ISIS critical mass must be destroyed by taking out its leaders
Needn't be a mathmatical genius to figure out how the Islam nations are growing populations. In fact, Islam will probably grow to outnumber most of the Christian and Jewish groups involved in Middle East conflagrations and rebellions. Sheer numbers build critical mass. That's one among several reasons why the Islamic State (ISIS) recruitment of thousands of fighters, every month, who join their horrific jihad, is seriously dangerous. Islam outnumbers opponents. Therefore, as powerful as air strikes are, this power alone won't destroy the rapidly growing numbers of fighters. Yet, boots on the ground won't necessarily improve outcomes, either. More troops equals increasing casualties. Consequently, the only way to destroy ISIS and their recruitment is to figure out how to destroy their leadership. Fighters without leaders make mistakes. Divide and conquer. Otherwise, the growing number of ISIS fighters will continue to build a critical mass and attract even more Islam extremists, like tumble weeds attracting dust.
More foreign jihadists are traveling to Syria and Iraq to take up arms alongside militants of the Islamic State, or ISIS, than ever before, according to a new report from the United Nations.
The recruits came from more than 80 countries, including ones that had previously not had problems with terrorist recruitment. Pew Research Center reports on the world's Muslim populations.
An estimated 1.6 billion Muslims live around the world, making Islam the world’s second-largest religious tradition after Christianity, according to areport from the Pew Research Center’s Forum on Religion & Public Life.
Although many people, especially in the United States, may associate Islam with countries in the Middle East or North Africa, nearly two-thirds (62%) of Muslims live in the Asia-Pacific region, according to the Pew Research analysis. In fact, more Muslims live in India and Pakistan (344 million combined) than in the entire Middle East-North Africa region (317 million).
Muslims make up a majority of the population in 49 countries around the world. The country with the largest number (about 209 million) is Indonesia, where 87.2% of the population identifies as Muslim. India has the world’s second-largest Muslim population in raw numbers (roughly 176 million) though Muslims make up just 14.4% of India’s total population.
Allies who are obviously opposed to the dangerous growth of the diabolic ISIS movement and their slaughter of Christians, must figure out how to stop the group's critical mass.
Destroying ISIS leadership is urgent. Obviously, ISIS leadership is hiding, but they must come up for air sometime, especially to meet their vestal virgins, and that's when they must be evaporated.
Kaci Hickox is free to travel unrestricted after a Maine judge on Friday rejected the state's bid to limit her movements as a medical worker who has treated Ebola patients.
Judge Charles C. LaVerdiere ruled Hickox must continue daily monitoring and coordinate travel with state health officials to ensure continuity of monitoring. The judge said there's no need to restrict her movements because she's not infectious because she's showing no symptoms.
With the judge's ruling, a state police cruiser parked outside her home drove away.
The state went to court Thursday to impose restrictions on Hickox until the 21-day incubation period for Ebola ends on Nov. 10. Hickox, who treated Ebola patients in Sierra Leone, contended confinement at her home in northern Maine violated her rights.
There was no immediate comment from state officials.
The judge thanked Hickox for her service in Africa and acknowledged the gravity of restricting someone's constitutional rights without solid science to back it up. "The court is fully aware of the misconceptions, misinformation, bad science and bad information being spread from shore to shore in our country with respect to Ebola," he wrote. "The court is fully aware that people are acting out of fear and that this fear is not entirely rational."
Hickox, 33, stepped into the media glare when she returned from treating Ebola patients in Sierra Leone to become subject to a mandatory quarantine in New Jersey. After being released from a hospital there, she returned to this small town, where she was placed under what Maine authorities called a voluntary quarantine.
She said she is following the federal Centers for Disease Control and Prevention recommendation of daily monitoring for fever and other signs of the disease.
"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she said earlier in the week.
The legal action is shaping up as the nation's biggest test case yet in the struggle to balance public health and fear of Ebola against personal freedom.
In a court filing, the director of the Maine Center for Disease Control and Prevention backed away from the state's original request for an in-home quarantine and called for restrictions that fall in line with federal guidelines.
Hickox remains at risk of being infected with Ebola until the end of a 21-day incubation period, Dr. Sheila Pinette.
"It is my opinion that the respondent should be subjected to an appropriate public health order for mandatory direct active monitoring and restrictions on movement as soon as possible and until the end of the incubation period ... to protect the public health and safety," she wrote.
"How sick are the world's healthcare systems" is deserving of a journalism award.
In the best of health? Photograph: Getty/Guardian
China - long lines; access to care is bureaucratic. A soaring demand for quality medical care by Jonathan Kaiman
In Lewis Carroll’s Through the Looking Glass, Alice finds herself facing a difficult conundrum. She’s running towards a distant hill; yet no matter how quickly she runs, her surroundings move with her, effectively stranding her. She meets the enigmatic Red Queen. “Now, here, you see, it takes all the running you can do, to keep in the same place,” the Queen explains. “If you want to get somewhere else, you must run at least twice as fast as that!”
China’s healthcare system suffers from the same problem – despite running at full speed over the past few decades, it can’t possibly move fast enough to keep up with the country’s social and economic changes. China’s per capita GDP grew more than 25-fold from 1980 to 2011; its life expectancy rose by nine years; its infant mortality rate quartered. Yet as Chinese citizens grow older and wealthier, they are also burdened by a rise in pollution, smoking, obesity and other public-health hazards, creating a soaring demand for quality medical care.
During the Mao era, in the 1940s through to the mid-70s, the country’s healthcare system was rudimentary but egalitarian, entirely supported by the state. Yet in the 80s, reformer Deng Xiaoping dismantled the system, leaving hospitals suddenly responsible for their own economic wellbeing. The result has been rampant profit-seeking: overprescription of medications, excessive testing and shocking efforts to cut corners. Many Chinese hospitals don’t keep soap in their public bathrooms. Physicians are so underpaid that they often must supplement their salaries with kickbacks from drug companies and patient bribes.
The system is also deeply stratified. A typical villager, upon falling ill, will first visit a local clinic – usually a concrete-floored, one- to two-room facility, equipped with little more than intravenous drips and a small pharmacy. If his malady requires further attention, he will be forced to ascend through a hierarchy of institutions – to a county hospital, then a provincial hospital, then a specialised clinic in a metropolis such as Beijing or Shanghai. Major institutions, inundated with patients from afar, suffer from chronic overcrowding. It is common to see families sleeping overnight on hospital lawns to avoid early-morning queues.
With the stakes so high, tempers run hot when treatments fail. Patient-on-doctor violence has become startlingly common – stabbings and mob-style attacks have risen 23% a year on average since 2002, according to the China Hospital Management Association. A typical hospital suffers one such incident every two weeks.
The Chinese government has poured billions of pounds into healthcare reform in recent years, and the system has improved accordingly. At present, 99% of the rural population gets some kind of insurance, up from 21% a decade ago; the country plans to roll out universal coverage by 2020. Yet the price of basic medical services has also risen, and many insured patients are paying as much as they once were. As of last year, the government gives each rural resident 280 yuan (£28.34) in annual healthcare subsidies. Yet elaborate procedures can cost many times that, and patients must pay the difference out of pocket. China has one of the highest savings rates in the world – about 50% – largely because families fear catastrophic healthcare costs.
Chinese authorities have been embracing other, more innovative ideas to improve the system: new technologies, private investment, new training regimens for doctors – in short, redoubling their speed just to keep up the pace.
South Africa: ‘Labouring under a two-tier system’ With the world’s biggest HIV caseload by David Smith
HIV with rampant tuberculosis (TB) and rising obesity, South Africa's healthcare is under strain.
The government spent more than 8.5% of GDP on healthcare in 2012, higher than the 5% recommended by the World Health Organisation (WHO) for a country of its socioeconomic status, yet performed worse than comparable nations.
The historical legacy of colonialism and apartheid is still manifest in one of the most unequal societies in the world. Health care is not exempt from this culture, so South Africa continues to labour under a two-tier system.
The private sector consumes 60% of total health spending yet caters to only about 15% of the population. The facilities are world class and less expensive than in Britain, the US or Australia – fertility treatment, for example, attracts foreigners at a fraction of the cost – but are beyond the financial means of most South Africans.
Public healthcare struggles to meet the needs of the other 85%, with often overcrowded facilities, poor equipment and shortages of drugs. Less than 30% of doctors, dentists, pharmacists, physiotherapists and psychologists, and just 40% of professional nurses, work in the public sector.
Some essential services are provided free by the state. TB treatment, for example, is not available in private clinics. After diagnosing a patient with TB, private doctors refer the patient to the public sector, where everyone receives TB medicine free of charge.
The most striking success in free provision is the antiretroviral treatment programme for people with HIV, initiated 10 years ago after the government, accused of “Aids denialism”, lost a landmark court case. Today, South Africa has the world’s biggest public-sector HIV programme, with 2.5 million people receiving treatment (!). The country’s life expectancy has consequently increased from 53 in 2002 to 60 in 2013.
But there are practical barriers. Patients’ first point of contact are primary healthcare clinics where, in serious cases, nurses and community health workers can refer them to hospital. These clinics are concentrated in cities and towns, often inaccessible to people in rural areas who cannot afford transport. Some 47% of children live in rural areas where only 12% of doctors and 19% of nurses work. Some villagers rely on an informal network of traditional healers and medicines.
Not everything in public hospitals is free, and only an estimated 17% of South Africans are part of a medical aid scheme to cover the costs. In addition, staff shortages translate into long waiting times. Critics say treatable conditions are not treated on time and preventable diseases are not prevented. The government has admitted the need for a “radical improvement” in the quality of services and “massive investment” in buildings and equipment, as well as fundamental changes in management.
The health minister, Dr Aaron Motsoaledi, has been known to roll up his sleeves and work a night shift at the Chris Hani Baragwanath hospital in Soweto, the biggest hospital in the southern hemisphere. He and his family use public hospitals and in 2011 he told the Mail & Guardian newspaper: “It’s a self-defeating prophecy to keep on saying we don’t have the means. There are good services in countries with fewer facilities and staff than us.” Nevertheless, Motsoaledi has a big plan for healthcare reform: a national health insurance scheme. The aim is to provide essential healthcare for all, irrespective of employment status and ability to pay, as enshrined in the post-apartheid constitution. Anyone earning above a certain income will be required to contribute to the NHI Fund.
The plan has met resistance from the private sector. But the government insists: “It will actually make the sector more sustainable by making it levy reasonable fees. The intention of NHI is rather to make sure that citizens are able to use both the public and private sectors in such a way that they complement each other rather than one undermining the other. At the moment, private healthcare is only for the rich. NHI is trying to blend the two in a more sustainable manner that benefits the population.”
India: ‘Public or private, India’s health care system is largely unregulated’ by Anu Anand
When Ria, 12, an illiterate maid’s daughter, suddenly developed a giant lump in her abdomen, her mother knew better than to trust India’s publicly run hospital system. Mazes of dingy corridors, outdated equipment and filthy wards where linens are absent and rats run freely greet the desperately poor and sick patients seeking care.
India spends just 1.3% of GDP on healthcare, one of the lowest in the world. Every day, patients from around the country, some who have travelled for days, can be seen queueing outside India’s biggest public teaching hospital, the All India Institute of Medical Sciences (AIIMS) in New Delhi. Hundreds jostle to see erratically available specialists. Others push their way to the counters of crowded roadside medical shops to purchase not just bandages and surgical equipment, but even life-saving drugs and the pints of blood patients are often expected to provide. At night, dozens of patients and their relatives sleep under the bright lights of the closest bus shelter, unable to afford accommodation.
The other option, equally inaccessible for poor Indians, lies a few miles away. In the lobby of one of New Delhi’s swanky corporate hospitals, wealthy patients from around the world sip lattes as they wait for doctors in brightly lit waiting rooms, complete with cleaners, attendants and stacks of glossy magazines.
Here, by global standards, the best diagnostic tests and procedures can be had for a fraction of western prices, a fact that fuels medical tourism to the tune of an estimated $78.6bn in India. But public or private, India’s health care system is largely unregulated.
In May, David Berger, a visiting Australian doctor writing in the British Medical Journal of his experiences in a small Indian hospital, blew the lid off the widespread practice of doctors receiving kickbacks for referring patients for medical tests, scans and even surgery. Subsequently, a group of doctors at AIIMS formed the Society for Less Investigative Medicine to counter corruption, which is deemed widespread by many.
India’s new health minister has also vowed to clean up corruption. And the new prime minister, Narendra Modi, has further spoken of his vision for universal healthcare. Partially inspired by Obamacare, it would potentially be the largest scheme in the world and tackle such daunting silent epidemics as tuberculosis, which claims 300,000 Indian lives annually.
But critics argue that such a private sector-led scheme will further marginalise the state system and leave India’s poorest citizens increasingly vulnerable to exploitation and substandard treatment, especially in rural areas.
Ria successfully had a grapefruit-sized tumour removed from her ovary. Her mother’s employer led the search for credible doctors, interpreting their advice and helping to cover the roughly £600 in diagnostic and surgical costs. Thankfully, her tumour was benign.
Brazil ‘A huge gap between standards of private and public care’ by John Watts
When more than a million protesters took to the Brazil streets last year, the woeful condition of the public healthcare system was high among their list of grievances.
Inequality and vast distances are the main problem. According to the World Bank, the country has 1.8 doctors for every 1,000 people – well below the 3.2 ratio in neighbouring Argentina, and significantly below those of Mexico, the US and the UK.
On paper, however, Brazil has one of the most comprehensive and generous public health networks in the world. The Unified Health System, or SUS as it is widely known, is universal and free for everyone. It has notched up impressive achievements. Since the turn of the century, life expectancy is up from 68.8 to 74.5, infant mortality is estimated to have fallen to 14.4 per 1,000 live births from 17.6, and the government says 95% of children are now fully vaccinated. Brazil’s healthcare spending was 9.3% of GDP in 2012.
But, reflecting this very unequal society, there is a huge gap between standards of private and public care. In state capitals, the one in four of the population who can afford private services benefits from almost double the doctor-patient ratio. For those in the SUS, there are insufficient beds, and waiting times for basic diagnosis and treatment are long.
Regional disparities are even more glaring. Residents Maranhão, the country's poorest state, have barely a quarter of the spend per head as the inhabitants of wealthy Rio de Janeiro.
To address this problem, President Dilma Rousseff last year launched a crash programme to fill the gap with thousands of primarily foreign medics. The “Mais Medicos” (More Doctors) programme offers incentives to those go to medical schools in remote and poor areas, such as the Amazon, so that in the long term they can train a new generation of professionals. So far, 4,199 doctors have been dispatched and the plan is to increase this to 11,500 doctors by the end of 2017.
The vast majority have come from Cuba. This is politically controversial because the Cuban government pockets about a quarter of their salaries. When they arrived, Brazilian doctors booed and chanted “slave” at the newcomers and accused them of lacking the necessary qualification and language skills needed to do a good job.
While it is true that the normal diploma requirement has been waived for the Cubans, the government says this is justified because they are only expected to provide primary care, not surgery. “Mais Medicos is a success because it is serving the public with quality and because it is greatly improving health indicators throughout Brazil,” says health minister Arthur Chioro. “Fifty million people who did not previously have primary care now have exactly what they need most of all.”
Egypt ‘A system that doesn’t know how to manage itself’ by Patrick Kinsley
A few weeks ago, a woman gave birth in a street outside of a public hospital in northern Egypt. Depending on who you believe, the hospital either didn’t have enough medics to tend to her – or they demanded money that she couldn’t pay.
Hers was an extreme example of the problems with Egypt’s public health service, particularly in provincial areas. Thanks to a decree issued earlier this year, all Egyptians should get free access to emergency hospital care for at least 48 hours. But in practice some state facilities, particularly in the countryside, either cannot provide instant healthcare – or have to charge for it. Due to a shortfall in government funding, they have no other way of paying their staff.
And the problem goes beyond A&E. A state-run insurance scheme nominally provides subsidised non-emergency healthcare to children, government workers and the families of those workers – a group that the government says totals 54% of the population. But by the government’s own count, only 8% of those covered by the scheme actually use state facilities. “This in itself denounces the problem,” says Ayman Sabae, a doctor and campaigner for healthcare reform at the Egyptian Initiative for Personal Rights, a prominent watchdog. “Both the service quality and access to the services are so limited that only 8% use them.”
A government clinic that Sabae visited in rural Qena province last month exemplifies the problem. Like about half of Egypt’s 4,000 state clinics, this one is well-equipped, and newly refurbished. But according to Sabae, there has not been a doctor here for the past four years. Clinicians assigned here might only earn around 1,200 Egyptian pounds a month – about £100, or little more than Egypt’s average monthly wage – whereas they can earn around five times as much in the private sector. So they opt for the latter.
“There’s a couple of finance employees, maybe a nurse,” says Sabae of the clinic. “But no doctors. And that’s very typical – you have a system that doesn’t know how to manage itself. You have the money to renovate the clinic, but not the human resources to manage it.”
As a result, the half of the population who are eligible for free healthcare are often no better off than the half who aren’t. Most end up paying for their care themselves – in fact, 71.8% of healthcare spending in Egypt comes from people’s pockets. NGOs, charities and religious groups pick up some of the slack (the now-banned Muslim Brotherhood part-built their influence on their network of clinics).
Those who aren’t covered by the state healthcare plan can apply for another of state-paid treatment – the Program for Treatment at the Expense of the State. But this is only for those with life-threatening diseases who can show they are incapable of paying through other means.
As a last resort, any patient can get free treatment at university training clinics and hospitals. On the plus side, the doctors here are often the best in the country. On the downside, students observe every operation, the facilities are often unhygienic, and the cost of basic supplies is frequently covered by the patients or the doctors themselves.
“When I worked there as a doctor, I was paid 200 Egyptian pounds [about £20] a month, and I would spend more per month from my own pocket to buy blood from other hospitals,” says Sally Toma, another doctor who campaigns for healthcare reform. “Otherwise, I was told, I would have to choose who should get blood, and who should not.”
Italy ‘A persistent complaint is unfairness’ by John Hooper
Italians by and large regard health as a priority. And it shows up in one of the highest life expectancies in the world. In 2012, according to the World Bank, the average newborn Italian could expect to live to the age of 83 – the same as in Switzerland or Japan.
But, like many things in a country of contrasts and disparities, the provision of health services varies widely from one part of Italy to another. Last year, a report was published by the parliamentary committee that scrutinises what Italians callmalasanita (literally “bad health”): cases of extreme negligence on the part of doctors or hospital staff. Out of 400 deaths attributable to malasanita between April 2009 and December 2012, more than 40% occurred in just two of Italy’s 20 regions, Calabria and Sicily.
Italy’s Servizio Sanitario Nazionale was founded in 1978 and modelled in large part on the NHS. But right from the outset it was only to a limited extent national.
The central government fixes the overall budget, determines minimum levels of care and, for example, negotiates drug prices with the big pharmaceutical companies. But it is the regional governments that administer the system, and there are huge discrepancies between them in levels of efficiency and integrity.
In parts of northern Italy, patients receive attention as good as anywhere in Europe. “Customer satisfaction”, however, falls off rapidly in the southern half of the country. And the drop goes hand in hand with a fall in measures of efficiency.
In Sicily, for example, there are roughly 10 hospital doctors for every hospital bed. In the north-eastern region of Friuli-Venezia Giulia, the ratio is half that.
Discernible in the statistics are variations in the degree of corruption and the use of public services to distribute jobs and patronage. Last year’s parliamentary commission report noted that in Campania, the region around Naples, 383 health officials had been taken on to the payroll without having to go through the bother of a selection process.
A persistent complaint among patients is of unfairness. In the southern half of Italy especially, they often move up waiting lists, not according to the date on which their names were first entered, nor by virtue of the seriousness of their condition, but according to whether they can secure a raccomandazione(reference) from someone with influence over the relevant surgeon.
By and large, the state has been open-handed in allocating resources to health. In 2012, Italy spent 7.2% of its gross domestic product on the public health system. That was less than was spent by the UK, Germany or France. But then Italy’s economy has scarcely grown since the turn of the century and is under growing pressure from European institutions to trim its spending.
Cuts have been made in recent years. But the overall budget for this year, of almost €111bn (£88bn), was still almost 4% higher than it had been in 2011.
The United States ‘More than 13% of Americans still have no health insurance’ by Nicki Woolf
When he announced the news that a doctor returning from Guinea to Harlem, in New York, had been diagnosed with Ebola in October, mayor Bill de Blasio said that New York’s had the “world’s strongest healthcare system”.
But the fact that he referred to the city’s system, rather than the nation’s, is telling. In fact, while the US can boast some of the best doctors and most advanced medical technology in the world, it doesn’t really have a coherent healthcare system at all. Healthcare in the US is private insurance-based and decentralised, with most care providers owned locally by private companies, and local and state governments controlling access to federal programs.
The private and public systems that overlap in some areas, and leave gaps in others, make the US the country that spends the most per capita and as a percentage of GDP of any country in the world, but paradoxically consistently last among comparable nations in measures of quality of coverage such as infant mortality.
Because their cost is decided by private companies, individual procedures can be extraordinarily expensive. A single MRI scan in some parts of the country can cost as much as $2,871 (£1,780); an appendectomy as much as $29,426 (£18,000), and a caesarean-section delivery as much as $26,305 (£16,000), according to a report by the International Federation of Health Plans. Some procedures can be as much as eight times the price of the equivalent operation in the UK, and a 2013 study by NerdWallet Health showed that medical bills are the biggest cause of bankruptcy in the US.
Some of the gaps are filled by government operations. One of these is Medicare, which guarantees health insurance for the elderly. Another is Medicaid, a low-income program which the Obama administration has recently expanded – but state governments, especially those controlled by rightwing Republican governors, have consistently rejected the expansion, leaving many poor residents without healthcare. Yet another is the Veterans Health Administration, which was hit by scandal in April 2014 when it was revealed that at least 40 US military veterans had died while waiting for medical care.
Perhaps the core struggle of Barack Obama’s presidency has been to pass his Affordable Care Act (ACA), which would aim to use state online insurance exchanges to reduce the number of people without coverage. But the bill has become a political football for the far-right Tea Party, who see any attempt to close the gaping holes in coverage as unacceptable government overreach.
The result has been that as of the beginning of 2014, more than 13% of Americans still have no health insurance coverage at all.
Germany ‘It gives patients a lot of choice’ by Philip Oltermann
Germany’s healthcare system is best understood as a middle option between the British state-run and the American market-led model. In principle, healthcare cover is universal, as in Britain: treatment of the unemployed is covered by the state, and ordinary patients rarely get presented with a bill after seeing a doctor.
Unlike in Britain, however, this universal care is not funded by a centrally collected tax, but by so-called Krankenkassen or sickness funds – a system that goes back all the way to Otto von Bismarck’s health insurance bill of 1883. Signing up with a sickness fund is compulsory for every German citizen. Once you have joined, you pay a premium calculated according to your income: half of it is paid by you, the other half by your employer. If you make less money, you pay less.
If you are lucky enough to have a career that makes you a lot of money – and this is where Germany veers towards the US model – you can choose to ignore one of the 131 public, non-profit sickness funds, and go with a private insurer instead. One advantage in comparison with the British system is that you don’t end up having to pay double – say, for Bupa and the NHS. In Germany, about 89% of the population is covered by public sickness funds, the remaining 11% are private.
One of the big plus points of the German system is that it gives patients a lot of choice: you are not restricted to the nearest general practitioner in your postcode but can sign up with any GP you like. GPs also have less of a gatekeeper function: if you know you have a back problem, you can go straight to see an osteopath.
Because the system is less centralised, doctors and nurses don’t have to stick to behavioural guidelines: for foreigners, some German doctors can come across as shockingly informal. “Practitioners enjoy a lot of freedom in Germany,” says Stefan Etgeton, a senior expert of the Bertelsmann Foundation. “But therein can also lie a problem: forcing through new medical standards can be arduous, because some doctors are convinced that their way of doing things is still best.”
In Germany, the healthcare system does not attract the same unholy combination of vitriol and affection that the NHS does – it just about works so that both the left and the free-marketeers can see in the system what they want. But that’s not to say that there aren’t problems eating away at the system.
For a start, the per-capita cost of healthcare has been much higher in Germany than in Britain for years. Most recent figures, from 2012, show the country spending 11.3% of its GDP on healthcare – 2% above the OECD average. “As a whole, the German system encourages overspending,” says Edzard Ernst, Exeter University’s German-born professor of complementary medicine. Doctors, who get charged per item, are incentivised to oversubscribe, and patients are incentivised to use the system more than in other countries.
There are also concerns about the long-term effects of the dual private-public system. One of the problems is that it provides an incentive for the best doctors to move to urban areas where there are more high earners who can afford private sickness funds. As a result, rural regions struggle. A public survey in 2012 showed 58% of the population supports scrapping private health insurance altogether.
New England Journal of Medicine describes how medical professionals should respond to the unproven use of mandatory isolation of health care workers who are being stigmatized with forced isolation after returning from providing humanitarian care for Western Africa's Ebola victims.
Ebola and Quarantine
Jeffrey M. Drazen, M.D., Rupa Kanapathipillai, M.B., B.S., M.P.H., D.T.M.&H., Edward W. Campion, M.D., Eric J. Rubin, M.D., Ph.D., Scott M. Hammer, M.D., Stephen Morrissey, Ph.D., and Lindsey R. Baden, M.D.
October 27, 2014DOI: 10.1056/NEJMe1413139
The governors of a number of states, including New York and New Jersey, recently imposed 21-day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease.
We understand their motivation for this policy — to protect the citizens of their states from contracting this often-fatal (Ebola) illness. This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal.
The governors' action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.
Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter.
This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset.
This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan's family members who were living in the same household for days as he was at the start of his illness did not become infected.
A cynic would say that all these “facts” are derived from observation and that it pays to be 100% safe and to isolate anyone with a remote chance of carrying the virus. What harm can that approach do besides inconveniencing a few health care workers? We strongly disagree. Hundreds of years of experience show that to stop an epidemic of this type requires controlling it at its source. Médecins sans Frontières, the World Health Organization, the U.S. Agency for International Development (USAID), and many other organizations say we need tens of thousands of additional volunteers to control the epidemic. We are far short of that goal, so the need for workers on the ground is great. These responsible, skilled health care workers who are risking their lives to help others are also helping by stemming the epidemic at its source. If we add barriers making it harder for volunteers to return to their community, we are hurting ourselves.
In the end, the calculus is simple, and we think the governors have it wrong. The health care workers returning from West Africa have been helping others and helping to end the epidemic that has killed thousands of people and scared millions. At this point the public does need assurances that returning workers will have their temperatures and health status monitored according to a set, documented protocol. In the unlikely event that they become febrile, they can follow the example of Craig Spencer, the physician from New York who alerted public health officials of his fever. As we continue to learn more about this virus, its transmission, and associated illness, we must continue to revisit our approach to its control and treatment. We should be guided by the science and not the tremendous fear that this virus evokes.
We should be honoring, not quarantining, health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also to help achieve source control, bringing the world closer to stopping the spread of this killer epidemic.
Kaci Hickox - Maine must produce evidence for why she should be forced to isolation
Dear Governor LePage and DHHS Commissioner Mary Mahew- please don't waste tax payer money trying to legally isolate one nurse who has no symptoms of Ebola and tested negative for the virus. With all due respect about the concern for public safety and risk of Ebola, you would both better spend your time walking in Maine's neighborhoods where dangerous drug trafficking is overt and epidemic.
There's no evidence about how mandatory isolation can prevent the spread of Ebola. Nevertheless, the fact is, creating undue stress on professional care givers, like nurses, treating them like criminals, will exacerbate problems involved in trying to control the virus
Ebola and public health 101 - disease outcomes follows socio economic status
Professional medical personal were asked how it is the Americans treated for the Ebola infection in the US were being cured? The response was: "The honest answer is, we're not exactly sure."
Yet, what public health officials know, because of decades of disease tracking, is that a person's socio-economic status is correlated with health outcomes.
In other words, Americans are much higher on the socio-economic scale than most Africans. Therefore, an American's chance of recovering from the Ebola virus, when treated in the US, is greater than a person who is an African, regardless of where they are treated. Consequently, "the honest answer is".. the right answer. Indeed, public health 101 doesn't know precisely why socio-economic status helps determine health outcome, but evidence supports the correlation.
For a disease that kills more than half of its victims abroad, Ebola in the United States is getting snuffed out at a remarkably fast rate.
When Dr. Kent Brantly became the first U.S. patient with Ebola in August, he was hospitalized for 19 days.
On Tuesday, when nurse Amber Vinson became the most recent American patient discharged, she was hospitalized for just 14 days.
Her colleague, Nina Pham, also went home after just 14 days.
"So the question is, why did our patient recover so quickly?" said Dr. Bruce Ribner of Emory University Hospital in Atlanta, where Vinson was treated."The honest answer is we're not exactly sure."
But he and other health experts have several hypotheses.
Younger patients recover faster
Vinson, 29, and Pham, 26, were among the youngest patients treated in the developed world.
"We know from a lot of data coming out Africa that younger patients do much better than patients who are older," Ribner said.
But unlike West Africa, where Ebola has killed close to 5,000 people, Americans have the advantage of better nutrition. If an infected patient getting proper care normally has a strong immune system -- and younger patients generally do -- the chance of survival goes up.
The virus was aggressively attacked
"The general dogma in our industry in July was that if patients got so ill that they required dialysis or ventilator support there was no purpose in doing those interventions because they would invariably die," Ribner said.
"I think we have changed the algorithm for how aggressive we can be in caring for patients with Ebola virus."
Of the nine Ebola patients treated at U.S. hospitals, eight have survived. And all of those released have something in common -- they were treated at one of the country's four hospitals that have been preparing for years to treat a highly infectious disease like Ebola.
The sole fatality in the United States -- Thomas Eric Duncan -- was not treated at one of those facilities. (Julie's note:What's worse, the basic rules about infectious disease triage weren't implemented at Texas Health Presbyterian, in Dallas Texas, when Mr. Duncan first presented, ie, identify, isolate and inform - others.)
Speed matters
This may seem obvious. But sometimes it's the basics -- namely, the ability to pump ample fluids through patients with severe diarrhea and vomiting -- that can mean the difference between life and death.
"The most important care of patients with Ebola is to manage their fluids and electrolytes, to make sure that they don't get dehydrated," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention. "And that requires some meticulous attention to detail and aggressive rehydration in many cases."
When he first arrived at Texas Health Presbyterian Dallas Hospital, Duncan was sent home with antibiotics. He wasn't admitted for another three days.
Brantly, Nancy Writebol and Dr. Rick Sacra became symptomatic while they were still in Liberia -- and they had to be flown here, spurring a slight delay in treatment.
Most others were quickly tested and quarantined as soon as a low-grade fever was detected.
Transfusions may have helped
Most of the American patients received blood or plasma transfusions from other survivors. The plasma contains antibodies that could fight the virus in others.
Brantly donated plasma to at least three patients -- Pham, Sacra and NBC freelance cameraman Ashoka Mukpo. All three survived.
"It's very fortunate that the three patients I've been able to donate to, they and I share the same blood type," Brantly told CNN's Anderson Cooper.
There was some controversy about why Brantly didn't give plasma to Duncan, who eventually died. But health officials said the two did not have the same blood type.
Dr. Craig Spencer, the only Ebola patient still being treated at a U.S. hospital, recently received a transfusion from Writebol, one of the first American survivors.
Experimental drugs may have helped, too (Julie's note - this is probably the least of the reasons for the improved outcomes of US patients because the drugs used were truly experimental.)
Duncan received experimental medicine six days after admission to the hospital. It was a far longer wait than four other Ebola patients treated in the United States. Those patients got experimental medicine immediately.
Experts, however, say the jury's out on the effectiveness of these drugs.
Protective wear reduces exposure
The relatively swift recoveries of Vinson and Pham might also be attributed to their personal protective equipment (PPE) they were wearing when they treated Duncan.
"She was wearing personal protective equipment during the care of her patient in Dallas, and therefore it is quite likely that the amount of virus she was exposed to was substantially less than what we see in patients who get infected in less developed countries," Ribner said.
"And we also know that the higher the viral load that you get infected with, the more severe your disease is likely to be."
American fixed wing air transport of Ebola patients using advanced isolation technologies
Republicans, especially New Jersey Governor Chris Christie, too quickly point fingers at the Center for Disease Control (CDC) response to the Ebola outbreak in Dallas Texas. Yet, the fact is the CDC has been involved in developing important transportation isolation technologies to provide quick treatment for infected individuals who need access to urgent care.
When it comes to transporting Ebola victims by air, the world relies on just one small U.S. company.
Phoenix Air, a jet-charter service based in Cartersville, Ga., has flown 15 infected patients, including Europeans who worked in West Africa and five individuals who were treated in the United States — doctor Kent Brantly, photojournalist Ashoka Mukpo, missionary Nancy Writebol, and nurses Nina Pham and Amber Vinson.
Now the Defense Department is stepping up. The Pentagon this week said it is developing portable isolation units for use on its military aircraft, as thousands of U.S. troops head to West Africa to help combat the outbreak. The modules are expected to be tested next month and deployed in C-17 and C-130 transport planes by January.
“This system is being developed out of an abundance of caution, to reassure our service members working in Ebola-affected areas,” said Pentagon spokeswoman Jennifer Elzea. “There are no plans for DOD personnel to provide direct patient care, and therefore the exposure risk remains low” for troops, Elzea said.
The Obama administration has not decided whether it will use the isolation systems to transport non-military patients.
“This particular capability remains under development, so it would be premature to speak to its potential use,” said White House spokesman Ned Price.
One thing is for sure: The military transports would have greater capacity. Phoenix Air can fly only one infected individual at a time, whereas the military’s isolation units will hold up to 12 patients.
The Pentagon declined to share information about the development costs for the transport modules, saying the contract has not been finalized.
The tent-like isolation chambers mainly consist of a metal frame, a plastic liner and an air-filtration system. For the Phoenix Air flights, one doctor and two nurses attend to each patient.
After each patient is transported, the company sprays toxic disinfectant inside the module for 24 hours and sends the contents — including the plastic, the stretchers and even the walkie talkies — off for incineration by a federally licensed hazardous-materials disposal team.
Phoenix Air created three isolation units in 2011 with help from the Centers for Disease Control and Prevention and the Defense Department. Those agencies provided scientific expertise and advice on how to manufacture special materials, respectively.
At the time, the CDC wanted a way to return infected medical workers to the United States instead of treating them in the field, because of growing concern about international conflicts, said Dent Thompson, the company’s vice president of operations.
The transport systems were finished in late-2011, but the outbreaks had long since died down. The units were placed in storage.
“We would periodically make various federal agencies aware that it existed and said, ‘If you ever need it, we can use it,’” Thompson said.
A call finally came from the State Department’s chief of emergency medicine in late-July, amid growing concerns about the West African Ebola outbreak. Phoenix Air quickly assembled a volunteer flight and medical crew after government officials inspected the system and gave it a thumbs-up.
“Within 48 hours, we were on our way to get the first patient,” Thompson said, speaking of the flight to transport Brantly on Aug. 2. The plane took Brantly to Atlanta and turned around almost immediately to fetch Writebol.
Both trips, which cost about $200,000 each, including the decontamination process, were paid for by Samaritan’s Purse, a Christian humanitarian organization that the patients worked with in Liberia.
After those missions, Phoenix Air decided that the U.S. government should manage future transport efforts, because of the “real-world complexities of what it takes to make a mission like this work,” Thompson said. The challenges include dealing with U.S. customs officials, gaining permission to use foreign airspace and deciding which medical centers should treat the Ebola victims.
The State Department has since coordinated all flights, including those for foreigners returning to their countries. U.S. taxpayers pick up the tab for American patients, but the government requires reimbursement for the others. “To me, this is no different from a soldier being shot in Afghanistan,” Thompson said. “The U.S. government is going to get that soldier and bring him home and put him in a medical facility.”
The federal government has been a longtime customer of Phoenix Air. In addition to flying executive charters and providing air-ambulance services, the business of about 225 employees also runs cargo for the military, provides flights for the U.S. Marshals Service and carried the White House’s presidential delegation to the 2014 Winter Olympics in Sochi, Russia.
The company now keeps one plane on standby for transporting Ebola victims.
“We’re like a firetruck in a fire station,” Thompson said. “We’re ready to go.” Josh Hicks covers the federal government and anchors the Federal Eye blog. He reported for newspapers in the Detroit and Seattle suburbs before joining the Post as a contributor to Glenn Kessler’s Fact Checker blog in 2011.
I was certainly inspired by this poem referenced by spokespersons on an American Nurses Association (ANA) webinar about Ebola preparedness.
The last nurse to leave the hospital room where Thomas Eric Duncan died has written a poem about the Ebola patient, penned during the sleepless days after Duncan's death, a source told ABC News.
The source provided the poem to ABC News, noting that the nurse who wrote it asked to remain anonymous. Duncan, the first person in the United States to be diagnosed with Ebola, died at the Dallas hospital on Oct. 8. Two of the nurses who cared for Duncan -- Nina Pham, 26, and Amber Vinson, 29, have been diagnosed with Ebola.
(Editor's note: THR refers to Texas Health Resources, the company that owns Texas Health Presbyterian Hospital.)
A message to you
Inspired by the THR Family
You came to us sick, frightened, confused,
What happened next became international news.
We saw you so ill, with everything to lose
Our goal was to help you because that’s what we do.
Alone in a dark ICU room
We fought for your life, our team and you.
We cared for you kindly
No matter our fear
You thanked us each time that we came near.
As each day pressed on, you fought so hard
To beat the virus that dealt every card.
No matter how sick or contagious you were
We held your hand, wiped your tears, and continued our care.
Your family was close, but only in spirit
They couldn't come in; we just couldn't risk it.
Then the day came we saw you in there
We wiped tears from your eyes, knowing the end was drawing near.
Then it was time, but we never gave up
Until the good lord told us he had taken you up.
Our dear Mr. Duncan, the man that we knew
Though you lost the fight, we never gave up on you.
Could this news just be too close to the truth for the American network anchors to deal with? I submit, President Putin can't pay his military to maintain an assault on the Ukraine, keep a stabilizing presence in the Crimea and prop up evil President Assad in Syria with a ruble that's rotting. Perhaps President Obama's lead on imposing economic sanctions against Russia is taking a toll on that nation's economy. Ya think? Our American news media should tell viewers the truth. Obama deserves credit. Rather than bomb Russia to smithereens over its unlawful invasion of the Ukraine, takeover of the Crimea, support for the evil Assad regime in Syria and the horrendous attack on an innocent Malaysian airliner, blowing it out of the sky, killing everyone on board....instead, President Obama's cautious approach tightened economic sanctions against Russia. Now, the ruble is worth slightly less or only 1 cent more than 2 bits $US. The Moscow Times reports on the ruble's free fall:
"Modest gains for Russia's beleaguered currency were rapidly reversed Monday as the ruble dropped to new record lows amid speculation that the Central Bank might abandon its policy of spending foreign reserves to slow the currency's decline."
Russia Eyes Shrinking Cash Reserves as Fight for Ruble Escalates by Harold Amos
The ruble sank to record lows against both the euro and the dollar Tuesday amid growing concerns over the Central Bank's policy of drawing down its foreign reserves to defend the country's beleaguered currency.
The Russian currency fell to 40.9 against the dollar in early evening trading, its lowest level since a traumatic 1998 restructuring, and dropped to 51.7 against the euro, a second historic low in two consecutive days. (note- today ruble = $0.24 cents)
Consistently butting at the upper end of the regulator-set trading corridor, the ruble's trajectory has caused the Central Bank to sell over $6 billion on currency markets since Oct. 6. While interventions have slowed the ruble's tumble, they have also generated questions about monetary policy.
In a bid to decelerate the ruble's devaluation, the Central Bank has burned through $54.9 billion worth of foreign currency since the start of the year, leaving its reserves at a four-year low.
Dear Republicans, especially those who are in rapture by Fox News rhetoric, it's time to wake up and deal with the truth. President Obama has led America out of a near depression; and now his lead on economic sanctions towards Russia appear to be working.
Moreover, Democrats need to be running toward these achievements and taking credit for supporting them.
Senator Michelle Obama? Is the first lady eyeing a Senate seat?
Let's hope it's not a rumor. Perhaps Michelle Obama has her eye on the seat of California Senator Dianne Feinstein, who is expected to retire in 2018.
That's the rumor, according to Orb Magazine, a new gossip site out of the Bronx. In an article published last Thursday, the magazine speculated that the first family has its sights set on California post-White House, and the first lady on a possible Senate seat.
"Michelle Obama is being urged to move to California and pursue the Senate seat that will almost certainly be vacated by Dianne Feinstein in 2018 when she will be 85 years old," Orb reports.
It later continues, "To lure her to the Senate race, supporters have been reminding Michelle that California is solidly Democratic and there is no apparent frontrunner to succeed Feinstein – certainly no one with the stature, broad appeal and fundraising connections Michelle has."
While few in the mainstream media paid much attention to the gossip when it was reported by the startup online publication quoting an anonymous source, ears perked when CNN's Candy Crowley gave the rumor a national platform by asking Sen. Feinsten about it in an interview on CNN's "State of the Union."
When Crowley asked Feinstein for her reaction to the speculation, the long-time senator from California punted.
"Well, I have no idea what I’m going to be doing in 2018. That’s four years from now, and that’s one of the nice things of a six-year term. I’ve served two years of my term and you know, I’ll make a decision in due time."
How likely is it that the rumor is true?
The Orb article suggested the Obamas are looking to relocate to Los Angeles – about as far removed from Washington as one can get – after the president finishes his term in 2016, which would allow Michelle Obama to fulfill the residency condition to run for Senate.
"Hawaii is too remote; Illinois is a cesspool of political corruption...and New York...is too dense with Clintons and Clinton acolytes," the magazine opines. California, however, is perfect.
To back it up, the Wall Street Journal recently reported that real estate brokers in the Golden State have claimed that Obama-appointed representatives have inspected houses in Palm Springs on the first family's behalf.
Of course, a Senate run would give the first lady – an Ivy League-educated attorney with a strong career that she reportedly set aside to support her husband's ambitions – an opportunity to pursue her own dreams.
“Barack could golf year-round and Michelle could emerge from his shadow after 20 years and retake control of her own life,” an anonymous source told Orb. “Remember, Michelle is a Harvard-educated lawyer whose career was more robust than Barack’s was when they met.”
And let's not forget that few can match Michelle Obama's name recognition, fundraising potential, and flat out popularity – at least in true-blue California. In fact, the first lady is a lot more popular than Barack Obama these days.
Thanks to her much-higher approval ratings and star power (who else can make a viral video dancing with a turnip to DJ Snake and Lil John's "Turn down for what?" and link it all back to a campaign for healthy eating?), it's Michelle Obama who's often hit the campaign trail to help Democratic contenders ahead of the midterms - not her husband, with whom some candidates don't want to be associated.
Still, we're inclined to think the rumor is just that: a rumor.
For starters, the source is as tenuous as they get – Orb is a relatively unknown publication that appears to publish mostly gossip, and, at least in the Michelle Obama article, quote only anonymous sources.
Even Sen. Feinstein – whose seat Michelle Obama is reportedly eyeing – doubts the story.
"I’m flattered, if that should be true," she told Crowley on CNN's "State of the Union." "Somehow I do not believe it is true, but I would be flattered if it were."
And of course, should she choose to run, Michelle the partisan candidate will suddenly become far more divisive than Michelle the 'above-the-fray' First Lady.
After all, the last first lady who ran for a Senate seat won – and went on to become Secretary of State, and may very well make a run for the Oval Office herself. Not bad for a former first lady better known for her headbands than her healthcare initiative back when the American public first met her.
Mrs. Obama is a Harvard-educated lawyer, former university administrator, and self-declared "mom-in-chief" who makes headlines with both her policy platforms and her fashion choices.
Although three Franco-Americans are summarized in my blog link above, the article posted below gives more information about Father Decary posted after speaking with Pat Frechette email is frechp@maine.rr.com
Posted: Wednesday, February 26, 2014 5:17 pm | Updated: 5:24 pm, Wed Feb 26, 2014.
Pat Frechette with photograph of Father Zenon Decary in Saco. Father Decary was born in Canada ordained in 1894 and died in Biddeford ME in 1940. Photo credit Kate Irish Collins
BIDDEFORD - There are many people locally who fervently believe that the Rev. Zenon Decary, born in 1870 and ordained as a priest in 1894, is still working miracles.
They also believe he should be granted the status of saint by the Roman Catholic Church, and they are dedicated to make that happen.
The first step in that long process is to get the new bishop from the Roman Catholic Diocese of Portland to agree to open an investigation into whether Decary was a “holy man,” who manifested the virtues of faith, hope and charity, along with those of prudence, justice, temperance and fortitude, during his life.
This is not the first time that an effort has been made to get Decary canonized by the pope, according to the diocese. In 1992, then-Bishop Joseph Gerry was approached about opening a case for beatification, which is the first step toward sainthood.
However, at that time Gerry said there was not enough evidence to support Decary’s reputation for holiness and there was also the absence of an authenticated miracle, which is required for someone to be beatified. In order for someone to be canonized, a second, separate miracle must also be authenticated.
Despite this backdrop, a dedicated group calling itself the Friends of Father Zenon Decary is once again attempting to get the priest, who served at the now-closed St. Andre Church in Biddeford, named a saint. Decary also served at churches in Westbrook and Augusta, as well as in Canada, where he was born.
Pat Frechette and her husband Gerry, who live in Saco, are the primary people attempting to get Decary declared a saint, although they are also supported by a core group of about a dozen members of the Good Shepherd Parish, which covers Biddeford, Saco, Old Orchard Beach and Lyman.
According to Dave Guthro, spokesman for the Diocese of Portland, Decary is the only Maine-based priest that’s ever been put up for sainthood.
He said that Bishop Robert Deeley, who was recently invested as the leader of the diocese, has not yet had an opportunity to review the request by the Friends of Father Zenon Decary to open an investigation and does not know when the bishop would make a ruling on the issue.
Pat Frechette said this week that the friends group formed about three years ago and has been hard at work since then gathering evidence of Decary’s holiness and his working of miracles both before and after his death in 1940.
In addition, the group has new efforts under way to prove that Decary was a holy man who is prayed to daily by many people seeking his intercession for healing and other favors. In fact Frechette believes she’s been blessed several times by Decary.
As part of the effort to gather proof that Decary did work miracles, Frechette has collected more than 400 letters written by parishioners who received favors from Decary both before and after his death.
Most of the letters were written soon after Decary died, and some were included in the book “The Good Father Zenon,” which was published in French in 1948 by the Congregation of the Sisters of the Presentation of Mary. It was recently re-issued in English by the friends group.
The letters Frechette has collected speak of Decary healing the sick, particularly children. One of those is the Rev. Ron Labarre, a retired priest who is also an active member of the Friends of Father Zenon Decary.
According to materials provided by the diocese, Labarre has often spoken about the times he was healed by Decary as a youngster. The first time occurred when Labarre was 15 months old and fell into a tub of boiling water.
He was badly burned and the doctor at the hospital, fearing that Labarre would die, urged his mother to call a priest. Decary responded to the request and laid his hands on Labarre praying.
He then told Labarre’s mother, “Have no fear, God has designs on this little boy.” In thanksgiving for that healing, Decary asked the Labarre family to make an annual pilgrimage to St. Anne de Beaupre in Quebec, which they did.
The second time Labarre said Decary healed him when he was suffering from convulsions. His mother again called on the priest, and Decary told her to have Labarre’s godfather make a metal cross, which Decary blessed and placed around Labarre’s neck.
Labarre said his convulsions ceased following that day and he kept the little cross with him always, until the time he was in seminary and the string on the cross broke, causing Labarre to lose it.
Another member of the friends group, Armand Janelle, tells the story of how, when he was a child, he was not able to walk. Decary, seeing his mother carrying him around one day, ordered her to place Janelle under a nearby tree. The boy was running in less than a week.
Decary also came to Janelle’s aid when he was 5 years old and had been struck by a car. One of his legs was so badly damaged that the doctors thought they would have to amputate, especially since gangrene had already set in.
Janelle’s mother prayed to Decary, who had died by then, and not long after the infection cleared up and Janelle kept his leg. Both Labarre and Janelle say to this day they pray to Decary daily seeking his help.
Other proofs of Decary’s holiness can be seen all along Pool Road, according to Frechette. She said when Decary’s brother, Arthur, who was also a priest, was assigned to St. Andre’s, as well, the two brothers would often walk from downtown Biddeford out to Hills Beach.
Along the way, she said, they would toss pennies on the ground and pray over them. Frechette then talked about the various institutions for good that sprang up on Pool Road, including the now-defunct Notre Dame Hospital, the current St. Andre Health Care Facility, the convent for both the Presentation of Mary and Good Shepherd sisters and St. Francis College, which is now the University of New England.
In addition, Frechette said that when Zenon Decary’s body was disinterred a few years after his death, in order for his grave to be moved, his casket was opened and his body showed no signs of decomposition, which she said is a sure sign of holiness.
Frechette acknowledges that it can take many years and lots of money to get someone canonized, but those facts are not a deterrent for her or the other members of the friends group.
She said their most immediate goal is to ensure that Decary’s spirit remains alive. To that end the friends are planning to create an interactive website, where people can learn about Decary, share stories of receiving favors from him and ask that prayers be said for them in Decary’s name.
In addition, the group has started a monthly healing service, which is held at 10 a.m. on the first Monday of the month in St. Ann’s Chapel at St. Joseph’s Church on Elm Street in Biddeford. And the group is also filming Masses around the Good Shepherd Parish, which are then shared with those who are homebound or living in nursing homes or assisted living facilities.
The friends are also in the process of creating a leaflet explaining the effort to get Decary proclaimed a saint.
“What we want most of all,” Frechette said, “is for people to cry out in favor of Fr. Zenon.”
Excellent 60 Minutes Segment on Ebola from the nurses who cared
"And we held his hand and talked to him and comforted him because his family couldn't be there."
(I was particularly appreciative of how these nurses revealed the intensity of the personal care they provided to the deceased Ebola patient Mr. Duncan.)
Nurses who cared for Ebola patient Mr. Duncan at Texas Presbyterian in Dallas Texas
Treating Ebola: Inside the first U.S. diagnosis
The medical staff who treated Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., tell the inside story to Scott Pelley.
The following is a script of "Treating Ebola" which aired on Oct. 26, 2014. Scott Pelley is the correspondent. Patricia Shevlin and Gabrielle Schonder, producers.
You've heard a lot about the Dallas hospital that treated Thomas Eric Duncan, the first Ebola patient diagnosed in America. But you've never heard what actually happened from the people who fought for his life at the risk of their own. You're about to meet four nurses who treated Duncan from the time he came into the emergency room, to the moment that he died. The staff had been blindsided by a biomedical emergency that burst into their ER like a wildfire. Contrary to reports that the hospital bungled the response, the story the nurses tell sounds more like a heroic effort to stop an outbreak.
On September 28, Duncan was rushed by ambulance to Texas Health Presbyterian Hospital. He was isolated in a separate section of the ER and nurse Sidia Rose, starting the night shift, was briefed on the special precautions required for what they now suspected was a case of Ebola.
Sidia Rose: I went over and met with a nurse who gave me a report. She also went over the protective gear that we would be wearing that night. She gave, you know, finished briefing me on what was going to happen, and I literally burst out in tears.
Scott Pelley: Why?
Sidia Rose: It's very scary. I know about Ebola, and the only reason I do, it's because I've been just researching it on my own. Since January, I kept hearing the word popping up in the news. And I just wanted to find out about it.
Richard Townsend: When our supervisor said that we had a potential Ebola case, I don't want to call it calamitous but there was a lot of concern, people became very vocal, understandably it's the boogie man virus.
Emergency room nurses Richard Townsend and Krista Schaefer made sure that Rose was suited up properly. As per the hospital's protocol, she worked with Duncan alone, with Townsend watching over her. "I got myself together. I'd done what I needed to get myself prepared mentally, emotionally, and physically, and went in there and did what I was supposed to."
Scott Pelley: When you went to approach Mr. Duncan for the first time, what did you do? How did you prepare for that?
Sidia Rose: I gathered myself together. I put on my protective wear and I went in and introduced myself to him and you know just let him know that I would be the nurse helping him tonight.
Scott Pelley: What were you telling yourself?
Sidia Rose: I was very frightened. I was. But and I just dried my tears, rolled down my sleeves, so to speak, and went on about my night.
Scott Pelley: But why do you go in there? Why don't you say, "You know, this one's not for me"?
Sidia Rose: As a nurse, I understand the risk that I take every day I come to work and he's no different than any other patient that I've provided care for. So, I wasn't going to say, "No, I'm not going to care for him."
Scott Pelley: But you were risking your life to take care of this patient.
Sidia Rose: Oh, I know that. And that's why I, as frightened as I was, I didn't allow fear to paralyze me. I got myself together. I'd done what I needed to get myself prepared mentally, emotionally, and physically, and went in there and did what I was supposed to.
Though Duncan's test results wouldn't be known for two days, she was certain she was witnessing Ebola.
Nurse Sidia Rose: The first time when I went in and he vomited, I was standing in front of him, he was sitting on the commode, and there was just so much it went over the bag, it was on the walls, on the floors. I had two pairs of gloves on and shoe covers. And I had my face shield on. I didn't have two masks on at the time, I had just one. No, we didn't have any head covers. But I wiped down the walls, wiped down the floor with some bleach wipes.
Nurse Richard Townsend: He was having so much diarrhea and vomiting that he, you know, she was constantly having to give him the little bags that we have for people to vomit into.
Nurse Richard Townsend: All of that was hazardous waste and it had to be bagged and then double bagged and then put into a separate container that could then be disposed of later. Because anything that has any of his bodily fluids on it has the potential to be lethal to somebody else.
"And that's when he said to me his family had suffered a loss. That he had buried his daughter who had died in childbirth."
Eric Duncan was 42 years old, from Liberia, which is ground zero for this outbreak. Half of all the cases in the world are in Liberia. He flew to Dallas to visit family, became sick a few days later, and then made his first visit to the Dallas hospital.
It was the night of September 25 when Duncan first came into this emergency room. According to the hospital records, he had a temperature of 100.1. Over the course of the four hours or so that he was here, his temperature spiked to 103, but then it dropped back down. Again, according to the hospital records, he told the staff that he had come from Africa, but did not specify West Africa or Liberia. About three o'clock in the morning, with his symptoms not very severe, the staff decided to send him home with antibiotics.
But three days later he was back in the ER gravely ill and about as contagious as he would ever be. The virus is not transmitted though the air but physical contact with a single viral particle can cause infection. The hospital notified state health authorities immediately. And they wanted Nurse Sidia Rose to ask several urgent questions of Duncan.
Nurse Sidia Rose: I explained to him, "We are under the impression that you may have been exposed to Ebola. And I said, "Where are you from?" And he told me Liberia.
Nurse Sidia Rose: And I asked, "Have you been in contact with anyone who's been sick?
Scott Pelley: He said?
Nurse Sidia Rose: No. He said no.
State and federal health officials wanted to know if Duncan had been with anyone who had died in Liberia.
Nurse Sidia Rose: And that's when he said to me his family had suffered a loss. That he had buried his daughter who had died in childbirth.
But nurse Rose says Duncan told her it wasn't Ebola that killed his daughter. Rose told us that she reported this to the Texas Department of Health, but then Duncan denied his own story when he spoke to those officials.
Scott Pelley: What information was it that he denied to the health officials?
Sidia Rose: About his travels, about him burying his pregnant daughter who had died in childbirth. He denied that. He said that's not true.
Scott Pelley: So he wasn't honest with them.
Nurse Sidia Rose: Yeah.
"And we held his hand and talked to him and comforted him because his family couldn't be there."
This is nurse Richard Townsend, who dressed in the protective gear that was recommended by the CDC at the time, just as Sidia Rose did.
Scott Pelley: Was any of your skin exposed?
Sidia Rose: At that time it was just a gown that I was wearing, so yeah. Not my hands, not my legs, my face, I had my face shield on, the mask with the face shield.
Scott Pelley: So your neck was exposed?
Nurse
Sidia Rose: Yes.
Scott Pelley: So the CDC protocols that you would've looked up the day he came into the emergency department was in your estimation deficient?
All: Yes.
On September 29, Duncan was carried from the emergency department to intensive care. Nurse Nina Pham, who was involved in the transfer, would become the first person to catch the virus in the United States.
It took 48 hours to get Duncan's positive test results. And by then the hospital, on its own, had equipped the staff with suits that allowed no skin to be exposed. It would be another three weeks before the CDC made this its new standard. Then the hospital moved out all of the patients in medical intensive care and reconfigured the 24-bed unit for just one patient. It was a strange scene for ICU nurse John Mulligan.
Nurse John Mulligan: By the time I came in, they had already received the Tyveks, the pappers. So we had the full hazmat gear that people are used to seeing.
Scott Pelley: Is this the full suit?
Nurse John Mulligan: This is the full suit, yes. There were always two of us in the room at all times. And we were designated two people to be in there. I've been in health care for nearly 20 years and I've never emptied as much trash as just from the waste of his constant diarrhea that he was having was remarkable. And we had these longer surgical type gloves on. They were taped to the Tyvek suit, full headgear with a circulator with a HEPA filter that would plug into the back. And the first time I got out of that suit, it literally looked like someone had pushed me into a swimming pool. I was drenched.
They were working 16 to 18 hour days, spending two hours at a time in Duncan's room.
Nurse John Mulligan: And we held his hand and talked to him and comforted him because his family couldn't be there.
Scott Pelley: You held his hand through the spacesuit?
Nurse John Mulligan: I did. He was glad someone wasn't afraid to take care of him. And we weren't. "We asked for volunteers. Everyone volunteered."
Nurse Richard Townsend: I have nothing but respect and admiration for everyone that was involved in his care you know everyone has someone in their lives that they love and they care about. I have a five-year-old and a three-year-old and my wife is pregnant. And the mortality rate for pregnant women with Ebola is, it's essentially 100 percent.
Scott Pelley: But Richard, why don't you go to the administration and say, "You know, I'm sorry. But my wife is pregnant."
Nurse Richard Townsend: People were allowed to request not to be tasked with his care.
Nurse Krista Schaefer: We asked for volunteers. Everyone volunteered.
Scott Pelley: Everyone was a volunteer, everyone that was there wanted to be there?
Krista Schaefer: Every person, housekeeping, respiratory, physicians, nurses.
But despite all the volunteers Duncan grew worse. An experimental drug wasn't helping.
John Mulligan: Early Saturday morning he had become very critically ill and was placed on a respirator.
Scott Pelley: He was intubated.
Nurse John Mulligan: He was intubated.
Scott Pelley: Tube down his throat?
Nurse Mulligan: Tube down his throat. He had a dialysis catheter placed because he was not making any urine, but he needed to. He was heavily sedated and he had tears running down his eyes, rolling down his face, not just normal watering from a sedated person. This was in the form of tears. And I grabbed a tissue and I wiped his eyes and I said, "You're going to be okay. You just get the rest that you need. Let us do the rest for you." And it wasn't 15 minutes later I couldn't find a pulse. And I lost him. And it was the worst day of my life. This man that we cared for, that fought just as hard with us, lost his fight. And his family couldn't be there. And we were the last three people to see him alive. And I was the last one to leave the room. And I held him in my arms. He was alone. "I would have nightmares, and still do, of my co-workers being infected and not being able to get to a hospital and treatment and dying."
Scott Pelley: Sidia, you spent perhaps the most time talking with Mr. Duncan and I wonder what you think people should know about him.
Nurse Sidia Rose: He was very kind and very appreciative. Even something as simple as me just giving him cold washcloth to cool his face down because his fever wasn't breaking, even that he was grateful for. He told me thanks.
Within days of Duncan's death, nurse Nina Pham was admitted to the hospital with Ebola.
Scott Pelley: When Nina became sick, that must've sent a lightning bolt through the staff because now it's one of you.
John Mulligan: I thought someone was playing a cruel joke until I finally looked at my phone and saw the missed text messages and the voicemails and turned the news on and went, "Oh my goodness."
Then four days later, nurse Amber Vinson fell ill. Both nurses have since recovered; this is Nina Pham leaving a hospital on Friday. But many on the staff still wonder whether they could be next.
Scott Pelley: Are any of you, all of you, still self-monitoring for signs of infection?
Nurse Sidia Rose: I am.
Scott Pelley: You are? You're still within the 21-day window?
Nurse Sidia Rose: For Mr. Duncan I'm passed my 21-day period. But for Nina Pham I'm still being monitored. I've been asymptomatic. My temperature has been rock solid.
Those who contract the virus are not infectious until they actually become sick. Members of the medical staff must take their temperature now twice a day and show the reading to a state health official. But, in at least one other way, the effect of fighting this virus could linger.
Nurse John Mulligan: I would have nightmares, and still do, of my co-workers being infected and not being able to get to a hospital and treatment and dying. And so it's like any traumatic event, this too shall pass. It's just going to take a little time.
