Tuesday, October 21, 2014

Immunovaccine Moving Forward With Ebola Vaccine

Published October 20, 2014 - 6:44pm

As the race to find an effective vaccine to treat the Ebola virus heats up, a Halifax clinical-stage vaccine company is attracting international attention.

“We have a potential solution to provide a single-dose (vaccine),” said Marc Mansour, chief executive officer with Immunovaccine Inc., in an interview Monday from Stanford University in California.

The first supplies of an Ebola vaccine developed at the National Microbiology Laboratory in Winnipeg were shipped Monday to the World Health Organization.

The vaccine has proved effective in animal trials and was recently cleared by the federal government for human trials to determine proper dosage levels and side effects.

Meanwhile, global pharmaceutical giant GlaxoSmithKline is accelerating the development of an Ebola vaccine currently in Phase 1 trials, with results expected by the end of the year.

Mansour said recent events demonstrating the virus’s ability to cross borders have heightened awareness about its potential global threat.

He said single doses of the Glaxo vaccine have proved effective in fighting Ebola in monkeys.

“It might work,” Mansour said.

The vaccine developed in Winnipeg also looks promising in animal tests but has to be kept at very cold temperatures, Mansour said.

“There needs to be a rapid single dose,” he said.

Immunovaccine recently reported positive results from an Ebola vaccine formulated in the company’s DepoVax delivery system, DPX-Ebola. The results were achieved in an animal vaccination trial organized by the United States National Institute of Allergy and Infectious Diseases.

All vaccinated animals survived exposure to a lethal dose of the wild Zaire strain of the virus, while all unvaccinated animals died from the disease.

Immunovaccine is working with the United States National Institutes of Health, which Mansour said is motivated to get Ebola vaccines in trials, to plan additional DPX-Ebola studies, with data expected in 2015. The data is expected to support advancing DPX-Ebola into human studies.
Canadian-made Experimental Ebola Vaccine to Begin Clinical Trials, Could Be Shipped to West Africa If Successful

The Canadian government said it will ship 800 vials of VSV-EBOV to the World Health Organization in Geneva. The trials will begin later this month in Europe and East and Central Africa.

If those go well, a second wave of trials in West Africa — the Ebola outbreak epicenter where 4,555 people have died — will begin after December.

Canada's VSV-EBOV, an experimental Ebola vaccine, will begin human clinical trials later this month.

Canada's set to send its experimental Ebola vaccine to the World Health Organization, marking the first step toward clinically testing and possibly approving the drug.

The country will ship about 800 vials of the untested vaccine VSV-EBOV to Geneva Monday, the government said in a Saturday statement. WHO is set to start clinical trials with the drug in Europe and parts of Africa later this month.

The drug has never been tested on humans, but has shown promising results in animals, the government said.

The trials couldn't come fast enough: 4,555 people have died from Ebola during the 2014 outbreak, the U.N. said Friday.

The clinical trials for the Canadian drug will run from late October until December in Switzerland, Germany, Gabon and Kenya, CBC News reported.

If the early trials show no significant side-effects, health officials will begin a second round of trials in West Africa, the epicenter of the 2014 Ebola outbreak.

Since the March onset, 8,997 people have contracted the virus. Nearly all the cases have been reported in three West African countries: Guinea, Liberia and Sierra Leone.

A handful of cases have been confirmed in Nigeria, Senegal, Spain and the U.S.

There is no cure for Ebola, but several countries have been experimenting with treatments and vaccines for the deadly virus.

U.S.-made ZMapp has shown some success in treating patients with the disease.

American aid workers Dr. Kent Brantly and Nancy Writebol, who developed the disease in Liberia, both recovered after receiving the drug. However a 75-year-old Ebola-stricken Spanish priest died even with the medication.

With News Wire Services
Ebola Vaccine Trials Carry Risks for Companies in Chase
Nigeria has been declared Ebola-free.
By Robert Langreth, Shannon Pettypiece and Caroline Chen
Oct 20, 2014 9:48 PM ET

Each of the Ebola vaccines being lined up for testing carries potential downsides, researchers say, ranging from efficacy that faded in less than a year to the chance it will give healthy people flu-like symptoms.

Human trials, just starting on some vaccines, could also unveil unknown side effects, an unwelcome possibility for shots designed to be taken by people who may never be infected with Ebola. That’s why it’s imperative to cast a wide net in seeking a solution, said Matthias Schnell, a microbiologist at Thomas Jefferson University in Philadelphia.

“We really should test as many vaccines as we can,” Schnell, who is working on a vaccine that targets Ebola and rabies, said in a telephone interview. “We need way more clinical data for each vaccine before we go ahead with mass vaccination.”

Safety testing has already begun on vaccines from GlaxoSmithKline Plc (GSK), which is working with the U.S. National Institutes of Health, and NewLink Genetics Corp. (NLNK), which is testing a product developed by government researchers in Canada. The next step, efficacy trials in humans, could start next year for Glaxo’s product in affected regions in Africa.

Meanwhile, clinical trials could begin later next year for as many as three other vaccines. While the vaccines have shown some levels of effectiveness in animals, that’s no guarantee they’ll work as well when they are tested in humans, said Thomas Geisbert, a virologist at the University of Texas Medical Branch in Galveston, Texas.

Arsenal of Alternatives

“That’s why it’s good to have an arsenal,” Geisbert said by telephone. “So that if one doesn’t work, you will have plenty of alternatives.”

Vaccines work by stimulating the body to generate antibodies with the ability to remember the virus. That allows them to recognize Ebola once an infection takes place, and mount a rapid counterattack. They differ from ZMapp and other experimental medicines given to Ebola patients primarily because the vaccines are designed for healthy people as a way to keep them from becoming infected.

The Glaxo and NewLink vaccines “have both been shown to be effective in monkeys, so there’s every reason to think they’ll be effective,” said Kartik Chandran, a microbiologist at the Albert Einstein College of Medicine in New York. “But you can’t assume the same thing will hold true in humans. There have been nasty surprises before.”

Modified Viruses

The vaccines from Glaxo and NewLink are based on modified viruses that are changed so they express an Ebola protein that’s strong enough to stimulate an immune response, but doesn’t carry the part of the Ebola virus that makes people sick. Glaxo’s vaccine is based on a chimpanzee cold virus, while the NewLink vaccine is based on vesicular stomatitis virus, which is found in cows.

For London-based Glaxo’s vaccine, there are unanswered questions about whether it will be able to protect against Ebola for an extended length of time, Schnell said.

A study in monkeys, published last month in the journal Nature Medicine, showed efficacy of the single-dose version of the vaccine waning over several months. While one dose of the vaccine protected all of the monkeys given the vaccine from a lethal dose of Ebola after five weeks, it only protects about half of the animals after 10 months.

Giving the monkeys a booster shot of a different vaccine construct provided longer-lasting protection, but Glaxo isn’t using that version in its initial studies in humans.

‘Effective Response’

Even with the one-dose version “we are hoping this vaccine will effectively prime the immune system so that when it does see a small amount of virus” the body will be able to mount an effective response, said Ripley Ballou, a Glaxo vice president.

Johnson & Johnson (JNJ), meanwhile, plans to test a vaccine it developed with a planned booster shot. The company’s human trial is set to begin in March 2015. While giving everyone two shots rather than one adds a logistical challenge, J&J thinks it could be the best way to provide long-term protection.

It “has the potential to provide the durability needed to ensure complete protection against the disease, particularly when we don’t how long an Ebola outbreak will continue,” said Seema Kumar, a J&J spokeswoman.

Durability, though, remains a key question for Ebola vaccines, according to Geisbert. In Africa, if patients have to keep coming in for booster shots, “it could be a very big problem,” he said. “You are lucky to get someone to come in one time, not multiple times.”

Vaccines based on weakened, live viruses that can still replicate “tend to have more durability,” said Geisbert. But they may also cause flu-like symptoms in some cases, he said.

“If you get high fever after you get vaccinated, that would be the end of the vaccine,” Schnell said.

NewLink Vaccine

NewLink’s vaccine is one with a weakened live virus that can still replicate. The Ames, Iowa-based company has started or will soon begin first-stage clinical trials in the U.S., Canada, Switzerland, Germany, and two African nations, Chief Executive Officer Charles Link said in an Oct. 14 interview.

Healthy volunteers in the trial will receive the vaccine, and then be tracked to see how their body responds, Link said. The first participants will get a very low dose of the vaccine to make sure it is safe before the dosage is gradually escalated for later subjects, Link said by telephone.

“We’re doing everything in our power to get the vaccine moving forward and get it into the hot zone,” he said. NewLink’s Chief Financial Officer John Henneman declined to comment on potential side effects.

While researchers often look at how well vaccines do in stimulating the production of antibodies, that isn’t always the best predictor, said Ben Neuman, a virologist at the University of Reading in the U.K. For example, he said, vaccines for HIV have triggered a good antibody response yet failed in human testing.

“Ebola is good at hiding,” Neuman said in a telephone interview. Making a vaccine “is hard,” he added. “If it was easy we would have one by now.”

To contact the reporters on this story: Robert Langreth in New York at rlangreth@bloomberg.net; Shannon Pettypiece in New York at spettypiece@bloomberg.net; Caroline Chen in New York at cchen509@bloomberg.net

To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Andrew Pollack
Ebola Virus Disease: A Potential Global Catastrophe
Illustration of the Ebola virus.

Once again the World Health Organization is seriously under-funded as it strives to fight against the worst outbreak of Ebola Virus Disease in the history of the planet, one which threatens to develop into a nightmare scenario in West Africa before Christmas, and one which could become a global catastrophe. Time to pull together.

Once again in a world which spends one point seven trillion USD on weapons to murder people, we see the World Health Organization (WHO) seriously under-funded as it struggles to control the worst Ebola Virus Disease (EVD) in history. However this is not the time for political in-fighting: it is a serious global threat which could easily turn into a catastrophe, especially if the virus attains sustained infection rates outside West Africa - imagine this disease in South-East Asia, or crowded cities in Latin America. Or anywhere else.

Worst outbreak in history

This outbreak of EVD has a mortality rate of around 50 per cent. 4,447 people (including 236 healthcare workers) out of the 8,914 infected, have died and the WHO predicts the number will rise to over 9,000 by the end of the week, and potentially could reach 10,000 new infections weekly by the end of the year, the infection rate being 1.7, meaning each infected person infects 1.7 others. Beginning in the Republic of Guinea, West Africa, in February, the outbreak has since spread to neighboring countries Liberia, Sierra Leone and Senegal, and also to Nigeria, there have been human-to-human transmission cases in Spain (1) and the USA (2) and other cases treated in Germany (5 successfully, one death), France (1), Norway (1) and the UK (1 case). There is now a suspected case in Poland, in the city of Lodz. There are currently 6 cases in quarantine in Spain, awaiting confirmation and one in France.

Inadequate preparation

The potential to spread is massive, especially because of the lackadaisical attitude of Institutions across the globe and even healthcare facilities in some cases, for instance the Texas Health Presbyterian Hospital, where Patient Zero, Thomas Eric Duncan, had reported ill after travelling from Liberia, and was sent home with a prescription for antibiotics, being diagnosed with a "low-grade common viral disease". Two of the nurses who treated him after he was finally re-admitted, Nina Pham and Amber Vinson, contracted the disease -Union officials allegedly claimed they were dealing with the patient in a terminal phase either with inadequate equipment or were not clearly informed about which protective gear to use.

It has been reported that nurses treating the patient were given the option to use the N95 masks, but some were told full protective gear was not necessary.

In Vinson's case, the hospital isolated her within two hours of reporting the virus. However, before this she had informed the Center for Disease Control about having a temperature and that she had treated a patient with EVD before taking her Frontier Airlines flight to Ohio, and was not prevented from doing so. The fact that she already showed symptoms means she was infectious and some of the 132 passengers on board that aircraft are at risk of infection.

One would expect higher control procedures at such a time, especially from healthcare professionals. Yet the situation is no different elsewhere: how many public Institutions (education ministries, health ministries, hospitals, clinics) have issued protocol procedures beyond a hastily-written flyer copying and pasting data from the WHO website?

Need for clear and concise information

It is this void in clear and concise information that gives rise to scare stories and panic attacks, apparently responsible for the lion's share of the expenses in such outbreaks. In just a week we have witnessed the Turkish Airlines' emergency landing in Rome because of two Bangladeshi passengers with temperatures, the five patients with flu-like symptoms evacuated from an Emirates aircraft at Boston Airport, the Nigerian passenger pulled off the aircraft in Madrid, the scare with the 132 passengers on the Frontier Airlines. This, the same week in which a more serious story came from the Middle East with the hospitalization of a patient in the United Arab Emirates and the news that EVD is spreading to new areas in the Republic of Guinea, Liberia and Sierra Leone.


While as yet there are claims that effective treatment does not exist, there is the experimental drug Brincidofovir, administered to Thomas Eric Duncan unsuccessfully, there is the plasma treatment in which a patient receives a transfusion from an EVD survivor with the same blood type (as was the case of Nina Pham receiving plasma from Dr. Kent Brantly, one of the first two American citizens infected), and there is Z-Mapp, which was successfully administered to these two patients, Dr. Brantly and aid worker Nancy Writebol.

What is ZMapp?

ZMapp is a treatment composed of the use of cultures of cells which make monoclonal antibodies, mAbs. The experimentation began with MB-003, a cocktail of three human/human-mouse mAbs, namely c13C6, h13F6 and c6D8, which showed promising results when administered to rhesus monkeys infected with EVD. The process evolved to the creation of ZMab, a cocktail of three mouse mAbs, namely m1H3, m2G4 and m4G7. These also proved very promising in trials on Ebola-infected macaque monkeys. ZMapp humanized the three ZMab antibodies and tested these with combinations of MB-003 first in guinea pigs and then in monkeys. The best and most successful therapeutic combinations were the c13C6 from MB-003 and the humanized mAbs c2G4 and c4G7, from ZMab, and the result is what is known today as ZMapp.

Contagion and symptoms

EVD is not yet an airborne virus like the Influenza viruses, although it is transmitted by contact with bodily fluids, such as blood, faeces and vomit, milk, urine and semen, possibly also saliva and tears, more especially in the later stages of the illness, and from sweat, studies are inconclusive, according to the WHO. However, the information is unclear because the same source, the WHO, states that EVD can be caught from touching contaminated surfaces. Some say that the virus then needs to be passed to mucous membrane through touching the mouth, nose or eyes, others say it can be transmitted through lesions in the skin, while others state that it can be absorbed directly through the skin, in which case it is enough to touch an infected and contagious person.

Contagion occurs when a patient is infectious, in other words displaying the first symptoms, which is a sudden high fever, extreme fatigue, headache, sore throat, body pain and lack of appetite. This develops into nausea, then diarrhea and vomiting. As the virus takes hold and destroys the blood vessels, the central nervous system takes control from the digestive system and tells the body to expel as much fluid as it can through violent and sustained, copious projectile vomiting and diarrhea, which in the terminal stage can include blood. The patient becomes a human volcano of bodily fluids and torrents of blood.

It is for this reason that the healthcare workers need to use full protective gear at all times, while treating the patient and when cleaning a room after a patient has been accommodated in it, and to follow the protocols for removal of the gear strictly, not touching the face with infected gloves.

Russia's contribution

The Russian Federation has been present fighting this pandemic at all levels. President Vladimir Putin has met the WHO Director-General Margaret Chan and has pledged full support. A medical team of Russian virologists, epidemiologists and bacteriologists is in the field in the Republic of Guinea, to date 19 million USD has been provided, alongside humanitarian aid. Russia is ready to send large numbers of doses of the anti-viral drug Triazavirin, which is effective in 70 to 90% of cases of infections with 15 strains of Influenza, including A H1N1 (Swine Flu) and H5N1 (Avian flu), at any stage of the infection.

Russia is also working on a vaccine and is ready to begin trials on primates. After this the human trials will begin and it may be ready for massive operations by Summer 2015.

A collective lesson: Pulling together

The history of the last week, which has seen success stories in Nigeria and Senegal (where EVD contagion appears to have been halted), but which has also seen social and political and economic disruption appearing in the areas where the infection is concentrated, is a history of heroic efforts by healthcare volunteers from around the globe fighting desperately, but together, against a common foe.

While there is no room for complacency, by pulling together and fighting side by side, the international community can beat this serious threat. Perhaps Ebola Virus Disease has taught us all a lesson.

Timothy Bancroft-Hinchey
US Looking to Boost Production of Experimental Ebola Drug
Ebola virus emerging from infected cell.
October 18, 2014 04:46

US officials have asked labs to submit plans for ramping up production of the experimental Ebola drug, Zmapp, of which supplies have run out. It successfully treated medical workers infected with the virus, but hasn't been widely tested for safety.

The US Department of Health and Human Services, through its BARDA division, issued the order for mass producing the antiviral cocktail on Thursday. Three advanced biological laboratories have until November 10 to submit detailed plans with budgets and timetables, according to Reuters.

The US government "is working with partners around the world as quickly as possible to advance the development of multiple vaccine and therapeutic candidates for clinical evaluation and future use in preventing or treating Ebola," BARDA Director Robin Robinson said in a statement.

Efforts to boost ZMapp production capacity are underway at the Centers for Innovation in Advanced Development and Manufacturing, which is composed of three separate labs: the Texas A&M Health Science Center in partnership with Britain’s GlaxoSmithKline Plc, Emergent Biosolutions in Maryland, and Novartis AG lab in North Carolina.

The three advanced labs were established by the US government in 2012 with $440 million in seed money, and are required to develop flexible manufacturing capabilities to allow them to produce countermeasures against chemical, biological, and other threats.

Supplies of ZMapp, which was manufactured by San Diego-based Mapp Pharmaceuticals, ran out in August after it was given to two American medical workers who contracted the disease in Liberia – Dr. Kent Brantly and Nancy Writebol. Both of the workers recovered. The drug is a cocktail of antibodies engineered to recognize the virus and bind to infected cells, and is made from genetically modified tobacco plants.

“We look forward to leveraging our manufacturing capabilities to expand production of this experimental therapeutic and to find other ways to support the U.S. government’s fight against Ebola,” said Adam Havey, president of Emergent's biodefense division. He also told Reuters that the company has been in discussions with plant-based manufacturers to develop a response to the task order.

It must be noted, however, that according to the Centers for Disease Control and Prevention (CDC), ZMapp has yet to be tested for safety and effectiveness in humans. Also, ZMapp can’t prevent infection, as it’s a therapeutic drug, not a vaccine for Ebola.
US Army Withheld Promise From Germany That Ebola Virus Wouldn't Be Weaponized

October 20, 2014 17:17

The United States has withheld assurances from Germany that the Ebola virus - among other related diseases - would not be weaponized in the event of Germany exporting it to the US Army Medical Research Institute for Infectious Diseases.

German MFA Deputy Head of Division for Export Control Markus Klinger provided a paper to the US consulate's Economics Office (Econoff), "seeking additional assurances related to a proposed export of extremely dangerous pathogens."

Germany subsequently made two follow-up requests and clarifications to the Army, according to the unclassified Wikileaks cable.

"This matter concerns the complete genome of viruses such as the Zaire Ebola virus, the Lake Victoria Marburg virus, the Machupo virus and the Lassa virus, which are absolutely among the most dangerous pathogens in the world," the request notes.

The Zaire Ebola virus was the same strain of Ebola virus which has been rampaging through West Africa in recent months.

"The delivery would place the recipient in the position of being able to create replicating recombinant infectious species of these viruses," the cable notes.

However, it also points out that Germany has in place an "exceptionally restrictive policy," adding that approval would not be granted to the export until US assurance was provided.

"A decision about the export has not yet been made. Given the foregoing, we would appreciate confirmation that the end use certificate really is from the Department of the Army and of the accuracy of the data contained therein," the document stated.

There is no follow-up document available to confirm whether the US Army eventually provided Germany with the necessary guarantees.

Bioweapons were outlawed in the Biological Weapons Convention of 1972 and was signed and ratified by 179 signatories, including Germany, the US and Russia.

It dictates that signatories, "under all circumstances the use of bacteriological (biological) and toxin weapons is effectively prohibited by the Convention" and "the determination of States parties to condemn any use of biological agents or toxins other than for peaceful purposes, by anyone at any time."
AU to Probe Sex Abuse by AMISOM Troops in Somalia
African Union Commission Chair Dr. Nkosazana Dlamini-Zuma.
Publish Date: Oct 19, 2014

The team is to conduct investigations into the specific allegations of sexual exploitation and abuse made against AMISOM personnel, particularly the Ugandan and Burundian contingents

By Raymond Baguma

THE African Union (AU) has established a team to investigate allegations of sexual exploitation and abuse by Ugandan and Burundian troops serving under the AU Mission in Somalia.

According to AMISOM, the chairperson of the AU Commission Nkosazana Dlamini-Zuma authorized the deployment of an investigation team into the allegations against AU personnel made by Human Rights Watch (HRW). Last month, the HRW published a damning 71-page report titled, “The Power These Men Have Over Us: Sexual Exploitation and Abuse by African Union Forces in Somalia.”

The report documented the sexual exploitation and abuse of Somali women and girls at two AMISOM bases in Somalia’s capital, Mogadishu, since 2013.

In a statement issued on Friday by AMISOM, the team comprised of four investigators, including two women is from Ghana, Tanzania and Zimbabwe. In a statement Eloi Yao, the AMISOM spokesperson said that the investigators have the requisite training, qualifications, expertise and experience at national, regional and international levels which they would bring to bear in the discharge of this very important responsibility.”

The team is to conduct investigations into the specific allegations of sexual exploitation and abuse made against AMISOM personnel, particularly the Ugandan and Burundian contingents as well as AMISOM civilian personnel. The investigators will establish the facts with respect to the allegations so that a determination can be made on whether the allegations of sexual exploitation and abuse occurred or not.

Also, the team is assigned to establish, if they occurred, the duration that such actions have been taking place and the actions taken by the AMISOM leadership that either contributed to, or deterred the alleged actions from occurring.

“The Investigation Team will conduct its assignment in an independent, professional and transparent manner. The Investigation Team will be responsive to the needs of alleged victims and potential witnesses as well as to the wishes of all concerned to find out the truth about these allegations,” said Yao in a statement.

Zuma also appointed an assessment team consisting of academics and women activists with special expertise on victim of sexual violence, protection and law enforcement and peace and security that will concurrently conduct a comprehensive assessment to determine the extent, nature, patterns and trends of sexual exploitation and abuse in AMISOM.

This is intended to inform and guide the AU in its policy and response mechanisms not only for AMISOM but for all its Peace Support Operations in Somalia. The two teams are expected to complete their assignments by next month (November 30), after which they will submit their reports to the AU Chairperson.

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Monday, October 20, 2014

Somalia: Residents Protest Against AU Peacekeepers

OCTOBER 19, 2014

Hundreds of residents on Sunday staged a protest in the town of Beled-weyne district, Central Somalia, against the Djibouti Peacekeepers who are part of the African Union mission.

The angry protesters accused AMISOM soldiers of killing innocent civilians during operations in an area close to the district.

But AMISOM said in a Press release that its forces came under attack by armed militia as they were en route to another district where a heavy clan fighting had occurred.

Several people were injured during the protests that caused the closure of many shops.

African Union special envoy to Somalia ambassador Mamadou Sidikou called for the residents to calm down.

“I am deeply saddened to hear of this clash in the Hiiran region. I wish to request for calm and restraint and hereby plead with the people of Hiiraan to choose peace and avoid any further conflict in Deefow and elsewhere. I wish to clarify to the people of Hiiraan – and indeed the whole of Somalia – that AMISOM is non-partisan and does not support any particular group or clan. We are in Somalia to serve all Somali people and support their government to achieve lasting peace,” he said in a Press statement.

Djibouti is one of the countries that have contributed troops to the African Union mission in Somalia with more than 800 troops.

Horseed Media
Somalia: UN Envoy Condemns Attack on African Union Troops in Hiiraan Region
Ugandan troops in Somalia on behalf of the AU and UN.
20 October 2014 – The UN envoy for Somalia condemned today an attack on African Union Mission in Somalia (AMISOM) forces in Hiiraan region and called for calm as rival clans caused insecurity in the area, which is near the centre of the East African country.

“I condemn yesterday’s attack on AMISOM troops near the village of Deefow in Hiiraan region. They were in the area to calm the situation and promote reconciliation,” declared Special Representative of the Secretary-General for Somalia, Nicholas Kay, in a press statement.

According to the UN, armed men and rioters blocked and attacked AMISOM troops yesterday morning while they were on a mission to help restore peace near the village of Deefow.

“The situation will not be resolved by further violence. Local leaders and traditional elders must work together to de-escalate the situation and resolve their differences through peaceful dialogue in full co-operation with the federal and regional governments,” said Mr. Kay.

The envoy also underscored that the Somali people have suffered enough and know that no good can come from further violence and insecurity.

“We remain committed to supporting the Somali people, the Federal Government and AMISOM, as they work together to restore peace.” said Mr. Kay, also extending his sincere condolences to the family and friends of those who were killed or injured as a result of the conflict in Hiiraan region.
Kenyan Military Kill Five People, Seize TNT Explosives

4:16pm EDT
By Joseph Akwiri

MOMBASA (Reuters) - Kenyan soldiers have killed five suspected al Shabaab militants near the border with Ethiopia and recovered a vehicle packed with explosives, preventing a potentially huge attack, a defense spokesman said on Monday.

Kenyan forces intercepted the five men in their car on Saturday in the northern frontier town of Moyale, and ordered them to stop, spokesman Bongita Ongeri said. The militants opened fire and were killed in the shootout.

Soldiers found 100 kg of highly explosive TNT in their vehicle along with six suicide vests.

"Those were chemicals that would be used to make dangerous explosives capable of mass destruction," Ongeri told Reuters.

Somalia's al Shabaab Islamist group has repeatedly taken aim at Kenya and other African states that are part of a U.N.-mandated African Union force in Somalia.

Militants belonging to the al Qaeda-allied group stormed Nairobi's upmarket Westgate shopping mall in September last year, killing at least 67 people.

That massacre was followed by a string of gun and grenade attacks on the Kenyan coast and in the capital that prompted some Western nations to warn citizens against travel to parts of the country, hitting the tourist industry.

Ongeri said the men had originally tried to cross into Kenya directly from Somalia but had failed.

"Security officers trailed them using intelligence information and tracked them to Moyale," he said.

The incident came just days after the U.S. Embassy in Ethiopia warned of a possible attack by al Shabaab there, and urged its nationals to avoid large crowds and hotels and restaurants in an upscale district of the Ethiopian capital.

It was not clear if the militants had precise plans for an attack in Kenya, but the shootout came as Kenyans were preparing to celebrate a holiday on Monday in honor of those who fought for its independence.

(Editing by Edith Honan and Crispian Balmer)

Sunday, October 19, 2014

RNs at St. Joseph Hospital Decry Management’s Response for Highest Standards of Ebola Preparation
California nurses protests lack of Ebola protocol, safeguards.
California Nurses Association Press Release, 10/17/14

Today, Registered Nurses at St Joseph Hospital in Orange, a hospital where RNs are not yet represented by a union, took the bold step of publicly calling on management to take immediate measures to ensure the health and safety of RNs and patients alike regarding Ebola.  The RNs pointed out that the hospital, like most hospitals in America, has failed to enact adequate measures to protect against Ebola. They requested the hospital immediately implement the following:

These same standards are being requested in hundreds of hospitals across the country represented by NNU and CNA, including the four St Joseph hospitals in California where RNs are already represented by CNA.

St Joseph RNs were appalled at management’s reaction to their petition.  First, the hospital allowed supervisors, and other RNs who don’t do direct patient care, to stage a protest on hospital property with signs saying “shame on CNA for preying on fear.”  Second, the hospital administration issued a statement to the press—without responding to employees’ concerns—claiming they are “prepared to deal with infectious diseases” and attacking the nurses’ union for using “scare tactics” to “address labor issues.”

Contrary to management’s assertion, St Joseph’s RNs recognize the hospital is not prepared to deal with Ebola, which is why these requests are so urgently necessary.  RNs and other healthcare workers are truly frightened, with good reason after the disastrous situation in Dallas at another hospital that was also “prepared” to deal with Ebola.  RNs are not looking for platitudes or future plans, but immediate action now to protect the lives of RNs and patients.  After all, RNs’ right not to have their lives placed in danger by doing their jobs may be ultimate “labor issue.”

“We are extremely disappointed that hospital administrators seek to undermine our legal and moral responsibility to advocate for our patients during this Ebola crisis.  We believe management should listen to the caregivers and enact these standards now, for the good of RNs, other healthcare workers and the patients in our community.” –Marlene Tucay, RN, Medical Tele Unit, St. Joseph Hospital.
Spanish Health Worker Declared Ebola-free
Spanish nurse Teresa Romero Ramos has been declared
By Al Goodman, CNN
6:45 PM EDT, Sun October 19, 2014
Source: CNN

Teresa Romero Ramos, a Spanish nurse's aide, is considered free of Ebola virus
Two previous tests showed only a "background" level of Ebola
She will still remain hospitalized for days or weeks

Madrid (CNN) -- Teresa Romero Ramos, a Spanish nurse's aide who had contracted Ebola after caring for a patient with the deadly disease, is now free of the virus, Spain's Special Ebola Committee said Sunday.

"Today I'm very happy, because it can be said that Teresa has overcome this illness," Romero's husband, Javier Limon, said in a video statement released by a family spokeswoman.

Two earlier tests showed that Ebola levels in the health worker were almost nil, and a third test came back negative.

"The last two measurements were in 'background' levels, and there is no significant statistical difference with negative results," Luis Enjuanes, an expert on viruses, said in a phone interview, in English, with CNN. "If for three times, throughout one week, you are background, background, background, in practical terms it means you don't have the virus."

Officials have previously said that the amount of the Ebola virus in Romero's blood had decreased dramatically from the time she was rushed to the hospital two weeks ago, but Enjuanes explained just how close to negative she has already come, even before the latest test sample on Sunday.
Romero has recovered enough to produce antibodies, he said.

"It means she's making her own protection, so any virus fooling around probably will be destroyed or neutralized," said Enjuanes, who's been attending the near-daily meetings of the government's special committee on Ebola, a panel of medical and scientific experts convened to deal with the crisis.

Even though Romero received the negative result for the Ebola virus on this third key test in a week, she will surely remain in hospital for days, possibly a few weeks, in order to recover, Enjuanes said.

She has received two main treatments in her battle against Ebola, for which there is still no vaccine.

The first was an IV drip with the antibodies of an Ebola survivor -- a Catholic nun who survived the disease in West Africa. And Romero also received an experimental anti-viral drug, favipiravir, Enjuanes said.

Spain imported another experimental drug, ZMab, but could only get an older version -- not the newest version, whose stocks have run low globally -- and Romero's doctors decided not to use it on her, Enjuanes said.

To fight her lung problems while also battling Ebola, the doctors administered anti-inflammatory drugs to ease her respiratory problems, even while unsure how that treatment might affect the anti-Ebola measures, Enjuanes said.

Other patients test negative

Two other patients being monitored at Carlos III hospital also tested negative for the virus on Sunday, according to the Special Ebola Committee.

The National Microbiology Institute received tests of Romero and the two other individuals under observation at Carlos III hospital, said the institute's director, Manuel Cuenca.

The tests from a man under observation in Tenerife will be received on Monday, Cuenca told CNN.
As of Sunday morning, Ramos was the only confirmed Ebola patient, according to a statement from the committee.

CNN's Laura Perez Maestro, Nic Robertson and Joshua Berlinger contributed to this report
Dallas Ebola Victims' Families Speak Out
Officials at apartment of Ebola victims in Dallas.  
By Alana Horowitz
Posted: 10/19/2014 5:08 pm EDT

The families of the Liberian man who died of Ebola earlier this month in Dallas, and one of the two nurses who contracted the virus after treating him, spoke out on Sunday.

In a statement, the family of Amber Vinson, a nurse at Texas Health Presbyterian Hospital Dallas, responded to critics who have blamed her illness on a possible failure to follow safety guidelines.

"In no way was Amber careless prior to or after her exposure to Mr. Thomas Eric Duncan," the family said. "Suggestions that she ignored any of the physician and government-provided protocols recommended to her are patently untrue and hurtful."

Last week, Center for Disease Control and Prevention Director Tom Freiden said that, because she was at risk, Vinson should not have flown. However, Vinson's family reiterated on Sunday that the CDC had cleared her for travel multiple times.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said that the CDC was planning to update its guidelines for Ebola treatment in light of the crisis in Dallas. The current protocol doesn't mandate that health workers cover all of their skin, which he said creates an added "vulnerability."

In a statement provided to WFAA, Louise Troh, the longtime partner of Thomas Eric Duncan, said that "our hearts go out to the two brave women who have been infected by this terrible disease as they were trying to help him."

Vinson was the second person to have contracted Ebola in the United States after Nina Pham, another nurse at the Texas hospital. Both women have been moved from Dallas to hospitals that specialize in Ebola treatment.

Troh, whose fiance Duncan was the first person to have been diagnosed with Ebola in the U.S., also thanked the Dallas community for their support.

"We have lost so much but we have our lives and we have our faith in God, which always gives us hope," she said. "Even though the quarantine is over, our time of mourning is not over."
CDC Updates Ebola Protocol as Anxiety Rises
Officials from the CDC and other centers testify before Congress.
Associated Press

Four dozen people who had contact with the original Ebola patient in Dallas will complete a three-week watch period on Monday with no sign any of them has contracted the virus — a watershed in the fight to contain the disease in the United States.

“We are looking forward to Monday morning, when (the) first wave of 48 contacts and potential contacts will no longer be monitored for Ebola,” the city of Dallas said online.

It has been a tense three weeks since the patient, Thomas Eric Duncan, became the first person diagnosed with Ebola in the United States. Duncan, who had flown to Dallas from Liberia, was turned away from Texas Health Presbyterian Hospital on a first visit and admitted later.

Duncan died Oct. 8. Within days, two nurses who cared for him were diagnosed with Ebola themselves.

The virus has a 21-day incubation period. When a case is confirmed, health officials monitor anyone who had contact with that person for three weeks. If they don’t develop symptoms, they are cleared.

“We are so happy this is coming to an end, and we are so grateful that none of us has shown any sign of illness,” Louise Troh, Duncan’s fiancée and mother to the couple’s son, said late Sunday in a statement. Troh and three other people have been under quarantine — ordered by the government not to go out in public.

“Our happiness is mixed with sadness at the same time,” she said. “We continue to mourn his (Duncan) loss and grieve the circumstances that led to his death, just at the time we thought we were facing a happy future together.”

After the isolation window closes, Troh and her children will spend a few more days at a temporary residence, then move to a new rental home in the Dallas area, said Dallas County Judge Clay Jenkins, who is heading the local Ebola response. Donors are paying for the family’s new home and hope to replace belongings that had to be destroyed in the cleanup process.

Troh’s daughter, Youngor Jallah, is among the group whose three-week watch period will end Sunday. Jallah, a nurse’s assistant who took Duncan’s vital signs, has stayed in an apartment she shares with her partner and their children, according to The Associated Press.

“I'm telling you, just to step outside will be so great,” she told The AP. “To hug my mom and grieve for Eric, not over the phone like we’ve been doing, but in the flesh.”

Troh’s family is among the first wave of people who had contact with an Ebola-infected person to finish the three weeks. Others, such as those who had contact with the two nurses, won't finish their quarantine for days.

More than 9,000 people in West Africa have been infected with Ebola, and half have died, sparking fears in the U.S. and elsewhere that the virus could spread.

Ebola spreads by close physical contact with the bodily fluids of someone who is infected and symptomatic. But despite the threat of the Ebola crisis growing exponentially in West Africa, Americans have little reason to fear the disease spreading here, experts told NBC’s “Meet the Press” on Sunday.

The Pentagon is fielding a 30-person expeditionary medical support team to provide immediate assistance to civilian health professionals in the U.S. if additional Ebola cases arise. The team will include 20 critical care nurses, five doctors trained in infectious disease and five trainers in infectious disease protocols, the Pentagon said in a statement.
Liberia's Ellen Johnson Sirleaf Urges World Help on Ebola
Liberian President Ellen Johnson-Sirleaf.
Liberian President Ellen Johnson Sirleaf says the whole world has a stake in the fight against Ebola.

In a "letter to the world" broadcast on the BBC, she said the disease "respects no borders", and that every country had to do all it could to help fight it.

President Johnson Sirleaf added that a generation of Africans were at risk of "being lost to economic catastrophe".

The Ebola outbreak has killed more than 4,500 people across West Africa, including 2,200 in Liberia.
International donations have so far fallen well short of the amounts requested by UN agencies and aid organisations.

In the worst-affected countries - Guinea, Liberia and Sierra Leone - about 9,000 people have been found to have the Ebola virus, which kills an estimated 70% of those infected.

Fragile states

The letter, commissioned by the BBC and read out on the World Service's Newshour programme, starts with the words "Dear World".

She goes on to say that the fight against Ebola "requires a commitment from every nation that has the capacity to help - whether that is with emergency funds, medical supplies or clinical expertise".

"We all have a stake in the battle against Ebola," she says. "It is the duty of all of us, as global citizens, to send a message that we will not leave millions of West Africans to fend for themselves."

She said it was not a coincidence that Ebola had taken hold in "three fragile states... all battling to overcome the effects of interconnected wars".

Liberia, she noted, had about 3,000 qualified doctors at the start of the civil war in the late 1980s - and by its end in 2003 it had just three dozen.

"Ebola is not just a health crisis," she added. "Across West Africa a generation of young people risk being lost to an economic catastrophe."

Donation shortfall

The latest crisis in West Africa is the worst-ever Ebola outbreak.

The virus spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments.

Donors have given almost $400m (£250m) to UN agencies and aid organisations, short of the $988m requested.

Separately, the UN has also appealed for donations to a $1bn Ebola trust fund, intended to act as a flexible source of back-up money to contain the disease.

UN chief Ban Ki-moon said on Friday that the fund, which was launched in September, had received just $100,000 (£62,000) in donations so far.

Former UN Secretary General Kofi Annan told the BBC he was "bitterly disappointed" with the international community's response.

"If the crisis had hit some other region it probably would have been handled very differently," he said in a BBC interview.
WFTU SECRETARIAT: Ebola Virus Deaths Facilitated by Imperialism

Thursday, October 16, 2014, 20:43 Beijing

Only free and public healthcare systems with a focus on prevention can provide an adequate response

The Ebola epidemic that has struck mainly in Liberia, Sierra Leone and Guinea of West Africa and threatens the entire world has killed thousands of people and caused panic to millions of others.

As high level officials of the World Health Organization confess, the epidemic has severely expanded over the last weeks and 70% of the people affected die because of the lack of proper healthcare facilities.

This epidemic brings in the forefront in the most tragic way the chronic and deep wounds in the African Continent by colonialism, by the continuous plundering of the wealth-producing resources and by the high public debts that keep African states and their economies enslaved to the IMF, the World Bank and monopolies cartels.

Crucial and chronic problems facilitating the Ebola epidemic are: The poverty, the malnutrition, the lack of basic healthcare infrastructure and social welfare, the limited access to a system of Public and Free Education capable to eradicate illiteracy and the effect of prejudices and superstitions, the slums that continue to exist being a disgrace for humanity and a danger to public health, the militarization and the state violence that are the answer of the panicked state mechanism.

The World Federation of Trade Unions expresses its indignation at the current situation in the existing healthcare facilities in the abovementioned countries which result in medical personnel offering their services while risking their own lives without any safety measures (gloves, masks). As a result, deaths amongst medical personnel have risen to extreme levels.

The World Federation of Trade Unions and its members worldwide have in the past, with two International Action Days, denounced the role of the Pharmaceutical Multinational Companies which profit from the people’s suffering.

State budget cuts in the funding of public institutions in the field of research, pharmaceutical production and healthcare in the USA and the European Union are aggravating the problems while working in favor of the privatization of those fields, the expansion of the control of the monopolies over the industry and against the satisfaction of the people’s needs.

It is very clear in the case of Ebola as well that as long as the research, the production and the healthcare are ruled by the laws of the monopoly competition and the profit, the people will be suffering from diseases that should have long been extinct or adequately controlled.

Furthermore, in complete contrast to the imperialist policy of the USA and Britain which in the midst of the crisis have ceased the opportunity to send new troops in Africa, the World Federation of Trade Unions feels the need to congratulate the heroic decision of the Cuban Government and the Cuban people to show in the most humanitarian way their solidarity to the people of Africa by sending in Liberia and Guinea a large group of doctors and medical personnel in order to assist in the efforts for the relief of the Ebola patients.

As More than 50,000 Cuban doctors and medical personnel working in 66 countries around the world and specifically 4,000 in 32 African countries, are offering high level Health services as a form of practical solidarity.

We congratulate our affiliate the CTC Cuba and its members in the Health Sector who heroically prove their international solidarity.

The World Federation of Trade Unions representing 90 million workers in 126 countries reaffirms its consistent position that preventive healthcare on a framework of a public, free and adequate healthcare system is the best solution in all Health issues.

The WFTU struggles for:

- The creation of contemporary, adequate and fully equipped institutions of healthcare in all countries that will be part of a broad Public, Free and centrally designed healthcare system to offer to all the population proper healthcare services at all stages of their lives. The sufficient number of medical personnel, the satisfaction of the labour rights and the proper conditions of hygiene and safety are important factors.
- The formation of public institutions of research, production and distribution of free or cheap pharmaceutical supplies, medicine and vaccination to all the people.
- The eradication of illiteracy by securing the access for all people to a public and free Education.
- For state policy that will solve the housing problems in many countries.
- The elimination of poverty and hunger. The African Continent is rich in natural resources and agricultural capabilities. If those are put in the control and the service of the people would offer greatly in the rapid improvement of the living standards of the ordinary people and to the drastic elimination of the diseases and poverty.

Ebola Travel Ban Sought by Lawmakers Opposed by Companies
Dallas hospital linked to all Ebola cases.
By Mark Drajem
Bloomberg News

Some of the biggest companies doing business in West Africa oppose a ban on travel to the U.S. from the countries hit hardest by Ebola, something a growing list of U.S. lawmakers are seeking.

"The restrictions are potentially damaging to the aid effort and destructive for the economies of these countries," said Ewa Gebala, a spokeswoman for ArcelorMittal. "We should be isolating Ebola, not these nations."

The Luxembourg-based company, which mines ore in Liberia and has had an expansion project there disrupted as contractors couldn't get personnel to the nation, met with other companies in the capital of Monrovia yesterday to discuss providing logistical help to fight the deadly virus.

"Without the support of the international community the situation for these economies, many of whom are only beginning to return to stability after decades of civil war, will be even more catastrophic," the chief executive officers of ArcelorMittal, Newmont Mining Corp., Aureus Mining Inc. and eight other companies said in a statement last month.

A ban on U.S. travel would undercut efforts to fight the disease and hurt any potential for economic recovery in those nations, the companies said.

Ebola has been devastating to Liberia, Sierra Leone and Guinea -- three of the world's poorest nations -- where it has claimed more than 4,500 lives. Some U.S. lawmakers have been pressing for a ban on travelers from that region since a Liberian man with the disease arrived in the U.S. and two caregivers became infected.

Medical Supplies

"I haven't heard a reason why it's in the best interest of our country not to do it," Tom Ridge, who served as the first secretary of the Department of Homeland Security under President George W. Bush, said of a travel ban.

Ohio Governor John Kasich, who is dealing with the fallout from Ebola-infected nurse Amber Vinson flying to the state last week, said U.S. President Barack Obama needs to seriously consider a travel ban.

It's difficult enough controlling the movement within the U.S. of people who may have been exposed to the virus without the risk of others from infected areas flying into the country, he said.

"At the end of the day, it's a decision for the president," Kasich, a first-term Republican and former congressman, said at a news conference today in Akron, Ohio. "If he called me and asked me, I'd would say I think a ban at this point makes sense."

Three Nations

House Speaker John Boehner, an Ohio Republican, said the possibility of an outbreak in the U.S. means a temporary ban on passengers from those three nations is necessary. Others have said the U.S. should refuse visas to anyone from the three countries.

"A travel ban won't solve the Ebola crisis, but it should be part of a broader strategy," Representative David McKinley, a West Virginia Republican, said yesterday in a statement. "Stopping the outbreak in West Africa is the only way to contain the virus" but "there are several common-sense steps we need to take to protect the American people."

'Isolating Us'

Liberian President Ellen Johnson-Sirleaf has pledged to U.S. lawmakers that airport officials are now ensuring that anyone who had contact with an Ebola patient can't get on a flight out of her country, as the passenger who made it to Dallas had done, according to Riva Levinson of KRL International. The Washington-based firm represents Liberia and companies working there.

"Isolating us will only contribute to the stigmatization of the country," said Abdulai Bayraytay, a spokesman for the Sierra Leone government. "Prohibiting passengers will not help the situation but rather would even make the supply of much needed medical supplies very very difficult as well."

Albert Damantang, a spokesman for Guinea president Alpha Conde, told reporters today at a press conference that they do not believe the idea of a ban is being seriously considered by the U.S.

"It is obvious that if ever it was set up the consequences would be enormous," Damantang said. "We do not wish that."

IMF Meeting

Isolating the disease and not the region was highlighted by International Monetary Fund Managing Director Christine Lagarde, who wore a button with hat slogan at the IMF's annual meeting in Washington Oct. 11.

Obama again waived off calls for a ban in his weekly radio address today.

"We can't just cut ourselves off from West Africa, where this disease is raging," Obama said in his address. "Trying to seal off an entire region of the world -- if that were even possible -- could actually make the situation worse" by causing people to evade screening.

David Dausey, dean of the school of public health at Mercyhurst College, disagreed with that assessment.

"Every argument that you hear against it doesn't hold up," Dausey said. "We've got to do more now to contain this disease."

The current airport screening measures with non-touch thermometers and questionnaires are ineffective, at best, he said. A U.S. travel ban should be accompanied by a surge of U.S. military efforts, transporting health officials and foreign aid to the region.

"We are willing to use peacekeeping troops for war, but we aren't willing to do it for Ebola," he said. "If this were a war, we would be responding very differently."

Porous Borders

Given the porous nature of the borders in West Africa, determined travelers could slip into other nations and make their way to the U.S., according to Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention.

If that happened, the passengers wouldn't have the exit screening nor the enhanced oversight when landing in the U.S., Frieden testified at a congressional hearing yesterday.

"We're able to screen on entry," Frieden said. "We're able to get detailed locating information. We're able to determine the risk level."

Aid Workers

The ban on travelers from those nations would restrict the ability to get aid workers into those nations. It would also undercut the economic and political stability of the nations, further spreading the disease there, opponents of the ban say.

"This holds the promise to turn this from a tragedy into a full-blown disaster," said David Evans, a World Bank economist who wrote a report on the economic impact of the outbreak. "It really could have destabilizing political effects."

Conde, the president of Guinea, made a similar argument in an Oct. 11 interview with Bloomberg Africa TV.

"We wish the panic would stop," Conde said. "In combating Ebola, we risk creating an even worse evil, namely breaking African economies."

The pressure to ban incoming passengers followed the revelation that two nurses who treated Thomas Eric Duncan in the U.S. contracted Ebola. Both have been transferred from Dallas to hospitals that specialize in the treatment of infectious diseases.

Of the 275,000 international passengers that arrive at U.S. airports every day, about 150 -- or less than 0.1 percent -- come from at-risk nations in Africa. The new U.S. airport checks started three days after Duncan's death from the disease.

21 Days

Even with a travel ban, it's not hard to come up with scenarios in which a person with a disease that can remain asymptomatic for up to 21 days can find their way to the U.S., said James Carafano, a national security fellow at the Heritage Foundation in Washington.

"No matter what procedures are put in place" individual cases, such as Duncan, may still find their way to U.S. hospitals, Carafano said. "The No. 1 task of the federal government should be working with state and local governments" so they can handle those individual cases, he said.

Ahmed Gaba in Freetown, Sierra Leone, said he is worried that a U.S. travel ban could prevent him from seeing his mother and siblings in Philadelphia any time soon.

"My family in the U.S. are afraid of coming" to Sierra Leone, because of the outbreak, "and if the call for a ban is approved then it will be long before we get to see each other," Ahmed said. "I am confident that Ebola will soon end and our fears will be over."

--With assistance from Silas Gbandia in Sierra Leone, Ougna Camara in Conakry, Anna Edney in Washington and Mark Niquette in Columbus.

To contact the reporter on this story: Mark Drajem in Washington at mdrajembloomberg.net To contact the editors responsible for this story: Jon Morgan at jmorgan97bloomberg.net; Jodi Schneider at jschneider50bloomberg.net Stephen West, Maura Reynolds
Kurds Thwart New Jihadist Bid to Cut Off Syria Town
Pentagon airstrikes have pounded Kobane.
Hindustan Times

Kurdish forces in the Syrian town of Kobane repulsed a new attempt by Islamic State fighters to cut off the border with Turkey Saturday as troops battled the jihadists in neighbouring Iraq. It came as the US military said it had unleashed 25 more air strikes in Syria and Iraq since Friday, hitting Islamic State (IS) jihadists and oil infrastructure they control.

But while Washington said it saw "encouraging" signs, it warned the raids might not prevent the fall of Kobane, and its priority remained the campaign against IS in Iraq.

Despite a wave of coalition air strikes in recent weeks, Iraqi forces are struggling to regain and hold ground from jihadists.

As fighting raged, Iraqi MPs finally agreed on the choices of defence and interior ministers to spearhead the pushback, in a moved welcomed as a "very positive step forward" by US Secretary of State John Kerry.

Heavy IS mortar fire hit the Syrian side of the border crossing with Turkey which is the Kurdish fighters' sole avenue for resupply and the only escape route for remaining civilians, Kurdish official Idris Nassen told AFP.

At least three rounds crashed onto Turkey's side of the border, one of them near a hill where the Turkish army is deployed, an AFP correspondent at the scene said.

The jihadists launched a fierce attack from the east towards the border gate before being pushed back, Nassen said.

IS suffered heavy losses in the fighting and was forced to send in reinforcements, the Syrian Observatory for Human Rights said.

The jihadists lost 21 of their people to air strikes and another 14 in ground fighting on Friday, the Britain-based monitoring group said. The Kurds lost three of their fighters.

UN Syria envoy Staffan de Mistura warned earlier this month that about 12,000 civilians remained in and around Kobane and risked "massacre" if the jihadists cut off the border.

Overnight coalition air strikes on IS targets elsewhere in Syria killed 10 civilians, the said the Observatory, which has a wide network of sources inside the country.

'Iraq our main effort'
Of 15 air strikes in Syria since Friday, 12 were aimed at "degrading and destroying their oil producing, collecting, storage and transportation infrastructure," the US Central Command said.

Three other strikes in Syria hit two IS fighting positions near Kobane and a military camp in mainly jihadist-held Raqa province.

The US commander overseeing the air war hailed "encouraging" signs in the defence of Kobane, but said the town could still fall and that Iraq remained the coalition's priority.

"Iraq is our main effort and it has to be, and the things that we're doing right now in Syria are being done primarily to shape the conditions in Iraq," said General Lloyd Austin.

In Baghdad, MPs on Saturday approved defence and interior ministers after weeks of delay.

Khaled al-Obaidi, a Sunni who was named defence minister, was a senior officer in the air force of ousted dictator Saddam Hussein.

Gaining some level of support from Iraq's Sunni Arab minority -- many members of which are deeply mistrustful of the Shiite-led government and view the armed forces as an instrument of repression -- will be key to pushing IS back.

The American secretary of state congratulated Iraq's Prime Minister Haidar al-Abadi.

"We had a very positive step forward in Iraq today," said Kerry. "These were critical positions to be filled, in order to assist with organising the effort" against the IS.

On Saturday, Spain announced it would begin training Iraqi forces later this year to battle Islamic State fighters.

Defence Minister Pedro Morenes made the announcement in Washington, where he has been meeting senior US officials.

Iraqi government troops are battling IS on two fronts -- in the Anbar provincial capital of Ramadi, west of Baghdad, and near Tikrit, Saddam's hometown.

Ramadi is in a shrinking patch of territory in the predominantly Sunni Arab province where forces loyal to the Shiite-led government still hold ground, and its loss would be a major blow for Baghdad.

On Friday and Saturday, 10 air strikes targeted IS in Iraq, including five near the strategic Mosul Dam, north of Baghdad, the US military said.

But security in the capital also remains a problem with bombings killing nearly 50 people in the past two days alone.

The UN Security Council on Friday unanimously called for increased support for the Baghdad government in the face of the "vicious string of suicide, vehicle-borne and other attacks" in the capital.

The IS jihadists have committed a wave of atrocities including massacres of ethnic minority civilians and captured soldiers, and beheadings of Western aid workers and journalists.

In Syria's northern province of Aleppo, IS jihadists on Thursday executed a man they accused of filming their headquarters, and displayed his body on a cross, the Observatory said.

Meanwhile, two IS fighters, one just 15, were executed after being captured near Kobane by Arab allies of its Kurdish defenders, the monitoring group said.


Saturday, October 18, 2014

Unable to Meet the Deductible or the Doctor
Advertisement for the Affordable Care Act.
New York Times
OCT. 17, 2014

Patricia Wanderlich, who suffered a brain hemorrhage in 2011, decided to forgo a brain scan this year because of the cost

Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring.

But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best.

“To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.”

About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.

Insurers must cover certain preventive services, like immunizations, cholesterol checks and screening for breast and colon cancer, at no cost to the consumer if the provider is in their network. But for other services and items, like prescription drugs, marketplace customers often have to meet their deductible before insurance starts to help.

While high-deductible plans cover most of the costs of severe illnesses and lengthy hospital stays, protecting against catastrophic debt, those plans may compel people to forgo routine care that could prevent bigger, longer-term health issues, according to experts and research.

“They will cause some people to not get care they should get,” Katherine Hempstead, who directs research on health insurance coverage at the Robert Wood Johnson Foundation, said of high-deductible marketplace plans. “Unfortunately, the people who are attracted to the lower premiums tend to be the ones who are going to have the most trouble coming up with all the cost-sharing if in fact they want to use their health insurance.”

Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans, according to Margaret A. Nowak, the research director of Breakaway Policy Strategies, a health care consulting company. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year.

In comparison, the average deductible for a bronze plan on the exchange — the least expensive coverage — was $5,081 for an individual and $10,386 for a family, according to HealthPocket, a consulting firm. Silver plans, which were the most popular option this year, had average deductibles of $2,907 for an individual and $6,078 for a family.

Jon R. Gabel, a health economist at NORC, a research organization affiliated with the University of Chicago, said that employer-sponsored plans had lower deductibles, in part, because they provided more generous coverage than the most popular exchange plans. The typical employer-sponsored health plan would qualify as a gold-level policy under the standards of the Affordable Care Act, Mr. Gabel said.

The website for the federal insurance marketplace serving 36 states, HealthCare.gov, strongly encourages consumers to focus on premiums: When consumers search for a plan online, the results are ranked by premium price, with plans offering the lowest premiums listed first.

But insurance plans with lower premiums generally have higher deductibles. Gina Brown, 37, of Nashville, was paying about $155 a month for a Blue Cross Blue Shield of Tennessee plan, after taking account of her subsidy. But her deductible was $4,000, she said, and so she avoided going to the doctor even when she got an ear infection over the summer.

“I attempted to treat it with over-the-counter and homeopathic meds,” she said. “Eventually it went away.”

Ms. Brown recently got a job with health benefits, so she canceled the marketplace plan. Her new insurance has a deductible of $1,000, but primary care visits and prescriptions are not subject to the deductible.

“Now that I know I can go and safely just pay a co-pay,” she said, “it makes me feel better.”

Mark Yuschak, 57, of Jackson, N.J., said he had a silver plan with an annual deductible of $3,000. He discovered its limits in March.

“My wife had an incident, a digestive disorder, and we had to go to the emergency room of a hospital in Freehold, N.J.,” Mr. Yuschak said. “We presented our insurance card and filled out all the forms. They told us, ‘You don’t have a co-payment, you’re free to go.’ ”

Later, though, they received a bill “that could choke a horse,” Mr. Yuschak said — for more than $1,000. “Our insurance wouldn’t cover any of it because we had not met our deductible.”

Carol Payne, a respiratory therapist in Gilbert, Ariz., signed up through HealthCare.gov for a Blue Cross Blue Shield plan with a $6,000 deductible. She pays $91 toward her monthly premium and gets a subsidy of $353 to cover the rest.

The plans she could have chosen with lower deductibles were from insurers that “were not as reputable,” Ms. Payne said. She has used the insurance for preventive care and an emergency room visit after a car accident.

“I’m just doing what I can to keep myself healthy,” she added. “I mean, $6,000 — do they think I’ve just got that under my mattress?”

People with low incomes may qualify for subsidies that reduce their deductibles, co-payments and other out-of-pocket costs. The assistance is available to people with incomes from 100 percent to 250 percent of the poverty level (from $23,550 to $58,875 for a family of four), but only if they choose a silver plan.

Consumers also benefit from a provision of the Affordable Care Act that limits out-of-pocket costs, which include deductibles. The limit this year is $6,350 for an individual and $12,700 for a family plan. But in general, the limits apply only to care provided by doctors and hospitals in a plan’s network and do not cap charges for out-of-network care.

Dr. Rebecca Love, of Moab, Utah, is well on her way to passing that limit. Dr. Love, 63, who has degenerative arthritis and a host of other health problems, pays $422 a month in premiums for a plan that has a deductible of $6,000. But she has already paid more than $6,000 in medical costs this year that did not count toward her deductible because the doctors and hospitals — more than 100 miles away in Grand Junction, Colo. — were not in her network.

To see certain specialists in her network, Dr. Love said, she would have had to travel to Salt Lake City, which is much farther away and requires driving through a treacherous mountain pass.

“Medical care costs too much and health insurance as it stands doesn’t address this,” she said. “What have we become?”

Ms. Wanderlich, who had suffered the brain hemorrhage, was even avoiding preventive care until last month, when she had to get a prescription renewed and her doctor’s office required her to be seen first. Grudgingly, she went for an annual physical exam on Sept. 12. She was relieved to learn that she owed only $30 for the visit; the provider billed her insurer more than $1,200.

When the next open enrollment period begins on Nov. 15, Ms. Wanderlich said, she will probably switch to a plan with a narrower network of doctors and a smaller deductible. It will probably mean losing her specialists, she said, but at this point she is resigned.

“A $6,000 deductible — that’s just staggering,” she said. “I never thought I’d say this, but how many minutes until I get Medicare?”
British Public Sector Workers Protest Brings Huge Crowds to the Streets
British public sector workers on the march.
Tens of thousands of people have protested in London, Glasgow and Belfast about pay and austerity.

Many of those protesting were public sector workers such as teachers and nurses opposed to a below-inflation 1% pay offer from the government.

The "massive turnout" will send a strong message to Downing Street, the Trades Union Congress (TUC) general secretary Frances O'Grady has said.

The government says pay restraint has safeguarded jobs and services.

Public sector workers including teachers, nurses, civil servants and hospital workers are among those taking part in the protests, alongside rail and postal workers and others from private firms.

The marches follow public sector strikes earlier this week.

The TUC, which organised the protests under the slogan "Britain Needs a Pay Rise", said between 80,000 and 90,000 people were taking part in the London march. There has been no independent confirmation of this.

The march in London was "very peaceful and well organised", the Metropolitan Police said.

'End the lock-out'

Dave Prentis, general secretary of the Unison union, said the "best thing" the government could do was "recognise the value of the masses of people here today who have suffered and give them a pay rise".

"Our members didn't cause this recession, our members didn't cause the failures of the banks," he said.

The TUC says average wages have fallen by £50 a week in real terms since 2008.

The union's general secretary Ms O'Grady said: "Our message is that after the longest and deepest pay squeeze in recorded history, it's time to end the lock-out that has kept the vast majority from sharing in the economic recovery."

Len McCluskey, general secretary of the Unite union, said Labour should support workers by offering a "clear socialist alternative" to the Conservatives at the next election.

"I say to Labour - stop being scared of your own shadow. Don't shrink what you offer the British people," he said.

Ms O'Grady said top directors were being awarded 175 times more than the average worker, while five million people were earning less than the living wage.

"If politicians wonder why so many feel excluded from the democratic process, they should start with bread and butter living standards," she said.

GMB union general secretary Paul Kenny said members' living standards were still falling.
"People are currently facing the biggest squeeze on their incomes since Victorian times, and wages have fallen in real terms every year since 2010," he said.

Case study: 'My lifestyle is pressured'

Mick Bowman, 56, is a mental health social worker for Northumberland County Council who lives in Newcastle and is taking part in the march in London.

"I've not had a pay rise for four years so with the cost of living rising, that's a very substantial pay cut," he said.

"At the same time my workload has increased and my job's become more stressful.

"At the end of every pay month I have to use my credit card to live on. I last had a holiday three years ago. So my lifestyle is pressured.

"I feel extremely angry about this. The national deficit was manageable and the way to deal with it is not to cut jobs and shrink the public sector.

"It's time to invest more in the public sector and get people into a position where they are able to spend more and put more money into the tax system."

'Depth of feeling'

The marches come after industrial action by health workers on Monday - the first strike over pay in the NHS since the 1980s and the first time midwives had ever taken action.

Hospital radiographers and prison officers will strike in the coming week as part of the same dispute.
Cathy Warwick, the chief executive of the Royal College of Midwives, said the response from members showed the "depth of feeling" over the issue.

Following a TUC attack on levels of boardroom pay on Friday, a government spokesman said:

"Under this government we've seen the largest annual fall in unemployment, more people in work than ever before, and this year the first above-inflation rise in the national minimum wage since the recession.

"We appreciate that although we are now on the road to recovery, the effects of the recession are still being felt. This is why we have taken continued action to help people by cutting income tax and freezing fuel duty.

"We also want to restore the link between top pay and performance... we have introduced comprehensive reforms which give shareholders more power to hold companies to account over what they pay and why."

BBC World News

Friday, October 17, 2014

United States Ebola Failures a Cause for Concern in Australia
Dallas Nurse Amber Vinson is the third Ebola patient in the
United States. She provided care for Thomas Eric Duncan.
Jamie Walker
Associate Editor, QLD

AT the height of the international emergency over avian influenza nearly a decade ago, John Howard was presented with a plan to close Australia’s borders. The then prime minister had been attending an exercise with state emergency services over how to enforce a quarantine and the likely fallout. One scenario involved an airline coming in, defying the stop order, filled with ill people.

As it turned out, Australia kept its airports open during the pandemic of H5N1 bird flu that reached its zenith, before flaming out in 2007. While the human death toll turned out to be mercifully low — about 150 died in eastern Asia — the chaos and fear were epic. More than 140 million birds and domestic fowls were slaughtered amid fears that millions of people were at risk. Public health officers across Australia dusted off plans to deal with a major outbreak of disease here, just as they are now doing with Ebola virus disease

Bird flu is highly contagious, but nowhere near as lethal as Ebola, which is killing seven in 10 of those infected in the red zone of West Africa. Still, worst-case modelling by Queensland Health in 2006 showed that up to 500,000 residents of the state would be infected with bird flu, 14,000 of whom would require hospitalisation, with 4000 deaths. At that time, contingencies were made for the state to commandeer hotels and use them as quarantine centres. None proved necessary, as Australia largely dodged a bullet with the H5N1 virus.

Until this week, senior public health officers were quietly confident that Ebola, though worrying, posed a low-level threat to this country because our world-class protocols, hospitals and clinicians would readily contain any outbreak.

The US experience changed all of that. The evident infection ­control failures at the top-tier Texas Health Presbyterian Hospital in Dallas during the treatment of a Liberian man who died of Ebola on October 8 has sounded alarm bells globally.

Two of the nurses who attended Thomas Eric Duncan, 42, were themselves infected with Ebola, despite wearing regulation protective suits, under protocols that are standard for most developed countries, including Australia.

As AMA president Brian Owler points out, the Dallas hospital is a “First World facility … you would not expect that two healthcare workers would become affected by Ebola. So I think, in light of that, people are going to be looking closely at the way the treatment was conducted in Dallas to make sure that the procedures are up to scratch.’’

There was another worrying aspect to the Dallas debacle. The second nurse to become Ebola-positive, Amber Joy Vinson, had been involved in the late-phase intensive care of Duncan, who had passed through US border control before becoming sick.

As he lay dying, she inserted catheters, drew blood and cleared away his mess. She was being monitored after her teammate, Nina Pham, 26, fell ill. But Vinson, 29, took time off and flew across the country to Cleveland, Ohio, on October 10, where she caught up with a friend, a teacher. By one account, she contacted the US Centres for Disease Control and Prevention (CDC) and asked whether she should fly home when she was running a temperature. Go ahead, she allegedly was told. Her diagnosis with Ebola the following day, after she had landed in Dallas, sparked a frantic effort to trace the 132 other passengers on the flight potentially exposed to the disease (the risk is rated extremely low).

Two Cleveland schools have now been closed as a result of contact with staff while there.

The US government is under intensifying pressure, from the public and politicians in congress, to slap travel restrictions on people under Ebola watch. There are calls for this to extend to an outright ban on people entering the country from the hot-button countries in West Africa, Sierra Leone, Liberia and Guinea. The Democratic Republic of the Congo, deep in the continent’s interior, also has been hit by a separate Ebola outbreak, though this appears to be under control, as is an early eruption in Nigeria. The Obama administration, at this point, is reported to be reluctant to close its borders to West Africans, especially when it has started to deploy the lead elements of a 3000-strong military-led relief mission to the region.

But CDC director Thomas Frieden told the House Judiciary Committee on Thursday that all options were on the table. “We will consider any options to better protect Americans,’’ he said.

To date, north Queensland MP Bob Katter has been the loudest and boldest proponent of mandatory quarantine for those who have been in the Ebola zone, including returning Australian health workers. They work in West Africa with aid groups such as the Red Cross and Medecins Sans Frontieres, not under the auspices of the Australian government, which is refusing to commit personnel on the basis that it can’t guarantee they can be airlifted out in the event of being infected.

Katter has been howled down by the AMA and other critics, but that doesn’t mean government ­decision-makers are not taking careful note of the discussion; Cabinet’s National Security Committee has considered the widening crisis on five separate occasions, as The Australian revealed yesterday.

The case of Cairns nurse Sue Ellen Kovack, who developed a mild fever after returning home from a secondment in Sierra Leone with the Red Cross and entering voluntary home quarantine, is not a million miles from Vinson. Kovack flew in to Perth on Sunday, October 5, and flew to Melbourne the following day before arriving home on Tuesday, October 7. She reported her elevated temperature two days later, sparking a major scare as fever is the first sign of Ebola. Thankfully, she tested negative.

The swine flu emergency in 2009 provides the precedent for stricter quarantine measures. This virulent strain of H1N1 influenza laid low more than 37,000 Australians, causing or contributing to the deaths of up to 1600 on some estimates. Cruise ships were quarantined, hotels and schools closed. The Chief Health Officer of NSW was given stronger powers to mandate that infected people stay in home isolation for up to 14 days, enforceable by the police.

Katter argued yesterday that returning health workers and others flying in from West Africa could sit out a period of mandatory isolation in holiday homes. “Anything short of three days’ isolation would be unacceptable,’’ the maverick backbencher declared.

Former AMA president Kerryn Phelps says there is a striking difference between Australia’s tough animal quarantine regulations and those for humans. “We’re really strict with livestock but we’re ­really slack with people getting on a plane,’’ she complains. This may gloss over the basic point, made by doctors opposed to quarantine, that animals can’t speak up if they’re feeling ill.

But Melbourne emergency physician Stephen Parnis says the priority is to ensure that anyone sick with Ebola or known to have had exposure to the virus needs to be isolated, and he has an open mind on how this can be done. Parnis, a federal vice-president of the AMA, won’t speculate on “specific measures’’, but tells Inquirer: “You would need to minimise direct contact with other people as a general principle.’’

In their weekly telephone hook-up yesterday, the nation’s chief health officers canvassed quarantine options. Jeannette Young, of Queensland, insisted ­afterwards there was no need for regular passengers to join health workers in voluntary home isolation or any other form of containment — provided, of course, they were well.

Since Ebola took hold in West Africa, claiming more than 4000 lives so far, 724 people had been checked on arrival at Australia airports, 11 of whom were subsequently tested for Ebola. None was positive.

“The major need is for healthcare workers because we know they have been exposed,’’ she says. “These other people have not been exposed to anyone. The risk is very, very low. It’s a matter of giving them information so they know what to look for. With that … the risk is covered.’’

Young says, however, there is merit in checking all passengers flying in from West Africa by no-touch laser thermometer, as is done at some airports in the US. But for all the reassuring talk by the experts about Australia being ready for Ebola, there was a jaw-dropping reality check on Thursday when federal Health Minister Peter Dutton toured the infectious disease unit of the Royal Brisbane and Women’s Hospital, one of three designated Ebola treatment centres in Queensland. In what was supposed to be a reassuring photo opportunity with the media, the clinical staff turned out in personal protective equipment that left skin on their necks exposed, replicating shortcomings in the PPE of the sick Texan nurses.

Owler was stunned. “The gear was clearly not appropriate … and only engenders worry,’’ he says. When he called around yesterday, the AMA chief was told that Royal Adelaide Hospital had only that morning received Ebola-standard PPE — which should include rubber boots, tear-resistant coveralls, hood, mask and face shield.

In addition, staff are to be ­double-gloved when interacting with a patient or suspected carrier. After all the “soul searching’’ prompted by the failure of infection controls in Dallas, Owler had expected better.

The Ebola threat to Australia does need to be kept in perspective. The disease, though terrible, is not contagious like the flu, and needs direct and probably fairly intensive contact with the bodily fluids of an infected person to be spread.

People are not infectious until symptoms emerge, generally with fever. All of this means a First World health system could and should cope. That the US health system failed the test of Ebola at the first hurdle is cause for genuine concern.