A Bit More Detail

• Wired notes a bill proposed at the state level in California to force cities to provide affordable and accessible housing through non-NIMBY zoning.


• The Toronto and Vancouver housing markets, perhaps uniquely among the markets of Canada's major cities, are not seeing as much new supply as others. The Globe and Mail reports.
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• The population of Saint John, New Brunswick, has fallen by a quarter since 1971. The city government wants to change this, somehow. Global News notes.


• VICE reports a new census of homelessness in Los Angeles, amid fears of locals that prior estimates might be undercounts.


• The mystery of what happened to Princess Pamela, a famous soul food cook whose Harlem restaurant was famous to those in the know, is explored in this thought-provoking essay.


• At Slate, Annie Risemberg explores how old connections to Liberia and ethnic restaurants helped a corner of southwestern Philadelphia become "Little Africa", a destination of note for West African immigrants.

• blogTO notes the erection of a new LCBO in a former funeral home on Queen Street West.


• The Dragon's Tales links to a study of Titan's magnetic field.


• Joe. My. God. notes a group of American pastors who are responding to civil same-sex marriage by refusing to enact civil marriages themselves.


• Lawyers, Guns and Money notes the complicity of Firestone in Liberia with Charles Taylor's rebel army in the early 1990s.


• Marginal Revolution notes the numerous human-dolphin fishing cooperatives scattered across the world.


• The Planetary Society Blog's Casey Dreier notes the probability of an American mission to Europa has risen.


• The Russian Demographics Blog links to a statistical study of the Ukrainian election suggesting it was fair.


• Strange Maps notes Al Ahwaz, a former Arab-populated pseudo-state in Iran on the Persian Gulf coast.


• Torontoist notes a Toronto protest arguing refugee claimants should be allowed access to social assistance.


• Towleroad notes that the National Organization for Marriage is facing financial meltdown.


• Window on Eurasia notes the Crimean Tatars' demand for recognition as an indigenous people.

Both nurses and doctors are scarce in the regions most heavily affected by Ebola. Even before the current crisis killed many of Liberia’s health professionals, there were fewer than fifty doctors working in the public health system in a country of more than four million people, most of whom live far from the capital. That’s one physician per 100,000 population, compared to 240 per 100,000 in the United States or 670 in Cuba. Properly equipped hospitals are even scarcer than staff, and this is true across the regions most affected by Ebola. Also scarce is personal protective equipment (PPE): gowns, gloves, masks, face shields etc. In Liberia there isn’t the staff, the stuff or the space to stop infections transmitted through bodily fluids, including blood, urine, breast milk, sweat, semen, vomit and diarrhoea. Ebola virus is shed during clinical illness and after death: it remains viable and infectious long after its hosts have breathed their last. Preparing the dead for burial has turned hundreds of mourners into Ebola victims.

Many of the region’s recent health gains, including a sharp decline in child mortality, have already been reversed, in large part because basic medical services have been shut down as a result of the crisis. Most of Ebola’s victims may well be dying from other causes: women in childbirth, children from diarrhoea, people in road accidents or from trauma of other sorts. There’s little doubt that the current epidemic can be stopped, but no one knows when or how it will be reined in. As Barack Obama said, speaking at a special session of the United Nations, ‘Do not stand by, thinking that somehow, because of what we’ve done, that it’s taken care of. It’s not.’ Preventing the next eruption is an even more distant goal.

As of 1 October, a third of all Ebola cases ever documented were registered in September 2014. More than seven thousand cases have been recorded since March, more than half of them fatal. In epidemiological terms, the doubling times of the current Ebola outbreak are 15.7 days in Guinea, 23.6 days in Liberia and 30.2 days in Sierra Leone. The US Centers for Disease Control and Prevention suggested at the end of September that unless urgent action is taken, more than a million people could be infected in the next few months.

The worst is yet to come, especially when we take into account the social and economic impact of the epidemic, which has so far hit only a small number of patients (by contrast, the combined death toll of Aids, tuberculosis and malaria, the ‘big three’ infectious pathogens, was six million a year as recently as 2000). Trade and commerce in West Africa have already been gravely affected. And Ebola has reached the heart of the Liberian government, which is led by the first woman to win a presidential election in an African democracy. There were rumours that President Ellen Johnson Sirleaf was not attending the UN meeting because she was busy dealing with the crisis, or because she faced political instability at home. But we knew that one of her staff had fallen ill with Ebola. A few days ago, we heard that another of our Liberian hosts, a senior health official, had placed herself in 21-day quarantine. Although she is without symptoms, her chief aide died of Ebola on 25 September. Such developments, along with the rapid pace and often spectacular features of the illness, have led to a level of fear and stigma which seems even greater than that normally caused by pandemic disease.

In Little Liberia, some 4,500 miles from where Ebola has ravaged parts of West Africa, the disease is still taking a toll. As fear and rumors spread around this enclave in New York’s Staten Island — home to the largest concentration of Liberians outside Africa — so, too, have stories of lost relatives and fracturing communities.

“I told my mom to stay away from that lady,” said Assie Jalloh, gesturing toward an apartment building near where she was picking up groceries on Targee Street in the Clifton area of the borough.

The object of her concern was a woman who recently returned from West Africa, said Jalloh, a nurse and a Sierra Leonean expat. She favors a mandatory 21-day isolation period for all travelers arriving from the affected countries.

In Little Liberia, Jalloh is not alone in her concern. Many Liberian-Americans share her fears. Momo Fully, a father of four, lost his cousin to Ebola in August. He worries the disease, which has killed more than 3,000 people in West Africa, could take hold in the United States.

“People go back and forth all the time. There’s always the possibly of Ebola coming to America and spreading,” he said.

[. . .]

“This is the sad reality. If my own brother came from Africa, I wouldn’t be comfortable meeting him," Fully said.

He faces another burden. Since the death of his cousin, he and his wife have been providing financial help for the man’s wife and children. “We are all they have now. We have to support them,” he said.

Top health officials have confirmed the first case of Ebola diagnosed in the United States, saying a patient who recently travelled to Liberia has the disease and is being treated in isolation at a Texas hospital.

[. . .]

Edward Goodman, an epidemiologist at Texas Health Presbyterian Hospital in Dallas, said Tuesday the patient is ill and being seen by "highly trained, competent specialists" under intensive care.

[. . .]

According to Dr. Thomas Frieden, director of the U.S. Centers for Disease Control, the patient left Liberia on Sept. 19 and arrived in the U.S. the next day.

Ebola symptoms can include fever, muscle pain, vomiting and bleeding, and can appear as long as 21 days after exposure to the virus. The disease is not contagious until symptoms begin, and it takes close contact with bodily fluids to spread.

The patient had "no symptoms" when leaving Liberia or entering the U.S., but began to develop symptoms around Sept. 24. Two days later the patient sought care, Frieden said, and was admitted to hospital on Sunday.

The patient had recently arrived in the U.S. from Liberia and was confirmed to be infected on Tuesday. He reportedly told officials at Texas Health Presbyterian Hospital of his recent travels when he went to an emergency department for care last week. He was sent home but was readmitted on Sunday, much sicker.

[. . .]

It's hard to identify Ebola in its early stages because the initial symptoms of the disease—fever, diarrhea, vomiting, and aches—are the same as for many other illnesses, including malaria, which is also common in West Africa.

That's why the Dallas patient was able to leave Liberia on September 19 without any indication that he would soon be ravaged by Ebola. The West African nations where the virus is raging are supposed to test outgoing passengers for fever, to make sure that no one with Ebola symptoms gets on a plane and spreads the disease.

[. . .]

The people who came into close contact with the Dallas patient while he was sick, from September 24 until he was isolated in a hospital room on September 28, are at risk for the virus.

Public health officials are tracking 12 to 18 people in Dallas who had contact with the patient, including 5 children who have been asked to stay home from school. Medical personnel plan to check their temperature twice a day and to look out for other symptoms.

There is little risk of the disease spreading widely in the U.S., Frieden said. Unlike highly contagious airborne pathogens like influenza, the Ebola virus requires contact with bodily fluids such as urine, saliva, feces, vomit, or semen to be transmitted. The risk is highest for people in direct contact with patients—typically healthcare workers and family members. In Africa, the lack of treatment centers and supplies has hampered efforts to contain the virus. But in the U.S., hospitals are better stocked and have better isolation facilities. In addition, public health officials have well-tested strategies to prevent the spread of infectious diseases. “This kind of contact tracing is core public health, it’s what we do day in and day out,” Frieden said.

[. . .]

The patient came to the U.S. to visit family members who are citizens and was not known to be participating in any aid efforts for Ebola patients in Liberia before coming here, Frieden said. The patient left Liberia on a plane the 19th, arrived in the U.S. on the 20th, and became symptomatic on the 24th or 25th, Frieden said. The patient sought medical care on the 26th, but was not admitted to the hospital until the 28th. Asked about that discrepancy, Frieden noted that the symptoms of Ebola, which include fever, severe headache, and muscle pain overlap with symptoms of many other infections. He added that the CDC is urging physicians to ask patients with these symptoms about their travel history.

“It is certainly possible that someone who had contact with this individual, a family member or other individual, could develop Ebola in coming weeks, but there is no doubt in my mind we will stop it there,” Frieden said.

American hospitals have been preparing since midsummer for the possibility of having to care for an Ebola patient, but Tuesday's news took the development out of the theoretical realm. Since then, there have been 12 false alarms—patients suspected of having Ebola who did not have the disease, the CDC said.

"It was virtual before," said Belinda Ostrowsky, an infectious disease expert at the Albert Einstein College of Medicine and Montefiore Medical Center in New York City. "Now it's happened, so it just makes us that much more vigilant."

The CDC has been advising hospitals for several months to prepare for patients with Ebola, though each hospital is preparing slightly differently.

At Texas Health Presbyterian Hospital, staff ran a drill last week to prepare for possible patients, according to the hospital's epidemiologist, Edward Goodman.

At Montefiore, signs in the emergency department ask patients to let caregivers know if they've recently traveled to the West African nations of Liberia, Sierra Leone, or Guinea.

Canada is considering placing doses of an experimental Ebola vaccine in hospitals around the country that have been designated to treat Ebola cases if any arrive in the country, the new chief public health officer said Wednesday.

Dr. Gregory Taylor said having vaccine at the ready means it could be used if health-care workers treating Ebola patients had risky exposures.

“We’re considering prepositioning some of that at receiving hospitals across the country who may be looking after Ebola patients. This is for the health-care workers,” Taylor said during a news conference held in Banff, Alta., where the federal, provincial and territorial health ministers met Wednesday.

Taylor said that includes the Ontario hospital that has been designated to care for Canadian responders if any become infected in the Ebola zone and are transferred back to Canada for care. He did not mention the hospital by name, but it is Toronto Western.

To date, that need has not arisen.

Here is what it would take for it to become a real airborne risk: First off, a substantial amount of Ebola virus would need to start replicating in cells that reside in the throat, the bronchial tubes and possibly in the lungs. Second, the airborne method would have to be so much more efficient than the current extremely efficient means of transmission that it would overcome any genetic costs to the virus stemming from the mutation itself. Substantial natural hurdles make it unlikely that either event will occur.

Currently, Ebola typically gains entry into the body through breaks in the skin, the watery fluid around the eye or the moist tissues of the nose or mouth. Then it infects various cells of the immune system, which it tricks into making more copies of itself. The end result: a massive attack on the blood vessels, not the respiratory system.

Even viruses that are well adapted to attacking the respiratory system often have a hard time getting transmitted through the airways. Consider the experience so far with avian flu, which is easily transmitted through the air in birds but hasn’t yet mutated to become easily spreadable in that fashion among people.

What's the hold-up? “The difficulty is that those [flu] viruses don’t have the protein attachments that can actually attach to cells in the upper airway. They have to develop attachments to do that,” Schaffner says. So even if a virus were exhaled, it would need to lodge onto something in another person’s cells that are already prepared for it in the upper airway. “Since the virus doesn’t have attachment factors that can work in the upper airway, it’s very rare for it to go human to human, and then it almost always stops and doesn’t get to a third person,” Schaffner notes. Similarly for Ebola, the virus would have to develop attachments that would allow it to easily attach receptors in the upper respiratory pathway—something that neither it (nor any of its viral cousins) has been known to do in the wild.

And yet Ebola already spreads very easily without such mutations. The delicate lock-and-key protein–virus fit required for the virus to successfully latch onto and replicate in the airway has not developed because there is no evolutionary pressure for it to do so; it simply would not be an efficient option. Epidemiologists can take some comfort in that.

Ivory Coast has closed its land borders with Ebola-affected West African neighbours Guinea and Liberia in an attempt to prevent the world's deadliest outbreak of the virus from spreading onto its territory, the government announced.

A number of African nations have defied advice from the World Health Organization (WHO) and put in place restrictions on travel to and from the countries where Ebola has appeared, which also include Sierra Leone and Nigeria.

The Philippines on Saturday ordered 115 troops to return home from peacekeeping operations in Liberia due to the outbreak there.

Meanwhile, Sierra Leone's parliament has passed a law that means a two-year prison sentence for anyone harbouring Ebola victims, the justice minister said on Saturday.

"The amendment is needed at this time taking into account the fact that when the 1960 ordinance was drafted and passed into law, a disease such as Ebola did not exist," Justice Minister Frank Kargbo told Reuters.

The international prosecutors contend that Taylor offered concessions to Western individuals in exchange for lobbying work aimed at enhancing his image in the United States. The prosecution maintains that Taylor also spent $2.6 million on lobbying firms and public relations outfits in the hopes of influencing the policies of former President Bill Clinton and George W. Bush.

Under cross-examination, Taylor said that Robertson had volunteered to make Liberia's case before U.S. administration officials, and had spoken directly to President Bush about Taylor. He also confirmed that Robertson's company, Freedom Gold Limited, signed an agreement to exploit gold in southeastern Liberia, but that it never generated any profit.

"Mr. Taylor, indeed at one point you said that you can count on Pat Robertson to get Washington on your side," he was asked by the lead prosecution counsel, Col. Brenda Hollis, a former U.S. Air Force officer. Taylor replied: "I don't recall the exact words, but something to that effect."

A spokesman for Robertson, Chris Roslan, confirmed that Robertson was awarded a gold exploration concession by the Liberian government during the 1990s. But he said that there was "no quid pro quo" to provide the government with anything in return. Roslan said the company, Freedom Gold, is no longer in operation and has never found any gold.

"This concession was granted by the Liberian government to promote economic activity and alleviate the suffering of the people of Liberia following a terrible civil war," said Roslan, adding that Robertson had never met Taylor or paid him any money. "Freedom Gold accomplished this by employing some 200 Liberians in addition to providing humanitarian efforts including free medical care and installation of clean water wells for area residents."

Religious broadcaster Pat Robertson accused President Bush of “undermining a Christian, Baptist president to bring in Muslim rebels” by asking Liberian President Charles Taylor, recently indicted for war crimes, to step down.

“How dare the president of the United States say to the duly elected president of another country, 'You've got to step down,'" Robertson said Monday on “The 700 Club,” broadcast from his Christian Broadcasting Network.

“It's one thing to say, we will give you money if you step down and we will give you troops if you step down, but just to order him to step down? He doesn't work for us.”

Robertson, a Bush supporter who has financial interests in Liberia, said he believes the State Department has “mismanaged the situation in nation after nation after nation” in Africa.

“So we're undermining a Christian, Baptist president to bring in Muslim rebels to take over the country,” he said in the broadcast.

Robertson told The Washington Post in an interview published Thursday that he has “written off in my own mind” an $8 million investment in a Liberian gold mining venture he made four years ago, under an agreement with Taylor's government.

“Once the dust has cleared on this thing, chances are there will be some investors from someplace who want to invest. If I could find some people to sell it to, I'd be more than delighted,” he said in the article.