l. NY Times reports that the new CDC Guidelines for Ebola Monitoring at: http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html#table-monitoring-movement differ from NY/NJ guidelines which differ from U.S. Army guidelines. So no wonder political parties and candidates are ‘stirring the pot’ with elections this coming Tuesday. While this debate in the media takes place, Dr. Jim Kim, President of the World Bank, reports that 5000 HCW are needed in Liberia, Sierra Leone, and Guinea, and they are not forthcoming. The African Union countries have promised 2000 workers, but none delivered to date. Caseloads and deaths continue to mount and supplies are low in these three West African countries.
2. Figure 2 of this week’s CDC Morbidity and Mortality Weekly Report (October 28) shows one reason the West Africa caseload is exponentially expanding: the highest concentration of cases are in Freetown, Sierra Leone, and Monrovia, Liberia. Both are large urban cities with crowded conditions. The concentration of cases fans out from these large cities along major roadways when you match concentration maps to Google terrain maps. See: http://www.cdc.gov/mmwr/pdf/wk/mm63e1028.pdf with Figure 2.
3. NEJM has published on-line an editorial by its editors stating their opinion that mandatory quarantines of EBOV HCW does not do any good. See: http://www.nejm.org/doi/full/10.1056/NEJMe1413139?query=featured_ebola for the editorial. Yet the editorial adds to the confusion about exactly when infected Ebola patients become contagious. Dr. Fauci has stated that RT-PCR tests may be positive up to 20 hours before symptoms. Dr. Drazen in his editiorial states that fevers in Ebola patients may develop 2-3 days before RT-PCR becomes positive. There is agreement that the larger the viral load, i.e., the more symptomatic the EBOV patient, the greater the risk for contact infection. I believe the U.S. Army has made the best decision re: isolation and monitoring: the Army does it for everyone involved in affected countries for 21 days. For civilians one half the isolation could be done in country in unaffected region, and the other half of the isolation (one week and pre and post weekends) in the U.S. That type of isolation shouldn’t dissuade committed volunteers to West Africa.
4. Ms. Vinson, the second nurse infected by contact with Mr. Duncan, was discharged from hospital today without any EBOV in her blood.
There is one bit of good news today: Dr. Karen DeSalvo, who has experience in federal government and epidemiology, has been transferred to Secretary Burwell’s office to help the Secretary manage EBOV in the U.S. So medicine/science is now a part of The White House mission to end EBOV in the U.S.