Time magazine honours Ebola fighters as 'person of the year'
December 11, 2014 - 7:01AM
Liberian Dr Jerry Brown on the cover of Time magazine. Photo: Reuters
New York: Time magazine has named the medics who have treated patients struck with the killer Ebola virus as its "person of the year 2014", paying tribute to their courage and mercy.
The Ebola outbreak has turned into an epidemic in Liberia, Guinea and Sierra Leone, and there have been scattered cases in Nigeria, Mali, Spain, Germany and the United States. More than 6000 people have died, according to figures from the World Health Organisation.
"Ebola is a war, and a warning. The global health system is nowhere close to strong enough to keep us safe from infectious disease," wrote Time editor Nancy Gibbs, announcing the prestigious annual title on Wednesday.
"The rest of the world can sleep at night because a group of men and women are willing to stand and fight.
"For tireless acts of courage and mercy, for buying the world time to boost its defences, for risking, for persisting, for sacrificing and saving, the Ebola fighters are Time's 2014 Person of the Year."
Time's annual selection goes to a man, woman, couple or concept that the magazine's editors feel had the most influence on the world during the previous 12 months.
This was originally published on The Washington Post on October 19, 2014.
I have taken pride over my 40-plus years as a photojournalist in offering dignity to subjects I photograph, especially those who are sick or in distress while in front of my camera. My recent photographic assignment to cover the Ebola outbreak in Liberia has proved exceedingly challenging for me. Respect is often the last and only thing that the world can offer a deceased or dying person. Yet the camera itself seems to be a betrayal of the dignity I so hope to offer.
Women who were among 15 Liberian patients who recovered from Ebola cry as they greet family members after their release from the ELWA 2 Ebola Treatment Unit in Monrovia, Liberia. Photo: MICHEL DU CILLE / The Washington Post
Sometimes, the harshness of a gruesome scene simply cannot be sanitised. How does one give dignity to the image of a woman who has died and is lying on the ground, unattended, uncovered and alone as people walk by or gaze from a distance? But I believe that the world must see the horrible and dehumanising effects of Ebola. The story must be told; so one moves around with tender care, gingerly, without extreme intrusion.
Telling the Ebola story in Liberia means being near, within shooting range, of the ravages of the virus. That work brought me face to face with another dehumanising element of this virus: fear. Since a silent danger hides inside the Ebola-infected person, a simple touch could prove harmful. Extreme caution is required.
In Monrovia, where I spent two weeks last month, fear is always present: among the people, and among photojournalists in the act of capturing scenes of desperately ill Ebola-infected persons. Fear produces an internal struggle: How close to the subject do I get to make a compelling photograph? If I get too close, is the risk of infection too great? Fear drives the process of capturing images. It becomes a tool that guides and reminds one to be excessively careful not to become infected. The rules are simple: Touch no one, and let no one touch you. Spray the bottom of your shoes with chlorine solution. Wash your hands frequently with that chlorine solution, even if you haven't touched anything. The act becomes habitual.
The body of a 17-year-old boy remained in a room for two days before a team of Liberian health workers could retrieve him. Photo: MICHEL DU CILLE
Back in the United States, fear took on a different significance — hysteria. Syracuse University rescinded an invitation to me to be a mentor and coach to photojournalism students there this past weekend. A student learned that I had recently been in Liberia and expressed concerns. On the day of the scheduled workshop, I received a phone call asking me to stay away.
When I returned from Liberia, I followed all the guidelines for people returning from the Ebola zones. I followed recommendations from the Centers for Disease Control and Prevention and Doctors Without Borders (Medecins Sans Frontieres, or MSF) on how to watch for signs of symptoms. I took my temperature twice daily; in my case, out of anxiety, almost on the hour. My recommended 21 days of monitoring ended, and I am well. I am cleared to go back to work and was ready and anxious to mentor aspiring photojournalists.
I'm angered by the decision and sorry not to get to teach. It was a disservice to journalism students at Syracuse, a missed opportunity to share real-world experiences with future media professionals.
Especially now, I am cognisant of what I could have told them — about the power and necessity of capturing images that interpret the human experience while daily life unfolds under the cloud of Ebola.
In one of the most emotional encounters I faced in Liberia, I photographed a family that accompanied a sick woman who seemed near death as they sought treatment. She was bleeding from the mouth and her breathing was shallow; she was not ambulatory. As the husband, a sister, a brother and a friend descended from the van, each wore large plastic bags around their hands, feet and bodies, trying to protect themselves from infection with makeshift coverings. They knew it was the only way to get their very ill relative to the Doctors Without Borders Ebola treatment unit. Waiting outside the gates was a given, but to the anxious family, I am sure one hour seemed far too long as the patient worsened.
At one point, I approached the woman's sister, who had secluded herself against a wall away from the others and her sister fading away in the van. Standing at a safe distance, I asked her how long her sibling had been sick; she said about a week. She asked me questions that I could not completely understand and could not answer. As we tried to converse, neither fully understanding the other's dialect, our eyes did the talking. To me, her eyes said, "This is the end." I looked at her and said, "You know she is very, very sick." She said, "Yes, I know." As I tried to continue our fruitless conversation, my voice broke and suddenly tears came involuntarily. By then, more patients arrived by ambulance and I resumed taking photographs.
It is profoundly difficult not to be a feeling human being while covering the Ebola crisis. Indeed, one has to feel compassion and, above all, try to show respect.
On three previous trips to Monrovia, near the end of the civil war there, I'd seen a country in ruins. People's struggle for basic subsistence was palpable. Today, as Liberia's economy began to improve after years of civil war, life moves at the hectic African pulse, and the Ebola virus continues to kill, seemingly, at a faster pace. As of Friday, according to the World Health Organisation, 2484 people have reportedly died from Ebola in Liberia alone, and there have been 4262 confirmed infected cases there. Government offices, including the Executive Mansion, are closed. The Liberian Ministry of Health and Social Welfare is the only government office currently functioning. It is the local authority responsible for eradicating the Ebola virus.
Life is far from normal during the crisis, yet the streets remain choked with heavy traffic. Old vehicles with smoke blowing from their exhausts manoeuvre around giant potholes and deep puddles, a result of the West African rainy season. Barefoot children in shorts race up to cars at intersections, hawking assorted items such as candy, chewing gum, cream biscuits, plastic bags of water and windshield wiper blades, while everybody seems to ignore traffic laws.
The Ebola virus has hit hard in the New Kru Town section of Monrovia. Burial crews in protective suits are so overwhelmed that bodies of people who have succumbed to Ebola often lie on the ground for long periods of time, even at the doorsteps of Redemption Hospital. The hospital, which is now closed to daily health concerns, is used as a holding and transfer facility for suspected and confirmed Ebola patients. When it is full, those who show up frequently wait outside, lying on the ground or sitting for hours in an ambulance, where they often eventually die. No one can approach or touch the bodies without protective gear. Health professionals say that the Ebola virus is most contagious when the host has died. Subsequently, bodies lie for hours before teams wearing protective suits can retrieve them.
In the capital, Monrovia, those who die from Ebola are cremated. But in the far outer counties, burial is still the only way. Health workers bury the dead inside plastic body bags. They lower the body, using simple strips of white cloth; then, leaning over the grave, a couple feet down; they have no choice but to simply drop the body down the rest of the way into the 6-by-4-by-6 hole — no coffin, no ceremony, no family or friends. The authorities have decreed this method to prevent the virus's spread through burials.
In West Point, a bustling Monrovia slum with a population of 70,000, an ordinary afternoon can seem like a chaotic dance, with shacks, stalls, shops and houses all indistinguishable from one other. Startlingly, one day I watched from the front seat of our vehicle as people lined up for food handouts from the United Nations World Food Program, body-to-body, blatantly ignoring the call from authorities not to touch for fear of spreading the Ebola virus from close contact.
Irony is no stranger to West Point. When a Liberian magisterial judge tried to arraign a man and woman accused of grand theft, the man vomited while handcuffed to the woman in the small courtroom. Suddenly, the place was cleared and the couple isolated as an ambulance was called. After spraying down the area and the two accused thieves with chlorine solution, health workers dashed off with them in an ambulance to Redemption Hospital. As the vehicle arrived with its siren blaring outside the treatment facility, the doors opened for the two, who immediately took flight, running down the street, escaping their earlier fate of a Liberian jailhouse.
Monrovia is on the Atlantic Ocean, on Africa's west coast. During the rainy season, which locals joke lasts six months of the year, the sky is gray, day and night. The nights are pitch-black, leaving visitors to ask, "Where is the moon?"
From high points in the city, I captured magnificent images of the ocean, the postcard-worthy sunset. It's an image of a city in crisis and moving forward as if things were normal, hoping for dignity.
A three-time Pulitzer Prize winner, Michel du Cille has worked for the Washington Post from 1988 to 2014.
Still Fighting Ebola: A View from Liberia’s Front Line
By Maryn McKenna 02.16.15
Nine-year-old Nowa Paye is taken to an ambulance after showing signs of the Ebola infection in the village of Freeman Reserve, about 30 miles north of Monrovia, Liberia. Jerome Delay/AP
We’ve pretty much signed off on Ebola in the United States — last week, President Obama withdrew the US troops sent to fight the disease — but in Africa, the news on the epidemic has seemed pretty good. The overall number of known cases stands at 22,894, with 9,177 deaths, far below the dire predictions made last fall that the epidemic could sicken millions.
Progress at beating the disease is stalling, though. According to the World Health Organization, the number of new cases has gone back up for two weeks in a row. Sierra Leone, now the outbreak’s epicenter, still has what the WHO calls “widespread transmission,” and on Saturday its government quarantined part of the capital. Guinea has had a spike in cases, and in several areas, mobs have attacked clinics.
The news is best from Liberia, where there were just three new cases last week compared to 65 in Guinea and 76 in Sierra Leone. Liberia was hard-hit, with 8,881 confirmed cases and 3,826 deaths — 300 cases per week at some points. But it also seems to have done the most to curb the disease’s spread: Today, schools that had been closed since last fall are supposed to open again.
Last week, though, I had the opportunity to speak to a front-line Ebola fighter in Liberia, and what he told me underlined how precarious that country’s progress is.
F. Zeela Zaizay is a registered nurse and the Liberian team leader for MAP International, a Christian medical-assistance nonprofit. MAP, which is based in Atlanta, has sent $1.7 million’ worth of supplies such as “no touch” infrared thermometers and protective equipment for health workers, and helped organize Ebola-education efforts in townships and on local radio.
“We are having an average now of less than one case per day,” he told me in a Skype call from Monrovia, Liberia’s capital. “That shows we have made tremendous gains in the fight against Ebola. But the practices that led to the gains we are having are being abandoned just as the cases are declining too, so it brings about fear. If we are not careful we could have more cases again.”
I asked him what practices he meant, and he told me about the difficulty in persuading people to relinquish treasured funeral rituals: washing and dressing a body, touching and kissing the corpse, and burying it near where the family lives.
“One of the practices we have is bathing and grooming the dead, and one of the ways we do honor to them is to dispose of them in their home town or village,” Zaizay said. “It is easy to say, do not touch the dead, do not touch the sick — but if you have a dead family member that you so much honored, you could be tempted to design a strategy to take the person back to where they were from.”
Under the anti-infection practices promoted by the WHO, the bodies of people who died of Ebola are bagged and buried in special cemeteries, or cremated. In the past two months, Zaizay said, two outbreaks in adjoining counties were sparked by people who objected to that treatment and retrieved the corpses of loved ones from an Ebola treatment unit and transported them home for burial — in one case, dressing the corpse in clothing and propping it up in the seat of a car.
The spread of Ebola back into communities is difficult to handle, Zaizay added, because some of the townships in Liberia are so lacking in resources and so remote. “Prior to Ebola, many communities had a problem with safe drinking water, because they use surface water — rivers, creeks — for drinking and for bathing,” he explained. “So there is sewage, and also the water is very turbid from run off.” Yet getting clean water into remote areas is difficult: “Some places, the roads are too bad to drive, and to reach them, we have to go by canoe.” In one remote area, he said, 500-ml bottles of water cost three times what they do in the capital.
I asked about the flow of supplies into the country, and Zaizay mentioned problems that also surfaced in reports last month: the Liberian economy, already dented by years of civil war, has been undermined by the retreat of foreign businesses and the slowdown in everyday commerce and farming. The first-line recommendation for preventing Ebola is washing in water spiked with bleach after any person-to-person contact, “but many people in Liberia cannot afford to buy chlorine (bleach),” he said. “Many persons are out of jobs, and with the interruption of the farming season, there is economic hardship in the countryside too.”
There are price hikes as well in the cost of protective equipment — gloves, face masks — for health care workers, he said: “Every health care worker in Liberia now is very sensitive to the use of personal protective equipment (“PPE”) and to not putting themselves in harm’s way. Comparing the daily consumption of PPE and versus the influx into the country, there is a huge demand.” The equipment is not only being used in Ebola wards, he added, but in maternity wards and in surgery, so there is competition within health care for where the supplies will go. Given the shortages, he said, health workers are tempted to re-use gloves and masks, even though they know it is a risk.
I asked Zaizay what he thought Liberia needed most to combat the disease, thinking he would say more gloves and bleach to start. Instead, at the top of his list he put “high quality medications” for diseases other than Ebola. “A third of our health care offices are now just conducting triage for Ebola,” he said. Patients with other diseases, such as leprosy and the bacterial disease Buruli ulcer, are afraid to come to those clinics. “If we could take them medications,” he observed, “they would not have to risk contact with sick people and the burden of disease would be less.”
After that, his list included bleach and protective equipment, and also structural help: well-digging to improve clean water supplies, and connectivity to shore up the poor Internet access that keeps Ebola cases from being reported.
“We are calling out to everyone to support us,” he said. “Support us with chlorine, with medications, with resources. We have proven we have the capability and the strategies and the bravery to fight Ebola. But it is too early for us to say we have beaten Ebola. We have only shown that, if we get the support, we can.”
India struggles to contain flu outbreak as death toll hits 700
February 21, 2015
Mumbai: India is urging its states to ensure sufficient supply of anti-flu medication and diagnostic tests as it struggles to curb an outbreak of H1N1 influenza that has killed more than 700 people.
The government said on Thursday that there was no shortage of the medicines to treat the virus, after news reports said that private chemists were running out of the drug as customers rushed to stockpile supplies. The outbreak has sickened more than 11,000 people, and killed 703 in the last eight weeks, the Press Trust of India reported on Thursday.
"People are panicking because it's very difficult to differentiate H1N1 from routine flus," Mumbai-based chest specialist Yatin Dholakia said. "Even for doctors it's hard. It's difficult to say why the death rates this year are so high."
Elderly people, pregnant women, young children, diabetics with improperly controlled sugar levels, and HIV patients are at the "highest risk" of developing complications following the flu, as their immune systems tend to be weaker.
Gujarat, Rajasthan, Telangana, Delhi and Jammu and Kashmir appear to be the states worst-affected by the outbreak.
The disease has been spreading rapidly. There were 5157 reported cases with 407 deaths this year, the Health Ministry said on February 11. In the following eight days, the number of cases more than doubled, the Press Trust of India reported.
Diagnostic testing services in some cities have been quick to profit on the mass panic by inflating test prices. The newly elected government in Delhi last week capped the price of the the diagnostic test at 4500 rupees ($92), after news reports some facilities were charging twice as much, the Financial Express reported pm Thursday.
A doctor has been evacuated from Australia's Ebola Treatment Centre in Sierra Leone after a "clinical incident" where he was potentially exposed to the deadly virus.
The man was taken to a hospital in the United Kingdom, where he is from, to undergo a 21-day observation period, but he has not been diagnosed with Ebola and is not exhibiting any symptoms of the disease.
A full investigation has been launched into the potential infection.
In a statement, the Minister for Foreign Affairs Julie Bishop said the treatment centre, which Australia has contributed $25 million to, has "strict infection prevention protocols in place" for the easily-transmitted disease, which is spread through bodily fluids like sweat or saliva.
The centre has discharged 118 patients since it opened in mid-December, including 36 who recovered from Ebola.
However, a second volunteer at the centre who recently returned home to New Zealand has since developed symptoms similar to gastroenteritis and is being treated as having Ebola.
The woman was transferred to Christchurch Hospital early on Saturday morning after she experienced the symptoms on Friday, six days after her return from Sierra Leone.
Almost 10,000 people have died since the outbreak, one of the deadliest since the disease was discovered, began in West Africa almost a year ago.
Pesticides blamed for mystery deaths in Nigerian town
April 19, 2015 - 10:12PM
Pesticide poisoning was the likely cause of the mysterious deaths of at least 18 people in a Nigerian town last week, the World Health Organisation said on Sunday.
The "current hypothesis is cause of the event is herbicides", WHO spokesman Gregory Hartl said in a Tweet.
"Tests done so far are negative for viral and bacterial infection," he added.
The victims began showing symptoms early last week in what Ondo state spokesman Kayode Akinmade called a "mysterious disease", prompting fears of a new infectious disease outbreak in a region ravaged by Ebola.
The victims, whose symptoms included headache, weight loss, blurred vision and loss of consciousness, died within a day of falling ill in the town of Ode-Irele, in Ondo state.
The Ondo state health commissioner, Dayo Adeyanju, told AFP on Saturday that 23 people had been affected.
Mr Akinmade said health officials and experts from the government and aid agencies, as well as WHO epidemiologists, had arrived in Ode-Irele to investigate the deaths.
The tests were carried out at the Lagos University Teaching Hospital, the WHO said.
Laboratory tests have so far ruled out Ebola or any other virus, Mr Akinmade said.
"Common symptoms were sudden blurred vision, headache, loss of consciousness followed by death, occurring within 24 hours," WHO spokesman Tarik Jasarevic told AFP by email, adding that an investigation was ongoing.
Mr Hartl said that, according to a preliminary report, all those affected began showing symptoms between April 13 and 15.
The WHO's Mr Jasarevic said blood and urine samples had been taken from two victims and cerebrospinal fluid from another.
Fears Ebola spreads through sex prompt US warning to abstain
April 21, 2015 - 4:39PM
New York: The US Centres for Disease Control and Prevention has told Ebola survivors to abstain from all forms of sex or use condoms every time, until scientists know more about how the disease spreads.
The organisation revised its guidelines on Ebola transmission "until more information becomes available," rather than three months as previously recommended.
The World Health Organisation and Liberia have issued similar recommendations in recent weeks. They were acting on evidence suggesting that a Liberian man who recovered from Ebola might have transmitted the virus to his female partner many months later.
Ebola genetic material was found in a semen sample the man provided 175 days after he developed symptoms, 74 days longer than ever before found in a survivor. Scientists in Liberia have compared the genetic sequence of the virus found in the woman, Ruth Tugbah, 44, to partial sequences obtained from the virus in her boyfriend's semen and in blood samples taken months ago from his potential contacts with Ebola, and found that they matched at several key points.
Thus far, the information is consistent with sexual transmission, scientists said, but not conclusive, and the study is continuing. Researchers at the CDC were also trying to establish whether the sample the man provided contained infectious virus, rather than only harmless genetic material or RNA.
Experts said they had expected sexual transmission of Ebola to be rare. It has not yet been proved, but "cannot be ruled out," the CDC guidance said.
Marburg, a similar virus, is thought to have been transmitted sexually.
The World Health Organisation, the CDC and the Sierra Leone Health Ministry are planning a study of survivors intended to help establish the range of time that various body fluids, such as semen, urine and breast milk, tend to contain Ebola after it has been cleared from the blood. That time frame has varied in the small number of survivors previously studied.
"The problem is we haven't looked at a large number of cases," said Stuart Nichol, an Ebola researcher at the CDC.
Philip Ireland, a Liberian doctor who contracted Ebola while working last summer at John F. Kennedy Medical Center in Monrovia, the capital, said that despite the practical difficulty involved in collecting semen samples, all survivors should be offered the chance to know after three months whether their body fluids, including semen, still contain traces of Ebola. "Tests have to be made available, and have to be made next-to-free," he said.
Dr Bruce Aylward, the lead Ebola official at the WHO, said the agency was exploring the feasibility of just such a program. "It's a smart thing to do," he said.
Ebola lurked in Ian Crozier's eye weeks after his recovery
May 8, 2015 - 4:28PM
Dr Ian Crozier, who was declared cured of Ebola only for doctors to later discover the virus had lingered inside his left eye. Photo: New York Times
When he was released from Emory University Hospital in October after a long, brutal fight with Ebola that nearly ended his life, Dr Ian Crozier's medical team thought he was cured. But less than two months later, he was back at the hospital with fading sight, intense pain and soaring pressure in his left eye.
Test results were chilling: The inside of Crozier's eye was teeming with Ebola.
His doctors were amazed. They had considered the possibility that the virus had invaded his eye, but they had not really expected to find it. Months had passed since Crozier became ill while working in an Ebola treatment ward in Sierra Leone as a volunteer for the World Health Organisation. By the time he left Emory, his blood was Ebola-free.
Dr Crozier's eye changed colour from blue (top) to green (above), then back again. Photo: Emory Eye Centre
Although the virus may persist in semen for months, other body fluids were thought to be clear of it once a patient recovered. Almost nothing was known about the ability of Ebola to lurk inside the eye.
Despite the infection within his eye, Crozier's tears and the surface of his eye were virus-free, so he posed no risk to anyone who had casual contact with him.
More than a year after the epidemic in West Africa was recognised, doctors are still learning about the course of the disease and its lingering effects on survivors. Information about the aftermath of Ebola has been limited because past outbreaks were small: no more than a few hundred cases, often with death rates of 50-80 percent. But now, with at least 10,000 survivors in Guinea, Liberia and Sierra Leone, patterns are emerging.
Crozier, 44, ruefully calls himself a poster child for "post-Ebola syndrome": His condition, uveitis - a dangerous inflammation inside the eye - has also been diagnosed in west Africans who survived Ebola.
At the height of the epidemic, health workers were too overwhelmed with the sick to worry much about survivors. But as the outbreak wanes, the World Health Organisation has begun to gather information to help those who have not fully recovered, said Dr Daniel Bausch, a senior consultant to the WHO and an infectious-disease specialist at Tulane University. He added that the reports of eye trouble were of particular concern.
When Crozier's eye trouble began, he and the Emory team suspected that Ebola had weakened his immune system and left him vulnerable to some other virus that had invaded his eye, maybe one that would be treatable with an antiviral drug.
So Dr Steven Yeh, an ophthalmologist, pierced Crozier's eye with a hair-thin needle, drew a few drops of fluid from its inner chamber and sent them to the lab. The results came as a shock.
For Crozier, it was deeply unsettling to learn that he was still occupied by something that seemed alien and malevolent. "It felt almost personal that the virus could be in my eye without me knowing it," he said.
Uveitis had been reported in some Ebola survivors from previous outbreaks, and a related virus, Marburg, had been recovered from one patient's eye. But those cases had seemed uncommon.
A report about Crozier's eye condition was published on Thursday in The New England Journal of Medicine.
The inside of the eye is mostly shielded from the immune system to prevent inflammation that could damage vision. The barriers are not fully understood, but they include tightly packed cells in minute blood vessels that keep out certain cells and molecules, along with unique biological properties that inhibit the immune system.
But this protection, called immune privilege, can sometimes turn the inner eye into a sanctuary for viruses, where they can replicate unchecked. The testes are also immune-privileged, which is why Ebola can persist in semen for months.
Finding Ebola in Crozier's eye threw his doctors off balance. Yeh had worn a protective gown and one pair of gloves but no mask when he drew the fluid. Doctors wear more protective gear when treating patients known to have Ebola. He could not rule out the possibility that he had been infected, so he slept in the guest room at home and avoided touching his infant son for three weeks, the incubation period of the disease.
Another concern was the examining room where Yeh had taken the fluid sample. As soon as they got the results, he and several Emory colleagues rushed back there, verified that no one else had used the room, and disinfected every surface.
Additional tests showed that Crozier's tears and the outer surface of his eye were Ebola-free, so he posed no danger to others. But his case suggests that doctors performing eye surgery on Ebola survivors could be at risk. It is not known how long the virus can persist within the eye.
The big question was whether the doctors could save Crozier's sight. They worried about both eyes, because ailments in one eye can sometimes spread to the other. But there was no antiviral drug proven to work against Ebola, and even if there were, there was no precedent for treating an eye full of the virus.
In addition, the severe inflammation suggested that the barriers that normally protect the eye from the immune system had been breached. So what was damaging Crozier's eye? The virus, the inflammation or both? They could not be sure.
The usual treatment for inflammation is steroids. But they can make an infection worse.
"What if it unleashed the virus?" Crozier said. "We were on a tightrope."
Maybe an experimental antiviral drug would help, the doctors thought.
Though Crozier was the patient, he was also part of his own medical team, and his focus on the scientific details helped counter his mounting fear that he was going blind.
As he and his physicians struggled to balance treating the inflammation with fighting the infection, his eyesight continued to deteriorate. They tried high doses of a steroid, prednisone. The drug caused mood swings like a teenager's, ravenous hunger, weight gain, high blood pressure and insomnia.
And still his sight worsened. It was like looking through brambles, he said. He reached a point where all he could see was movement when Yeh waggled his fingers.
He also had significant hearing loss on the same side. "The whole left side of your life is gone," he said. "It was a very dark and depressing time."
He spent Christmas in the hospital with his younger brother Mark, who had stayed with him constantly throughout his illness and recovery.
The pressure inside his eye, which had been dangerously elevated, began to drop - too much. The eye became doughy to the touch, as if it were turning to mush.
"The eye felt dead to me," Crozier said.
The biggest shock came one morning about 10 days after his symptoms started, when he glanced in the mirror and saw that his eye had actually changed colour. His iris, normally bright blue, had turned a vivid green. Rarely, severe viral infections can cause such a colour change, and it is usually permanent.
"It was like an assault," he said. "It was so personal."
As the days passed with no sign of improvement, Crozier and the Emory team began to think he had little to lose. Dr. Jay Varkey, an infectious-disease specialist who had handled much of Crozier's care, got special permission from the Food and Drug Administration to use an experimental antiviral drug taken in pill form. (The doctors declined to name it, preferring to save that information for future publication in a medical journal.) They were not even sure that the drug would find its way into Crozier's eye.
To add to the treatment for inflammation, Yeh also gave Crozier a steroid injection above his eyeball that would slowly release the drug into his eye.
At first, there seemed to be no effect. But one morning a week or so later, Crozier realised that if he turned his head this way and that, he could find "portals" and "wormholes" through the obstructions in his eye and could see his brother Mark, who was sitting on the end of his bed.
Gradually, over the next few months, his sight returned. Surprisingly, his eye turned blue again. A video shows him excitedly calling out letters on an eye chart as he works his way down to smaller and smaller type, with his brother and the doctors standing by, laughing.
Was it the antiviral drug? He cannot be sure, but he thinks so.
"I think the cure was Ian's own immune system," Varkey said, explaining that he suspected the treatments had reduced Crozier's symptoms and helped preserve his sight long enough for his immune system to kick in and clear out the virus - just as supportive care during the worst phase of his initial illness had kept him alive until his natural defenses could take over.
Crozier believes information from his case may help prevent blindness in Ebola survivors in west Africa. On April 9, he headed to Liberia with Yeh and several other Emory physicians to see patients who had recovered from Ebola and examine their eyes.
"Maybe we can change the natural history of the disease for survivors," Crozier said. "I want to start that conversation."
Ebola numbers rise again in Guinea and Sierra Leone
May 20, 2015 - 3:25PM
Dakar: Only days after declaring the lowest number of new Ebola cases in Guinea and Sierra Leone this year, officials at the World Health Organisation said Tuesday that there had been a nearly fourfold increase during the most recent week of reporting, to about 35 new cases.
With Liberia, the other West African nation at the centre of the epidemic, being declared free of Ebola this month, the recent drop in infection numbers in Sierra Leone and Guinea had offered hope that the worst Ebola outbreak in history might end soon.
Officials warned against reading too much into the latest uptick, given the steep overall decline in Ebola cases. As recently as the week of March 15, there were 95 new cases in Guinea alone.
Health officials said that sharp falls and rises were normal as an epidemic approached its end. But they also said that some persistent risky practices, like unsafe burials of Ebola victims in Guinea, had contributed to the rise in new infections.
Most of the new cases, about 27, are in Guinea, and one area in particular is a problem spot: the Forecariah district southeast of the capital, Conakry. It is far from where the outbreak started, in Guinea's Forest Region, but it is in an area where there has been resistance to the sanitary burials necessary to contain Ebola.
"We've been concerned about a number of cases coming from there, of people dying in the community," said Dr Margaret Harris, a spokeswoman for the WHO, referring to the failure to turn corpses over to the authorities in Ebola hot spots, a refusal that has bedevilled health officials since the beginning of the outbreak.
"There is still some concern that there are unsafe burials going on," she said. "The burial issue is still a very tough one."
Dr Harris said a team of experts had been sent to the Forecariah area to help combat the spread of the disease.
"It doesn't surprise us that within the tail of the epidemic there are peaks and valleys," said Brice de la Vigne, the Brussels operations director of Doctors Without Borders, which has led the response to the epidemic over the last 14 months.
"This is not scaring us beyond reason; it is normal," Dr de la Vigne said, but "we know that there are still people who are contaminating themselves at funerals."
Adding to the cases are renewed efforts by officials to find the sick, said Sylvie Jonckheere, a Doctors Without Borders official in Conakry.
"They've been doing a roundup," she said. "They have plenty of people looking for the sick in the villages. It's not really different from what we've seen with Ebola in the past."
It is not a coincidence that the disease is lingering longest in Guinea, where the outbreak began 18 months ago.
In Guinea, resistance to the intervention of outsiders - doctors, health officials, politicians - has been stronger than in either Sierra Leone or Liberia.
Guinea has reacted with occasional violence to efforts to contain the disease. In the Forest Region, eight officials and journalists were killed by villagers during an anti-Ebola rally in September. Before that, doctors and health officials were repeatedly attacked and ambushed, and villages were classified as "closed" or "open" by health officials, depending on whether they would allow outsiders in to combat the disease.
More than 11,000 people have died of Ebola in the three countries, and there have been over 26,000 confirmed, probable and suspected cases, according to the WHO's last situation report on the epidemic.
But one telling statistic in the report indicates how sharply the Ebola epidemic has dropped off: Out of 55 districts in the three countries that had reported at least one case of the disease, 43 have not reported a single one for more than six weeks.
South Korea races to contain MERS virus outbreak, with two dead and 1300 quarantined
June 4, 2015 - 3:18AM
Tokyo: South Korea has scrambled to try to contain an outbreak of Middle East respiratory syndrome, a virus that has already claimed two lives in the country, with more than 1300 people quarantined and upwards of 500 schools set to close their doors on Thursday.
Amid criticism it has been too slow to respond to the virus, which has no vaccine or cure, President Park Geun-hye ordered the establishment of a task force to try to contain the infection and to be more transparent along the way.
"There are a lot people worried about this situation," Park told an emergency meeting of officials and health experts Wednesday. "We must make the utmost effort to stop MERS from spreading."
The case brings back memories of severe acute respiratory syndrome, or SARS, that began in Asia in 2003, spreading to Europe and the Americas and leading to 774 deaths worldwide, according to the Centres for Disease Control. Fearful that MERS has already spread, China is also taking measures to contain it.
Two people have died from MERS in South Korea, while 28 others have been confirmed as having the virus, five of them on Wednesday alone. This makes the outbreak the largest outside Saudi Arabia, where MERS began three years ago, the World Health Organisation said, warning that "further cases can be expected".
Another 398 cases are suspected and a total of 1364 more people have been quarantined, the vast majority of them at home.
Education authorities have left it to principals to decide whether to shut their schools, and 200 kindergartens and schools closed their doors on Wednesday while more than 500 planned to shut on Thursday. Almost all of them are in Gyeonggi province, the area around Seoul, where the first patient with the virus sought treatment, although six primary schools and a middle school in Seoul will also close until Friday at parents' request.
Drugstores reported a run on surgical masks and hand sanitiser as fear about a wider outbreak spread.
MERS arrived in South Korea in a 68-year-old "index patient" who had travelled to four countries in the Middle East and showed no symptoms when he returned home on May 4.
But a week later, he sought treatment at two outpatient clinics and then two hospitals, potentially exposing a large number of health-care workers and other patients to the virus.
"Given the number of clinics and hospitals that cared for the index case, further cases can be expected," the World Health Organisation said in a statement.
The two patients who died, a 58-year-old woman and a 71-year-old man, had both been in contact with the index patient in the hospital and both had other health problems that could have weakened their ability to fight the infection. The exposure times could have been as short as five minutes to a few hours, the WHO said.
The South Korean government has come under fire for refusing to disclose the names of the clinics and hospitals where the index patient sought treatment. But three doctors at the emergency meeting on Wednesday rejected demands for greater openness, Yonhap News Agency reported, saying that 25 out of 30 people were infected at a single hospital, which has since closed to new patients.
Meanwhile, Chinese authorities quarantined 88 people, including 14 South Koreans, after a 44-year-old South Korean man, the son of one of the people who has contracted the virus, defied medical advice and flew to Hong Kong on May 26 while he had symptoms of the virus. He then travelled to the southern Chinese province of Guangdong by bus.
China informed WHO on May 29 that the man had tested positive for the virus and had been isolated at a hospital in Huizhou, Guangdong, while Chinese authorities try to track down other people who might have been exposed.
Seoul: South Korea has reported two more deaths and five new cases in the growing outbreak of MERS, which has placed more than 5,200 people under quarantine and sparked widespread alarm.
The latest deaths of two men - aged 58 and 61 - put the total number of fatalities from Middle East Respiratory Syndrome at 16 since the outbreak began less a month ago.
One victim had diabetes while the other had no underlying illness, the health ministry said in a statement on Monday.
The total number of cases has risen to 150, with 17 patients in an unstable condition.
The five new patients were infected in hospitals in cities including Seoul and Daejeon, 140 kilometres south of the capital.
Among them was a doctor who had performed CPR on an infected patient in Daejeon and one infected in Samsung Medical Centre in Seoul - the epicentre of the outbreak where more than 70 patients, visitors and medical staff have contracted the virus.
The outbreak is the largest outside Saudi Arabia, and started on May 20 when a 68-year-old man was diagnosed after returning from a trip to Saudi Arabia.
South Korean health workers wearing protective gear sanitise a public bus on Sunday. Photo: AFP
Since then the virus has spread at an unusually rapid pace, sparking alarm in Asia's fourth-largest economy. Almost all patients have been infected in hospital.
The Samsung hospital - one of the country's largest - suspended most services on Sunday to help curb the spread of the deadly virus.
There is no vaccine for MERS which has a mortality rate of 35 per cent, according to the World Health Organisation.
Seoul: In a bar in Seoul's upmarket Gangnam district this week, music was blasting from the speakers and a Harry Potter film played on a giant flat-screen television.
But the electronic darts board and kung fu video game stands were bereft of customers, and all but one of the tables were empty.
The barman had a simple answer for the unusual lack of business: Middle East Respiratory Syndrome (MERS).
South Korea on Thursday reported three more deaths from MERS, in what has become the largest outbreak of the virus outside Saudi Arabia, with 14 deaths in the past few weeks and 138 people diagnosed. Health officials have begun urging people to go about their normal daily activities, saying the rate of new cases was slowing, but in South Korea's capital, the fear is still palpable.
"The number of newly confirmed cases has fallen sharply and there are little risks of the virus spreading through airborne transmissions or to communities outside hospital settings", the Health Ministry said. "Therefore, we ask the people to conquer their fear and engage in day-to-day business."
Currently, 3680 people are under quarantine, down from 3805. A total of 1249 people have been released from quarantine, including 294 on Friday. Nevertheless, public and private events – from briefings on the forthcoming World Military Games 2015 to a Japan-Korea goodwill noodle banquet – have been cancelled, while 2400 schools remain closed.
Businesses, including shopping malls, restaurants and cinemas, have reported a sharp drop in sales as people shun public venues with large crowds.
In Seoul's Insadong, a pedestrianised area which is usually heaving with tourists, the streets are easy to navigate.
"Customers are down by 70 per cent, everyone's staying home," said a staff member at the "Dragon's Beard" traditional confectioner.
More than 54,000 foreign travellers have cancelled planned trips to South Korea so far this month, according to the Korea Tourism Board.
The industrial-port city of Pyeongtaek, south-west of Seoul, where the first cases originated, has been described as "a ghost town". The 105-resident rural village of Janduk has been quarantined with police barricades.
Every transmission has been traced to hospitals, where patients presenting with flu-like symptoms went for treatment.
The first case, a man who contracted MERS in the Middle East, visited St Mary's in Pyeongtaek on May 20, from where it spread to 29 hospitals nationwide, including the Samsung Medical Centre in Gangnam.
MERS first emerged in Saudi Arabia in 2012 and has since infected more than 1200 people. Overall mortality rates are 37 per cent, according to the WHO. In South Korea, fewer than 10 per cent of patients have died. Most of those who have died have been elderly people with compromised immune systems, according to Yonhap.
Scientists in South Korea and China – where one of the Korean cases was diagnosed after travelling to that country – have sequenced the genetic codes of the MERS viruses involved in the outbreak. According to the WHO, scientists have not detected any significant mutations in the virus that would make it more dangerous or easily transmitted.
Why is there no MERS vaccine? Lack of foresight frustrates scientists
June 16, 2015 - 11:45PM
Kate Kelland and Ben Hirschler
Three years after the mysterious MERS virus first emerged in humans, scientists and drugmakers say there is no excuse for not having a vaccine that could have protected those now falling sick and dying in South Korea.
The facts behind the coronavirus that causes Middle East respiratory syndrome have been slow to emerge, partly due to a secretive response in Saudi Arabia, which has suffered an outbreak stretching back to 2012.
But scientists do know that it is similar to the deadly SARS virus, that it probably originated in bats, that it is linked to camels, and can pass from person to person. They also understand its molecular structure.
That all yields scientific detail for researchers to begin developing a vaccine, and there is clear frustration that work on one has barely begun.
The problem is that big pharmaceutical firms are uncertain about the economics of such a vaccine and no governments have yet offered to underwrite a major research effort.
"The question is: How long are we going to wait around and just follow these outbreaks before we get serious about making vaccines?" said Dr Adrian Hill, a professor and director at the Jenner Institute at Britain's Oxford University.
"There is no sign of MERS going away. It's been around since 2012. And there is really clear evidence now of human-to-human transmission."
South Korea said on Monday 150 people there had been infected with MERS in an outbreak started by a businessman returning from the Middle East. Sixteen have died.
The vast majority of MERS infections and deaths have been in Saudi Arabia, where more than 1000 people have been infected since 2012, and some 454 have died.
Yet cases of the disease have already been recorded in at least 25 countries, including the United States, China and Britain. MERS, which causes coughing, fever and breathing problems, can lead to pneumonia and kidney failure.
Some scientists suspect it has probably crossed other international boundaries undetected, since diagnosing MERS and distinguishing it from other respiratory illnesses that kill elderly or sick people in hospital may not always be possible.
MERS infection is caused by a coronavirus from the same family as the one behind severe acute respiratory syndrome (SARS), which killed around 800 people worldwide in 2002-2003.
High death rate
MERS has a much higher death rate - 38 per cent versus around 10 per cent for SARS, according to World Health Organisation figures - but it also spreads more slowly from person to person, making it less of a threat, for now.
"The chances are that South Korea will control it," Dr Hill said. "But should we be taking this risk? No. Should we have made a MERS vaccine? Yes. Could anyone have afforded it? Yes, the government of Saudi Arabia. So should something be done? Yes, someone should go and develop a MERS vaccine sooner rather than later."
So far only a handful of small biotechs, including Greffex, Inovio, Novavax, have done any MERS vaccine work and their research is still pre-clinical.
Larger drugmakers, however, such as GlaxoSmithKline, are keeping an eye on the situation.
"We don't have an active MERS programme but we are certainly thinking about what we should do if this becomes an issue," said Dr Ripley Ballou, an infectious diseases expert at GSK who has led the company's Ebola vaccine work.
"There is a threat list of diseases that people think are potentially going to do something and MERS is at the top."
For profit-orientated drug companies, the problem is working out who is going to use a vaccine, who is going to pay for it and whether this is a commercial market.
Many experts, including billionaire philanthropist and champion of global health Bill Gates, now argue there should be a much more structured process whereby governments and companies work together to back early vaccine development work.
It is not as if we don't have the scientific know-how.
"Viruses are pretty simple organisms and they all have antigens on their surface that are necessary to get them inside cells," Dr Ballou said.
"Everybody knows what the target for MERS is, it is the core spike protein, which is one of things that targets the cell receptor and allows it to get in. It's a single protein that can be used to induce an immune response."
Bangkok: Thailand says a 75-year-old man from Oman has been confirmed to have MERS in south-east Asia's first case of the virus since a devastating outbreak in South Korea.
Middle East Respiratory Syndrome (MERS) has spread at an alarmingly rate in South Korea since the first case was diagnosed on May 20, killing 23 and infecting 165 in what is the largest outbreak outside Saudi Arabia.
Thailand announced its first positive MERS case on Thursday after about 20 people earlier tested negative for the virus.
"(The man) is from a Middle Eastern country. The (test) results confirmed that he has Middle East Respiratory Syndrome," said Rajata Rajatanavin, Thailand's Public Health Minister, adding the patient had arrived in the kingdom with his family three days ago.
A Thai government spokesman said the man was from Oman and had travelled to a central Bangkok hospital for treatment for a heart problem.
After being tested for MERS he was moved to Bamrasnaradura Infectious Diseases Institute in Nonthaburi province on the outskirts of the Thai capital Bangkok.
Authorities are looking for people who were on the same flight as well as anyone else who came in contact with man in Bangkok.
"We are confident that we can control the outbreak," said spokesman Major General Sunsern Kaewkamnerd, adding that "disease control" measures were in place, including monitoring the health of the patient's family.
Meanwhile, World Health Organisation chief Margaret Chan expressed guarded optimism over South Korea's ability to contain an outbreak after the WHO previously described the spread of the disease as a "wake-up call".
"Our current assessment of the MERS situation in South Korea ... is the government is now on a very good footing," she said, adding that the situation did not constitute an international public health emergency.