Ugandan health workers hit by Ebola, causing panic

Ugandan health workers hit by Ebola, causing panic KAMPALA, Uganda: Health workers are among the dead in an Ebola outbreak in Uganda, spreading panic among those needed to help. Doctors and nurses did not at first know what they were facing, so failed to protect themselves, according to a lawmaker representing the western area at the center of the outbreak.

Experts say the Ebola subtype that sparked the outbreak is new and the classic Ebola symptoms were not always present, slowing diagnosis. "We are facing a crisis in health care here," said Jane Alisemera, the lawmaker representing Bundibugyo, the district 200 kilometers (120 miles) from Kampala where the outbreak has claimed at least 18 lives. Health workers "are scared and morale is low." "There is a very big shortage of nursing staff now at the hospital," she said. According to the Ministry of Health's latest figures, Bundibugyo has 93 suspected cases of Ebola, among them 22 deaths. Four health workers were among the dead in an outbreak that began on Aug. 20 but the disease was not confirmed as Ebola until Nov. 29.

Kenya moves to halt Ebola spread

The Ebola virus is one of the world's most deadly Kenya has set up screening centres on its borders with Uganda following an outbreak of the Ebola virus which has killed about 20 people.

The highly infectious virus has killed two health workers in western Uganda, where the outbreak was first reported.

Dr James Nyikal, the head of medical services in Kenya, said they are screening people entering the country and all facilities are on alert.

There is no known cure for Ebola, which is fatal in around 80% of cases.

Health authorities in Uganda say some 91 people have been infected with the current strain of the virus and experts from United States are helping to counter its spread.

Crisis

"The sad news is that our doctor and a senior clinical officer who were in critical condition have died at Mulago hospital in Kampala," Samuel Kazinga, the Bundibugyo district commissioner said.

Bundibugyo district is the most affected region - so far 36 people are still in local health centres.

"We are facing a crisis, health workers are scared and the morale is low, there is a very big shortage of nurses," Bundibugyo MP Jane Alisemera, told the Associated Press news agency.

Media reports say the doctors contracted the virus due to a lack of safety equipment.

http://news.bbc.co.uk/2/hi/africa/7130654.stm

Ebola Bundibugyo Wednesday Numbers

Back from the daily Task Force meeting. The group is getting larger every day, as planes fly in, and is both numerically and culturally more complex. I can easily count 8 different countries represented; there are probably more. The Africans and the MSF advance team showed up first, but the bajungu (whites) are increasing in force. It is oddly reassuring to hear those good old American accents from the CDC, and heartening to see four fresh young doctors on the ground.

The epidemiologists outnumber the clinicians I’m afraid. There must be a dozen people there with high graduate degrees working on the numbers, the transmission, the pattern . .. . But only three seeing patients. I have such great respect for all of them, but particularly those who are donning the head to toe PPE “Personal Protective Equipment” and caring for patients.

OK the numbers:

Cumulative cases 93 (controversial actually. Now that we have MSF, WHO, something like African Epidemiology Network, Ministry of Health, and CDC all wanting a say in who is a case and who isn’t, they don’t totally agree on this . . .also as wise Dr. Yoti pointed out, if numbers shoot up this week it can be a reflection of good surveillance, of contact tracing, not of a spike in the epidemic.)

New admissions to isolation units today: 4. Two were in Bundi and two in Kikyo.

Deaths: 21. But they decided not to include Jonah’s death in that number because he died in Kampala not Bundibugyo. Clearly he got his disease in Bundibugyo, so in my opinion 22 more accurately reflects the toll of the disease to date. Again one must bear in mind that there may have been others that were missed in the community.

Deaths in the last 24 hours: 3, all medical workers, Dr. Jonah Kule, clinical officer Joshua Kule, and nurse matron Rose.

Main discussion points: should public gatherings be banned, even weddings? Is it a mixed message to ban public gatherings and then travel in a film van to show an educational film about Ebola, if that attracts hundreds of people? The decision was: yes. Bag the film for now and educate in small groups. Should community educators be paid for their mobilization efforts? I bit my tongue when it was mentioned that would be too expensive, yet the lab plan is to fly samples every other day from Bundibugyo to Entebbe (at $600/flight??).

Specimens collected for testing and sent today on MAF: 28: the CDC has set up a lab in Entebbe at the Uganda Viral Research Institute. They have a few people in Bundi, not sure what all they do, but the main lab will be off site. They will try to leave behind a sophisticated lab that Uganda can then use to find answers on outbreaks like this much faster.

They said that the PCR (test for presence of virus by detecting the genetic material of the virus) has not been fully developed for this new strain, so we’ll have to rely on antigen detection (looking for various proteins the virus makes) which has “very good” sensitivity (read: we think it should work for this strain like it has for others to find all the cases but we don’t know the real numbers yet, so it is hard to feel too secure about a negative test) and 99% specificity (read, if you get a positive test, it really means you have the disease). They will tests all samples for the antigens (presence of the virus) plus antibodies (evidence of a person’s immune response, therefore indirect evidence of the virus).

Unfortunately not all the lab equipment arrived, so the first batch won’t be run until Friday.

Data I wish we had: non-Ebola district death and suffering, as a result of fear, of lack of health center staff, of patients running away. The usually bursting-full maternity unit was EMPTY. Maybe that’s fine, maybe that’s not fine and there will be dozens of dead babies or mothers or both in the wake of this.

http://paradoxuganda.blogspot.com/

Uganda: MPs Want Public Gatherings Banned Over Ebola
The Monitor (Kampala)

6 December 2007
Posted to the web 6 December 2007

Risdel Kasasira
Parliament

PARLIAMENT has demanded that the Ministry of Health bans all public gatherings in the country as a preventive measure against the deadly Ebola.

During a parliamentary debate yesterday, MPs called on Cabinet to suspend public gatherings like weddings, rallies and church masses.

The debate followed a statement by the Shadow Minister for Health, Mr Francis Epetait, who requested the government to compensate families of health workers who have died of the disease while treating patients. The MPs said handshakes and public gatherings expose the risk of spreading the disease that has so far killed four medical workers.

State Minister for Defence Ruth Nankabirwa said: “We should immediately ban these gatherings like Kwanjula and weddings because we don’t know who is carrying the disease now.”

Ibanda MP Otada Amooti said the Ministry of Health should treat the outbreak as a matter of urgency and “ban people who travel from the affected areas”

In response, Prime Minister Prof. Apollo Nsibambi said Cabinet would sit on Friday to decide on compensating families of the health workers who have died.

http://allafrica.com/stories/200712060122.html

Hundreds flee as Ebola cases rise to 93

First published: 20071206 4:53:36 AM EST

Ultimate Media

As Uganda continues the struggle to contain the deadly Ebola virus, hundreds of people are fleeing the affected districts of Bundibugyo, Kasese, Kabarole and Kyenjojo.

Reports from Mubende district health department indicate that hundreds of people are fleeing to the district. Those fleeing are mostly Bakonzo and Bamba from Kasese district.

The Director General of health services, Sam Zaramba this morning confirmed more three Ebola cases in Bundibugyo, pushing the total number of cases to 93. He says already twenty people have been confirmed dead including four medical officers.

Those fleeing their homes are currently settled in the sub counties of Nabyongola, Kasabya and Kigando in Mubende district.

However, there is no evidence to suggest whether some of those fleeing are carrying Ebola symptoms although no specific measures have been put in place to screen them. Mubende district boarders Kyenjojo one of the districts affected by Ebola.

Meanwhile, Mubende town council officials have banned food vending along Mubende - fort portal high way saying it could increase the risk of contracting Ebola. Kampala and Mbarara are other districts which have registered Ebola cases.

http://www.ugpulse.com//articles/daily/news.asp?ID=4544

Commentary

Deaths of Uganda Ebola Health Care Workers Cause Concern
Recombinomics Commentary
December 6, 2007

4 B’gyo hospital health care workers quarantined 1/12/07, following complaints of fever (Med Sup Bundibugyo, Dr Sesana, Dr Kule, Clinical officer, and 1 Nurse. So far all improving. Dr Kule in Mulago Isolation unit.

The above comments are from a December 3 weekly update of the Bundibugyo Ebola situation in Uganda. Earlier reports included concerns about hospitalized health care workers, and the above comments paint a fairly benign clinical course.

However, within 24 hours of the release of the report, three of the four health care workers were dead, as were two additional workers not mentioned in the report. The deaths of five health care workers raise serious questions about earlier reports on a low case fatality rate and potential containment due to virus burn-out.

Ebola was first identified as the etiological agent for the current outbreak, but the isolates were a new species that was had only 75% identity with earlier strains, suggesting that the new strain was a recombinant. Since new primers are under development, the lab confirmation of Ebola is far from ideal. Similarly, identification of four other infectious disease outbreaks in the area hamper identification of true Ebola cases, and the large number of cases that are still hospitalized limits the reliability of the case fatality rate, which is said to be low for Ebola, which can kill up to 90% of infected patients.

Although Ebola was not identified until Friday, the health care workers knew that patients were dying from an infectious disease, so they did take precautions, although full PPE’s were not available. Thus, the deaths of five health care workers within a 24 hour period raises concerns that transmission is relatively efficient, and suspect cases at additional locations raises concerns that the virus has already significantly spread.

Tracking down additional patients is hampered by community concerns of the deaths of hospitalized patients, which has greatly reduced the number of patients and workers in local hospitals.

The establishment of a local testing lab should clarify questions on the transmissibility and case fatality rate for the new species of Ebola in Uganda.

Well it’s a sad fact of life, but everybody’s gotta die of somethin’.

That’s a pretty strange statement to make. And I thought I was cynical. Yes we will all die of something but I certainly don’t’ want my cause of death to be from Ebola.

Mkjessup cica 1350: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be the Black Death.

Mkjessup cica 1750: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be Small Pox.

Mkjessup cica 1850: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be Yellow Fever.

Mkjessup cica 1918: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be the Influenza.

Mkjessup cica 1930: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be Polio.

Mkjessup cica 1980: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be AIDS.

Mkjessup cica 2007: Well it’s a sad fact of life, but everybody’s gotta die of somethin’. Might as well be Ebola.

Mkjessup cica 2008:………

I’m not suggesting that Ebola should be taken lightly either, however it is unlikely that there is any real defense against the virus (beyond strict quarantine), and if Ebola mutates into a virus which does not ‘burn out’ the victims as rapidly as in the past, the only possible way of containing an outbreak would be a global ban on commercial air travel, which would result in economic chaos at nearly every level of society.

Having said that, the plagues of the past did not result in the extinction of our species, although the death tolls were of course, tragic. But we are, if nothing else: resilient. The fact that we are all still here testifies to that fact.

My initial comment about ‘we all have to die from something’ wasn’t intended as cynical or uncaring commentary, but just an observation that we are all mortal, we are all indeed going to die, and some of us (speaking generally) will sadly die from disease, from violent crime, from accidents, from war, from any number of mishaps. Some (as Kenny Rogers said) will get the ‘best thing you can hope for’ which is to ‘die in your sleep’.

There is no cure for human mortality. Which makes it all that more important to obtain that Eternal Insurance (and Assurance) before the end of our earthly lives.

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