Health

Better Ebola testing in West Africa would save lives and could help bring an end to the outbreak

The dying at the tin-roofed clinic in the rural Kono district of Sierra Leone comes at a ruthless pace. In the first two weeks of October, 20 out of the 22 patients seeking treatment for Ebola died. That fatality rate, high even by the lethal standards of Ebola, could easily be brought down, says Dan Kelly, an infectious-disease doctor who is currently in Kono with the Wellbody Alliance, a medical nonprofit organisation he set up eight years ago. “The ability to test for Ebola, to test quickly, has become ever more important,” says Kelly, who believes the high death toll in the Kono clinic was due in part to the fact that there is no place to test for Ebola in the entire district. Instead, blood samples from suspected Ebola patients have to be sent to the capital over rutted mud roads that are often washed out by rain. “Even if we have the best treatments available, without a timely diagnosis people are still going to die,” says Kelly.

Work out quickly who does and does not have Ebola and you’ll get a long way toward stopping an outbreak that has killed at least 4,877 and infected thousands more. Right now that simple proposition can feel like a fantasy. In Guinea, Sierra Leone and Liberia, the three countries with the most cases, the need for rapid test results far outpaces the capacity to carry them out.

That means patients often aren’t getting treatment until it’s too late, when the disease has ravaged their bodies beyond repair, and when they may have already infected friends and family. “If patients are promptly diagnosed and receive aggressive supportive care, the great majority, as many as 90%, should survive,” wrote the global health expert Paul Farmer in a recent issue of the London Review of Books.

Even in a top U.S. laboratory it can take up to eight hours to search a blood sample for Ebola through an expensive and complex array of technical hardware and computer software called a polymerase chain reaction (PCR) test. The U.S. Centers for Disease Control and Prevention and the U.S. military have helped by setting up four additional labs in West Africa over the past six months—Liberia now has a total of five, Sierra Leone four and Guinea three—but capacity is still limited to about 100 tests per lab per day, not nearly enough to cope with an epidemic that could grow to 10,000 new cases a week by December, according to the World Health Organization. Laurie Garrett, an expert on Ebola at the Council on Foreign Relations and author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance, says that number could be brought down through better testing. “The only thing that makes a dent when you model what is going on with the epidemic now and what it looks like in two months, is being able to separate the infected from the non-infected.”

Health care workers on the ground say that more PCR labs are urgently needed. “Crushing this epidemic means getting 70% of the population with Ebola into isolation and care,” Kelly says. That could be achieved, he believes, by putting a PCR lab in every district.

The challenges don’t stop there. Testing can create risks even as it offers solutions. Medical personnel must draw blood from patients for a PCR test, a potentially lethal process for caregivers. “Taking samples is extremely dangerous,” says Dr. Estrella Lasry, a tropical medicine adviser in Liberia for Doctors Without Borders (MSF). “At any time you risk a needlestick injury that can expose you to the virus.”

And then there’s the risk that patients without Ebola are being exposed to patients with the disease. Lasry estimates that 30% to 50% of people coming into the MSF clinics end up testing negative for Ebola and instead have other illnesses like malaria that have similar early symptoms. All those being tested for Ebola must wait in holding centers for their results, to ensure they don’t have an opportunity to infect others back at home if they test positive. That means patients with other illnesses must wait among patients with Ebola, increasing the chances of transmission.

Kelly hopes researchers can develop a test that could give readings at a clinic immediately and wouldn’t require trained technicians to interpret the results. “It would be a game changer if you could immediately identify patients needing quarantine from those who do not,” he says. Several versions of so-called point-of-care rapid diagnostic tests are already in development, but while some are at the testing stage, it is not clear when they could actually be used on the ground.

One U.S. company, Corgenix, received a $2.9 million grant in June from the National Institutes of Health to perfect its prototype, a pregnancy-test-style slip of paper that reveals a dark red line within 15 minutes when exposed to a drop of Ebola-infected blood. Instead of needles and syringes, test takers need only a pinprick to get the sample, much like an insulin test for diabetes patients. These tests, which would cost anywhere from $2 to $10 (PCR tests average about $100 each) could also be used in airports to confirm whether someone with symptoms has Ebola.

If the Corgenix test had been available, says one of its lead researchers, Robert F. Garry, a professor of microbiology and immunology at Tulane University School of Medicine in New Orleans, it might have helped diagnose Amber Vinson, an American nurse infected with Ebola, before she boarded a flight from Cleveland to Dallas on Oct. 13. “This is a test that could be used anywhere you would want to test for Ebola,” says Garry. “Anyone could use it, and anyone could read it.”

With the epidemic worsening in West Africa, medical staff in Ebola-hit countries can’t afford to wait for companies like Corgenix to bring their product to market. Kelly has been hearing about better, faster tests almost since he started working on Ebola in June. He fears that pinning hopes on future technologies undermines efforts to ramp up testing facilities. “Everyone says they have a new test, but at this point I’m like, ‘Show me the money,’” says Kelly. “ We already have a working technology that is deployable. Get me a PCR in every district capital, and then we can start talking about faster tests.”

Garry says he has people in every U.S. time zone working “as fast as humanly possible” to get the Corgenix test out. “We want to make an impact on this outbreak,” he says. “With enough tests, we can shut it down it down.” Without them, Ebola may be here to stay.

“The chemicals used to make hand sanitizers, soaps, lotions, and sunscreen degrade the skin’s ability to act as a barrier"

An order of French fries may be bad for your health in ways that extend well beyond the outsize calorie count. According to a new study by scientists at the University of Missouri, people who used hand sanitizer, touched a cash register receipt and then ate French fries were quickly exposed to high levels of bisphenol A (BPA), a chemical widely used to coat receipt paper.

BPA has been identified as an endocrine disrupting chemical for its ability to interfere with estrogen and other hormones. In human and animal studies, BPA exposure has been linked to adverse effects on the reproductive and neurological systems as well as increased risk for obesity, diabetes and cardiovascular disease. Some animal studies also suggest that BPA can set the stage for certain cancers, including breast and prostate cancer.

The study, published in PLOS One, is the first to show how handling BPA-coated receipts can account for exposure at levels that have been shown to harm health.

Most studies of BPA exposure, including those that have informed current regulation of the chemical, have focused on exposure that happens through food or after BPA passes through the gut, explains study author Frederick S. vom Saal, Professor of Biological Sciences at the University of Missouri-Columbia.

But this study shows that skin absorption of BPA appears to lead to higher levels of biologically active BPA in the body than when the chemical is digested with food. When scientists added in two other factors—scrubbing hands with hand sanitizer and eating greasy food—the evidence points to a super-sized dose of BPA.

“The chemicals used to make hand sanitizers, soaps, lotions, and sunscreen degrade the skin’s ability to act as a barrier and so act as skin penetration enhancers,” says vom Saal. So BPA enters the body more efficiently than it would otherwise. Food grease and other oils can act similarly because BPA itself is fat-soluble, explains vom Saal.

Vom Saal also explains that BPA can be absorbed rapidly by tissue in the mouth so that the chemical enters the body without first being metabolized–or broken down in digestion.

“The combination of dermal and oral BPA absorption led to a rapid and dramatic average maximum increase in unconjugated (bioactive) BPA…in blood and urine within 90 minutes,” write the study authors. In experiments, BPA was absorbed by people who held a receipt for as little as two seconds. The amounts absorbed in the study “are in a zone where effects associated with obesity, diabetes and neurological effects can result,” says vom Saal.

Many laboratory studies have shown that BPA can produce health effects at very low levels of exposure—or just a few parts per trillion. BPA has also been shown to effect developing embryos, which means a mother’s exposure to BPA can affect her children. Some studies have shown that a single BPA exposure can affect even a third generation as the chemical has the potential to alter the ovary and eggs of the exposed fetus. At the same time many studies have found associations between BPA exposure in humans and the health effects found in lab studies.

Given the concern about BPA’s health effects, manufacturers of baby bottles and toddler’s sippy cups have largely stopped using it. In 2012, the U.S. Food and Drug Administration withdrew its approval for use of BPA in these products. But its use is still allowed in other products that come into contact with food. Industry trade associations, including the American Chemistry Council, maintain that BPA is safe and that average exposure levels, including from receipts, are not harmful.

Meanwhile, 12 different states have passed laws barring BPA in various products—primarily food and beverage containers intended for use by children. Only one state, Connecticut, has passed a law banning use of BPA in receipts.

But simply switching to another chemical may not solve the problem. As vom Saal and his coauthors point out in this study, a common BPA alternative used in receipts is bisphenol S, which can also interfere with estrogen. In fact, in its assessment of available alternatives for receipts, the U.S. Environmental Protection Agency found no chemical that was clearly safer than BPA. “What we need,” says vom Saal, “is an alternate technology.”

In the meantime, it appears that grabbing the fast food receipt before snacking on French fries may not only be packing on the extra calories. It might also be disrupting our hormones.

This post originally appeared on CivilEats.com.

A quarter of schools don't educate their athletes on the injury

Policies guiding concussion treatment at scores of colleges across the country still run afoul of rules set by the National Collegiate Athletic Association (NCAA), according to a new study in The American Journal of Sports Medicine.

“The vast majority of schools did have a concussion management plan, but not all of them did,” said Christine Baugh, a Harvard researcher and one of the study’s co-authors. “The number of schools who reported to us that they didn’t have a concussion management plan in place affects tens of thousands of athletes each year.”

The study comes as the NCAA faces increased pressure to protect the health of college athletes. Earlier this year, the organization set aside $70 million for concussion testing and research to settle several class action lawsuits. The exact number of college athletes who suffer from concussions during practice and games is unclear, but some estimates put it in the thousands.

To combat concussions, the NCAA has mandated that colleges create “concussion management plans.” While 93% of the 2,600 schools surveyed said they had drafted such a plan to guide their response to concussions, many of those plans lacked components that Baugh says are critical to actually reducing the head injury. For one, about a quarter of schools don’t train athletes to detect concussions, making it difficult for athletes to recognize when they need to seek medical attention. And more than 6 percent of schools allow coaches or athletes who lack formal medical training to make the final decision about whether a student can return to competition after suffering a concussion.

“It may be the case that coaches and athletes are being extra cautious; despite being cleared by a clinician, they are withholding themselves or withholding their athletes,” said Baugh, who was a Division I athlete during her college years. “But it may also be the case that some of these schools, coaches or athletes are pressuring clinicians to prematurely return to play before their symptoms have been resolved.”

The study concludes with a recommendation for the NCAA: step up enforcement of concussion policies.

There's a veritable fish pharmacy in your freezer

When we think about food raised with antibiotics, we probably picture oversized chickens and plumped-up cows. But they’re also in our fish—both farmed and wild, finds a new study published in the Journal of Hazardous Materials.

Antibiotics are used in fish largely to treat and prevent disease, not to promote growth, says study leader Hansa Done, a PhD candidate at Arizona State University’s Center for Environmental Security. They’re dispersed into the water in fish farms and are sometimes injected into fish directly. And once they get into the fish, they generally stay there, even though their concentration diminishes over time.

MORE: Obama Plan to Fight Antibiotic Resistance ‘Disappointing,’ Critics Say

The study looked at 27 fish from 11 different countries, all bought at an Arizona supermarket. Researchers used a meat grinder to pulverize the fish and tested the meat for 47 types of antibiotics. They found residues of five antibiotics, some of which are also used to treat human diseases. Residues of a kind of tetracycline, for instance, showed up in farmed tilapia, farmed salmon and farmed trout. It was also present in wild-caught shrimp from Mexico—probably due to wastewater treatment plant runoff, Done says. Even fish marketed as antibiotic-free wasn’t off the hook: researchers found virginiamycin in one sample of farmed salmon bearing the label.

All traces of the drugs were within legal limits of what’s allowed—which is a victory for our food supply, says Done, but there is a caveat: “For there to still be something in there”—after untold stages of processing and months in Done’s freezer—“means that at one point, it was injected or fed a lot more,” she says. “We just don’t know how much.”

The problem with low-dose antibiotics isn’t that they’re immediately harmful to human health, Done says. It’s that high or low levels in our food supply can breed antibiotic resistance. “Antibiotics present at levels well below regulatory limits still can promote the emergence of drug resistant microorganisms,” the researchers write in the study. In a related meta-analysis of studies on antibiotics and seafood, Done found that antibiotic resistant bacteria in seafood has grown more than 8-fold in the past three decades.

Beyond fending off disease, it’s not clear what antibiotics are doing to the fish themselves. “There’s this rumor that high levels of [the antibiotic] oxytetracycline could lead to spinal deformities in rainbow trout if it’s fed to them during their growth stages,” Done says, though she notes a definite lack of research on the matter. In the six fish she tested, the group with normal spines didn’t have detectable levels of oxytetracycline, but the three with deformed spines did—though only very slightly detectable levels, she says.

More research is needed.

Two thirds of recalled supplements still contain the substance banned by the FDA

Dietary supplements with recalled ingredients often remain on the shelves despite a health warning from the Food and Drug Administration (FDA), according to a new study in the Journal of the American Medical Association.

Looking at 27 supplements recalled between 2009 and 2012, researchers found that two thirds of those supplements what were still being sold contained the substance banned by the FDA. The other supplements either remained on the shelf with the recalled ingredient removed or were pulled completely.

The study also found that some types of supplements were more likely to contain recalled ingredients than others. Sports supplements stayed on the shelf despite containing recalled ingredients 85% of the time, higher than any other type of supplement. Only 20% of sexual enhancement supplements that had faced a recall continued to be sold with the recalled element still included, the study found.

Supplement manufacturers make varying levels of effort to ensure that their recalled product is taken off the shelves, says Pieter Cohen, a Harvard researcher who helped conduct the study.

“These companies…were so unabashedly willing to continue to sell exactly the same product that they had recalled with banned drugs in them,” he says. “It shows that the FDA is not … double checking.”

Ebola survivor and NBC freelancer Ashoka Mukpo says “today is a joyful day,” in a statement he released Wednesday about his recovery.

Mukpo, who was infected with Ebola while working in Liberia, was evacuated to Nebraska Medical Center for treatment. “I owe this staff a debt I can’t ever repay,” said Mukpo in a statement.

The fact that Mukpo was able to be treated in America is a circumstance that weighs on him, he writes: “I feel profoundly blessed to be alive, and in the same breath aware of the global inequalities that allowed me to be flown to an American hospital when so many Liberians die alone with minimal care.” He thanked everyone from the United States State Department, to Doctors Without Borders to NBC.

He paid a special thanks to fellow survivor Dr. Kent Brantly, who donated blood to Mukpo. “May his health flourish and his compassion be known to all,” said Mukpo.

Mukpo was declared free of Ebola and released from the hospital on Oct. 21. It’s unclear how exactly he was infected with the disease. Mukpo says he plans to discuss his experience in writing, and will talk to media, but for now he is spending time with his family and asks for privacy.

You can read his full statement here.

Experts point to strong national health systems and proper contact tracing

Though a few cases of Ebola in the U.S. and Europe have sparked panic that the deadly virus is spreading far and wide, a closer look at the outbreak in West Africa tells a slightly different story. The epidemic, which the World Health Organization reports has claimed at least 4,877 lives, largely in West Africa, has so far been mainly confined to three countries: Guinea, Sierra Leone and Liberia. But why have others like Guinea-Bissau, Mali and Côte d’Ivoire — which all share at least one border with a badly afflicted country — so far managed to avoid any cases of the virus?

“Part of it is still luck of the draw, due to movement of people and the relatively porous nature of borders,” says Aboubacry Tall, West Africa Regional Director for Oxfam. And the threat seemingly posed by open borders has led to the affected countries gradually sealing themselves off to prevent Ebola from being passed on to neighbors. When the first cases were confirmed in March by Guinea’s Ministry of Health, Senegal decided to close its southern border with the country. As the outbreak spread to Sierra Leone and Liberia, more border closures followed: Sierra Leone shut its borders on June 11 and Liberia did the same on July 27, with the exception of a few major entry points (such as the main airport) where screening centers would be set up.

Greg Rose, a health advisor at the British Red Cross, says that while border controls may have had “a small effect” on the situation in West Africa, a key difference “was that that other countries had been forewarned,” which allowed them to “set up systems to prevent further infections.” Moreover, Tall says that “in neighboring countries like Côte d’Ivoire, Senegal and Mali, the health systems were in a slightly better shape.” In comparison, the three most-affected countries already had overburdened health care infrastructure before the Ebola outbreak. Sierra Leone and Liberia had not yet fully recovered from the damaging effects of long civil wars — Sierra Leone had two doctors per 100,000 people and Liberia had only one, whereas Mali had eight and Côte d’Ivoire had 14. (The U.S. has 242.) With a lack of staff and resources, Tall says, “Ebola came in and rapidly overwhelmed the health systems” in the three countries, which have now collectively seen more than 9,900 cases of the virus.

Tall adds that two key elements in containing the spread in neighboring countries are community mobilization and the preparedness of the public health system. He highlights the importance of “raising public awareness on Ebola” and of putting the medical system “on high alert all the way to border areas, so that anything that looks like a suspect case has a higher chance of being picked up.” The difference made by a rapid response can be seen in Senegal’s success with its one Ebola case. Despite closing its border, Senegal reported its first case on Aug. 29, after a a Guinean university student traveled by road to Dakar, the capital. He was treated and recovered, and his contacts were traced and monitored. On Oct. 17, WHO declared the outbreak in Senegal officially over, saying the “most important lesson for the world at large is this: an immediate, broad-based, and well-coordinated response can stop the Ebola virus dead in its tracks.”

Though not a bordering country, Nigeria suffered an outbreak of 20 cases — including eight deaths — after a Liberian-American man died of Ebola after arriving at the main airport in Lagos. However, the government of Africa’s most populous nation was able to successfully trace those in contact with him and has since been declared Ebola-free. Nigeria has kept its borders open to travelers from the most affected countries, but increased surveillance. Dr. Faisal Shuaib, of the country’s Ebola Emergency Operation Center, recently told TIME that “closing borders tends to reinforce panic and the notion of helplessness. When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.”

Shuaib pointed out that closing borders has another unwelcome effect: it stifles commercial activities in countries whose economies are already struggling because of the Ebola crisis. “Access to food has become a pressing concern for many people in the three affected countries and their neighbors,” Bukar Tijani, a U.N. Food and Agriculture Organization representative, said in September. In Liberia, for example, the collapse of cross-border trade meant that the price of cassava — a food staple — jumped 150% in early August. Another immediate consequence of travel restrictions, says Tall, is that “most airlines have stopped flying to these countries, which makes it more difficult for humanitarian personnel to get in and out.”

The most effective way to contain the spread of Ebola is in “proper tracing of the epidemic, containment within communities and caring for those infected,” says Rose, the Red Cross advisor, who believes “this problem is not going to be solved by closing borders.” And though Ebola has not spread quickly beyond Guinea, Liberia and Sierra Leone, it’s clear that neighboring countries in West Africa need to remain vigilant. As Tall says, “we’re not out of the woods yet.”

Travelers will be monitored for 21 days upon arrival in the U.S.

All travelers entering the United States from Liberia, Guinea, and Sierra Leone will now be actively monitored for Ebola-like symptoms by state and local health officials for 21 days upon landing in the U.S., the Centers for Disease Control and Prevention announced on Wednesday. Those three West African countries are the hardest-hit by a recent outbreak of the deadly disease, and about 150 people travel from them to the U.S. every day.

CDC Director Dr. Tom Frieden announced the new program as the U.S. began requiring travelers from those three countries to arrive in the country through one of five airports performing intensive screening procedures. The new monitoring program will start on Monday in New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia, the six states where most travelers from the three countries end their trips.

When travelers from the three West African countries arrive in the U.S., they will be given an explanatory kit that includes a thermometer and will be asked to provide two email addresses, two telephone numbers, a home address and an address for the next 21 days. They will also need to provide the same information for a family member or friend. Travelers will be asked to report to a public health worker from a state or local health department daily, providing a temperature as well as well reporting any symptoms. They must also inform officials if they plan to travel, and if so, they must coordinate their tracking their symptoms with health officials.

“We have to keep up our guard against Ebola,” said Frieden, adding that it’s the “CDC’s mission is to protect Americans.”