'Protective clothing doesn't work against Ebola': Outrage grows after Spanish nurse caught disease DESPITE wearing a safety suit - and WHO now warns more cases in Europe are 'unavoidable'Quarantines come after authorities traced nurses' contacts
Unnamed nurse was part of team that treated Manuel Garcia Viejo
Spanish missionary was brought back from Africa last month for treatment
Officials say they 'don't know' how his nurse became infected with the virus
But unnamed medics claimed their gear did not meet WHO standards
Medical teams in Norway treating their first Ebola victim who returned today
She is a doctor who had been working MSF in West Africa
By Damien Gayle and Lizzie Parry and Stephanie Linning for MailOnline
Published: 04:13 EST, 7 October 2014 | Updated: 10:17 EST, 7 October 2014
Anger was growing in Spain today over how a nurse became infected with Ebola as it was claimed the protective suits given to health officials were not good enough.
Four suspected Ebola patients are now in hospital in Madrid after the nurse was confirmed as the first person to catch the virus outside of West Africa.
The escalation in Spain's Ebola outbreak comes as officials revealed 30 people were being monitored for symptoms, including the woman's husband.
It has also since emerged that a week before she tested positive for Ebola she had contacted health workers to complain of a fever and fatigue, telling them she had helped treat two priests who contracted Ebola in Africa and were repatriated to Spain.
But it wasn't until she went to her local hospital on Monday that she was finally admitted and tested for the virus.
It is not the same hospital where she worked, raising questions over the number of people she has come into contact with.
Meanwhile the World Health Organisation warned that it is 'unavoidable' more cases will be diagnosed in Europe.
It comes following claims the nurse, who has yet to be named, did not have the sufficient equipment required to tackle the highly contagious virus
A woman is pictured wearing a protective mask as she leaves Hospital Fundacion Alcorcon in Madrid, where the Spanish nurse first tested positive for the virus
Hospital staff walk out past police guarding the entrance to protest outside the Carlos III hospital in Madrid, Spain where a Spanish nurse is being treated after testing positive for the Ebola virus
A hospital worker looks out from behind the main gate of the Carlos III hospital where five people are now being treated in connection with the possible outbreak - the first time the illness has spread outside of West Africa
WHO's European director Zsuzsanna Jakab said further such events were 'unavoidable'.
She said: 'Such imported cases and similar events as have happened in Spain will happen also in the future, most likely.
'It is quite unavoidable... that such incidents will happen in the future because of the extensive travel both from Europe to the affected countries and the other way around.'
'It will happen,' she added. 'But the most important thing in our view is that Europe is still at low risk and that the western part of the European region particularly is the best prepared in the world to respond to viral hemorrhagic fevers including Ebola.'
Officials have said they 'don't know' how the Spanish nurse became infected with the deadly virus.
But last night staff at the Carlos III hospital where she worked claimed the protective suits they were given were not good enough.
Unnamed sources told Spanish daily El Pais the suits did not meet World Health Organisation standards.
They said the suits they were issued with were permeable and lacked breathing apparatus.
'We don't know yet what failed,' he was quoted by the Guardian as saying. 'We're investigating the mechanism of infection.'
Mercedes Vinuesa, the head of Spain's public health service, told parliament today that the nurse's husband had been placed in quarantine. Although he has shown no signs of Ebola, the measures have been taken as a precaution.
In addition, a second nurse who also treated the priest who died on September 25 was put into quarantine after experiencing diarrhoea but she did not have a fever, the most common initial symptom for Ebola.
A Nigerian man who recently arrived in Spain is also under quarantine but tested negative for Ebola in his first test.
The 44-year-old nurse is said to have spent the last 15 years working at Madrid's Carlos III Hospital, where two Spanish missionaries infected with Ebola died.
She was part of the team that treated Spanish priest Manuel Garcia Viejo, who was brought back from Africa last month so that he could be treated for the deadly virus.
News of the quarantines has hit Spain's stock market. It is one of Europe's biggest tourist destinations and stocks in companies such as airlines and hotel chains fell on the Madrid stock exchange.
The Spanish nurse has become the first person in the world to contract Ebola outside of Africa after treating a patient with the deadly virus at Madrid's Carlos III Hospital. Pictured: Police escort an ambulance with the nurse
The medical workers donned full protective clothing as they transported the nurse between Spanish hospitals
Unnamed staff at the hospital where the nurse worked complained the protective gear they were given was inadequate, saying they were permeable and had no breathing apparatus
Prof Jonathan Ball, Professor of Molecular Virology at the University of Nottingham, said: 'If appropriate containment measures were adopted this really should not have happened.
'It will be crucial to find out what went wrong in this case so necessary measures can be taken to ensure it doesn't happen again.
'As the African outbreak perfectly illustrates, healthcare workers put their life on the line, so everything should be done to ensure that risks are minimised as much as possible.
'As for the suggestion of screening people as they arrive at airports, this would only work if people were already showing symptoms.'
Dr Ben Neuman, Lecturer in Virology, University of Reading, said: 'Nurses face a problem in that a person who is sick with Ebola can make quite a lot of highly infectious waste, as the patient loses fluid through diarrhoea and vomiting.
'Those bodily fluids can contain millions of Ebola viruses, and it only takes one to transfer the infection.
'The protective suits that Ebola workers wear provide excellent protection, but there is a danger when it is time to take the suit off.
'It is also possible that a tiny amount of Ebola-containing liquid splashed on the protective garments, and then was transferred to her skin while removing the protective clothing.'
RIGOROUS INFECTION PREVENTION AND CONTROL GUIDANCE SHOULD PROTECT HEALTHCARE WORKERS FROM CONTRACTING DEADLY EBOLA The World Health Organisation (WHO) has set out infection prevention and control guidance, which should be followed by all countries.
It is designed to give advice to any country providing direct and non-direct care to patients with suspected or confirmed Ebola.
Ebola is highly infectious, but it can be prevented, the WHO said.
It is spread through direct contact with bodily fluids, including blood, saliva, urine, semen, vomit and diarrhoea, of an infected patient.
It can also be spread via contact with contaminated surfaces or equipment, including bed linen soiled by body fluids.
The World Health Organisation has outlined detailed infection prevention and control guidelines to help protect healthcare workers from Ebola. Pictured are British army medics training before being deployed to Sierra Leone where they will set up a hospital to treat all medics who have contracted the disease
What are the standard precautions health workers can take?
It is not always possible to identify patients with Ebola in the early stages, because initial symptoms may be non-specific.
WHO advises it is therefore important for all healthcare workers to adhere to standard precautions, including:
hand hygiene
using disposable medical gloves before coming in contact with body fluids, mucus membrane, injured skin and contaminated items
gown and eye protection before procedures, and patient care involving contact with blood or bodily fluids
In addition WHO advises healthcare workers follow best practise advice when giving patients injections, when disposing of sharp instruments, disinfecting reusable equipment and tasked with laundry and waste management.
What if treating suspected or confirmed Ebola patients?
Patients with suspected or confirmed Ebola should be treated in single rooms.
If unavailable, special confined areas should be cordoned off to treat patients.
It is vital, WHO guidelines state, that all suspected and confirmed cases are treated separately.
Clinical and non-clinical staff and dedicated equipment must be assigned exclusively to Ebola care areas.
Access to these areas should be restricted and visitors' access should be limited to those essential for the patient's well-being and care, a parent in the case of a child for example.
In each hospital one member of staff must be named to oversee infection prevention and control compliance.
What protective clothing should healthcare workers wear?
Each person going into Ebola designated areas should be provided with:
correctly sized, non-sterile examination gloves or surgical gloves
disposable, long-sleeved, impermeable gown to cover all clothing and exposed skin
medical mask and eye protection
closed, puncture and fluid resistant shoes
In addition, depending on the level of risk, health workers should wear:
waterproof apron
disposable overshoes and leg coverings, where boots are not available
heavy duty rubber gloves, when carrying out environmental cleaning or handling waste
a respirator
Before leaving the isolation area, medics must carefully remove all protective gear and dispose of it into waste containers. All reusable equipment should be decontaminated.
The 44-year-old Spanish woman was moved between the hospitals in a special fully-incubated stretcher
Medical staff could be seen removing the woman on an enclosed stretcher out of the ambulance last night
The woman has moved from Alcorcon Hospital to Madrid's Carlos III Hospital by those in full protective suits
A medical worker in protective gear stands next to a special stretcher carrying the infected Spanish nurse
Two separate tests confirmed that the woman had contracted the disease.
Despite the concerns raised today, colleagues last night expressed their surprise at news the nurse, from Galicia in northwest Spain, had contracted the virus, saying that there had been 'extreme' measures in place to protect hospital staff.
One told Spanish daily El Pais that nurses were equipped with two protective overalls, two pairs of gloves and glasses. All medics had to use a special card to access the hospital's sixth floor - where the two men were treated.
The Carlos III Hospital was evacuated before the arrival of the first missionary, Miguel Pajares, who contracted the disease in Liberia, but not for Mr Viejo as the sixth floor had already been hermetically sealed.
Mr Pajares, the first person in Europe to be treated for Ebola, died at Madrid's Carlos III Hospital in August despite receiving experimental drug ZMapp after he returned.
Mr Viejo died at the hospital the following month after contracting the virus in Sierra Leone.
The Spanish nurse is understood to have tested positive for Ebola in a first analysis after going to hospital in Alcorcon near Madrid with a high fever early yesterday morning.
Doctors isolated the emergency treatment room.
A Ministry of Health source told Spanish daily El Mundo: 'She arrived at the University Hospital Alcorcon Foundation with fever and has undergone tests. The first test has come back positive.'
From the scene: Spanish nurse contracts Ebola The Spanish nurse was part of the team that treated Spanish priest Manuel Garcia Viejo, who was brought back from Africa last month so that he could be treated for the deadly virus pictured. He died on September 26
Mr Viejo was a member of the Hospital Order of San Juan de Dios who worked in the Western city of Lunsar
Meanwhile, in Oslo medical teams received their country's first Ebola victim after a Doctors Without Borders worker flew home after testing positive for the virus.
Anne-Cecilie Kaltenborn, the organization's general secretary in Norway, said the Norwegian female doctor started feeling sick over the weekend and was isolated after she came down with a fever on Sunday.
'We don't know how she was infected. We have very strict rules about working in the field, and all our workers use protective clothing,' Ms Kaltenborn told reporters in Oslo. 'She will be placed in an isolation ward in hospital in Oslo after arrival.'
Ms Kaltenborn declined to name the worker or give further details pending an investigation by the organization.
She said Doctors Without Borders has 86 foreign workers among the 1,200 working currently in Sierra Leone.
Health Minister Bent Hoie said Norway is ready to accept the patient and that health officials had been preparing for months to treat people infected with the virus.
Another European victim: Ambulances and medical workers gather near an airplane carrying an Norwegian woman infected by Ebola in Sierra Leone, after its arrival at Oslo airport Gardermoen, Norway, today
Ebola spreads through contact with the bodily fluids of someone who has the virus and the only way to stop an outbreak is to isolate those who are infected.
The current outbreak in west Africa, the worst ever, has infected nearly 7,500 people and caused more than 3,400 deaths. There have been a handful of cases in the West.
British nurse William Pooley, 29, who was infected with the virus while working in Sierra Leone, recovered last month after being flown back to London for treatment.
He later jetted to the US to give blood to an American battling the disease.
Today in the U.S., video journalist Ashoka Mukpo, who became infected while working in Liberia, arrived at the Nebraska Medical Centre in Omaha. It's not clear how he was infected said his father, Dr. Mitchell Levy, adding that on Monday, his symptoms of fever and nausea still appeared mild.
Mr Mukpo is the fifth American sick with Ebola brought back from West Africa for medical care.
The others were aid workers - three have recovered and one remains hospitalised.
There are no approved drugs for Ebola, so doctors have tried experimental treatments in some cases.
A critically ill Liberian man hospitalised in Dallas is getting an experimental treatment, Texas Health Presbyterian Hospital said.
Thomas Eric Duncan is the first person to be diagnosed with Ebola in the U.S., he was admitted to the hospital on September 28.
The hospital said Mr Duncan was receiving an experimental medication called brincidofovir, which was developed to treat other types of viruses. Laboratory tests suggested it may also work against Ebola.
Texas Governor Rick Perry urged the U.S. government to begin screening air passengers arriving from Ebola-affected nations, including taking their temperatures.
But Federal health officials say a travel ban could make the desperate situation worse in those countries. White House spokesman Josh Earnest said it was not currently under consideration.
President Barack Obama said the U.S. will be 'working on protocols to do additional passenger screening both at the source and here in the United States.' He did not outline any details.
Spanish priest Manuel Garcia Viejo is pictured being flown home from Sierra Leone in a plastic isolation chamber. It is understood that the female Spanish nurse was part of the team that treated him
COUNTRIES MOST AT RISK The researchers at Northeastern University, in Boston, calculated the countries most at risk in the short term, are:
Ghana
UK
Nigeria
Gambia
Ivory Coast
Belgium
France
Senegal
Morocco
Mali
Mauritiania
Guinea Bissau
U.S.
Germany
South Africa
Kenya
Leading charity Save the Children warned recently Ebola is spreading at a 'terrifying rate' with the number of recorded cases doubling every week.
Speaking at a conference in London co-hosted with Sierra Leone last week, UK Foreign Secretary Philip Hammond called for more financial aid, doctors and nurses.
Scientists have warned that the deadly virus could spread across the world infecting people from the U.S. to China within three weeks.
There is a 50 per cent chance a traveller carrying the disease could touch down in the UK by October 24, a team of U.S. researchers have predicted.
Using Ebola spread patterns and airline traffic data they have calculated the odds of the virus spreading across the world.
They estimate there is a 75 per cent chance Ebola will reach French shores by October 24.
And Belgium has a 40 per cent chance of seeing the disease arrive on its territory, while Spain and Switzerland have lower risks of 14 per cent each.
A team of scientists at Northeastern University in Boston have used air travel information to predict where the deadly Ebola virus could reach in the next three weeks
Professor Alessandro Vespignani of Northeastern University in Boston, who led the research, said: 'This is not a deterministic list, it's about probabilities � but those probabilities are growing for everyone.
'It's just a matter of who gets lucky and who gets unlucky.
'Air traffic is the driver.
'But there are also differences in connections with the affected countries (Guinea, Liberia and Sierra Leone), as well as different numbers of cases in these three countries - so depending on that, the probability numbers change.'
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