Banishing Ebola By Banning Travel?

"I wouldn't be surprised at all if we saw a case of Ebola in Canada in the weeks or months ahead."
"[...Entry screening of travellers may be reassuring to the public] but it's unlikely to have any meaningful impact in terms of preventing the introduction of Ebola virus into Canada."
"So traveller screening, whether it's exit screening or entry screening, isn't likely to have a big impact in terms of mitigating the spread of this disease."
"This is the type of outbreak where many might feel compelled to try and close down their borders and lock the disease out. That's really almost impossible. Source control is the real priority right now."
Dr. Kamran Khan, infectious disease physician, St. Michael's Hospital, Toronto

In the United States pressure is rising to have federal authorities ban flights to and from the affected regions of West Africa; Sierra Leone, Liberia and Guinea where there has arisen a total of 8,216 confirmed cases of Ebola resulting in 4,555 deaths to date, according to the World Health Organization. Projections into the near future -- a mere two months ahead -- conjecture the potential of 1.4-million Ebola cases diagnosed by the end of 2014.

By that time, should it occur, and the international effort to curtail the spread fail, there will be any number of Ebola cases diagnosed in Europe and North America, the Middle East and Asia, as well as an inevitable spread to the rest of Africa. That's the absolute worst-case scenario. With the belated alarm raised by the World Health Organization and the alarm felt around the world, it is entirely possible that well before that time the outbreak will be contained. And that is most certainly what everyone hopes for.

Reuters   A health worker is reflected in a mirror as he prepares protective equipment in Sierra Leone’s capital city, Freetown. Cuba has dispatched 165 health workers to the country to combat the Ebola outbreak.

Nations outside Africa are sending volunteer medical staff to help in the massive effort to stem the Ebola tide. Cuba, famous for its 'barefoot doctors' and its propensity over the years to send its physicians abroad to aid less developed countries when health scares such as this arises, has pledged to send 300 health workers to aid in the fight against the spread of Ebola.

There are any number of courageous, dedicated health workers from around the international community who have travelled to West Africa to aid how and wherever they can at risk to themselves. If a travel ban into and out of the countries involved occurs, the ban would make it impossible for such international volunteers to reach the sites requiring their assistance. Nor would medical equipment be permitted entry, further complicating matters.

Any medical personnel from abroad who become infected would then be forced to remain where they are, without the more advanced hygienic methods used in the West available to them, where water is plentiful and the luxury of technical advances can be applied, along with whatever ameliorating protocols can be advanced, from using blood transfusions from those who have survived Ebola, to experimental drugs.

An analysis published in the medical journal The Lancet, interpreted the expected number of internationally exported cases of Ebola virus, based on epidemic conditions and flights from Guinea, Liberia and Sierra Leone. The analysis team projects that three travellers infected with Ebola virus will depart their affected regions on commercial flights very month, on average. And the risk of transmission increases the longer the Ebola outbreak persists, and grows, according to study co-author Dr. Kamran Khan.

In their bid to estimate the potential for Ebola spread internationally Dr. Khan and his colleagues examined the size of each country's population, the number of active cases reported and the volume of outbound travellers leaving those affected areas. The research team estimated that for commercial airports where direct flights from Guinea, Liberia or Sierra Leone are absent, on average 2,512 travellers would have to be screened to identify one traveller originating from one of the three countries.

While exit screening takes place in the three affected countries, cases are certain to be missed, with the reality of the long incubation period -- up to 21 days -- when people may be infected, but do not yet show any symptoms, which was just what occurred with Thomas Eric Duncan whose Ebola fever showed up days after he landed in Texas, and who ended up contaminating a large swath of area, from the plane he arrived in to the apartment he stayed within to the Texas Presbyterian Health Hospital where transmission infected two health-care workers.

Strident Ebola Insecurity

"Airborne transmission has not been ruled out and this is the fundamental disagreement that we're having with the government. We need to err on the side of safety."
Ontario Nurses' Association president Linda Haslam-Stroud

"It was the nurse in Texas that really rang the alarm bells for us."
"We will do our jobs 24/7 if we are well-protected, and we have the training. But we have to ramp up what we have on paper and ramp it up fast."
"My understanding is there are gaps. We are nurses for a reason. We know that you will be placed in some kind of danger, but the best option is to make sure you are well-trained and have proper personal equipment."
Linda Silas, head, Canadian Federation of Nurses Unions

"I think we passed the test in terms of the appropriate precautionary steps being taken, appropriate treatment being offered, lab tests being ordered in a rapid way. ... It was useful to see our planning that has been in place to now has really paid off."
Dr. Vera Etches, associate medical officer of health, Ottawa

A Doctors Without Borders (MSF), health worker in protective clothing carries a child suspected of having Ebola in the MSF treatment center on Oct. 5 in Paynesville, Liberia. The girl and her mother, showing symptoms of the deadly disease, were awaiting test results for the virus. The Ebola epidemic has killed more than 3,400 people in West Africa, according to the World Health Organization. (John Moore/Getty Images)

One Ottawa-area patient suspected of having the Ebola virus has been cleared. Clearance is awaited in yet another individual in Belleville. But the case of the nurse in Spain and the Texas nurse, both of whom acquired the virus from patients they were tending with Ebola, hangs heavy in the minds of Canadian nurses. The head of the organization representing 60,000 Ontario nurses expressed her fears that the province is not fully prepared.

Questions revolve around whether protective equipment should include special respirators to protect health workers from airborne particles. As well as some coverage offering more than simply gowns. Uncertainty about equipment and their protective capabilities stirs the fears of health care workers, particularly nurses across the country. Ms. Silas speaks of equipment problems she has heard of with some nurses complaining chins and necks were exposed, others that protective gowns had sleeves too short.

Equipment, she stressed, must be available at all facilities. The SARS epidemic, Ms. Haslam-Stroud reminded, infected dozens of health-care workers and death claimed three. That Canada is not yet fully prepared to cope with an epidemic in the country is a major concern to these nurses' representatives, particularly in light of the heavy death toll taken on health-care workers in the four West African countries most heavily impacted by Ebola.

And the World Health Organization warned that up to ten thousand new Ebola cases weekly could be surfacing in West Africa within the next several months. This, at the same time that it revealed the death rate in the present outbreak has risen, to 70 percent. Previous estimates given by the agency had given the Ebola mortality rate at around 50 percent. Contrast that to flu pandemics where the death rate typically is under two percent.

Ebola is considered a high-mortality disease, and the problem of isolating the ill, providing treatment as early as possible is being compounded by the increase in cases. Doctors Without Borders has said that 16 of its employees were infected with Ebola, nine of them having died. "Where is WHO Africa? Where is the African Union?" asked Sharon Ekambaram head of the South Africa unit of Doctors Without Borders. "We've all heard their promises in the media but have seen very little on the ground."

In Leipzig, Germany a 56-year-old medical worker with the United Nations infected in Liberia, died. Prompting Liberia's UN mission to place 41 other staff members under "close medical observation". In Dallas the American nurse who became Ebola-positive after treating a Liberian patient who then died, received a transfusion of plasma from Dr. Kent Brantly who received an experimental treatment to survive the virus.

The assistant nurse in Spain infected with Ebola has seen slight improvement while still in serious condition. Fifteen of her contacts were being monitored. And in the United States, over 200 people who shared a flight with another nurse from Texas Health Presbyterian Hospital who has now tested positive for Ebola are being sought for the purpose of isolating them until such time as their condition can be cleared.

The deadly spread appears inexorable... While withering the confidence of health-care workers to whom is entrusted the care of the infected.

Ebola, Liberia

"The family says the person is not an Ebola patient and they pull them away from the other people. Then they say, 'We can give you a certificate from the Ministry of Health that it wasn't Ebola'."
"Sometimes it is $40. Sometimes it is $50. ... Then they offer bags to them and [the family] carry on their own thing."
Vincent Chounse, Community outreach worker, Monrovia, Liberia

"They told us not to bury the bodies. They told us to bury the bodies. They told us to call. But now I am not sure if they are the ones trying to eradicate this virus or to make it grow."
Robert Johnson, 17, Grand Gedeh County, Liberia

A sign lists the "10 Commandments of Ebola" in West Point. (Photo by Tim Freccia)

An epidemiologist at South Africa's University of Pretoria, who travelled to Liberia to help with the Ebola response, claimed to have received reports of people paying bribes to teams sent out for retrieval and safe disposal of the bodies of Ebola victims. The bribes resulted in the teams looking the other way, permitting the custom in the region of family washing, handling, and burying bodies of the deceased to take place as usual.

"Low-level corruption has a high-level impact", said Andrew Medina-Marino.

The teams whose job it is to retrieve dead Ebola victims issue death certificates to families claiming their family members died of other causes, accepting bribes for that privilege. The body is then left behind, for the families to practise their traditional burial procedures. Locals and health workers alike have made allusion to this dangerous practise.

A development that will make it all the more difficult to halt the dread virus from spreading. Since dead bodies of Ebola victims remain the major source of contagion. And the corruption of some of the teams in accepting bribes will ensure that the effort to contain the virus will be hugely unsuccessful, since Liberian funerals include washing the body and retaining it for a wake lasting days.

A health worker holds a poster warning that Ebola is real in the West Point area of Monrovia, Liberia. (Photo by Tim Freccia)

Relatives and friends attend the ceremonial practise to kiss the corpse before it is interred, most often in a family cemetery plot nearby. Another reason for families of the deceased to hope to deny that their loved ones suffered from Ebola, is that the deadly disease carries a social stigma. So avoidance of the reality of the cause of death becomes a point of family honour, one which guarantees wider spread of the devastating virus.

Outside the capital Monrovia, Commissioner Hawa Johnson has stopped issuing burial permits to anyone who cannot produce a death certificate from a hospital giving confirmation of a non-Ebola death. This, after one of her workers came to the realization that body-retrieval teams were offering to sell fake death certificates in the community. Funeral home directors too have taken to double-checking death certificates.

Vincent Chounse, a community outreach worker, claims to have witnessed the corrupt negotiations four times in another township on the outskirts of Monrovia. Teen-age Robert Johnson explained he saw the man who lived next door fall ill. When he died, a team from a funeral home came to collect the cadaver. The family protested and young Mr. Johnson watched as a document certifying the body was Ebola-free was handed over for $150.00.

He professes confusion now, that while the government informs residents they must call body-retrieval teams, the teams fail in their duty to remove the corpses.

A man showing serious symptoms of Ebola was sent to the JFK Ebola treatment center in Monrovia, where he was turned away. (Photo by Tim Freccia)