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PostPosted: Thu Sep 04, 2014 1:58 am 
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when he was exposed to an obstetrics patient stricken with the deadly disease


So:

- if the patient was ebola-stricken and Sacra ditched his gear, she was showing no symptoms. only a madman would act in this fashion had she been presenting even the slightest sign.

- the patient screening at admittance was poorly carried out or this may indicate that clinical onset is changing thus eluding what health officials believe to be the warning signs.

- can the virus be spreading farther across the air due to higher humidity? does the definition of "close contact" for projected sputum and sneeze droplets vary according to temperature and humidity?


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PostPosted: Thu Sep 04, 2014 3:59 am 
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morning wrote:
Quote:
when he was exposed to an obstetrics patient stricken with the deadly disease


So:

- if the patient was ebola-stricken and Sacra ditched his gear, she was showing no symptoms. only a madman would act in this fashion had she been presenting even the slightest sign.

- the patient screening at admittance was poorly carried out or this may indicate that clinical onset is changing thus eluding what health officials believe to be the warning signs.

- can the virus be spreading farther across the air due to higher humidity? does the definition of "close contact" for projected sputum and sneeze droplets vary according to temperature and humidity?

He said she was symptomatic.

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PostPosted: Thu Sep 04, 2014 5:21 am 
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Location: Pittsburgh, PA USA
morning wrote:
Quote:
when he was exposed to an obstetrics patient stricken with the deadly disease


So:

- if the patient was ebola-stricken and Sacra ditched his gear, she was showing no symptoms. only a madman would act in this fashion had she been presenting even the slightest sign.

- the patient screening at admittance was poorly carried out or this may indicate that clinical onset is changing thus eluding what health officials believe to be the warning signs.

- can the virus be spreading farther across the air due to higher humidity? does the definition of "close contact" for projected sputum and sneeze droplets vary according to temperature and humidity?

He was a new arrival and thought it was too hot for full gear. He did note that one patient was a likely Ebola case. Details on cases have consistently shown transmission via fluids from symptomatic cases. This case fits that pattern. No new speculation required.
Moreover, new HCW Ebola cases in Monrovia are reported almost daily from a VERY limited number of locations. Ebola is widespread in patients and HCWs in Monrovia. Transmission is NOT a surprise and this is #3 for SIM in Monrovia.

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PostPosted: Thu Sep 04, 2014 6:07 am 
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Fourth American Infected With Ebola Identified As Rick Sacra, A Doctor From Boston
By Alroy Menezes
on September 04 2014 2:29 AM
Image
Doctor for tropical medicine Florian Steiner (R) and ward physician Thomas Klotzkowski step out of a disinfection chamber after cleaning their protective suits, at the quarantine station for patients with infectious diseases at the Charite hospital in Berlin August 11, 2014. REUTERS/Thomas Peter

Rick Sacra, a doctor from the Boston area, was identified Wednesday as the fourth American to be infected with the Ebola virus. Sacra reportedly contracted the deadly disease while working at a hospital in Liberia.

Bruce Johnson, head of the missionary group Serving in Mission, or SIM USA, which sponsored Sacra's work in the West African country, said that it was not known exactly how Sacra contracted the deadly virus, and added that all of Sacra’s patients in Monrovia were being screened for Ebola, according to a report in the New York Times. Sacra, 51, was reportedly working in a maternity ward of a hospital in Monrovia.

“A strong possibility is that the Ebola symptoms were masked and not presenting themselves with a patient who was admitted and cared for,” Johnson reportedly said.

Sacra is currently being treated in the Ebola ward at the Eternal Love Winning Africa, or ELWA, hospital run by SIM in Monrovia, the same hospital where he reportedly contracted the disease. Johnson said there were no plans to bring the infected doctor back to the U.S., and added that Sacra had not received the experimental Ebola drug ZMapp.

Sacra, who had previously worked in Liberia, reportedly decided to go back to the country after two other American missionary workers, Kent Brantly and Nancy Writebol, contracted the deadly virus.

“He approached us after hearing of Dr. Brantly being unable to carry on his medical duties,” Johnson reportedly said, adding: “Plus, our other two doctors had been pulling very long hours, under extremely fatiguing conditions, and they needed a break.”

Brantly and Writebol, the American aid workers who contracted Ebola in West Africa, were flown to the U.S. and treated at an isolation unit in Atlanta’s Emory University Hospital and given the experiment drug ZMapp. Both Writebol and Brantly were discharged from the hospital late last month.

Writebol, 59, making her first public appearance Wednesday since being discharged, recounted her personal experience battling the disease. Writebol reportedly spent the last few days in seclusion with her husband, and said she did not know whether to credit the experimental drug ZMapp, or the care she received, for her recovery but said that she believed God played an important role, the Times reported.

The third American patient, a Liberian-American, who contracted Ebola after he arrived in Nigeria, died in the African country soon after being infected with the disease.

According to figures released by the World Health Organization, or WHO, on Wednesday, more than 1,900 people have died and over 3,500 have been infected from the largest outbreak of Ebola that has ravaged the West African countries of Liberia, Guinea and Sierra Leone in the last few months. Ebola cases have also been confirmed in neighboring countries like Nigeria and DR Congo as well.

WHO fears that more than 20,000 people could get infected by the Ebola virus, which was first identified in 1976, before the current outbreak runs its course. The second major outbreak of the disease happened in 1995, also in West Africa. Ebola outbreaks have a fatality rate of up to 90 percent, according to the WHO.

http://www.ibtimes.com/fourth-american- ... on-1678110

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PostPosted: Thu Sep 04, 2014 7:08 am 
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Third American With Ebola Returning to U.S.
By Brenda Goodman, MA
WebMD Health News Reviewed by Brunilda Nazario, MD

Sept. 3, 2014 -- The third American infected with Ebola will be coming back to the U.S., although it is not yet known when that will be, says Kristen Nordlund, a CDC spokesperson.

The doctor, identified Wednesday as 51-year-old Rick Sacra, MD, will be transported in an aerobiomedical containment system, otherwise known as “the pod,” Nordlund says. The State Department and SIM USA, the missionary group Sacra was working with, have contracted with Phoenix Air to transport Sacra. Phoenix Air also transported two other American patients infected with the Ebola virus.

It is not yet known where Sacra will be hospitalized. The two other American patients, Kent Brantly, MD, and Nancy Writebol, were treated and released from Emory University Hospital. The hospital houses a special isolation unit for people with infectious diseases.

SIM USA president Bruce Johnson said at a press conference Wednesday that Sacra was clad in protective gear as he delivered babies at ELWA Hospital in Liberia -- and he was not treating patients known to have the virus.

Public records show Sacra is a family practice physician from Holden, MA. He and his wife, Debbie, have three children.

Sacra has been working with SIM since the late 1980s, Johnson said. He volunteered to go back to Liberia a month ago after he heard that his colleagues Brantly and Writebol had caught the disease.

In an interview with NBC, Brantly described Sacra as “a dear friend.”

Johnson said Sacra’s point of contact with the Ebola virus isn't yet known, though staff members at ELWA Hospital are working with CDC investigators to figure out how he got sick.

“They check patients at our hospital before admittance for Ebola symptoms,” Johnson told reporters. “There’s a strong possibility that the Ebola symptoms were masked.”

Sacra is being treated at the Ebola isolation ward at ELWA Hospital, a 35-bed facility that’s overcrowded, according to Will Elphick, country director for SIM Liberia, who also spoke at the news conference.

Despite the cramped conditions, Johnson said Sacra is getting excellent care and is in good spirits. “Many of those who are caring for Rick are those he has taught and mentored in his medical practice,” he said.

While there are currently no firm plans to bring him back to the U.S., Johnson said the organization was “exploring all opportunities and options.”

When asked if Sacra might receive a dose of the experimental drug ZMapp, Johnson said it was his understanding, based on news reports, that there is no more ZMapp in the world. Mapp Biopharmaceuticals, the company that developed ZMapp, released a statement last month saying supplies of the medication are exhausted.

So far, seven health care workers are known to have received doses of ZMapp, a 12-hour infusion of Ebola-fighting antibodies. Two have died, despite treatment. The latest to get the drug was British nurse William Pooley, who was discharged from a London hospital Sept. 3.

While it’s not clear if the drug helped, the BBC reported that his doctors said the levels of Ebola virus in Pooley’s blood fell after treatment. And last week, a study of 18 monkeys infected with Ebola showed all survived after they received the drug.

On Sept. 2, the U.S. Department of Health and Human Services announced it had awarded a $25 million contract to Mapp Biopharmaceuticals to speed up the testing and making of ZMapp.

Shortly before SIM released details of Sacra’s condition, Nancy Writebol, a missionary with SIM, spoke to reporters for the first time, describing her own “dark days” with Ebola. Writebol was brought back to the United States for treatment in August and has since recovered.

“When we got to the airport, I really was very, very sick, and pretty much in and out of it. The only way they could get me on the airplane was to put me on the baggage conveyor belt,” she said, laughing. “I could feel the movement of what was happening.”

As she waited to board the specially equipped aircraft that would carry her home, Writebol said she recalled thinking, "I don’t even know if I’m going to make it back to the U.S."

Once at Emory University Hospital, in Atlanta, doctors told her that because of lingering pain she was feeling in her legs and feet, she might need special treatment in a rehabilitation hospital after she was released from isolation.

“They didn’t know if I was going to be able to walk,” she said.

But one day, Writebol said, she was determined to take a shower and started to climb off the bed to get to the bathroom. Nurses on duty stopped her and helped her.

“Oh, that shower was wonderful,” she said. Each day after that, her legs got stronger.

Writebol said she is often asked what she believes saved her -- whether it was returning to the U.S. for treatment, an experimental medication, her deep faith, or the supportive care she received from doctors in Liberia.

“My answer to that question is all of the above,” she said.

“God uses means. God uses doctors, and I can tell you again, amazing doctors. God uses experimental drugs. We don’t know whether the ZMapp helped. We don’t know. We don’t know if it was the supportive care. The supportive care was very, very necessary,” she said.

“All of those things played a part in saving our lives.”

http://www.webmd.com/news/20140903/ebol ... ican-sacra

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PostPosted: Thu Sep 04, 2014 7:35 am 
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Ebola survivors speak out on bad hospital conditions
Sapa-AP | 04 September, 2014 08:15

The hospital in Liberia where three American aid workers got sick with Ebola has been overwhelmed by a surge in patients and doesn't have enough hazard suits and other supplies to keep doctors and nurses safe, a missionary couple told The Associated Press on Wednesday.

The latest infection - of Dr. Rick Sacra, an obstetrician who wasn't even working in the hospital's Ebola unit - shows just how critical protective gear is to containing the deadly epidemic, and how charities alone can't handle the response, they said.

Nancy Writebol and her husband David called for reinforcements during the AP interview, which followed her first news conference since recovering from Ebola disease. They work for North Carolina-based SIM, the charity that runs the ELWA hospital in Monrovia, Liberia.

About 250 staffers at the hospital use thousands of disposable protective suits each week, but that's not enough to fully protect the doctors and nurses who must screen people entering the emergency room or treat patients outside the 50-bed Ebola isolation unit, they said.

"We don't have enough personal protective safety equipment to adequately be able to safely diagnose if a patient has Ebola. So they are putting themselves at risk," David Writebol said.

Sacra, a Boston-area obstetrician and veteran of many tours in Africa, felt compelled to return to Liberia about a month ago despite these challenges. As soon as he heard that Dr. Kent Brantly and Nancy Writebol were sick, Sacra called and said "I'm ready to go," SIM President Bruce Johnson said.

Sacra's job was to deliver babies at the hospital and take care of patients who were not infected with Ebola. He followed all the protocols to protect himself, said Will Elthick, the group's operations director in Liberia.

But Sacra got infected nonetheless by the virus that has killed more than 1,900 people and sickened 3,500 in five West African nations.

The disease is spreading faster than the response in part for lack of protective gear, said Tom Kenyon of the U.S. Centers for Disease Control and Prevention. At least $600 million is urgently needed to provide these tools and extra hazard pay so that more doctors and nurses are willing to risk their lives, the World Health Organization said Wednesday.

Health care workers at other West African hospitals have gone on strike demanding more protections, the Writebols said.

"They are saying, 'I can't go to work safely until there is personal protective equipment available - the right gear, the right procedures in place. And then, if they don't go to work, are they going to get paid?" David Writebol said.

The Writebols are veteran missionaries in Africa; David helped with the hospital's technology while Nancy helped dress and disinfect people entering and leaving the Ebola unit. They say the challenges are far bigger than what any one hospital can handle alone.

Liberians were already struggling to survive before Ebola, and now it's even more chaotic, they said. The numbers of patients are surging, and finding food and supplies is more costly and difficult since airlines stopped serving the country.

Ebola has "overwhelmed the supply chain," David Writebol said. "They can't get equipment in because there aren't any regular flights coming in. Same thing with aid workers from the international community. There are only a limited number of seats available to come into Liberia. ... That's one of the biggest problems - getting medicine, protective gear and supplies for health care workers who are there."

Nancy Writebol said the emergency room is often where patients would show up first, and people showing symptoms were ushered into triage. But health workers were sometimes exposed as they screened these patients, who may not have known or advertised that they were carrying the virus.

And sometimes, the sick would leave before finding out if they had Ebola. "Those are the people you really worry about going back into the community, because if they are sick with Ebola, it will ultimately spread," she said.

Sacra immediately got tested for Ebola after coming down with a temperature, his brother Doug Sacra told the AP. Like his colleagues he also went into isolation to avoid spreading the virus.

Some other doctors haven't been so rigorous.

The WHO announced today that a doctor in southern Nigeria was exposed by a man who evaded surveillance efforts, and then in turn exposed dozens of others by continuing to treat patients after he became ill. Then he died, and his family and church members followed their funeral traditions by laying their hands on his body.

Now his widow and sister are sick and about 60 others in the city of Port Harcourt are under surveillance.

Sacra, who left behind his wife and three grown children for this latest trip to Africa, was in good spirits Wednesday and able to send emails, Elthick said, which could mean that he's physically well enough to be evacuated.

His wife, Debbie, said in a statement that she's focusing on her husband, but she said "Rick would want me to urge you to remember that there are many people in Liberia who are suffering in this epidemic and others who are not receiving standard health care because clinics and hospitals have been forced to close.

"West Africa is on the verge of a humanitarian crisis, and the world needs to respond compassionately and generously," she said.

http://www.timeslive.co.za/africa/2014/ ... conditions

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