Health

America’s top universities may be teaching a dangerous lesson about tanning.

Twelve percent of the nation’s top colleges and universities have tanning beds on campus, and nearly half have them either on campus or in off-campus housing, according to a report published online Wednesday in JAMA Dermatology.

Rare, reliable data about Ebola from inside a treatment center in Sierra Leone

Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.

But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system—originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May—and the results of that record-keeping appear in the New England Journal of Medicine.

MORE: Ebola Tests Fast Tracked By FDA

The new records were a challenge to collect, since infection control rules meant that the paper charts could not be transferred back and forth between the ward where patients were treated and other areas of the hospital. “The nurses’ station was separated from the patient rooms by essentially a chicken wire window, so the nurses would talk to each other through the chicken wire—the nurse inside, in personal protective equipment, would tell the nurse outside what to write down,” says paper co-author Dr. John Schieffelin, an assistant professor of clinical pediatrics and internal medicine at Tulane University who has been serving stints at the hospital for the last four and a half years. Even that rudimentary system was state of the art for the region, where most health clinics do not keep medical records. “In most of Sierra Leone, the hospital chart is one of those little composition books that we used to write essays in during high school,” says Schieffelin. “There was no structure to it; the physician would just write daily notes and most hospitals don’t have a charting system.”

MORE: See How Ebola Drugs Grow In Tobacco Leaves

The new documents confirm what previous health workers knew about Ebola from experience. Of 106 patients with Ebola, 44 had complete medical charts in paper form (the rest were destroyed because health officials feared they had been contaminated with the virus), and the findings supported some basic tenets of Ebola infection: that the incubation period for Ebola virus is about six to 12 days, that 74% of those infected died, that younger patients were more likely to survive infection than those over age 45, and that people with less virus in their blood when diagnosed were more likely to survive.

“It affirms our understanding of how to treat Ebola patients,” says Schieffelin. “We need to treat them aggressively with IV fluids and monitor their blood chemistries. The study also gives us a good solid baseline for understanding the disease, so we can build on it in a lot of different ways. It’s a foundation for doing further studies for optimizing treatment. It provides a great foundation for studies looking at novel treatment methods. Now that we understand how Ebola affects patients, can we improve symptoms and outcomes with novel therapies? We can start to ask and answer those questions.”

MORE: 12 Answers to Ebola’s Hard Questions

Turning those answers into new treatment strategies, however, might be a daunting task—especially in the context of the current outbreak. On most days, the Kenema hospital would see about 90 Ebola-related patients, some of whom were suspected to have the disease but still needed to be tested, and others with confirmed infections who needed to be immediately assigned to a bed and given IV fluids. “There are a lot of confused Ebola patients,” says Schieffelin. “These people are wandering around the ward, often going from one bed to the next, and they are scared so often not very cooperative. To top that off, a lot of people didn’t speak English, so that made it even more challenging.”

He admits to often tossing patient confidentiality concerns aside by asking other patients who were feeling well to translate critical information to their peers, who either didn’t need to be in the hospital any longer because they tested negative, or needed to be immediately transferred to another ward if they were infected.

MORE: Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak

At Kenema, the health care workers did not use the full-coverage hazmat suits that Medecins Sans Frontieres uses in its clinics. Instead, they wore Tyvek suits that covered their front and back, a mask, face shield, double gloves and a head covering. That left some skin in the front and back of the neck exposed. The reason was partly for practical reasons—Schieffelin was often the only health care worker on his part of the ward where patients were triaged, and frequently had to spend four to four and a half hours at a time suited up. The full coverage suits become uncomfortable and unbearable after about 45 minutes.

“But I was personally okay with our equipment,” he says. “Because my biggest concern was getting a needle stick. My mucous membranes—my eyes, nose and mouth—were pretty well covered.”

After about four hours, he and whoever else was working on the wards with the infected patients would get sprayed with a bleach solution from the shoulders down, in order to avoid splashing any potentially contaminated material onto their face and neck. Then they would take each piece of equipment off and wash their hands in bleach after each step. After a break of an hour or so, they would suit up again.

MORE: Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

When Schieffelin returned from his work in Sierra Leone in August, he was told by the World Health Organization, U.S. Centers for Disease Control and the Louisiana state health department (he lives in the state) to monitor his temperature twice a day for 21 days, which he did. He was also told not to use mass transportation. He worked at home for a couple days, only because he was exhausted after his trip, and when he returned to work he didn’t see patients for a few weeks—mostly out of a scheduling coincidence, not intentionally.

Given public concerns about Ebola potentially coming to the U.S. and spreading here, however, he says, “Perhaps we should say that in terms of physicians and nurses, maybe direct patient care for a couple of weeks would not be in anyone’s best interest.”

But while he recognizes that hospital organizations and the general pubic have legitimate concerns about being protected against an agent as deadly as Ebola, Schieffelin is against mandatory self-isolation or quarantine, measures the states of New York and New Jersey recently decided to require for all health care workers returning from the three countries affected by Ebola. “I think self-isolation is completely unnecessary if you are not symptomatic. In my mind, that enhances hysteria. I have young children. If their dad were in self isolation away from everybody for three weeks, that would adversely affect them and would be telling the community and the schools the wrong message: that I need to be a pariah and an outcast for three weeks,” he says. “In my mind, that’s not the right message. If I have no symptoms, I am not a threat to anybody—I’m not a threat to my children, nor are my children a threat to other children at their school.” Such mandatory quarantines could also deter health workers from contributing to the effort to control the epidemic, and that will only prolong it, he says.

Schieffelin says that if he had recorded a fever at any point during this 21 day monitoring period, he would have immediately reported to the Louisiana health department and gone into isolation. He knows how deadly Ebola can be from personal and professional experience: seven of Schieffelin’s co-authors on the paper have died of Ebola infection since the data were collected over the summer.

A father's claim that his two boys were beaten and called "Ebola" raises concern among Africans

The father says the bullying began soon after his two sons arrived at their New York City school from Senegal almost one month ago. They were called “Ebola” by other students, taunted about possibly being contagious and excluded from playing ball. Ousmane Drame says the baiting finally erupted into a physical fight on Oct. 24 when 11-year-old Amadou and his 13-year-old brother, Pape, were pummeled by classmates on the playground of Intermediate School 318 in the Bronx.

“It’s not just them,” Drame said at a press conference. “All the African children suffer this.”

The brothers’ experience is an extreme example of the backlash felt by some Africans in the United States since the Ebola virus arrived from West Africa. Many others tell of facing subtler, but no less hurtful, forms of discrimination at work, in school and as they commute as fear of the little-known but often deadly disease has spread among the public.

In Staten Island, the largest Liberian community outside of Africa, one woman says she was forced to take temporary, unpaid leave from her job because of her nationality. Liberians in Minnesota have been told to leave work after sneezing or coughing. In New Jersey, two elementary school students from Rwanda were kept out of school after other parents pressured school officials. At Navarro College, a public community college in Texas, officials mailed letters rejecting international applicants from African countries, even ones from countries without confirmed Ebola cases. (The school has since apologized for sending out “incorrect information.”)

“This is a larger problem,” says Charles Cooper, president of the African Advisory Council in New York, an advocacy group. “People are on the train and they sneeze and hear, ‘I hope you don’t have Ebola. I hope you don’t give me Ebola.’ Xenophobia is growing around this, but many people are afraid to come out publicly.”

The spread of previously unknown, contagious diseases in the U.S. has often led to these sorts of overreactions. For Ebola, those fears appear driven by the circumstances of the virus—its high mortality rate, its gruesome symptoms, its origins on a continent often misunderstood by Americans—even though the odds of contracting it in the U.S. remain exceedingly low. A recent poll from the Harvard School of Public Health found that more than half of adults worry there will be a large Ebola outbreak inside in the U.S. over the next year, while over a third are worried that they or a family member will be infected.

While fears erupted around people diagnosed with Polio in the 1940s and SARS in the 2000s, public health experts point to the start of the AIDS epidemic in the early 1980s as the last time Americans attached a similar stigma to people even loosely associated with the virus. At the time, many Americans refused to be near those suspected of having HIV, unaware of how it was actually transmitted.

“A lot of what I’m seeing today was present at the very beginning of the AIDS epidemic,” says Robert Fullilove, a Columbia University professor of sociomedical sciences, who has been researching HIV since the mid-1980s. “It’s this tendency to separate between two different groups, when somebody’s ‘otherness’ is associated with a deadly disease. It’s like déjà vu all over again.”

That toxic brew of fear and misinformation led to discrimination against gays—the disease was unfairly yet colloquially known as the “gay plague” for its disproportionate toll among homosexual men—and people from Haiti, which was the first country in the Western Hemisphere with confirmed cases of HIV.

“Haiti itself became stigmatized,” says Dr. Joia Mukherjee, a Harvard Medical School associate professor. “The same thing is happening now with Liberians, and indeed all of Africa.”

In both cases, the driving forces are the same: a general lack of understanding about the disease, how it is transmitted and where it’s been concentrated.

“The average American doesn’t even recognize how big Africa is,” Fullilove says of the Ebola stereotypes.

The bullying allegedly faced by the Drame brothers is a case in point. The vast majority of Ebola cases are in Liberia and Sierra Leone. Senegal had only one confirmed case and is now considered free of the disease by the Centers for Disease Control.

Countering such misinformation has been central to the messaging strategy of the CDC and government officials. It’s no coincidence that President Obama hugged Nina Pham after the Dallas nurse was declared free of the virus. And the image offensive may be paying off. According to a new ABC News/Washington Post poll, the people least worried about catching the disease or a larger U.S. outbreak were the ones who knew the most about how Ebola is transmitted.