CDC Reversal on Ebola Fuels Calls for Director to Quit

Ebola patient Amber Vinson arrives by ambulance at Emory University Hospital on October 15, 2014 in Atlanta, Georgia. Nurse Amber Vinson joins Nina Pham as health workers who have contracted the Ebola virus at Texas Heath Presbyterian Hospital while treating patient Thomas Eric Duncan, who has since died.

Photo by Kevin C. Cox/Getty Images

As the first patient diagnosed with Ebola in the U.S. lay dying in a Dallas hospital, the nation’s top health officer assured Americans that the facility was up to the task.

“Essentially any hospital in the country can safely take care of Ebola,” Thomas Frieden, head of the Centers for Disease Control and Prevention, said Oct. 2.

That confidence all but evaporated yesterday, as a second nurse in Dallas tested positive for the virus and the CDC flew her to a specialized hospital in Atlanta. Lawmakers and health specialists say such reversals and missteps mar the Obama administration’s handling of the outbreak -- and fueled calls for the resignation of Frieden, who testifies today in Congress.

It’s not just the issue of the hospitals. The CDC took weeks to heed lawmakers’ calls for increased screening of airline passengers from Liberia, Sierra Leone and Guinea, the West African nations gripped by the outbreak. And Frieden said it was a mistake for the nurse, who helped treat the man who died, to travel by commercial aircraft from Cleveland to Dallas -- even though she alerted the CDC of an elevated body temperature ahead of time and the agency didn’t tell her to stay off the plane. The government is now trying to track down the other 132 people on her flight.

“The latest troubling news regarding the Ebola crisis demonstrates why our government must be more proactive in the fight to prevent the spread of Ebola,” Ohio Republican Senator Rob Portman said in a statement. “I have been calling on the president to take such proactive measures for weeks and it’s time for the administration to act.”

Ebola Czar

Portman said President Barack Obama should appoint an official to coordinate U.S.stategy to combat Ebola. Senator John McCain, an Arizona Republican, also has called on Obama to designate an “Ebola czar.”

In the House, two Republican lawmakers, Pete Sessions and Tom Marino, called for Frieden’s resignation as head of the CDC. Sessions's district includes the Dallas hospital where Ebola patient Thomas Eric Duncan died Oct. 8 and two caregivers contracted the disease. Marino, from Pennsylvania, said the “Ebola situation is beginning to spiral beyond control.”

The House Energy and Commerce Committee has scheduled a hearing today to hear from Frieden and other officials about their response in West Africa and whether U.S. hospitals and health workers are ready to handle the infectious disease.

Changing Course

To some degree, Frieden, 53, acknowledged early missteps by changing course.

“The situation changes everyday,” Frieden said in a call with reporters yesterday. “We’re going to put in extra measures of safety to protect Americans.” A spokeswoman for the CDC, Barbara Reynolds, declined to comment on the calls for Frieden’s resignation.

After leaving Duncan’s care primarily to the Texas Health Presbyterian Hospital in Dallas and focusing on tracing Duncan’s contacts, the CDC sent a team of 16 infectious disease professionals to Texas to oversee the safety protocols that nurses and doctors are using. The agency also set up a special Ebola response team on Oct. 14, which could be sent to any hospital that receives a confirmed patient within hours, the agency said.

The CDC staff has adopted procedures similar to those used by the humanitarian group Doctors Without Borders in West Africa, including setting a specific sequence for removing protective gear.

Emory Center

“We are taking this very seriously at the highest levels of government,” Obama said yesterday at the White House after meeting with members of his cabinet and other officials involved in the Ebola response.

White House Press Secretary Josh Earnest said that Obama has confidence in Frieden.

Amber Vinson, a nurse from the Dallas hospital, the second to contract the disease, was in Ohio when public health officials began requiring hospital workers who had contact with Duncan to check in daily, said Barbara Reynolds, a CDC spokeswoman without identifying her by name. Before Vinson boarded the return flight to Dallas, she informed the CDC that she had a temperature of 99.5 degrees Fahrenheit, below the CDC’s fever threshold for those exposed to Ebola, Reynolds said. She reported to the hospital with a fever the next morning.

CDC ‘Learning’

Vinson was flown yesterday by private aircraft to an infectious-disease unit at Emory University Hospital. The isolation unit at Emory last month treated two American missionaries who contracted Ebola in Africa and are now recovered. And the CDC, after ignoring for weeks Portman’s demand for active screening of passengers from the three West African nations, ordered U.S. border agents to begin that process at major airports last week.

“CDC is learning and adapting very quickly and you have a director willing to say, ‘This wasn’t done the best, I wish I could have foreseen this,’” said Georges Benjamin, executive director for the American Public Health Association, a Washington-based nonprofit.

“A lot of assumptions were made about the readiness of this hospital and its ability to manage this outbreak in their hospital,” Benjamin said. “It appears that a lot of those assumptions were incorrect.”

Expertise Lacking

According to National Nurses United, a union group, the CDC failed because it responded to Duncan by focusing on tracing who he had met, and not on patient care. The hospital didn’t have the expertise to protect its caregivers, supplying safety suits with exposed necks and playing down the need for more protective masks, the group said.

“Not one more patient, nurse, or health-care worker should be put at risk due to a lack of health care facility preparedness,” RoseAnn DeMoro, the executive director of the National Nurses United, said in a letter to Obama yesterday. “They are our first line of defense. We would not send soldiers to the battlefield without armor and weapons.”

The group called on Obama to order all U.S. hospitals to meet the highest “uniform, national standards and protocols.”

All of the nation’s hospitals aren’t ready to handle a deadly disease that’s novel to this country, and present one-of-a-kind challenges for health-care delivery and waste disposal, according to a medical specialist who helped Nigeria successfully contain the disease.

Waste Equipment

“Why would you want an Ebola patient treated at a hospital that hasn’t prepared for it, doesn’t have the equipment for it and can’t manage the waste?” Gavin Macgregor-Skinner, who helped the Nigerian government prepare a hospital in Port Harcourt to handle the outbreak there, said in an interview. “Not all hospitals in the country can do this.”

In fact, few hospitals have the waste sterilization equipment required by law, or have the means to truck it to incinerators, he said.

“What the Nigerian government did is a model for how the rest of the world should handle this,” Macgregor-Skinner said. “The Nigerian government beat Ebola.”

Frieden is the former New York City Health Commissioner and a tuberculosis medical officer for the CDC in India. He was appointed to be director of the CDC by Obama in 2009.

Almost 9,000 people have been infected with the Ebola virus in Africa with about 4,500 deaths, according to the World Health Organization.

Increasing Criticism

In addition to pledging that any hospital could handle the disease, Frieden has repeated in news conferences that “We know how to stop Ebola.” That pledge of confidence rang hollow as first one and then a second health worker reported a fever and then tested positive for the disease after helping to treat Duncan.

With daily revelations of the disease’s spread in the U.S., criticism of the CDC is mounting.

The CDC was too quick to reach conclusions about how well health officials could control the virus, and in an effort to reassure the public, raised expectations beyond what it could deliver, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“We wanted so badly to assure the public not to be frightened that we have frightened the public by having the credibility of public health questioned,” Osterholm said.

Travel Ban

Senator Sherrod Brown, an Ohio Democrat, yesterday called on the CDC to “dedicate immediate resources to organize monitoring services in Northeast Ohio.”

House Speaker John Boehner said Obama should consider a temporary ban on travel to the U.S. from countries where the Ebola virus is rampant.

“This administration must be able to assure Americans that we will stop the spread here at home,” Boehner, an Ohio Republican, said in an e-mailed statement.

White House Press Secretary Josh Earnest said yesterday that the administration isn’t considering a travel ban “at the moment.”

It’s not the first time the agency has drawn criticism this year. In July, it banned the movement of infectious material from its labs, and closed two of them, after an accidental release of a lethal strain of avian flu.

In June, more than 80 people were potentially exposed to anthrax at a CDC lab in Atlanta. No one became ill from either mishap.

The incidents were among five that have occurred over the past decade, the agency said in a report.

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