Anta Assamey Posted October 17, 2014 Report Posted October 17, 2014 Nina Pham and Amber Joy Vinson contracted Ebola while treating Thomas Eric Duncan, a Liberian man who traveled to Dallas. Both nurses were with him during what federal health officials have called the highest risk period, when he was vomiting and having diarrhea. Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sept. 19 20 After a fever check, Duncan boards flight from Liberia. Duncan arrives in Dallas area to visit family. 21 22 23 24 25 26 27 Duncan begins to develop symptoms. Duncan seeks care at Dallas hospital but is sent home. Oct. 1 2 3 4 28 29 30 Duncan returns to hospital and is put in isolation. Duncan’s positive Ebola test is confirmed. Highest risk period: Both hospital workers who were later diagnosed with Ebola were treating the patient during this time. 5 6 7 8 9 10 11 Vinson flies to Cleveland from Dallas area. Pham tests positive for Ebola. Duncan dies. 12 13 14 15 Vinson flies to Dallas area from Cleveland. Vinson tests positive for Ebola. How many Ebola patients have been treated outside of West Africa? At least 17 cases have been treated in Europe and the United States. Most involve health and aid workers who contracted Ebola in West Africa and were transported back to their home country for treatment. Cases shown below are compiled from reports by the C.D.C., the World Health Organization, Doctors Without Borders and other official agencies. Recovered In treatment Died Oslo Hamburg London Leipzig Omaha Nebraska Medical Center Paris Frankfurt Madrid Bethesda, Md. N.I.H. Clinical Center Dallas A Spanish nurse contracted Ebola while treating a missionary who died in a Madrid Hospital. Atlanta Emory University Hospital The two nurses who contracted Ebola at a Dallas hospital were transfered to specialized units in Atlanta and Bethesda, Md. Countries with Ebola outbreaks Cases of Ebola Outside of West Africa As of Oct. 16, 2014 United States Arrival date Spain Arrival date Aid worker Missionary Doctor Doctor Visitor NBC cameraman Hospital worker Hospital worker Aug. 2 Aug. 2 Sept. 5 Sept. 9 Sept. 30* Oct. 6 Oct. 11* Oct. 15* Recovered Recovered Recovered In treatment Died In treatment In treatment In treatment Missionary Priest Nurse Aug. 7 Sept. 22 Oct. 6* Died Died In treatment Germany Doctor Doctor U.N. medical worker Aug. 27 Oct. 3 Oct. 9 Recovered In treatment Died France Norway Nurse Sept. 19 Recovered Aid worker Oct. 6 In treatment Britain *Date of Ebola diagnosis. Nurse Aug. 24 Recovered How many health care workers have contracted Ebola? More than 400 health care workers in West Africa have been infected with Ebola during the current outbreak, and 233 had died as of Oct. 8. The W.H.O. said that the high rates of infection among medical workers could be attributed to shortages or improper use of protective equipment; not enough medical personnel; and long working hours in isolation wards. 416 cases 400 Ebola cases in health care workers in West Africa Source: World Health Organization 301 300 233 deaths 200 144 100 April 2 May 2 Sept. 7 Oct. 8 What is the United States doing to make sure that Ebola does not spread? New screening protocols have begun at five U.S. airports: Kennedy International, Washington Dulles International, O’Hare International, Hartsfield-Jackson International and Newark Liberty International. Travelers from West Africa have their temperatures taken and are questioned about their possible exposure to Ebola. The C.D.C. has also announced that a site manager would be sent immediately to any U.S. hospital treating Ebola patients to oversee all aspects of infection control, including making sure that health officials properly remove protection gear. How contagious is the virus? Officials have emphasized that there is no risk of transmission from people who have been exposed to the virus but are not yet showing symptoms. Ebola spreads through direct contact with bodily fluids. A cough from a sick person could infect someone who has been sprayed with saliva. Specialists at Emory University Hospital in Atlanta have also found that the virus is present on a patient’s skin after symptoms develop, underlining how contagious the disease is once symptoms set in. According to the C.D.C., the virus can survive for a few hours on dry surfaces like doorknobs and countertops and can survive for several days in puddles or other collections of body fluid. Bleach solutions can kill it. Are there drugs to treat or prevent Ebola? There are more than a dozen Ebola drugs in development, but none have been approved by the Food and Drug Administration. Several of these have been approved for emergency use in the current crisis. One of these, ZMapp, has been used on at least two patients in the United States, but there were no more doses available as of early October. The W.H.O. suggests that blood from Ebola survivors might be used to treat others, but there is no proof that such a treatment alone would work. The United States government plans to fast-track development of a vaccine shown to protect macaque monkeys, but there is no guarantee it will be effective in humans. Host cell Ebola virus Antibodies ZMapp Viral RNA Ebola virus The Ebola virus infects cells by punching into the cell and injecting a small piece of viral RNA. The RNA hijacks the machinery of the cell and uses it to create more copies of the Ebola virus, which in turn infect other cells. Ebola survivors have antibodies against the Ebola virus in their blood. Antibodies are Y-shaped proteins that can latch on to a specific virus and prevent it from infecting cells. Plasma extracted from the blood of Ebola survivors might be transfused into infected people, possibly helping them fight the infection. The drug ZMapp is a mixture of three different antibodies that were developed in mice and modified to work in humans. The drug was first tested in humans during the current outbreak, but it is unclear if the drug is effective. ZMapp is made in tobacco plants and there is only limited manufacturing capacity. Correction: An earlier version of this graphic referred incorrectly to the structure that encloses human cells. It is the cell membrane, not the cell wall. How does the disease progress? Symptoms usually begin about eight to 10 days after exposure to the virus, but can appear as late as 21 days after exposure, according to the C.D.C. At first, it seems much like the flu: a headache, fever and aches and pains. Sometimes there is also a rash. Diarrhea and vomiting follow. Then, in about half of the cases, Ebola takes a severe turn, causing victims to hemorrhage. They may vomit blood or pass it in urine, or bleed under the skin or from their eyes or mouths. But bleeding is not usually what kills patients. Rather, blood vessels deep in the body begin leaking fluid, causing blood pressure to plummet so low that the heart, kidneys, liver and other organs begin to fail. How many Americans have contracted Ebola in West Africa and returned to the U.S? Five. Three American health workers, Dr. Kent Brantly, Nancy Writebol and Dr. Rick Sacra, contracted Ebola in Liberia, were treated in the United States and later released. Another American, who has not been identified, contracted Ebola in Sierra Leone and was treated at Emory University Hospital in Atlanta. The fifth American, Ashoka Mukpo, is a freelance cameraman for NBC who was filming in Liberia. He arrived at the Nebraska Medical Center on Oct. 6. How many people have been infected in Africa? More than 8,900 people in Guinea, Liberia, Nigeria, Senegal and Sierra Leone have contracted Ebola since March, according to the World Health Organization, making this the biggest outbreak on record. More than 4,400 people have died. 8001,6002,4003,2004,000MAR 21OCT 15843deaths1,472casesGuinea8001,6002,4003,2004,000MAR 21OCT 152,458deaths4,249casesLiberia8001,6002,4003,2004,000MAR 21OCT 151,183deaths3,252casesSierra Leone8001,6002,4003,2004,000MAR 218deaths20casesNigeria Where is the outbreak? The disease continues to spread in Guinea, Liberia and Sierra Leone. The C.D.C. said on Sept. 30 that Nigeria appeared to have contained its outbreak. EBOLA CASES SENEGAL MALI 1 15 150 250 500 or more GUINEA- BISSAU GUINEA Atlantic Ocean Guéckédou SIERRA LEONE IVORY COAST Kenema WEST AFRICA Monrovia 150 Miles NIGERIA LIBERIA DETAIL Source: USAID Note: Areas affected as of Sept. 29 How many people could become infected? The W.H.O. reported on Oct. 14 that the number of new Ebola cases could reach 10,000 per week by December. The C.D.C. published a report in September that outlined a worst-case situation, in which the total number of cases could reach 1.4 million in four months. The C.D.C.’s model is based on data from August and includes cases in Liberia and Sierra Leone, but not Guinea (where counts have been unreliable). It also projects further into the future and adds ranges to account for underreporting of cases. 1,400,000 Cumulative cases in Liberia Best-case scenario Worst-case scenario 1,200,000 11,000-27,000 cases through Jan. 20 537,000-1,367,000 cases through Jan. 20 Assumes 70 percent of patients are treated in settings that confine the illness and that the dead are buried safely. About 18 percent of patients in Liberia and 40 percent in Sierra Leone are being treated in appropriate settings. If the disease continues spreading without effective intervention. Dr. Thomas R. Frieden, the C.D.C. director, said, “My gut feeling is, the actions we’re taking now are going to make that worst-case scenario not come to pass. But it’s important to understand that it could happen.” 1,000,000 800,000 600,000 Range 400,000 200,000 0 Oct. Nov. Dec. Jan. Oct. Nov. Dec. Jan. Sept. Sept. 2014 2015 2014 2015 Source: Centers for Disease Control and Prevention An earlier version of this chart was mislabeled. The chart shows cumulative cases in Liberia, not in Liberia and Sierra Leone. What is the United States doing to help? President Obama announced Sept. 16 an expansion of military and medical resources to combat the outbreak, including the deployment of as many as 4,000 American military personnel to Liberia and Senegal. He said the United States would help Liberia in the construction of more than 17 Ebola treatment centers in the region, with about 1,700 beds, and would also open a joint command operation to coordinate the international effort to combat the disease. But military planners say construction of the centers has been delayed because of the difficulty in getting heavy equipment to the areas. How does this compare to past outbreaks? It is the deadliest, eclipsing an outbreak in 1976, the year the virus was discovered. Ebola cases and deaths by year, and countries affected Cases Deaths 1976 1995 2000 2007 2014 2nd-worst year 5th 3rd 4th 1st Sudan, Democratic Republic of Congo Democratic Republic of Congo Uganda Uganda, Democratic Republic of Congo Guinea, Liberia, Nigeria, Senegal and Sierra Leone 602 cases 431 deaths 315 cases 254 deaths 425 cases 224 deaths 413 cases 224 deaths 6,553 cases 3,083 deaths as of Sept. 26 Source: World Health Organization Where does Ebola come from? Ebola was discovered in 1976 and was once thought to originate in gorillas, because human outbreaks began after people ate gorilla meat. Scientists now believe that bats are the natural reservoir for the virus, and that apes and humans catch it from eating food that bats have drooled or defecated on, or by coming in contact with surfaces covered in infected bat droppings and then touching their eyes or mouths. The current outbreak seems to have started in a village near Guéckédou, Guinea, where bat hunting is common, according to Doctors Without Borders. Note: On Sept. 30, officials with the federal Centers for Disease Control and Prevention said Mr. Duncan first went to the hospital on Sept. 26. On Oct. 1, the Texas Health Presbyterian Hospital issued a statement that he first arrived there after 10 p.m. on Sept. 25.
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