Second Ebola Nurse May Have Shown Early Symptoms Longer Than First Reported

More Ebola news that could have a negative impact on public opinion.

Ebola Virus And Caduceus

Late yesterday it was reported that Amber Ray Vinson, the second nurse to treat Thomas Eric Duncan to be infected with the Ebola virus, may have shown early signs of an infection much earlier than first reported:

A nurse with Ebola may have shown symptoms of the virus as many as four days before authorities once indicated, meaning that she might have been contagious while flying on not just one, but two commercial flights, officials said Thursday.

Amber Vinson was hospitalized Tuesday, one day after she took a Frontier flight from Cleveland to Dallas. Tests later found that Vinson — who was among those who cared for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, at Dallas’ Texas Health Presbyterian Hospital — had Ebola.

Authorities indicated Vinson had a slightly elevated temperature of 99.5 degrees Fahrenheit, which was below the fever threshold for Ebola, but didn’t show any symptoms of the disease while on her Monday flight. This is significant because a person isn’t contagious with Ebola, which spreads through the transmission of bodily fluids, until he or she has symptoms of the disease.

But on Thursday, Dr. Chris Braden of the Centers for Disease Control and Prevention told reporters in Ohio that “we have started to look at the possibility that she had symptoms going back as far as Saturday. … We can’t rule out (that) she might have had the start of her illness on Friday.”

“So this new information now is saying we need to go back now to the flight that she took on Friday the 10th and include them in our investigation of contacts,” said Braden.

The CDC announced later Thursday that is “expanding its outreach to airline passengers now to include those who flew from Dallas-Fort Worth to Cleveland on Frontier flight 1142” last Friday — which is how Vinson got to Ohio, from Texas, originally.

The medical director in Summit County, Ohio, where Vinson spent time before returning to Texas, told CNN that two things have changed: what the CDC defines as a “contact” of someone with Ebola and more information has been gathered on how Vinson was feeling.

“What the CDC has discovered, through interviews, is that she may not have been feeling well earlier than we initially thought on (Monday),” said the director, Dr. Marguerite Erme.

“… It was nothing you could point your finger at and say, ‘Ah, this is a particular disease,” Erme added. Nonetheless, the new information “kind of signified that maybe she had the illness longer than what she had when (hospitalized).”

Her uncle, Lawrence Vinson, said Thursday night that his niece didn’t feel sick until Tuesday morning, when she went to the hospital with a temperature of 100.3 degrees (which is still below the CDC’s Ebola threshold).

Yet a federal official with direct knowledge of the case gave different information to CNN’s Elizabeth Cohen, relating that Vinson said she felt fatigue, muscle ache and malaise while she was in Ohio. She did not have diarrhea or vomiting while in that state or on the flight home.

The fact health officials are working from this latter assumption — that Vinson may have been ill for longer than once thought — could significantly expand the number of people who might have been in contact with Vinson while she was contagious.

Given the manner in which Ebola is spread, it’s unlikely that Vinson actually spread the disease to anyone else even if she was showing early signs of an infection earlier than when she called the C.D.C. on Sunday before her scheduled return flight to Dallas. Notwithstanding that, however, the possibility that there may have been some symptoms creates several issues.

First of all, as noted, it will greatly expand the amount of contact tracing that health authorities will have to do, including not just the C.D.C. and authorities in Ohio, but also authorities in wherever the passengers on these two flights may have gone afterwards. While nothing is likely to come from the fact that they were on the plane with her, this is a step that is called for just as a matter of simple prudence and to as a demonstration to the public that public health authorities are on doing their best to combat. Second, even with that action by public health authorities, news like this, combined with what I’m noticing to be an increased level of hysteria coming from news coverage of this story at all levels, news like this is likely to raise public concern even if there are no future cases of Ebola reported outside of the environment of Texas Presbyterian Hospital. Finally, all of this calls the protocols that were in place before the Duncan case became public, and the way that Texas Presbyterian handled Duncan’s case initially, further into question. According to every that I’ve read, the protocols themselves have said from the beginning that  someone who has been treating an Ebola patient should not be taking non-supervised travel during the incubation period. Given reports yesterday that the staff at Texas Presbyterian had not even been briefed on Ebola prior to Duncan’s arrival at the hospital, one has to wonder just how well Vinson and her fellow health care workers were briefed on proper procedures, and whether she would have taken the initial trip to Cleveland if she had been.

As I noted yesterday, it seems obvious that mistakes have been made at several levels in responding to this first Ebola case in the United States. What remains to be seen now is how far those mistakes will reach, whether we will learn from them and change procedures and protocols as necessary, and how much confidence the public will continue to have in authorities if those mistakes continue.

FILED UNDER: Health, US Politics,
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. Jack says:

    CDC = Keystone Cops

  2. KM says:

    Dallas Health Care Worker Who Handled Specimen From Ebola Victim Quarantined On Cruise Ship

    According to every that I’ve read, the protocols themselves have said from the beginning that someone who has been treating an Ebola patient should not be taking non-supervised travel during the incubation period.

    OK, this is getting ridiculous. I understand that Ebola is not very easily transmitted when compared to other killers like influneza. I understand 20+ days is a long time to begin to feel confident in your health status and to hold up your life. I understand that a lot of this is hysteria from a public facing a deadly disease they know little about and thus fear things that they perhaps shouldn’t. But for god sake these people are supposed to be medical professionals – you know, the ones with medical knowledge? Even if they might not personally have know all the relevant details and protocols, are you telling me no one was curious enough to research more into the potentially fatal disease they’d been exposed to?! No one stopped and thought, maybe I shouldn’t go traveling long distances yet since I’m not 100% clear?

    This is a complete lack of common sense on the part of people who’s entire job consists on understanding and treating illnesses. Screw the CDC and their recs – a personal overabundance of caution when dealing with something that requires PPE should be the norm, not “need to be briefed” mentality. Strict isolation for all the hospital workers should have been mandatory policy, if only for the simple reason that there’s no kill like overkill. If it’s an epidemic that requires iso then damnit go big or go home. Half-assed helps no one – there used to be a sign on the elevator outside my lab “Take off your gloves before you touch. Whatever you’re protecting yourself from, we don’t want either!” specifically for people like this. This whole thing could have been nipped in the bud very easily – instead, we’re going to be hearing about this crap for months.

  3. Jack says:

    @KM: I’m sure the CDC gave her permission to take the cruise.

  4. Dave Schuler says:

    I don’t see that this revelation changes things much. We’re still relying on it being unlikely that disease will be transmitted among passengers on a plane.

    IMO the more serious question is what’s the plan? The present plan which appears to be a combination of flying squads and transporting patients to hospitals with experience in treating Ebola would appear to assume a very small number of patients. Let’s hope that remains the case.

  5. JKB says:

    @KM:

    I agree. If you’ve ever done anything dangerous, the first rule is that no one cares whether you live or die more than you yourself. Do your own planning and don’t trust the “expert”. I tried to inculcate that into all my crews.

    Infectious disease and they seem to have had not training or have forgotten about the concept of barrier medicine. Of course, this isn’t new. My aunt who hasn’t done such nursing in 50 years tells of how the nurses had to put on all this protection but the doctors, for no virus would dare infect a doctor!, would walk in and sit on the edge of the bed in their street clothes then go to the next patient. Still happens today.

    It does seem odd that the “medical” and public health professionals don’t seem to know what I was able to learn in a half hour using Google and common sense.

    Nothing calms a panic like competency. Nothing sparks one like being shown to be clueless and a liar.

  6. JKB says:

    @Dave Schuler:

    The only good news is, if we look at who caught it from Patient US1, it appears for the Ebola to be really communicable the patient has to be well into the vomit/bleeding phase and not just feeling poorly.

    Of course, the Administration could be hiding patients from the media. Sad, we have to consider that possibility. Incompetent. And Obama has freaked people out with his canceling fundraisers to go to a meeting about the “crisis”. He wouldn’t do that when his direct representative was being murdered in Libya. If he cancels a golf game, it will be time to panic.

  7. C. Clavin says:

    Is there any news about her morning bowel movement? Did she cough? Roll over in bed?
    Seriously…this breath by breath coverage is getting ridiculous.
    2 people in a country of 320 million people have a disease. That’s less than statistically insignificant.
    In West Africa there are maybe 20 – 30,000 cases…in a region of 340 million. That’s something on the order of .01%.
    And people like Jack, who are crying like little babies, watched as how many people died from Aids? We can’t do anything about him….but the rest of you should get a grip.

  8. C. Clavin says:

    @JKB:

    Of course, the Administration could be hiding patients from the media.

    Idiot.

  9. grumpy realist says:

    This is starting to sound like Keystone Cops on all levels. Geez. I work in a legal firm and my job is to double-check stuff. With an infectious disease with such a high death rate, it would seem the very first thing to do when treating it is an overabundance of caution and carefully overlapping systems so that nothing falls through the cracks. It may be expensive to suit up your nurses and lab people in the beginning, but given all the cost, time, effort, and panic involved in tracking down the contacts of everyone who turns out to be infected, isn’t this false economy?

    What we really need ASAP are two things. First, a method of discovering that someone has been infected BEFORE the person has enough of a viral load to be contagious. PCR may be the way to do on this. Second (also obvious) is a vaccine. And once it’s developed, no exceptions to getting vaccinated “because of my religion”, or “oh my god my kid will develop autism!” (I suppose saving him from autism is more important than having him end up vomiting and excreting blood until his organs give out, right?)

    I think a lot of what we’re seeing now is a) we’re not really sure about how the viral load increases over time and the relation between infectiousness and viral load, and b) how good ARE some of our standard policies when having to deal with a dangerous illness like this?

    Still, I’m not panicking. Am still at a much higher risk to being killed in a car accident with some dumb idiot texting/talking on phone while driving.

  10. Jack says:

    @C. Clavin: Crying like little babies??

    Clavin, you ignorant douchebag.

    The CDC has bungled Ebola from the get go and you darn well know it. Any agency that gives a nurse with direct exposure to patient zero in the US permission to fly on a commercial aircraft with a self reported low grade fever has failed in its mission to protect the public. They failed to offer appropriate guidelines for dealing with possible Ebola patients and then blame the nurses who followed the CDCs stupid advice to the T. The CDC failed to properly quarantine patient zero’s family here in the US until the family decided to ignore the CDC guidelines and go shopping. The CDC waited a week before cleaning the apartment in which patient zero lived.

    You can defend the CDC all you want, but it simply makes you look more stupid than you already are.

    The CDC should be renamed the CDD – Center for Disease Distribution.

  11. C. Clavin says:

    @Jack:

    You can defend the CDC all you want

    Please show me where exactly I defended the CDC.
    And if you can’t…then maybe you should just STFU.

  12. Jack says:

    @C. Clavin: You poor, poor, misguided and ignorant shitbucket.

  13. Guarneri says:

    It’s ironic to note Clavin pooh-poohing a disease in its infancy and with ill- defined transmission characteristics in contrast to the significant ultimate impact of a virus similarly not well understood in its infancy.

    But then again, perhaps Ebola is the JV virus.

  14. C. Clavin says:

    @Jack:
    Well clearly you couldn’t back up your claim…so you should probably just shut up until you learn to read.

  15. C. Clavin says:

    @Guarneri:
    We can address diseases and epidemics without panicking like little children.
    In one case people like you ignored it. Now you are panicking. Neither reaction is rational.
    I’m merely counseling rational behavior.
    Clearly you disagree.
    I’m not surprised.

  16. Jack says:

    @C. Clavin: I have done nothing but blame the CDC in my posts. Attacking me is a defense of the CDC you mental midget. Additionally, this administration has done nothing but defend the CDC at every misstep, so defending the administration defense of the CDC is defending the CDC. Apparently your brain is simply too small to make the connection.

    But you keep on being you. Your powers of deduction and reason will work well for you as a fry cook at McDonalds.

  17. C. Clavin says:

    @C. Clavin:
    And to take it even further…it’s the same panic that led us to f’ up post 9.11…which cost us mightily in blood and treasure.
    Try growing a pair.

  18. C. Clavin says:

    @Jack:

    Attacking me is a defense of the CDC you mental midget.

    Pretty f’ing impressed with yourself, eh?
    Attacking you is taking advantage of the disadvantaged. Nothing more.

  19. Rafer Janders says:

    @JKB:

    And Obama has freaked people out with his canceling fundraisers to go to a meeting about the “crisis”.

    Really? People were “freaked out” by this? There are people alive who are so weak-willed and hysterical that they throw themselves into an emotional tailspin based on changes in the president’s travel schedule? And those people otherwise manage to feed, clothe and bathe themselves, and are not patients in an asylum for the chronically overwrought?

  20. Jack says:

    @C. Clavin:

    And to take it even further…it’s the same panic that led us to f’ up post 9.11…which cost us mightily in blood and treasure.

    The same post 9.11 freight train that the Obama administration has happily hopped onto to further the causes that he believes in.

    You ignorant retard.

  21. grumpy realist says:

    @Jack: So what do you suggest we do? Take them all out and shoot them? Yeah, that’ll really help matters.

    One question I have, however. Did the nurse, when she called the CDC, let them know that she had been exposed to a patient with Ebola? Or did she just call and say “oh, I have a temperature of 99.4 degrees?”

    It does sound like she was given an answer by some mindless wight who just looked up the “standard policy answer” and wasn’t thinking.

    Part of the problem is that we haven’t made changes yet that really emphasize safety. Did you know that there is absolutely nothing that keeps you from being fired if the reason you can’t show up at work is because you’re being quarantined?

  22. Jack says:

    @C. Clavin: And arguing with you is like playing basketball with the short bus kids and calling them for double dribbling.

  23. Jack says:

    @grumpy realist: My suggestion is for the CDC to get its house in order. That includes determining a exposure criteria and post exposure quarantine. That includes defining proper handling methods that reduce the risk to those providing healthcare and proper destruction methods for medical waste. That includes proper cleaning of infected or possible infected areas. That includes clamping down on anyone and everyone that may have come in contact with those that were exposed and definitely not allowing them to take public transportation.

    No one is suggesting we execute everyone at the CDC, but even you agreed, the current CDC protocols are more akin to keystone cops.

  24. C. Clavin says:

    @Jack:
    It’s not arguing when you just make shit up that doesn’t exist and that you can’t back up.
    What you do is called ranting. Pure fever-swamp irrational ranting.
    But hey, it works for you.

  25. Jack says:

    @C. Clavin: Well if you are comparing my posts to your mental midgetry, I suppose they would be considered rants.

  26. KM says:

    @C. Clavin:

    2 people in a country of 320 million people have a disease. That’s less than statistically insignificant.

    We can address diseases and epidemics without panicking like little children.

    Yes we can and should. That’s not what’s happening here, though. What’s happening is people are putting their personal lives and agendas (marriage, vacations, etc) ahead of the public good. I’m sorry but it’s incredibly selfish of someone who knows they’ve been in a hot zone to want to carry on with their daily lives at the expense of the general public. That’s what’s fueling the “panic” here – the idea that someone who’s not been officially cleared casually going “Yep, time for a vacay!” and thus potentially putting others at risk.

    Does it suck to be them? Yes. Is it fair to make them stay in iso for almost a month to be sure? Not really but containment is key. You can’t close that barn door after the horse is miles away. It’s significant because we’re seeing again and again selfish people – medical professionals – who should know better perpetuating the issue by not doing the right thing. I once had an idiot contaminate 3 whole floors by wearing his dirty PPEs to the cafeteria because he was hungry. They had to keep over 50 people in iso for 48 hours because one moron was selfish enough to do what he wanted instead of engaging his brain.

    Again, there is no reason for new vectors to be introduced. We can stop this – its not even hard.

  27. JKB says:

    @grumpy realist:

    You can’t shoot them, it’ll aerosolize the virus in the blood. Geez, we have to keep these things in mind. I suppose you could flamethrower them?

    The nurse called CDC as per protocol for someone under Ebola infection surveillance. Although, apparently, she could have just checked the CDC website.

    Unless the quarantine was due to your employment and the risk of exposure was due to the conduct of you assigned duties. Then you have a Worker’s comp claim.

  28. C. Clavin says:

    @KM:
    Yes…you are 100% correct.
    And the Hospital in Texas failed. Miserably.
    My only point is that people like Jack throwing hissy fits doesn’t solve anything.
    Heart disease, cancer, traffic accidents, guns, and climate change will all kill far more people and cost far more money than Ebola ever will. And yet probably few of us gave any of them any thought this morning.

  29. Jack says:

    @C. Clavin:

    Heart disease, cancer, traffic accidents, guns, and climate change

    I can’t catch any of the above because you decided to take the bus to work or forgot to wash your hands at a local restaurant.

  30. grumpy realist says:

    @JKB: So what you’re saying is that quarantining of anyone who innocently comes into contact with an Ebola-infected nurse is something that would NOT be covered under Worker’s comp, right? Just as I said….no protection against getting fired.

    It looks like the CDC didn’t have good policies in place (I think they fell into the “we gotta keep people from panicking” trap), probably because of not knowing better. Also probably because they thought if they insisted on a much higher level (such as the WHO) for any cases of suspected Ebola they’d get a lot of bitching about “how you’re forcing us to waste money!”

    And considering that the hospital doesn’t sound like they were even adhering to the CDC protocols, it’s a little thick to blame the CDC for this. Heck, why not blame the State of Texas? The hospital was licensed and working under their regulations. Why didn’t Rick Perry do something about this? (I think local authorities are the ones who are supposed to put in place quarantines.)

    Basically, nobody wants to put policies and emergency systems in place for a rare event and always complain bitterly about the expense. Then, when the rare event takes place, it’s always “why didn’t you warn us about it?!”

  31. JKB says:

    @Jack:

    What is needed is to get ahead of the CDC keystone act. I recommend this CDC pamphlet for VHF infection control in an African setting. If you look at it, they recommend much more stringent personnel protection procedures than the current CDC does for a US healthcare setting. Oddly, other than a HEPA or N95 mask, and face shield, all the technology was available in 1918. The face shield was even available but would have been glass.

    On the other hand, the Dallas hospital has released a statement where they cite complying with the changing CDC guidelines which started out with the N95 (or better) mask, optional. We are having caregiver infections because the CDC is creeping up on the standard rather than going stringent then lessening the requirements as more is learned. Morons.

    We should worry that the average US hospital seems incapable of instituting the kind of infection control recommended and achieved in a makeshift African setting.

  32. grumpy realist says:

    @KM: Bravo, well-said. We want to be able to continue our normal lives without any interruption.

    (Considering that I think we need a far higher appreciation for our duty to the group, I’m slightly hopeful. You know who will probably NOT have any problem containing any cases of Ebola? Japan. People will know their responsibility to society and not try to avoid it because of “freedom!”.)

  33. KM says:

    @JKB:

    Worker’s comp claim.

    I was actually talking about this with my friend the other day. She’s an Infection Control Specialist in a major hospital and noted one of the reasons people don’t stay home when ill is financial reasons. Perhaps we should consider some sort of funding for cases like this; people who have to stay in iso through no fault of their own reviving some sort of compensation to ease the pain. Maybe a law saying you can’t be fired or docked pay for being quarantined? I think there’d be far more compliance if we took on of the major stressors off; instead of worrying if you’re going to have a job tomorrow, all you have to worry about is your health.

  34. C. Clavin says:

    @Jack:
    You should spend less time crying and more time understanding facts. Just sayin’

  35. C. Clavin says:
  36. grumpy realist says:

    @JKB: I’m wondering if the difference in levels is because we don’t regularly have drastic diseases running around in the US but Ebola/Marburg/whatever pop up pretty frequently in Africa.

    What the CDC should have done is immediately swapped the African levels in for the US levels as soon as it became obvious this episode in Africa wasn’t being controlled.

    Some of this stuff is starting to smell suspiciously like the Challenger accident. You know, where the engineers were squawking about the effects of cold on the O-rings and one of the executives told them to “swap out your engineering hat for a management hat.”

    An infectious virus doesn’t give a crap about whether a for-profit hospital makes money or not.

  37. Slugger says:

    I like KM’s idea to provide funding for people in quarantine.
    BTW, I don’t like comments that include ad hominem attacks. Personally, I confess to being a big, big douchebag, but when someone calls me on it, I dig my heels in rather than be convinced. In this failing, I am like every other person on earth.

  38. Jack says:

    @C. Clavin: The facts are, the CDC has bungled this mess all in the name of political correctness. Rather than go in full bore, like JKB noted, they seem to be creeping up to the recognized standard protocols rather than starting out with the known and increasing precautions from there as needed.

    Yes, based upon the most recent obesity studies, this country has more of a problem with pastabola and icecreambola than Ebola, yet it is not something to mess around with as is evident by the outbreak in Africa.

    Had proper protocols been in place with patient zero, it would/could have ended there with no further possibility of retransmission. Yet, because the CDC did not enforce the proper protocols, there are x number of passengers in danger from the commercial flights, x number of passengers in danger from the commercial cruise, and x number of people who came in contact with the people who were on the cruise and flight…in addition to the fact that the planes flown on by the currently infect nurse remained in service for several more days. The number of people possible exposed to Ebola has now grown exponentially, all because the CDC didn’t want to panic the public.

  39. Jack says:

    @C. Clavin:

    In West Africa there are maybe 20 – 30,000 cases…in a region of 340 million. That’s something on the order of .01%.

    And yet, those exact same numbers apply to gun deaths in the US and you leave skid marks in your tighty whiteys. Hypocrite much?

  40. grumpy realist says:

    @Jack: Don’t blame just the CDC. It looks like almost everyone dropped the ball in this case.

    Including the professional health individuals, by the way.

    And now Texas is finally deciding to lock the barn door after the horse has been stolen. Notice–nothing is being said about how these people are supposed to get food if they’re living by themselves or anything. Or what they’re supposed to do if they don’t have cars to get around. Just “do this, and any problems with compliance are your own problem.”

    (Incidentally, I can’t think of a better way for someone who turns out to be contagious with Ebola to spread the disease randomly than by having continued pizza deliveries and paying with money taken out of his wallet.)

  41. Jenos Idanian #13 says:

    Oh, Jesus. Cliffy has finally met the anti-Cliffy.

    Maybe Cliffy and Jack will mutually annihilate each other…

  42. Jack says:

    @grumpy realist: I agree that the Dallas hospital and the medical professions that work there are also culpable. However, hospitals take their lead from the CDC with regard to Ebola, and the advisories at the time of patient zero, simply were not there.

    As to home detainment for 30 days, I think if you live in a single family dwelling…not an apartment complex, that food and/or groceries should be delivered by health professionals. Simply put, you are in witness protection at that point and the government should absorb the costs. If you live in an apartment, then you should be moved to a government facility away from others.

  43. beth says:

    @grumpy realist: I thought we had established that the state or local health department was responsible for quarantining people. Wasn’t it a local judge who found Duncan’s relatives a place to stay through church connections? It seems to me that locals would be in a much better position to arrange for housing and food unless the CDC has always had a local Dallas office.

    What worries me are reports like the one published in Talking Points Memo by a spouse of a nurse at a large hospital. She claims they are not prepared at all for an Ebola patient (no training, no equipment) yet the head of infectious disease went on local tv and assured the city that they were fully prepared. Who to believe? (TPM is usually pretty good about checking out their sources so I tend to believe this story.)

  44. grumpy realist says:

    @beth: Yeah, so I find it amusing that people are ventilating about the supposed sins of the CDC for “not controlling” this. It’s not the CDC that a raspberry should be blown at in this case–it’s the State of Texas and the hospital.

    (Trust me, if the CDC had tried to impose the stricter WHO rules from the beginning, we would have seen angry letters from hospital bean-counters complaining about money-wasting procedures.)

  45. steve says:

    Just for the record, since I have been following this for months,and my life will be on the line if an Ebola patient shows up in our ER, the CDC has been doing a very credible job in helping stop the spread of the disease when people will listen to them. They had a lot of input in helping with the case that showed up in Nigeria. They have been working with the MSF people. They have been sending out warnings and advice to hospitals for months. They have been following the genome of the virus looking for change. All that said, the CDC has limits. So, while Ebola has been ongoing for many months, we have had only one case enter the US so far. Not bad.

    First, it cannot prevent stupid. When the first patient showed up and they sent him out with antibiotics, that was just stupid. You can have the best protocols and advice in the world, but it people are going to be stupid and incompetent, they won’t matter.

    Second- The CDC is an advisory body. They don’t control hospitals. I don’t want them controlling hospitals. I suspect that if you get off of your high horse you would admit that you don’t want them to either. Could they have actually ordered and enforced hospitals training. I don’t think so. Do you want to give them those kinds of powers?

    Third- The CDC is acting on the best information it has from dealing with a fairly small number of patients over the last 20 years, somewhere in the neighborhood of 2500 patients. They have sought and used advice from the patients taken care of and observed in the past.

    Fourth- Mistakes. This is a brand new disease in the US. I lived through the early years of AIDS. We got many things wrong at first, but everything got corrected. So, the CDC assumed that our hospitals, with many more resources, could manage patents as well as they do in Africa with many fewer resources. That was wrong, and they have now adapted. They have altered the suggested protocols (within a couple of days) and are now taking patients to specialty hospitals. This is a fast response and correction. There will probably need to be others. If your expectation was that they will do everything correctly on the first go around, then you can, I guess, make Keystone Cops comparisons. In reality, the large majority of what they have been doing has been working and they are responding quickly when they found out things are not working. I am pretty happy with that. (just to be a tiny bit wonky, we may be facing problems not sen by MSF. Their patients get better or die fairly early. Since we dialyze these people and put them on vents, we may be treating patients with a much higher viral load. Protocols that worked in Africa may not work here.)

    Fifth- I suspect that they probably expected people to behave a bit more responsibly. They should have remembered that people are emotional, not rational. I am pretty sure that none of my nurses would have gotten onto a plane if they had been exposed. I would have talked with them about it. In the case of the nurse who flew, her leadership failed her, and she was also incredibly irresponsible.

    6- Since I am in the trade, perhaps I really don’t hear what others hear. I never expected zero cases, but somehow it appears someone said something that made people think that. I never expected it to go perfectly in the first round, yet people seemed to hear stuff that made them think it would.

  46. al-Ameda says:

    @Jack:

    And yet, those exact same numbers apply to gun deaths in the US and you leave skid marks in your tighty whiteys. Hypocrite much?

    I just knew there was a Second Amendment relationship to the Ebola “Crisis”

  47. Jack says:

    @al-Ameda: I didn’t say there was a relationship, you did. I simply pointed out that the numbers are the same and Clavin…among others, thinks it’s a big deal when it comes to guns, but it’s overreacting when it comes to Ebola.

  48. Scott says:

    @steve: Great corrective.. Thanks.

  49. beth says:

    @steve: I know you’re probably very busy but could you please go post that on every single internet comment section? Thanks.

  50. al-Ameda says:

    @Jack:

    …among others, thinks it’s a big deal when it comes to guns, but it’s overreacting when it comes to Ebola.

    Necessary procedures and precautions should be taken, however, I believe that EVERYONE is overreacting when it comes to Ebola.

  51. Jack says:

    @al-Ameda: You ain’t cool unless you pee your pants.

  52. ernieyeball says:

    From today’s Huffington Post
    I’m a Hazmat-Trained Hospital Worker: Here’s What No One Is Telling You About Ebola by Abby Norman

    We have the technology, and we certainly have the money to keep Ebola at bay. What we don’t have is communication. What we don’t have is a health care system that values preventative care. What we don’t have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don’t have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed. What we don’t have is the social culture of transparency, what we don’t have is a stopgap against mounting hysteria and hypochondria, what we don’t have is nation of health literate individuals. We don’t even have health-literate professionals. Most doctors are specialists and are well versed only in their field.

    http://www.huffingtonpost.com/abby-norman/im-a-hazmat-trained-hospi_b_5998486.html?ncid=txtlnkusaolp00000592

  53. Grewgills says:

    @Jack:

    The CDC failed to properly quarantine patient zero’s family here in the US until the family decided to ignore the CDC guidelines and go shopping.

    This has been gone over in multiple threads, the CDC does NOT have the power to forcibly quarantine anyone that is not traveling internationally or interstate. Only the government of Texas could have legally forcibly quarantined Duncan’s family in Texas. I see you have no criticism for the Texas board of health or governor Perry who could have legally forcibly quarantined Duncan’s family. Is that due to ignorance or politics?

  54. Grewgills says:

    @grumpy realist:

    Part of the problem is that we haven’t made changes yet that really emphasize safety.

    A friend of mine works for a major hospital chain in Kentucky. They distributed protocols after the incident in Dallas. Among those protocols is that if a patient appears to be from Africa and doesn’t speak English, the nurses and techs are NOT to use the translation phone. Instead they are to show the patient a map and point to Africa. If this is the kind of protocol being distributed by major hospital networks (that has absolutely no connection to CDC protocols) then that is reason for worry if this spreads any further.

  55. Grewgills says:

    @Jack:
    Most of what you suggested was done well before Duncan arrived in Dallas.

    That includes clamping down on anyone and everyone that may have come in contact with those that were exposed and definitely not allowing them to take public transportation.

    Again, unless that travel is interstate or international the CDC doesn’t have that legal authority. And again, if they had asked for it a year ago people like you would have been screaming about the coming socialist tyranny.

  56. Jack says:

    @Grewgills: If the CDC wanted to forcibly quarantine Duncan’s family, they could have; however, I agree that Texas, on the advice of the CDC should have forcefully quarantined the family from the get go. I should have said that the CDC likely did not advise Texas to forcibly quarantine the family, or, that the CDC did not make it clear to Texas the importance of quarantining the family. Texas is not clean on this either, but ultimately this lands at the doorstep of the CDC. Nowhere in the name TEXAS are the words “disease control”.

  57. Jack says:

    @Grewgills:

    Again, unless that travel is interstate or international the CDC doesn’t have that legal authority.

    The CDC can certainly submit a name to the TSA for inclusion on a “no-fly list”, which would have kept the nurse from flying to Cleveland.

  58. Jack says:

    Texas-Based Carnival Magic Cruise Ship Stuck At Sea With 4,633 Passengers (walking petri dishes) and Dallas Healthcare Worker With Ebola Symptoms – Belize Refuses Port Entry – Belizeans Saying “Sink Ship” – Armed Belize Coast Guard Keeping Ship At Sea…

    Yeah, the CDC couldn’t have done anything about it……..

  59. Jack says:

    EBOLA – Brought to you by the government that wants to control your health care.

  60. lounsbury says:

    @grumpy realist: In Central Africa. Not West Africa. Distance greater than your E. to W. coasts.

    The distances are massive. “Africa” is a huge place mate. The fact that the Ugandans are quite skilled in Ebola containment from practice doesn’t really say anything about the poor far-Western West Africans who’ve never dealt with this before.

    The sheer hysteria in the US over a handful of cases is… rather sad and pitiful.

    However, I remain boggled by the bizarre incoherency of comment – Americans seem to want to have Centralized Government but Not Want Centralized Government. Analytical incoherent.

  61. Grewgills says:

    @steve:
    Thank you for saying that better and more thoroughly than anyone here so far.

  62. Grewgills says:

    @Jack:

    If the CDC wanted to forcibly quarantine Duncan’s family, they could have

    On what legal authority?

  63. Jack says:

    @Grewgills: Exigent Circumstances. The legalese could have waited until they were certain the outbreak would not spread…turned over the responsibility to local/state after an agreement to keep them 21 days. In this instance it’s definitely better to ask for forgiveness than ask for permission. A court case would certainly have taken longer than the time needed to ensure family members were not a danger to others.

    If the NDAA says the military can “indefinitely detain” Americans suspected of terrorism, then we can certainly detain people suspected to be infected with Ebola.

  64. beth says:

    @Jack: Oh for f*cks sake – the woman onboard is a lab worker. Every day in this country lab workers handle all sorts of contagious diseases – anthrax, plague, etc. and when the day is done, they take off their work clothes, go out to dinner, shopping, movies and even take vacations on planes and ships. For goodness sakes, stop peeing your pants in panic.

  65. Jack says:

    @beth: Oh for f*cks sake…she is exhibiting Ebola symptoms!!!!!

  66. Jack says:

    @beth: The Belizean authorities are stating the Dallas Healthcare worker is exhibiting Ebola symptoms and refusing port entry for emergency airlift evacuation. Armed Coast Guard vessels are forcing the Carnival Magic Cruise Ship to remain at sea. This is quickly becoming an international incident.

  67. Grewgills says:

    @Jack:

    Exigent Circumstances. The legalese could have waited

    That is rich coming from you. If they had done so, people like you would have been screaming from the rafters about tyranny and the sovereignty of states. The CDC doesn’t have the authority you ascribe to it, nor should they.
    Given your history I am not sure whether you are actually as irrationally scared as you come across or if you just find this a convenient cudgel.

    If the NDAA says the military can “indefinitely detain” Americans suspected of terrorism, then we can certainly detain people suspected to be infected with Ebola.

    How on earth is one related to the other?

  68. Jack says:

    CDC: You cannot get Ebola from riding the bus.

    CDC: You can spread Ebola if you ride the bus.

    Keystone cops indeed.

    http://cnsnews.com/news/article/brittany-m-hughes/cdc-you-can-give-can-t-get-ebola-bus

  69. C. Clavin says:

    @steve:
    Thanks for some well needed level-headedness.
    And thanks too for doing what you do…when someone shows up in your ER with this you, and people like you, show some major cojones by being on the front line.

  70. Jack says:

    @Grewgills: Like I said, this is one of those cases where you ask for forgiveness later.

    Exigent Circumstances works for police when they want to catch a criminal, why not when the government wants to prevent an epidemic?

  71. C. Clavin says:

    @Jack:

    she is exhibiting Ebola symptoms!!!!!

    Holy 5 exclamation points Boy Robin…you must be scared absolutely $hitless.
    Go hide under your bed.
    We’ll be sure to tell you when it’s OK to come out again.

  72. beth says:

    @Jack: And who’s telling you this? The same people who were screaming about “clipboard man” all day yesterday only to be proven wrong?

  73. Jack says:

    Forget medical experience, what the USA needs to combat the worst Ebola pandemic ever is “an American lawyer and political operative” who is current Chief of Staff for Joe Biden.

    Meet America’s New Ebola Czar

    Ronald A. “Ron” Klain is an American lawyer and political operative best known for serving as Chief of Staff to two Vice Presidents – Al Gore (1995–1999) and Joseph Biden (2009–2011). He is an influential Democratic Party insider. Earlier in his career, he was a law clerk for Supreme Court Justice Byron White during the Court’s 1987 and 1988 Terms and worked on Capitol Hill, where he was Chief Counsel to the Senate Judiciary Committee during the Clarence Thomas Supreme Court nomination.

    Yeah, we don’t need someone with medical experience, a simple Democrat operative should do the trick.

  74. Grewgills says:

    Regarding the cruise ship off Belize

    Though the employee did not have direct contact with Duncan, he or she “may have had contact with his specimen,” the U.S. State Department said Friday. A doctor at the cruise ship has declared the worker symptom-free and in good health, but the worker will remain under isolation as a precaution, it said.
    It’s been 19 days since the worker handled Duncan’s fluid samples — two days shy of the 21-day incubation period for Ebola.

    Note that the worker MAY have had contact, is not symptomatic, and is two days shy of the incubation period. There is absolutely no reason to panic on this and talk of the passengers being walking petri dishes is hysterical gibberish by the irrational or people with an ax to grind.

  75. Jack says:

    @beth: Belize Prime Minister, Dean Barrow, has told U.S. State Department the cruise ship will not be allowed to port. • Dallas healthcare worker who did lab work for Patient Zero, Thomas Duncan, is on board, and quarantined. • Armed Belize Coast Guard refuse to allow docking for emergency airlift. • Belizean Harbor pilot also not permitted to leave ship. • Belize Government Issues Press Release.

    https://www.facebook.com/GOBPressOffice

  76. Jack says:

    @C. Clavin: You’re one to talk….skidmark.

  77. Mikey says:

    @Jack: And here we see what this is really all about for you: you’re whipping up irrational panic because you can use it to discredit the government.

    That’s the case with most Republicans, but few let their guard down enough to actually admit it, as you’ve done.

  78. beth says:

    @Jack: Well now that’s quite different from OMG SHE’S EXHIBITING SYMPTOMS – WE’RE ALL GONNA DIE!!!! isn’t it?

  79. Jack says:

    @Mikey:

    discredit the government.

    Obama has done that all by himself, no assistance necessary, cupcake.

  80. C. Clavin says:

    @Jack:

    the worst Ebola pandemic ever

    Run for the hills, Chicken Little. Don’t forget your diapers.

  81. beth says:

    @C. Clavin: I like how this:

    The Belizean authorities are stating the Dallas Healthcare worker is exhibiting Ebola symptoms and refusing port entry for emergency airlift evacuation. Armed Coast Guard vessels are forcing the Carnival Magic Cruise Ship to remain at sea. This is quickly becoming an international incident.

    turned into this:

    elize Prime Minister, Dean Barrow, has told U.S. State Department the cruise ship will not be allowed to port. • Dallas healthcare worker who did lab work for Patient Zero, Thomas Duncan, is on board, and quarantined. • Armed Belize Coast Guard refuse to allow docking for emergency airlift. • Belizean Harbor pilot also not permitted to leave ship. • Belize Government Issues Press Release.

    in just a few short minutes. Priceless.

  82. al-Ameda says:

    @Jack:

    EBOLA – Brought to you by the government that wants to control your health care.

    Non-sequitur alert.

  83. Jack says:

    @Grewgills: You forget, this is the same government that interred over 120, 000 Japanese Americans for the duration of WWII because they might be a danger to the rest of America. Their property and belongings stolen and sold off.

    I seem to remember that was done by another President with a D behind his name. Yeah, our government certainly knows its limits and never steps over the line.

  84. Jack says:

    @C. Clavin: That’s rich, coming from you…skidmark.

  85. Mikey says:

    @Jack:

    this is the same government that interred over 120, 000 Japanese Americans for the duration of WWII

    Did they dig them up afterward?

  86. C. Clavin says:

    @beth:
    Inconceivable.

  87. Jack says:

    @Mikey: Imprisoned. I couldn’t remember the past tense of internment.

  88. Mikey says:

    @Jack: I believe you were looking for “interned.”

    And it’s not “the same government.” It was a very different government, in a very different country, in a very different time.

  89. Grewgills says:

    @Jack:
    So one horrible and unjustified overreach justifies another?

  90. Grewgills says:

    @Grewgills:
    I just found out that the person in charge of the Dallas hospital was previously the head of the hospital chain where my friend works.

  91. Jack says:

    @Grewgills: I’m going back to the point that if the government wanted to, they could.

  92. C. Clavin says:

    @Jack:
    So we need to inter every Asian-American because 2 people have Ebola?
    Makes as much sense as invading and occupying Iraq, I suppose.

  93. Grewgills says:

    @Jack:
    The government could have burned the hospital to the ground with everyone in it. That is a far cry from saying it has the legal authority to do so or should. Meanwhile the state of Texas had the legal authority to do so and did not. You are putting an awful lot of blame on the CDC for not exceeding its legal authority while placing next to no blame on the government of Texas, which does have legal authority to do what you claim should have been done. Why is that?

  94. Jenos Idanian #13 says:

    Wow, another OTB thread degenerates into borderline sociopaths playing “who hates Republicans more” thread, with such terms as “douchebag,” “shitbucket,” and other terms of endearment. These terms join other such pet names as “a$$wipe” and “fvckhead” as apparently now acceptable at OTB.

    I think I’ll refrain from participating in this new, lower standard, but I can’t speak for anyone else.

  95. Jenos Idanian #13 says:

    @Grewgills: You are putting an awful lot of blame on the CDC for not exceeding its legal authority while placing next to no blame on the government of Texas, which does have legal authority to do what you claim should have been done. Why is that?

    The CDC is an “advisory” body, as in “here’s our advice — take it or you’ll be in huge trouble.” They don’t have any formal or even informal way of enforcing their advice, but everyone knows that if you even suspect Ebola or anything similarly nasty, your first two steps are 1) contact the CDC and 2) do what they “advise” you to do.

    Case in point: the second nurse. She called the CDC when she thought she might be in trouble, and followed their advice. Consequently, we now have a planeful of people who might have been exposed.

  96. Mikey says:

    @Jenos Idanian #13: I don’t hate Republicans. Some of my best friends are Republicans. My grandfather is as staunch a Republican as they come, and he’s one of my favorite people. 95 years young and still going strong. The other day I asked him “Who’s the first President you remember in your lifetime?” His answer: “Calvin Coolidge.” The man’s a walking history book.

    But when it comes to Ebola, they just go utterly nutso. There are a couple (Grandpa not among them, thankfully) whose statements make me think they want an epidemic in the U. S. because it will ensure a GOP victory and the death of Obamacare. How otherwise intelligent, well-meaning people can just completely flip their shit over something the way they are just mystifies me.

    I just want everyone to calm the eff down, really. @steve has it absolutely right, and he’s a health care worker so he’s got some actual skin in the game. He’s the one we should be listening to.

  97. anjin-san says:

    @Jenos Idanian #13:

    who hates Republicans

    I think you are confusing “hating cowardice, fearmongering, and panic” with “hating Republicans.”

  98. Grewgills says:

    @Jenos Idanian #13:

    They don’t have any formal or even informal way of enforcing their advice, but everyone knows that if you even suspect Ebola or anything similarly nasty, your first two steps are 1) contact the CDC and 2) do what they “advise” you to do.

    Apparently not everyone knows that because the CDC has had protocols out to hospitals for months now and many if not most have not prepared to meet them. The CDC put people in Texas on a voluntary quarantine (all they were authorized to do). That would seem to indicate that they wanted the people quarantined. The state of Texas could have made those voluntary quarantines mandatory. They did not. So, if everybody knows this then there are an awful lot of people doing what they know they should not and those people are administering major hospital chains and the health department in one of our largest states.
    So we come down to it again, the state of Texas has the authority to do what you and Jack and Charles and others thinks should have been done. The CDC does not. Yet the vitriol is all aimed at the CDC for not exceeding its legal authority and excuses are made for the government of Texas and the hospital. It’s beginning to seem that this is all about politics rather than public safety on the part of the people stoking fear.

  99. humanoid.panda says:

    @Jack: I have to say that I had seen lots of stupidity online, but having multiple posters on this board to argue that a potential epidemic is an argument AGAINST a system that ensures basic access to healthcare for everyone really, really takes the cake. I mean, how does it work in your head? Are people without health insurance immune to Ebola, or they should just self-quarantine or something?

  100. Bob@youngstown says:

    Amber Vinson’s uncle and the Texas dept of health agree that Amber DID NOT call the CDC, she actually spoke with someone at the county health department.

  101. al-Ameda says:

    @Jack:

    CDC = Keystone Cops

    Actually, most of the public, the media, and our political leaders CDC = Keystone Cops

    America’s response to Ebola has been disgraceful. How many incidences of Ebola have we experienced here in stupid-scared-to-death America? Hundreds of thousands? Tens of thousands? A thousand? Hundreds? Tens? Actually it’s four, and each one was infected in Liberia or Sierra Leone, was or was treating Thomas Duncan, the Liberian patient in Dallas.