World

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.

Russia denies it has a submarine in the area but the search continues

For the last six days, Sweden’s Navy has been in full Hunt for Red October-mode. Ever since a mysterious, unidentified vessel was spotted south of Stockholm, Swedish ships and helicopters have been searching the area for what media reports says is a damaged Russian submarine that has surreptitiously made its way into the Nordic country’s waters. Those reports were only amplified when, on Oct. 18, Sweden reportedly intercepted communications between transmitters in the Stockholm archipelago and the Russian town of Kalingrad. If all that activity sounds like it was lifted from the screenplay of a 1980s Hollywood military thriller, it raises a very real question. Twenty-five years after the fall of the Berlin Wall, has the Cold War returned?

According to Swedish newspaper Svenska Dagbladet, the first sign that something was amiss came on Oct. 16, when Swedish intelligence detected a distress call from somewhere in the Stockholm archipelago. The next day, two civilians reported spotting a submarine-like object in waters about than 40 kilometers east of Stockholm. Sending out 200 troops on corvettes and minesweepers, the military began scouring the area for what it said was most likely a foreign vessel conducting operations in Swedish waters. The sightings, which have now increased to five, took place in “an area that is of interest to a foreign power,” said Swedish Rear Admiral Anders Grenstad at a press conference on Oct. 19. “This does not belong to us. It is a foreign vessel and we have no indications that there would be any civilians involved in underwater activity.”

Although Swedish military and government officials have not identified the nationality of the craft, nor even confirmed that it is indeed a submarine, Dagbladet was less circumspect, publishing stories about the encrypted Russian transmissions and noting that a Russian tanker supposed to be sailing to Denmark had instead been zigzagging through the Stockholm archipelago for the past week, possibly in an attempt to aid a damaged submarine. The Russian government has denied it has a submarine in the area.

Konstantin Sivkov, a retired navy officer of the former Soviet Union who is now head of the Academy of Geopolitical Problems, a think tank with ties to the Russian military, said that surveillance in foreign waters was the normal practice of many navies but that it was very unlikely that a Russian submarine was currently in Swedish waters.

“Judging by the available information, there was no submarine. Had there been a submarine stranded in Swedish waters, and if it had been sighted surfacing and heard giving audio transmissions, it would be found in 3-4 hours maximum,” he told TIME.

Magnus Nordenman, deputy director of the Brent Scowcroft Center on International Security in Washington, D.C., suggests that the presence of a clandestine vessel in the Nordic region would certainly fit within recent Russian practices. “It’s one more data point in a larger pattern,” Nordenman says. “Over the past three years, and especially in the last year, the Russians have made more and more incursions into Swedish airspace. There have been close calls between their ships too.”

And it’s not just the Swedes who are the target. In March, Russia staged a large-scale military drill close to the Finnish border, and its fighter jets have violated Finnish airspace five times already this year. In 2013, Russian jets challenged Danish airspace more than 40 times—double the number of the previous year—and are on track to surpass that number this year. “I keep arguing that the Baltic Sea area is the next friction point between an assertive Russia and NATO,” says Nordenman. “It looks like a peaceful, prosperous area, but when it comes to security, it’s quite soft.”

Ironically, part of that softness comes precisely from the distance that the Nordic countries have tried to put between themselves and the Cold War era. With threats to their territorial integrity greatly diminished, Sweden and Denmark have, in recent years, made the strategic decision to dedicate the better part of their military budgets toward establishing a global presence (in Iraq and Afghanistan, among other places). As a result, Sweden has reduced its number of submarines to just five; Denmark has gotten rid of them altogether. “In part, it was symbolic,” says Johannes Nordby, a commander in the Danish navy and security expert at the Royal Danish Defence College. “Submarines represented a Cold War weapon, and the Cold War was over.”

Or so the Nordics thought. With the conflict in Ukraine, Putin has made clear his desire to both re-establish a broader sphere of Russian influence and to stand up to NATO and the European Union. “The Cold War was a political and ideological war as much as it was a military one, and we don’t have those [elements] now,” says Nordby. “But it was also about influence. I would argue that what’s happening now is a sign of Russia wanting a new and more significant role in the Baltic region, and internationally.”

Russia’s increased assertiveness is already influencing political debate in the Nordic region. Neither Finland nor Sweden are members of NATO, and with public opinion running strongly against, neither shows any immediate inclination to join. But both signed a pact in August that would increase their cooperation with the alliance, and would allow NATO troops to assist in the two countries in case of emergencies, and there may be more concessions to come. “If the submarine proves to be Russian,” says Harri Mikkola, a global security researcher at the Finnish Institute of International Affairs, “it will further increase security policy discussions in Finland. Nato discussion will intensify, but even more so the discussion concerning the need to deepen military cooperation with Sweden.” And this week, while debates broke out in the Danish press about Denmark’s military preparedness, the Swedish Prime Minister announced he would increase defense spending.

But if history is any example, none of that will likely help capture the unidentified vessel currently hiding in Swedish waters. During the Cold War, Soviet submarines reportedly made numerous incursions into the country’s territory, but with the exception of one that ran aground in 1981, none were ever caught. Which is why Admiral Grenstad probably had the past in mind when he announced to the press on Tuesday that his navy would continue the search. “It’s like Jesus,” he said. “Everyone knows who he is but no one has seen him.”

With additional reporting from Simon Shuster/Moscow

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.”

A soldier was reportedly shot while guarding the War Memorial

Updated Wednesday 3 p.m. ET

Ottawa Police said Wednesday afternoon that a member of the Canadian Forces is dead after being shot at the city’s National War Memorial just outside Parliament earlier in the day. One male suspect was also confirmed dead, the police said, in what appears to have been an armed assault in the heart of Canada’s capital city. Police have not said if the dead suspect was responsible for killing the soldier or if any other suspects remained at large.

“Today is a sad and tragic day for our city and country,” Ottawa Mayor Jim Watson said Wednesday afternoon.

At least one gunman entered Parliament Wednesday morning about the time of the soldier’s shooting, witnesses told the Associated Press, while some later heard shots fired from within the building. Parliament was in session during the incident. A Globe and Mail reporter captured this footage of shots firing out as police swept Parliament following reports of the soldier’s shooting: (warning: footage is violent but not graphic)

Canadian Prime Minister Stephen Harper was quickly evacuated from the scene, the Globe and Mail reports. Harper was scheduled to meet with Pakistani youth education activist Malala Yousafzai in Toronto Wednesday, but that meeting has since been canceled.

The Ottawa Police at first said there were three separate shooting events, but later reduced that number to two.

Ottawa police said in a press conference Wednesday afternoon that the situation is “fluid” and “ongoing,” giving few details beyond what has already been reported. They have asked the public to remain “vigilant,” and are warning people in downtown Ottawa to stay away from windows and rooftops until the situation returns to normal. Those outside downtown Ottawa are being advised to stay away from the area.

White House Press Secretary Josh Earnest said Wednesday that U.S. President Barack Obama was briefed on the incident Wednesday morning in the Oval Office by Homeland Security Advisor Lisa Monaco. U.S. officials have been in close contact with their Canadian counterparts to offer assistance, Earnest added. Obama and Prime Minister Harper spoke on the phone Wednesday afternoon.

Earnest said that he was “not in a position to render judgement” whether the shootings were a terrorist attack. He added he was “unaware” of any changes being made to the domestic threat level or the security posture at U.S. government facilities, though NORAD said earlier it had gone on “high alert” after the shootings.

Wednesday evening’s National Hockey League game scheduled to see the Ottawa Senators host the Toronto Maple Leafs was postponed in light of the incident, the NHL said Wednesday.

– With reporting from Zeke J. Miller

(OTTAWA, Ontario) — Police and witnesses say a gunman has shot a Canadian soldier standing guard at the National War Memorial in Ottawa.

Witnesses also said the gunman entered Parliament and shots rang out. Royal Canadian Mounted Police warned people in downtown Ottawa to stay away from windows and rooftops.

The shooting, which happened shortly before 10 a.m., comes just two days after two Canadian soldiers were run over — and one of them killed — in Quebec by a man with jihadist sympathies.

Earlier: Police say a soldier standing guard at the National War Memorial has been shot by an unknown gunman.

Ottawa police confirmed they had a call at 9:52 a.m. Wednesday with a report of shots fired, and witnesses reported seeing a gunman running toward Parliament Hill, which is under lockdown. Others on the Hill told Canadian Press they heard shots being fired in several different corridors.

The top spokesman for Prime Minister Stephen Harper said Harper was safe and had left Parliament Hill.

Emergency responders are still on the scene and paramedics took the wounded soldier away in an ambulance.

The incident comes just two days after two Canadian soldiers were run over — and one of them killed — in Quebec by a man with jihadist sympathies.

Jeffrey Fowle returns after a half a year in captivity

An Ohio man who was detained in North Korea for nearly half a year has arrived back home.

Jeffrey Fowle landed at Wright-Patterson Air Force Base near Dayton, Ohio Wednesday morning, one day after being released from North Korean custody, the Associated Press reports.

The 56-year-old Miamisburg resident was arrested earlier this year by North Korean authorities after he left a Bible at a nightclub. Christian evangelism is considered a crime in North Korea.

Fowle was the only one of three Americans held by Pyongyang who was not convicted of any charges. Two other Americans, Kenneth Bae and Matthew Miller, continue to be held.

[AP]

(WRIGHT-PATTERSON AIR FORCE BASE, Ohio) — An Ohio man detained for nearly half a year in North Korea has landed back home.

Officials say a plane carrying Jeffrey Fowle landed Wednesday morning at Wright-Patterson Air Force Base, near Dayton.

The State Department announced Tuesday that the 56-year-old Miamisburg resident had been released. The news came about six months after he was taken into custody after leaving a Bible at a nightclub. Christian evangelism is considered a crime in North Korea.

He had been awaiting trial — the only one of three Americans held by Pyongyang who had not been convicted of charges.

The two others were each sentenced to years in North Korean prisons after court trials that lasted no more than 90 minutes. The three Americans entered North Korea separately.