Ebola

"You don't want to hear that you have Ebola"

Amber Vinson, a 29-year-old nurse at Texas Health Presbyterian Hospital in Dallas, remembers the moment a doctor confirmed her diagnosis.

“Even when he told me I had it, it’s like I didn’t hear it,” she told People in one of her first interviews since she recovered from the deadly virus. “Because you don’t want to hear that you have Ebola.”

The nurse had spent multiple nights treating Thomas Eric Duncan, the first person to be diagnosed with Ebola in the U.S. When he died on Oct. 8, she was distraught, but she didn’t realize that she, too, had contracted the virus until her temperature spiked days later.

Read more at People

"The entire time I was checking my temperature and hoping I didn't have a fever or any symptoms."

A Dallas nurse who survived a bout of Ebola caught while treating a Liberian patient with the disease has told how she received only a “crash course” on treating the highly infectious disease.

Amber Vinson told People of her surprise at learning that her hospital, Texas Health Presbyterian, would be treating Ebola patient Thomas Eric Duncan, and that she would be assigned to his care. “They told everyone to go downstairs except for me and one other nurse,” she says. “They gave us a crash-course education on this is what you have to wear, this is how you take it on and off.”

Vinson was sent to Emory University Medical Center for treatment after she tested positive for the disease, while a colleague who also contracted and survived the disease, Nina Pham, was treated at the National Institutes of Health. She says the two would text back and forth to encourage each other’s recovery.

Read more at People.

Over the next week, a donation prompt will appear atop your News Feed

Facebook announced a new initiative on Thursday that it hopes will encourage its massive user base to donate and help tackle the worst Ebola outbreak on record.

Over the next week, the social network said in a blog post, users will see a message at the top of News Feeds that will ask for donations to organizations like the International Medical Corps, International Federation of Red Cross and Red Crescent Societies and Save the Children. All donations will go directly to the charities.

Beyond that, Facebook is working with UNICEF to spread key information about Ebola symptoms and treatment and collaborating with NetHope in order to provide emergency voice and data services for health and aid workers in the three hardest-hit countries: Liberia, Guinea and Sierra Leone.

The Ebola response in West Africa has seen a smaller flow of individual charitable donations than other recent relief efforts. An analysis by the CNNMoney last month found that the American Red Cross had raised $486 million in the wake of the 2010 earthquake in Haiti, while it had raised just $100,000 in individual donations toward combatting Ebola, aside from a $2.8 million foundation contribution.

Philanthropists, meanwhile, have represented the largest source of private donations, including a $100 million pledge from Microsoft’s Paul Allen and a $25 million donation from Facebook’s Mark Zuckerberg.

Seventy uniformed officers to specifically care for doctors and nurses

Uniformed American officers are due to open and staff a field clinic for Ebola patients outside the Liberian capital of Monrovia this coming weekend, marking the United States’ latest bid to help bring the regional outbreak under control.

President Barack Obama had previously said none of the roughly 4,000 American troops deployed to Liberia would care for patients suffering from Ebola. But, USA Today reports, 70 uniformed government personnel from the U.S. Public Health Service Commissioned Corps, of the Department of Health and Human Services, will be the first to do so and specifically treat health care workers who contract the deadly virus.

“They have to feel secure that there will be a high level of care provided if they do fall ill of Ebola,” Rear Adm. Scott Giberson, acting U.S. deputy surgeon general, said in the report, adding that the volunteers were among some 1,700 members who had expressed a willingness to be deployed.

The World Health Organization said Wednesday that at least 310 health care workers have died in the West Africa outbreak that has killed more than 4,800 people this year. That same day, Obama announced he would ask Congress for $6.2 million to fight Ebola.

[USA Today]

"I don't know what went wrong," Teresa Romero said

The Spanish nurse’s aide believed to be the first person to have contracted Ebola outside Africa was on Wednesday released from a Madrid hospital.

Teresa Romero, 44, thanked God and her caregivers for “giving her back life,” the New York Times reports.

Health officials said it was impossible to discern which of several factors — including the use of an experimental Ebola drug and blood plasma from another survivor — had beaten the often fatal disease

Romero had tested positive for the illness almost a month ago, after treating a missionary who had come down with the disease in West Africa and later died in Madrid.

Her case had stoked fears that Ebola could threaten countries with advanced health care systems — worries that reached new heights when two health care workers in Dallas also contracted the illness — and played into a furious blame game.

“I don’t know what went wrong, I don’t even know if anything went wrong,” Romero said. “I only know that … if my infection can be of some use, so that the disease can be studied better or to help find a vaccine or to cure other people, here I am.”

[NYT]

As the world waits for new treatments and a vaccine, doctors in Guinea have found the best way to help patients survive Ebola

With the number of cases topping 13,000 and deaths climbing close to 5,000, the current outbreak of Ebola in West Africa is the virus’s worst yet. But from the tragic illness and mortality emerge some important lessons from the region.

The latest, published in the New England Journal of Medicine, details the cases that first appeared in Guinea’s capital city of Conakry between March and April. Unlike in other parts of the region, where the mortality rate from Ebola averages around 60% to 70%, in Conakry it has remained around 43%.

MORE: Here’s What Scientists Know About Ebola in Sierra Leone

Why? As Dr. Robert Fowler, a clinician in pandemic and epidemic diseases with the World Health Organization (WHO) and physician at the University of Toronto, explains, Guinea’s first Ebola treatment center, established in the capital, took a very aggressive approach to handling patients. Working with the humanitarian aid group Medecins Sans Frontieres (MSF) or Doctors Without Borders, the WHO and the country’s Ministry of Health set up a facility where Ebola patients were immediately hooked up to IV fluids and treated for dehydration—often a complication of infection. They were also monitored regularly for changes in their blood chemicals, including the electrolytes that are a marker for whether the body’s cells are getting enough water and nutrients to function. While routine blood work is standard practice at every hospital in developed nations, such testing wasn’t at Conakry health facilities.

“At the beginning of the outbreak, there was no [Ebola] treatment center,” says Fowler. “It evolved from an old cholera treatment facility and the evolution of care went from having no beds to having IVs, IV fluids, antibiotics and antimalarial [drugs]. We were only able to do hand-held point-of-care testing [of blood samples] but that was quite novel for treatment centers anywhere in the outbreak, even though that’s expected and routine almost everywhere else in the world.”

MORE: This Map Will Show You Every Ebola Outbreak in History

The key to helping Ebola patients survive their infection, Fowler and his colleagues saw, was hydrating them with IV fluids, ensuring that their blood work remained stable and addressing any changes in their metabolites as quickly as possible. In the first month of Ebola cases, 37 patients tested positive for the virus, 28 were treated with IV fluids and 16 died. While the death rate remained high, it was lower than that typically seen in other parts of West Africa.

“Our hypothesis has always been that we wanted to establish a culture of very aggressive supportive care for patients who were coming in dehydrated with electrolyte and metabolic abnormalities and try to correct those very early on, so the complications of very severe depletion don’t compound the effects of Ebola virus infection,” Fowler says.

MORE: Why Cuba Is So Good at Fighting Ebola

Fowler is convinced that the key to improving Ebola survival rates is to think about it differently. Instead of thinking of Ebola as an almost-always fatal disease, see it instead as one that is survivable with the right treatments, he says. If people understood that survival is possible—and at higher rates than previously thought—then more people who might be exposed or infected would seek care sooner rather than later, when it’s too late. “I truly do think we can change the way people think about this illness if we evolve the thinking from needing to have isolation facilities…to saying we need rapidly mobilized treatment facilities that can help care for patients with aggressive supportive care as early as possible,” he says.

Even with the dozens of patients he and his team saw at the treatment facility in Conakry, “we just weren’t keeping up with their fluid needs as much as we needed to,” he says. “Collectively as a team, we were thinking we were failing miserably in terms of our goal of delivering optimal care.”

To succeed takes an enormous amount of resources, labor and personnel. Health workers need to routinely draw and measure patients’ blood to track any slight negative changes in their physical state. Fowler acknowledges the need for drug treatments and an effective vaccine, but for now, as thousands of patients struggle to fight off the virus, “we really, really need more health care workers so we can spend enough time with patients and deliver the kind of supportive care that will improve their outcomes,” he says.

MORE: Nurse Explains Why She Fought Ebola Quarantine

Fowler admits the challenges facing recruitment. For starters, working with Ebola patients requires health care personnel to suit up in personal protective equipment that leaves no skin exposed, making them uncomfortable in the equatorial heat of the region. “We are nowhere near hitting the mark that needs to be hit to improve outcomes,” he says. But as data like his starts to build, best practices and the most effective ways to treat Ebola patients are emerging. And hopefully they will start to make a difference.

U.S. has previously committed $500 million and more than 3,000 troops

President Barack Obama is seeking more than $6 billion in emergency funds from Congress to fight Ebola in West Africa and prevent the virus from again reaching the United States.

If approved, the Associated Press reports, $2 billion would be allocated to the United States Agency for International Development (USAID) and $2.4 billion would be set aside for the Department of Health and Human Services. Another $1.5 billion would go to a contingency fund. With the new funding, the report adds, the U.S. would create dozens more treatment centers and secure additional safety suits.

Health officials have long warned that the U.S. is not safe from Ebola until the outbreak is stopped at the source in West Africa. New figures released by the World Health Organization on Wednesday detail the virus’ wrath in the region, with more than 13,000 reported cases, including some 4,800 deaths, as of Nov. 2.

The U.S. has previously committed $500 million to deploy more than 3,000 troops, some of whom are erecting treatment facilitates. As TIME reported in September, Obama also requested another $88 million from Congress, which included $58 million to speed up the development of experimental drugs.

The international community has been criticized by medical aid groups like Doctors Without Borders and the Red Cross for reacting too late to the outbreak.

[AP]

It's the only country besides the U.S. to send substantial human resources to West Africa

As the first nation to dedicate hundreds of health care workers to West Africa, Cuba is an unlikely hero in the Ebola outbreak.

In spite of not being among the wealthiest countries, Cuba is one of the most committed when it comes to deploying doctors to crisis zones. It has offered more than 460 Cuban doctors and nurses to West Africa, and currently, 165 are working there under the direction of the World Health Organization (WHO). More than 50,000 health care workers from Cuba are working in 66 countries around the world.

“Cuba is world-famous for its ability to train outstanding doctors and nurses,” said WHO director Margaret Chan in a Sept. press conference announcing Cuba’s surge of health care workers. In the same meeting, Cuban Minister of Health Roberto Morales Ojeda called on all countries to “join the struggle against this disease.”

But why is Cuba so uniquely prepared to treat Ebola? It comes down to a national priority that even has its own name, coined by academics: “Cuban Medical Internationalism.”

Cuba’s global health crisis response system is a Doctors Without Borders-like program, but instituted by the government. When Cuban doctors graduate medical school, they are given the opportunity to volunteer to be called upon for medical missions, like an Ebola outbreak or a natural catastrophe. Often, these are one to two-year commitments. To prepare for something like Ebola, health care workers not only undergo aggressive training for the specific disease they are treating, but they also take courses on the region’s culture and history as well.

“This is something built into the psyche of Cuban doctors and nurses—the idea that ‘I am a public servant,'” says Gail Reed, co-founder of Medical Education Cooperation with Cuba (MEDICC). “It’s coming from a commitment to make health care a universally accepted right.”

It started around 1960, shortly after the Cuban Revolution. A massive earthquake killed up to 5,000 people in Chile, and Cuba sent health care workers into the disaster aftermath. A few years later, a medical team of more than 50 people went into war-torn Algeria. In 1998, two major hurricanes—Georges and Mitch—ravaged Latin America and the Caribbean. Once again, Cuba went in. Even during Hurricane Katrina, a team of Cuban doctors trained to go into the U.S., but President Bush said it wasn’t necessary.

In 1998, Cuban medical teams discovered that they were treating a lot people who had never before had access to doctors, and they decided that leaving the health care systems as they found them was irresponsible. So Cuba founded the Latin American Medical School (ELAM), which offers scholarships to low-income students from around the world with the expectation that they will graduate and return to their home countries as health workers.

“There are not many schools founded on the belief that poor people can become doctors and serve their community and be part of the solution,” says Reed. More than 23,000 physicians from low-income communities in 83 countries (even the U.S.) have graduated from ELAM, and nearly 10,000 are currently enrolled.

Not surprisingly, Cuba’s leadership in the current Ebola epidemic has become political in the U.S.—Republicans are angry that a CDC worker recently went to Cuba for an Ebola meeting. And many argue that Cuba’s motivations aren’t purely altruistic. Some countries pay Cuba for their services, though price tags differ by country.

Others argue that Cuba’s deep reverence for solidarity among the marginalized is the real motivator and that working in countries that don’t provide adequate care to their own citizens is a political statement. Besides payment, Cuba also gains international goodwill and cooperation between countries. “The very fact that Cuba is the only other nation than the United States to contribute human resources to the Ebola crisis in a big way creates enormous international political capital, especially when most nations are unwilling to send their own people into the center of the calamity,” says Robert Huish, an assistant professor of international development studies at Dalhousie University in Canada.

On Oct. 17, Fidel Castro wrote an op-ed in the country’s state-run newspaper, arguing the U.S. and Cuba should work together on Ebola, if only for better coordination. “We will happily cooperate with U.S. personnel in this task, not in search of peace between these two states which have been adversaries for so many years, but rather, in any event, for World Peace, an objective which can and should be attempted,” Castro wrote.

At the very least, the Cuban model has a message for the international community: that local people can work for the greater health of their homelands, and that constant preparation is more sustainable than being caught off-guard. “Cuba’s lesson for us is that health, and global health in particular, needs to be addressed with pro-active, forward-looking commitment to strengthening health systems, not just by reacting to [disaster],” says Huish. Aid groups like the Red Cross and Doctors Without Borders have been calling for more physical boots on the ground, and so far Cuba has been the only country well poised to answer that call.

Read next: How Guinea Found the Best Way to Survive Ebola