Ebola - The New Pandemic - Coming to someplace near you soon?!

[Peter Lemkin]

Another hospital worker in Dallas has ebola. So how will they spin it this time? We know they were in protective gear. A sneeze perhaps?

I just heard how that Dallas hospital handled this case - twice; they did worse than most Liberian health facilities. The first time he was given antibiotics and send home. On re-admission the patient first long sat in an emergency waiting room with other patients and staff. Then, he was finally moved to an isolation unit, but the nurses and others who were around him did NOT have anything NEAR sufficient protective clothing! [nor the training on how to use them, and how to treat an Ebola patient!]...and worst of all, they sent his lab specimens through the hospitals pneumatic tube system - infecting the entire system, other lab specimens, and lab technicians. That hospital will likely have to be partly closed and disinfected - and many who work there and/or were patients/visitors will come likely down with Ebola...sorry to say. Dallas is the new American epicenter of Ebola.....ironic fate. Now would be a good time to stop shaking hands around town and go on vacation......

Wasn't there a note written by a nurse in the electronic records system alerting to possibility of Ebola?

Yes, the nurse that attended the man the first time he self-admitted and said he had just returned from 'West Africa' suspected he MIGHT have Ebola and noted this in the computer - but NONE of the doctors that 'treated' him ever saw that computer entry - so he was just given antibiotics and sent home. This hospital has made MANY mistakes and will pay dearly for them, I'm afraid. When he returned in an ambulance the second time he stated he feared he had Ebola - and they put him in a waiting room for some hour.......

[Magda Hassan]

Another hospital worker in Dallas has ebola. So how will they spin it this time? We know they were in protective gear. A sneeze perhaps?

I just heard how that Dallas hospital handled this case - twice; they did worse than most Liberian health facilities. The first time he was given antibiotics and send home. On re-admission the patient first long sat in an emergency waiting room with other patients and staff. Then, he was finally moved to an isolation unit, but the nurses and others who were around him did NOT have anything NEAR sufficient protective clothing! [nor the training on how to use them, and how to treat an Ebola patient!]...and worst of all, they sent his lab specimens through the hospitals pneumatic tube system - infecting the entire system, other lab specimens, and lab technicians. That hospital will likely have to be partly closed and disinfected - and many who work there and/or were patients/visitors will come likely down with Ebola...sorry to say. Dallas is the new American epicenter of Ebola.....ironic fate. Now would be a good time to stop shaking hands around town and go on vacation......

Wasn't there a note written by a nurse in the electronic records system alerting to possibility of Ebola?

Yes, the nurse that attended the man the first time he self-admitted and said he had just returned from 'West Africa' suspected he MIGHT have Ebola and noted this in the computer - but NONE of the doctors that 'treated' him ever saw that computer entry - so he was just given antibiotics and sent home. This hospital has made MANY mistakes and will pay dearly for them, I'm afraid. When he returned in an ambulance the second time he stated he feared he had Ebola - and they put him in a waiting room for some hour.......

For-Profit Healthcare Under Fire As Ebola Spreads to Second US Healthcare Worker

CDC says Dallas healthcare worker took a flight from Cleveland to Dallas the day before reporting symptoms



by
Lauren McCauley, staff writer

As a second healthcare worker contracts Ebola in Texas, the privatized U.S. hospital system is facing increasing scrutiny. (Photo: CDC)

Update:
The Centers for Disease and Control announced Wednesday that the second Dallas healthcare worker infected with Ebola flew from Cleveland to Dallas on Monday, the day before Amber Vinson, 29, a nurse at Texas Health Presbyterian Hospital was confirmed to have Ebola. Vinson had a temperature of 99.5 Fahrenheit before she boarded her flight. The CDC said they will interview all 132 passengers on the flight, Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth, which landed at 8:16 p.m. CT Monday.
Earlier:
A second healthcare worker at Texas Health Presbyterian Hospital who helped treat the late Ebola patient Thomas Eric Duncan has now tested positive for the virus, state health officials confirmed on Wednesday.
The unidentified worker reported having a fever on Tuesday and was immediately isolated. A preliminary Ebola test confirmed the presence of the disease and confirmatory testing is now being conducted by the Centers for Disease Control and Prevention in Atlanta.
According to the Texas Department of State Health Services, officials are in the process of interviewing the patient to identify individuals who may have had contact or potential exposure to the virus.
News of the infection comes four days after a nurse from Texas Health Presbyterian, identified as the 26-year-old Nina Pham, also tested positive for Ebola.
A growing number of health experts are drawing a line between this gross unpreparedness and the United States' for-profit healthcare system, under which there is minimal oversight and no uniformity between healthcare providers.The National Nurses Union for months has warned that poor hospital training and oversight is putting U.S. healthcare workers at great risk of contracting the virus. The NNU conducted a recent survey of healthcare workers across the country and found that 76 percent said their hospital had not yet communicated to them any policy regarding potential admission of patients infected by Ebola.
"What concerns me is that this validated what our systems say all over the country throughout the last two months, that hospitals are not prepared to take care of Ebola patients," Deborah Burger, co-president of NNU, told ABC News.
A growing number of health experts are drawing a line between this gross unpreparedness and the United States' for-profit healthcare system, under which there is minimal oversight and no uniformity between healthcare providers.
Speaking on Democracy Now! Wednesday morning, Dr. Lawrence Gostin, faculty director at the O'Neill Institute for National & Global Health Law at Georgetown University, asked: "We call ourselves the most advanced health system in the world, but what do we meant by that?"
"I think what we mean is that we have the best of the best of the world," Gostin continued. "We also have a highly variable system: so many different hospitals, so many different emergency rooms, over 300 local health authorities with such different standards." Gostin said that the U.S. needs to "up our game," with more uniform systems in place, more uniform equipment and training at every institution.
The NNU is holding a national conference call Wednesday at 3 PM for a discussion about U.S. hospital preparedness. Over 1,000 nurses have already signed up for the call.
The World Health Organization on Tuesday warned that the number of cases of Ebola is growing exponentially as the global response continues to fall far short of what's needed to combat the spread of the deadly virus. WHO assistant director-general Dr. Bruce Aylward said that if efforts do not improve there could be as many as 10,000 new cases per week within two months within those hardest hit areas in West Africa. According to the WHO, over 4,400 people have now died of Ebolathe vast majority in Liberia, Sierra Leone and Guinea.

[Peter Lemkin]

America is always claiming/bragging that it has the 'best healthcare system in the World' when anyone who has traveled knows many other countries, including little Cuba, in many ways have better health care systems. Yes, in some major US hospitals etc. one can find the most sophisticated machinery and surgeons, doctors; however, few now in the USA can afford this highest level of care. The entire system is built to offer lesser [or no] care to those who aren't wealthy, and there is almost zero emphasis on public health or health promotion. (the emphasis is on prolonged hospital stays, unnecessary expensive procedures and profit, profit, profit. This epidemic and other situations like it show the huge flaws in the privatized U.S. system. All the shiny bells and whistles on the machinery won't save you - good training and an ethic of care might.

[Peter Lemkin]

The day before she went to the hospital with Ebola symptoms, Amber Vinson was flyinghalfwayacross the country on a commercial jet with 132 other people.
Centers for Disease Control and Prevention Director Dr. Tom Frieden said she never should have stepped foot on the flight, but another federal official told CNN that no one at the agency stopped her.
Before flying from Cleveland to Dallas on Monday, Vinson called the CDC to report an elevated temperature of 99.5 Fahrenheit. She informed the agency that she was getting on a plane, the official said, and she wasn't told not to board the aircraft.
After authorities announced the 29-year-old nurse had been diagnosed with Ebola on Wednesday, they were quick to say guidelines weren't followed when she took the commercial flight.
Dallas Mayor Mike Rawlings said he wasn't sure how it happened
"She was being monitored here in Dallas," he told CNN's "The Situation Room."
"And if she was being monitored correctly, I think she should have never gotten on that flight."
Frieden said Vinson shouldn't have flown because she helped care for Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Dallas, and because another health worker who cared for Duncan had already been diagnosed with the virus.
"The CDC guidance in this setting outlines the need for what is called controlled movement. That can include a charter plane, a car, but it does not include public transport," Frieden said. "We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement."
The agency also is considering expanding its "no-board" list for people with known infectious diseases to include people being monitored for Ebola, a CDC official said.
CDC guidelines warn airport screeners that travelers returning from West Africa with a temperature of 100.4 Fahrenheit and higher could be showing Ebola symptoms. That threshold is nearly a degree higher than the temperature Vinson reported.
Frieden said that Vinson's slightly elevated temperature was another sign she shouldn't have boarded the aircraft.
Vinson didn't show any symptoms when she got on the flight Frontier Airlines flight from Cleveland to Dallas, the airline said.
Frieden said there's an "extremely low" risk to anyone else on that plane, but the CDC is reaching out to everyone on the flight as part of "extra margins of safety."
Vinson was transferred Wednesday nightfrom the Dallas hospital to Emory University Hospital in Atlanta, which has successfully treated two other patients. It is now treating a third: a male health care worker who was infected in Sierra Leone.
Vinson is "ill but clinically stable," Frieden said.
The first Dallas health care worker diagnosed with Ebola, Nina Pham, remains in good condition, officials said. It has not been determined whether she will be transferred to another facility.
Both Dallas health workers had "extensive contact" with Duncan on September 28-30, when he had "extensive production of body fluids" such as vomit and diarrhea, Frieden told reporters in a conference call.
Should air travel be restricted because of Ebola?
Health care workers who had been exposed to Duncan were undergoing self-monitoring.
CDC wants to interview passengers
Vinson flew from Dallas-Fort Worth to Cleveland on October 10, Frontier Airlines said. On October 13, she headed home.
That's the flight health officials are concerned about, though they stress that the risk of exposure to passengers who were on the plane with Vinson is low, since she did not yet show symptoms. The Ebola virus is not contagious before symptoms set in.
"Because of the proximity in time between the evening flight and first report of illness the following morning, CDC is reaching out to passengers who flew on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth Oct. 13," the CDC said in a statement.
Are you on the front lines fighting Ebola?
The October 13 flight was cleaned thoroughly after it landed, "per our normal procedures which is consistent with CDC guidelines," the airline said. After the airline was informed of the Ebola patient, the plane was removed from service.
After going through decontamination, the plane was going back into service on Wednesday, Ricky Smith, Cleveland's Director of Port Control, said at a news conference. Both the CDC and the airline were comfortable that it was safe to resume operations, he said.
In a sign of growing concerns about Ebola, President Barack Obama canceled trips to New Jersey and Connecticut on Wednesday to convene a meeting at the White House of Cabinet agencies coordinating the government's response to the outbreak. The President canceled planned travel Thursday in order to oversee the response.
Obama said he called Wednesday's meeting after the second nurse's diagnosis.
"We're going to make sure that something like this is not repeated, and that we are monitoring, supervising, overseeing in a much more aggressive way exactly what's taking place in Dallas ... and making sure that the lessons learned are then transmitted to hospitals all across the country," he said.
Hospital denies 'institutional problem'
The news that Vinson contracted Ebola cast further doubt on the hospital's ability to handle the virus and protect employees.
On Wednesday night, a federal official told CNN Chief Medical Correspondent Dr. Sanjay Gupta that staffing issues at the hospital were behind the decision to transfer Vinson to Emory.
"What we're hearing is that they are worried about staffing issues and a possible walkout of nurses," the official said.
Some nurses at the hospital have slammed conditions there, telling a union they felt "unsupported, unprepared, lied to and deserted."
Complete coverage on Ebola
It's the same hospital that initially sent Duncan home, even though he had a fever and had traveled from West Africa. By the time he returned to the hospital, his symptoms had worsened. He died while being treated by medical staff, including the two women who have contracted the disease.
"I don't think we have a systematic institutional problem," Dr. Daniel Varga, chief clinical officer of Texas Health Resources, told reporters, facing questions about the hospital's actions.
Rick Perry heads to Europe despite Ebola situation
Medical staff "may have done some things differently with the benefit of what we know today," he said, adding, "no one wants to get this right more than our hospital."
But on Wednesday night, the hospital released a statement offering a room to any employee who is concerned about exposure to Ebola.
"Texas Health Dallas is offering a room to any of our impacted employees who would like to stay here to avoid even the remote possibility of any potential exposure to family, friends and the broader public," the hospital said.
"We are doing this for our employees' peace of mind and comfort. This is not a medical recommendation. We will make available to our employees who treated Mr. Duncan a room in a separate part of the hospital throughout their monitoring period."
People in Vinson's office building were informed when officials went door to door, and also through early morning reverse 911 calls, officials said.
The health care worker had no pets, authorities said.
Official: Duncan should have been moved
An official close to the situation says that in hindsight, Duncan should have been transferred immediately to either Emory University Hospital or Nebraska Medical Center in Omaha.
Those hospitals are among only four in the country that have biocontainment units and have been preparing for years to treat a highly infectious disease such as Ebola.
"If we knew then what we know now about this hospital's ability to safely care for these patients, then we would have transferred him to Emory or Nebraska," the official told CNN senior medical correspondent Elizabeth Cohen.
"I think there are hospitals that are more than ready, but I think there are some that are not."

[Peter Lemkin]

Ironic, but not too surprising that after W. African nations, the USA has become the first Western country with the possible widespread of Ebola. That second nurse went on a plane with 132 person the day before she was hospitalized - yet I don't hear that the CDC or anyone is contacting those persons [or those who were in the hospital with the man who died of Ebola]...and isolating them as well as tracking those who they, in turn, have been in contact with. Without such measures Ebola could spread in the USA like wildfire. The more 'developed' and mobile the society - the quicker such a disease will spread! The USA is as unprepared to deal with this as are the poor W. African countries, sadly. We have the technical resources - but do not have the will, the care, the infrastructure of national health care, etc. We don't even have MSF - who know how to treat Ebola and maybe should be sent to poor 'ol USA to help out. Meanwhile Obama is talking tough and saying that he'll send CDC 'swat teams' (disgusting analogy!) to anywhere there is a case of Ebola. Well, there are several hundred potential ones and I don't see the 'CDC swat teams'. If the USA would put as much effort and money into stopping such diseases as they have in bioweapons and just ordinary weapons, then something might happen positive. We're all in the same small 'boat' called Planet Earth - and with modern communications and travel, what befalls one befalls all.....

[Peter Lemkin]

Ebola virus outbreak in the United States

From Wikipedia, the free encyclopedia


For a background of the ongoing outbreak, see Ebola virus epidemic in West Africa.

On September 30, 2014, the CDC announced that Thomas Eric Duncan, a 42-year-old Liberian national, had been diagnosed with Ebola virus disease in Dallas, Texas.[SUP][6][/SUP][SUP][7][/SUP] Duncan, who had been visiting family in Dallas, was treated at Texas Health Presbyterian Hospital Dallas.[SUP][8][/SUP][SUP][9][/SUP] By October 4, Duncan's condition had deteriorated from "serious but stable" to "critical."[SUP][10][/SUP] On October 8, Duncan died of Ebola virus disease.[SUP][11][/SUP][TABLE="class: infobox, width: 22"]
Cases in the United States[TR]
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[TH="colspan: 2, align: center"]Map showing location of Ebola patients diagnosed in the U.S. (in red). Does not include people evacuated to the U.S. after contracting Ebola in Africa. Updated:October 13, 2014[/TH]
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[TH]Deaths[/TH]
[TD]1[/TD]
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[TH]Cases first diagnosed in U.S.[/TH]
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[TH]Cases evacuated to U.S. from other countries[/TH]
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[TH]Suspected cases in medical isolation[SUP][note 1][/SUP][/TH]
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[TH]Quarantined people[/TH]
[TD]4[SUP][3][/SUP][/TD]
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[TH]Under observation[/TH]
[TD]10 (via primary contact)[SUP][note 2][/SUP]
100 (via secondary contact)[SUP][note 3][/SUP][SUP][5][/SUP][/TD]
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A second case of Ebola was diagnosed on October 11 in a nurse, Nina Pham, who had provided care to Duncan at the hospital.[SUP][12][/SUP] A third case was diagnosed on October 14 in another nurse, Amber Vinson, who had also treated Duncan.[SUP][13][/SUP]

Contents

[hide]

• 1 Background
  • 1.1 First case
    
  • 1.2 Secondary infections of health workers
    • 1.2.1 Nina Pham
      
    • 1.2.2 Amber Vinson
      
    
    
  • 1.3 Monitoring of other health care workers
    
  
  
• 2 Reaction
  • 2.1 Containment efforts
    
  
  
• 3 Medical evacuations to the U.S.
  
• 4 Biocontainment units
  
• 5 See also
  
• 6 Notes
  
• 7 References
  
• 8 External links
  

Background[edit]

First case[edit]

[TABLE="class: vertical-navbox nowraplinks hlist, width: 18"]
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[TD]Articles related to the[/TD]
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[TH][URL="https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa"]Ebola virus epidemic in
West Africa[/URL][/TH]
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[TH]Background articles[/TH]
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• Ebola virus disease Timeline
  

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[TH]Overview[/TH]
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• Ebola virus epidemic in West Africa
  
• Responses
  

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[TH]Affected nations[/TH]
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• Guinea
  
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Thomas Eric Duncan was from Monrovia, Liberia, a country among those hardest hit by the Ebola virus epidemic. Duncan worked as a personal driver for the general manager of Safeway Cargo, a FedEx contractor in Liberia.[SUP][14][/SUP] According to the manager, Henry Brunson, Duncan abruptly quit his job on September 4, 2014, giving no reason.[SUP][15][/SUP] Duncan was traveling on a visa when he made his first trip to the U.S. to reunite with his estranged son and the teen's mother, Louise Troh, who had been his girlfriend in Liberia.[SUP][16][/SUP][SUP][17][/SUP]
On September 15, 2014, the family of Ebola virus disease patient Marthalene Williams were unable to summon an ambulance to transfer Williams to the hospital. Their tenant, Duncan, helped to transfer Williams by taxi to an Ebola treatment ward in Monrovia, Liberia. Duncan rode in the taxi to the treatment ward with Williams, her father, and her brother. The family was turned away due to lack of space and Duncan helped carry Williams from the taxi back into her home, where she died shortly afterward.[SUP][18][/SUP]
On September 19, Duncan went to the airport in Monrovia, where according to Liberian officials Duncan lied about his history of contact with the disease on an airport questionnaire before boarding a Brussels Airlines flight to Brussels. In Brussels, Duncan boarded United Airlines Flight 951 to Washington Dulles Airport.[SUP][19][/SUP] From Washington, he boarded United Airlines Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT[SUP][20][/SUP] on September 20, 2014,[SUP][8][/SUP][SUP][21][/SUP] and stayed with his partner and her five children, who live in the Fair Oaks neighborhood of Dallas.[SUP][22][/SUP][SUP][23][/SUP]
Duncan began experiencing symptoms on September 24, 2014, and went to the Texas Health Presbyterian Hospital emergency room late in the evening of September 25, 2014. During this visit, the hospital reported his symptoms were a 100.1 °F (37.8 °C) fever, abdominal pain for two days, a headache, and decreased urination; and that he had no vomiting, diarrhea, or nausea at the time. The ER nurse had asked about his travel history and recorded he had come from Liberia. It was initially reported that this information was not relayed to the doctor by the hospital's electronic medical record (EMR) system,[SUP][24][/SUP] but the hospital later retracted that statement. Hospital officials also said that Duncan had been asked if he had been around anyone who had been sick, and said Duncan told them he had not.[SUP][25][/SUP] He was diagnosed with a "low-grade, common viral disease" and was sent home with a prescription for antibiotics.[SUP][26][/SUP] Medical records later retrieved by the Associated Press revealed Duncan had a fever as high as 103 °F (39 °C) during the initial visit and that he rated his pain as 8 on a scale of 1 to 10.[SUP][27][/SUP] Duncan began vomiting on September 28, 2014, and was transported the same day to the same Texas Health Presbyterian Hospital emergency room by ambulance.[SUP][28][/SUP][SUP][29][/SUP] His Ebola diagnosis was confirmed during a CDC news conference on September 30, 2014.[SUP][30][/SUP][SUP][31][/SUP]
On October 1, 2014, Texas Governor Rick Perry announced at a news conference that Duncan had contact with up to 18 people in Dallas, including several school children,[SUP][32][/SUP][SUP][33][/SUP] who are being monitored at home.[SUP][34][/SUP] Up to 100 people may have had contact with people who had contact with Duncan after he showed symptoms. Health officials later monitored 50 low-risk contacts, and 10 high-risk contacts. The 10 high-risk contacts are Duncan's close family members and three ambulance workers who took him to the hospital.[SUP][35][/SUP] Everyone who came into contact with Duncan is currently being monitored daily to watch for symptoms of the virus.[SUP][36][/SUP] The same day, a second person who had close contact with Duncan was put under close observation.[SUP][37][/SUP] On October 3, Howard University Hospital announced they had placed a patient in isolation after he displayed Ebola-like symptoms and had recently traveled to Nigeria,[SUP][38][/SUP] but that patient was later "ruled out" of having Ebola.[SUP][39][/SUP] On October 4, 2014, two people earlier suspected of having Ebola were declared not infected.[SUP][2][/SUP]
Duncan was treated at Texas Health Presbyterian Hospital in Dallas.[SUP][8][/SUP] As of October 4, Duncan's condition had deteriorated from "serious but stable" to "critical".[SUP][40][/SUP] Duncan was not given the experimental drugZMapp, which was used to treat previous cases of Ebola in aid workers and medical staff, as stocks of the drug were depleted at the time of his infection.[SUP][41][/SUP] American Ebola survivor Kent Brantly offered to donate his blood to Duncan; however, their blood types were incompatible.[SUP][42][/SUP]
On October 4, Duncan began receiving the experimental drug brincidofovir, which only received an FDA emergency investigational new drug authorization for Ebola treatment on October 6. Duncan was still in critical condition as of October 6, while still receiving brincidofovir.[SUP][43][/SUP][SUP][44][/SUP] The next day, the CDC announced it had lost track of a homeless man who had been in the same ambulance Duncan had taken. They announced efforts were under way to locate the man and place him in a comfortable and compassionate monitoring environment.[SUP][45][/SUP] Later that day, the CDC announced that the man had been found and is being monitored.[SUP][4][/SUP] On October 7, it was reported that Duncan's condition was improving.[SUP][46][/SUP] However, Duncan died at 7:51 a.m. Central Time (DST) on October 8, 2014, and became the first patient to die within the United States of Ebola virus disease.[SUP][47][/SUP][SUP][11][/SUP]
Josephus Weeks, the nephew of Duncan, accused Texas Health Presbyterian of "ignorance, incompetence and indecency" in the care of his uncle. Jesse Jackson also accused the hospital of discrimination.[SUP][48][/SUP]The hospital stated Duncan received the "highest level of attention and care, regardless of nationality or ability to pay."[SUP][49][/SUP]

Secondary infections of health workers[edit]

Nina Pham[edit]

On the night of October 10, a 26-year-old nurse, Nina Pham, who had treated Duncan at Texas Health Presbyterian Hospital, reported a low-grade fever and was placed in isolation. On October 11, Pham tested positive for Ebola virus, becoming the first person to contract the virus in the U.S.[SUP][12][/SUP][SUP][50][/SUP][SUP][51][/SUP] On October 12, the CDC confirmed the positive test results.[SUP][12][/SUP] Hospital officials said Pham wore the recommended protective gear when treating Duncan on his second visit to this Dallas hospital, and she had "extensive contact" with him on "multiple occasions". Pham was in stable condition as of October 12.[SUP][12][/SUP][SUP][50][/SUP][SUP][52][/SUP] Although no evidence exists of dogs transmitting Ebola virus to humans, Pham's dog is being quarantined out of caution.[SUP][53][/SUP]
Tom Frieden, director of the Centers for Disease Control and Prevention, initially blamed a breach in protocol for the infection.[SUP][54][/SUP] The hospital's chief clinical officer, Dr. Dan Varga, said all staff had followed CDC recommendations. Bonnie Costello of National Nurses United said, "You don't scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct."[SUP][55][/SUP]Frieden later spoke to "clarify" that he had not found "fault with the hospital or the healthcare worker." [SUP][56][/SUP] National Nurses United criticized Texas Health Presbyterian for its lack of Ebola protocols and guidelines that were "constantly changing."[SUP][57][/SUP] Nurses at the hospital who were assigned to care for Duncan claimed they did not receive the proper training or personal protective equipment.[SUP][58][/SUP] A report indicated that healthcare workers did not wear hazmat suits until Duncan's test results confirmed his infection due to Ebola, two days after his admission to the hospital. Frieden later admitted that the CDC could have been more aggressive in the management and control of the virus at the hospital.[SUP][59][/SUP]
Pham's infection represents the first case contracted on U.S. soil, leading Frieden to launch an investigation as to how she became infected.[SUP][60][/SUP][SUP][61][/SUP] On October 13, Dr. Frieden urged the public to brace for more bad news, however, suggesting that there could be additional cases in coming days, particularly among the health care workers who cared for the previous patient, Duncan.[SUP][60][/SUP]

Amber Vinson[edit]

On October 14, a second nurse at Texas Health Presbyterian Hospital, identified as 29-year-old Amber Vinson,[SUP][62][/SUP] reported a fever. Vinson was among the nurses who provided treatment for Duncan and was isolated within 90 minutes of reporting the fever. By the next day, Vinson had tested positive for Ebola virus.[SUP][63][/SUP] On October 13, Vinson had flown Frontier Airlines Flight 1143 from Cleveland to Dallas, after spending the weekend in Akron, Ohio. She had a fever of 99.5 °F (37.5 °C) before boarding the 128-passenger jet, according to public health officials. Vinson had flown to Cleveland from Dallas on Frontier Airlines Flight 1142 on October 10.[SUP][64][/SUP] During a press conference, CDC Director Tom Frieden stated she should not have traveled, since she was one of the health care workers known to have exposure to Duncan.[SUP][65][/SUP] Passengers of both flights were asked to contact the CDC as a precautionary measure.[SUP][66][/SUP][SUP][67][/SUP][SUP][68][/SUP]
It was later discovered that the CDC gave Vinson permission to board a commercial flight to Cleveland.[SUP][69][/SUP] Before her trip back to Dallas, she called the CDC several times to report her 99.5 °F fever before boarding her flight. A CDC employee who took her call checked a CDC chart, noted that Vinson's fever wasn't 100.4 °F (38.0 °C) or higher which the CDC deemed as "high risk", and gave her permission to board the commercial flight.[SUP][70][/SUP]
On October 15, the U.S. Department of Health and Human Services announced Vinson will be transferred to Emory University Hospital in Atlanta.[SUP][71][/SUP]

Monitoring of other health care workers[edit]

There are currently 76 Texas Presbyterian Hospital health care workers being monitored because they had some level of contact with Thomas Duncan. [SUP][72][/SUP]

Reaction[edit]

"First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low."

US President Barack Obama, Remarks by the President on the Ebola Outbreak, September 16, 2014.[SUP][73][/SUP]

On October 2, Liberian authorities said they could prosecute Duncan if he returned because he had filled out a form before flying falsely stating he had not come into contact with an Ebola case.[SUP][74][/SUP] Liberian President Ellen Johnson Sirleaf told the Canadian Broadcasting Corporation she was angry with Duncan for what he had done, especially given how much the United States was doing to help tackle the crisis: "One of our compatriots didn't take due care, and so, he's gone there and in a way put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him.…The fact that he knew (he might be a carrier) and he left the country is unpardonable, quite frankly."[SUP][75][/SUP]
The United States federal government told American citizens not to worry about an epidemic of Ebola in the United States, stating that the risk of such an epidemic was very low.[SUP][76][/SUP] On Twitter on September 30, over 50,000 tweets in response to the Ebola case were posted in one hour.[SUP][77][/SUP]

Containment efforts[edit]

On October 12, Dr. Aileen Marty, a doctor with the WHO who had spent 31 days in Nigeria, criticized the complete lack of screening for Ebola on her recent return to the United States through Miami International Airport.[SUP][78][/SUP] After the death of the Liberian national Duncan, who had been exposed to Ebola but lied on a questionnaire regarding his exposure, President Obama announced that the government would develop expanded screening of airline passengers for Ebola, but there would be no travel ban.[SUP][79][/SUP]
The process of screening airplane passengers for fever, as well as the issuance of Ebola questionnaires, is to be implemented at five U.S. airports, which take more than 94% of the passengers from Guinea, Liberia, and Sierra Leone, the three countries that are hit heavily with Ebola. These airports are John F. Kennedy International Airport (Queens, New York); Newark Liberty International Airport (Newark, New Jersey); O'Hare International Airport (Chicago, Illinois); Washington Dulles International Airport (Dulles, Virginia); and HartsfieldJackson Atlanta International Airport (Atlanta, Georgia).[SUP][80][/SUP][SUP][81][/SUP] Although no plans have been announced for other airports, screening in the U.S. represents a second layer of protection since passengers are already being screened upon exiting these three countries. However, the risk can never be totally eliminated.[SUP][82][/SUP]

Medical evacuations to the U.S.[edit]

Map, showing countries and U.S. states affected with Ebola in color.
Nebraska and Georgia are in blue, indicating medically evacuated cases with no deaths.
Texas is in lighter red, indicating local transmission with no deaths, and orange, indicating an initial case that lead to an Ebola death.

As of October 6, 2014, five Americans have been evacuated to the U.S. for treatment after contracting Ebola in West Africa.[SUP][83][/SUP] Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan's Purse, and co-worker Nancy Writebol were infected while working inMonrovia.[SUP][84][/SUP][SUP][85][/SUP][SUP][86][/SUP] Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital.[SUP][87][/SUP]On August 21, Brantly and Writebol recovered and were discharged.[SUP][88][/SUP]
On September 4, a Massachusetts physician, Rick Sacra, was airlifted from Liberia to be treated in Omaha, Nebraska at the Nebraska Medical Center. Working for Serving In Mission (SIM), he is the third U.S. missionary to contract EVD.[SUP][89][/SUP] He thinks he probably contracted Ebola while performing a caesarean section on a patient who had not been diagnosed with the disease. While in hospital, Sacra received a blood transfusion from Kent Brantly, who had recently recovered from the disease. On September 25, Sacra was declared Ebola-free and released from the hospital.[SUP][90][/SUP]
On September 9, the fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. The identity of the patient, a doctor working for the WHO in Sierra Leone, was not released.[SUP][91][/SUP] He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease.[SUP][92][/SUP] In addition, on September 21, a CDC employee was flown back to the United States after low risk exposure with a healthcare worker. Currently he shows no symptoms and is being monitored. The CDC announced he poses no risks to his family or the United States.[SUP][93][/SUP] On September 28, a fourth American doctor was admitted to National Institutes of Health hospital.[SUP][94][/SUP]
On October 2, NBC News photojournalist Ashoka Mukpo, covering the outbreak in Liberia, tested positive for Ebola after showing symptoms.[SUP][95][/SUP]Four other members of the NBC team, including Dr. Nancy Snyderman, were being closely monitored for symptoms.[SUP][96][/SUP] Mukpo was evacuated on October 6 to the University of Nebraska Medical Center for treatment in their isolation unit.[SUP][83][/SUP]
Another doctor was evacuated from Sierra Leone after suffering a needle prick injury while treating Ebola patients and developing a fever. He was treated at the National Institutes of Health Clinical Center where he was found not to have Ebola and was released.[SUP][97][/SUP]

Biocontainment units[edit]

There are four specialized biocontainment units in the United States: the University of Nebraska Medical Center in Omaha, Nebraska, where Mukpo and Sacra were treated; the U.S. Army Medical Research Institute of Infectious Diseases (Fort Detrick, Maryland); St. Patrick Hospital and Health Sciences Center (Missoula, Montana);[SUP][98][/SUP] and Emory University Hospital (Atlanta, Georgia), where Brantley, Writebol and the unnamed patient had gone after contracting Ebola.[SUP][95][/SUP]

[Peter Lemkin]

Although the rate of new Ebola infections has slowed in some areas, the World Health Organization says it would be premature to read that as a success. New WHO projections suggest there could be between 5,000 and 10,000 new cases a week by December. The head of the United Nations Mission for Ebola Emergency Response told the U.N. Security Council that the steps implemented by the international community are not enough to halt the advance of the fatal disease. "This is an international humanitarian and health crisis," says Lawrence Gostin, university professor and faculty director at the O'Neill Institute for National and Global Health Law at Georgetown University. Gostin says privatized healthcare has undermined the U.S. response to Ebola, with a lack of available vaccines and access to proper care. "Much of our innovation is driven by the private sector, and from their point of view, Ebola was not a predictable disease and those who got Ebola were too poor to pay for it." We are also joined by Karen Higgins, co-president of National Nurses United.




JUAN GONZÁLEZ: Although the rate of new Ebola infections in some areas has slowed down, the World Health Organization said Tuesday it would be premature to read that as a success and that projections suggest there may be between 5,000 and 10,000 new cases a week by December. This is WHO Assistant Director-General Bruce Aylward speaking.

DR. BRUCE AYLWARD: We anticipate the number of cases occurring per week by that time is going to be somewhere between 5,000 and 10,000 a week; you know, it could be higher, could be lower, you know, but that it's going to be somewhere in that ballpark. And the goal now is taking all the different pieces of the response that are planned, everything from the Ebola treatment centers to the people deployments to the community engagements, and trying to make sure we've got that capacity in place by that time, so that we can ensure 70 percent of cases can be properly managed or isolated, and 70 percent of burials can be done safely by then.

AMY GOODMAN: For more, we're joined in Washington, D.C., by Lawrence Gostin, university professor and faculty director at the O'Neill Institute for National and Global Health Law at Georgetown University, director of the World Health Organization Collaborating Center on Public Health Law. Still with us in Boston, Karen Higgins, co-president of the National Nurses United.
Professor Gostin, thanks so much for being with us. Talk about the global scene right now and also what's happening in the United States, though it seems we are paying much more attention to the global scene because of what's happening in the United States.
LAWRENCE GOSTIN: Yeah, we are. I mean, I think we have to really remember that the main tragedy is going on in West Africa, and it was an avoidable tragedy, it's a humanitarian disaster. Just think about what the World Health Organization said. It aspires to handle in a rudimentary way 70 percent of cases. That's its top level. And that's just unacceptable. We're now well over a half a year into this epidemic, well over a half a year, almost coming to nearly a year if you go back to the first index case, and the international community is now only mobilizing. Now, I appreciate everything the United States has done, and they've stepped up. President Obama sent military assets in. I think the rest of the world needs to do more. But nonetheless, we have just let this spin out of control in a horrible crisis, a tragedy, really, and are only now mobilizing it when it's on our front doorstep. We're better than that. I think we need to do better. And so, I would really like to see usif we want to be safe here in the United States, we have to attack this at its source in West Africa, and we need to try to get that epidemic under control, first and foremost.
JUAN GONZÁLEZ: And, Professor Gostin, about that response, there's been all the publicity now about the U.S. troops being sent to West Africa to build some treatment centers, but none of those are actually yet operational, and they're only talking about maybe 1,700 total bed capacity in the treatment centers they expect to build over the next few months. Do you think it's time maybe to actually just dispatch major ships to be offshore of these African countries and be able to handle a greater volume of patients as they get stricken?
LAWRENCE GOSTIN: I do. And, you know, you have to remember that only for the second time in the history of the United Nations, the U.N. Security Council called a health threatAIDS was the first, Ebola is the seconda threat to international peace and security. So you have a U.N. Security Council mandate for all countries in the world, with the United States, should be the European Union, Australia, Canada, all of our allies. This is an international humanitarian and health crisis. It threatens the stability of the region politically, economically, and, of course, human health matters most. And yes, so we should be mobilizing much, much more. We should have done it earlier. We should do it now.
AMY GOODMAN: Professor Gostin, you're a specialist in quarantine and issues like that. What do you think about the discussions now, the airports that are setting up to see if people have temperatures? I was just listening to Congressmember Sessions of Texas, who was saying he wants to stop all flights coming in from West Africa from the affected countries, letting U.S. citizens come in, but not anyone else.
LAWRENCE GOSTIN: Yeah, I mean, that is such a bad idea. And in many ways, it's very mean-spirited. First of all, it won't make the United States safer; it will actually make us less safe. Here's why. First of all, if you cut flights, it means that aid workers will find it very difficult getting to and from the affected region. And the countries themselves will experience economic hardship, commercial hardship. Food prices will go up. And ultimately, I think, the epidemic will spin further out of control. It will make these countries more at risk. And the higher the reservoir of infection in West Africa, the greater the risk we have here in the United States, in Canada, the European Union. That's just basic math. If you have a lot of people infected in a part of the world, and we live in a modern, globalized world, you can't put a cellophane wrapper around a whole region and expect to keep germs out. It doesn't work that way. And so, we think we're trying to save ourselves, but actually we're making ourselves at greater risk, and we're also doing something that's deeply against the American spirit, which is exacerbating the hardships of people that are undergoing unbelievable suffering at the moment. And I just think we're better than that. And what I hate about this is, is that health is not a Democrat and Republican issue. It's not party politics. We don't play games with this. What we do is we send all of our assets that are available to help bring this under control. If we do that, it will help us at home.
I also want to say something about infection control, because we've been talking aboutthere are two lessons I think we can learn. The first is, is that health workers are always on the front lines of the greatest risk. We knew that with SARS. With SARS, it was all the health workers who were at the greatest risk, and now that's happening with Ebola. And it's not just here in the United States. In West Africa, they've lost several hundred doctors and nurses, and they can ill afford to do that, from Ebola. And the other lesson that we've learned is, we can do thisnot only in Atlanta and other places in the United States, but Doctors Without Borders, who are operating in horrendous conditions on the ground in West Africa, haven't had any infections there. So if you have really good equipment, really good training, and you only put your very best-trained people at work with a systems approach and clear protocols, there is no reason for any health worker to become ill.
JUAN GONZÁLEZ: I'd like to ask Karen
LAWRENCE GOSTIN: And it's unacceptable that they should.
JUAN GONZÁLEZ: I'd like to bring Karen Higgins back into the conversation, co-president of National Nurses United. I wanted specifically to ask you about the role of the CDC in this crisis. The executive director of your union, RoseAnn DeMoro, at yesterday's press conference, specifically raised the fact that the CDC has no control over these individual hospitals, that in the privatized hospital system that we operate in here in the United States, the CDC can only offer guidelines, and it's up to individual hospitals whether they're going to enforce those guidelines, practice those guidelines. And, in fact, the CDC said yesterday, after your press conference, that they have no plans to investigate what happened at Texas Health Presbyterian, that that's the responsibility of the local Department of Health in Texas.
KAREN HIGGINS: I think, you knowunfortunately, I think she's right, as far as what powers the CDC has. But the actual interesting part is that when you are looking up any type ofyou know, what you do for infections, the place that is always looked to and always looked at is what CDC recommends. And what happens is then CDC makes recommendations, guidelines, and then it falls apart, because what you do with it as an individual hospital, because every hospital is pretty much individual, is where it starts to fall apart. And that's why we're saying, what CDCif everybody is looking to CDC for direction, they need to come up not just with guidelines, but with an actual standard of care, like I said, that everybody will be following, that is expected. And then the follow-up should be with the public health departments in the states to make sure that these hospitals in fact are doing this. And again, putting the teaching in place has to be a huge part of this.
AMY GOODMAN: You know, one
KAREN HIGGINS: I think, as was discussed
AMY GOODMAN: One of the ways you learn about
KAREN HIGGINS: As was discussed, if you do it right
AMY GOODMAN: One of the ways you learn about how we go from here is for hospitals to admit what they have done wrong. And, Juan, if you could describe the conference call you were on yesterday, who was on the conference call and listening, but not speaking?
JUAN GONZÁLEZ: Right. Well, the
KAREN HIGGINS: You know what? I know that thereI'm sorry.
AMY GOODMAN: I just wanted Juan to describe that conference call
KAREN HIGGINS: OK.
AMY GOODMAN: the workers who wanted to protect themselves.
KAREN HIGGINS: Great.
JUAN GONZÁLEZ: Well, as I mentioned earlier, the workers were actually in Dallas on the conference call, whereas the union leaders were in Oakland at their national headquarters. And so, because there are no nurses unions in Dallas that represent the workersso these are non-unionized workers, who were exposed for the possibility of being fired for talking publicly about this situation, and so they actuallyas reporters asked questions, they emailed; the nurses emailed their responses to the
AMY GOODMAN: So they listened, and they emailed their responses to the union?
JUAN GONZÁLEZ: And then the union read their responses to the reporters. And this is because of the fear, obviously, that many employees have that they might be retaliated against for talking about these issues and talking about the lapses of their own institution. But
KAREN HIGGINS: And I
JUAN GONZÁLEZ: Yes, Karen Higgins?
KAREN HIGGINS: No, I was going to say, and that is so true. I mean, you know, this hospital has been saying from day one that the protocols were there and everything was good, the protocols were there, they were fine. And I think, you know, to be honestand then to have the nurses come out and the healthcare workers come out and say, "Oh, no, it wasn't. No, it was not. This was a lot of, you know, changing of information, not enough equipment, not the right equipment"you know, I think they're absolutely right, that theyyou know, their fear of being retaliated, because they have come out when the hospital continues to say. And this is the problem. They all continue to say they're ready. We don't need another Dallas in another state if another patient shows up.
AMY GOODMAN: Finally, Larry Gostin, the issue of these vaccines and the issue of the lack of investment in public health, something we're feeling certainly the blowback from right now
LAWRENCE GOSTIN: Yeah.
AMY GOODMAN: now the NIH says they are developing a vaccine. It sounds like this has been possible for a long time, but private corporationsand which this is usually their purviewthey knew there wasn't a lot to be made in this profit-wise. So, this is why there were so few shots available, whether it's a vaccine or other drugs. Can you talk about the importance of public health, and are vaccines possible in dealing with Ebola?
LAWRENCE GOSTIN: Yeah, I mean, the problem is, is that most of our innovation is driven by the private sector. And from their point of view, Ebola was not a predictable disease, and those who got Ebola were too poor to pay for it, and so there's been a lack of investment. Not only were there not enough doses of ZMapp and things, but they weren't even tested. There are only now vaccines and others going through clinical testing. And so, we really just don't have those things on the ground.
Just want to make a very quick comment, if I can, aboutwe call ourselves the most advanced health system in the world, but what do we mean by that? I think what we mean by that is, is that we have the best of the best of the world. But we also have a highly variable systemso many different hospitals, so many different emergency rooms. We have over 3,500 local health authorities. Everybody iswe've got such different standards about what we can do. And what we need to do, as Karen says, is up our game. We need to be more uniform, and we need to have systems in place and the kind of equipment and training at every institution, so that this doesn't happen again. It's really unacceptable.
AMY GOODMAN: One last quick comment, Washington Post writing, "In the medical response to Ebola, Cuba is punching [far] above its weight."
LAWRENCE GOSTIN: Yeah.
AMY GOODMAN: Cuba answering the call by sending 165 health workers to hard-hit Sierra Leone, a disproportionately large number for a tiny island nation of 11 million people.
LAWRENCE GOSTIN: Yeah.
AMY GOODMAN: Is Cuba an example for the United States, Dr. Gostin?
LAWRENCE GOSTIN: Well, you know, Cuba isalways sends a lot of health workers to humanitarian crises. And I think it iswe need to do much more of that ourselves. But I have to say this: We arewe have sent our military in when very few others have. I think we need to do a heck of a lot more, but the rest of the world needs to do more. I mean, they have just been sitting back and letting this epidemic get out of control, even after the U.N. Security Council. I would venture to say that I would like the U.N. Security Council to come back and pass a binding resolution that would actually set markers for the kinds of resources that are needed to bring this under control. And I think if we do that, we'll really show a seriousness of purpose. And I think we can do this.

[Peter Lemkin]

On Oct. 26, 2009 the CDC filed a patent claim on the genome of the Ebola virus [and its variants] and means to produce it, replicate it, produce in mass quantities etc. The Patent can be seen here: https://www.google.com/patents/US20120251502

Exactly what this patent means is not perfectly clear...but does raise some questions. Yes, it could be used to create a vaccine or find cures, but it could equally be used to bioengineer it into a bioweapon or create new forms that are more virulent or more 'targeted', etc. It could also be used to prevent others from using the virus to produce a vaccine or cure!

It would also be interesting to know what is going on with Ebola at Ft. Dietrich, MD - but what goes on there is highly kept secret.

I believe the CDC has granted rights to at least on pharmaceutical company to use their patent.

[Magda Hassan]

How a natural thing like a genome can be patented I don't know but fwiw the AIDS virus has also been patented for many years also.

[Magda Hassan]

Wikileaks cable says US Army withheld promise from Germany that the Zaire Ebola Virus and other pathogens wouldn't be weaponized

UNCLAS BERLIN 001588 SENSITIVE SIPDIS STATE FOR ISN/CB AND OES/IHA E.O. 12958: N/A TAGS: ETTC, MOPS, PARM, TBIO, GM SUBJECT: GERMANY REQUESTS ASSURANCES ON VIRUS EXPORT
1. (SBU) This is an action request. Please see paragraph 4.
2. (SBU) German MFA Deputy Head of Division for Export Control Markus Klinger provided the following non-paper to Econoff, seeking additional assurances related to a proposed export of extremely dangerous pathogens to the U.S. Army Medical Research Institute for Infectious Diseases. The Army's end use certificate provided to Germany is lacking an official seal. Klinger's deputy, Nancy Reck, noted that Germany had made two follow-up requests to the Army seeking assurances and clarifications related to this proposed export. The GOG seeks assurances from the USG or US Army that the end use certificate and the information contained therein are legitimate and accurate.
3. (SBU) Begin text of informal translation of German MFA non-paper: "For Official Use Only" Against the background of our partnership in the area of non-proliferation and our excellent cooperation in the matters of export controls, we would like to bring the following issue to the attention of your government. A German firm has applied for the approval of the export of 184 genetic elements with nucleic acid sequences of viruses for the production of recombinant viruses. The viruses will be used in optical imaging to identify host factors required for viral replication. The recipient in the USA is, according to the enclosed end use certificate, the Department of the Army "US Army Medical Research Institute for Infectious Diseases (USAMRIID)" Fort Detrick, Maryland. Specifications in English about the goods, the recipient and end use can be seen from the end use certificate. The goods are controlled by the Australia Group and are subject to compulsory export approval (List position C1C353A). This matter concerns the complete genome of viruses such as the Zaire Ebola virus, the Lake Victoria Marburg virus, the Machupo virus and the Lassa virus, which are absolutely among the most dangerous pathogens in the world. The delivery would place the recipient in the position of being able to create replicating recombinant infectious species of these viruses. Because of the particular criticality of these goods, the German federal government practices an exceptionally restrictive approval policy for such exports. An approval here can only be issued if an improper end use in association with the development or production of biologic weapons approaches can be foreclosed with a probability approaching certainty. The enclosed end use certificate is on the letterhead of the U.S. Army. The required official seal is missing, however. A decision about the export has not yet been made. Given the foregoing, we would appreciate confirmation that the end use certificate really is from the Department of the Army and of the accuracy of the data contained therein. We look forward to the continuation of our excellent cooperation in matters of non-proliferation and export controls. End text of informal translation of German MFA non-paper.
4. (SBU) Action Request. Post requests guidance on responding to the GOG request in the non-paper. MURPHY