Ebola outbreak: the deadliest in history

One of the largest Ebola outbreaks in history shows no signs of slowing — and the Trump administration barred US health experts who want to help at the outbreak’s epicenter in the Democratic Republic of Congo from traveling there.

Centers for Disease Control and Prevention officials were working in Beni, the city that’s ground zero for the outbreak in eastern DRC, for a few days in late August and early September. Experts say that’s an unusually short period of time for infectious disease responses; CDC deployments usually last at least four weeks, and many run for several months.

Health officials in the Democratic Republic of the Congo have confirmed one case of Ebola in what appears to be the first new outbreak of the deadly virus since the massive epidemic that hit West Africa in 2014-’15.

According to reports, nine people in a very remote part of the country recently fell ill with a hemorrhagic fever. The World Health Organization reports three have died, but only one so far has tested positive for Ebola.

It took a major Ebola epidemic that led to more than 11,000 deaths, but we now finally have a successful Ebola vaccine candidate in development. If approved, the vaccine would vastly reduce the likelihood of ever seeing another major Ebola outbreak.

More than a year ago, researchers published striking preliminary results from a large trial on a vaccine called rVSV-ZEBOV in the Lancet. They showed that everyone who got the shot immediately after contact with an Ebola victim didn’t get the virus.

This week, an annual meeting of the world’s most powerful global health players is taking place in Geneva. It’s called the World Health Assembly, and ministers of health, heads of state, and civil society leaders are gathered at the United Nations’ Palace of Nations to set health priorities and policies for the entire world.

At the moment, they’re focused on whether we’re prepared for future deadly disease outbreaks — a question that’s particularly urgent in the wake of the Ebola epidemic in West Africa. More than a year and 25,000 cases later, it’s clear the World Health Organization and the countries involved weren’t ready for that crisis. The world took too long to act, leading to avoidable suffering and long-term devastation.

Throughout the recent Ebola outbreak, the World Health Organization has been universally admonished for being too slow to respond to the crisis. And one of the key reasons cited for the delay is that the WHO is underfunded, understaffed, and underpowered.

But as this chart from the Institute for Health Metrics and Evaluation shows, that’s only part of the story. Though funding for the WHO has leveled off in recent years, that only came after more than 20 years of massive increases. Overall funding for development assistance for health also increased dramatically in the period.

We journalists often rush from one story to the next with whiplash-inducing speed — and sometimes without time to reflect. On Monday, however, a few of us paused. Just as Liberia was finally declared Ebola-free, I appeared on a panel organized by the One Campaign alongside colleagues from NPR, the Washington Post, Ebola Deeply, and the Centers for Disease Control and Prevention. Together, we looked back at how the media dealt with the epidemic. What could we have done better? What lessons did we learn? What were we most proud of? And where did our coverage go off the rails?

Since this outbreak won’t be the last — and we can and should do a better job reporting on the next one — I wanted to share some thoughts.

Duncan died nine days later. At the time, what the public knew about him mostly focused on how he contracted the virus, whom he may have infected, whether his case would spark an outbreak (it didn’t), and that he was America’s first Ebola diagnosis and death.

What we didn’t hear about, however, was the tragic love story behind his visit to America: Duncan was here to meet with Louise Troh, a Dallas nurse, his longtime love, and the mother of one of his children, a 13-year-old son named Karsiah. The couple had been planning for Duncan to come to the US since 2013, but it took months for them to secure a visa and raise enough funds for his first trip here.

In a new memoir, My Spirit Took You In, Troh writes a personal tale of immigrating from Liberia to the US, leaving Duncan behind in Liberia, how Ebola eventually tore them apart after their brief reunion, and the quarantines and media circus that ensued.

A must-read roundup by Norimitsu Onishi in the New York Times on the impact of the American Ebola response included a fact that perfectly sums up the wrongness of our approach to global health:

So: the United States built 11 treatment units in Liberia, drawing from the $1.4 billion allotted for the Ebola mission. Eighty percent of those units have never seen a single Ebola patient.

When his work in Nigeria was done, the 29-year-old headed to Liberia to volunteer. By early March this year, the outbreak there seemed under control. “The last Ebola patient has been discharged,” Umenze wrote in an email. “Children are back at school and life is gradually returning to normal.”

Then just a few days later, on March 20, came a setback. Liberia confirmed a new case. The news was devastating: the country had been on day 27 of a 42-day countdown that would allow it to declare itself virus-free. But now the clock had to be turned back again.

Here’s a reminder that the Ebola epidemic isn’t over yet: another American health-care worker who contracted the virus while volunteering in Sierra Leone was just flown home for treatment.

The patient — who has not been named — arrived in the US by a private-charter medevac, getting to the NIH Clinical Center in Maryland after 4 am Friday. The patient will be the second to be treated for Ebola in the hospital’s high-level isolation facility.

As if being stricken by the most deadly virus known to man weren’t enough, now, it seems, West Africa is on alert for outbreaks of vaccine-preventable diseases including measles, whooping cough, and tuberculosis.

In a new study in the journal Science, researchers focused on measles — the most contagious virus recorded — and applied statistical models to quantify the likelihood of an epidemic in the three countries worst hit by Ebola, Liberia, Sierra Leone, and Guinea.

The Liberan government will release the last known Ebola patient today, Front Page Africa reports, capping off a nearly yearlong battle with the vicious disease.

The patient — a 58-year-old English teacher named Beatrice Yardolo — had spent the last two weeks at a Chinese-run treatment center outside of Monrovia. After multiple tests, she was declared free of the virus.

On October 17, 2014, just as Ebola panic reached a fever pitch in America, President Obama did something unusual: he appointed Ron Klain as America’s first-ever “Ebola response coordinator” — a title that very quickly morphed into “Ebola czar.”

Nina Pham, the nurse who was the first person to ever contract Ebola in the United States last October, will be filing a law suit today against the hospital chain where she worked and got the virus.

In an exclusive interview with Dallas Morning News, Pham told the paper that she’s still recovering from the disease, suffering with aches and pains, insomnia, hair loss, and fatigue. The nurse, an employee of Texas Health Presbyterian Hospital in Dallas, says that the hospital lacked preparedness and training in dealing with the disease and committed what she alleges were violations of her privacy by sharing information about her condition.

Yesterday, I was on the phone with a Liberian man who survived the world’s worst Ebola epidemic. I asked him to rate his fear of the virus during the height of spread in his home city, Monrovia. When he knew little about the disease, he said, he was extremely fearful, even preemptively pulling his children out of their classes before schools across the country shutdown.

But as he learned more, his fears went away. “Ebola is simple,” he reasoned, calmly. “Obey the rules and you won’t get infected.”

In the wake of the world’s first Ebola epidemic, efforts to develop a new treatment for the deadly disease have faced fire for moving too slowly.

In a Guardian feature today, intrepid global health reporter Sarah Boseley explains exactly why the race to find an Ebola cure has looked more like a rambling lurch.

In this paragraph, the British journalist sums up what a team of scientists trying to organize a treatment trial with the experimental drug brincidofovir in West Africa were up against:

There’s finally good news on the ongoing struggle to stamp out the world’s worst Ebola outbreak: the number of new cases is falling quickly.

Fewer than 100 Ebola cases were discovered in West Africa last week: there were 30 in Guinea, four in Liberia, and 65 in Sierra Leone. The World Health Organization says the epidemic has entered its “second phase,” and that the global community can now focus on slowing transmission to get to the finish line.

You can see the downward trends in the three worst-affected countries from the most recent (January 25) WHO update:

There were 30 confirmed cases in the seven days before January 25 compared with 20 the week prior. “This is the first time this year that case incidence has increased in Guinea from week-to-week,” the WHO said.

“No donors have attached clear timelines to their contributions for delivery,” according to a statement on the One website. “The time lag between turning pledges into contractual commitments and then converted into fully paid out disbursements is, in many cases, too long.”

Based on data from the Office for the Coordination of Humanitarian Affairs (OCHA), the UN, and the World Bank, the analysis shows that there continue to be sizable gaps between money pledged and money distributed.

But progress is being made, albeit slowly. The last time Vox checked in on One’s tracker in October, only Japan and Australia had disbursed more than a quarter of the funding they committed.

Now, the US, UK, Japan, France, Canada, Netherlands, Australia, and Italy have done so, though some of these and many other countries still haven’t reached the half-way mark.

A health-care worker arriving from Ebola-stricken Sierra Leone in Glasgow was just diagnosed with the virus, according to Scotland’s National Health Service. Here are the details:

The unnamed patient will be transferred to a high-level isolation unit in London as soon as possible.

After the midterm elections, and the calming of the Ebola nurse debacle, our collective attention turned away from an epidemic that continues to burn in West Africa.

Just because politicians here stopped fighting over travel bans and quarantines doesn’t mean the Ebola virus has gone back into hiding among its animal hosts. There may be no new cases in the US. But the war against Ebola continues to rage in West Africa, particularly Sierra Leone. Here’s what you need to know about the Ebola epidemic today.

Sadly, Sierra Leone has struggled the most to get Ebola under control. According to the New York Times, “The number of new cases in Sierra Leone was above 600 in each of the three weeks leading up to Nov. 25, the most in any three-week period so far.” In the capital, Freetown, the number of cases quintupled in the last two months.

A Maryland doctor who was working amid the Ebola epidemic in Sierra Leone died of the disease on Monday at a Nebraska hospital.

On Saturday, Dr. Martin Salia — a Sierra Leone native — was flown back to the US for treatment at Nebraska Medical Center and arrived in critical condition, already experiencing kidney and respiratory failure. He was placed on life support, and given the experimental drug ZMapp and a plasma transfusion from the blood of an Ebola survivor.

Still, Dr. Salia died just after 4 a.m. Monday morning, leaving behind a wife and two sons.

Local newspapers are writing about the remarkable courage Dr. Salia had to be working in West Africa, which is currently battling the worst Ebola epidemic in history. His son, Maada Salia, said this to CBS Baltimore:

As an Ebola outbreak in West Africa turned into a global epidemic, public panic mounted with the rising death toll. The US only had a small and contained handful of cases, but it quickly became clear that facts about the virus could not calm people’s fears.

We saw calls for travel bans. We saw a volunteer nurse returning from West Africa get locked up in quarantine tent outside of a New Jersey hospital. We saw the forced resignation of a Kentucky teacher because parents were afraid that she might have Ebola after visiting Kenya in East Africa. (Kenya is about 5,000 miles away from the Ebola-affected region.) And we saw rage directed at a New York physician — who had been doing the good work of helping Ebola patients in Guinea — after it came to light that he had gone bowling in the city before coming down with the disease. In each of these cases, we lost our compassion and reason, and fear took hold of us.

Today, a new article in the New England Journal of Medicine looks at how public-health officials could have done better at communicating uncertainty during this crisis, perfectly encapsulating why fear mattered, and why it couldn’t be overcome with facts:

Beyond its inherent unpleasantness, fear is a risk in itself because it demands a response... Mandatory quarantines for Ebola aim to assuage fear but may pose greater public risk than no quarantine, if they make it too difficult for U.S. health care workers to provide aid in West Africa.My instinct is to tell people who fear Ebola how much more likely they are to be sickened by influenza or heart disease. If fears were guided by facts, such comparisons might help. But when we face an uncertain prospect that we deeply fear, we evince what Cass Sunstein calls “probability neglect”: we tend to conflate the horror of what might happen with the likelihood that it will. Unless we can prove there’s zero risk, the dreaded event feels exceedingly likely, and thus making probabilistic comparisons may not feel reassuring.The author of the article, Dr. Lisa Rosenbaum — a national correspondent for the journal — writes that over-reassurance by public-health authorities may have had the opposite of the desired effect: “The public suspects they’re insufficiently worried or insufficiently candid and becomes more frightened.”

This played out as the Centers for Disease Control and Prevention and Texas health officials projected a know-it-all cool while they were handling (and seen to be fumbling) the first-ever Ebola cases on US soil.

Perhaps they should have admitted that they were in uncharted territory, letting the public know that they were doing the worrying for them. Since people seem to be drawn to “confident projections of any sort,” another way the fear could have been better handled would be if public-health agents admitted how uncertain they were.

Rosenbaum also suggests that health officials could have quelled public fear by celebrating the “good nonevents,” or all the horrible things that never came to pass. For example, we focused on the fact that America’s “patient zero” — Thomas Duncan — infected two of the nurses who cared for him at the end of his life. But it seemed to escape our collective attention that he didn’t infect any of the people he was living with, including his fiancée, in the days before his hospitalization.

Same goes for Dr. Craig Spencer, of the now infamous New York bowling incident: no one he came into contact with prior to his hospitalization got sick, not even his fiancée.

Of course, hindsight is 20-20, and all of this seems clear as we appear to have passed through the worst of the Ebola situation here in the US. In future, the guardians of public health need to remember and apply these learnings to the next great global-health challenge.

We also need to remember that, while all the cases that stoked our fears are contained here and public attention seems to be drifting away, the epidemic continues to rage in West Africa, a crisis worthy of our attention and concern.

Learn more about this Ebola outbreak with our 13 things you need to know.

Facebook has been accused of subjecting its 1.2 billion users to all kinds of unsavory social engineering experiments. But sometimes, the media giant uses its powers for good. Starting today, a donation button will go live on the site where users can send money to one of three, hand-picked Ebola-relief charities.

The button will appear at the top of users’ news feeds, according to the news website Re/code. Facebookers can give to the American Red Cross, the International Medical Corps, or Save the Children — and share news of their do-gooding, perhaps prompting others to donate.

Read: What you need to know about the Ebola epidemic

In October, Facebook chief executive Mark Zuckerberg and his wife Priscilla Chan donated $25 million to support the Ebola response in West Africa.

The announcement about the donation came with news from charities that raising money for Ebola relief has been very difficult, and donations slow to trickle in.

The Obama administration has asked Congress to approve $6.18 billion in funding to fight Ebola. This is a huge increase from the $88 million the White House requested in September and the $750 million allocated from the Pentagon budget in October.

“It represents a real commitment by the US to combat Ebola in Africa and elsewhere if it travels,” said Dr. Howard Markel, a physician who researches epidemic responses at the University of Michigan.

The money is desperately needed, experts say, to fight what is still “persistent and widespread” Ebola transmission in the three most-affected West African countries. And it appears that’s where the bulk of the money would go.

This is what a breakdown of the funding request looks like:

Canada is a country built by and still composed mostly of immigrants. It’s a country that prides itself on being a good global citizen. It’s a country that lobbied against — and was economically scarred by — short-lived travel restrictions following the SARS outbreak of 2002-03.

Now, Canada is one of only two developed countries to issue a visa ban for people from Ebola-stricken West Africa — a wrong-headed decision that is xenophobic, bad science, and against international law.

Following Australia, the federal government’s department of citizenship and immigration announced last week that it would no longer grant travel visas to Canada for residents and citizens of Ebola-affected countries, including Guinea, Sierra Leone, and Liberia. It’s also halting the residency applications of folks from these countries. The restrictions don’t actually apply to Canadian travelers — but only to West Africans themselves.

Though the government is framing these moves as “new precautionary measures to protect the health and safety of Canadians,” there are at least five reasons why they are disgraceful and harmful to public health:

The decision to enact travel restrictions goes against the evidence and monolithic advice of public-health officials, who have roundly stated that travel restrictions don’t work and that they will drive travel underground and make Ebola cases more difficult to track.

As I have written previously, calls for travel restrictions are revived with every pandemic threat, most recently Ebola. They haven’t worked before, and everyone from the head of the World Health Organization to the head of the Centers for Disease Control and Prevention and the director of the National Institute of Allergy and Infectious Diseases have said they will only make this Ebola epidemic worse.

There’s a very clear problem with using travel bans to stop Ebola: it renders useless the two best methods we have for stopping the spread of the virus. Determined people will find ways to cross borders anyway, and if they don’t go through airports or they lie about where they came from, health officials can’t track their movements. And this is an important point because, to fight Ebola, we need to be able to follow up with the contacts of the infected. Getting aid and resources to the region to contain the disease at the source would also become more challenging with travel restrictions.