l. NPR interview this morning with representative from Doctors Without Borders (MSF) made it clear to me that a ‘buddy system’ is mandatory in ‘donning and doffing’ PPEs. MSF has treated 4000 EBOV patients in West Africa with only a few EBOV infections of HCW. MSF says it takes 50 hours to fly an infected MSF HCW out of West Africa to Europe for treatment; that long delay is causing a shortage of HCW volunteers for MSF.
2. Laurie Garrett of Council of Foreign Relations and author of ‘The Coming Plague’ was interviewed tonight on PBS said that WHO Situation Report today did not list caseload or deaths from EBOV for Liberia. No reliable data from Liberia because of lack of public health measures and spread of EBOV. Ms. Garrett estimates the current caseload in West Africa is 22,000 EBOV cases and 15,000 EBOV deaths, not the 9000 cases and 4500 deaths reported in the media.
3. NEJM on-line tonight contains a Perspective on the EBOV outbreak in DRC. The EBOV strain is EBOV Zaire; this strain is different than the strain in West Africa. The authors propose several possible reasons that the outbreak in DRC is much smaller than the outbreak in West Africa; the most plausible reasons are: DRC patients are isolated in remote jungle villages (no roads to larger settlements) and DRC has experience with 6 prior EBOV outbreaks and moved quickly to stop the DRC outbreak. See the entire NEJM article at: http://www.nejm.org/doi/full/10.1056/NEJMoa1411099?query=TOC
4. NY Times reports that the National Nurses United stated today that nurses caring for Mr. Duncan at Texas Health Presbyterian did not have proper PPEs or education. Dr. Frieden at CDC will investigate but confirmed some truth to these statements.
5. NY Times reports that CDC has made some changes to their recommended PPEs: hood covering neck in place of mask and googles only; standardization of PPE but specifics not stated.
6. President Obama had 2 hour meeting with his EBOV team at White House today. He demanded more ‘aggressive’ monitoring of EBOV contacts and investigation into how 2 Texas Presbyterian nurses contracted EBOV. No statement of an EBOV czar, so still no ‘command and control’ structure overarching EBOV containment in U.S. I believe the ‘czar’ should be a military commander assigned as the U.S. Surgeon General to command CDC, NIH, state agencies, etc.
Dr. Gandhi, the Mahatma’s grandson, said today on NPR that we do not have the luxury of pessimism with respect to the world’s problems. If each of us does not remain hopeful and working, then the world cannot be saved.