Ebola news 11/18

[Buster's Uncle]

Doctor hesitates, then returns to Ebola front line
Associated Press
By LYNSEY CHUTEL  57 minutes ago



In this photo taken Sunday, Sept. 21, 2014, volunteer doctor, Juli Switala, seated front, poses with the national Ebola response team in Bo hospital Sierra Leone. Returning last month to Sierra Leone to treat Ebola victims after a break, volunteer doctor Switala was shocked to see the obituaries and photographs of colleagues who had died of the disease in her absence, pinned to a board in the treatment center. “That was quite terrible, to realize that people you met a few weeks ago, who were happy, helping you with this fight, have now died because of what they were treating,” Switala, a South African who works for Doctors Without Borders, told The Associated Press in a telephone interview from Sierra Leone. (AP Photo)



JOHANNESBURG (AP) — Returning last month to Sierra Leone to treat Ebola victims after a break, volunteer doctor Juli Switala was shocked to see the obituaries and photographs of colleagues who had died of the disease in her absence, pinned to a board in the treatment center.

"That was quite terrible, to realize that people you met a few weeks ago, who were happy, helping you with this fight, have now died because of what they were treating," Switala, a South African who works for Doctors Without Borders, told The Associated Press in a telephone interview from Sierra Leone.

Ebola has killed more than 5,000 people in the west African countries of Sierra Leone, Liberia and Guinea. Many were health workers, and cases of American and other foreign medical staff who got the virus generated widespread international attention. Doctors Without Borders said 24 of their staff have been infected by the disease, with nine surviving.

Switala believes the local staffers are the unsung heroes who have carried out desperately needed but dangerous work while risking rejection in their homes and communities. Many are under increased pressure at home to quit their jobs. Some have been left by partners who worried that they might catch Ebola from their health-worker partners, according to the South African.

"What makes it incredibly difficult is that they are not only dealing with this at work, they are going home with the same fear," she said.

On her return last month, Switala noted that the local staffers' wariness of making contact with patients is increasing while their determination is faltering under Ebola's relentless attack on people close to them.



In this photo taken Saturday, Aug. 9, 2014, volunteer doctor, Juli Switala, left, poses for a photograph alongside an unidentified Doctors Without Borders colleague in protective gear, at the Bo hospital Sierra Leone. Returning last month to Sierra Leone to treat Ebola victims after a break, volunteer doctor Switala was shocked to see the obituaries and photographs of colleagues who had died of the disease in her absence, pinned to a board in the treatment center. “That was quite terrible, to realize that people you met a few weeks ago, who were happy, helping you with this fight, have now died because of what they were treating,” Switala, a South African who works for Doctors Without Borders, told The Associated Press in a telephone interview from Sierra Leone. (AP Photo)


Switala, 33, trained in South Africa at the height of the country's AIDS pandemic, spending many nights of her internship filling out death certificates. She has also worked in the northern Kunduz region of Afghanistan.

The doctor is where she wants to be, working nine-hour shifts, most of them in a sweaty protective suit, in a tent hospital. The facility was recently erected in what was a cassava field in Bo, Sierra Leone's second-largest city.

As a child, Switala watched news reports about Sierra Leone's civil war. And now she is there fighting in another war, against a deadly and invisible foe.

In May, on her first trip, she tended to patients in a pediatric hospital that is struggling to function in a country overwhelmed by the pandemic. There, she had worried that the disease might be hiding in a patient in the ward. If she suspected Ebola she could put on a protective outfit, but handling each patient felt like a gamble to her.

She went as a pediatrician, landing in Sierra Leone just days after the virus claimed its first victim, and had to change her focus to Ebola. She found herself making hard decisions to help some victims and turn others away because resources are stretched.

"So much of what we're doing is going completely against your gut," she said. "It's almost like being in a war, where you're picking which one has the best chance of survival and that's who you need to spend your time on."

Switala recalled how she once did her rounds with a 3-year-old boy on her hip, eight layers of protective gear separating them. It was the only affection the recently orphaned child had received because most other people were too afraid to pick him up, fearing he might have the Ebola virus. The boy was discharged after he was declared Ebola free, only to be admitted with malnutrition to a government hospital days later.

Doctors have devised mock hugs or high-fives that don't involve physical contact but let them share lighter moments.

European Union officials said Tuesday that thousands more health professionals like Switala are needed to eradicate the Ebola epidemic.

Help is required "today, not tomorrow — it's very crucial," the EU's Ebola coordinator, Christos Stylianides, said in Brussels after visiting Sierra Leone, Liberia and Guinea.

Switala said her mother struggled to understand her decision to return to Sierra Leone, and says she considered remaining in Johannesburg when she learned that a friend had fallen ill with Ebola.

"The gut feeling was 'Oh no, I don't know if I want to go back there,'" she said. "That lasted for about a minute and then I thought, 'Now I have to go back even more because this time it's personal.'"


http://news.yahoo.com/doctor-hesitates-then-returns-ebola-front-line-144716108.html

[Buster's Uncle]

Man who died from Ebola endured treatment delays
Associated Press  7 hours ago



OMAHA, Neb. (AP) — A surgeon who contracted Ebola in his native Sierra Leone did not receive aggressive treatment until nearly two weeks after he first started showing symptoms — a delay that doctors said probably made it impossible for anyone to save his life.

Dr. Martin Salia was in the 13th day of his illness when he reached Omaha on Saturday. It took three days for him to be formally diagnosed after an initial test for Ebola came back negative and then another five days to be flown to the United States.

By the time the 44-year-old Maryland man got to the University of Nebraska Medical Center in Omaha, the deadly virus had done too much damage, shutting down Salia's kidneys and making breathing difficult, doctors said. He died Monday.

"In the very advanced stages, even the modern techniques we have at our disposal are not enough to help these patients once they reach a critical threshold," said Dr. Jeffrey Gold, chancellor of the medical center.

Sierra Leone's government said it was shocked to learn that Salia was dead and questioned whether "the strain of the 16-hour trip could have had a negative impact on his recovery."

The virus has already killed more than 5,000 people in West Africa.

Salia, who chose to work in his homeland despite more lucrative opportunities elsewhere, was first tested for Ebola on Nov. 7, but the test was negative, and he was discharged from a treatment center in Sierre Leone.

It's not unusual to see false negative tests for Ebola in the early stages because the amount of the virus in the bloodstream is still low, said Dr. Phil Smith, the infectious-disease expert who leads the Nebraska Medical Center's biocontainment unit.

The U.S. government warns doctors to be wary of possible false negative tests for Ebola.

Salia tested positive for the disease on Nov. 10 but did not arrive at an Omaha hospital until Saturday.

Two other Ebola patients treated in Omaha this fall arrived at the hospital roughly a week earlier in their illnesses, before nausea, vomiting and more serious symptoms set in. Both of those men recovered.

Government officials in Sierra Leone promised a full investigation into the treatment Salia received.

"At this point, we can't say for certain whether it was this misdiagnosis or not that led to his death," Deputy Information Minister Theo Nicol said in a statement to The Associated Press. The government planned to request a full medical report from the hospital where he was last treated.

Salia, a permanent U.S. resident, was reportedly receiving blood from an Ebola survivor while in Sierra Leone, the government statement said. The treatment is believed to provide antibodies to fight the virus.

Doctors with an air-transport service assessed Salia in Sierra Leone last week before deciding he was stable enough for the long flight to Nebraska.

In Omaha, Salia was placed on kidney dialysis and a ventilator and was given several medications, the hospital said. He was given the experimental Ebola drug ZMapp and received another plasma transfusion from an Ebola survivor.

"I know that we gave him every possible chance to survive. I think that his family feels confident in that as well," Dr. Daniel Johnson said Monday at a news conference.

Salia's wife, Isatu Salia, who lives in New Carrollton, Maryland, said Monday that the family believed he was treated "in the best place possible."

But by the time her husband arrived in Omaha, he was already unresponsive, doctors said.

In a Friday telephone interview, she said she had spoken to her husband and prayed with him. Although his voice sounded weak and shaky, she said he told her "I love you" in a steady voice.

Salia graduated from the Pan African Academy of Christian Surgeons training program in 2008. He was free to practice anywhere he wanted, but he chose to stay in Sierra Leone, where the need for surgeons is immense.

"He honestly believed that's what God wanted him to do," said Bruce Steffes, executive director of the academy.

Salia was a member of a United Brethren Church congregation in Sierra Leone, and the church helped support his medical training.

Jeff Bleijerveld, director of global ministries for the church, knew Salia through missionary work. He said Salia's death is a testament to "his Christian faith, his willingness to, if necessary, lay down his life for others."

___

Associated Press writers Nedra Pickler in Washington, D.C., Clarence Roy-Macaulay in Freetown, Sierra Leone, Nelson Lampe in Omaha, Nebraska, and Krista Larson in Dakar, Senegal, contributed to this report.


http://news.yahoo.com/nebraska-hospital-surgeon-ebola-died-134817996.html

[Buster's Uncle]

Liberian couples marry, a sign of less Ebola fear
Associated Press
By JONATHAN PAYE-LAYLEH  1 hour ago



In this photo taken on Saturday, Nov. 15, 2014, an unidentified couple that just got married walk in a park used for wedding photography in the city of Monrovia, Liberia. Many have postponed their weddings in October as Ebola ravaged Liberia’s capital and the government warned people to avoid large gatherings. Weddings are full of kissing and hugging and just one unknowingly sick person could infect dozens. Now in a sign that daily life is returning as cases fall, the couple tied the knot without waiting any longer. (AP Photo/ Abbas Dulleh)



MONROVIA, Liberia (AP) — Robert Kollie and his fiancee postponed their October wedding as Ebola ravaged Liberia's capital. The government had warned people to avoid large gatherings. Weddings are full of kissing and hugging and just one unknowingly sick person could infect dozens.

A month later, even as Ebola continues to ravage parts of West Africa, the situation has improved in Monrovia and a scenic park in the eastern suburbs is once again busy on weekends with photographers shooting bridal parties. The Kollies were among them.

"When Ebola was spreading and at the same time my wedding was being prepared, I asked myself what will I tell God if I die in this crisis and don't get married?" Yongor Kollie, 31, told The Associated Press, flanked by her bridesmaids. "And so today, I am a happy woman."


Happy but still cautious.

"Even before coming here, we had to wash our hands," said the 33-year-old groom, referring to the ubiquitous plastic buckets with water and bleach that Liberians have come to accept as a daily part of life.

Liberia has been hardest hit of the West African countries battling Ebola outbreaks, with more than 2,800 people killed this year. But the number of new cases has dropped precipitously in Monrovia after months of public awareness campaigns emphasizing the need to isolate the sick and get tested as soon as symptoms emerge, according to the World Health Organization.



In this photo taken on Saturday, Nov. 15, 2014, Liberian couple Dickson Torgbor Gbarjolo, left, and Quoisey Korzu, second left, cut their cake during their wedding ceremony in the city of Monrovia, Liberia. Many have postponed their weddings in October as Ebola ravaged Liberia’s capital and the government warned people to avoid large gatherings. Weddings are full of kissing and hugging and just one unknowingly sick person could infect dozens. Now in a sign that daily life is returning as cases fall, the couple tied the knot without waiting any longer. (AP Photo/ Abbas Dulleh)


Other hotspots are popping up in areas of Liberia outside Monrovia as well as in neighboring countries. Sierra Leone is particularly hard-hit now, with dozens of new cases reported weekly in the capital, Freetown. Cases continue to emerge in Guinea, believed to be ground zero for this Ebola outbreak, the world's worst.

"It is absolutely premature to start being optimistic," Birte Hald of the International Federation of Red Cross and Red Crescent Societies said Monday in Brussels. She noted that the virus "is flaring up in new villages, in new locations."

In Monrovia, though, ordinary life is resuming and there are some signs of normalcy that were all but absent during the height of the crisis here. Washing hands before entering is no longer enforced in many shops. Radio stations are not playing anti-Ebola jingles as often as they did two months ago.

And on Sunday, a small park near the Ministry of Health was full of cameramen jostling for space to get the best shots of the newly wedded.

Jordan Jackson, 36, and his bride Jacquelyn, 33, were married on Sunday after more than a decade together. The couple already has three children — 10, 7 and 5 years old — who took part in the ceremony along with them.

"The feeling I am leaving this park with this afternoon is that Liberia is returning to normalcy and things are getting better," the groom said.

Jacquelyn, a hairdressing instructor, said she felt proud to tie the knot — though that can't relieve the pain of losing some of her friends to Ebola: "I just gave God the glory because I am alive."


http://news.yahoo.com/liberian-couples-marry-sign-less-ebola-fear-103243967.html

[Buster's Uncle]

EU: many more health workers needed for Ebola
Associated Press
By JOHN-THOR DAHLBURG  1 hour ago



European Union Commissioner for Health and Food Safety Vytenis Andriukaitis gestures while speaking during a media conference on Ebola at EU headquarters in Brussels on Tuesday, Nov. 18, 2014. The European Commission on Tuesday briefed the press on the current situation after returning from a visit to Ebola-effected countries in West Africa. (AP Photo/Virginia Mayo)



BRUSSELS (AP) — Thousands more physicians, especially epidemiologists, and other health professionals are needed to halt and eradicate Ebola, European Union officials said Tuesday after returning from countries in West Africa hit by the deadly epidemic.

EU Health Commissioner Vytenis Andriukaitis said the requirements include paramedics, nurses and health care volunteers.

"We need these people to provide treatment and also to locate Ebola victims, guide them toward clinics, train local personnel, perform contact tracing, implement awareness programs," Andriukaitis said.

He said other pressing needs include mobile laboratories, leaflets showing people how to stem the spread of the virus and thousands of portable toilets to improve sanitation and the purity of the water supply.

The trade bloc's Ebola coordinator, Christos Stylianides, said greater help is required "today, not tomorrow — it's very crucial."

The EU officials spoke to journalists after returning to Brussels from the countries most affected by Ebola: Liberia, Sierra Leone and Guinea.

Stylianides said the trip left him shaken and his immediate priority will be drafting an EU "action program." The program will specify exactly how many doctors, nurses, hygienists and other professionals are needed in West Africa, what specialties they should possess, and what training they will require.

After meeting with officials in the affected countries, Stylianides said he felt more reassured that people leaving there for Europe or other destinations will be checked for Ebola symptoms.

"We will manage to combat the virus there, in the area where it has spread," he said. "We shouldn't allow it to escape and spread to other parts of the world."

To end the epidemic, which has claimed more than 5,000 lives in West Africa, and also prevent future outbreaks, Andriukaitis said local hygiene practices and primary health care systems must be enhanced.


http://news.yahoo.com/eu-many-more-health-workers-needed-ebola-143649624.html

[Buster's Uncle]

Love in the time of Ebola: teen pregnancy and violence
AFP
By Anne Chaon  2 hours ago



Experts worry that the Ebola epidemic is giving rise to a darker trend -- spiralling teenage pregnancies and violence against women (AFP Photo/Christophe Simon)



Freetown (AFP) - In Ebola-hit Sierra Leone people abide by a chaste new set of social norms which can be broken down to an easily remembered mantra: no touching, and definitely no kissing.

Yet aid workers and health professionals worry that under the surface the epidemic is giving rise to a darker trend -- spiralling teenage pregnancies and violence against women.

The closures of schools, stadiums and entertainment venues coupled with a ban on public gatherings have left young people idle and disaffected, and their parents worried.

The ABC of Ebola -- "Avoid Body Contact" -- is now deeply ingrained, with people renouncing handshakes and hugs, but the rule stops at the bedroom door.

Maternity wards in Freetown have been deserted by women who fear being infected by Ebola, yet nurses report seeing an increase in pregnant teenage girls, some aged as young as 13.

"If you were expecting a decline in the birth rate, it is quite the opposite," says Musab Sillah, director of the Kuntorloh clinic in the capital Freetown.



A baby naps on his mother's shoulder as they enter the vaccination room during a routine visit at the Kuntorloh Community Health Centre in the outskirts of Freetown on November 14, 2014 (AFP Photo/Francisco Leong)


"Everyone recommends avoiding contact but at the same time schools are closed and there is no more social activity. The girls stay at home and meet the boys," he said.

"As you see fewer and fewer women coming to deliver their babies there are more girls coming in (who are) two months, three months pregnant," said Eugenia Bodkin, a nurse at the Mabella clinic overlooking the Freetown slum of Susan's Bay.


- Transactional sex -

The evidence is anecdotal but UNICEF, the United Nations' children's fund, expects the experience of medical personnel to be borne out eventually by the data.

"We have no evidence or currently no way to conduct a statistical study due to Ebola, but we can expect a large increase in teenage pregnancies," said Matthew Dalling, UNICEF's head of child protection in Sierra Leone.



A baby is prepared for a vaccination during a routine doctor's visit at the Kuntorloh Community Health Centre in the outskirts of Freetown on November 14, 2014 (AFP Photo/Francisco Leong)


"This is a logical assumption, as 2.8 million young people are out of school," he added, noting that even before Ebola, 38 percent of girls were getting pregnant before 18 and half were married before 15.

Sierra Leone languishes in 183rd place on the UN's human development index of 187 countries and is also near the bottom in terms of GDP per capita.

Hunger has given rise to what Dalling calls "transactional sex" among young people -- not quite prostitution "but a relationship in exchange for a favour, a mobile phone, bread, some food".

"We know there was a problem before. It's hard to estimate how much it has increased, but combined with the levels of vulnerability, the lack of schools, the impossibility of going anywhere, it makes sense that it must be growing," he said.

Sierra Leone, like its neighbour Liberia, is struggling to recover barely a decade after the end of a brutal civil war.



A mother feeds her child as they wait to see a doctor at the Kuntorloh Community Health Centre in the outskirts of Freetown on November 14, 2014 (AFP Photo/Francisco Leong)


- Sex attacks -

The conflict left the world with images of child soldiers and rebels funded by "blood diamonds" hacking off limbs, and by 2002 some 50,000 people had died.

The teenagers coping with Ebola were born during the 11-year conflict, in many cases to parents who were themselves in their young teens.

The epidemic, with its accompanying military roadblocks, curfews and all-pervading fear of other people, has opened old wounds.

"Sierra Leone is experiencing a collective trauma with Ebola. That is a big stress on people and people are in pain and getting frustrated and angry," Dalling said.

"We are expecting to see a surge of gender-based violence and exploitation and abuse in the coming months."

Rights group Humanist Watch Salone said it has seen a spike in sexual and gender-based violence in eastern Sierra Leone, the area hit hardest as the epidemic began to spiral out of control in July and August.

The head of the agency, Christopher Braima, told a recent news conference his staff had recorded 33 cases of sex attacks, mostly on girls aged under 14, in the last four months, according to local media.

Meanwhile, parents agonise over how much freedom to give their children and whether they are safe -- parents like Michael, a driver in Freetown who has blown his savings on an expensive television for his 13-year-old daughter.

"I'm afraid she's going to get herself into trouble. I'd prefer that she stays at home and watches films," he said.


http://news.yahoo.com/love-time-ebola-teen-pregnancy-violence-151352613.html

[Buster's Uncle]

Seventh Sierra Leone doctor killed by Ebola: source
Reuters  30 minutes ago



FREETOWN (Reuters) - A Sierra Leonean doctor died of Ebola on Tuesday, a medical source said, bringing to seven the number of doctors killed by the virus savaging the nation's healthcare system.

Still recovering from years of conflict, Sierra Leone has seen at least 128 of its health personnel infected by Ebola as staff working in general wards and special treatment centers have been exposed to the disease.

"Dr Michael Kargbo died this afternoon," said a senior health worker at the Hastings Treatment Center in the outskirts of Freetown, asking not to be named. There was no official comment.

It was not clear how Kargbo, a 64-year-old dermatologist working at the Magburaka Government Hospital, was infected with Ebola as he was not serving in a frontline Ebola treatment unit.

All seven Sierra Leonean doctors who have contracted Ebola have died. Kargbo's death comes a day after Dr. Martin Salia died in the United States after being evacuated from Sierra Leone for treatment.

The worst Ebola outbreak on record has killed over 5,000 people, mainly in Guinea, Liberia and Sierra Leone. Mali is facing a new wave of cases but Senegal and Nigeria have successfully contained outbreaks.

Having been the worst affected nation, Liberia has seen the number of Ebola cases ease off and President Ellen Johnson Sirleaf has set a goal having no new cases by Dec. 25.

However, U.N. officials say the disease is advancing rapidly in Sierra Leone, where there is a lack of treatment centers.

(Reporting by Umaru Fofana; Writing by David Lewis; Editing by Tom Heneghan)


http://news.yahoo.com/seventh-sierra-leone-doctor-killed-ebola-source-183053056.html

[Buster's Uncle]

WHO seeks swifter Ebola test to help stamp out epidemic
Reuters  2 hours ago



GENEVA (Reuters) - The World Health Organization is seeking faster and cheaper tests to detect the Ebola virus to help stamp out the last few cases of the deadly fever once the main epidemic has been tackled, WHO officials said on Tuesday.

The world's worst ever outbreak of Ebola has killed over 5,000 people, almost all in Liberia, Sierra Leone and Guinea. While the number of cases has been falling in Liberia, the outbreak remains out of control with continuing spread in Sierra Leone and parts of Guinea and a new cluster of cases in Mali.

Ebola tests currently take 2-6 hours to deliver a result and are "cumbersome, slow and complex", requiring a full tube of blood, sophisticated equipment, trained staff and a high level of bio-safety, the WHO's Pierre Formenty said.

Labs in Ebola-hit countries currently test 1,000-1,200 samples per day and could test as many as 2,000, but a faster and more agile testing strategy is needed, Formenty, an expert in emerging and epidemic diseases, told a news conference.

Slow test speeds have contributed to Ebola's spread with clinics unable to quickly separate Ebola and non-Ebola patients, and getting samples to laboratories can take hours or days.

Small and cheap testing kits will be crucial for the aggressive testing needed to finally declare the outbreak over, according to Formenty. "We have missed several chains of transmission in the population, in the community, and we need to find these ones to be able to say that the outbreak is over.

"We are also looking at where we will be in 4-6 months from now when the cases hopefully are going to decrease sharply and we will be trying to find the very last cases and notably we are going to reopen non-Ebola facilities," he said.

The WHO hopes to find a test that can yield results in 30 minutes and can be easily stored, with no need for a power supply or maintenance and no bio-safety requirements beyond the usual personal protective gear worn for treating Ebola patients.

Ideally it should take less than half a day to train somebody in how to use it, WHO experts say.

(Reporting by Tom Miles; Editing by Mark Heinrich)


http://news.yahoo.com/seeks-swifter-ebola-test-help-stamp-epidemic-181309950.html

[Buster's Uncle]

Hospitals improvise Ebola defenses, at a cost
Associated Press
By DAVID B. CARUSO  2 hours ago



In this Friday, Nov. 14, 2014 photo, a medical worker stands outside a patient care room in a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital, in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)



NEW YORK (AP) — What does it take to Ebola-proof a hospital?

Over the past few months, U.S. medical centers have spent millions of dollars putting together a plan to treat patients with the scary, but extremely rare disease.

To a large extent, it has been an exercise in improvisation.

In Newark, New Jersey, a hospital dealing with a space-crunch and staff anxiety moved its Ebola operation out of its main building and into a mobile medical shelter ordinarily used during natural disasters. In Dallas, Texas, three hospital systems pooled resources to create a treatment center in a defunct intensive care unit sitting empty since the spring. In Kansas, a hospital hastily built walls and hung plastic sheeting to create an isolation suite. A New York City hospital put together one unit, decided it wasn't optimal, and is finishing work on a replacement.

Federal officials have said they're trying to identify up to 20 hospitals around the country as Ebola referral centers. U.S. Centers for Disease Control and Prevention inspection teams have visited nearly 30 hospitals to offer advice and see if they have the right safeguards in place to treat patients with Ebola.

A U.S. House subcommittee held a hearing on Ebola preparedness Tuesday. A U.S. Senate committee had another hearing on the subject planned for Wednesday. President Barack Obama has asked Congress for $6.18 billion to fight Ebola globally, some of which could be used to strengthen domestic health defenses.

There is no tried-and-true way to build an Ebola ward, but the administrators cobbling them together have been guided by a few key principals gleaned from clinics in Africa and the few full biocontainment facilities in the U.S.



This Friday, Nov. 14, 2014 photo shows doctors and nurses holding a meeting through a closed-circuit monitoring system in a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


At a minimum, treatment units need a "hot" zone where patients can be isolated, a "cold" zone kept free of anything that might be tainted with the virus, and a "warm" zone where workers can peel off protective gear while spotters watch for any small break in protocol. Most hospitals have also preferred to locate their Ebola treatment areas far, far from other patients.

Here is a look at some of the solutions that they've come up with in three months of frenzied planning:

___

THE MASH UNIT

The first few times patients turned up at Newark's University Hospital with symptoms that could be caused by Ebola, "we were bordering on hysteria," said Dr. Greg Sugalski, chief of the emergency department.

There was confusion about safety protocols. The emergency room was too cramped; It had two rooms for isolating patients, but no adjacent space for health care workers to get in and out of protective gear. Plus, other patients were freaking out.



In this Friday, Nov. 14, 2014 photo, a nurse sits beside a closed-circuit monitoring system outside a patient care room in a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital, in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


"There was a lot of gawking," Sugalski said. "People were walking out, not wanting to be near someone who might have Ebola."

The solution was sitting in storage: A Western Shelter GK-1935 medical tent system — sort of an emergency room in a box that the hospital had previously deployed after Hurricane Sandy.

It quickly became a pop-up isolation unit, erected inside a vacant, unfinished floor in the hospital's ambulatory care building.

The public got a peek at the setup when it was used to quarantine Kaci Hickox, a Doctors Without Borders nurse returned from helping treat Ebola patients in Sierra Leone.

Hickox disparaged her three-day confinement, saying it was "inhumane" to imprison her while she was healthy. In the tent, she had to wear paper scrubs and use a port-a-potty-style toilet and could only see visitors through a plastic window.

But hospital officials said the shelter solved a multitude of problems. It was quiet, calm and distant from other patients. There was plenty of room to lay out the proper hot and warm zones. Caregivers also had space to practice going through the complicated ritual needed to safely don and doff protective suits (They went through more than 60 of them in the short time Hickox was in the unit).



In this Friday, Nov. 14, 2014 photo, a worker passes a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital, in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


"It was just a world of difference," Sugalski said.

"It lets us screen and isolate patients and not have an effect on the normal operations of the hospital," said Dennis Boos, director of University Hospital's community training center. "If we had to do this in the emergency room, we would probably lose between three and four beds."

___

THE ABANDONED ICU

When a Liberian traveler turned up sick with Ebola at a Dallas hospital in September and subsequently infected two nurses, health officials in Texas began a feverish search for facilities that could treat other victims.

They ultimately picked two. The first one was a no-brainer: The University of Texas Medical Branch in Galveston, which was already home to a national biocontainment training center.



In this Friday, Nov. 14, 2014 photo, a prosthetic arm for IV training rests on a bed in a patient care room inside a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


The second was the lesser-known Methodist Campus for Continuing Care, a former full-service hospital outside Dallas that had been sitting mostly empty since the staff moved to a new campus last spring.

In some ways, having a whole, empty hospital to create the new unit was a luxury, said Dr. Sam Bagchi, the chief quality officer at Methodist Health System.

There was an intensive care unit free of any other patients. It had its own lab — one that wouldn't have to shut down for a lengthy decontamination every time it handled a sample from someone with Ebola. There was even living space where caregivers could quarantine themselves for up to three weeks.

Officials teamed Methodist with two other area hospitals, Parkland Hospital and UT Southwestern Medical Center, to assemble the personnel and gear needed to get the unit functioning. It is now on standby status and can be ramped up to accept a patient within 12 hours.

Bagchi said officials still had to work through a list of over a hundred problems to make the collaboration happen, including figuring out which electronic medical record system to use in the unit. All three hospitals had their own, incompatible systems.

One thing that was never discussed was cost.



In this Friday, Nov. 14, 2014 photo, a new custom-built bio-containment unit for potential Ebola cases, indicated by the roof mounted ventilation system, is nestled between buildings at Mount Sinai Hospital, in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


"Frankly, that would have made it an almost impossible equation to solve," Bagchi said. "We would have spent any number of dollars to say we were ready to accept Ebola patients."

Now that the immediate crisis in Dallas has passed, though, that is beginning to change. It could be, he said, that there are more efficient models than having an entire medical building sitting empty, waiting for a hypothetical patient who may never appear.

At Tuesday's House hearing, Dr. Jeffrey Gold, chancellor of the University of Nebraska Medical Center, said the cost of treating Ebola patients at the biocontainment unit at the Nebraska Medical Center averaged $30,000 per day — a figure that doesn't include hundreds of thousands of dollars spent each year on extra training or the cost of emptying the 10-bed unit of other, revenue-generating patients to make way for someone with Ebola.

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BIOCONTAINMENT ON A BUDGET

Until 2010, the nation's pre-eminent place for treating people exposed to incurable, deadly diseases like Ebola was a biocontainment unit nicknamed "the slammer," located at the US Army Medical Research Institute of Infectious Diseases in Frederick, Maryland.



In this Friday, Nov. 14, 2014 photo, a nurse walks down a hallway alongside a patient care room in a new custom-built bio-containment unit for potential Ebola cases at Mount Sinai Hospital, in New York. The unit, built over two weeks, is completely separate from the main medical buildings and can house three patients simultaneously. (AP Photo/John Minchillo)


Patients entered through airtight entry doors made of heavy steel. Caregivers wore pressurized suits. The containment suite had a chemical decontamination shower and a high-tech ventilation system designed to prevent anything but pure air from reaching the outside world. Items entering and leaving the unit could be passed through an autoclave, a disinfectant dunk tank and an ultraviolet light chamber to kill off any clinging microbes. Even the toilet water passed through a steam sterilization system.

That unit was decommissioned in 2010, in part because of new thinking that a lot of those measures were overkill.

Its successors included a few places that might be a better model for how to do bio-containment on a budget, including St. Patrick Hospital, a community hospital in Missoula, Montana, that built a high-level isolation unit in 2007 for $624,000, according to a 2010 paper in the journal Emerging Infectious Diseases.

That's the model the University of Kansas Hospital tried to replicate in a hurry when it got its first suspected Ebola patient turned up in early October.

The Kansas City, Kansas, hospital emptied out a seven-bed patient care unit and quickly put up $10,000 worth of temporary walls and heavy plastic sheeting to create an isolation suite. It included sealed tunnels that caregivers could use to move between the patient's room and a decontamination area.

The hospital even stockpiled shoes and undergarments for doctors and nurses, who were told to dispose of every stitch as hazardous waste during decontamination.

It took less than 48 hours to determine that the patient didn't have Ebola, but since then even more light construction has been done to make it easier to ramp up in the future.

"We need to be prepared for this kind of patient. If they present, we're going to care for them. There's no alternative," said Chris Ruder, the hospital's vice president of patient care services.

A similar transformation was undertaken at Mount Sinai Hospital in New York City, which walled off a section of a coronary care unit to create an isolation suite after health officials said they wanted several Manhattan hospitals ready to treat Ebola within 10 days.

Administrators have already decided that new unit isn't optimal, so work is now proceeding on a second biocontainment unit.

This one is located outside the main hospital in a 20-by-100 foot temporary building previously used as construction offices.

Meanwhile, staff has been pulled from their regular duties or brought in on overtime for intensive training. Those preparations have included having clinicians practice regularly in full protective gear.

The costs of all this preparation are still being tallied.

"It's going to be in the millions. I just don't know how many millions yet," said Dr. David Reich, the hospital's president and chief operating officer.

All those expenses raise a question, Ruder said: With so few actual patients, would it make more sense to have a few, well-placed, well-funded hospitals ramp up, and save everyone else the cost?

"Should we replicate this effort times thousands of hospitals across the country ... or should we look at more of a regionalization or referral center concept?" asked Ruder. "I think that's the point of discussion that is emerging.


http://news.yahoo.com/hospitals-improvise-ebola-defenses-cost-184056149.html