Commission summons Spain over Ebola case mishandling

Disinfecting healthcare workers. Sierra Leone, August 2nd. [European Commission]

The European Commission asked for “explanations” from Spain Tuesday (7 October) about the circumstances surrounding the infection of a nurse with the Ebola virus, who was in contact with one of two ill Spanish priests, who died of the disease in Madrid. EURACTIV Spain contributed to this article.

Brussels wants to know how it was possible that the nurse, who is now hospitalized in the Spanish capital, got infected, and if all international protocols in the field were respected.

On Monday, the Commission sent a message to the Spanish Ministry of Health to request clarification of the circumstances that have led to this first contagion with Ebola that took place outside of Africa, said Frédéric Vincent, spokesman for the EU executive.

“Obviously there was a problem somewhere,” Vincent said, adding that Brussels expects a response on Wednesday.

The nurse, Teresa Romero, 40, had been in contact with Manuel García Viejo, 69, during his treatment in the Carlos III Hospital in Madrid. García Viejo ran the San Juan de Dios Hospital in Lunsar, Sierra Leone, where he contracted the disease. The priest was repatriated by special military transport, and died four days later, on 26 September, in the Spanish capital.

The World Health Organization said yesterday that Europe would almost certainly see more cases of Ebola, but that chances were slim of a full-blown outbreak outside Africa.

With concerns growing globally that the worst Ebola outbreak on record could spread beyond West Africa, where it has killed more than 3,400 people in three impoverished countries.

Rafael Perez-Santamaria, head of the Carlos III Hospital in Madrid, where Teresa Romero treated the Spanish missionaries, said medical staff were “revising our protocols”.

Four people, including the nurse’s husband, were admitted to hospital for observation. One of the four, another nurse, who had diarrhea but no fever, tested negative for the virus, a Spanish health source said.

Madrid’s regional government said it had ordered a dog belonging to Romero and her husband to be put down, despite the husband’s opposition.

“The existence of this pet which has been in the home and in close contact with the patient affected by the Ebola virus […] presents a possible transmission risk to humans,” a statement said. It would be killed in such way as to spare it any suffering and then be incinerated, the authorities said.

Even though western European hospitals, unlike most of those in the affected parts of Africa, have the facilities to isolate an infected patient, WHO European director Zsuzsanna Jakab said it was “quite unavoidable […] that such incidents will happen in the future because of the extensive travel from Europe to the affected countries and the other way around”.

Nevertheless, she said that “the most important thing in our view is that Europe is still at low risk, and that the western part of the European region particularly is the best prepared in the world to respond to viral haemorrhagic fevers including Ebola”.

Still, health authorities in the developed world are being forced to reexamine their alertness to a disease that has been raging through Guinea, Sierra Leone and Liberia since March, killing more than half of those it infects.

Nurses demonstrating

Dozens of doctors and nurses demonstrated outside La Paz Hospital in Madrid demanding more information about how Romero had caught Ebola, which is not airborne but transmitted through direct contact with the body fluids of a person who, experts say, must already be showing symptoms.

“Given that both the transmission methods and the methods of prevention are well known, it is clear that some mistake was made,” the Madrid College of Doctors said in a statement.

The story of slow response was echoed in Dallas, Texas, where the first Ebola patient diagnosed on US soil, Thomas Eric Duncan, was in critical condition.

Thomas is on a ventilator and a kidney dialysis machine to help stabilize him, the hospital said Tuesday.

Even though Duncan told a nurse he had flown from West Africa, the hospital initially sent him back to his apartment with antibiotics, only to have him return two days later in an ambulance.

Peter Piot, a professor at the London School of Tropical Medicine who was one of the discoverers of Ebola, said caring for its victims demanded draconian discipline, as the slightest mistake could be fatal.

“It should be a lesson for everybody that you can’t overreact. You can’t overprotect,” he told a WHO science group teleconference.

But he also said such cases would remain rare, with careers most at risk: “There is a difference with what is going on in West Africa. It won’t really give rise to outbreaks.”

The European Centre for Disease Prevention and Control (ECDC), which monitors disease in the EU, said that, while there was a small risk of travellers bringing Ebola in without knowing it, the region’s public health authorities “can efficiently detect and confirm cases of Ebola virus disease and thus prevent its onward spread”.

While the White House said there were no plans for a travel ban, US authorities were developing new procedures to screen airline passengers. Senator Chuck Schumer said the measures could include screening air travelers for fever when they arrive in the United States from the worst-hit countries on direct or indirect flights.

Experimental drugs

In contrast to the vast majority of African patients, some of those in Europe and the United States have been given experimental treatments for Ebola, which has no proven cure.

In Madrid, Romero has received antibodies from patients who survived Ebola. Texas Health Presbyterian Hospital in Dallas said Duncan had been given the experimental drug brincidofovir, developed by U.S.-based company Chimerix Inc for use against a respiratory virus but untested on Ebola patients.

American Ebola patient Ashoka Mukpo also was receiving brincidofovir, the Nebraska hospital where he was being treated said on Tuesday.

The Ebola epidemic has overwhelmed the health systems and battered the economies of Guinea, Sierra Leone and Liberia, which were showing signs of recovering from a decade of civil wars in the 1990s.

The UN Development Program noted that the price of rice was up 30% in Sierra Leone, while production had fallen by 10% in Guinea as fewer people were tending to crops.

Fears of economic consequences were felt in Europe too, where travel and leisure shares fell an average 2.4% on the London exchange on news of the Spanish Ebola case.

The Ebola epidemic, the worst since the disease was discovered in 1976, has killed more than 3,400 people in Guinea, Sierra Leone, Liberia and Nigeria and has also spread to Senegal.

Ebola is a haemorrhagic fever spread through the blood, sweat or vomit of those infected, making those working directly with the sick among the most vulnerable to the disease.

The WHO believes it will take six to nine months to contain and may infect up to 20,000 people.

F14 of Liberia's 15 counties have reported confirmed cases. As soon as a new Ebola treatment centre is opened, it is immediately swamped with patients.

Liberia's government announced it was extending a nationwide nighttime curfew imposed last month to curb the spread of the disease.

There is not yet any macroeconomic analysis of Ebola's impact on West Africa, with IMF figures only indicating a modest decrease in growth for Liberia, Sierra Leone and Guinea. But NGOs on the ground describe the situation as “catastrophic”.

>> Read: Economic impact of Ebola shrouded in mystery

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