Ebola-infected doctor is case No. 2 in Nigeria

Man who was treated died; 2nd ill American off to U.S.

Nigeria health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)

Nigeria health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria, Monday, Aug. 4, 2014. Nigerian authorities on Monday confirmed a second case of Ebola in Africa's most populous country, an alarming setback as officials across the region battle to stop the spread of a disease that has killed more than 700 people. (AP Photo/Sunday Alamba)

Tuesday, August 5, 2014

ABUJA, Nigeria -- The doctor who treated a man who flew to Nigeria and died of Ebola now has contracted the disease, authorities said Monday, presenting a dire challenge to Africa's most populous nation as the regional toll for the outbreak grew to 887 dead.

As Nigerian health authorities rushed to quarantine others who had been exposed to the doctor, a special plane left Liberia to evacuate the second American missionary who fell ill with Ebola. Nancy Writebol, 59, is expected to arrive in Atlanta today, where she will be treated at a special isolation ward.

The second confirmed case in Nigeria is a doctor who treated Patrick Sawyer, the Liberian-American man who died July 25, days after arriving in Nigeria from Liberia, Nigerian Health Minister Onyebuchi Chukwu said.

Three others who also treated Sawyer now show symptoms of Ebola, and their test results are pending, he said. Authorities are trying to trace and quarantine others in Lagos, sub-Saharan Africa's largest city of 21 million people.

"This cluster of cases in Lagos, Nigeria, is very concerning," said Dr. Tom Frieden, director of the U.S. Centers for Disease Controls and Prevention, which is dispatching 50 experienced disease control specialists to West Africa.

"It shows what happens if meticulous infection control, contact tracing and proper isolation of patients with suspected Ebola is not done. Stopping the spread in Lagos will be difficult, but it can be done," he said.

In Liberia, Writebol has received the second dose of an experimental treatment, according to the aid organization SIM USA, the Charlotte, N.C.-based group that she works for in Africa.

Writebol has been in isolation at her home in Liberia since she was diagnosed last month. She's now walking with assistance and has regained her appetite, said Bruce Johnson, president of SIM USA.

"Her husband, David, told me Sunday her appetite has improved," Johnson said Monday in a statement. "She requested one of her favorite dishes -- Liberian potato soup -- and coffee. We are so grateful and encouraged to hear that Nancy's condition remains stable and that she will be with us soon."

Johnson was hesitant to credit the treatment for her improvement. Dr. Kert Brantly's condition has also improved.

"Ebola is a tricky virus, and one day you can be up and the next day down. One day is not indicative of the outcome," he said. But "we're grateful this medicine was available."

The experimental treatment is made by Mapp Biopharmaceutical of San Diego, with funding from the government. The treatment is aimed at boosting the immune system's efforts to fight off the virus. It is made from antibodies produced by lab animals exposed to parts of the Ebola virus.

There is no vaccine or specific treatment for Ebola, but several are under development. Brantly, who works for the international relief group Samaritan's Purse, also received a unit of blood from a 14-year-old boy, an Ebola survivor, who had been under his care, according to the group.

A Liberian government official has confirmed that a medical evacuation team is scheduled to fly back to the United States early today with Writebol. Atlanta's Emory University Hospital said last week that she would be treated there, along with Brantly.

The process of transferring Writebol will be similar to that used for Brantly, said Alexander Isakov, an emergency physician with Emory University Hospital who was involved in Brantly's move to the hospital.

During the first trip, "we tried to limit the number of health-care workers who came into contact with the patient," Isakov said, explaining that only a single paramedic was allowed to touch the patient.

The health-care workers wore special protective suits with two functions, he said, providing a barrier against bodily fluids and providing a powered respirator to filter the air.

Virus leaves 887 dead

In other news, the World Health Organization announced Monday that the death toll has increased from 729 to 887 deaths in Guinea, Sierra Leone, Liberia and Nigeria.

Cases in Liberia jumped from 156 to 255, WHO said, as the government ordered that all Ebola victims must now be cremated because of rising opposition to burials in neighborhoods around the capital. Over the weekend, police were called in amid a standoff over whether health authorities could bury nearly two dozen victims in a neighborhood on the outskirts of the capital, Monrovia.

Sierra Leone marked a national stay-at-home day Monday in an effort to halt the disease's spread. A documentary film of the first outbreak of the Ebola disease in Congo was being shown intermittently throughout the day by the national broadcaster.

The emergence of a second case in Nigeria raises serious concerns about the infection control practices there, and also raises the specter that more cases could emerge. It can take up to 21 days after exposure to the virus for symptoms to appear. They include fever, sore throat, muscle pains and headaches. Often nausea, throwing up and diarrhea follow, along with severe internal and external bleeding in advanced stages of the disease.

"This fits exactly with the pattern that we've seen in the past. Either someone gets sick and infects their relatives or goes to a hospital and health workers get sick," said Gregory Hartl, World Health Organization spokesman in Geneva. "It's extremely unfortunate, but it's not unexpected. This was a sick man getting off a plane and unfortunately no one knew he had Ebola."

Doctors and other health workers on the front lines of the Ebola crisis have been among the most vulnerable to infection as they are in direct physical contact with patients. The disease is not airborne, and only transmitted through contact with bodily fluids such as saliva, blood, sweat or feces.

Sawyer, who was traveling to Nigeria on business, became ill while aboard a flight, and Nigerian authorities immediately took him into isolation upon arrival in Lagos. They did not quarantine his fellow passengers and have insisted that the risk of additional cases was minimal.

Nigerian authorities said about 70 people are under surveillance and that they hoped to have eight people in quarantine by the end of Monday in an isolation ward in Lagos.

Tracking down all the people who came into contact with Sawyer and his caregivers could prove difficult at this late stage, said Ben Neuman, a virologist and Ebola expert at Britain's University of Reading.

"Contact tracing is essential but it's very hard to get enough people to do that," he said. "For the average case, you want to look back and catch the 20 to 30 people they had closest contact with and that takes a lot of effort and legwork. ... The most important thing now is to do the contact tracing and quarantine any contacts who may be symptomatic."

With dozens of West African doctors and medical staff among the dead, U.S. and foreign experts are preparing to flood into West Africa to help fight the deadliest Ebola outbreak on record. More than 60 local medical staff, about 8 percent of the fatalities, have died in Sierra Leone, Liberia and Guinea.

Ebola expert G. Richards Olds, dean of medicine at the University of California, Riverside, compared local health care workers there to doctors who donned beaked masks, leather boots and long, waxed gowns to fight the plague in Medieval Europe.

"This is one of the few cases in modern times of true health care heroism," Olds said. "They're taking some significant risks, as you can see, to help others."

The protective gear required to confront the disease consists of rubber boots, medical scrubs, two pairs of rubber gloves, a waterproof, airtight yellow suit, a rubber apron, a rubber bib, a rubber hood and a mask. It is a suffocatingly hot outfit in West Africa's tropical heat.

There's a complex five-minute procedure to put the gear on, take it off and determine whether gowns can be reused. One mistake can be fatal. In West African public hospitals, some staff members are working 12-hour shifts. Whether it's heat (the temperature inside suits can rise to more than 100 degrees Fahrenheit), long hours, exhaustion, lack of staff or lack of training, fatal mistakes have been made.

Frieden, the CDC director, said Sunday that the U.S. plans to send 50 public health officials to West Africa in the next 30 days to help fight the disease. The World Health Organization said Friday it planned to fly hundreds more medical staff into West Africa to stem the spread of the disease and trace those who had contact with infected people.

U.S. airports on alert

Federal agents at U.S. airports are watching travelers from Africa for flu-like symptoms that could be tied to the recent Ebola outbreak, as delegations from some 50 countries arrive in the nation's capital for a leadership summit this week.

Border Patrol agents at Washington's Dulles International and New York's JFK airports in particular have been told to ask travelers about possible exposure to the virus and to be on the lookout for anyone with fever, headache, achiness, sore throat, diarrhea, throwing up, stomach pain, rash or red eyes. Andrews Air Force Base in Maryland, which will receive several African heads of state, is screening passengers, too, and U.S. Secret Service agents in charge of security for the three-day summit have been briefed on what to look for and how to respond, officials said Monday.

If a passenger is suspected of carrying the deadly virus, they would be quarantined immediately and evaluated by medical personnel, according to the Centers for Disease Control and Prevention, which provided the additional training to local airports.

Health officials say the threat to Americans remains relatively small, even with the uptick in travel this week between Africa and the United States. In the past decade, five people have entered the U.S. known to have a viral hemorrhagic fever, including a case last March of a Minnesota man diagnosed with Lassa Fever after traveling to West Africa.

CDC spokesman Barbara Reynolds said that in all five instances, U.S. officials were able to contain the illness.

A vaccine against Ebola has been successfully tested on monkeys, and there is hope it could become available as early as next July, Dr. Anthony Fauci of the National Institutes of Health told CBS This Morning on Monday.

A man who recently visited West Africa and had a high fever and gastrointestinal symptoms was placed in isolation at a New York hospital on Monday and was being tested for possible Ebola but likely didn't have it, health officials said.

"Odds are, this is not Ebola," said Dr. Jeremy Boal, chief medical officer at Mount Sinai Health System in Manhattan. Boal said he expected a definitive answer about the man's condition within a day or two.

The man, who recently traveled to a country where Ebola has been reported, was ill when he arrived at Mount Sinai Medical Center early Monday.

The city's Health Department echoed what Mount Sinai hospital officials said, that "the patient is unlikely to have Ebola." It said more testing was being done for common causes of illness and to definitively exclude Ebola.

Information for this article was contributed by Bashir Adigun, Jonathan Paye-Layleh, Maria Cheng, Krista Larson, Clarence Roy-Macaulay, Maram Mazen, Bill Barrow, Roxana Hegeman, Anne Flaherty, Frank Eltman, Vanessa Alvarez, Jonathan Lemire and Mike Stobbe of The Associated Press; by Robyn Dixon and Lauren Raab of the Los Angeles Times; and by Marie French, Michael Sasso, Silas Gbandia, Pauline Bax, Andres R. Martinez, David Lerman, Greg Giroux and Phil Mattingly of Bloomberg News.

A Section on 08/05/2014