capacity.

 

In Sierra Leone, where healthcare facilities and community resilience were already badly degraded before the epidemic began, that tipping point appears to have already been reached as the official (albeit, likely badly underestimated ) case count nears 3,000 (see WHO Situation report - 10 October 2014).  

 

Yesterday, in what has been described as an admission of `defeat’ (see NYTs Officials Admit a ‘Defeat’ by Ebola in Sierra Leone), health officials there have approved plans to assist families in treating patients at home. 

 

While work is still being done to increase the number of hospital beds and treatment centers in Sierra Leone – until that can be done – there is little else that health providers can do at this point.  Hundreds of people have already been turned away from over crowded treatment facilities, and their option of last resort – treatment at home by family and friends – is already a reality for many.

 

After months of extolling the advantages of seeking early, professional treatment – in part to save lives, and in part to isolate infectious patients and lower the community transmission rate – the number of people seeking treatment has completely overwhelmed their limited ability to deliver care.  

 

The plan now is to distribute gloves, rehydrating solution, and pain killers to hundreds of Ebola stricken households, and hope that additional aid will arrive in time to prevent a massive spike in deaths, and new cases in the community. 

 

For more details, we turn to Adam Nossiter’s report from the NYTs.

 

Officials Admit a ‘Defeat’ by Ebola in Sierra Leone

FREETOWN, Sierra Leone — Acknowledging a major “defeat” in the fight against Ebola, international health officials battling the epidemic in Sierra Leone approved plans on Friday to help families tend to patients at home, recognizing that they are overwhelmed and have little chance of getting enough treatment beds in place quickly to meet the surging need.

(Continue . . . )

 

As the collapse of the healthcare systems in Liberia, Sierra Leone, and Guinea proceed, getting routine or emergency medical care for non-Ebola conditions is becoming all but impossible.  Collateral damage – from hunger, violence, and numerous untreated non-Ebola health concerns – threaten to claim nearly as many lives in the region as the disease itself.

A genuine concern is, as this epidemic spirals out of control, that Sierra Leone’s capitulation will be repeated in Liberia and Guinea.  And if the virus were to spread substantially beyond these three countries, that other healthcare dominos could fall.

 

While we seem to be overly focused on few errant, scattered, cases showing up in Texas, or Madrid . . .  the real battleground against this virus lies in West Africa, and that is where the most focus must remain. 

 

For now – while it may not be perfect, or pretty – I’m confident that the public health response in most developed nations can prevent large outbreaks of the disease.  That said, I fully expect to see ongoing introductions of the virus from infected travelers, and the possibility of seeing small clusters of locally acquired disease cannot be ruled out. 

But should the world fail to stop this virus in West Africa – and relatively soon – that dynamic could easily change, with difficult to predict, but potentially dire consequences for other regions of the world.

Sierra Leone Declares State Of Public Emergency Over Ebola

 

# 8896

 

 

 

In a statement released last night on the Ebola crisis, Sierra Leone’s President Ernest Bai Koroma stated  `. . .  the disease is beyond the scope of any one country, or community to defeat. Its social, economic, psychological and security implications require scaling up measures at international, national, inter-agency and community levels.’

Noting that `Extra-ordinary challenges require extra-ordinary measures’, President Koroma officially declared a State of Public Emergency last night – expected to last  at least 60 to 90 days.  In his statement he outlined the following steps to be taken to combat the Ebola outbreak.

 

We are launching a National Response Plan to inaugurate Phase Two of our fight against the disease. I also hereby establish a Presidential Task Force on Ebola which I will chair to champion the implementation of the following:

• All epicenters of the disease will be quarantined;
• The police and the military will give support to health officers and NGOs to do their work unhindered and restrict movements to and from epicenters;
• Localities and homes where the disease is identified will be quarantined until cleared by medical teams;
• Public meetings and gatherings will be restricted with the exception of essential meetings related to Ebola sensitization and education;
• Active surveillance and house-to-house searches shall be conducted to trace and quarantine Ebola victims and suspects;
• Parliament is recalled to promote MPs leadership at constituency levels;
• Paramount chiefs are required to establish bye-laws that would complement other efforts to deal with the Ebola outbreak;
• Mayors, chairmen of councils and councilors are hereby required to support Ebola control measures in their local government areas;
• All deaths must be reported authorities before burial;
• New protocols for arriving and departing passengers have been instituted at the Lungi International Airport;
• Cancellation of all foreign trips by ministers and other government officials except absolutely essential engagements.

You can read the entire Presidential Statement at the link below:

 

Address to the Nation on the Ebola Outbreak By His Excellency The President Dr. Ernest Bai Koroma July 30, 2014