Infectious disease

This work is dedicated to all fearless health professionals that had the courage to prevent the spread of the Ebola virus from spreading and the caring nurses that take the pains of providing health care to Ebola patients though knowing that they have a very high risk of contacting the virus yet they still do it, not for the money but for the love of them It is also dedicated to the families of all those that lost the lives of their loved ones to this disease because knowing the pain they passed through before dyeing is not a wonderful tale and not able to go near the corpse during the burial to pay tribute for fear of contacting this deadly disease that has caused so much pain and sorrow.

Finally this research work is dedicated to God alone because he alone knows when this pandemic will end. 3 PREFACE The world is in the midst of the largest Ebola outbreak ever; there have been over 5000 deaths and many new cases are reported each day. The World Health Organization (WHO) declared it an outbreak in March 2014 and on August 6, 2014 and it declared the outbreak a public health emergency of international concern. Based on number of deaths and total number of cases reported to the World Health Organization as of August 11, 2014, the current outbreak has an overall mortality rate of 55%.

What then can the legal profession do to prevent the spread? Ebola is transmitted through bodily fluids and immediately attacks the immune system, then progressively attacks the major organs and the lining of blood vessels. Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas. This has been made more challenging by the fact health care workers are at risk of contracting Ebola virus disease.

Treatment to date has been supportive, not curative and outbreak control strategies of the law have been met with distrust due to fear and misinformation. However, important progress is being made. The international response to Ebola is gaining momentum, communication strategies have been developed to address the fear and mistrust, and promising treatments are under development, including a combination of three monoclonal antibodies that has been administered to two American Ebola-infected health care workers.

The purpose of this research therefore aims at answering this problem of Ebola and thus prove that the lawyer can be important in the fight against this pandemic that is ravaging country’s economies and then causing world-wide fear. Chizoba Victory Onyinyechi University of Nigeria Enugu campus Tuesday 13th 2015 4 -AKNOWLEDEMENT- I am using this opportunity to express my gratitude to everyone who supported me throughout the course of this research. I am grateful for their aspiring guidance, invaluably constructive criticism and friendly advice during the completion of this term paper.

I am sincerely grateful for them for sharing their truthful and illuminating views on a number on issues relating to the project. In particular, I would like to pay tribute to all the librarians and archivists everywhere, the unsung heroes who safeguard our past, for their unstinting devotion and their priceless work at a time when resources have been and are still under severe threats and pressures because without them this research would never be complete. Special thanks to my lecturer Mrs. Ngozi Nwodo, who gave me the chance to express my view on Ebola and what lawyers can do to prevent its spread in form of this research work.

 

?EBOLA: Ebola virus disease (EVD, also Ebola hemorrhagic fever or EHF), or simply Ebola, is a disease of humans and other primates caused by Ebola viruses. Ebola is an infectious and generally fatal disease marked by fever and severe internal bleeding, spread through contact with infected body, whose normal host species is unknown. ?PANDEMIC: A pandemic is a disease prevalent throughout an entire country, continent or the world, an epidemic over a large area. ?EPIDEMIC: The occurrence of more cases than the world would be expecting in a community or region during a given time period.

it can also be said to be a disease among many people in a community at the same time. ?VIRUS: A micro-organism that is smaller than a bacterium that cannot grow or reproduce apart from a living cell. They are tiny organisms that may lead to severe illnesses in humans, animals and plants. ?LAWYER: A person that has been trained in the legal profession and can appear in courts on behalf of clients. 1. 2 BACKGROUND OF STUDY 8 The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in

Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name. The current outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.

The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern. A separate, unrelated Ebola outbreak began in Boende, Equateur, and an isolated part of the Democratic Republic of Congo. 1. 3 STATEMENT OF PROBLEMS: During the course of this research, there are numerous problems that I discovered 1. The fact that the Ebola virus has no vaccine 2.

The insufficiency of the media in dissemination on health information concerning Ebola 3. The fact that Ebola is highly contagious probes a serious problem. 9 1. 4 OBJECTIVES OF RESEARCH The aim of this article is to uncover resourceful information about Ebola virus disease, what the legal profession (i. e. lawyers) can do to prevent further spread and the current challenges to controlling the outbreak and its progress to date. Thus this study aims ?To identify factors that contribute to the prevention of Ebola, with a Focus on lawyers ? To document social networks and communication channels that facilitate rapid.

Dissemination of information about, and adoption of, Ebola. 1. 5 RESEARCH QUESTIONS At the end of reading this research the reader should be able to answer the following questions 1. What is Ebola and why is it an important issue? 2. What solutions have been put forth to help solve the Ebola crisis? 3. What role do international organizations play in the control of Ebola? 4. Based on my research, why do I conclude that lawyers play an important role in curbing the spread of the virus?

1. 6 RESEARCH METHODOLOGY To achieve this research paper, I used various methods to do it. Most of the research articles were gotten from a virologist, I encountered various senior colleagues and asked them questions on the connection between a lawyer and Ebola. I also 10 attended lectures that explain the process of writing a term paper work and as a result got information on how to write it.

CHAPTER TWO LITERATURE REVIEW 2. 1 INTRODUCTION TO CHAPTER This chapter aims to provide insight on different pertinent issues from journals on Ebola and its relationship touching the law like what are the lessons for the international health regulations from Ebola?

2. 1 EBOLA: WHAT LESSONS FOR THE INTERNATIONAL HEALTH REGULATIONS? PUBLISHED ONLINE OCTOBER 7, 2014 www. thelancet. com Vol 384 October 11, 2014 With more than 3000 deaths since the first case was confirmed in March, 2014, and after months of slow, fragmented responses, the international community has recognized Ebola as a public health emergency of international concern and a clear threat to global health security.

It is the subject of a high-level UN Security Council resolution, and has triggered the creation of a UN Mission for Ebola Emergency Response. Despite these 11 efforts, Ebola is staying ahead of efforts to contain it. In such a situation, although it is understandable to focus on urgent actions, it would be a mistake not to reflect on How we arrived at this situation and what we need to do to prevent it from happening again.

The International Health Regulations (IHR) represent the system designed to prevent national public health emergencies from becoming international crises. WHO’s historic responsibility has been to control the spread of disease. Although all WHO member states have agreed to the IHR principles, countries were left to self-report their progress on core capacity development, such as surveillance, Diagnostic, and containment demands.

With no additional financing in place and no proper accountability mechanism to ensure independent monitoring, this laudable vision has become a huge missed opportunity. Today, every person newly infected with Ebola reminds us of this lost opportunity. Whereas most developed countries certainly have the capacities to implement such a framework, many low-income and middle-income countries, and especially fragile states, do not. It was only on Aug 8, after a meeting of the International Health Regulations Emergency Committee, that WHO declared the outbreak a “public health emergency of international concern”.

Such delays have probably enabled the outbreak to spread rapidly. Several commentators have questioned the capability of WHO to address international threats, such as Ebola. Acknowledging gaps in global governance, and with its distinctive interest in global security, the USA has taken the lead and launched its Global Health Security Agenda earlier this year “to accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international security priority”. On Sept 26, a meeting took place in the White House to discuss the implementation of this new security agenda, together with

the delivery of commitments to assist West Africa. In view of the seriousness of the crisis, US leadership should be welcomed. However, the US Government is not a 12 multilateral health agency. The final responsibility to prevent the international spread of disease rests with WHO and it’s IHR. But WHO has been poorly served by its member states and governing bodies. Member states have failed to invest in WHO to ensure the agency has full capacity to address its global mandate.

And WHO’s Executive Board and WHA failed utterly to keep the promise they made in 2005 to scale-up attention and investment in crucial surveillance and reporting systems so necessary to prevent the kind of epidemic that is Ebola today. Two priorities stand out. First, an urgent donor conference must be convened to discuss the implications of the Ebola epidemic and the international community’s failure to invest in the IHR.

That conference must end with substantial financial commitments to strengthen delivery of core IHR public health capacities. Second, a robust mechanism must be put in place to guarantee independent monitoring and review of country implementation of the IHR. Self-reporting is an unreliable way to protect the world’s peoples from new and dangerous epidemics.

2. 2 WHY EBOLA HAS BEEN SO CHALLENGING TO CONTROL Canada Communicable Disease Report CCDR ISSN 1481-8531 (On-line) Semalulu T ,Wong G, Kobinger G and Huston P There are various reasons why Ebola has been so challenging to control some are:

2. 2. 1 Lack of adequate information on Ebola 13 Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. It then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e. g. bedding, clothing) contaminated with these fluids. Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD.

This has occurred through close contact with patients when infection control precautions are not strictly practiced. 2. 2. 2 The outbreak has reached urban areas Historically, Ebola virus disease has been responsible for smaller outbreaks in the remote forests of Sub-Saharan Africa that have typically involved animal-to- human transmission and sporadic human-to-human transmission.

This outbreak marks the first time EBOV has appeared in a capital city and has been imported by an infected person into Africa’s most populous country, Nigeria. The unprecedented size and location of the outbreak, combined with the fact that the virus is now circulating in densely populated urban centers, sets up the conditions for sustaining human-to- human transmission making the outbreak even more challenging to control. 2. 2. 3 Affected countries have challenges in health care infrastructure Sierra Leone, Guinea and Liberia are small countries that have limited resources to respond to prolonged outbreaks, especially in rural areas.

This is the first time that West Africa has had to deal with an EBOV outbreak, therefore most primary health workers did not have any prior experience dealing with this virus. Limited surveillance and reporting systems may have delayed outbreak identification and the subsequent global response. The WHO has identified these issues as gaps in the outbreak response 14 2. 2. 4 Health care workers are at risk of infection The WHO has reported health-facility transmission as a central issue during the current outbreak. Health care workers are at risk of contracting EBOV while caring for infected patients through accidental exposure to infected bodily fluids.

To date, more than 170 health care workers have been infected and at least 81 have died These deaths have discouraged some health care workers and international organizations from participating in treatment and control efforts 2. 2. 5 Outbreak control strategies have been met with distrust Persistent community resistance has been identified as a major challenge in the health sector response to the outbreak. Effective prevention and control strategies have been undermined by fear, mistrust and misinformation within affected communities, leading some to believe that medical staff have brought the virus to the country.

This has resulted in people refusing to cooperate with medical personnel, helping patients escape isolation wards, and exhibiting hostile behavior. Traditional burial practices also pose a major risk to close relatives, since they typically involve the cleaning and rubbing of dead bodies that may have a high load of Ebola virus. The recommendation that these burial practices be performed by outbreak response team members has been perceived to conflict with beliefs and cultural practices.

15 2. 3 IMPORTANCE OF THE LAW IN THE PREVENTION OF EBOLA International aid and resources have been increasingly directed to West Africa to control the EBOV outbreak. The WHO has coordinated efforts to scale up the human and financial resources necessary to effectively conduct infection prevention and control activities and to implement infrastructure needed to manage future outbreaks, such as strengthening the surveillance and laboratory capacities. Numerous non- governmental organizations, including Medecins Sans Frontieres, Save the Children, and religious organizations have been working on the ground to help stop the spread of this disease.

Based on the deliberations of an Emergency Committee, the WHO Director General has made a number of recommendations, including: affected states should declare the outbreak a national emergency and establish an emergency operation center to coordinate support and response efforts; exit screening be conducted at all international airports, seaports and major land crossings to identify individuals with unexplained febrile illness; appropriate contact management; and all states should enhance their capacity to detect, investigate and manage Ebola cases through improved surveillance, laboratory diagnostic support and rapid response.

An assessment of the current outbreak led Dr. Luis Sambo, the WHO Regional Director for Africa, has recommended that affected governments scale up national resources to promote behavioral change while respecting cultural practices. Local collaborations (e. g. training community members to identify contacts, and working with local leaders and lawyers to effectively disseminate the correct information on EBOV) are being used to dispel misconceptions and strengthen control strategies .Collaborations with religious, community and tribal leaders are being used to 16 disseminate information.

These messages are also being spread by television and radio. CHAPTER THREE ANALYSIS OF MAJOR ISSUES 3. 1 INTRODUCTION TO CHAPTER: This chapter tend to create awareness of a lawyers relation with Ebola thus proving that a lawyer is not only useful in courts but also in the medical field and it tends to expose us towards this with sub-topics like the importance of a lawyer in the spread of Ebola and the consequence of a lawyers help in Ebola prevention.

3. 2 IMPORTANCE OF LAWYERS IN THE PREVENTION OF EBOLA SPREAD The EVD (Ebola virus disease) is a very serious one and as such stringent measures must be taken to achieve its prevention and as such help is needed from everyone: the government, the people and patients.

A lawyer can help in the prevention of the spread of the disease in the following ways. A lawyer being an expert in the interpretation of the law can help in fighting for the rights of patients carrying Ebola. Most Ebola patients are highly stigmatized by people and even by the doctors and nurses themselves because of how contagious the disease is. But as at that the Ebola patient still has rights on that sick bed (i. e. right to life). Such a person must be treated well.

And if he/she is rejected he or she can sue 17 the hospital and that’s when the lawyer is needed (i. e. when there are cases in the court). The fact an Ebola patient is rejected goes against the medical ethics in that expressly states that no patient should be rejected by the nurses in the hospital’’. Laws are made by the legislature and lawyers could help in the creation of public health laws that aim at preventing the disease in collaboration with the government for the execution of the laws because one of the major reasons why in Liberia Ebola spread very fast is the inability of stringent laws to come up by the government that aim at prevention of the spread of Ebola within and to outside the country.

The greatest reason for the wide spread of Ebola is lack of adequate information. The disease keeps up spreading because the people there obey their hazardous cultural practices that can spread the disease like burning the corpses of the Ebola victims and conducting such burials in their traditional ways instead of handing over to the government the Ebola victim for a proper healthy burial that would curb its spread but instead they would prefer to obey culture and bury the person and as such everyone in the burial would get the disease.

So a lawyer could create special laws that could be applied in the remote parts of the country and then make sure the people there are being notifies of the implication of their cultural practices to Ebola’s widespread International lawyers could be of great help because they could help big international health bodies like (WHO, IHR etc. ) in the drafting of laws to curb the pandemic globally. 3. 3 EFFECTS OF A LAWYER’S INTERVENTION TO THE PREVENTION OF EBOLA If the laws are adequately created on time before it spreads wide in a country, the number of Ebola patients would reduce drastically because it would help a lot as in the prevention and even the stop of the pandemic. 18.

The fact a lawyer can also defend a patient as to a patient rights could also help to create a picture that the lawyers care to about the Ebola patients and as such they have the right to be treated. Lawyers are very important in the dissemination of information and as such their effect to curb the pandemic cannot be over emphasized. Lawyers through this tend to speak up in public seminars on Ebola awareness and as such that would help in dissemination of information on the deadliness of the disease.

CHAPTER FOUR DISCUSSION OF MAJOR ISSUES 4. 2INTRODUCTION TO CHAPTER The chapter explains other major issues on the topic of research in it one would find information like the solution to the Ebola widespread in regards to the law and the implication of the Ebola to the law 4. 2 A LAWYERS SOLUTION TO EBOLA The Ebola pandemic is paradoxical: it is out of control yet readily controllable, the key to epidemic control is rapid diagnosis, isolation and treatment of the infected individuals and all these cannot be done without the help of the law. No coherent national or international approach has so far been implemented to integrate the intervention chain from case identification to diagnosis, to secure transport, to isolation and treatment.

While efforts to create new vaccines, medicines, and diagnostics are underway, we recommend that three measures be adopted in a concerted way. First, there should be adequate information given to individuals on the danger of this disease especially in regards to the fact that it has a very high mortality rate. 19 Hygiene must be emphasized on greatly and as such the importance of hand sanitizers are there There should also be laws promulgated by the government of the nation to curb its spread.

in the non-Ebola states there should be laws that temporarily ban travelers from country’s with Ebola and even if there is no ban on such country’s the people coming in from there should be quarantined and checked for symptoms because some patients may not show signs of the virus at first but later on they may display symptoms and by then it’s too late as seen in the case of the first U. S patient who came from Liberia without exhibiting the symptoms of the virus in the airport. Lastly, the government can employ educated personnel to create seminars for public awareness to her people on the virus. 4.

3PUBLIC HEALTH MANAGEMENT OF CASES In the current context, the majority of febrile patents from affected areas will likely have an alternate diagnosis such as malaria or influenza. It is expected that these cases would be rapidly identified through surveillance activities and that the case(s) would be immediately isolated to prevent spread to close contacts. EVD is a severe illness with no licensed antiviral treatment; cases will likely require hospitalization for supportive care and strict infection prevention and control (IPC) management.

The role of public health for case management is to support early identification of probable cases and persons under investigation (PUI) through surveillance, contact tracing, public and health care professional education and communication activities. Public health authorities may also be involved in providing information regarding the routing of PUIs, probable cases and confirmed cases to specific health care facilities where optimal IPC measures can be implemented and supporting hospital preparedness in this regard as needed.

This may include the provision of information regarding laboratory testing requirements and specimen transport protocols.

This chapter serves as the closing remark for the research work as it contains a summary of the whole research and to wrap up on some other issues that may not be necessary to bring as a major topic as a result of the nature of the topic. it shall also entail our summary, suggestion/recommendation and references/bibliography. 5. 2 CONCLUSION We have immensely discovered beyond any reasonable doubt that Ebola is a deadly disease and one of the most contagious and should be avoided by any human for survival, healthy living, etc.

However, good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilization. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission.

There should be laws guiding the people on this outbreak and information dissemination would be help a lot 21 4. 3 SUMMARY The overriding purpose of this study was to determine the relative importance of how a lawyer can help prevent the spread of Ebola when viewed from a general education perspective.

To accomplish that goal it became necessary to reach some prerequisite goals. Determining what Ebola means and how that ideal is connected with the legal profession assumed a high degree of importance during the literature review conducted for this dissertation. Related to that effort, it became necessary to reach an understanding about the nature of the virus. To provide for the possibility that Ebola could be preventes and measured as a viable component of these philosophical constructs, it was important to develop a model with the potential for encompassing the totality of the ebola/law interaction.

Once these fundamental steps were achieved, this research was able to go forward. 4. 4 RECOMMENDATION Based on the research findings and conclusions on this project I hereby recommend the following: 5. 3REFERENCES n. d. “Ebola: what lessons for the International Health Regulations. ” the Lancet 7 october 2014: 1-4. Heinz Feldmann, M. D.

“Ebola_AGrowing threat. ” The New England Journal of medicine 9 october 2014: 2-7. http://www. cdc. gov/vhf/ebola/outbreaks/2014-west-africa/qa. html. 6 JANUARY 2015. document. 10 JANUARY 2015. medicine net. http://www. news-medical. net/health/What-is-Ebola. aspx. 10january 2015. 10 january 2015. medicinenet. http://www. medicinenet. com/script/main/art. asp? articlekey=4751. 13 october 2013. 3 january 2015. 22 Semalulu T, Wong G, Kobinger G and Huston P.

“Why Has This Ebola Outbreak In West Africa Been So Challenging To Control? ” CCDR(Canada communicable disease report) 8 august 2014: 3-7. stobbe, Mike. “where scientists believe ebola sarted from. ” TIME MAGAZINE 31 DECEMBER 2014. WHO. http://www. who. int/mediacentre/factsheets/fs103/en/. 14 SEPTEBER 2014. 1 JANUARY 2015. Wikipedia. http://en. wikipedia. org/wiki/Ebola_virus_disease. 9 january 2015. 10 january 2015. 23.

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