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PostPosted: Thu Aug 07, 2014 10:38 am 
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House committee meeting at 2 PM EDT today.

http://foreignaffairs.house.gov/hearing ... ola-threat

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PostPosted: Thu Aug 07, 2014 10:41 am 
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Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations | 2172 Rayburn House Office Building Washington, DC 20515 | Aug 7, 2014 2:00pm to 5:00pm
Chairman Smith on the hearing: “The Ebola virus had been contained in one small area of Central Africa for years. Even when there was an outbreak, such as in Uganda, international cooperation was able to prevent a broader spread of the disease. This hearing will examine current international efforts to meet the challenge of the worst outbreak of Ebola in history.”

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PostPosted: Thu Aug 07, 2014 10:42 am 
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Witnesses
Panel I

Tom Frieden, M.D.
Director
Centers for Disease Control and Prevention

Ariel Pablos-Méndez, M.D.
Assistant Administrator
Bureau for Global Health
U.S. Agency for International Development

The Honorable Bisa Williams
Deputy Assistant Secretary
Bureau of African Affairs
U.S. Department of State

Panel II

Mr. Ken Isaacs
Vice President of Program and Government Relations
Samaritan’s Purse

Frank Glover, M.D.
Missionary
SIM



***Any changes to witness list will be reflected above.

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PostPosted: Thu Aug 07, 2014 6:48 pm 
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(CNN) -- Missionaries from Samaritan's Purse had hoped they wouldn't have to become involved in the clinical care of Ebola patients in West Africa. But by June, they realized they had no choice, says Ken Isaacs, vice president of international programs and government relations for Samaritan's Purse.
The deadly Ebola virus had spread from Guinea to Liberia and Sierra Leone. At the time, nearly 400 cases and more than 200 deaths had been reported.
Now there are more than 1,711 suspected and confirmed Ebola cases in the region, including 932 deaths, according to the World Health Organization, and the epidemic has spread to Nigeria.
Samaritan's Purse believes these numbers represent fewer than half of the real number of cases, Isaacs said Thursday at an emergency congressional hearing on the Ebola outbreak.
How an Ebola outbreak can start, and end CDC issues highest-level alert for Ebola Ebola treatment raises ethical questions Step inside the CDC's Ebola war room
"The Ebola crisis we are now facing is not a surprise to us at Samaritan's Purse, but it took two Americans getting the disease in order for the international community and the United States to take serious notice of the largest outbreak of the disease in history," Isaacs said.
He characterized the initial international response to the Ebola outbreak as a "failure" because the virus spread outside the country where the outbreak originated. He said that a broader coordinated intervention is the only thing that will slow the size and speed of this disease.
"The ministries of health in Guinea, Liberia and Sierra Leone do not have the capacity to handle these crises in their countries," Isaacs said. If the international community does not get involved, "the world will be relegating the containment of this disease that threatens Africa and other countries to three of the poorest nations in the world."
Centers for Disease Control and Prevention Director Dr. Tom Frieden agrees that the number of people who have been infected with Ebola is likely undercounted. That's in large part, he said at the hearing, because there are a limited number of lab facilities there to confirm the cases accurately.
Ebola virus: Nine things to know about the killer disease
That's why developing a better lab system is so important, he said. The CDC is working with international partners, the U.S. Defense Department and the National Institutes of Health to bulk up the lab infrastructure in West Africa and to develop a better way to transport blood samples to those labs.
What's most important, Frieden said, is that people understand that there is a clear way to stop this outbreak -- and that's at the source in Africa. This, he said, is the only way to get it under control.
"It's laborious. It's hard. It requires local knowledge and local action."
The roots of our Ebola fears
Stopping the epidemic will be particularly challenging since the local health system is so weak, he said. While the CDC will send at least 50 staff in the next week or two, the health system has to be beefed up to stop and prevent future outbreaks.
Frieden said that someone once told him the CDC is the world's 911 system. While he appreciated the compliment, he wants to make sure that every country or region has its own 911.
Ebola is here: 5 reasons not to panic
Dr. Ariel Pablos-Méndez, the assistant administrator for the U.S. Agency for International Development's Bureau for Global Health, said that USAID is providing funding to help with the response to this outbreak.
They are coordinating a response with local health workers and have provided 35,000 sets of protective equipment, supplies, soap and water. Many health care workers are still laboring in the region without protective gear, which is why these workers make up a large portion of Ebola cases.
There was a sense of optimism at the hearing.
"We are confident we can contain and stop the virus," said Bisa Williams, the State Department's deputy assistant secretary for the Bureau of African Affairs.
The State Department is working closely with the governments of all the countries impacted by the outbreak. They are trying to help health care providers gain access to affected areas. They are also giving technical and financial assistance to treatment centers.

http://www.cnn.com/2014/08/07/health/eb ... index.html

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PostPosted: Thu Aug 07, 2014 6:52 pm 
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CDC director says scale of Ebola crisis unprecedented: ‘It will be a long and hard fight’
By - Associated Press - Thursday, August 7, 2014
WASHINGTON — The current Ebola crisis in West Africa is on pace to sicken more people than all other previous outbreaks of the disease combined, the health official leading the U.S. response said Thursday.

The next few weeks will be critical, said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, which is sending more workers into the affected countries to help.

“It will be a long and hard fight,” Frieden told a congressional committee Thursday.

In his prepared testimony, he estimated it would take at least three to six months to end the outbreak, under what he called a best-case scenario.

Frieden said the outbreak, which began in March, is unprecedented in part because it’s in a region of Africa that never has dealt with Ebola before and has particularly weak health systems. He said the outbreak’s two main drivers are lack of infection control as both health workers and families care for the sick and risky burial practices.

More than 1,700 people have been sickened in the current outbreak, in Guinea, Liberia, Sierra Leone and Nigeria. Nearly 1,000 have died, according to the World Health Organization, or WHO.

On Thursday Frieden said there’s no way to know exactly how accurate that count is, or whether some cases are going unreported.

“The data coming out is kind of a fog-of-war situation,” he said.

A medical charity told the House Foreign Affairs subcommittee that the world was too slow to react to the crisis, until recent headlines about two American aid workers who became infected in Liberia and were flown to the U.S. for care.

“Ebola is out of control in West Africa, and we are starting to see panic now around the world,” said Ken Isaacs, vice president at Samaritan’s Purse.

The two American aid workers, who were flown to Emory University Hospital in Atlanta, “seem to get a little better every day,” Isaacs said.

Frieden didn’t rule out the possibility that a traveler could arrive in the U.S. unknowingly infected with Ebola. But he said he is confident there will not be a large Ebola outbreak here. The CDC has put hospitals on alert for symptoms and to check whether people are recent travelers so that they can promptly isolate any suspected cases until proper testing can be done.

Frieden said it is possible to stop the outbreak in West Africa using tried-and-true public health measures: find and isolate all possible patients, track down everyone they could have exposed, educate the public about risks and ensure health workers follow proper infection control. The virus is spread through direct contact with the bodily fluids of someone who is sick.

Any case missed or exposed person lost to follow-up could keep the outbreak going.

“If you leave behind even a single burning ember, it’s like a forest fire,” he said. “It flares back up.”

Isaacs of Samaritan’s Purse said that a huge problem will be persuading African communities to abandon the traditional practice of washing the body and kissing the corpse immediately after death, when the body is most infectious. He said aid workers have been attacked when trying to intervene, and that some physicians in Liberia even mocked the existence of the Ebola virus, shunning protection around patients.

Liberian President Ellen Johnson Sirleaf declared a national state of emergency this week, and officials said Thursday that no one with a fever would be allowed in or out of the country. In the capital, there were reports of bodies abandoned in the streets. Relatives have been hiding feverish patients at home for fear that if they are brought to isolation centers and don’t have Ebola, they will catch it.

Troops were deployed there and in Sierra Leone to stem movement of possibly infected people. According to the WHO, Liberia and Sierra Leone account for more than 60 percent of the deaths so far.

On Thursday, Frieden said Guinea was furthest along in responding to the outbreak although it is still spread there.

The World Bank Group on Monday pledged as much as $200 million in emergency funding to fight the outbreak, including paying for urgently needed medical supplies, medical staff salaries and lab networks. On Thursday, the U.S. Agency for International Development said it was sending tens of thousands of protective suits for health care workers.

At least one of the affected countries, Nigeria, has requested access to the experimental drug ZMapp, used on the two American aid workers. U.S. health officials have stressed that only extremely limited doses exist, the drug hasn’t ever been tested in people and there’s no proof it helped the two Americans. They have said it would take several months to make enough even for a small study.

“The plain fact is that we don’t know whether that treatment is helpful, harmful or doesn’t have any impact,” Frieden told the congressional subcommittee. He added, “I don’t want any false hopes out there.”

Read more: http://www.washingtontimes.com/news/201 ... z39kWvJBga
Follow us: @washtimes on Twitter

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PostPosted: Thu Aug 07, 2014 7:01 pm 
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Ebola's spread to US 'inevitable' - US health authorities

10:21 AM Friday Aug 8, 2014

Already one man with dual US-Liberian citizenship has died from Ebola, after becoming sick on a plane from Monrovia to Lagos and exposing as many as seven other people in Nigeria.

More cases of Ebola moving across borders via air travel are expected, as West Africa faces the largest outbreak of the hemorrhagic virus in history, said Tom Frieden, the head of the US Centers for Disease Control and Prevention.

Read more: How does Ebola virus spread and can it be stopped?

The virus spreads by close contact with bodily fluids and has killed 932 people and infected more than 1,700 since March in Sierra Leone, Guinea, Nigeria and Liberia.


"It is certainly possible that we could have ill people in the US who develop Ebola after having been exposed elsewhere," Frieden told a hearing of the House Subcommittee on Africa, Global Health, Global Human Rights and International Organizations.

"We are all connected and inevitably there will be travelers, American citizens and others who go from these three countries -- or from Lagos if it doesn't get it under control -- and are here with symptoms," he said.

"But we are confident that there will not be a large Ebola outbreak in the US."

There is no treatment or vaccine for Ebola, but it can be contained if patients are swiftly isolated and adequate protective measures are used, he said.

Healthcare workers treating Ebola patients should wear goggles, face masks, gloves and protective gowns, according to CDC guidelines.

Equipment lacking
However, Ken Isaacs, vice president of program and government relations at the Christian aid group Samaritan's Purse warned that the world is woefully ill-equipped to handle the spread of Ebola.

"It is clear that the disease is uncontained and it is out of control in West Africa," he told the hearing.

"The international response to the disease has been a failure."

Samaritan's Purse arranged the medical evacuation of US doctor Kent Brantly and days later, missionary Nancy Writebol, from Monrovia to a sophisticated Atlanta hospital.

Both fell ill with Ebola while treating patients in the Liberian capital, and their health is now improving.

"One of the things that I recognized during the evacuation of our staff is that there is only one airplane in the world with one chamber to carry a level-four pathogenic disease victim," Isaacs said.

He also said personal protective gear is hard to find in Liberia, and warned of the particular danger of kissing the corpse farewell during funeral rites.

"In the hours after death with Ebola, that is when the body is most infectious because the body is loaded with the virus," he said.

"Everybody that touches the corpse is another infection."

Traveler cases
Ebola can cause fever, muscle aches, vomiting, diarrhea and bleeding. It has been fatal in about 55 per cent of cases during this outbreak.

Last month, Patrick Sawyer, a Liberian finance ministry employee who was also a naturalized American citizen, brought the virus to Lagos.

Sawyer had traveled to Nigeria from Liberia via Togo's capital Lome, and was visibly sick upon arrival at the international airport in Lagos on July 20.

He died in quarantine on July 25.

As many as seven people who had close contact with Sawyer have fallen ill with Ebola, Nigeria's Health Minister Onyebuchi Chukwu said.

One of them, a nurse, died on Tuesday.

Frieden said helping West African nations screen passengers who are departing airports could help contain the virus.

A Saudi Arabian man who had recently traveled to Sierra Leone and showed Ebola-like symptoms died Wednesday of a heart attack, but authorities in Riyadh did not reveal the results of Ebola tests that were done on the man.

A suspected New York patient tested negative on Wednesday.

Meanwhile, Benin, which shares a border with Nigeria, said it was running tests on two potential Ebola cases. Both patients are now in isolation, authorities said.

Ebola first emerged in 1976, and has killed more than 1,500 people since then. Within weeks, the death toll from this outbreak alone is expected to surpass that number.

- AFP

http://www.nzherald.co.nz/world/news/ar ... d=11305873

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PostPosted: Thu Aug 07, 2014 8:59 pm 
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Ebola Experts Warn of an African 'Apocalypse'

At an emergency hearing Thursday, leaders of the fight against Ebola gave updates on the situation in Africa and the future of the deadly disease’s possible spread.

At an emergency hearing in Washington Thursday afternoon, major players in the fight against Ebola in West Africa addressed the outbreak that has stolen the lives of more than 900. Leaders from health agencies and humanitarian efforts addressed the need for increased support as one called the current state of affairs in West Africa “apocalyptic.”

Rep. Christopher Smith, the chairman of the House Foreign Affairs Subcommittee on Africa and Global Health, opened the hearing by urging the speakers to clear the air on a “grave issue” that has “gripped” the mass media for weeks. “We hope to gain a realistic understanding of what we’re up against while avoiding sensationalism,” he told the floor. Here are the takeaways:

The outbreak is getting worse.

Already an unprecedented outbreak, CDC Director Dr. Tom Frieden says the number of infected and killed by Ebola will likely soon outnumber all other Ebola outbreaks in the past 32 years combined. According to the CDC, there have already been more than 1,700 suspected and confirmed cases of Ebola in West Africa, and more than 900 deaths—numbers which Frieden later called “too foggy” to be definitive. Ken Isaacs, the Vice President of Program and Government Relations for Samaritan’s Purse (SIM), painted an even bleaker picture. According to SIM, West Africa has counted 1,711 diagnoses and 932 deaths, already, which could represent only a small fraction of the actual number. “We believe that these numbers represent just 25-50 percent of what is happening,” said Isaacs.

The atmosphere in West Africa is “apocalyptic.”

In a six-hour meeting with the president of Liberia last week, Isaacs said SIM workers watched as the “somber” officials explained the gravity of the situation in their countries, where hundreds lie dead in the streets. “It has an atmosphere of apocalypse,” Isaacs said of the Liberia Ministry of Health’s status updates. “Bodies lying in the street … gangs threatening to burn down hospitals. I believe this disease has the potential to be a national security risk for many nations. Our response has been a failure.” Isaacs says that the epidemic is inciting panic worldwide that, in his opinion, may soon be warranted. “We have to fight it now here or we’re going to have to fight it somewhere else.”

140807-haglage-ebola-embedUS Centers for Disease Control and Prevention (CDC) Director Tom Frieden shows an awareness poster as he testifies before Africa, Global Health, Global Human Rights and International Organizations Subcommittee hearing on "Combating the Ebola Threat" at the Rayburn House Office Building in Washington, DC, on August 7, 2014. (AFP/Getty)

It’s unclear how many “serums” are available in the U.S.

Frieden explained that the government is looking carefully into any possible treatment for the infection, but stressed that because of “rapidly evolving” information, it is unclear how many of the potentially life-saving Ebola “serums” are available. “I can’t tell you definitively how many courses there are,” said Frieden. “I heard there are a handful—fewer than the fingers of one hand. Some manufacturers have reportedly said they can make some, but some companies are saying it could take months. I don’t have definitive information. Frieden further reiterated that Dr. Richard Brantly and Dr. Nancy Writebol are the first two humans to be given the treatment, suggesting that even if additional treatments were available it may not be ethical to use them. “Whatever happens with these individuals…we will still do not know from their experience whether these drugs work. Antibodies are only one part of our response to an illness—in other conditions antibodies can make a disease worse. It’s too soon to know.”

The international response has been disastrous.





Isaacs, head of the humanitarian agency for which Writebol and Brantly worked, vehemently condemned the international community for a response that he considers both delayed and insufficient. “The disease is uncontained and out of control, the international response has been a failure,” he said. With three of the poorest nations in the world currently affected, West Africa is extremely ill-prepared for the disaster—a fact, which Issacs argued, necessitates more response. “The ministries of health in these countries do not have the capacity to handle this. If a mechanism is not found the world will be effectively relegating the containment of this disease to three of the poorest nations in the world,” he said, adding later: “Is the world willing to let the public health of the world be in their hands?”

Dr. Writebol and Dr. Brantly are “getting better.”

When asked to update the current status of the two American SIM workers being treated at Emory after contracting the disease in Liberia, Issacs said they were “getting better every day.” He was not able to confirm whether either can be classified as stable. “I don’t think [their recovery] will be fast,” he said. “I will say that they seem to have gotten better. We appreciate that they are getting good treatment—we pray that they will survive.”

But their introduction back to the U.S. will be painful.

In the days since the two American doctors have returned to America, SIM has heard widespread concern about the two’s reintegration. “People are afraid to get around them—husbands, wives, no one knows if it’s safe,” he said. “We are doing everything we can to give them a safe place to be, but imagine how difficult it is for American citizens—and all citizens—to suffer from this,” he said. Some from the communities where the two doctors came from have reportedly expressed concern for them infecting others in the community. “This is a nasty, bloody disease; I could give you descriptions of people dying that you cannot even believe.”

Doctors in the Ebola-infected countries are in desperate need of supplies.

Dr. Frank Glover, a missionary with SIM who also testified at the hearing, expressed frustration with the lack of personal protective gear (PPG), which he says is increasing the spread of infections significantly. Glover says the doctors and nurses in these areas, particularly Liberia, are “terrified” to enter the hospitals because of lack of proper gloves, goggles, and gowns that are needed to protect them. “The number one cause of infections in Liberia is lack of protective gear. It’s unconscionable that we’re asking them to take care of people without gloves. If we’re putting people on the line, we owe it to them to give them a fighting chance.”

The quarantined towns are in desperate need of other vital support systems.

Rep. Karen Bass, a standing member on Smith’s subcommittee who spoke with Liberian President Ellen Johnson Sirleaf, says the quarantined areas in West Africa are in desperate need of basic supplies like food and water. “Health care is a human right. We must ensure these countries have what they need to fight for it.” Both Isaacs and Glover also expressed concern for the lack of education in West Africa, both the symptoms and proper response that should be taken in the wake of an infection. “A poster on the wall saying ‘Ebola kills’ isn’t going to do it,” said Isaacs. “They need education.” Grover cited the 14-year civil war in Liberia, which left millions illiterate, as one of the main roadblocks in educating the country.

The U.S. may not be prepared to treat American relief workers should they get infected.

According to SIM director Isaacs, the plane that flew Writebol and Brantly to safety in Atlanta is the sole vehicle of that kind in existence. “There is only one airplane in the world with one chamber to carry level 4 pathogenic victim. One—and it’s in the U.S,” said Isaacs. “There is no other aircraft in the world.” Isaacs says that unless the Department of Defense is secretly in possession of another aircraft, than the U.S. will not have the power to evacuate more than one American relief worker at a time, should they get infected. “If the U.S. is going to expect CDC people [in these nations], there has to be assurance that we can care for them when they are sick.”

The disease could spread to other countries.

Isaacs, whose urgings to Congress about the urgency for a better response prompted Thursday’s meeting, is gravely concerned about the future. After first observing the outbreak in April, he’s watched the disease spread furiously across West Africa with little to no effective international support. “I think we are going to see death tolls in numbers that we can’t imagine,” said Isaacs. “If we do not fight and contain this disease, we will be fighting this and containing this in multiple countries across the world. The cat is, most likely, already out of the bag.”

http://www.thedailybeast.com/articles/2 ... yptic.html

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PostPosted: Thu Aug 07, 2014 9:41 pm 
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Health official downplays hopes for experimental Ebola drugs
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A Spanish priest who was infected with the Ebola virus while working in Liberia arrives in Spain for treatment. (Spanish Defense Ministry)
By REBECCA BRATEK, ROBYN DIXON contact the reporter NationMedical ResearchWestern AfricaDiseases and IllnessesLiberiaU.S. Centers for Disease Control and PreventionSierra Leone

A top federal health official downplays hopes that new drugs to combat the Ebola virus are imminent
Experts at the World Health Organization meet for a second day to consider measures to control Ebola outbreak
A top federal health official sought Thursday to downplay hopes that new drugs to combat the Ebola virus are imminent despite reports that experimental drugs may have helped two stricken U.S. aid workers as the deadly epidemic continued to ravage parts of West Africa.

"We don't know if [the drugs] work and we can't have them in significant numbers," Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, told a House subcommittee hearing. "I don't want any false hopes out there."

In Geneva, global health experts at the World Health Organization met for the second day to consider additional measures to control the outbreak, which has killed at least 932 people since March. The death toll is the worst since the virus was identified in 1976.

The CDC has raised its emergency response to Level 1, its highest, to support a surge of U.S. medical personnel being sent to Liberia, Sierra Leone and Guinea, the worst-hit countries, backed by more than 200 in Atlanta.

The CDC has deployed 31 doctors and other medical workers to the region, and will send 50 more in coming weeks, Frieden said. With more than 1,700 confirmed Ebola cases, some hospitals have collapsed and clinics have closed as local medical workers have become sick or fled, adding to the challenge.

The outbreak is West Africa's first experience with Ebola, and it appears especially deadly because much of the region is impoverished, with poor healthcare and burial practices that encourage the virus to spread.

"It's like fighting a forest fire: Leave behind one burning ember, one case undetected, and the epidemic could reignite," Frieden said. "We have a difficult road ahead, which will take many months, but we must redouble our efforts to bring this terrible outbreak under control."

There is no cure or vaccine for Ebola, which is spread by contact with infected bodily fluids.

After months of lax quarantine procedures, Liberia and Sierra Leone trucked in soldiers and set up roadblocks to limit travelers' movements and to enforce a quarantine on affected areas.

Officials in Sierra Leone said passengers would undergo health inspections at the international airport, and no one would be allowed to travel if he or she had a temperature.


Liberia has been overwhelmed by the crisis, and President Ellen Johnson Sirleaf declared a 90-day state of emergency Wednesday, giving soldiers the power to close the borders and enforce strict quarantines. She said 32 doctors and health workers have died from Ebola.

A nurse and three more clinical staff died at the C.H. Rennie Hospital in Kakata, northwest of the capital, Monrovia. Eleven other staffers at the hospital had Ebola symptoms, according to local media reports.

A Liberian Senate election scheduled for October has been canceled because of the disease, with health experts warning it will take months to get the outbreak under control.

Nigerian Health Minister Onyebuchi Chukwu described the Ebola outbreak in Lagos, the nation's largest city, as a national emergency. Seven Ebola cases have been confirmed in Nigeria, and two people have died.

"Everyone in the world today is at risk," Chukwu told a parliamentary committee.

Dr. Kent Brantly, 33, and Nancy Writebol, 59 — the Americans who contracted the disease in Liberia — were reported to be improving at Emory University Hospital in Atlanta. Both were treated with ZMapp, an experimental drug that had been tested only on monkeys, before they were flown to the U.S.

Frieden said it wasn't clear whether ZMapp had helped them. The drug is not "easy to use," he said, and may cause unknown side effects. He said clinical trials and other studies must be conducted before the drug is proved to be safe and effective against Ebola.

"There will be hope, great hope, if ZMapp works and the two Americans who have bravely agreed to test it — and it has a positive effect," said Rep. Christopher H. Smith (R-N.J.), chairman of the House Foreign Affairs subcommittee on Africa and global health, which held the hearing. "Still, it won't mean that it'll be produced in great quantities quickly and sent to affected people in West Africa."

rebecca.bratek@latimes.com

robyn.dixon@latimes.com

Bratek reported from Washington and Dixon from Johannesburg, South Africa.

http://www.latimes.com/nation/la-na-us- ... story.html

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PostPosted: Thu Aug 07, 2014 9:45 pm 
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House witnesses paint grim picture of Ebola epidemic
Filed Under: Ebola
Robert Roos | News Editor | CIDRAP News | Aug 07, 2014

The hearing of the US House Foreign Affairs Subcommittee on Africa, Global Human Rights, and International Organizations today at the Rayburn House Office Building heard grim testimony about the Ebola outbreak in west Africa.
A US House committee heard grim testimony today on West Africa's Ebola epidemic, with an official of a leading aid group asserting that inaction by the rest of the world has let the disease get out of control.

"It's clear to say that this disease is uncontained and out of control in West Africa," said Ken Isaacs, vice president of program and government relations for the relief group Samaritan's Purse (SP). "The international response has been a failure, and it's important to understand that."

He said SP's experts believe the official epidemic case numbers from the World Health Organization (WHO) represent only 25% to 50% of the true numbers. Yesterday the WHO put the Ebola total for Guinea, Liberia, Sierra Leone, and Nigeria at 1,711 cases and 932 deaths.

"The governments simply do not have the capacity to handle the crisis in their countries," Isaacs added. "If a mechanism isn't found to create a paradigm for the international community to get involved, the world will effectively relegate the containment of this disease to three of the poorest nations in world."

Isaacs spoke at a hearing convened by the House Foreign Affairs Subcommittee on Africa, Global Human Rights, and International Organizations. The session was streamed over the Web.

The subcommittee also heard from several other witnesses, including Tom Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), who called the epidemic unprecedented in multiple ways but asserted that it can be stopped by using tried-and-true public health interventions.

A daunting challenge
But Isaacs made the challenge sound daunting. His organization employs Keith Brantly, MD, one of two American health workers who contracted Ebola while working in Liberia and were recently flown back to the United States for treatment. He and Nancy Writebol of SIM (Service in Mission), the other patient, have been treated with an experimental drug and are said to be improving.

"There are bodies lying in the street in Liberia," a nation that's still trying to recover from a long civil war that left lingering tensions, Isaacs said. "There are gangs threatening to burn down hospitals."

"It's clear to me that Liberia is in a severe crisis that I believe threatens the stability of the society as it exists today," he told the panel.

SP's office in Liberia remains open, but "we've in fact suspended all other program activity," he said. "We're in the process now of backing up and reloading. We intend to come back."

The committee also heard sobering observations from Frank Glover, MD, a urologist and medical missionary with SIM, who described the weakness of Liberia's medical system.

Glover said 95% of expatriate doctors in Liberia have left, leaving only 50 doctors in the country. After the second of two doctors died of the disease, all the government hospitals shut down.

The country has only two Ebola treatment centers, one in Monrovia and one in Lofa, Glover reported. Many patients are dying of Ebola in community settings because of the lack of treatment facilities.

Unprecedented in five ways
The epidemic has previously been described as unprecedented, but Frieden expanded on the theme, saying that's true on five counts.

"First it's the largest outbreak ever. In a few weeks there'll be more cases than in all previous outbreaks put together," he said. "Second, it's multi country. One of the epicenters is on the confluence of three different countries" (Liberia, Guinea, and Sierra Leone).

"Third, this is the first outbreak in west Africa. And because of this it's been a particular challenge. Fourth, many of the cases have been in urban areas, and there's been spread in urban areas, and this is something we've not seen before."

Fifth, Frieden said, "it's the first time we've had to deal with it in the US." Besides the presence of the two sick American medical workers, the nation has to worry about testing travelers who are sick after returning to the states from the affected countries, he explained.

He noted that the CDC has an Ebola test that's relatively fast, and the agency is working to make it available to the Laboratory Response Network (LRN) within a few weeks. The network consists of state public health labs and other labs that can test for a wide range of diseases.

Frieden laid out what he called three basic facts about Ebola: "First, we can stop Ebola, we know how to do it. It will be a long and hard fight, the situation in Lagos [Nigeria] is particularly concerning. Second, we have to stop it at the source in Africa, that's the only way to get control. Third, we have to stop it at the source through tried and true means, the core publih health interventions that work."

He re-emphasized the CDC message that only people who have symptoms can spread Ebola to others and that transmission occurs only through close contact with body fluids.

To arrest an outbreak requires "meticulous isolation" of those infected, followed by equally carefully tracing and management of their contacts, Frieden said. If a contact gets a fever, the process must be started all over. "It's laborious, it's hard, it requires local knowledge, but it's how Ebola is stopped."

Isaacs, however, told the committee that that type of follow-up isn't happening in Liberia. "I don't think the ministry of health can fight this. There's no contacts being run down in Liberia," he said.

Frieden, who voiced confidence that the United States will not face a big Ebola outbreak, was asked if the virus can spread through sneezing or coughing.

"In medicine we often say, 'Never say never,'" he replied. He noted that a Liberian official who died in Nigeria was sick on an airliner. So far no illnesses have been identified in his fellow passengers, but "we do have concerns that there could be transmission from someone who is very ill."

"If someone is ill on an airplane, having a fever or bleeding, that might present a risk to someone who came in contact and didn't take appropriate precautions," he said.

See also:

Information on Aug 7 House hearing
http://www.cidrap.umn.edu/news-perspect ... a-epidemic

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PostPosted: Fri Aug 08, 2014 10:52 am 
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U.S. and Global Efforts to Contain Ebola Draw Criticism at Congressional Hearing
By ANDREW SIDDONSAUG. 7, 2014

WASHINGTON — Members of Congress questioned Thursday whether the American response to the Ebola outbreak in West Africa had been effective, and a spokesman for a group battling the virus went further, saying no country had done enough.

“The international response to the disease has been a failure,” said the spokesman, Ken Isaacs, of Samaritan’s Purse. The group employed the American doctor, Ken Brantly, and nurse, Nancy Writebol, who contracted the disease and were brought back to the United States for treatment.

It was only after they were confirmed to have Ebola on July 26 “that the world sat up and paid attention,” Mr. Isaacs said during a hearing of a House Foreign Affairs subcommittee.

The criticism came as African leaders held their final sessions of a summit meeting here that was intended to focus on economic development, but was shadowed by the Ebola crisis. Only two meetings — both on Monday — were scheduled to address the outbreak, even as the death toll mounted. Almost 1,000 people have died of Ebola since March.

Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations, said in an interview that it was a missed opportunity.

“It seemed to me a huge loss to have so many of the key players of the African continent — all of the heads of states, all of the finance and trade ministers, all in Washington, all available for a conversation — and there was no specific, concerted effort to ask the ‘what if’ question and reach some kind of basic agreement,” she said.

At the subcommittee hearing, Representative Frank Wolf, Republican of Virginia, expressed concern that the Obama administration had taken too long to respond to the outbreak. He also said that the response by the United States and nongovernmental agencies was uncoordinated and rudderless.

“Despite early warnings from NGOs working on the ground, there was little action to get out in front of this problem, and now we are seeing the consequences,” said Mr. Wolf, a member of the subcommittee, which deals with United States policy in Africa.

The American effort has been led by the Centers for Disease Control and Prevention; its director, Dr. Thomas Frieden, defended his agency’s handling of the outbreak during questioning by the lawmakers.

He said it was possible to stop the outbreak by meticulously isolating patients and identifying who had come into contact with them. Dr. Frieden said his agency would have 50 staff members on the ground in West Africa in the next week or so.

“It won’t be quick, and it won’t be easy,” he said. “When we finish this response, we’re determined to not only stop the outbreak, but leave behind strong systems that will be better at finding the disease and other threats, at stopping it before it spreads, of preventing it in the first place.”

But Mr. Isaacs said that the response had been too little and too late in the three countries that have been hit the worst — Guinea, Liberia and Sierra Leone.

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“You have three poor countries that clearly don’t have the capacity to contain it,” Mr. Isaacs said. “And is the world willing to allow the public health of the world to be in their hands to contain the disease?”

The leaders of Liberia and Sierra Leone canceled their summit meeting trips to focus on the epidemic. Guinea’s president, Alpha Condé, was in Washington this week, and in one of the Monday meetings, he described the situation as serious, said a health policy expert who was there.

But the expert, J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, said Mr. Condé had tried to convey that “it’s not really as catastrophic as people are painting it.” No one was available at the Guinea Embassy to discuss Mr. Condé’s remarks.

In the second Ebola-related meeting at the summit, Mr. Condé and Dr. Frieden met with other top American health officials, including Sylvia Mathews Burwell, the secretary of health and human services, and officials from Liberia, Nigeria and Sierra Leone. The meeting did not result in any specific commitments from the administration, but Ms. Burwell and Dr. Frieden “reiterated U.S. engagement and support for efforts to control the outbreak and address the challenge,” according to a State Department official.

“We didn’t go to that meeting cap in hand, going to give a shopping list of what we want,” Bockari Kortu Stevens, Sierra Leone’s ambassador to the United States, said in an interview.

Liberia’s foreign minister, Augustine Kpehe Ngafuan, said the infection rate would rise for the next few weeks before Liberia could finally stop the outbreak from spreading.

“It’s going to get worse before it gets better,” he said.

A version of this article appears in print on August 8, 2014, on page A11 of the New York edition with the headline: U.S. and Global Efforts to Contain Ebola Draw Criticism at Congressional Hearing. Order Reprints|Today's Paper|Subscribe

http://www.nytimes.com/2014/08/08/world ... pe=article

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