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**Vibrant62** · July 31, 2014, 03:07 AM

Re: Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms

Comment: We are seeing a very common feature here of individuals being well enough to work/ travel right up until they develop severe diarrhoea and vomiting, going home from work, and then dying very shortly thereafter (within days). A particular example is the HCW who most likely infected the US personnel, Brantly and Writebol, as he worked with them on the Monday and Tuesday before anyone noticed he was ill, was isolated Wednesday when there was a clear onset of symptoms and died Thursday.

It needs to be determined how infectious these patients are during this nascent period of the illness. Traditionally, we assume that ebola is not infectious until fully symptomatic, but we need to assess if this aspect of the virus behaviour has changed (so many other aspects/ characteristics of infection have altered in this outbreak, so this is something that needs to be determined/ double checked).

**Nika** · July 31, 2014, 07:18 AM

Re: Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms

This sort of change would definitely confer a selective advantage.

**sharon sanders** · July 31, 2014, 07:36 AM

Re: Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms

Originally posted by Vibrant62 View Post

http://www.liberianobserver.com/news...ebola-symptoms

The death of an Education Ministry employee on Monday night has forced authorities there to close down the entire Ministry effective as of yesterday (Tuesday) for an indefinite period of time.

The decision, taken by Education Minister, Etmonia David Tarpeh, came immediately after she discovered that one of the Ministry?s employees, who had been at work on Monday, had left the office vomiting and later died at home.

snip

On Monday night, it was reported that one of the employees of the Ministry, identified as Henry Karma, 40, assigned at the Procurement Division, died at his Barnesville residence from ?running stomach.? He showed up for work on early Monday, but returned home complaining of an uninterrupted ?running stomach?, which reportedly led to his demise.

The deceased, according to a highly placed source at MOE, upon coming down with the ?running stomach,? decided to stay away from any of the nearby medical facilities. He rather remained at home because he feared being diagnosed with the Ebola virus.

snip

The Education Ministry is the second GOL office to be temporarily shut down. On Monday, the Ministry of Finance was also evacuated and all employees ordered to go home until further notice. Finance Minister Amara Konneh ordered the building fumigated by the Ministry of Health.

more at http://www.liberianobserver.com/news...ebola-symptoms

It appears the government of Liberia is being affected. The Ministry of Education is the 2nd ministry to be exposed to ebola. High ranking officials at the Ministry of Finance & Development are quarantined after exposure to Mr. Sawyer who later died:

"MOF officials under Ebola surveillance
Tuesday, 29 July 2014 00:00

Several senior level officials at the Ministry of Finance and Development Planning have been placed under 21 days observatory surveillance.

The officials were said to have come in direct or indirect contact with Ebola victim late Mr. Patrick Sawyer. Mr. Sawyer died last Thursday upon arrival in Lagos, Nigeria hours after he disembarked from an Arik airliner."

Liberia - Ebola: 10 212 confirmed cases, 4 573 deaths (WHO, April 22, 2015) - FluTrackers News and Information

http://www.flutrackers.com/forum/showpost.php?p=540721&postcount=122

Liberia - Ebola: 10 212 confirmed cases, 4 573 deaths (WHO, April 22, 2015)

**Vibrant62** · July 31, 2014, 10:48 AM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

An additional news report that gives another example re: the comment above on transmissibility during the nascent stage of the disease. From

reuters.com

http://www.reuters.com/article/2014/07/31/us-health-ebola-transport-idUSKBN0G011O20140731

Taxis, planes and viruses: How deadly Ebola can spread

The spread of this outbreak from Guinea to Liberia in March shows how tracing even the most routine aspects of peoples' lives, relationships and reactions will be vital to containing Ebola's spread.

The original case in that instance is believed by epidemiologists and virus experts to have been a woman who went to a market in Guinea before returning, unwell, to her home village in neighboring northern Liberia.

The woman's sister cared for her, and in doing so contracted the Ebola virus herself before her sibling died of the hemorrhagic fever it causes.

Feeling unwell and fearing a similar fate, the sister wanted to see her husband - an internal migrant worker then employed on the other side of Liberia at the Firestone rubber plantation.

She took a communal taxi via Liberia's capital Monrovia, exposing five other people to the virus who later contracted and died of the Ebola. In Monrovia, she switched to a motorcycle, riding pillion with young man who agreed to take her to the plantation and whom health authorities were subsequently desperate to trace.

A taxi driver would not permit anyone exhibiting symptoms of diarrhoea and vomiting into his taxi, and I think it improbable that strangers would ride in a taxi with someone showing such symptoms. This suggests this case was not yet exhibiting these symptoms during her journey, but was sufficiently infectious to pass the disease to all 5 taxi contacts. There are no reports of this incident that tell us if these symptoms developed during the taxi ride on the way to Monrovia, but I cannot imagine it would be physically possible to ride pillion on a motorbike for the last leg of her journey whilst experiencing them.

**JimO** · July 31, 2014, 11:56 AM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

It seems unlikely that all five taxi contacts would have come into direct contact with bodily fluids. The evidence of a more efficient mode of transmission seems to be building. I know that officials don't want to cause panic; however, out of an abundance of caution, people should be made aware of the potential to contract the disease without coming into direct contact with bodily fluids while patients are exhibiting severe symptoms.

**Vibrant62** · July 31, 2014, 12:46 PM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

I dont know that such a thing could be deduced from this situation. It is more likely that the fellow passengers shook hands, which is a traditional and (almost obligatory) greeting in Liberia. I think the issue here is the possible potential for transmission prior to obvious symptoms being present i.e increased transmissibilitry during the nascent period of infection. Hopefully WHO science teams will be on the ground evaluating and checking this, to make sure there has not been a change in ebola's behaviour and/or infectivity.

**Emily** · July 31, 2014, 01:51 PM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

"Running stomach" = ebola? When that MERS case was misdiagnosed in Indiana initially, at least there was a false positive test result to go on.

**Vibrant62** · July 31, 2014, 05:09 PM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

I would guess they are erring on the side of caution, or have a local positive test result. There is insufficient information to be clear, but they cannot afford to have senior echelons of govt & management wiped out by ebola, so it seems a fairly sensible response in the circumstances.

**Emily** · July 31, 2014, 05:29 PM

Re: Liberia - Education Ministry Shut Down as Senior Staff Dies of Ebola-Like Symptoms - Ministry of Finance also quarantines high level workers

I don't think Liberia is over-reacting to a report of an official dying at home, (with no medical care?), of an unknown illness in the context of the the current outbreak.

But I do want to point out that we don't know what caused this man's death and whether the $100's of millions of public funding that are starting to churn around now will be well-directed in terms of good public health outcomes.

Liberia: U.S.$20 Million to Fight Ebola, Liberia's Health Ministry Proposes

WHO, CDC See $100 Million Surge for Africa Ebola Battle