Dallas healthcare worker who treated patient zero tests positive

Obama organises conference call with EU leaders to discuss crisis

African nations continue to grapple with worsening conditions

Texas nurses give scathing statement about hospital readiness

WHO warns virus could infect 10,000 new cases a week

4.15pm BST

The president of Sierra Leone says containing the virus will require drastic laboratory improvements, my colleague Lisa OCarroll relays.

Ernest Bai Koroma has said Ebola test results need to be turned around within four hours, and told a delegation from the Italian-run Emergency Hospital in Freetown the the country is in urgent need laboratories.

We need these facilities today as there is no time to waste.

If we can increase our capacity of handling over 500 samples a day, it will be helpful to handle the pressure. Forty-eight hours is not good, as some will get infected while waiting. We should maintain the four hours and work on improving it further.

4.01pm BST

EU countries may screen airport travellers for Ebola, Reuters reports, which would follow actions by the UK and US.

The European Commission, the blocs executive body, says it is still weighing up the effectiveness of entry screening, given that travellers are screened on departure from the affected areas and have a low probability of developing infectious symptoms between leaving an African airport and arriving in Europe.

An EU official said one key element of entry screening could be informing arriving passengers of what to do if they later fell ill notably telling them not to turn up without warning at hospital after developing symptoms of Ebola.

3.44pm BST

CDC guidelines for protective gear could be more careful and guarded yet, according to CNNs Sanjay Gupta.

Gupta notes that the recommended gear leaves skin exposed, that theres no buddy system for healthcare workers to ensure that colleagues are careful, and that there should likely be more about cleaning your hands. He says that in Guinea, he and healthcare workers would dip their hands in buckets of bleach.

3.23pm BST

Heres a summary of todays key events so far:

2.51pm BST

Sam Jones also sends these heartbreaking details from the UNs World Food Programme about the devastating impact of the Ebola outbreak on some families:

According to John Crisci, the World Food Programmes emergency co-ordinator in Sierra Leone, the spread of Ebola is making it harder for people to feed their families.

The average Sierra Leonean family spends anything from 60% to 70% of their income on food and with this crisis, families in highly infected hotspots such as Kenema and Kailahun have lost one of the breadwinners in the family either to Ebola or to unemployment.

In some areas, says Crisci, families are now spending 80-90% of their income on food and adopting what the WFP calls severe food coping strategies: when food becomes the predominant concern, people stop buying medicines, clothes and hygiene products.

With unemployment rising in towns and the countryside as people lose jobs in banks, hotels and restaurants, farmers stop tending their lands and plantation employees shun work that involves large groups, mothers and fathers are beginning to limit what they eat.

Parents in some areas are now eating one meal a day to try to give two meals to their children, says Crisci. When both parents were working and had a steady income, theyd be having three meals a day.

In response, the WFP is conducting a no-regrets operation, opting to bring in and then withdraw excess resources rather than risk failing those in need.

Dry rations of rice, beans, salt, vegetable oil and supercereals for children - supplemented by onions, stock cubes, tea and toothpaste from the Sierra Leonean government - are being delivered to families whose houses have been locked down by the military and police in the hope of halting Ebolas spread.

The biggest challenge in this operation is that its forever-evolving, says Crisci. The number of areas in the country that are being isolated continues to grow. Were always moving quickly behind the target but were now trying to beat it.

With the food pipeline beginning to open up and the WFP bringing in large shipments this month and next, Crisci believes it will have the capacity to respond to the needs of up to 600,000 people.

But he does not underestimate the scale of the emergency. Last week, while on an assessment mission to a village 45 miles from Freetown that had been placed in isolation, he came across a quarantined house guarded by soldiers.

Behind them on the patio, covered with a coloured cotton sheet were two sisters, probably about two and nine years old. One was face up and one was face down. Their mother was there on the patio, keeping a distance of couple of metres. She was looking over at them and you could see that she was desperate and hopeless. Her hands were tied and she couldnt do anything to comfort them. She kept on looking out at the road hoping that the ambulance was coming any time. We intervened heavily but unfortunately one of the little girls passed away. The other sister is in a treatment centre now in Port Loko and we hear the chances are slim.

If it had been a kid who had broken their leg or bumped their head, wed have thrown them in the WFP car and run to the hospital; we do it all the time. But in a case like this, we couldnt do anything. We try to change the world, we try to assist millions of people but here there were these two children just lying there and none of us could do anything except pull every contact we had to get the ministry of health to intervene. You feel like youre doing a big thing and then you see the two children and their mother. It broke my heart.

2.30pm BST

My colleague Sam Jones sends this about the wider social effect of the outbreak in Sierra Leone:

Ebolas impact on Sierra Leone goes far beyond swamped clinics and closed schools, according to Simitie Lavaly, the executive director at AdvocAid, an NGO that works with women and their children in detention in Sierra Leone.

Very few lawyers are going to court because its not worth their while financially and there are not many judges because a lot of them are stranded outside the country because they went abroad for the high court summer recess. The flights were cancelled and they cant come back.

The few magistrates who are now sitting dont hear more than 10 cases a day because the emergency public health declarations say there should not be large gatherings. If you have more cases, you have more people. Before, theyd hear 30 cases a day. Now theyre adjourning cases and theyve also restricted litigants: it has to be your case and you cant come with lots of friends and witnesses to support you. Lots of the male prisoners are not in good health and some lawyers are worried about coming across them in the corridors.

Lavaly says the situation in prisons is also becoming increasingly difficult as peoples cases are adjourned. With visits from family suspended, it is left to the NGOs to bring baby food to mothers detained with young children, and to top up the prisons ever-dwindling supplies of chlorine, buckets and gloves.

We also bring in a bit of cassava for people, because a lot of time they complain that the dont have enough food, says Lavaly. And God forbid, if you get Ebola, your immune system needs the food not to mention oral rehydration solution. Even without Ebola, there are a lot of malnourished prisoners.

While it applauds the efforts of those judges and magistrates still managing to do their jobs, AdvocAid wants the police to relieve some of the pressure by dealing with minor offences in the police station rather than clogging up the courts.

But what it most needed, argues Lavaly, is neither a fast-tracked legal process nor a judicial airdrop, but international help in bringing a swift end to the crisis.

Many of us lived through the war, she says. It feels like we are back in that time again, but only it is worse. Then, we could see our enemy but now the enemy is unknown and could be a loved one or close associate. Then, the international community and relatives overseas were sympathetic to our plight and readily gave financial and moral support. Now we feel like a pariah nation, closed from the outside world and with not much sympathy for our plight as no one wants to contract Ebola from us.

2.28pm BST

Heres a photo of the Dallas apartment block where the second healthcare worker to contract Ebola lived. Their home is currently being decontaminated.

2.21pm BST

My colleague Ben Quinn sends this about the Sierra Leonean population in the UK:

The UK is home to one of the largest Sierra Leonean diasporas outside of Africa some 16,972 people born in the country were living in Britain at the 2001 census and theyre certainly getting involved in helping relatives in their homeland.

Ive been speaking to Londoner Memuna Janneh, who grew up in Sierra Leone, about the charity she has set up to channel resources there (see the audio below).

Her Charity, Lunchbox, has already supplied thousands of meals to people living in a number of communities. Its next goal is to raise £50,000 to supply 50,000 meals to those in hospital in Sierra Leones western region, including patients, nurses, doctors, drivers and others.

She talks also about the strong sense of community among the Sierra Leone diaspora in the UK.

Everybody who is on the front line should at least be able to get meal, she said.
The idea is that we free up the Ministry of Health and Sanitisation so that they dont have to worry about that part of the struggle. This is a very complex situation and we are all battling to get things going.

The campaign - Lunch Is On Me - launches this Saturday. People are going to be asked to take photographs of their lunch, make a donation to the value of their lunch, post a photograph online and perhaps nominate three other people to do the same.

2.18pm BST

Heres a photo of the press conference in Dallas earlier.

2.06pm BST

The Associated Press has more on the accusations by nurses at the Texas Health Presbyterian hospital of lax safety protocol in the handling of Thomas Eric Duncans Ebola case. The nurses allege that:

Duncan was kept in a non-isolated area of the emergency department for several hours, potentially exposing up to seven other patients to Ebola

1.38pm BST

Ashifa Kassam in Madrid sends me this on Spains latest response to the crisis:

Spanish health authorities have begun rolling out a series of improvements after repeated complaints of inadequate training by those on the frontline of fighting Ebola in Spain.

Officials said they would begin offering specialised training courses to health workers on Wednesday. Earlier this week they promised training to anyone who might come in contact with Ebola, from doctors to firefighters, and said they would enlist the help of groups such as Doctors Without Borders in developing the training.

1.26pm BST

The Dallas Morning News reports that staff at the Texas Health Presbyterian hospital have described chaotic scenes when Thomas Eric Duncan was brought in with Ebola:

Nurses at the Dallas hospital where a Liberian man died of Ebola described a confused and chaotic response to his arrival in the emergency room, alleging in a statement on Tuesday that he languished for hours in a room with other patients and that hospital authorities resisted isolating him.

In addition, they said, the nurses tending him had flimsy protective gear and no proper training from hospital administrators.

1.20pm BST

City officials in Dallas have been holding a press conference about the new Ebola case. I missed the start of the comments by the citys judge, Clay Jenkins, but according to local reporters (see tweet below) they are preparing for more possible cases. He said of new cases:

Its a very real possibility.

We are a hospital that maybe could have done things differently, with the benefit of hindsight today.

The only way we are going to beat this is person by person, moment by
moment, detail by detail we want to minimise rumours
and maximise facts. We want to deal with facts not fear.

Judge Clay Jenkins says the city is preparing contingencies for more cases of Ebola. "It's a very real possibility".

12.57pm BST

The New York Times has a fascinating piece about how the medical charity MSF (Doctors Without Borders), has been at the forefront of trying to combat the outbreak in west Africa. Heres a taster:

When the Ebola virus began relentlessly spreading in Sierra Leone months ago, government officials made an urgent plea to Doctors Without Borders, all that appeared to stand between the country and chaos.

They asked us to be everywhere, recalled Walter Lorenzi, the medical charitys former coordinator in Sierra Leone. They didnt know what to do.

12.51pm BST

Max Miller sends me this on British companies currently seeing a rush in sales of protective medical equipment.

Sales of disease protection items have spiked in the wake of the Ebola outbreak in west Africa, according to one British firm which sells the equipment online.

As many as 10,000 protective suits, 5,000 Ebola kits, and 25,000 hand gel units have been sold in the last three months by SP Services, who are based in London.

12.40pm BST

My colleague Rebecca Davis has produced this timeline of the current outbreaks spread, beginning with the death last December of a two-year-old child from a then-unidentified haemorraghic fever in the town of Guéckédou in Guinea.

12.34pm BST

My colleague Lisa OCarroll sends this:

More than 2,000 health and logistics workers have volunteered to help the fight against Ebola after a global email campaign.

Avaaz petitioned 39m of its members over five days seeking volunteers with appropriate medical or logistical response and says that more than 363 doctors and nurses have put their names forwards.

12.27pm BST

Another photo from the front line of the Ebola crisis, this time in Sierra Leone.

12.13pm BST

Wednesdays conference call (see 11.17 update) will also involve the German chancellor, Angela Merkel, the French president, Francois Hollande, and the Italian prime minister, Matteo Renzi, as well as Cameron and Obama.

On Thursday, Cameron is due to chair a meetings of the British governments Cobra contingencies committee to discussEbola, the Press Association reports.

We held an emergency exercise simulating two Ebola cases here at the weekend. We are constantly keeping our measures and procedures under review.

We do believe that they are robust, but it is right that they are tested in the way they were at the weekend.

12.07pm BST

Why are nurses and other health workers catching Ebola, despite precautions? In USA Today, Peter Hotez, dean of the National School of Tropical Medicine in Houston, explains.

Ebola, he says, is unusual because the virus replicates very rapidly as the disease becomes more advanced. When people are first infected they are not contagious because levels of the virus in blood are too low to spread the infection.

So by the time you are in the end stages of your illness, your liver and your spleen and your kidneys are just teeming with billions of viral particles.

11.50am BST

This useful interactive map tracks every outbreak of Ebola from 1976 to this year.

11.46am BST

My colleague in Berlin, Philip Oltermann, sends this update:

The body of the Sudanese Ebola victim who died in a German clinic on Monday night has been burnt to stop further spreading of the disease.

Authorities at the clinic in Leipzig took the step to burn the remains of the UN worker, who was a Muslim, even though cremation is not permissible in Islam.

11.39am BST

Returning to the cases in Texas, the USs Centers for Disease Control and Prevention (CDC) has conceded that a quicker response to Thomas Eric Duncans diagnosis might have prevented the two healthcare workers catching the disease, my colleague Lauren Gambino reported last night.

The CDC director, Tom Frieden, said the agency should have sent a larger team to Dallas:

That might have prevented this infection. Ebola is unfamiliar. Its scary and getting it right is really important because the stakes are so high.

11.30am BST

Today is the UN-organised Global Handwashing Day, marking a simple yet hugely effective public health measure which has a particular resonance at the moment.

Sanjay Wijesekera, from the UN childrens charity Unicef, said:

Handwashing with soap is one of the cheapest, most effective vaccines against viral diseases, from the seasonal flu, to the common cold.

Our teams on the ground in Sierra Leone, Liberia and Guinea are stressing the importance of handwashing as part of a raft of measures that are needed to halt the spread of Ebola. It is not a magic bullet, but it is a means of additional defence which is cheap and readily available.

11.26am BST

If anyone needed reminding about the devastating impact of the crisis on west Africa, photographs such as these, by photographer Marcus DiPaola, make the situation clear.

11.17am BST

Amid a fast-moving global response to the crisis, Barack Obama will discuss the outbreak with David Cameron and other EU leaders in a video conference call on Wednesday afternoon. Our story on the subject says:

It is understood that the leaders will discuss what further action can be taken to help stop the spread of the virus in west Africa.

They will also discuss the steps that are being taken to screen air passengers arriving in Europe and the EU from west Africa.

11.17am BST

On Tuesday the World Health Organisation warned that the outbreak could see 10,000 new cases a week within two months.

Dr Bruce Aylward, the WHO assistant director-general, said the number of new cases was likely to be between 5,000 and 10,000 a week by early December. While official figures show 4,447 deaths from 8,914 reported cases, Aylward said many deaths are not recorded officially, and it seemed only 30% of people were surviving, particularly in the hardest hit countries of Guinea, Liberia and Sierra Leone.

11.17am BST

The rapid global spread of the Ebola outbreak has been reinforced with the news that a second Texas healthcare worker who treated the first patient in the US to be diagnosed with the illness has also tested positive for the virus.

The worker, as yet unnamed, helped to care for Thomas Eric Duncan, a Liberian man who contracted the disease before arriving in the US and dying at the Texas Health Presbyterian hospital in Dallas last Wednesday. The worker was immediately isolated after reporting a fever on Tuesday, the department of state health services says.

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