The World Health Organization (WHO) warned Friday that “many people” in Mali are at high risk of developing Ebola because a toddler who brought the disease to the country earlier this week was bleeding profusely from her nose as she traveled on a bus from Guinea, the World Health Organization warned Friday.
The U.N. agency is treating the situation as an emergency since many people may have had “high-risk exposures” to the 2-year-old girl during her journey through several towns in Mali, including two hours in the capital, Bamako. The toddler was reported to have died on Friday.
This is the first Ebola case in Mali and may expand to many more. The case highlights how quickly the virus can hop borders and even oceans, just as questions are being asked about what precautions health care workers who treat Ebola patients should take when they return home from the hot zone. Doctors Without Borders insisted Friday, after one of its doctors who worked in Guinea came down with Ebola in New York, that quarantines of returning health workers are not necessary when they do not show symptoms of the disease.
In the Mali case, however, the girl was visibly sick, WHO said, and an initial investigation has identified 43 people, including 10 health workers, she came into close contact with who are being monitored for symptoms and held in isolation. The child was confirmed to have Ebola on Thursday.
“The child’s symptomatic state during the bus journey is especially concerning, as it presented multiple opportunities for exposures — including high-risk exposures — involving many people,” the agency said in a statement.
The girl first went to a clinic in Mali on Monday and she was initially treated for typhoid, which she tested positive for. When she did not improve, she was tested for Ebola, and then treated in an isolation tent in the western city of Kayes. Local media stations, citing government officials, reported Friday that the child had died earlier in the day.
Mali has long been considered highly vulnerable to Ebola and was one of 15 countries identified as a “priority” by the WHO as the outbreak spread — due in part to its proximity to the most severely affected regions. Staff from WHO and the U.S. Centers for Disease Control and Prevention were already there helping to prepare for a case, and more WHO staff are being deployed.
The 2014 Ebola outbreak began in Guinea and has since spread to five other West African countries. The virus has also been imported to Spain and the United States. On Thursday, Dr. Craig Spencer, a physician who had been working with Doctors Without Borders in Guinea and returned home to the U.S. about a week before, reported a fever and was placed in isolation at Bellevue Hospital in New York City. Spencer tested positive for Ebola and is now being treated at Bellevue, one of eight New York hospitals designated to treat Ebola patients.
Some countries have banned travelers from the three main Ebola countries — Guinea, Liberia and Sierra Leone — and the U.S. started health screening of travelers arriving from there. But Doctors Without Borders said having its staffers quarantine themselves after leaving a country with Ebola is going too far if no symptoms are evident. A person infected with Ebola is not contagious until he or she starts showing symptoms.
“As long as a returned staff member does not experience any symptoms, normal life can proceed,” Doctors Without Borders said in a statement issued on Friday. “Self-quarantine is neither warranted nor recommended when a person is not displaying Ebola-like symptoms.”
“Any change would be based on politics,” because all the evidence indicates that people are not contagious before they have obvious symptoms of Ebola, said Robert Glatter, an emergency physician at Lenox Hill Hospital in New York.
“Extremely strict procedures are in place for staff dispatched to Ebola affected countries before, during, and after their assignments,” said Sophie Delaunay, executive director of Doctors Without Borders in the U.S. The guidelines workers must follow upon returning to the U.S. include the following instructions:
1. Check temperature two times per day
2. Finish regular course of malaria prophylaxis (malaria symptoms can mimic Ebola symptoms)
3. Be aware of relevant symptoms, such as fever
4. Stay within four hours of a hospital with isolation facilities
5. Immediately contact the Doctors Without Borders-USA office if any relevant symptoms develop
The group also discourages staff returning from West Africa from going back to work before the incubation period is up, so they can recover from the grueling work in the field and also so they don’t pick up an infection while at work whose symptoms may look like Ebola, causing unnecessary anxiety.
The group said Spencer followed these procedures and immediately notified the New York office when he came down with a fever. Doctors Without Borders is investigating how Spencer became infected, the statement said. “Despite the strict protocols, risk cannot be completely eliminated. However, close post-assignment monitoring allows for early detection of cases and for swift isolation and medical management,” it added.
Earlier this evening, Doctors Without Borders confirmed that a patient being tested for Ebola at a New Jersey hospital is a staff member who had recently treated Ebola patients in West Africa. The worker initially had no symptoms but was placed in quarantine upon arrival at New Jersey’s Newark International Airport per new state law, in both New Jersey and New York, mandating that all health care workers returning from the hot zone be quarantined for 21 days. After developing a fever Friday night, the worker was placed in isolation at University Hospital in Newark to undergo Ebola testing.