MSF: Ebola rapid teams needed for Liberian hot spots

Though Ebola cases have recently declined in Liberia, the outbreak is far from over, and new hot spots signal the need for a new strategy—rapid response teams that can swoop in to isolate patients, do contact tracing, and conduct safe burials—Doctors without Borders (MSF) said yesterday in its latest update.

The group warned that the international response must quickly address the epidemic's new phase or risk eroding the progress that has been made in Liberia.

MSF said that, for the first time, case numbers are declining in Liberia's Ebola treatment centers; for example, a 250-bed unit in Monrovia is treating only 50 patients. And no new cases have been confirmed in Foya, in the northern part of the country, since Oct 30.

MSF warned, though, that cases could rise again, as they did twice in MSF centers in Guinea. The group added that cases in Guinea and Sierra Leone continue to rise.

Fasil Tezera, who leads MSF operations in Liberia, said in the update that the international response is starting to gain traction in the country, with financial aid coming in and large treatment centers being built, with enough isolation units in Monrovia and some other areas. The next step is to stay ahead of the curve, he said. "Priority should be given to a more flexible approach that allows a rapid response to new outbreaks and gets the regular health care system safely up and running again."

MSF officials also said active engagement with the community has played a role in the decline in Ebola cases and that reestablishing essential health services is a critical response component. It recently began mass distribution of malaria prophylaxis and treatment in Monrovia and is opening an Ebola screening unit next to a government-run hospital, with the goal of helping the hospital reopen safely.

Last US Ebola patient discharged from hospital

Meanwhile, Craig Spencer, MD, who was hospitalized on Oct 23 with an Ebola infection in New York City after he served with MSF in Guinea, was discharged from Bellevue Hospital today. After a rigorous treatment course, tests show that he is free of the virus and poses no public health threat, the New York City Health and Hospitals Corporation (HHC) said today in a statement. Bellevue is one of eight designated Ebola treatment centers in New York.

With Spencer's hospital discharge, no more Ebola patients are hospitalized in the United States.

Laura Evans, MD, Bellevue's director of clinical care and associate chief of medicine, said as a doctor experienced in treating Ebola patients, Spencer took an active role in treatment decisions about his care. According to earlier reports, he received convalescent plasma from Nancy Writebol, who survived an Ebola infection she contracted while working as a medical missionary in Liberia. Spencer also reportedly received the experimental antiviral brincidofovir.

Spencer today in a statement thanked his medical team and urged the public and the media to turn their attention to the Ebola situation in West Africa. The statement was released by MSF and appeared on the hospital's Web site.

"While my case garnered international attention, it is important to remember that my infection represents but a fraction of the more than 13,000 reported cases to date in West Africa—the center of the outbreak, where families are being torn apart and communities are being destroyed," he said.

He added that his recovery shows that protocols for health workers returning from West Africa are effective.

Canada, ECDC weigh in on traveler, health worker monitoring

In a related development, Canada's government yesterday announced stronger steps for monitoring travelers returning from Ebola-hit countries.

The Public Health Agency of Canada (PHAC) said in a statement that quarantine officers will order anyone with a travel history to the three main outbreak countries to report to a Canadian public health authority and to self-monitor for 21 days. Quarantine officers will give travelers an information kit that contains a thermometer and instructions about reporting to public health authorities.

Those without symptoms will be assigned to a high- or low-risk category. Low-risk people with no known virus exposure are subject to self-monitoring and required to report any symptoms or travel plans. Those at high risk, such as people who attended a funeral or are a family contact of an infected patient, must self-isolate and be monitored daily for symptoms.

For humanitarian workers, the PHAC said asymptomatic people are generally subject to the low-risk steps applicable to other travelers, but local public health officials can decide on a case-by-case basis if self-isolation is required. For example, it said a health worker with a known personal protective equipment (PPE) breach would be considered at higher risk.

Similarly, the European Centre for Disease Prevention and Control (ECDC) yesterday released a technical report on managing healthcare workers returning from the countries affected by the Ebola outbreak.

All healthcare workers should receive information covering general protective measures for contacts, health monitoring, and how to report symptoms, the agency said. It added that returning workers should be assessed individually to gauge exposure risk. Levels range from no direct contact with Ebola patients to mucosal or parenteral direct contact with the body fluids of an infected patient.

The ECDC recommends active monitoring for all but those with no exposure to Ebola patients. Restriction of social interactions and movement is proposed for only those in the riskiest exposure group. The agency added that full quarantine for asymptomatic health worker would be a disproportionate measure unless there is evidence of noncompliance with the other recommended steps.

Other developments

  • The full Senate appropriations committee will hold a hearing on the US Ebola response tomorrow at 2:00 pm Eastern time, with several top federal officials on the witness list. They include Health and Human Services (HHS) Secretary Sylvia Burwell, Department of Homeland Security (DHS) Secretary Jeh Johnson, State Department Deputy Secretary Heather Higginbottom, and Department of Defense (DoD) Assistant Secretary Michael Lumpkin. Several other top government officials are slated to accompany the witnesses.

  • Japan-based Fujifilms Holding Corp said today that it should have clinical test results by the end of the year on the use of its antiviral drug Avigan as an Ebola treatment and that it expects to receive approval by international government groups about a month after the results are in, Reuters reported today. Company chairman Shigetaka Komori said at a press conference today that four Ebola patients so far have recovered after being treated with the drug. The report didn't say if the patients received other treatments alongside Avigan. France and Guinea will conduct trials using 200-mg Avigan tablets.

  • A 25-bed treatment field hospital in Monrovia designed to treat health workers infected with Ebola is now open but so far has no patients, the DoD reported yesterday. In another development, a 100-bed US military–built Ebola treatment center in Tubmanburg, Liberia, located in the western part of the country, is complete and yesterday was transferred to nongovernmental organization officials. According to the DoD, the agency now has 2,000 personnel in Liberia assisting with the outbreak response.

See also:

Nov 10 MSF report

Nov 11 HHC statement

Nov 11 Spencer statement

Nov 10 PHAC statement

Nov 10 PHAC fact sheet

Nov 10 ECDC press release

Nov 10 MSF blog post

Oct 20 Senate appropriations committee statement

Nov 11 Reuters story

Nov 10 DoD report

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