Origin of Ebola
outbreak may be a bat and virus has rapid mutation rate
The Ebola virus has mutated 300 times since the deadliest outbreak in
history began in West Africa in May, and these transformations lead
scientists to conclude that it is unlike any past Ebola epidemic. This could
make it both harder to treat and harder to diagnose, according to a study
published in Science magazine.
The outbreak began as a single human infection, the authors write, but the
genetic sequences observed in the 78 patients sampled showed a rapid spread
in both the number of people infected and the geographical regions affected.
As it stands, the virus is unlike anything seen in the past, which will
hinder the creation of treatments and make it difficult to fully contain the
contagion, the study found.
"We've uncovered more than 300 genetic clues about what sets this outbreak
apart from previous outbreaks," said Stephen Gire, a co-author and disease
researcher at Harvard.
The initial infection, contracted by a woman in Sierra Leone, came from one
of five strains of Ebola known to affect humans called the Zaire strain. The
Zaire strain came about a decade ago in a related strain from an animal
host. Researchers are not positive which animal hosted the virus, but said
it was most likely was a bat in Guinea. At least one species of fruit bat
has a geographic range that spreads from Guinea to Sierra Leone. If bats are
really the culprit, "about 150 million more people than previously thought
are at risk of the disease," according to a previous study published in
Science about Ebola.
The virus then crossed into Sierra Leone when the first woman diagnosed
attended a funeral for someone who had recently been in contact with Ebola
in Guinea, the study found.
Since then, it "has exhibited sustained human-to-human transmission
subsequently, with no evidence of additional zoonotic [animal] sources."
One of the problems with this particular outbreak is that scientists have
not been able to fully trace the virus from 2004 in Guinea to the current
outbreak. Being unable to predict where it will next appear makes it very
difficult to contain. The World Health Organization said Thursday that it
hopes to stop the spread by 2015.
Clues from the study have scientists hopeful that nonstop research on
mutations will help develop new diagnostic tests and treatments. In the
study, 99 Ebola samples were taken from 78 patients diagnosed with Ebola
from May to late June. More than 50 people co-authored the study with help
from Harvard University scientists and the Sierra Leone Health Ministry.
Five of the authors died before the paper was even published.
Visit the IB Times for the story.
It was already the
worst Ebola outbreak in history; Now it's moving into Africa's cities
FREETOWN, Sierra Leone â€” The dreaded Ebola virus came to the children's
hospital in the form of a 4-year-old boy. His diagnosis became clear three
days after he was admitted. The Ola During hospital â€” the nation's only
pediatric center â€” was forced to close its steel gates. Fear swelled. The
boy died. The 30 doctors and nurses who had contact with him were placed in
quarantine, forced to nervously wait out the 21 days it can take for the
virus to emerge. And remaining staff so far have refused to return to work.
They, along with millions of others, are facing the worst Ebola outbreak in
Already, the hardest-hit West African nations of Guinea, Liberia and Sierra
Leone have reported more than 3,000 cases, including the infections of 240
Ebola is now spreading from the remote provinces and into the teeming cities
such as Freetown, where 1.2 million people jostle for space. Previous
outbreaks had been limited to remote villages, where containment was aided
by geography. The thought of Ebola taking hold in a major city such as
Freetown or Monrovia, Liberia's capital, is a virological nightmare. Last
week, the World Health Organization warned that the number of cases could
hit 20,000 in West Africa.
"We have never had this kind of experience with Ebola before," David
Nabarro, coordinator of the new U.N. Ebola effort, said as he toured
Freetown last week. "When it gets into the cities, then it takes on another
Detection is difficult because early symptoms are hard to distinguish from
those of malaria or typhoid, common ailments during the rainy season. While
Ebola is not transmitted through the air like the flu, it does spread by
close contact with bodily fluids such as blood, saliva and sweat â€” even
something as innocent as a tainted tear.
And so now it is headed to Freetown, where the streets hum with low-level
panic. People long ago stopped shaking hands. Hugs are unheard of. Plastic
buckets filled with a diluted chlorine solution are posted outside many
businesses to encourage handwashing. Some of these homemade solutions tingle
and burn; others smell like aromatic cleansers. For a while, street
peddlers, who normally sell peanuts or umbrellas from stacks balanced on
their hands, sold surgical gloves, $1 each.
But the roads are still crammed with autos and people, stray dogs and wild
chickens. Trucks with loudspeakers rumble down rutted roads. "Wash your
hands!" they announce in Krio. "Ebola is real!" shout banners strung
throughout the city. Radio ads detail the virus's symptoms: headache, fever,
nausea and vomiting. The Sierra Leonean government has been running these
messages in the capital for months, just in case.
Sierra Leone's first case appeared in late May, in the distant Kailahun
district. A month later, the country had 158 total cases. In late July, it
was up to 533 cases. A national state of emergency was declared. Soldiers
erected roadblocks to cordon off the rural epicenter, raising memories of
the country's brutal civil war, which ended in 2002.
The government has passed laws to limit close contact, altering the city's
daily rhythms. Riders in the city's many "Poda Poda" minibuses, usually
packed shoulder to shoulder, are now curtailed to four people per row.
"Okara" taxi motorbikes are restricted at night. Even banks have cut hours
to limit time spent in their crowded lobbies. And large public gatherings
have been outlawed. The small cinemas where patrons would pay to watch
foreign soccer matches on TVs have been shuttered. The popular clubs along
Freetown's Atlantic Ocean beaches are now empty.
Many of the people who can afford to leave Freetown are gone â€” some on
vacation, others to foreign countries to wait out the virus. But getting out
has become harder as several airlines have stopped flying to Lungi
International Airport. Air France, under orders from the French government,
became the latest last week. The nation's school year is supposed to begin
Sept. 9, but few expect that date to hold.
At the Lighthouse Hotel, the usual executives from the mining,
pharmaceutical and banking industries are absent. The hotel is running at 15
percent occupancy, said general manager Andrew Damoah. He is barely able to
cover the cost of gas for the hotel's generator â€” a necessity in a country
with a shaky power grid. Most of his guests now are the international
doctors and nurses responding to the outbreak.
The city's hospitals are empty, too. People avoid them over worries about
catching Ebola. They would rather suffer at home and hope that what they
have is just a mild case of malaria. It is not an unreasonable concern. The
Kenema government hospital in the provinces has seen 40 staff members die of
Ebola. At Connaught Hospital in Freetown, the doctor running the Ebola ward
died two weeks ago. Shortly before that, the government issued a public
alert for a 32-year-old hairdresser with an Ebola diagnosis who was pulled
from Connaught by her family. They wanted her to be treated by a faith
healer. All of them subsequently died of Ebola.
At Connaught, the Ebola ward sits behind a gate with prison-like metal bars.
Staff members are covered head to toe in protective scrubs. The unit
recently had 12 beds for 13 patients. At first, one or two patients were
being diagnosed with Ebola each day. That picked up to three a day. Now, lab
results on up to seven people a day are coming back positive.
The virus's march into Freetown was slow to start. The first case officially
emerged in mid-July. Six weeks later, the city had 30. The number is now
over 40 and is expected to quickly shoot up.
Doctors Without Borders has warned about a worldwide shortage of the
full-body protective suits worn by Ebola healthcare workers. Sierra Leone's
Ebola emergency operations center said it faces a six-week wait for the
specialized ambulances needed to transport Ebola patients.
A new Ebola treatment center â€” the country's third â€” is expected to be
constructed near Freetown. But it might not be ready for a month. Just
outside Freetown in Lakka, a new Ebola isolation unit is almost open, on
property shared by a tuberculosis hospital and housing for sufferers of
leprosy. A mobile Ebola testing lab, flown in from South Africa, also just
Visit the Washington Post for the story.
Experimental drug ZMapp is '100% effective' in animal trials
The only clinical trial data on the experimental Ebola drug ZMapp shows it
is 100% effective in monkey studies, even in later stages of the infection.
The researchers, publishing their data in Nature, said it was a "very
important step forward".
Yet the limited supplies will not help the 20,000 people predicted to be
infected during the outbreak in West Africa. And two out of seven people
given the drug, have later died from the disease.
Researchers have been investigating different combinations of antibodies, a
part of the immune system which binds to viruses, as a therapy. Previous
combinations have shown some effectiveness in animal studies. ZMapp is the
latest cocktail and contains three antibodies.
Trials on 18 rhesus macaques infected with Ebola showed 100% survival. This
included animals given the drug up to five days after infection. For the
monkeys this would be a relatively late stage in the infection, around three
days before it becomes fatal.
Scientists say this is significant as previous therapies needed to be given
before symptoms even appeared. However, there is always caution when
interpreting the implications for humans from animal data.
A Liberian doctor, one of three taking the drug in the country, and a
Spanish priest both died from the infection despite ZMapp treatment.
William Pooley, the first Briton to contract Ebola during this outbreak, has
been given the experimental drug ZMapp as were two US doctors who recovered.
The course of the infection is slower in humans than macaques so it has been
cautiously estimated that ZMapp may be effective as late as day nine or 11
The group wants to start clinical trials in people to truly assess the
effectiveness of the drug.
Visit BBC for the article.
Why doctors are
sick of their profession
What happens when doctors are unhappy? They have unhappy patients. A new
memoir, 'Doctored,' presents one cardiologist's take on the challenges
facing American medicine and the real impact on patient care.
Today medicine is just another profession, and doctors have become like
everybody else: insecure, discontented and anxious about the future. In
surveys, a majority of doctors express diminished enthusiasm for medicine
and say they would discourage a friend or family member from entering the
profession. In a 2008 survey of 12,000 physicians, only 6% described their
morale as positive. Eighty-four percent said that their incomes were
constant or decreasing. Most said they didn't have enough time to spend with
patients because of paperwork, and nearly half said they planned to reduce
the number of patients they would see in the next three years or stop
American doctors are suffering from a collective malaise. We strove, made
sacrificesâ€”and for what? For many of us, the job has become only thatâ€”a job.
That attitude isn't just a problem for doctors. It hurts patients too.
Consider what one doctor had to say on Sermo, the online community of more
than 270,000 physicians:
"I wouldn't do it again, and it has nothing to do with the money. I get too
little respect from patients, physician colleagues, and administrators,
despite good clinical judgment, hard work, and compassion for my patients.
Working up patients in the ER these days involves shot gunning multiple
unnecessary tests (everybody gets a CT!) despite the fact that we know they
don't need them, and being aware of the wastefulness of it all really sucks
the love out of what you do. I feel like a pawn in a moneymaking game for
hospital administrators. There are so many other ways I could have made my
living and been more fulfilled. The sad part is we chose medicine because we
thought it was worthwhile and noble, but from what I have seen in my short
career, it is a charade."
The discontent is alarming, but how did we get to this point? To some
degree, doctors themselves are at fault.
In the halcyon days of the mid-20th century, American medicine was also in a
golden age. Life expectancy increased sharply (from 65 years in 1940 to 71
years in 1970), aided by such triumphs of medical science as polio
vaccination and heart-lung bypass. Doctors largely set their own hours and
determined their own fees. Popular depictions of physicians ("Marcus Welby,"
"General Hospital") were overwhelmingly positive, almost heroic.
American doctors at midcentury were generally content with their
circumstances. They were prospering under the private fee-for-service model,
in which patients were covering costs out of pocket or through fledgling
private insurance programs such as Blue Cross/Blue Shield. They could
regulate fees based on a patient's ability to pay and look like benefactors.
They weren't subordinated to bureaucratic hierarchy.
After Medicare was introduced in 1965 as a social safety net for the
elderly, doctors' salaries actually increased as more people sought medical
care. In 1940, in inflation-adjusted 2010 dollars, the mean income for U.S.
physicians was about $50,000. By 1970, it was close to $250,000â€”nearly six
times the median household income.
But as doctors profited, they were increasingly perceived as bilking the
system. Year after year, healthcare spending grew faster than the U.S.
economy as a whole. Meanwhile, reports of waste and fraud were rampant. A
congressional investigation found that in 1974, surgeons performed 2.4
million unnecessary operations, costing nearly $4 billion and resulting in
nearly 12,000 deaths. In 1969, the president of the New Haven County Medical
Society warned his colleagues "to quit strangling the goose that can lay
those golden eggs."
If doctors were mismanaging their patients' care, someone else would have to
manage that care for them. Beginning in 1970, health maintenance
organizations, or HMOs, were championed to promote a new kind of healthcare
delivery built around price controls and fixed payments. Unlike with
Medicare or private insurance, doctors themselves would be held responsible
for excess spending. Other novel mechanisms were introduced to curtail
health outlays, including greater cost-sharing by patients and insurer
reviews of the necessity of medical services. That ushered in the era of
In 1973, fewer than 15% of physicians reported any doubts that they had made
the right career choice. By 1981, half said they would not recommend the
practice of medicine as highly as they would have a decade earlier.
Public opinion of doctors shifted distinctly downward too. Doctors were no
longer unquestioningly exalted. On television, physicians were portrayed as
more humanâ€”flawed or vulnerable ("M*A*S*H*," "St. Elsewhere") or
professionally and personally fallible ("ER").
As managed care grew (by the early 2000s, 95% of insured workers were in
some sort of managed-care plan), physicians' confidence plummeted. In 2001,
58% of about 2,000 physicians questioned said that their enthusiasm for
medicine had gone down in the previous five years, and 87% said that their
overall morale had declined during that time. More recent surveys have shown
that 30% to 40% of practicing physicians wouldn't choose to enter the
medical profession if they were deciding on a career againâ€”and an even
higher percentage wouldn't encourage their children to pursue a medical
There are many reasons for this disillusionment besides managed care. One
unintended consequence of progress is that physicians increasingly say they
don't have enough time to spend with patients. Medical advances have
transformed once-terminal diseasesâ€”cancer, AIDS, congestive heart
failureâ€”into complex chronic conditions that must be managed over the long
term. Physicians also have more diagnostic and treatment options and must
provide a growing array of screenings and other preventative services.
At the same time, salaries haven't kept pace with doctors' expectations. In
1970, the average inflation-adjusted income of general practitioners was
$185,000. In 2010, it was $161,000, despite a near doubling of the number of
patients that doctors see a day.
While patients today are undoubtedly paying more for medical care, less of
that money is actually going to the people who provide the care. According
to a 2002 article in the journal Academic Medicine, the return on
educational investment for primary-care physicians, adjusted for differences
in number of hours worked, is just under $6 per hour, as compared with $11
for lawyers. Some doctors are limiting their practices to patients who can
pay out of pocket without insurance company discounting.
Other factors in our profession's woes include a labyrinthine payer
bureaucracy. U.S. doctors spend almost an hour on average each day, and
$83,000 a yearâ€”four times their Canadian counterpartsâ€”dealing with the
paperwork of insurance companies. Their office staffs spend more than seven
hours a day. And don't forget the fear of lawsuits; runaway
malpractice-liability premiums; and finally the loss of professional
autonomy that has led many physicians to view themselves as pawns in a
battle between insurers and the government.
The growing discontent has serious consequences for patients. One is a
looming shortage of doctors, especially in primary care, which has the
lowest reimbursement of all the medical specialties and probably has the
most dissatisfied practitioners.
Dr. Jauhar is director of the Heart
Failure Program at the Long Island Jewish Medical Center. This essay is
adapted from his new book, "Doctored: The Disillusionment of an American
Physician," published by Farrar, Straus and Giroux.
Visit the Wall Street Journal for the article.
cancer with electronic noses
Sniffing feces with an "electronic nose" can detect strains of bacteria that
can cause deadly infections, say UK researchers. The tool was able to sniff
out different types of Clostridium difficile based on the stinky
chemicals they released. The team at the University of Leicester say the
findings could be useful for screening patients in hospital.
Electronic noses are already being investigated for cancer, by looking for
the unique smell of the chemicals produced by a lung or breast tumor.
The team in Leicester investigated whether different strains of C.
difficile, some of which cause disease, had a different chemistry that
could be detected by the e-nose. They showed that different levels of
methanol, sulphur compounds and others were produced by the 10 different
strains tested in the study.
One of the research team, Prof Paul Monks, told the BBC: "By smelling
different strains of C. difficile we could tell which are good and
which are potentially bad, which leads to the question, 'Can you screen
"We've shown it is possible to do it in the lab - the next thing we need to
do is in bedpans. We can [put the e-nose] on the side of bedpan washers as
you start the cycle, sniff it and then say, 'You may want to look at that
As well as being able to identify which strain of bacterial species is
present, the researchers believe understanding more about the chemistry of
bacteria could help understand why some cause disease and others do not.
Dr Martha Clokie, from the university's department of microbiology, said:
"Current tests for C. difficile don't generally give strain
information - this test could allow doctors to see what strain was causing
the illness and allow doctors to tailor their treatment." The study was
published in the journal Metabolomics.
Visit the BBC for the study.
Study: Novel heart
failure drug shows big promise
A new study reports one of the biggest potential advances against heart
failure in more than a decade - a first-of-a-kind, experimental drug that
lowered the chances of death or hospitalization by about 20 percent.
Doctors say the Novartis drug - which doesn't have a name yet - seems like
one of those rare, breakthrough therapies that could quickly change care for
more than half of the 6 million Americans and 24 million people worldwide
with heart failure.
"This is a new day" for patients, said Dr. Clyde Yancy, cardiology chief at
Northwestern University in Chicago and a former American Heart Association
It involved nearly 8,500 people in 47 countries and was the largest
experiment ever done in heart failure. It was paid for, designed and partly
run by Novartis, based in Basel, Switzerland. Independent monitors stopped
the study in April, seven months earlier than planned, when it was clear the
drug was better than an older one that is standard now.
During the 27-month study, the Novartis drug cut the chances of dying of
heart-related causes by 20 percent and for any reason by 16 percent,
compared to the older drug. It also reduced the risk of being hospitalized
for heart failure by 21 percent.
"We are really excited," said one study leader, Dr. Milton Packer of UT
Southwestern Medical Center in Dallas. The benefit "exceeded our original
Results were disclosed Saturday at a European Society of
Cardiology conference in Barcelona and published online by the New
England Journal of Medicine.
Novartis will seek approval for the drug - for now called LCZ696 - by the
end of this year in the United States and early next year in Europe.
The people in this study were already taking three to five medicines to
control the condition. One medicine often used is an ACE inhibitor, and the
study tested one of these - enalapril, sold as Vasotec and in generic form -
against the Novartis drug.
The new drug is a twice-a-day pill combination of two medicines that block
the effects of substances that harm the heart while also preserving ones
that help protect it. One of the medicines also dilates blood vessels and
allows the heart to pump more effectively.
In the study, 26.5 percent on the older drug, enalapril, died of
heart-related causes or were hospitalized for heart failure versus less than
22 percent of those on the Novartis drug. Quality of life also was better
with the experimental drug.
Visit CBS News for the report.
CMS shuts down
Sunshine Act database, again
The Centers for Medicare and Medicaid Services (CMS) is again taking the
Open Payments database, which details payments made to physicians by drug
and device companies, offline for maintenance, the agency has announced.
The database, which was developed as a result of the Physician Payments
Sunshine Act, has had various troubles of late. First, CMS took the site
offline from Aug. 3 until Aug. 14 to resolve a problem in which records for
physicians with similar names were getting mixed up. As a result of the
problem, CMS said it would be excluding about a third of its records from
the database until the issue is fully resolved.
Then it was announced that CMS would not be including another section of
data -- regarding payments made indirectly, through contract research
organizations, from drug and device firms to physicians -- in the database
because of problems with data integrity.
On Thursday, word came that the system will be offline on two different days
for routine maintenance: Saturday from 11 a.m. to 5 p.m., and Friday, Sept.
5 for an indeterminate period of time. Physicians will also now have until
Sept. 10 to review and, if necessary, dispute their data before it is made
The announcement of the shutdown "adds to the growing concerns that the site
is simply not ready to go public," the American Medical Association said
Thursday in a press release. "It also further underscores the need for
physicians to have more time to register, review and correct inaccurate data
that may be housed on the government website."
The informal online survey of 204 physicians also found that 44% of those
who tried to register were unsuccessful.
CMS has said it remains committed to having the database open to the public
on Sept. 30, but the AMA and 100 other physician groups have been lobbying
for a delay in order to give physicians more time to register and review
their data for accuracy.
"Patients need accurate information," AMA president Robert Wah, MD, said in
the release. "If the government releases incorrect information to the
public, it can lead to misinterpretations, harm reputations and cause
patients to question their trust in their physicians ... That's why the AMA
is calling on CMS to extend by 6 months the time that physicians have to
register and ensure the accuracy of their reports before release to the
public. Physicians need enough time to register for the Open Payments
system, review their data and seek corrections in order to ensure accuracy."
Visit the MedPage Today for the story.