Several US states break with CDC and enact stricter ebola guidelines

Since the diagnosis of Craig Spencer with Ebola in New York last week, states around the US have introduced a flurry of new policies on how to monitor those returning from west Africa’s most affected countries.

That’s resulted in a patchwork of rules for those flying into the US from the Ebola-ravaged west African countries of Guinea, Liberia and Sierra Leone.

The Centers for Disease Control and Prevention (CDC) published new guidelines on Monday. But with ambitious governors mindful of public fear over Ebola, some states have enacted tighter restrictions.

New York & New Jersey

At a press conference, the governors of New York and New Jersey on Friday declared a mandatory quarantine for anyone arriving from Liberia, Sierra Leone or Guinea who had had contact with an Ebola sufferer. Just as the policy was introduced, a nurse, Kaci Hickox, landed at Newark airport in New Jersey. She ended up in isolation in a New Jersey hospital despite testing negative for Ebola, and published a scathing letter in the Dallas Morning News about her treatment on Saturday.

The efficacy of such a mandatory quarantine was criticised by the White House, the UN, public health experts, aid groups and civil liberties advocates.

Questions still remain over the specifics of the Ebola quarantine policy. The governors under pressure appeared to soften their stances on the hastily drafted policy in the days since it was introduced, even though both say they have not.

Anyone arriving at John F Kennedy airport in New York or Newark airport in New Jersey from the three countries will pass through three layers of screening that will determine who should be quarantined.

Travellers who arrive from one of the countries and have symptoms of the Ebola virus will be immediately transported to a designated hospital and placed in isolation, according to a fact sheet distributed by the office of Governor Andrew Cuomo of New York on Sunday.

Those who are asymptomatic but have had direct contact with an Ebola sufferer can carry out their three-week quarantine at home. Although, on Friday, Cuomo said high-risk travellers could be quarantined at a “government regulated facility”. The fact sheet said accommodations would be made for those without homes in New York.

On Monday, Governor Chris Christie of New Jersey also said asymptomatic travellers who had contact with Ebola sufferers could carry out their quarantines at their homes, wherever in the country that may be.

“If you are screened and you are asymptomatic, you can be allowed then to go to your home, travel to your home, whether it’s in New Jersey, New York or someplace else in the country and be quarantined for 21 days there,” he told reporters.

Under quarantine, health officials will make two unannounced visits each day to take the traveller’s temperature and check for symptoms. New York state said it will provide financial assistance to quarantined healthcare workers and adults whose employers will not compensate them while they are not allowed to work during this three-week period. It is not clear if this is the case for those quarantined in New Jersey.

Asymptomatic travellers who did not have direct contact with Ebola patients will be handled on a case-by-case basis, the fact sheet said.

Virginia & Maryland

On Monday, the governors of Virginia and Maryland announced that all travellers arriving from Guinea, Liberia and Sierra Leone will be actively monitored by public health officials.

Travellers arriving from those three countries at Dulles international airport, outside Washington DC in Virginia, already undergo screenings for the disease. Dulles is the third of five airports in the US through which passengers travelling from the region must enter.

The states’ new policies require airport screeners to provide local health departments with passengers’ contact information so officials can follow up with them about their health. Such passengers will be asked to record their temperature twice daily and report to local health officials for a 21-day period.

The policy says a traveller who develops an Ebola-like symptom, such as a fever, but does not test positive for the virus, may still be asked to quarantine for the remainder of their three-week incubation period.

Illinois

On Friday, the state’s health department issued a memo that calls for travellers with a high risk of exposure to the virus to be issued with a formal 21-day home quarantine order. The memo said the updated policy was to offer local health departments guidance on how to follow up with travellers who are screened for the disease upon arrival at Chicago’s O’Hare International, the fourth designated US airport for those coming from west Africa.

The state’s health department identifies “high risk” individuals as those who have had direct contact with the blood or body fluids of an Ebola sufferer or the body of someone who died from the virus. There is an exemption for healthcare workers who wore appropriate personal protective gear and had no known lapse of infection control protocol while treating patients. But those healthcare workers who did not wearing proper protective clothing, or were exposed to the virus via a needle or other injury, will be quarantined in their homes.

Georgia

On Monday, Georgia’s governor, Nathan Deal, updated the state’s monitoring policy for travellers returning from the most affected region of Africa, adding measures that go beyond what the CDC recommends. (Georgia is home to the fifth designated airport for west Africa arrivals: Hartsfield-Jackson International in Atlanta.)

Such passengers are placed in a quarantine station where officials take their temperatures and check for symptoms. If travellers show symptoms, they will be isolated immediately and transferred to a designated hospital for evaluation.

Asymptomatic travellers returning from the region are divided into three categories: high-risk, low-risk and medical personnel.

High-risk travellers, those known to have had direct exposure to the Ebola virus, will be subject to a 21-day quarantine at a designated isolation facility; low-risk travellers, those with no known exposure to the disease, must take their temperature and check for symptoms twice daily and report their status to a public health official once a day. Those who don’t comply with the daily reporting requirement will be tracked down and could be issued with a mandatory quarantine order.

Healthcare workers who have cared for Ebola patients will be monitored daily by public health officials either by video or in-home visits for a three-week period.

Florida

On Saturday, Florida’s Governor Rick Scott signed a strict executive order mandating twice-daily 21-day health monitoring by state health officials for people returning from Liberia, Sierra Leone and Guinea, regardless of whether the travellers show symptoms or not.

Travellers from these countries will face a risk assessment upon their arrival in Florida, as well as active monitoring by state health officials.

Scott said he decided to move ahead with the order when the CDC failed to respond to a request for more information on the risk levels posed by travellers returning from the region. Passengers cannot travel directly from west Africa to Florida.

Ebola: How Nigeria and Senegal stopped the disease ‘dead in its tracks'

It seemed like the nightmare scenario: Ebola had reached Africa’s biggest city, a chaotic and densely populated metropolis of slums and shantytowns where the virus threatened to spread to millions of people.
Health experts were terrified when Ebola struck Lagos in late July. They were deeply worried that it would be unstoppable in Nigeria, a rapidly urbanizing country of 170 million, far bigger than the nations where Ebola had begun. Their fears were heightened in August when the virus leaped another border and reached Senegal, another key West African country.

Yet today, in a remarkable display of how to beat the lethal virus, both Nigeria and Senegal have defeated their Ebola outbreaks. The World Health Organization announced on Friday that the outbreak was officially over in Senegal, and made the same declaration for Nigeria on Monday. In both countries, 42 days have passed since their last reported case – the standard rule for declaring an outbreak over, since it is twice the maximum 21-day incubation period for the virus.

“The most important lesson for the world at large is this: An immediate, broad-based and well-co-ordinated response can stop the Ebola virus … dead in its tracks,” the WHO said on Friday after declaring the end of the Senegal outbreak.

Based on the successes of Nigeria and Senegal, here are the strategies that can be adopted by other countries, including the United States and Canada, as they prepare for the threat of the virus.

Nigeria’s first Ebola patient, Patrick Sawyer, was initially thought to have malaria. But when malaria treatment failed at a local hospital, doctors immediately began treating him as a possible Ebola patient, and he was kept in isolation at the hospital. Officials were notified and a blood sample was rushed to a testing lab.

On July 23, just three days after Mr. Sawyer arrived in Lagos on an indirect flight from Liberia, the Nigerian health ministry set up an Ebola Incident Management Centre, which evolved into an Emergency Operations Centre to co-ordinate the response and the decision-making.

The centre took over the management of each suspected Ebola case. It investigated every possible case and supervised the decontamination of their homes. Each suspected case was isolated in a special ward of a treatment facility. Blood tests were rapidly conducted to verify if suspected cases were genuine or not.

Senegal, meanwhile, had been well-prepared with an Ebola response plan as early as March. It created a National Crisis Committee as the “nerve centre” for its response, and deployed its emergency plan nationwide in August, even though only a single case had been detected. “The whole country moved into a heightened state of alert,” the WHO said.

Nigerian health teams visited 18,500 homes in Lagos and Port Harcourt, the two cities where Ebola cases were reported, as they searched for anyone who had been in contact with the 20 Ebola patients in the country. More than 150 contact tracers were deployed.

The tracing teams tracked down 894 people who had been in contact with Ebola patients, and began monitoring their health closely. The WHO described it as “world-class epidemiological detective work.” Even mobile-phone data and law-enforcement agencies were employed to trace contacts, using an emergency presidential decree, and airplane manifests were scrutinized. Health workers visited any contact who reported symptoms – or who failed to provide health updates via cellphone text messages.

In Senegal, tracers found 74 close contacts of the country’s sole Ebola patient. The health of each of these 74 people was carefully monitored, twice a day. To encourage their co-operation, the contacts were offered food, money and psychological counselling.

In Nigeria, social mobilization teams went house-to-house to visit 26,000 families who lived within two kilometres of the Ebola patients. They explained Ebola’s warning signs and how to prevent the virus from spreading. Leaflets and billboards, in multiple languages, along with social-media messages, were used to educate the broader Nigerian population.

Education was crucial in a country where dangerous myths were spreading. There was even a rumour that drinking large amounts of salt water would protect people from Ebola – a rumour that sickened and even killed some Nigerians who attempted the harmful diet.

Senegal, too, created a national public-awareness campaign, using media experts and local radio networks.

Effective public-health institutions

Senegal and Nigeria both benefited from a stronger and better-financed system of public health than Liberia, Sierra Leone and Guinea, the impoverished countries where the current epidemic began.

Nigeria also took advantage of the infrastructure of a polio eradication program that had been active for years. A polio and HIV clinic in Lagos, financed by the Gates Foundation, was transformed into an emergency centre for Ebola, with dozens of doctors available.

Nigeria was also quick to welcome foreign help. There was remarkable co-ordination between every level of Nigerian government and global health organizations such as the WHO, the U.S. Centers for Disease Control and Prevention, and Médecins sans frontières (Doctors Without Borders). Private companies donated ambulances, disinfectant and other important supplies.

Nigeria and Senegal boosted their surveillance for Ebola, especially at land border crossings, but they never closed their airports.

“Critically important early on was the government’s decision to open a humanitarian corridor in Dakar to facilitate the movement and activities of humanitarian agencies,” the WHO said. “This decision meant that food, medicines and other essential supplies could seamlessly and efficiently flow into the country.”

 Report by Geoffrey York 

Nigeria is free from ebola

The World Health Organization has declared Nigeria Ebola-free — after more than six weeks without a new case of the disease that has claimed the lives of more than 4,500 people in West Africa, mainly in Liberia, Sierra Leone and Guinea.

“Nigeria is now free of Ebola,” WHO representative Rui Gama Vaz told a news conference in the capital Abuja, Reuters reported. “This is a spectacular success story … It shows that Ebola can be contained but we must be clear that we have only won a battle. The war will only end when West Africa is also declared free of Ebola.”

The last reported case in Nigeria was confirmed Sept. 8. The nation’s response to Ebola is being held out as an example to the still-stricken West African nations, as well to Texas. 

Ebola hit Nigeria in July when an American-Liberian citizen, Patrick Sawyer, was diagnosed in Lagos with the disease — and Nigerian officials quickly declared a public health emergency. Sawyer later died.

It was a nightmare scenario with the potential to spiral out of control, given the bustling city of Lagos, Africa’s largest, is a major transportation hub.

In total, Nigeria reported 20 people with Ebola, according to WHO. Eight of them died. But John Vertefeuille, with the U.S. Centers for Disease Control and Prevention, said Nigeria took the right steps to stop it.

“Nigeria acted quickly and early and on a large scale” Vertefeuille told Agence France-Presse. “They acted aggressively, especially in terms of contact-tracing.”

Last week, WHO announced Senegal was free of the disease. The infection was brought to Senegal in August by a man who had traveled by road from Guinea to Dakar. The government of Senegal identified more than 70 people who had come in contact with the man and began testing anyone considered at high risk. On Sept. 5, the man tested negative, recovered and later returned to Guinea, according to a statement from WHO. According to WHO, the success of Nigeria — Africa’s most populous nation — was attributable to ample funding, quick action and assistance from the WHO, the U.S. Centers for Disease Control and the non-profit Doctors Without Borders.

Unlike the situation in Guinea, Liberia and Sierra Leone, “all identified contacts were physically monitored on a daily basis for 21 days. The few contacts who attempted to escape the monitoring system were all diligently tracked” by special teams and returned to observation.

The organization noted Nigeria had resources unavailable to the poorer nations of West Africa, including experienced epidemiologists and a virology lab associated with a teaching hospital at Lagos University.

Officials conducted house-to-house information campaigns, explaining the risks and the preventive measures necessary to keep control of the situation. 

Reported by World Health Organization (WHO)

UNICEF Canada launches urgent appeal against ebola

UNICEF Canada is launching an urgent appeal for donations to respond to the Ebola outbreak that is ravaging West Africa and putting 10 million children at risk. The humanitarian organization says it needs more than $200 million to respond, but has only raised $25 million to date, amid heightened concerns about the rapidly escalating crisis.

"Ebola is spreading more quickly than we ever could have imagined and is outpacing global efforts to combat it. It's hard for us to imagine as Canadians what it's like to be in these countries where a fatal disease is spreading like wildfire. Luckily for most of us, our understanding of this kind of crisis is only what we've seen in movies. But for millions of children and families in West Africa, it's a stark reality," says David Morley, President and CEO of UNICEF Canada.

"I can't stress how urgent the need is. New cases are reported every day—and tens of thousands of new cases are expected in the coming months. Whole communities are at stake. Canadians are among the most generous people in the world when humanitarian crises hit and we're urging them to continue this legacy by donating to help children affected by Ebola."

Ebola stats and facts:

• This Ebola outbreak has claimed more than 2,600 lives and devastated communities in Guinea, Liberia and Sierra Leone where an estimated 10 million children and youth under 20 years old live in Ebola-affected areas. Of them, 2.5 million are under the age of five.
• The outbreak is spreading fast with 47 per cent of the total number of cases seen within the past 21 days.
• Guinea, Liberia, Nigeria, Senegal, and Sierra Leone, have reported 4,963 cases and 2,453 deaths (as of 16 September).
• Women have been disproportionately affected by the virus because of their role as caregivers, comprising nearly 75 per cent of all cases so far.

Other risks:

• Lack of protection for health workers, challenges in providing protective supplies to families and monitoring burials, misconceptions and social unrest, have contributed to the spread of the virus.
• In contrast to previous outbreaks, this outbreak has reached urban centres and has been transmitted across international borders.
• The potential longer term impact of this crisis – on trade, economic growth, education, employment, social services – can be minimized if affected countries are not isolated.
• The breakdown of services to prevent epidemics - such as immunization, provision of clean water and sanitation and provision of bed nets - increases the risk of outbreaks of measles, cholera and malaria as well as resurgence in polio. This would in turn seriously damage the response efforts against Ebola and lead to a significant number of deaths amongst children and their families.

UNICEF's response:

1. Providing social mobilization and information in affected countries, playing a critical role to support, mobilize and incentivize networks of community health workers and volunteers.
2. Airlifting essential supplies to the affected countries on a massive scale for use in treatment and care centres as well as for continuity of basic services. By early October, UNICEF will have delivered 1300 metric tonnes (MT) on 55 flights.
3. Planning support for water supply, sanitation, and solid waste disposal and hygiene standards in care centres, alongside support for health standards.
4. Working closely with the governments in providing alternative means of learning for children affected by the closure of schools.
5. Providing counselling for children and families severely affected by the outbreak, including orphaned children and widows.
6. In the neighbouring countries at risk (Mali, Senegal, Guinea Bissau and Ivory Coast), UNICEF is working with the governments and partners to create awareness among the communities, while emergency supplies and medical equipment are being delivered for preparedness.