Quotes of the day

About 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Thomas Eric Duncan after he was hospitalized, including a nurse now being treated for the same Ebola virus that killed the Liberian man who was visiting Dallas, according to medical records his family provided to The Associated Press…

A CDC spokeswoman said the agency reviewed the medical records with Duncan’s care team and concluded that the documents were not helpful in identifying those who interacted directly with the patient.

“This is not something we can afford to experiment with. We need to get this right,” said Ruth McDermott-Levy, who directs the Center for Global and Public Health in Villanova University’s College of Nursing…

Typically, the nurses, doctors and technicians caring for a contagious patient in isolation would be treating other people as well, and going home to their families after decontaminating themselves. The hospital has refused to answer questions about their specific duties.


U.S. hospitals are ridden with mistakes. Common infections like C. diff and Staph rage through hospitals because doctors and nurses sometimes forget even the basic protocol, washing hands. I’ve been an advocate for patient safety for over a decade, and I know that hospitals unable to stop these infections can’t stop Ebola. To claim they can is a lie.

Many hospitals also lack equipment. Texas Health Presbyterian nurses relied on facemasks, which is what the CDC prescribes. But other experts say they should have respirators. Epidemiologists at the University of Illinois explain that Ebola “has the potential to be transmitted through aerosol particles both near and at a distance from infected patients, which means that healthcare worker should be wearing respirators, not face masks.” CDC and Emory University staff wore respirators when they cared for two healthcare workers evacuated from Africa. Some healthcare professionals even complain they see a double standard in the CDC’s protocols…

National Nurses United, a union, is protesting the lack of equipment and training. Eighty-five percent of nurses surveyed by NNU said they hadn’t received Ebola training. Then, there’s the lack of staff. It takes twenty full time medical staff to care for one Ebola patient. Texas Health Presbyterian cordoned off its ICU for Ebola, and is diverting emergency patients to other hospitals. Not all communities have several hospitals.


3. The CDC didn’t encourage the “buddy system” for doctors and nurses.

Under this system, a doctor or nurse who is about to do a procedure on an Ebola patient has a “buddy,” another health care worker, who acts as a safety supervisor, monitoring the worker from the time he puts on the gear until the time he takes it off.

The “buddy system” has been effective in stopping other kinds of infections in hospitals.

Skinner said the CDC is considering recommending such a system to hospitals.


In Brussels, Doctors Without Borders requires two days of training for providers and other professionals volunteering to help in Liberia, Sierra Leone or Guinea. One of the most critical components deals with the protective gear they will receive, and as field coordinator Anna Halford explained recently to the BBC, in the field no one ever gears up alone.

“All dressing is done with an observer,” Halford said. New staffers are specifically paired with experienced staff “until putting [the equipment] on and taking it off and the way in which you move is second nature.”

The process is laborious in the beginning and dangerous in the end. Removing all pieces — apron; impermeable, full-body suit; multiple layers of gloves, often with the outer pair taped shut; full face and head protection; goggles — can take nearly half an hour. That’s also done in pairs, Halford told the BBC, so one person can watch to ensure the other person doesn’t touch any Ebola-contaminated material…

An initial temp check is always done as workers arrive for their shift, Isaacs explained. No one self-monitors for a fever; the checks are taken by another person. Every time, the individual being assessed gets a sticker with the result noted. Wearing the sticker is required.


So, we have an office for public health threat preparedness and response. And one of HHS’ eight assistant secretaries is the assistant secretary for preparedness and response, whose job it is to “lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters, ranging from hurricanes to bioterrorism.”

In the video below, the woman who heads that office, Dr. Nicole Lurie, explains that the responsibilities of her office are “to help our country prepare for, respond to and recover from public health threats.” She says her major priority is to help the country prepare for emergencies and to “have the countermeasures—the medicines or vaccines that people might need to use in a public health emergency. So a large part of my office also is responsible for developing those countermeasures.”…

Now, you might be wondering why the person in charge of all this is a name you’re not familiar with. Apart from a discussion of Casey’s comments on how we don’t need an Ebola czar because we already have one, a Google News search for Lurie’s name at the time of writing brings up nothing in the last hour, the last 24 hours, not even the last week! You have to get back to mid-September for a few brief mentions of her name in minor publications. Not a single one of those links is confidence building.

So why has the top official for public health threats been sidelined in the midst of the Ebola crisis?


Nearly two-thirds of Americans say they are concerned about an Ebola outbreak in the United States, and about the same amount say they want flight restrictions from the countries in West Africa where the disease has quickly spread.

A new poll from the Washington Post and ABC News shows 67 percent of people say they would support restricting entry to the United States from countries struggling with Ebola. Another 91 percent would like to see stricter screening procedures at U.S. airports in response to the disease’s spread.

Thus far, some countries in Europe have restricted flights from these countries in West Africa, and an increasing number of U.S. lawmakers are calling for similar bans. The White House has yet to increase restrictions, with federal officials saying such a move could actually increase the spread of the disease by hampering the movement of aid workers and supplies.


Vaccine manufacturers scrambling to get Ebola-related products to market could enjoy nearly unlimited immunity from lawsuits, thanks to language inserted into a defense spending bill under questionable circumstances days before Congress headed home for Christmas in 2005.

The language allows the secretary of the Department of Health and Human Services (HHS) to provide blanket liability immunity to manufacturers of vaccines and other “countermeasures” after declaring a public health emergency in response to a pandemic…

At the time, outbreaks of avian bird flu had raised fears of a massive pandemic that could catch governments off guard. Frist and other supporters argued the language was critical to ensuring vaccines could be quickly provided in case of an outbreak.


Dr. Robert Garry, the Tulane professor of microbiology and immunology who helps lead the Viral Hemorrhagic Fever Consortium based in Sierra Leone, said that early detection and diagnosis should go a long way toward stemming the worst Ebola outbreak in history.

In June, the National Institutes of Health awarded his team and Corgenix Medical Corp. $2.9 million to develop a rapid diagnostic test that would give health care workers a fast and easy way to test patients for Ebola with a simple finger-stick.

“Everyone has their shoulder to the wheel to get this done,” Garry said from his office on the New Orleans campus.


There is a fourth strategy, although it will need to be evaluated and deployed carefully. Since the 1990s, novel methods have allowed doctors to detect viruses in the pre-symptomatic phase of an infection, often with remarkable sensitivity and precision. One of these involves the polymerase chain reaction, or P.C.R., a chemical reaction that amplifies pieces of a virus’s genes floating in blood by more than a millionfold, which is what makes early, pre-symptomatic infections identifiable. The technique is not particularly cumbersome: As an oncologist working with blood cancers, I have been using variants of it to detect subclinical infections in patients for nearly a decade.

A 2000 study in The Lancet illustrates the power of this approach. Twenty-four “asymptomatic” individuals exposed to Ebola were tested using P.C.R. Eleven of the exposed patients eventually developed the infection. Seven of the 11 tested positive for the P.C.R. assay; none of the other 13 did. In 2004, virologists at the Centers for Disease Control and Prevention further refined this method to increase its sensitivity. The test now requires only a teaspoon of blood. The sample is transported, on ice, to a centralized lab. Results are back in a few hours.

Technologies like this allow us to imagine a new form of quarantine. Rather than relying on primitive instruments, indiscriminate profiling or questionnaires, we should consider running a pilot program to test asymptomatic travelers using sensitive P.C.R.-based techniques.


In late July, when it looked like Dr. Kent Brantly wasn’t going to make it, a small news item escaped Liberia. It spoke of Brantly’s treatment – not of the Ebola vaccine, Zmapp, which Brantly later got. But of a blood transfusion. He had “received a unit of blood from a 14-year-old boy who had survived Ebola because of Dr. Brantly’s care,” the missive said.

Now months later, Brantly, who has since recovered from his battle with the virus, has passed on the favor. A 26-year-old Dallas nurse named Nina Pham, who contracted the illness while treating the United States’ first Ebola patient, has received Brantly’s blood. It’s not the first time it has been used to treat Ebola patients. Recovered Ebola victim Richard Sacra got it, as well as U.S. journalist Ashoka Mukpo, who last night said he’s on the mend…

“We’re trying to discover what in their immune response enabled them to survive,” Israeli scientist Leslie Lobel, who’s trying to develop a vaccine using those antibodies, recently told Nova. “…The survivors that we follow we view these people as the blessed ones. Those who have the gold in their blood that enabled them survive this serious disease.”


Ebola is exposing a broader problem: the sober reality of our fragmented, uncoordinated private health-care system. We have enormous health-care resources in the United States. What we lack is a national, integrated system needed to respond effectively to a severe national threat such as Ebola.

The Centers for Disease Control and Prevention issues guidelines but has no authority to enforce them. Hospitals have wide latitude to pick and choose what protocols they will follow; too often in a corporate medical system those decisions are based on budget priorities, not what is best for the health and safety of patients and caregivers. Congress and state lawmakers put few mandates on what hospitals must do in the face of pandemics or other emergencies, and local health officials do not have the authority to direct procedures and protocols at hospitals…

We know what works: a federal agency with the authority to ensure local, state and national coordination in response to outbreaks. In such an empowered public health system, local health officials are assured of having the resources to identify the source of an outbreak, isolate and treat the sick, and follow up with those who have had close contact with the sick. Only greater integration and the authority of a public health system with national, uniform standards can protect Americans.


But the case [of Nina Pham] is also noteworthy for another, potentially positive reason: Nearly 50 people were exposed to Ebola before the nurse, and none of them has been diagnosed with the disease

This group of neighbors, family members and first responders are being watched carefully by health authorities. They had some degree of close contact with Duncan during the four-day period when he was contagious – from when he started showing Ebola symptoms on Sept. 24 to when the hospital finally admitted him on Sept. 28. They didn’t take any Ebola-specific precautions. They didn’t know he was infected. Some stayed in the same apartment as Duncan as his condition worsened. Yet, so far, they have not gotten sick. And their 21-day Ebola incubation period started before Pham’s…

“Ebola is not a terribly infectious disease,” said Dr. Joel Selanikio, a former U.S. Centers for Disease Control and Prevention (CDC) epidemiologist. “It’s quite difficult to get.”



The Centers for Disease Control and Prevention says it’s moved a team of experienced experts in to help a Dallas hospital where a nurse became infected with Ebola to improve “every step in the process.” And they’ll send in a special response team to help any hospital in the future that gets an Ebola patient…

And he promised any hospital that receives an Ebola patient that CDC will help with a special response team. “We will put a team on the ground within hours with some of the world’s leading experts on how to take care of and prevent health workers form Ebola virus infection,” Frieden said.

“I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection,” Frieden added. “But we are prepared to do this in the future with any case anywhere in the U.S.”