Given yet another, previously publicly denied ebola outbreak in Nigeria, and the subsequent reasonable flight of the CDC and WHO workers from the affected regions, I have analyzed the changes to the WHO Ebola FAQ subsite between July and August 2014, using the Wayback machine. The changes are underlined below.
In short, finally the WHO have updated it with some sound advice after months of misinformation, but in my opionion, they are not thorough enough.
Consequently, I have written this semi-public letter to them. I wonder if it will help to save some lives.
I am happy that you are introducing changes to the FAQ guidelines posted here, e.g.:
"This happens because they [version in July:
[Added in August:]
In addition, it is important to ensure safe processing of laboratory samples from suspected or confirmed patients with EDV and safe handling of dead bodies or human remains for post-mortem examination and burial preparation. "
However, some advice is wrong, or still missing.
Very wrong: "If the individual has not developed symptoms (see FAQ #4), they cannot transmit EVD to those around them." "Although the risk to fellow travellers in such a situation is very low..."
Why? Many patients are asymptomatic, and also Ebola does not result in increased temperature readings.
There were cases in Liberia where just taking a taxi with one Ebola-infected patient caused deaths from Ebola of ALL the passangers. See such reports below.
"Transmission requires direct contact with blood, secretions, organs or other body fluids of infected living or dead persons or animal"
Again, no. Also hugging, touching, etc. See the WHO worker case, the British nurse, or many other ones.
Now, about the missing advice.
I want to draw your attention to the likely overlooked vectors of Ebola contagion: the asymptomatic patients, both before and after the mandated 21 quarantine period. Simple changes in epidemiological procedures, without any material investments, could close these gaps.
On my non-specialist and, granted, very partisan, blog (http://futurepresent-past.blogspot.com/?q=ebola) I have been collecting snippets from the local newspapers, which mention the measures that the local doctors, real heroes I hasten to add, have been unsuccessfuly employing to protect themselves.
As we all know these WHO and CDC mandated measures and procedures proved grossly inadequate. Of particular importance is the humane habit of public hugging the ebola survivors before they are released to their communities.
Dr. Khan: Indeed yes, they no longer have Ebola and in fact as a matter of fact these are people *I embrace myself on the day of discharge* because don’t forget the stigma about Ebola with some people you have to give them certificates so that by the time they return to their villages people will understand that they are no more suffering from the disease and they are free to interact with the population.
Source: Politico SL interview, URL below
The other infected doctors and nurses, even the British one, did the same.
Using the precautionary principle, please consider these likely yet hidden vectors in your WHO medical advice, so that additional CDC or WHO or local workers do not need to be evacuated and hundreds of lives of doctors, nurses and Africans be saved.
Here is my key post from some weeks ago already, with this and other salient quotes from the interviews with front-line teams:
Please excuse its harsh tone about the previous WHO ebola guidelines and other general musings.
I admire your work in the field and I wish you all the best in your fight for the lives of so many of us.
Now, here's WHO's FAQ with changes.
Frequently asked questions on Ebola virus disease
1. What is Ebola virus disease?
Ebola virus disease (formerly known as Ebola haemorrhagic fever) is a severe, often fatal illness, with a death rate of up to 90%. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees).
Ebola first appeared in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo, and the other in a remote area of Sudan.
The origin of the virus is unknown but fruit bats (Pteropodidae) are considered the likely host of the Ebola virus, based on available evidence.
2. How do people become infected with the virus?
Infection occurs from direct contact
(through broken skin or mucous
membranes ) with the blood, or other bodily
fluids or secretions (stool, urine, saliva, semen) of infected people.
Infection can also occur if broken skin or mucous membranes of a healthy person
come into contact with environments that have become contaminated with an Ebola
patient’s infectious fluids such as soiled clothing, bed linen, or used
Burial ceremonies in which mourners have direct contact with the body of the deceased person
also play a role in the transmission
of Ebola. Persons who have died of Ebola must be handled using strong
protective clothing and gloves , and be buried
People are infectious as long as their blood and secretions contain the virus. For this reason, infected patients receive close monitoring from medical professionals and receive laboratory tests to ensure the virus is no longer circulating in their systems before they return home. When the medical professionals determine it is okay for the patient to return home, they are no longer infectious and cannot infect anyone else in their communities. Men who have recovered from the illness can still spread the virus to their partner through their semen for up to 7 weeks after recovery. For this reason, it is important for men to avoid sexual intercourse for at least 7 weeks after recovery or to wear condoms if having sexual intercourse during 7 weeks after recovery.
3. Who is most at risk?
During an outbreak, those at higher risk of infection are:
- health workers;
- family members or others in close contact with infected people;
- mourners who have direct
contact with the bodies of the deceased as part of burial ceremonies
; and hunters in the rain forest who come into contact with dead animals found lying in the forest.
More research is needed to understand if some groups, such as immuno-compromised people or those with other underlying health conditions, are more susceptible than others to contracting the virus.
Exposure to the virus can be controlled through the use of protective measures in clinics and hospitals, at community gatherings, or at home.
4. What are typical signs and symptoms of infection?
Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
Laboratory findings include low white blood cell and platelet counts, and elevated liver enzymes.
The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.
Ebola virus disease infections can only be confirmed through laboratory testing.
5. When should someone seek medical care?
If a person has been in an area known to have Ebola virus disease or in contact with a person known or suspected to have Ebola and they begin to have symptoms, they should seek medical care immediately.
Any cases of persons who are suspected to have the disease should be reported to the nearest health unit without delay. Prompt medical care is essential to improving the rate of survival from the disease. It is also important to control spread of the disease and infection control procedures need to be started immediately.
6. What is the treatment?
Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease.
Some patients will recover with the appropriate medical care.
To help control further spread of the virus, people that are suspected or confirmed to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions.
7. What can I do? Can
Currently there is no licensed vaccine for Ebola virus disease
Several vaccines are being tested, but none are available for
clinical use right now.
Ways to prevent infection and transmission
While initial cases of Ebola virus disease are contracted by handling infected animals or carcasses, secondary cases occur by direct contact with the bodily fluids of an ill person, either through unsafe case management or unsafe burial practices. During this outbreak, most of the disease has spread through human-to-human transmission. Several steps can be taken to help in preventing infection and limiting or stopping transmission.
- Understand the nature of the disease, how it is transmitted, and how to prevent it from spreading further. (For additional information, please see the previous questions about Ebola virus disease in this FAQ.)
- Listen to and follow directives issued by your country’s respective Ministry of Health.
- If you suspect someone close to you or in your community of having Ebola virus disease, encourage and support them in seeking appropriate medical treatment in a care facility.
- If you choose to care for an ill person in your home, notify public health officials of your intentions so they can train you and provide appropriate gloves and personal protective equipment (PPE), as well as instructions as a reminder on how to properly care for the patient, protect yourself and your family, and properly dispose of the PPE after use.
- When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, or touching his/her surroundings.
- People who have died from Ebola
should only be handled using appropriate protective equipment and should
be buried immediately
Additionally, individuals should reduce contact with high-risk infected animals (i.e. fruit bats, monkeys or apes) in the affected rainforest areas. If you suspect an animal is infected, do not handle it. Animal products (blood and meat) should be thoroughly cooked before eating.
8. What about health workers? How
they protect themselves from the high risk of
caring for sick patients?
Health workers treating patients with suspected or confirmed illness are at higher risk of infection than other groups.
- In addition to standard health
Theyshould use personal protection equipment such as individual gowns, gloves, masks andgoggles or face shields . They should not reuse protective equipment or clothing unless they have been properly disinfected. They should change gloves between caring for each patient suspected of having Ebola.
medical doctors, nurses and others to infection should be carried out under strict, safe
conditions. Infected patients should be kept separate from other patients and healthy people, as much as possible.
9. What about rumours that some foods can prevent or treat the infection?
WHO strongly recommends that people seek credible health advice about Ebola virus disease from their public health authority.
While there is no specific drug against Ebola, the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures. The infection can be controlled through recommended protective measures.
10. How does WHO protect health during outbreaks?
WHO provides technical advice to countries and communities to prepare for and respond to Ebola outbreaks.
WHO actions include:
- disease surveillance and information-sharing across regions to watch for outbreaks;
- technical assistance to investigate and contain health threats when they occur – such as on-site help to identify sick people and track disease patterns;
- advice on prevention and treatment options;
- deployments of experts and the distribution of health supplies (such as personal protection gear for health workers) when they are requested by the country;
- communications to raise awareness of the nature of the disease and protective health measures to control transmission of the virus; and
- activation of regional and global networks of experts to provide assistance, if requested, and mitigate potential international health effects and disruptions of travel and trade.
11. During an outbreak, numbers of cases reported by health officials can go up and down? Why?
During an Ebola outbreak, the affected country’s public health authority reports its disease case numbers and deaths. Figures can change daily. Case numbers reflect both suspected cases and laboratory-confirmed cases of Ebola. Sometimes numbers of suspected and confirmed cases are reported together. Sometimes they are reported separately. Thus, numbers can shift between suspected and confirmed cases.
Analyzing case data trends, over time, and with additional information, is generally more helpful to assess the public health situation and determine the appropriate response.
12. Is it safe to travel during an outbreak? What is WHO’s travel advice?
During an outbreak, WHO reviews the public health situation regularly
, and recommends
any travel or trade restrictions if necessary .
WHO’s general travel advice
- Travelers should avoid all contact with infected patients.
- Health workers traveling to affected areas should strictly follow WHO-recommended infection control guidance.
- Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness.
- Clinicians caring for travelers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease.
I also tried to comment the "ebola is not scary" article on NYT, with a quote from the front-line medics, but it was rejected, even without any URL.
I wonder why. Here it is what I wrote:
Date: 4 April 2014
"It was like a wave, coming with a huge team of cheering squad, JFK General Administrator Dr. Wannie Mae-Scott McDonald was yelling in the corridors of the JFK at nurses who wore protective gears and face mask to deal with patients. The nurses are dealing with patients whose Ebola status, they don’t know, the JFK Administration until today has done nothing to provide protective wears for nurses and hospital workers but is blasting nurses for wear protective gloves and suits."
Now, who was right? "Educated" doctors or the nurses? The doctors who claimed "you are safe" are dead themselves. See my site with their names and what they had been told by the WHO and CDC, poor souls.