National Doctor's Day! Lets Celebrate the Profession!

Medic-ALL (03:30:2015) PROFESSION

Its National Doctors Day today, the 30th of March in the U.S and there truly is a lot to celebrate about the profession that makes it absolutely necessary to have a day set aside Doctors to reflect on the evolution of medicine and appreciate the quality of physician care today.

Doctors have come a long way from the ancient healers they once were thousands of years ago. The profession has survived many transformations with the unfailing commitment to maintaining and improving human health.

The U.S. Senate and House officially declared March 30 as National Doctor’s Day in 1990, however, it’s been celebrated for decades longer, according to the National Doctor’s Day website. In 1933, Dr. Charles B. Almond’s wife Eudora recognized the dedication, discipline, and aptitude that was required of her husband and his colleagues every day in their practice.


The Wonders You Call Doctors

When you feel sick or in pain, whether it's the body or mind, you seek doctors to restore you back to health. Doctors improve the quality and length of life through helping to manage and defeat the many diseases and conditions that plague people all over the world. Doctors reassure and empathize with the "sickest" of patients and comfort those in the most broken conditions. It has to be one of the most difficult jobs anywhere in the world. 


There are challenges facing the world of medicine and particularly doctors today especially as It concerns certain medical conditions with no known cure, but such challenges can only demand more of medicine.It has taken thousands of years to accumulate the knowledgd doctors have today, and modern medicine will continue to improve and ensure a better living and healthier future. 

Ref:Medical Daily

Getting into U.S Residency: Experience That Counts

Medic-ALL 03:20:2015

Yet another matching season is rounding up and while many medical graduates are celebrating their acceptance into residency programs across the United States, a good number are left to wonder what went wrong with their application and were they might have missed it. 

It is now common knowledge to Foriegn medical graduates pursuing residency programs in the U.S that matching into a U.S residency program depends mostly on good USMLE scores, visa status and U.S clinical experience (USCE)

There’s no doubt that US clinical experience or USCE, is a vital part of the residency application. As a bonus, your USCE can also provide another valuable boost to your application, in the form of strong letters of recommendation. But many applicants find themselves overwhelmed or confused when trying to decide what type of experience will boost their application.


Continue READING HERE

Conjoined Twins Sharing a Heart delivered in Atlanta!

Medic-ALL (05:12:2014)

A set of conjoined male twins sharing a heart, torso, arms and legs, were born, early Thursday in an Atlanta hospital, in the United States, marking a medical rarity as many such babies do not survive delivery

Asa and Eli Hamby - who can never be separated as they share a heart and circulatory system - were welcomed into the world at 7.32am(EST) via a pre-planned (elective) Caeserean section to parents Robin (Mum) and Michael (Dad) and according to a dedicated 'Hamby Twins' Facebook page are healthy and well.

The rare and extremely risky pregnancy was carried through to 37 weeks and Robin and Michael traveled from Alabama to Atlanta's Northside Hospital for specialist care.

Born with two heads, but sharing one body, the condition Asa and Eli have is known as dicephalic parapagus - an extremely unusual form of conjoinment, affecting only one-in-a-million births.

Shortly after the birth of the twins however, the Mother of the babies was told there was a slight issue with her sons' heart, but that they are doing well.

"There is an issue with the right side of the heart. The left side is perfect. The right side has like an extra atrium and an extra ventricle, and there's two aortas. One of the arteries is like switched, not in the right place because of having extra ones, but he said that their vital signs are stable,' said the mum to the Ledger Enquirer (a local newspaper).

Conjoined twins generally occur once in every 200,000 live births and most do not survive, according to the University of Maryland Medical Center. About 40 to 60 percent are stillborn, and about 35 percent live only one day.

The newborn brothers were given medication for their joint heart and intubated to help them breathe, Michael Hamby told the Columbus Ledger-Enquirer newspaper on Thursday morning.

Sadly, Doctor loses Ebola Battle, Dies in Omaha

Medic-ALL (17:11:2014) Courtesy New York Times 

WASHINGTON — This time, the challenge of Ebola was much steeper for the doctors and nurses at Nebraska Medical Center, one of a handful of hospitals specially designated to handle cases of the deadly virus in the United States.

Unlike the two Ebola patients they had successfully treated earlier this year at the hospital’s biocontainment unit in Omaha, the man who arrived from Sierra Leoneon Saturday, Dr. Martin Salia, was in extremely critical condition. Dr. Salia, a legal permanent resident of the United States who had been working as a surgeon in Sierra Leone, died early Monday morning, barely into his second day of treatment, but almost two weeks into his illness.

The Late Dr Martin Saila

“Even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold,” said Dr. Jeffrey P. Gold, chancellor of the University of the Nebraska Medical Center, the hospital’s academic partner.

Dr. Philip Smith, the medical director of the biocontainment unit, said that Dr. Salia, 44, had initially been tested for Ebola in Freetown, the capital of Sierra Leone, on Nov. 7, but that the test came back negative. He was retested there on Nov. 10, at which point the results were positive. Dr. Smith said such false negatives were not uncommon early in the illness.

Dr. Daniel W. Johnson, a critical care specialist at Nebraska Medical Center, said that Dr. Salia’s kidneys had stopped functioning and that he was laboring to breathe when he arrived at the hospital late Saturday afternoon after a 15-hour flight. Doctors quickly tried two treatments they had used on their other Ebola patients: an experimental antiviral drug and a plasma transfusion from theblood of an Ebola survivor, which researchers believe may provideantibodies against the virus.

But Dr. Salia was already so ill that within hours of his arrival at the hospital, he needed continuous dialysis to replace his kidney function. By the pre-dawn hours of Sunday, he was in respiratory failure and needed a ventilator, Dr. Johnson said on Monday. Around the same time, he added, Dr. Salia’s blood pressure plummeted.

“He progressed to the point of cardiac arrest, and we weren’t able to get him through this,” Dr. Johnson said at a news conference in Omaha. “We really, really gave it everything we could.”

Dr. Smith said he did not know how Dr. Salia had contracted the virus. “He worked in an area where there was a lot of Ebola disease, much of it probably unrecognized,” Dr. Smith said, “and there were many opportunities for him to have contracted it.”

In the frenetic neighborhood of Kissy, on the eastern end of Freetown, an eerie quiet hung over the United Methodist Hospital on Monday as news spread that Dr. Salia had died. He was the chief medical officer and the only surgeon at United Methodist Kissy Hospital, according to United Methodist News Service.

Leonard Gbloh, the administrator of the hospital, said he did not think Dr. Salia could have contracted Ebola there.

“We have not been taking Ebola patients here” he said. “And we had stringent control measures in place to prevent it entering.”

The hospital even stopped all surgical work several months ago as a precaution, Mr. Gbloh said. Now, the hospital is being decontaminated and several staff members who came into contact with Dr. Salia after he fell ill are in quarantine there.

U.S free of Ebola case as New York Doctor is Cleared!

Washington Post (10:11:2014) by Mark Berman

The doctor who contracted Ebola in West Africa before returning to New York City has been declared free of the virus, hospital officials announced Monday. This news means that 41 days after the first Ebola diagnosis in the United States, there are no known cases of the virus in the country.

Craig Spencer, 33, who had been treating Ebola patients in Guinea, was diagnosed with Ebola on Oct. 23. Bellevue Hospital Center in New York City, where Spencer was being treated, confirmed in a statement Monday that he “has been declared free of the virus.” Spencer will be discharged on Tuesday, according to the hospital. (News of his release was first reported Monday by theNew York Times.)

Spencer’s diagnosis created concerns in New York, as the news of his illness was followed by the revelation that he visited a popular restaurant and coffee shop, rode multiple subway lines and went to a bowling alley and bar in Brooklyn. As city officials preached caution and calm,“disease detectives” fanned out to visit the places Spencer had gone and visit the people with whom he had interacted.

After returning to New York, Spencer had been self-monitoring and taking his temperature. He reported a fever of 100.3 degrees on Oct. 23, two days after he began feeling sluggish, and was taken to the hospital and isolated. He was the fourth person diagnosed with Ebola in the United States and the only one of this group to contract the disease after treating patients overseas. (Other people responding to the epidemic in West Africa have been diagnosed and brought back to the country for treatment.)

His diagnosis also sparked a panic among authorities, as the governors of New York and New Jersey hurriedly announced that they would quarantine any medical workers returning from West Africa, a highly-criticized move that went against the advice of public-health officials. This drama spilled up the East Coast, as a nurse who had treated patients in West Africa (and had no symptoms of Ebola) was quarantined in New Jersey and had a prolonged confrontation with authorities in Maine over her treatment.

The first person diagnosed in this country, Thomas Duncan, was a Liberian man who contracted it before flying to Texas in September; two nurses who treated Duncan were infected during his hospitalization. Duncan died eight days after he was diagnosed, becoming the only person to die from Ebola in the United States, while the Texas nurses who contracted Ebola were both treated and declared safe. The news that Spencer was cleared came three days after the last person being monitored for Ebola in Texas was also cleared, ending the Ebola saga there.

More than 350 people were being actively monitored by the New York City health department for Ebola as of last week, the department said in a statement. Most of these people had traveled to New York City from Liberia, Guinea or the Sierra Leone, but that number also included Bellevue staff members treating Spencer and lab workers who took his blood.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday that people should be reassured by the fact that tried-and-true approaches, such as contact-tracing and active monitoring, have helped to prevent broader transmission of the disease in the United States.

“In fact, it has worked,” he said, noting that contacts of patients in Dallas have all been cleared and that people who interacted with Spencer so far appear healthy.

“That doesn’t mean we are not going to see another case; it’s possible we will,” he said. “[But] I think we are pretty well prepared.”

Medic-ALL.Inc.2014

New York Doctor with Ebola after return from Guinea

By Ellen Wulfhorst and Sebastian Malo

NEW YORK (Reuters) - A doctor who worked in West Africa with Ebola patients was in an isolation unit in New York on Friday after testing positive for the deadly virus, becoming the fourth person diagnosed with the disease in the United States and the first in its largest city.

The worst Ebola outbreak on record has killed at least 4,900 people and perhaps as many as 15,000, mostly in Liberia, Sierra Leone and Guinea, according to World Health Organization figures.

Only four Ebola cases have been diagnosed so far in the United States: Thomas Eric Duncan, who died on Oct. 8 at Texas Health Presbyterian Hospital in Dallas, two nurses who treated him there and the latest case, Dr. Craig Spencer.

Spencer, 33, who worked for Doctors Without Borders, was taken to Bellevue Hospital on Thursday, six days after returning from Guinea, renewing public jitters about transmission of the disease in the United States and rattling financial markets.

Three people who had close contact with Spencer were quarantined for observation - one of them, his fiancée, at the same hospital - but all were still healthy, officials said.

Mayor Bill de Blasio and Governor Andrew Cuomo sought to reassure New Yorkers they were safe, even though Spencer had ridden subways, taken a taxi and visited a bowling alley between his return from Guinea and the onset of his symptoms.

"There is no reason for New Yorkers to be alarmed," de Blasio said at a news conference at Bellevue. "Being on the same subway car or living near someone with Ebola does not in itself put someone at risk."

Health officials emphasized that the virus is not airborne but is spread only through direct contact with bodily fluids from an infected person who is showing symptoms.

After taking his own temperature twice daily since his return, Spencer reported running a fever and experiencing gastrointestinal symptoms for the first time early on Thursday. He was then taken from his Manhattan apartment to Bellevue by a special team wearing protective gear, city officials said.

He was not feeling sick and would not have been contagious before Thursday morning, city Health Commissioner Mary Travis Bassett said.

Owners of the bowling alley he visited said they had voluntarily closed the establishment for the day as a precaution. But the driver of the ride-sharing taxi Spencer took was not considered to be at risk, and officials insisted the three subway lines he rode before falling ill remained safe.

"We consider that it is extremely unlikely, the probability being close to nil, that there would be any problem related to his taking the subway system," Bassett said.

The U.S. Centers for Disease Control and Prevention (CDC) will confirm Spencer's test results within 24 hours, she said.

RESIDENTS, INVESTORS RATTLED

His case brings to nine the total number of people treated for the disease in U.S. hospitals since August, but just two - Duncan's nurses - contracted the virus in the United States.

The New York case surfaced days after dozens of people who were exposed to Duncan emerged from the 21-day incubation period with clean bills of health, easing a national sense of crisis that took hold when his nurses, Nina Pham and Amber Vinson, became infected.

"I'm really concerned," said Kiki Howard, 26, a student who lives on the block next to Spencer's home in Harlem. "There's a school at the end of the block. My main concern is for the safety of the children."

The health commissioner said Spencer's apartment was isolated and sealed off, noting, "I see no reason for the tenants in the apartment building to be concerned."

Still, there were signs that the latest Ebola case had unnerved investors. S&P futures fell 9 points or 0.45 percent. The dollar slipped against the euro and the U.S. 10-year Treasury rose, lowering its yield to about 2.24 percent.

The city health commissioner said Spencer completed work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York on Oct. 17. His Facebook page, which included a photo of him clad in protective gear, said he stopped over in Brussels.

Spencer has specialized in international emergency medicine at Columbia University-New York Presbyterian Hospital in New York City since 2011.

Columbia, in a statement, said he has not been to work nor seen any patients since his return.

A woman named Morgan Dixon was identified on Spencer’s Facebook page as his fiancée. Her Linked-In profile said she worked in nonprofit management and international development with the Hope Program, a career development agency for homeless and welfare-dependent adults.

The CDC did not name Spencer but said he "participated in the enhanced screening" instituted for all travelers returning from Guinea, Liberia and Sierra Leone this month at five major U.S. airports - including Kennedy.

The doctor "went through multiple layers of screening and did not have a fever or other symptoms of illness", the CDC said in a statement.

End of 21-day Quarantine for Family of Ebola Patient

USA Today News (20:10:2014)

People who had contact with Ebola patient Thomas Eric Duncan before he was hospitalized are breathing a sigh of relief today.

Those 48 contacts, including four family members who shared a small Dallas apartment with him, have completed the 21-day observation period without falling ill and are no longer at risk of the disease. About 10 of the 48 contacts were considered to be a higher risk because of their closer contact with Duncan.

Ebola has an incubation period of up to 21 days, according to the World Health Organization. People who are exposed to an Ebola patient who don't become sick during that time are considered to be out of the woods.

That's welcome news to Dallas and U.S. public health officials, who have struggled to contain Ebola since Duncan's diagnosis at Texas Health Presbyterian on Sept. 28. Duncan died Oct. 8.

Last week, two of Duncan's nurses were diagnosed with Ebola and have been moved to specialized hospitals. Other health workers who treated Duncan during his hospital stay continue to monitor themselves for fever and other symptoms.

In Spain, a nursing assistant appears to have recovered from the Ebola virus, the Associated Press reported Sunday.

The good news for Duncan's family should also reassure Americans about a fact that public health officials have been emphasizing for weeks -- that Ebola is not spread through casual contact -- said Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine.

Dallas Health officials quarantined 4 members of Duncan's family after he was diagnose, ordering them not to leave the small apartment they shared with Duncan. Officials worried that the family was at risk

not just because they spent time with Duncan while he was sick but also because they stayed in an apartment with his soiled bed linens after he was hospitalized.

The fact that Duncan's family remained healthy even as two of his nurses became infected illustrates the peculiar nature of Ebola, said Peter Hotez, dean of the National School of Tropical Medicine and professor at Baylor College of Medicine in Houston.

Although the West Africa outbreak of Ebola has a 70% mortality rate, the virus is actually not very contagious in the early stages of disease when people are most likely to circulate in the community, Hotez said. Ebola doesn't spread through coughs and sneezes, only through direct contact with bodily fluids.

Even then, people aren't contagious at all until they begin showing symptoms such as a fever. Before symptoms appear, levels of the virus in their blood are too low to be measured, Hotez said.

Yet Ebola is frighteningly infectious at advanced stages of the disease, when the virus begins multiplying out of control and patients begin producing large amounts of diarrhea, vomit and blood. At that point, even a tiny amount of blood is teeming with Ebola, which puts nurses and caregivers at high risk, Hotez said.

Few people in the general community are exposed to Ebola patients who are that contagious, because patients at that stage are usually too sick to move around. Most are hospitalized if a bed is available. In West Africa, patients who can't get to a hospital are bedridden and typically attended by relatives.

Those aspects of Ebola help explain why, on average, people in West Africa spread the disease to only one or two other people, said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. In contrast, people with an airborne virus such as measles can spread the disease to 14 susceptible people.

Ebola has spread in West Africa because of burial rites that aren't practiced in the USA, in which relatives of the deceased touch the body and prepare it for the grave.

Only about 15% of Ebola cases in West Africa involve children, reflecting the fact that children are rarely home caregivers, Offit said.

Ebola In America: Nigerian Flight raises Fears

Medic-ALL (17:10:2014)

A man died on a plane from Nigeria landing at Kennedy Airport in Queens early Thursday, sparking fears that the deadly Ebola virus had finally touched down in New York, sources said.

Unnamed man aboard an Arik Air flight from Lagos, Nigeria, died an hour before the plane landed at Kennedy Airport

.

Centers for Disease Control and Health Department members in protective gear swarmed the Arik Air flight landing at JFK’s Terminal 4 after the 63-year-old man, a U.S. citizen, died on the plane about an hour before landing at 5:45 a.m.

The Arik air plane had departed from Lagos, officials said.

The man, who was traveling alone, was vomiting profusely and complaining of chest pains before he died of an apparent heart attack, a Port Authority source said.

Passengers were held on the plane for about 45 minutes after arrival as CDC officials determined that the dead passenger didn’t have the disease that’s infected more than 7,500 people in the West African countries of Liberia, Sierra Leone, Guinea and has recently surfaced in Dallas.

The United States has recently been hit by the deadly Ebola virus that has ravaged parts of West Africa in the past months with three cases diagnosed on U.S soil and five others infected in the West Aftrican outbreak treated in the U.S.

About  3400 people have died from the outbreak as the world continues to fear a pandemic.

Ref: DailyNews, New York

Ebola: Containing The Spread...How Feasible?

Medic-ALL (13:10:2014) by Kayode Kuku

Nearly 3 months ago, the news of a Liberian-American infected with the Ebola virus entering into Africa's most populous nation, Nigeria filled the air and the spotlight was on the African continent, particularly the West African countries; Guinea, Sierra Leone and Liberia that had been ravaged by the outbreak of the  deadly disease many months before one of Africa's biggest economies was hit by the news of the "immigrant" index patient ; a remarkable 38 years after the first recorded outbreak in the Democratic Republic of Congo in 1976.

Fears were raised at the time as to the the likelihood of the virus to spread to other parts of the world as many believed the alarming spread in the lesser developed West African countries may have been due to sub-standard level of their healthcare systems. 

HOW MUCH ATTENTION AND ASSISTANCE DID THIS COUNTRIES REALLY GET FROM THE INTERNATIONAL COMMUNITY before the Nigeria incident was reported late July?

In a Medic-ALL blog post titled "Ebola; Will it Keep Spreading" at the outset of the now aborted outbreak in Nigeria, it was reported that Public health experts expect the virus to reach other parts of the world including the United States but unlikely to spread in regions with well-funded hospitals and standard infection-control procedures. Barely months later and the news of the first case diagnosed in the United States and then another case of an infected healthworker in Spain were reported, raising worldwide fears of a pandemic if more austere measures are not in place to contain the virus and its spread from continent to continent. ARE WE REALLY WINNING ?

More disturbing news emanated yesterday, with the United States confirming a second case involving a female nurse at the Texas Health Presbyterian Hospital infected as a result of an unknown breech in hospital Protocol and was confirmed positive for the virus on Sunday afternoon according to the CDC. She is said to have attended to Duncan (the first U.S patient) after his second visit to the emergency room on September 28 and followed all CDC precautions including wearing of masks ,gowns, gloves and protective face shield. The CDC's Thomas Frieden in a statement outlined several steps taken to care for the health worker and prevent the infection of others, he however said more cases of the deadly virus may be likely.

There is no doubt that we are dealing with a highly transmissible and truly lethal disease that deserves worldwide attention. The question of whether the virus will "Keep spreading" seems to be getting answered on a daily basis and the staggering figures of the lives that have been claimed so far, particularly in the West African region is enough to put the whole world on our toes.

Containing the spread of the virus in countries with reported cases is most paramount at this stage and it is obvious that this will require not just a "well-funded healthcare system" but a step up in our standard infection-control procedures worldwide, as Frieden highlighted that taking off protective equipment- gowns, gloves, face masks and goggles is one of the greatest areas of contamination and risk. Certainly there is need for a new note of urgency to this outbreak , this cannot be over-emphasized.

Medic-ALL.Inc 2014 

First Ebola Patient Dies in the U.S

Medic-ALL (08:10:2014)

The first Ebola patient diagnosed in the U.S. died this morning in Dallas at 7:51 A.M. local time. The sad news was announced by the facility offering his care, Texas Health Presbyterian Hospital Dallas, in an emailed statement this morning that read:

 

“It is with profound sadness and heartfelt disappointment that we must inform you of the death of Thomas Eric Duncan this morning at 7:51 am. Mr. Duncan succumbed to an insidious disease, Ebola. He fought courageously in this battle. Our professionals, the doctors and nurses in the unit, as well as the entire Texas Health Presbyterian Hospital Dallas community, are also grieving his passing. We have offered the family our support and condolences at this difficult time.”

 

Texas health official David Lakey, commissioner of the state’s health department, also offered his condolences to the family and said, in a statement, that the past week was an “enormous test of our health system.”

 

The patient, who had been admitted to the hospital on September 28 after contracting the virus in Liberia, had been placed on a ventilator and was receiving dialysis in the final days before his death. 

Courtesy : Scientific American

CONTAINING EBOLA: Learning From Nigeria

Medic-ALL (05:10:2014) 

Ref: Washingtonpost

After several months of the Ebola outbreak and devastating reports streaming out of West Africa where the deadly virus has overwhelmed already weak public health systems and left thousands of people dead, anxiety has begun to grip in the United States over the first case of Ebola diagnosed in the country, one West African nation serves as an example of hope: Nigeria, which appears to have successfully contained  the Ebola virus, with no new case reported in the country since the 31st of August 2014.

As concerns spread over the readiness of U.S. hospitals , there are some lessons to be learned from Nigeria, where officials managed to get ahead of the fast-moving virus after it was brought into Africa's most populous country by an Ebola-infected Liberian-American man who had flown into Lagos from Liberia for an ECOWAS meeting.

As in the U.S. case, Ebola arrived in Nigeria by passenger plane. But unlike Thomas Eric Duncan — who arrived in Dallas before he became symptomatic and was therefore not contagious during his flights from Liberia to Texas through Brussels and Dulles International Airport — Patrick Sawyer was already symptomatic when he landed in Lagos on July 20. At that point, Sawyer, Nigeria's Patient Zero, was contagious and dying.

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. As Sawyer was placed in isolation, public health officials had to track down every single person who'd come into contact with him, from the flights he'd boarded to the Lagos airport and the private hospital where he went after landing. And they had to do so quickly, making the process known as contact tracing a priority.

"In the whole system approach in beating the war on Ebola, contact tracing is the key public health activity that needs to be done," said Gavin MacGregor-Skinner, who helped with the Ebola response in Nigeria with the Elizabeth R. Griffin Research Foundation. "The key is to find all the people that patient had direct close contact with."

From that single patient came a list of 281 people, MacGregor-Skinner said. Every one of those individuals had to provide health authorities twice-a-day updates about their well-being, often through methods like text-messaging. Anyone who didn't feel well or failed to respond was checked on, either through a neighborhood network or health workers.

Nigeria is said to have taken a "whole community approach," with everyone from military officials to church elders in the same room, discussing how to handle the response to the virus.

Such an approach, and contact tracing in general, requires people be open and forthright about their movements and their health, he said. Stigmatization of patients, their families and contacts could only discourage that, so Nigerian officials sent a message to "really make them look like heroes," MacGregor-Skinner said.

"This is the best thing people can do for Nigeria: They are going to protect and save Nigeria by being honest, by doing what they need to do, by reporting to the health commission," he said. This made people feel like they were a part of something extremely important, he said, and also took into account real community needs. "You got real engagement and compliance from the contacts. They're not running and hiding."

In Nigeria, Sawyer had come into contact with someone who ended up in Port Harcourt, Rivers State That person, a regional official, went to a doctor who ended up dying from Ebola in August. Within a week, 70 people were being monitored. It ballooned to an additional 400 people in that one city.

Success stories of people coming through strict Ebola surveillance alive and healthyhelped encourage more people to come forward, as they recognized that ending up in a contact tracer's sights didn't mean a death sentence.

In the end, contact tracers — trained professionals and volunteers — conducted 18,500 face-to-face visits to assess potential symptoms, according to the CDC, and the list of contacts throughout the country grew to 894. Two months later, Nigeria ended up with a total of 20 confirmed or probable cases and eight deaths.

The CDC also pointed to the robust public health response by Nigerian officials, who have had experience with massive public health crises in the past — namely polio in 2012 and large-scale lead poisoning in 2010.

When someone is on a contact list, thatdoesn't mean that person has to stay at home for the entire incubation period of 21 days from the last contact with someone who had Ebola. People on contact lists are not under quarantine or in isolation. They can still go to work and go on with their their lives. But they should take their temperature twice a day for 21 days and check in with health workers.

Officials in Texas began with a list of about 100 names; they have whittled the list down to 50 people who had some contact with Duncan. Of those, 10 are considered high-risk.

The CDC recommends that people without symptoms but who have had direct contact with the bodily fluids of a person sick with Ebola be put under either conditional release, meaning that they self-monitor their health and temperature and check in daily, or controlled movement. People under controlled movement have to notify officials about any intended travel and shouldn't use commercial planes or trains. Local public transportation use is approved on a case-by-case basis.

When symptoms do develop, that's when the response kicks into high gear. People with Ebola are contagious only once they begin exhibiting symptoms, which include fever, severe headaches and vomiting.

While four people in Dallas are under government-ordered quarantine, that is not the norm. Those individuals "were non-compliant with the request to stay home. I don’t want to go too far beyond that," Dallas County Judge Clay Lewis Jenkins said Thursday.On Friday, the four people were moved to a private residence from the apartment where Duncan had been staying when he became symptomatic.

A law enforcement officer will remain with them to enforce the order, and none of the people are allowed to leave until Oct. 19.

Duncan is the only person with an Ebola diagnosis in Dallas, and no one else is showing symptoms at the moment. But, as Nigeria knows, the work in Dallas has just begun.

Washingtonpost article by Elahe Izadi

U.S Ebola Patient: Family Quarantined

Courtesy Medpage Today by Michael Smith

The family of the Dallas Ebola patient has been quarantined so they can be monitored twice a day for symptoms of the virus, according to a Texas health official.

The so-called "control order" was issued in order to ensure the family members would be available for the monitoring, according to David Lakey, MD, the commissioner of the Texas Department of State Health Services.

They're among about 100 people being assessed for possible exposure to the patient, identified as Thomas Eric Duncan, while he was symptomatic, Lakey told reporters in a joint telebriefing between the CDC and Texas officials.

But Lakey and other Texas officials didn't explain why the quarantine order was needed, except to say they were concerned that the family might not be properly monitored -- with temperatures taken twice daily -- without it.

In a later news conference, Dallas County Judge Clay Lewis Jenkins, the country's chief executive, said he and other officials had information that suggested the order was "appropriate ... for the safety of the family and the safety of the public."

But he said he would not be disclosing the information.

Earlier, Lakey said food and groceries were being delivered to the family and a cleaning organization would be brought in to decontaminate the apartment and safely to remove soiled sheets, laundry, and other potentially contaminated items.

At the moment, he said, the family members have no symptoms and pose no risk to others.

Lakey also said the man was sent home with antibiotics after his first appearance at Texas Health Presbyterian Hospital even though he had told a nurse that he had been in Liberia. "Unfortunately, connections weren't made between the travel history and symptoms," he said.

He said the case is a "lesson for all of us ... across the U.S., people don't take the travel history as seriously as they need to."

CDC Director Tom Frieden, MD, said the lapse is "a teachable moment."

The officials gave no details of Duncan's condition, except to say that it is serious. Frieden added that the use of experimental therapies is "being discussed" and decisions will rest with the treating physician and the patient.

Several of the American Ebola patients airlifted from West Africa for treatment in the U.S. were given investigational therapies, but it remains unclear what effect they had.

The "bottom line," Frieden said, is that "we remain confident that we can contain any spread of Ebola within the United States."

He said some of the people in Dallas who were in close contact with Duncan might have been infected, but systems are being put in place so that those infections won't spread.

That requires "meticulous and rigorous" work to assess possible contacts and identify those who are at risk and need to be monitored for 21 days, Frieden said. CDC experts, as well as state and local officials, are doing that work now, he said.

Indeed, "the risk of an ongoing or uncontained outbreak in the U.S. is highly unlikely within our public health and medical infrastructure," commented Steven Lawrence, MD, of Washington University School of Medicine in St. Louis.

And the infection is unlikely to spread within the hospital where Duncan is being cared for, he told MedPage Today in an email: "We know how to contain it ... the infection prevention methods are effective when used properly."

UPDATE: U.S Diagnose First Ebola Case

Medic-ALL (01:10:2014) 

The United States yesterday confirmed its first case of the deadly Ebola virus, according to the Centre for Disease Control and Prevention. This marked the first appearance of the disease which has ravaged parts of the African continent over the last few months in the country.

Officials of the Texas Health Presbyterian Hospital in Dallas, United States had earlier said in a statement on Monday, the 29th of September , that an unnamed patient was being tested for Ebola and had been placed in "strict isolation" due to presenting symptoms and recent travel history.

In a news conference on Tuesday by the Director of the Center for Disease Prevention and Control, Thomas Freiden , the body stressed it's confidence to control the situation and keep the virus from spreading in the United States.

It has been revealed that the infected man left Liberia on September 19 and arrived the U.S the next day to visit family members. Health officials are working to identify anyone who may have been exposed to the patient. A handful of people may in the coming days be monitored to see if symptoms of the deadly virus emerge, according to the Director.

Until now, the only known cases of Ebola in the U.S. involved American doctors and aid workers who were infected and returned to the country for treatment. One of them, Richard Sacra, was discharged last weekfrom a Nebraska hospital. Days later, the National Institutes of Health in Bethesdaadmitted an American physician who was exposed to the Ebola virus in Sierra Leone. There were reports of possible Ebola patients in New York, California, New Mexico and Miami, but all of them tested negative for the virus.

The unidentified person with Ebola is being treated in intensive care at Texas Health Presbyterian Hospital Dallas, according to Edward Goodman, the hospital's epidemiologist.

People who traveled on the same plane as this man are not in danger because he had his temperature checked before the flight and was not symptomatic at the time, Frieden said. Ebola is only contagious if the person has symptoms, and can be spread through bodily fluids or infected animals but not through the air.

"There is zero risk of transmission on the flight," Frieden said.

Medic-ALL.Inc 2014

Ref: washingtonpost