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A Strategic Shift On Ebola Care

A Strategic Shift On Ebola Care

By Noam N. Levey and Michael Muskal, Tribune Washington Bureau (MCT)

WASHINGTON — The federal government effectively began to restrict the care of Ebola patients to hospitals with special bio-containment units Thursday, and the Obama administration labored to reassure jittery Americans and increasingly skeptical lawmakers that public health authorities can prevent a widespread Ebola outbreak here.

The tacit shift in policy came amid growing concerns about mistakes at Texas Health Presbyterian Hospital in Dallas, where two nurses who treated Thomas Eric Duncan of Liberia have since come down with the disease.

One of the nurses is being treated at Emory University Hospital in Atlanta, and the other was being transferred to a specialized treatment center at the National Institutes of Health near Washington.

On Capitol Hill, lawmakers demanded answers from the director of the U.S. Centers for Disease Control and Prevention, Dr. Thomas Frieden, who has acknowledged his agency’s lapses in responding to the disease, including allowing one of the nurses to board a commercial flight after she treated Duncan.

Frieden strenuously defended the CDC’s efforts.

“CDC works 24/7 to protect Americans. There are no shortcuts,” he said. “We have a team of 20 of some of the world’s top disease detectives in Texas now. We were there. We left the first day (Duncan) was diagnosed.”

Despite repeated assurances from Frieden and other top health officials that the risk of a widespread outbreak is extremely low, fear of the deadly disease has led to school closings and a suggested ban on travel from the U.S. to and from West Africa — which President Barack Obama said Thursday evening that he might consider in the future.

Domestic air travel was of more immediate concern in Texas and Ohio, where several public schools closed as a precaution after officials learned that faculty and students had flown on the same plane as Ebola patient Amber Vinson, the second of Duncan’s nurses to be diagnosed with the virus that killed him.

Now hospitalized at Emory, Vinson flew to Cleveland on Friday, returned to Dallas-Fort Worth late Monday and was diagnosed with Ebola on Wednesday.

Eight people who came into contact with Vinson quarantined themselves and are being monitored, according to health officials there.

Officials also are asking anyone who visited an Akron bridal shop that Vinson visited Saturday to contact health officials.

The deadly virus is transmitted by the bodily fluids of a symptomatic person.

In Dallas, where fears about Ebola are highest, local officials signed off on “control orders” Thursday that will restrict those being monitored for Ebola from using public transportation or venturing out to public places such as grocery stores.

Dallas County Judge Clay Jenkins said he expected officials to start serving the orders on 75 health care workers Thursday. During an emergency meeting of county leaders, Jenkins said the addresses of those being monitored would be flagged for first responders but not publicly distributed.

Growing public anxiety has fueled Republican lawmakers’ escalating attacks on the Obama administration.

“People are scared,” House Energy and Commerce Committee chairman Fred Upton, R-Mich., told federal health officials at the Washington hearing. “People’s lives are at stake, and the response so far has been unacceptable.”

GOP lawmakers and some Democrats urged a travel ban on passengers from Liberia, Sierra Leone and Guinea, the three West African countries at the center of the Ebola outbreak.

Many public health experts oppose such a move. And Thursday, Frieden also rejected that call, noting it would likely induce travelers from the heart of the outbreak to go underground.

“Right now, we know who’s coming in,” he said. “If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don’t know that they’re coming in, will mean that … when they arrive, we wouldn’t be able to impose quarantine as we now can if they have high-risk contact.”

On Thursday evening, Obama said he might consider imposing a ban on travel to Ebola outbreak areas, but he fears it could encourage the sick to hide their illness and result in “more cases rather than less.” But the president said he “may consider it if experts recommend it.”

Obama emphasized, as have Frieden and others, the need to focus on containing the outbreak in West Africa.

The president signed an executive order Thursday authorizing the Pentagon to call up additional Ready Reserve forces to assist in the ongoing U.S. military effort to combat Ebola in Liberia, Sierra Leone and Guinea.

The order was aimed at calling up personnel with key skills, according to an administration official; so far the Pentagon had identified just eight people for the mission.

Obama also met at the White House for the second day in a row with senior officials coordinating the federal Ebola response.

Administration officials have insisted for months that a wider Ebola outbreak in the U.S. is unlikely because American hospitals can effectively isolate and care for infected patients, a key capacity missing in West Africa.

But the apparent breakdown at Texas Health Presbyterian in Dallas that led to the infection of Duncan’s nurses has prompted growing calls for a new system to concentrate care in designed facilities.

The U.S. has four specialized facilities, including Emory, the NIH in Bethesda, Md., the Nebraska Medical Center in Omaha and St. Patrick’s Hospital in Missoula, Mont.

Officials at Texas Presbyterian have acknowledged that they erred in sending Duncan home when he initially came to the hospital with flu-like symptoms and reported he had recently been in West Africa.

On Thursday, Dr. Daniel Varga, chief clinical officer of Texas Health Resources, which owns the hospital, testified at the congressional hearing that the hospital had not trained the medical staff to deal with Ebola, even after the CDC alerted U.S. hospitals to watch for possible cases.

Nevertheless, Nina Pham, the first nurse to be infected, had remained at Texas Presbyterian since her diagnosis over the weekend.

The hospital said in a statement Thursday that officials decided to transfer her because so many of the hospital’s staff are being monitored for Ebola.

Pham was in good condition, according to health officials.

(Levey of the Tribune Washington Bureau reported from Washington and Muskal of the Los Angeles Times from Los Angeles. Times staff writers Molly Hennessy-Fiske and Geoffrey Mohan in Dallas, Kathleen Hennessey and Christi A. Parsons of the Tribune Washington Bureau in Washington and Christine Mai-Duc of the Times in Los Angeles contributed to this report.)

AFP Photo/Nicholas Kamm

Obama Names Former Biden Aide As Ebola ‘Czar’

Obama Names Former Biden Aide As Ebola ‘Czar’

By Christi Parsons, Kathleen Hennessey, Tribune Washington Bureau (MCT)

WASHINGTON _ President Obama will name former vice presidential chief of staff Ron Klain as Ebola “czar” to coordinate the administration’s response to the disease, a White House official said Friday.

The move is aimed at better coordinating the U.S. response to the deadly virus and restoring public trust after a series of missteps.

Klain, a longtime Democratic political operative, served as Vice President Joe Biden’s chief of staff and is a trusted manager at the White House. He left the vice president’s office in 2011 to become president of Case Holdings, the company that manages the business and philanthropic interests of former AOL Chairman Steve Case.

Klain also served as chief of staff for Vice President Al Gore during the Clinton administration.

Obama has been under pressure to take more dramatic action as worries about the spread of the virus have grown_and spilled into campaign season politics. Some Republican critics had pushed for the appointment of an Ebola czar, although most of the criticism of the administration has focused on its resistant to enacting a travel ban on passengers from affected countries in West Africa. Obama suggested Thursday he could also consider travel restrictions in the future.

In his comments Thursday night, Obama hinted he was considering naming a point person to coordinate the government effort. So far, the president’s homeland security advisor Lisa Monaco has been taking on the role at the White House but Obama noted she and others involved have other responsibilities.

“It may make sense for us to have one person to have a more regular process just to make sure that we’re crossing all the t’s and dotting all the i’s,” he said.

Photo: United States President Barack Obama talks with Ron Klain during presidential debate preparations in Henderson, Nevada on 2 October 2012. Senator John Kerry, background, played the role of Mitt Romney during the preparatory sessions.

U.S. Health Chiefs In Hot Seat Over Flawed Ebola Response

U.S. Health Chiefs In Hot Seat Over Flawed Ebola Response

Washington (AFP) – Top U.S. health officials faced a grilling Thursday by lawmakers infuriated over the nation’s fumbling response to the Ebola outbreak, as the Obama administration scrambles to contain the disease’s spread.

Centers for Disease Control (CDC) director Thomas Frieden has become the most prominent target of the criticism, which has mounted as it emerged that a second Texas health care worker infected with the deadly disease was allowed to board a commercial flight despite reporting a low-grade fever.

Some lawmakers have demanded Frieden’s resignation and others have accused President Barack Obama of a lack of leadership.

Congressional leaders meanwhile are urging a travel ban to the United States on all citizens of the three West African nations hardest hit by the epidemic: Guinea, Liberia and Sierra Leone.

“The stakes in this battle couldn’t be any higher,” Tim Murphy, who chairs the House Energy and Commerce Subcommittee on Oversight, told a packed hearing with Frieden and other health experts.

“The trust and credibility of the administration and government are waning as the American public loses confidence each day with demonstrated failures of the current strategy,” he added.

Murphy, echoing other senior lawmakers like House Speaker John Boehner and Senator Marco Rubio, said he had “ongoing concern that administration officials still refuse to consider any travel restrictions” on people from West Africa entering the United States.

Some experts and lawmakers warned that isolating West Africa could further strain its health care resources.

Frieden and other officials acknowledged they still did not know how two Dallas nurses who treated a sick man contracted the virus, highlighting concerns about the government’s ability to prevent its spread.

But Frieden insisted authorities could keep the hemorrhagic virus at bay in America.

“We remain confident that Ebola is not a significant public health threat to the United States,” he told the panel.

“It is not transmitted easily, and it does not spread from people who are not ill.”

That statement offered little consolation to worried lawmakers.

“People are scared. We need all hands on deck. We need a strategy,” House Energy and Commerce Committee chairman Fred Upton warned.

“People’s lives are at stake, and the response so far has been unacceptable.”

But some warned of the dangers of sparking hysteria among the public.

“We need to put all of this in perspective, and not panic,” House Democrat Henry Waxman told the panel.

The White House stressed that Obama, who cancelled political events Wednesday and Thursday in order to coordinate the U.S. Ebola response, maintained confidence in Frieden.

Nearly 4,500 people are known to have died from Ebola — mainly in West Africa — although Frieden cautioned the toll “may be substantially under-reported.”

While legislators insist there is no margin for error, mistakes in handling Ebola continued to crop up in the United States after a Liberian Ebola victim, Thomas Eric Duncan, was cared for in Texas.

“Unfortunately, in our initial treatment of Mr Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” said Daniel Varga, chief clinical officer of Texas Health Resources which runs the hospital where Duncan was treated.

A nurse who treated one of the sick caregivers accused Texas Health Presbyterian Hospital of failing to adequately prepare staff for handling Ebola cases prior to Duncan’s arrival.

“We never talked about Ebola and we probably should have,” nurse Brianna Aguirre told NBC’s Today show.

“They gave us an optional seminar to go to. Just informational, not hands on,” she added. “We were never told what to look for.”

Compounding concerns, the CDC allowed a health care worker who had been exposed to an Ebola patient to fly by commercial plane after she reported a low-grade fever.

Officials are now considering a travel ban in such cases, a source told AFP.

U.S. authorities began screening for Ebola on Thursday at the Washington area Dulles airport, Chicago’s O’Hare, Newark and Atlanta airports, after New York’s JFK began screening last week.

Together, the airports receive 94 percent of travelers from the Ebola-affected countries.

Frieden said the two U.S. transmissions showed the need “to strengthen the procedures for infection-control protocols.”

“It’s like fighting a forest fire: leave behind one burning ember, one case undetected, and the epidemic could re-ignite,” he said.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the first person to contract Ebola in the United States, Nina Pham, was “stable” and being transferred to the National Institutes of Health in Maryland for treatment.

AFP Photo/Nicholas Kamm

Ebola Patient Nina Pham To Be Relocated; Congress Grills Health Officials

Ebola Patient Nina Pham To Be Relocated; Congress Grills Health Officials

By Noam N. Levey, Tribune Washington Bureau (MCT)

WASHINGTON — The first Texas nurse to contract Ebola is being moved to a National Institutes of Health clinic near Washington, health officials said Thursday during a congressional hearing about the breakdowns that led to the spread of the deadly virus in Dallas.

Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases, said that Nina Pham’s condition is stable and that she is “doing reasonably well.”

The nurse was diagnosed with Ebola on Sunday after treating Thomas Eric Duncan, the Liberian man who died last week at Texas Health Presbyterian Hospital. Pham is being transferred to the NIH Clinical Center in Bethesda, Md. — which has treated other Ebola patients — so she can be in a state-of-the-art facility, Fauci said.

Meanwhile, in Texas and Ohio, some public schools were closed as a precaution Thursday after officials learned that faculty and students had flown on the same plane as Ebola patient Amber Vinson. Vinson, a nurse who also treated Duncan at Texas Health Presbyterian, flew from Cleveland to Dallas-Fort Worth late Monday and was diagnosed with Ebola on Wednesday.

Belton Independent School District, about 130 miles south of Dallas, closed two elementary schools and a middle school.

“Canceling classes at the three campuses will allow us to thoroughly clean and disinfect the schools and buses that served them this week. It will also allow health officials additional time to reassess the health risk to passengers on the plane,” Belton District Supt. Susan Kincannon said in a statement.

Kincannon said the district was notified late Wednesday that the Centers for Disease Control and Prevention was re-evaluating the health risk to some passengers on Frontier Airlines Flight 1143.

In Ohio, the Solon City School District in the Cleveland suburbs closed an elementary and a middle school, spokeswoman Tamara Strom said.

“Two students from these schools were on the same plane that carried the Ebola patient, but not the same flight,” Strom said. “This is totally precautionary as we try and figure out the health situation.”

In Washington, senior federal health officials and the head of the Dallas hospital where the two nurses contracted Ebola were testifying before House lawmakers Thursday afternoon to try to explain the breakdowns that led to the virus’ spread.

Dr. Daniel Varga, the chief clinical officer of Texas Health Resources, which owns the hospital, plans to apologize for breakdowns in the care of Duncan.

“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes,” Varga says in his prepared testimony.

“We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.”

Varga also is to testify that the hospital is working diligently with federal officials to identify where breakdowns in safety protocols may have occurred, causing two nurses who care for Duncan to also be infected.

The hearing before the House Energy and Commerce Committee’s oversight subcommittee is giving members of Congress their first opportunity to grill federal officials since the Texas health workers were diagnosed with Ebola.

A growing number of Republican lawmakers are calling on the Obama administration to take stronger steps to cut off travel from West Africa and strengthen the federal government’s response to Ebola in the United States.

Dr. Thomas Frieden, head of the federal Centers for Disease Control and Prevention, has sought to reassure lawmakers and the public that the agency is stepping up assistance to local hospitals to prevent further spread of the disease.

And in his prepared testimony, the CDC director again expressed confidence that a wider outbreak in this country was highly unlikely.

“As we learn from the recent importation case in Dallas and subsequent transmissions, and continue the public health response there, we remain confident that Ebola is not a significant public health threat to the United States,” Frieden said.

“It is not transmitted easily, and it does not spread from people who are not ill, and cultural norms that contribute to the spread of the disease in Africa — such as burial customs and inadequate public health measures — are not a factor in the United States. We know Ebola can be stopped with rapid diagnosis, appropriate triage, and meticulous infection-control practices in American hospitals.”

AFP Photo/Nicholas Kamm