Double-gloving, better face protection added in new guidance on Ebola gear

The UN health agency is updating its guidelines for health workers dealing with the deadly Ebola virus, recommending
tougher measures such as doubling up on gloves and making sure the mouth, nose and eyes are better protected from contaminated droplets and fluids.

But the World Health Agency says the choice of equipment is much less important than the way it's used.

Dr. Edward Kelley, director of service delivery and safety for WHO, told reporters Friday the updated guidelines call for wearing one of two materials for gowns or coveralls and "an absolute recommendation for double-gloving that didn't exist before."

Doctors Without Borders already recommends some of its staff in high-risk jobs, like cleaning Ebola treatment centres or handling bodies of Ebola victims, wear two or three pairs of gloves.

Meanwhile, two people are suspected of having Ebola after coming into contact with a two-year-old girl who died of the disease in Mali last week, according to data from the World Health Organization and the U.S. Centers for Disease Control.
 
An epidemiological presentation by both agencies, given on Thursday and seen by Reuters on Friday, breaks down the girl's journey from Guinea to Mali with her grandmother, five-year-old sister and her uncle, and shows she may have had contact with 141 people in all, 57 of them yet to be identified.

One of the 84 contacts who have so far been traced is suspected of having Ebola but has not been tested, the presentation shows. Another four suspected cases have been tested. Three showed negative results, with one result yet to come in.

Elsewhere, Liberia has opened one of its largest Ebola treatment centres yet in Monrovia, bracing for a new wave of infections even as officials express hope the disease is on the decline.

The World Health Organization said this week that the rate of infection in Liberia appears to be falling but warned that the response effort must be kept up or the trend could be reversed.

 Despite the signs of hope, President Ellen Johnson Sirleaf said Friday that the memory of the sick and dying lying at home or in the streets with no place to go is still fresh.

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Microbicides an 'empowering tool' to prevent HIV infection in women

Microbicides, products specifically aimed at protecting women from HIV without the need to negotiate condom use, are missing in the scientific response to the AIDS pandemic, say researchers working to bridge the gap.

In North America and Europe, HIV is most prevalent in the gay population. But in sub-Saharan Africa, where the virus has taken the greatest toll, the face of the epidemic is a young African woman, said Elizabeth Bukusi, deputy director of research and training at the Kenya Medical Research Centre.

South Africa has the highest prevalence of HIV/AIDS compared to any other country in the world, according to UNAIDS. (Themba Hadebe/Associated Press)

"We need an option that women have the choice about using," Bukusi said. "If she can't protect herself because her partner will not put [a condom] on, we need her to have something she can use to protect herself."

At Crossroads, a poor township with one of the highest rates of HIV in South Africa, residents are recruited for various HIV prevention studies. In return, participants are offered health care and the community receives educational and recreational programs.

For two years, Ntanda Kiwana has attended a clinic for monthly checks as part of a trial to see whether a vaginal ring with a long-acting microbicide embedded in it can prevent women from becoming infected.

"I don't even feel it," she said.

Prof. Sharon Hillier of the University of Pittsburgh is principal investigator for the Microbicide Trials Network, directing  research projects in seven countries.

"I think microbicides are just the kind of empowering tool that give women the chance to control their own health," Hillier said.

There are several microbicide designs that work to provide a physical barrier to keep out HIV and other sexually transmitted viruses from attaching to the vaginal walls or boost natural vaginal defences, such as by manipulating acidity levels.

So far, one study has shown a microbicide gel is partially effective against HIV. Researchers say two large studies reporting results in 2015 will likely confirm and possibly surpass that finding.

Two trials with microbicidal rings will release results shortly after. If the trials are successful, the products could be available to use commercially in a few years.

The HIV Research for Prevention Conference in Cape Town ends tomorrow.

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2 rounds of chemo fail to shrink Rob Ford's tumour

Two rounds of chemotherapy have failed to shrink the tumour in Toronto Mayor Rob Ford's abdomen, CBC News has confirmed.

Last month the Toronto mayor was diagnosed with a rare but aggressive type of malignant tumour.

His tumour has not shrunk, it has also not grown in size.

Ford is also battling pneumonia and is due to begin a third round of chemotherapy at Mount Sinai hospital on Monday.

The cancer diagnosis forced Ford to withdraw from the mayor's race last month. Instead, he won a council seat in the northwest Toronto ward currently held by his brother, who ran for mayor but finished second to John Tory.

Tory will be officially sworn in in December.

There are reports that Ford's doctor will provide an update about his treatment on Monday.

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Maine gets court order to isolate Ebola nurse who defied quarantine

Maine health officials obtained a 24-hour court order restricting Kaci Hickox's movement after the nurse repeatedly defied the state's quarantine for medical workers who have treated Ebola patients.

A judge granted the order Thursday limiting Hickox's travel, requiring a buffer of about a metre if she encounters people, and banning her from public places until there's a further decision Friday.

The state went to court Thursday, following through with a threat to try to impose restrictions on her until the 21-day incubation period for Ebola ends on Nov. 10. In court documents, the judge indicated further action was anticipated Friday.

Police were under orders to monitor the movements of the nurse who twice left home, once to talk to reporters Wednesday and again for a bike ride with her boyfriend on Thursday.

A state police cruiser remained outside her home Friday. Fort Kent Police Chief Tom Pelletier went inside the home briefly Friday morning and said afterward, "We just had a good conversation." He said he was not there to arrest or detain her.

Fort Kent Police Chief Thomas Pelletier leaves the home of nurse Kaci Hickox after a brief visit Friday. Main has obtained a 24-hour court order restricting Hickox's movements. (Robert F. Bukaty/Associated Press)

The legal action is shaping up as the nation's biggest test case yet in the struggle to balance public health and fear of Ebola against personal freedom.

In a court filing, the director of the Maine Center for Disease Control and Prevention backed away from the state's original request for an in-home quarantine and called for restrictions that fall in line with federal guidelines.

Hickox remains at risk of being infected with Ebola until the end of a 21-day incubation period, Dr. Sheila Pinette.

"It is my opinion that the respondent should be subjected to an appropriate public health order for mandatory direct active monitoring and restrictions on movement as soon as possible and until the end of the incubation period ... to protect the public health and safety," she wrote.

Hickox, who treated Ebola patients in Sierra Leone, says confinement violates her rights. She says that she has no symptoms and poses no risk to the public.

Hickox, 33, stepped into the media glare when she returned from treating Ebola patients in Sierra Leone to become subject to a mandatory quarantine in New Jersey. After being released from a hospital there, she returned to this small town, where she was placed under what Maine authorities called a voluntary quarantine.

She said she is following the federal Centers for Disease Control and Prevention recommendation of daily monitoring for fever and other signs of the disease.

"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she said Wednesday evening.

Some states like Maine are going above and beyond the CDC guidelines to require quarantines. So is the U.S military.

President Barack Obama, the nation's top infectious-disease expert and humanitarian groups have warned that overly restrictive measures could cripple the fight against the disease at its source by discouraging volunteers like Hickox from going to West Africa, where the outbreak has sickened more than 13,000 people and killed nearly 5,000 of them.

"These kinds of restrictions could dissuade hundreds, if not thousands, of skilled volunteers from helping stop Ebola's spread, which is in the national interest of every one of our countries," Samantha Power, U.S. ambassador to the United Nations, said Thursday in Brussels.

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Final arguments in dispute over chemotherapy for First Nations girl

McMaster Children's Hospital is challenging a First Nations mother's decision to withdraw her daughter from chemotherapy. (McMaster)

An Ontario court on Wednesday heard final arguments in the precedent-setting case of whether a child can be forced into protective care without the say-so of the Children's Aid Service. 

The Ontario Court of Justice in Brampton, Ont. is considering the case of a young First Nations girl with acute lymphoblastic leukemia, whose mother in August called off her chemotherapy in favour of a U.S. clinic that she says is more in line with their traditional indigenous culture.

When Brant Children's Aid Society did not to intervene, McMaster Children's Hospital in nearby Hamilton, Ont., where the girl had been receiving chemotherapy, took the unusual step of going to court, to force the agency to intervene and return her to treatment. 

The McMaster medical team has stated the girl has an 90 to 95 per cent chance of survival on chemotherapy but, without it, the cancer could kill her.

A lawyer for the Six Nations band said in court last week that forcing the child back into chemo treatment would be the same as sending the child to a residential school to face abuse.

'This mother is doing everything possible to protect her child. She's just doing things that doctors disagree with.'- Mark Handelman, Brant Children's Services lawyer

Mark Handelman, the lawyer for Brantford Children's Aid Services, also argued the case is "a treatment dispute, in our view, not a child in need of protection."   

"My god — this mother is doing everything possible to protect her child. She's just doing things that doctors disagree with," Handelman said in court.

The mother, who, along with her daughter, cannot be identified because of a publication ban, told CBC News the family had a comprehensive health-care plan.

"We would not make a choice that would compromise her health or life. There is enough case evidence behind Onkwehonwe medicine and the practices at [the Hippocrates Health Institute​] that we know we have made the right choice," she said. Her daughter has since been treated at and returned from the U.S. clinic 

"My daughter feels great. I truly believe that there will be a positive outcome and this will be ended soon," her mother said. 

Judge Gethin Edward, presiding in this case, expressed concern about the legal precedent he could be setting, about who gets the final say over children in the future — and one very sick child, right now.

Edward will read his decision Nov. 14.

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Nurse Kaci Hickox defies Ebola quarantine again in Maine

A nurse who vowed to defy Maine's voluntary quarantine for health-care workers who treated Ebola patients followed through on her promise Thursday, leaving her home for a bike ride.

Kaci Hickox and her boyfriend stepped out of their Fort Kent, Me., home Thursday morning and rode away on mountain bikes, followed by state police cruiser.

Police were monitoring her movements and public interactions but couldn't detain her without a court order signed by a judge.

Hickox contends there's no need for quarantine because she's showing no symptoms. She's also tested negative for the deadly disease.

"I really hope that we can work things out amicably and continue to negotiate," she said Thursday morning while riding on a dirt trail.

Nurse Kaci Hickox rides away from the home she is staying in on a rural road in Fort Kent, Me., to take an hour-long bike ride on Thursday with her boyfriend Ted Wilbur. They were followed by state police who are monitoring her movements and public interactions. (Robert F. Bukaty Associated Press)

There was no immediate comment from state health officials, who were going to court in an effort to detain Hickox for the remainder of the 21-day incubation period for Ebola that ends on Nov. 10

It was the second time Hickox broke quarantine. She left her home Wednesday evening briefly to speak to reporters, even shaking a hand that was offered to her.

"There's a lot of misinformation about how Ebola is transmitted, and I can understand why people are frightened. But their fear is not based on medical facts," Norman Siegel, one of her attorneys, said Wednesday.

Hickox, who volunteered in Sierra Leone with Doctors Without Borders, was the first person forced into New Jersey's mandatory quarantine for people arriving at the Newark airport from three West African countries. Hickox spent the weekend in a tent in New Jersey before travelling to the home she shares with her boyfriend, a nursing student at the University of Maine at Fort Kent.

"I'm not willing to stand here and let my civil rights be violated when it's not science-based," she told reporters Wednesday evening.

State may have tough case to make

Generally, states have broad authority when it comes to such matters. But Maine health officials could have a tough time convincing a judge that Hickox poses a threat, said attorney Jackie L. Caynon III, who specializes in health law in Worcester, Massachusetts.

"If somebody isn't showing signs of the infection, then it's kind of hard to say someone should be under mandatory quarantine," he said.

Ebola, which is spread through direct contact with the bodily fluids of an infected person, has killed thousands of people in Africa, but only four people have been diagnosed with it in the United States. People can't be infected just by being near someone who's sick, and people aren't contagious unless they're sick, health officials say.

Guidelines from the federal Centers for Disease Control and Prevention recommend daily monitoring for health-care workers like Hickox who have come into contact with Ebola patients. But some states like Maine are going above and beyond those guidelines.

The defence department is going even further. On Wednesday, Defense Secretary Chuck Hagel ordered military men and women helping fight Ebola to undergo 21-day quarantines that start upon their return — instead of their last exposure to an Ebola patient.

President Barack Obama warned that overly restrictive measures imposed upon returning health care workers could discourage them from volunteering in Africa.

Filing expected today

But Maine Gov. Paul LePage, who cancelled campaign events to keep tabs on the situation, maintained that the state must be "vigilant" to protect others.

State law allows a judge to grant temporary custody of someone if health officials demonstrate "a clear and immediate public health threat."

The state's court filing was expected Thursday, officials said.

If a judge grants the state request, then Hickox will appeal the decision on constitutional grounds, necessitating a hearing, Siegel said.

Siegel said the nurse hopes her fight against the quarantine will help bring an end to misinformation about how the Ebola virus is transmitted.

"She wants to have her voice in the debate about how America handles the Ebola crisis. She has an important voice and perspective," he said.

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Refugee health cuts: Tories prep contingency plan as deadline looms

Immigration officials are working furiously to finalize contingency plans for refugee health care coverage in the event the government loses a court battle this week on how much coverage refugee claimants ought to receive.

The long-running fight over the existing program is before the Federal Appeal Court on Thursday with the government arguing it needs more time to comply with last summer's Federal Court decision that the current program is unconstitutional.

In her ruling, Justice Anne McTavish savaged the coverage system imposed by the Conservatives in 2012, saying it amounted to cruel and unusual treatment.

"The 2012 modifications to the interim federal health program potentially jeopardize the health, the safety and indeed the very lives, of these innocent and vulnerable children in a manner that shocks the conscience and outrages our standards of decency," she wrote.

She gave the government four months to create a charter-proof plan — that deadline is Nov. 4.

The government has appealed the decision, but in the meantime is asking for a stay, so that it doesn't have to impose a new system before the court finishes deliberating on the old one.

Judge sped up process

Officials would not reveal details of the contingency plans, saying they're not finished.

"The government is working on various contingency plans but intends to vigorously appeal this ruling," a government source said on the condition of anonymity as the matter remains before the court.

Justices often will suspend their decisions in charter cases for a year to give government enough time to create new policy.

But in this case, McTavish decided to speed up the process, ruling that while a certain amount of bureaucratic disruption is inevitable, lives were at risk.

In the court documents, the government outlines all the steps it would need to take to implement a new system, including getting it approved by cabinet and making sure border officers and immigration officials are up to speed on the changes.

The four months it was given weren't enough, the government argues.

"Should changes be implemented Nov. 4, 2014, the training process will likely be incomplete, potentially resulting in eligible clients being without IFHP certificates or being given incorrect IFHP coverage," one argument for more time suggests.

But the lead lawyer for the refugees said four months is plenty of time.

"The government has various alternatives and one of them would be to just return to the situation before 2012," Lorne Waldman said in an interview.

Changes made in 2012

The interim federal health program was developed in the wake of the Second World War to meet the needs of refugees coming to Canada, which at the time had a private health-care system.

Over the years, the program was expanded and prior to the 2012 changes, the federal government covered all manner of health-care expenses for those awaiting refugee claims until they were eligible to apply for provincial health-care coverage.

But citing a need to cut costs and bring health care for refugee claimants in line with what ordinary Canadians get, the government instituted sweeping changes in 2012.

They essentially reduced what taxpayers pay for to the bare minimum, depending on the nature of the refugee claim and the care being sought.

The cases of one of the men who filed the lawsuit against the government illustrates the differences.

Hanif Ayubi is a failed refugee claimant from Afghanistan who could not be deported because there is a moratorium on removals to that country.

Prior to the changes, he had full coverage of all his medical needs to manage his diabetes.

After, he received no coverage of medical supplies as he is a failed claimant, though the minister did intervene to make sure his doctor's appointments are paid for.

He now receives free samples of his required drugs through a community health-care centre.

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Wheelchair-bound students get level playing field in Grand-Digue, N.B.

Physical education teacher Rhéal Hébert of Grande-Digue, N.B., has gone an extra step to see that all students get moving in his classes.

When Hebert had two students with muscular dystrophy in his École Grande-Digue class — Renelle Belliveau and her older sister — he realized they weren't getting as much physical activity as the other students.

Rheal Hébert was honoured by Ability New Brunswick for exposing all students to para sports and recreation activities. (CBC)

"They still had their everyday wheelchair," said Hebert.

"They were being pushed around by the teacher's assistant, and that's when it really hit me that we have to do something about that, because everybody's moving and they're not. And that's not OK."

Hébert applied for a grant last year to purchase two wheelchairs designed for use in sports. They have a wide wheelbase and can turn on a dime.

"From one day to the other, it was such a huge difference," said Hébert.

"I knew from that point we had to go further, and we had to explore para sports at school."

Hébert wanted to do more than just have Renelle play with the other Grade 8 students.

He wanted the other students to be able to play with her. So Hébert borrowed about half a dozen sports wheelchairs from a club in Moncton that could be used by able-bodied students.

Now, Renelle and her friends have a level playing field: everyone's on wheels.

"It's really fun, because they feel what I felt when I was in a wheelchair and I played sports, and they like it very much," said Renelle, who was voted class president this year.

"They're very good at it."

Along with badminton, Renelle Belliveau and other students in Grand-Digue have been exposed to sledge hockey, basketball and track and field. (CBC)

​The class is currently doing court sports like badminton. They've also played sledge hockey, basketball and track and field.

Janie Cormier participates in para sports regularly at the school now that the sports chairs are available.

"She used to do things by herself with only her in a wheelchair, but now we get to do it with her, so we can see like how she got used to it and all that stuff," said Janie.

"So it's really nice."

Hébert's Sports Plus program is exposing students to para sports and recreation activities. It has grown from a pilot project involving two schools three years ago and now operates in eight schools.

Ability New Brunswick honoured Hébert this year with its Para Sport and Recreation Award.

"Rhéal strongly believes that all students deserve the same opportunities at school," states Ability NB's award citation for Hébert.

Lynn Belliveau, Renelle's mother, says she appreciates what the physical education teacher has done for the family.

Lynn Belliveau appeciates the effort of her daughter's physical education teacher to include her in sports activities. (CBC)

"It's getting them to be able to do stuff that I didn't imagine they'd be able to do and obviously as a mom, I'm really happy that they get that opportunity," said Belliveau.

Belliveau has installed a basketball hoop at the home where her daughters and their friends can play.

"It's important to them," said Belliveau. "Even though you have a disability, it's not going to stop you from doing what you want, and that's what I want them to learn from that. I mean, you thought you weren't able to participate in sports, but now you can."

Renelle also knows she has a teacher who has gone above and beyond what's expected. But she's never told him so.

"I never really thanked him because like, I get nervous and I just, like — I don't want to start crying because it really means so much to me."

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Texas nurse leaves Emory University Hospital free of Ebola virus

A nurse who fuelled Ebola fears by flying to Cleveland after being infected by her dying patient in Dallas was released Tuesday from a hospital isolation unit, where doctors defended her as a courageous and passionate front-line caregiver.

Another nurse, held for days against her will in a medical tent in New Jersey after volunteering in West Africa, was in an undisclosed location in Maine, objecting to quarantine rules as overly restrictive.

While world leaders appeal for more doctors and nurses on the front lines of the Ebola epidemic, health care workers in the United States are finding themselves on the defensive.

Lawyers now represent both Amber Vinson, who contracted the virus while caring for a Liberian visitor to Texas, and Kaci Hickox, who is challenging the mandatory quarantines that some states have imposed on anyone who came into contact with Ebola victims.

Getting more volunteers to the front lines is the only way to keep the virus from infecting people around the world, experts say. It's still spreading faster than the response, killing nearly half of the more than 10,000 people it has infected in West Africa.

World Bank President Jim Yong Kim said Tuesday that at least 5,000 more health workers are needed in Liberia, Sierra Leone and Guinea to fight the epidemic. Kim was in Ethiopia with United Nations Secretary-General Ban Ki-moon, who has spoken out against mandatory quarantines for health care workers, and said Ebola-related travel restrictions and border closings are not the answer.

Vinson was cleared to fly

Dr. Bruce Ribner, an infectious disease expert who oversaw Vinson's recovery at Emory University Hospital, said fellow medical workers "deeply admire Ms. Vinson's care and courage in caring for patients with serious communicable diseases."

But Vinson's trip home to join her bridesmaids for wedding preparations was one of several moves by doctors and nurses that may have exposed others in the United States. In Ohio alone, 163 people were still being monitored Tuesday because of contact or potential contact with Vinson in a bridal shop and on the airplanes she travelled in.

This undated image provided by University of Texas at Arlington shows Kaci Hickox. The nurse is back in her native Maine, where it appears she will remain quarantined at home for a period of time. (University of Texas at Arlington/Associated Press)

N.J. Gov. Chris Christie said voluntary stay-at-home measures were obviously insufficient, since even doctors and nurses had moved around in public before getting sick. He was among the first to announce mandatory 21-day quarantines for anyone who had contact with possibly infected people.

Vinson, 29, was infected while caring for Thomas Eric Duncan, who died at Texas Health Presbyterian Hospital Dallas on Oct. 8. She inserted catheters, drew blood, and dealt with Duncan's body fluids, all while wearing protective gear.

Ribner said her doctors in Atlanta don't have any knowledge of how she got infected in Dallas. Neither would he release any details about her treatment, or whether certain drugs are proving more effective. "The honest answer is we're not exactly sure," he said.

But Emory University Hospital spokeswoman Holly Korschun later confirmed that Vinson received blood plasma from Ebola survivor Kent Brantley, and said Ebola survivor Nancy Writebol also donated her plasma, but it wasn't ultimately needed.

Ebola is only contagious when people who carry the virus get sick, and Vinson didn't show symptoms before flying to Ohio on Oct. 10. She reported her temperature to the Centers for Disease Control and Prevention, as required, on Oct. 13, and was cleared to fly back to Dallas. The next day, she developed a temperature, and on Oct. 15, she tested positive for Ebola.

Hickox will be quarantined at home

Another nurse, Nina Pham, also was infected by Duncan, and was released Oct. 24 from the National Institutes of Health.

Vinson didn't take any questions at the Emory news conference. Instead, she read a statement thanking God, her relatives and her doctors, and asked "that we not lose focus on the thousands of families who labour under the burden of this disease in West Africa."

Hickox, the Doctors Without Borders volunteer, was staying meanwhile in an "undisclosed location," said Steve Hyman, one of her lawyers. Maine health officials announced that she will be quarantined at home for 21 days after the last possible exposure to the disease, following the state's health protocols.

But Hyman said he expected her to remain in seclusion for the "next day or so" while he discusses her situation with Maine health officials. Hyman said the state should follow the Centers for Disease Control and Prevention guidelines, which require only monitoring, not quarantine, for health care workers who show no symptoms after treating Ebola patients.

"She's a very good person who did very good work and deserves to be honoured, not detained, for it," he said.

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South Africa aiming to be 'leading player' in HIV research

South African doctors and researchers seem to be gaining confidence in their decades-long battle against HIV, international delegates at a conference in Cape Town say.  

The HIV Research for Prevention Conference is dedicated to biomedical HIV prevention research.

A nurse, left, speaks with a patient at an AIDS centre in South Africa, which strives to be a leading player in HIV science. (Schalk van Zuydam/Associated Press)

Sub-Saharan Africa remains the epicentre, with nearly 1 in every 20 adults living with HIV and accounting for 71 per cent of the people living with the illness worldwide, according to the World Health Organization.

South Africa's minister of science and technology, Naledi Pandor, told the conference today it's time the country assumed more responsibility "to be a leading player in science and not a client of others."

The country's government provides anti-retroviral medications to nearly 40 per cent of HIV-infected South Africans. On the research front, new labs, scientists, technicians and funding commitments are on the rise.

"They're very competitive for research funding elsewhere," said Canadian HIV researcher Cate Hankins, currently deputy director of science for the Amsterdam Institute for Global Health and Development.

Conference co-chair Anatoli Kamali, of Uganda's Medical Research Council, pointed out that a third of the research papers being presented this week are from African researchers.

Professor Robin Shattock of Imperial College London is another co-chair of the conference. Shattock said it makes sense to have people work across fields of prevention rather than working in a bubble.

The conference aims to build linkages between investigators in developing and developed countries to open the door to collaboration.

Before the conference closes on Oct. 31, scientists plan to present 550 research papers, such as new results on microbicidal gels and vaginal rings, to try to prevent HIV infections.

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