Ebola Death Toll Tops 4,000 in Africa

American Marines scrambled to add Ebola treatment beds in Liberia on Friday, while the U.S. and Britain readied new disease screenings for passengers arriving at their airports from West Africa. Doctors tried out experimental drugs in a global battle against the deadly sickness.

The U.N. said nations must all work together — and fast — or "the world will have to live with the Ebola virus forever."

The death toll in West Africa passed 4,000 for the first time in the World Health Organization's count of confirmed and suspected Ebola cases.

As worry ricocheted around the globe, medical records obtained by The Associated Press underscored questions about the United States' front-line defenses. The Dallas hospital that initially missed the nation's first Ebola diagnosis put a Liberian man through a battery of tests and CT scans for appendicitis, stroke and other serious ailments before sending him home, the records show.

Before he was released, Thomas Eric Duncan's fever spiked to 103 degrees, he reported severe pain and told a nurse that he'd recently come from Africa. But doctors didn't think of Ebola until he returned to the hospital two days later by ambulance. On Thursday, Duncan became the first person to die of Ebola in the United States.

Questions linger about the readiness of the medical system in Spain, too.

Prime Minister Mariano Rajoy's motorcade was jeered by health care workers when he made a surprise visit Friday to the Madrid hospital where a nursing assistant is lying sick with Ebola, which she apparently caught while treating a patient infected in West Africa. Unions and opposition politicians said the national health care system didn't give medical workers the proper training and protective gear.

At the United Nations, the focus was on the three countries where the virus is multiplying out of control — Liberia, Sierra Leone and Guinea.

"As long as there is one case of Ebola in any one of these countries, no country is safe from the dangers posed by this deadly virus," said Anthony Banbury, who heads the new United Nations Mission for Ebola Emergency Response.

A guide to development around the globe:

On the Ground

The U.S. military is rushing to set up a 25-bed hospital in Liberia for health workers who catch the disease. Because Ebola is spread by bodily fluids such as blood and urine, West African doctors and nurses are especially vulnerable to infection at a moment when their nations need them desperately.

Rear Adm. Scott Giberson, the acting U.S. deputy surgeon general, said the facility would be ready within weeks.

"We have experience deploying in lots of medical settings," Giberson said. "However, this is unique."

In addition to the hospital, a vanguard of Marines brought aircraft this week that will help ferry construction supplies for 17 treatment units with 100 beds each, to be finished by the end of November.

The total American forces responding to the crisis may reach 4,000, U.S. officials said.

At Big U.S. Airports

New York's Kennedy International was slated to begin checking some arriving passengers Saturday for fever, which could be a sign of Ebola but also is common with many other illnesses.

Passengers traveling from Liberia, Sierra Leone or Guinea are to be screened using no-touch thermometers. Over the next week, the screenings will expand to Newark Liberty, Washington Dulles, Chicago O'Hare and Hartsfield-Jackson in Atlanta. Together, those airports receive more than 90 percent of passengers from the three nations.

A U.S. citizen who presents a heightened risk of disease upon arrival at the United States has a legal right to re-enter the country and be safely quarantined, said Lawrence Gostin, a public health law expert at Georgetown University. That same guarantee would not apply to non-U.S. citizens, but as a practical matter, giving them immediate treatment might be safer than putting them on a plane back home.

British authorities announced their own plans to impose enhanced screening at Heathrow and Gatwick airports, as well as Eurostar rail terminals. Prime Minister David Cameron's office said passengers arriving from West Africa would be questioned about their travels and contacts.

The Hunt for a Cure

Texas Presbyterian, the Dallas hospital where Duncan died, said he became the first Ebola patient to receive the investigative antiviral drug Brincidofovir.

In Spain, nursing assistant Teresa Romero was to be treated with the experimental drug ZMapp, which is in extraordinarily short supply worldwide, a spokeswoman for Madrid's regional health agency said.

Meanwhile, a possible Ebola vaccine developed by the U.S. government is being tested on up to 40 medical workers in the West African nation of Mali, which shares a border with Guinea. If safety tests go well, larger trials could be done in the outbreak zone early next year. The vaccine also is being safety tested in the United States and Britain.

A group of leading doctors published a letter in the journal Lancet on Friday, arguing that promising Ebola drugs should be tried in West Africa without randomized trials in which one group of patients receives a new drug or vaccine and another group receives standard care or a placebo so the results can be compared.

"We accept that RCTs (randomized controlled trials trials) can generate strong evidence in ordinary circumstances; not, however in the midst of the worst Ebola epidemic in history," wrote the authors, including Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine.

The scientists propose different approaches to testing in this emergency, such as trying different experimental treatments at the same time at different sites.

A Plea for Faster Action

The number of Ebola cases is probably doubling every three-to-four weeks, says the U.N. special envoy on Ebola, David Nabarro.

Without a mass mobilization of nations and relief groups to help West Africa, he told the U.N. General Assembly, "it will be impossible to get this disease quickly under control, and the world will have to live with the Ebola virus forever."

The world's response needs to be 20 times greater than it is now, Nabarro said.

Yet he said the United Nations is committed to rallying the response necessary to stop Ebola "within a matter of months — a few months."

Connie Cass reported from Washington. Emily Schmall in North Carolina, Holbrook Mohr and Nomaan Merchant in Dallas, Edith M. Lederer at the United Nations, Jonathan Paye-Layleh in Monrovia, Liberia, Robbie Corey-Boulet in Abidjan, Ivory Coast, Ciaran Giles in Madrid and Harry Dunphy in Washington contributed to this report.

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