The Spanish
nurse who became the first person in Europe to become infected with
Ebola says she 'hasn't the slightest idea' how she contracted the killer
disease.
Teresa
Romero Ramos, 44, from Galicia in northwest Spain, one of the medical
team that treated two repatriated Spanish priests who died from Ebola,
was diagnosed with the illness on Monday.
She
is now being held in quarantine at a hospital in Madrid under police
guard but terrifyingly said she followed all safety protocols but still
became ill.
Though
she is bewildered about how she fell ill, there are fears from
frontline medics in Madrid that the protective suits they've been issued
with do not provide an adequate barrier to the killer virus.
It raises concerns that Britain may not be able to cope should an outbreak of Ebola occur here.
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Care: Teresa Romero Ramos, 44, from
Galicia in northwest Spain, one of the medical team that treated two
repatriated Spanish priests who died from Ebola, and is shown here
cleaning a room after one of their deaths
There are fears from frontline medics
in Madrid that the protective suits they've been issued with do not
provide an adequate barrier to the killer virus
Unwell: Teresa Romero Ramos, the
Spanish nurse who is the first case of Ebola contagion in Europe, says
she has 'no idea' how she got it
Security: Police are guarding the nurse's home and also her hospital room
RIGOROUS INFECTION PREVENTION AND CONTROL GUIDANCE SHOULD PROTECT HEALTHCARE WORKERS FROM CONTRACTING DEADLY EBOLA
The
World Health Organisation (WHO) has set out infection prevention and
control guidance, which should be followed by all countries.
It is designed to give advice to any country providing direct and non-direct care to patients with suspected or confirmed Ebola.
Ebola is highly infectious, but it can be prevented, the WHO said.
It
is spread through direct contact with bodily fluids, including blood,
saliva, urine, semen, vomit and diarrhoea, of an infected patient.
It can also be spread via contact with contaminated surfaces or equipment, including bed linen soiled by body fluids.
The World Health Organisation has
outlined detailed infection prevention and control guidelines to help
protect healthcare workers from Ebola. Pictured are British army medics
training before being deployed to Sierra Leone where they will set up a
hospital to treat all medics who have contracted the disease
What are the standard precautions health workers can take?
It is not always possible to identify patients with Ebola in the early stages, because initial symptoms may be non-specific.
WHO advises it is therefore important for all healthcare workers to adhere to standard precautions, including:
- hand hygiene
- using disposable medical gloves before coming in contact with body fluids, mucus membrane, injured skin and contaminated items
- gown and eye protection before procedures, and patient care involving contact with blood or bodily fluids
In
addition WHO advises healthcare workers follow best practise advice
when giving patients injections, when disposing of sharp instruments,
disinfecting reusable equipment and tasked with laundry and waste
management.
What if treating suspected or confirmed Ebola patients?
Patients with suspected or confirmed Ebola should be treated in single rooms.
If unavailable, special confined areas should be cordoned off to treat patients.
It is vital, WHO guidelines state, that all suspected and confirmed cases are treated separately.
Clinical and non-clinical staff and dedicated equipment must be assigned exclusively to Ebola care areas.
Access
to these areas should be restricted and visitors' access should be
limited to those essential for the patient's well-being and care, a
parent in the case of a child for example.
In each hospital one member of staff must be named to oversee infection prevention and control compliance.
What protective clothing should healthcare workers wear?
Each person going into Ebola designated areas should be provided with:
- correctly sized, non-sterile examination gloves or surgical gloves
- disposable, long-sleeved, impermeable gown to cover all clothing and exposed skin
- medical mask and eye protection
- closed, puncture and fluid resistant shoes
In addition, depending on the level of risk, health workers should wear:
- waterproof apron
- disposable overshoes and leg coverings, where boots are not available
- heavy duty rubber gloves, when carrying out environmental cleaning or handling waste
- a respirator
Before
leaving the isolation area, medics must carefully remove all protective
gear and dispose of it into waste containers. All reusable equipment
should be decontaminated.
David
Cameron will today chair a meeting of the Government's Cobra
contingencies committee to discuss the ongoing epidemic, which has
killed more than 3,500 people.
Professor
David Heymann, the chairman of Public Health England told BBC Radio 4's
Today programme that monitoring the borders to stop people with Ebola
entering the UK would be difficult, because infected travellers may not
have developed any symptoms.
'It's
very difficult to monitor and to stop infections at borders, because
many people who are affected cross borders in the asymptomatic phase,'
he said.
'So
it's very important that countries have systems that can detect persons
who come from West Africa with a fever and that if they find a person
with a fever they diagnose it and deal with it accordingly.'
He
added: 'There is certainly not a crisis in the UK at this time. The UK
is prepared, having prepared over many, many years to deal with events
such as this.'
Ebola is spread via bodily fluids like vomit or diarrhoea, but Mrs Romero Ramos was wearing a full protective suit.
When asked how she thinks she became ill she told El Mundo: 'I can't tell you, I haven't the slightest idea'.
She
was asked if she did anything that would have put herself at risk she
said: 'No, not at all,' adding 'yes, I followed protocols'.
Mrs
Romero Ramos said days after contracting Ebola: 'I'm a little better
now.' But she would not expand on her health and was described as
struggling to speak by the journalist who briefly interviewed her.
Her
husband Javier Limon Romero, who is also in quarantine over fears he
may too have contracted the disease, said his wife was not worried about
getting ill and volunteered to help the priests.
'She volunteered. Other people run way. But not Teresa,' he said.
'I have heard that others called in sick. But not Teresa. She asked to be sent there.'
The
nurse began to feel ill on September 30 while on leave after treating
the two missionaries, but was not admitted to hospital until five days
later.
Asked where she was during this time, her husband Javier Limon told daily newspaper El Mundo: 'At home, mainly.'
Armed
police have been spotted outside the nurse's Madrid home in the suburb
of Alcorcon, as curious members of the public gathered outside.
Their
identities came out after Mr Romero asked a Spanish animal charity to
start a social media campaign to stop health officials putting his dog
down.
Her
husband raged: 'I want to publicly denounce a man called Zarco, who I
think is Head of Health for the community of Madrid and who's told me
that I have to sacrifice my dog. He's asked for my consent and I've
denied it, to which he responded that they would ask for a court order
to enter my house and sacrifice it.'
Anger
was growing in Spain meanwhile over how the nurse became infected with
Ebola as it was claimed the protective suits given to health officials
were not good enough.
Spanish
health authorities said on Wednesday that another person being
monitored in Madrid for Ebola had tested negative for the disease.
The
man, a Spaniard who had travelled from Nigeria, was one of several
people hospitalised after authorities confirmed on Monday that a Spanish
nurse had caught the disease in Madrid.
A
second nurse was also cleared of Ebola. A third nursing assistant was
hospitalised late on Tuesday for monitoring, a source at La Paz hospital
said - bringing the number of people examined in hospital for Ebola to
five, two of whom tested negative.
The escalation in Spain's Ebola outbreak comes as officials revealed 30 people were being monitored for symptoms.
David
Alandete, Managing Editor of the Spanish national newspaper El Pais
said that 50 people were now being monitored having come into 'close
contact' with Teresa.
The mother (right) of Teresa Romero
Ramos, the Spanish nurse who is the first case of ebola contagion in
Europe, looks through a window at her home in Becerrea town, Lugo
province, Galicia, north-western Spain
Unexpected victim: An SOS message
Javier Limon Romero sent to a friend ended up on the Facebook page of an
animal welfare association
Javier Limon Romero, the husband of
the Spanish nurse infected with Ebola. The couple are being held in
quarantine in separate rooms at the same hospital in the Spanish
capital. His wife Teresa, 44, from Galicia in northwest Spain, is one
of the medical team that treated two repatriated Spanish priests who
died from Ebola
Health workers protest outside La Paz
Hospital, calling for Spain's health minister Ana Mato to resign after a
Spanish nurse became the first person to contract Ebola outside of West
Africa
The protest follows claims the nurse did not have the sufficient equipment required to tackle the highly contagious virus
Mr Alandete said the nurse had attended an exam in 'one of the biggest universities in Spain' in late September.
'There is a lot of tension in Madrid. People are anxious and scared especially in the neighbourhood where she lives,' he said.
He added that 'there is not a lot of information coming through from the government.'
'People are scared,' he added.
In a further worrying development, the World Health Organisation says Europe must brace itself for even more outbreaks.
It
has also since emerged that a week before she tested positive for Ebola
Teresa had contacted health workers to complain of a fever and fatigue,
telling them she had helped treat two priests who contracted Ebola in
Africa and were repatriated to Spain.
But it wasn't until she went to her local hospital on Monday that she was finally admitted and tested for the virus.
A woman is pictured wearing a
protective mask as she leaves Hospital Fundacion Alcorcon in Madrid,
where the Spanish nurse first tested positive
It is not the same hospital where she worked, raising questions over the number of people she has come into contact with.
Today
husband Javier, who is also being looked after at the Carlos III
Hospital, spoke to respected Spanish daily El Mundo, which managed to
get a quick phone interview with him in hospital.
He sounded fit and in good health during their five-minute chat.
He told the paper: 'My wife has been working normally and has followed all the normal protocols.
'We've no idea how she could have been infected.
'She's never appeared worried about anything. We were going to go on holiday and couldn't because of an accident I had at work.
'She
volunteered to help the second priest who died from Ebola. She was on
the rota when the first patient arrived but volunteered second time
round.'
Anger
was growing in Spain today over how the nurse became infected with
Ebola as it was claimed the protective suits given to health officials
were not good enough.
Meanwhile the World Health Organisation warned that it is 'unavoidable' more cases will be diagnosed in Europe.
WHO's European director Zsuzsanna Jakab said further such events were 'unavoidable'.
DON'T SACRIFICE OUR DOG! HUSBAND OF SPANISH NURSE INFECTED WITH EBOLA ATTACKS HEALTH CHIEFS FOR THREATENING TO PUT HIS DOG DOWN
Last
night the pet dog at the centre of a growing Ebola row in Spain took a
new twist as it emerged its owner had ceded possession to an animal
welfare group which is now trying to save it.
Health
chiefs in Madrid obtained a court order to sacrifice Excalibur and sent
police to the home of nurse Teresa Romero Ramos, who has been diagnosed
with the deadly disease, and her husband Javier Limon Romero.
They
were understood to be planning to gain entry to the property in the
Madrid suburb of Alcorcon last night so they could take it away and put
it down.
But
a lawyer working for Madrid-based animal welfare group Mascoteros
Solidarios rushed to the couple's flat to try to prevent the animal
sacrifice.
The
move came after Javier, who has been quarantined in a Madrid hospital
with his wife, handed his pet dog over to the organisation's president
Carlos Rodriguez, a vet and well-known radio presenter in Spain.
The
association confirmed in a press release tonight: 'Teresa Romero's
husband Javier, has ceded the custody of his dog to Carlos Rodriguez
through a WhatsApp message while he is in Carlos III Hospital in Madrid.
'The
dog, Excalibur, is currently inside the family home in Alcorcon.
Several animal welfare groups and private individuals have mobilised
following Javier's message over social networking sites about the plans
to sacrifice the animal.'
Thousands of people had last night signed an online petition to save the dog.
Mascoteros Solidarios spokesman Beatriz Ramos said: 'We're not suggesting doing anything that endangers public health.
'All
we want is for the authorities to consider the option of treating this
animal like a human being and putting it into quarantine.
'This
dog has been interacting with other animals over the past few days who
in turn will have have been interacting with their owners.
'It's something that needs to be studied and we don't believe that just putting the animal down is the answer.'
Madrid health chiefs said the animal was a health risk and could transmit the Ebola virus to humans.
They
said in a statement: 'The only way of eliminating the existing risk of
the transmission of the illness is by putting the animal which has been
in contact with the virus to sleep.'
Earlier
today Javier, who lives in the Madrid suburb of Alcorcon, raged:
'Before leaving hospital I left several buckets of water out for it as
well as filling the bath with water, along with a 15 kilo sack of food.
'I also left the door to the terrace open so it could do it necessities.'
He added: 'It seems unfair to me that because of a mistake they've made, they want to solve this the easy way.
'A dog doesn't have to infect a person and vice versa.
'If
this problem worries them so much I think they should look for another
type of alternative solution, such as putting the dog in quarantine and
observation like they've done with me. Or perhaps they feel they should
sacrifice me just in case. Of course a dog is easier, it doesn't matter
as much.'
Hospital staff walk out past police
guarding the entrance to protest outside the Carlos III hospital in
Madrid, Spain where a Spanish nurse is being treated after testing
positive for the Ebola virus
A hospital worker looks out from
behind the main gate of the Carlos III hospital where five people are
now being treated in connection with the possible outbreak - the first
time the illness has spread outside of West Africa
She said: 'Such imported cases and similar events as have happened in Spain will happen also in the future, most likely.
'It
is quite unavoidable... that such incidents will happen in the future
because of the extensive travel both from Europe to the affected
countries and the other way around.'
'It
will happen,' she added. 'But the most important thing in our view is
that Europe is still at low risk and that the western part of the
European region particularly is the best prepared in the world to
respond to viral hemorrhagic fevers including Ebola.'
Officials have said they 'don't know' how the Spanish nurse became infected with the deadly virus.
But
last night staff at the Carlos III hospital where she worked claimed
the protective suits they were given were not good enough.
Unnamed sources told Spanish daily El Pais the suits did not meet World Health Organisation standards.
They said the suits they were issued with were permeable and lacked breathing apparatus.
Medic
Santiago Yus, who is expecting to be asked to help care for Teresa in
the next few hours, said their training was not thorough enough and
consisted of a 10-minute chat and photos put up on a wall.
He
told Spanish daily El Mundo: 'A doctor and a nurse came. They put the
protective suit on and took it off. Very friendly and very willing. But
the training was and is totally insufficient.'
It
also emerged on Wednesday that the vehicle used to take Teresa to
hospital - five days after she first complained of feeling unwell - was a
normal ambulance which wasn't taken out of service or disinfected until
hours later.
Teresa's
apartment block in Alcorcon, a city of 170,000 inhabitants near Madrid,
is yet to be disinfected and frightened neighbours have called for
heads to roll after finding out from newspapers and not health officials
that she had been diagnosed with Ebola.
'At
the moment we are investigating the way in which the professional was
infected,' said Antonio Alemany, the head of Madrid's primary health
care services.
'We don't know yet what failed,' he was quoted by the Guardian as saying. 'We're investigating the mechanism of infection.'
News
of the quarantines has hit Spain's stock market. It is one of Europe's
biggest tourist destinations and stocks in companies such as airlines
and hotel chains fell on the Madrid stock exchange.
The Spanish nurse has become the first
person in the world to contract Ebola outside of Africa after treating a
patient with the deadly virus at Madrid's Carlos III Hospital.
Pictured: Police escort an ambulance with the nurse
The medical workers donned full protective clothing as they transported the nurse between Spanish hospitals
Unnamed staff at the hospital where
the nurse worked complained the protective gear they were given was
inadequate, saying they were permeable and had no breathing apparatus
Prof
Jonathan Ball, Professor of Molecular Virology at the University of
Nottingham, said: 'If appropriate containment measures were adopted this
really should not have happened.
'It
will be crucial to find out what went wrong in this case so necessary
measures can be taken to ensure it doesn't happen again.
'As
the African outbreak perfectly illustrates, healthcare workers put
their life on the line, so everything should be done to ensure that
risks are minimised as much as possible.
'As
for the suggestion of screening people as they arrive at airports, this
would only work if people were already showing symptoms.'
Dr
Ben Neuman, Lecturer in Virology, University of Reading, said: 'Nurses
face a problem in that a person who is sick with Ebola can make quite a
lot of highly infectious waste, as the patient loses fluid through
diarrhoea and vomiting.
'Those bodily fluids can contain millions of Ebola viruses, and it only takes one to transfer the infection.
'The
protective suits that Ebola workers wear provide excellent protection,
but there is a danger when it is time to take the suit off.
'It
is also possible that a tiny amount of Ebola-containing liquid splashed
on the protective garments, and then was transferred to her skin while
removing the protective clothing.'
The 44-year-old Spanish woman was moved between the hospitals in a special fully-incubated stretcher
Medical staff could be seen removing the woman on an enclosed stretcher out of the ambulance last night
The woman has moved from Alcorcon Hospital to Madrid's Carlos III Hospital by those in full protective suits
A medical worker in protective gear stands next to a special stretcher carrying the infected Spanish nurse
Two separate tests confirmed that the woman had contracted the disease.
Despite
the concerns raised today, colleagues last night expressed their
surprise at news the nurse had contracted the virus, saying that there
had been 'extreme' measures in place to protect hospital staff.
One
told Spanish daily El Pais that nurses were equipped with two
protective overalls, two pairs of gloves and glasses. All medics had to
use a special card to access the hospital's sixth floor - where the two
men were treated.
The
Carlos III Hospital was evacuated before the arrival of the first
missionary, Miguel Pajares, who contracted the disease in Liberia, but
not for Mr Viejo as the sixth floor had already been hermetically
sealed.
Mr
Pajares, the first person in Europe to be treated for Ebola, died at
Madrid's Carlos III Hospital in August despite receiving experimental
drug ZMapp after he returned.
Mr Viejo died at the hospital the following month after contracting the virus in Sierra Leone.
The
Spanish nurse is understood to have tested positive for Ebola in a
first analysis after going to hospital in Alcorcon near Madrid with a
high fever early yesterday morning.
Doctors isolated the emergency treatment room.
A
Ministry of Health source told Spanish daily El Mundo: 'She arrived at
the University Hospital Alcorcon Foundation with fever and has undergone
tests. The first test has come back positive.'
The Spanish nurse was part of the team
that treated Spanish priest Manuel Garcia Viejo, who was brought back
from Africa last month so that he could be treated for the deadly virus
pictured. He died on September 26
Mr Viejo was a member of the Hospital Order of San Juan de Dios who worked in the Western city of Lunsar
Meanwhile,
in Oslo medical teams received their country's first Ebola victim after
a Doctors Without Borders worker flew home after testing positive for
the virus.
Anne-Cecilie
Kaltenborn, the organization's general secretary in Norway, said the
Norwegian female doctor started feeling sick over the weekend and was
isolated after she came down with a fever on Sunday.
'We
don't know how she was infected. We have very strict rules about
working in the field, and all our workers use protective clothing,' Ms
Kaltenborn told reporters in Oslo. 'She will be placed in an isolation
ward in hospital in Oslo after arrival.'
Ms Kaltenborn declined to name the worker or give further details pending an investigation by the organization.
She said Doctors Without Borders has 86 foreign workers among the 1,200 working currently in Sierra Leone.
Health
Minister Bent Hoie said Norway is ready to accept the patient and that
health officials had been preparing for months to treat people infected
with the virus.
Another European victim: Ambulances
and medical workers gather near an airplane carrying an Norwegian woman
infected by Ebola in Sierra Leone, after its arrival at Oslo airport
Gardermoen, Norway, today
Ebola
spreads through contact with the bodily fluids of someone who has the
virus and the only way to stop an outbreak is to isolate those who are
infected.
The
current outbreak in west Africa, the worst ever, has infected nearly
7,500 people and caused more than 3,400 deaths. There have been a
handful of cases in the West.
British
nurse William Pooley, 29, who was infected with the virus while working
in Sierra Leone, recovered last month after being flown back to London
for treatment.
He later jetted to the US to give blood to an American battling the disease.
Today
in the U.S., video journalist Ashoka Mukpo, who became infected while
working in Liberia, arrived at the Nebraska Medical Centre in Omaha.
It's not clear how he was infected said his father, Dr. Mitchell Levy,
adding that on Monday, his symptoms of fever and nausea still appeared
mild.
Mr Mukpo is the fifth American sick with Ebola brought back from West Africa for medical care.
Spanish priest Manuel Garcia Viejo is
pictured being flown home from Sierra Leone in a plastic isolation
chamber. It is understood that the female Spanish nurse was part of the
team that treated him
The others were aid workers - three have recovered and one remains hospitalised.
There are no approved drugs for Ebola, so doctors have tried experimental treatments in some cases.
A
critically ill Liberian man hospitalised in Dallas is getting an
experimental treatment, Texas Health Presbyterian Hospital said.
Thomas Eric Duncan is the first person to be diagnosed with Ebola in the U.S., he was admitted to the hospital on September 28.
The
hospital said Mr Duncan was receiving an experimental medication called
brincidofovir, which was developed to treat other types of viruses.
Laboratory tests suggested it may also work against Ebola.
Texas
Governor Rick Perry urged the U.S. government to begin screening air
passengers arriving from Ebola-affected nations, including taking their
temperatures.
But
Federal health officials say a travel ban could make the desperate
situation worse in those countries. White House spokesman Josh Earnest
said it was not currently under consideration.
President
Barack Obama said the U.S. will be 'working on protocols to do
additional passenger screening both at the source and here in the United
States.' He did not outline any details.
Leading
charity Save the Children warned recently Ebola is spreading at a
'terrifying rate' with the number of recorded cases doubling every week.
Speaking
at a conference in London co-hosted with Sierra Leone last week, UK
Foreign Secretary Philip Hammond called for more financial aid, doctors
and nurses.
Scientists
have warned that the deadly virus could spread across the world
infecting people from the U.S. to China within three weeks.
There
is a 50 per cent chance a traveller carrying the disease could touch
down in the UK by October 24, a team of U.S. researchers have
predicted.
Using Ebola spread patterns and airline traffic data they have calculated the odds of the virus spreading across the world.
They estimate there is a 75 per cent chance Ebola will reach French shores by October 24.
And
Belgium has a 40 per cent chance of seeing the disease arrive on its
territory, while Spain and Switzerland have lower risks of 14 per cent
each.
A team of scientists at Northeastern
University in Boston have used air travel information to predict where
the deadly Ebola virus could reach in the next three weeks
Professor
Alessandro Vespignani of Northeastern University in Boston, who led the
research, said: 'This is not a deterministic list, it's about
probabilities – but those probabilities are growing for everyone.
'It's just a matter of who gets lucky and who gets unlucky.
'Air traffic is the driver.
'But
there are also differences in connections with the affected countries
(Guinea, Liberia and Sierra Leone), as well as different numbers of
cases in these three countries - so depending on that, the probability
numbers change.'
The
Sierra Leone Broadcasting Corporation reported Wednesday that bodies of
Ebola victims have been left in the country's streets because of a
strike by burial teams, who complain they have not been paid
Health
Ministry spokesman Sidie Yahya Tunis said the situation is 'very
embarrassing,' insisting money was available to pay the teams. He
promised to provide more information later Wednesday.
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