24 Hours Later, CDC Still Doesn't Know How Nurse Contracted Ebola

Categories: Healthcare

Frieden.jpg
Centers for Disease Control and Prevention
Tom Frieden
The news Sunday was disturbing. A Texas Health Presbyterian Hospital nurse -- confirmed Monday to be 26-year-old Nina Pham -- had contracted Ebola. Pham was not one 10 people being monitored for close contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, nor was she one of the 38 people who, in the Centers for Disease Control's estimation, might have had unprotected contact with Duncan after he became symptomatic. Pham was simply one of the health professionals who treated and cared for Duncan on his second visit to Presbyterian, during which appropriate precautions were supposed to have been taken.

Monday morning, as he's done almost every day since Duncan's diagnosis was confirmed on September 30, CDC Director Tom Frieden held a news conference. Initially, Frieden's press conferences inspired confidence. He calmly repeated to everyone how difficult the transmission of Ebola was and complimented Texas Health Director David Lakey and Presbyterian on how they were dealing with the situation.

See also: CDC Boss Frieden, "That Is Not in the Cards"

Monday was different. With less apparent confidence than he's shown at any point to date, Frieden told the world what the CDC knew about Pham's case, which wasn't much.

"We don't know what the exposure was," he said of how Pham might have contracted Ebola. If it was something like a needle stick, he said, the number of Pham's colleagues at a high risk for Ebola could be easily ascertained. It would be the group of workers who performed the same action or who were subject to the same conditions as Pham. Because no one, not the CDC, not Presbyterian and not the state of Texas, knows how Pham was exposed, any workers who treated Duncan must be considered to be at risk, Frieden said.

"We have to consider the possibility that there are additional cases, especially among healthcare workers," he said. The process of identifying healthcare workers who need monitoring, he said, is "still underway."

Frieden hinted that Pham's exposure might have occurred because of inappropriate removal of personal protective gear. The CDC, Frieden said, is now monitoring the removal of that gear by Presbyterian workers after they are in contact with Pham.

Lakey emphasized that the most important action being taken now is determining who else is at risk.

"Our top priority right now is contact investigation," he said.

Frieden closed the conference by saying that all hospitals in the country should ask about travel histories of patients with a fever.


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73 comments
Veritas
Veritas

To Dr. Tom Frieden - Primum non nocere- first, do no harm to Americans. Our health, our economy. Had travel restrictions been in effect, Nina Pham and Amber Vinson would not be ill right now. Stop thinking like a political appointee, and start thinking like a doctor. You owe it to yourself and your fellow citizens.


It is possible to have travel restrictions and help West Africa at the same time.


ThePosterFormerlyKnownasPaul
ThePosterFormerlyKnownasPaul topcommenter

Please keep in mind that all of the healthcare personnel at Presbyterian who were caring for Duncan volunteered for the work.


I feel certain that the hospital was following the recommended protocol levels in caring for Duncan.


Now whether or not those recommended protocol levels are appropriate is an entirely different story.


I would hope that

bmarvel
bmarvel topcommenter

Speaking of plagues: "Online trolls are psychopaths and sadists, psychologists claim at www.independent.co.uk. Canadian researchers have confirmed what most people suspected all along: that internet trolls are archetypal Machiavellian sadists."

"

holmantx
holmantx topcommenter

 Transfer the infected to rural hospitals.

Guesty
Guesty

Why does anyone expect the CDC to be able to answer the question, let alone in 24 hours?  I'm not sure how one could specifically identify a cause, even if it was a simple and scientifically known potential method of transmission.  It could be as simple as touching a body fluid while removing protective gloves and then rubbing your eye, almost certainly done uncontentiously if it happened at all.  Or it could be some method of transmission not scientifically explainable with today's knowledge of Ebola.  Scientifically, you probably will never be able to explain it unless the nurse remembers something specific (e.g. a needle prick) or there is video of the likely transmission. 

bmarvel
bmarvel topcommenter

All the Ebola experts here. How DID you all get so smart?

ThePosterFormerlyKnownasPaul
ThePosterFormerlyKnownasPaul topcommenter

What I was going to add is:


I would hope that the transmission of Ebola is seriously re-evaluated.


The current model is based on data from a country where medical care, much less sophisticated medical care and isolation facilities, is minimal to absent.  Family members without any personal protective equipment are caring for Ebola victims who are in the end stage of the disease and are highly infectious.


So yes, Ebola can be transmitted by direct contact with bodily fluids from an infected, end stage Ebola patient.


The question is, at what point in the progression of the disease is either an asymptomatic or a symptomatic patient capable of transmitting the disease and by what means is the disease transmitted.  Is it bodily fluids, intimate contact, simple contact, or aerosol transmission?

Additionally, for how long outside of an infected person can the virus survive?


The CDC needs to get off of its arrogant a$$ and take a serious look at just how this disease can be transmitted.  Blaming the transmission to the nurse on failure to follow protocol is the lazy and dishonest way to come to a conclusion.

Chattering_Monkey
Chattering_Monkey

@bmarvel Hey ol' pal Bill.  It appears you have become the troll.  all you do is rant about the commenters here.  It's ok to admit you are not the smartest person here, or that others have salient points.  Unfortunately for you, it appears age has addled your brain

TheRuddSki
TheRuddSki topcommenter

@bmarvel

Two-thirds of your comments here are complaints directed at the commentariat.

TheRuddSki
TheRuddSki topcommenter

@holmantx

In Saskatchewan.

TheRuddSki
TheRuddSki topcommenter

@ColenelAngus

Another nurse noted that Duncan's urine was "darker in color with noted blood streaks."

wow, I had ebola in '72, when it was hip.

dingo
dingo

@Guesty 

The CDC should be able to answer the question because they are infallible, just like the airport screeners.

TheRuddSki
TheRuddSki topcommenter

@bmarvel

How DID you all get so smart?

By asking dumb questions.

roo_ster
roo_ster

@bmarvel 

Holiday Inn Express was running this special....

===========================

But, you really don;t need a degree in epidemiology to see what is occurring with the CDC honcho.  That is some old-school face-saving, CYA, blame-shifting, anybody-but-me-ism on display.

A nurse, who apparently was trained by CDC drones, got infected while using CDC protocols.  Couldn't be the protocol is ate up, she had to have screwed it up!  Of course, USAMRIID deals with Ebola using Level 4 protocols, while CDC was teaching the nurse & her co-workers Level 2 or Level 3 protocols.  Meh, good enough for (civilian) gov't work!

 

 

TheRuddSki
TheRuddSki topcommenter

@TPFKAP

... nobody has even discussed the fact that the federal government not ten years ago created and funded a brand new office ... specifically to coordinate preparation for and response to public health threats like Ebola.

The woman who heads that office, and reports directly to the HHS secretary, has been mysteriously invisible from the public handling of this threat. And she’s still on the job even though three years ago she was embroiled in a huge scandal of funneling a major stream of funding to a company with ties to a Democratic donor—and away from a company that was developing a treatment now being used on Ebola patients.

http://thefederalist.com/2014/10/14/president-obama-already-has-an-ebola-czar-where-is-she/#.VD00GzVpH9w.facebook

TheRuddSki
TheRuddSki topcommenter

@holmantx

Don't bother sadistically trolling Canadians, they only have dial-up mukluks.

There's great news from #waronebola, via thehill.com:

The Obama administration is battling for control of the media narrative about Ebola as conditions worsen in West Africa and fears of an outbreak mount in the United States.

We can't lick this thing until the embattled administration gains control of The Narrative.

I'm thinking airstrikes on CBS:

From the way the White House vehemently refuses to disclose information on the costs of presidential political travel and calculations on reimbursing the government, you might think they were state secrets.

As President Obama embarks Thursday on a three-day Democratic fundraising trip to California, the White House again refuses an umpteenth request from CBS News for the political travel information.

Transparency. You're Doing It Wrong.

bmarvel
bmarvel topcommenter

@TheRuddSki I don't exempt myself from the Canadian research, Ruddski. I often wonder what it is we're doing here. Much of it surely can't pass for intelligent discussion.


everlastingphelps
everlastingphelps topcommenter

@TheRuddSki I believe that the term for hijacking threads and turning them into ad hominem attacks is "trolling".

wcvemail
wcvemail

@TheRuddSki

The former polygamous Mormon compound in West Tx.

(and the meeting erupts in applause)

TheRuddSki
TheRuddSki topcommenter

@holmantx

Every other word.

bmarvel
bmarvel topcommenter

@roo_ster @bmarvel "A nurse, who apparently was trained by CDC drones...CDC was teaching the nurse & her co-workers Level 2 or Level 3 protocols. "

Strange, rooster. Because as several have already pointed out here  -- accurately -- CDC had nothing to do with training Presbyterian personnel in Ebola protocols.

mavdog
mavdog topcommenter

@roo_ster 

CDC does not train the hospital staff. The hospital is responsible for their training.

"Even as the CDC has hastened to reassure the public that the virus won’t spread in the U.S., the agency doesn’t monitor hospitals and has no authority to make sure they comply with official guidelines"

It’s up to each hospital to enforce infection control, and standards vary depending on funding for infection experts and time devoted to training.

http://www.bloomberg.com/news/2014-10-12/ebola-control-training-lags-with-gap-in-federal-oversight.html

holmantx
holmantx topcommenter

@TheRuddSki

Mad Magazine would have His flight plan box Dallas airspace on his way to a California fundraiser.

But He really is between a rock and a hard place.  His henchmen have an election coming up, he needs Reid in charge of the Senate for the next two years, and he mysteriously refuses to bar West Africans from entering the United States until we get a handle on this.

And all of America knows the only way this shit shows back up is just like it did in the first place - a West African flies in and runs straight-away to a hospital for treatment, spewing Ebola all along the way.

Optics - not exactly a doe-eyed Honduran preteen.

TheRuddSki
TheRuddSki topcommenter

@bmarvel

I don't exempt myself from the Canadian research, Ruddski.

Your choice, but they use probes.

I often wonder what it is we're doing here.

I wondered as well, until I realized it was the comments section of a blog - then it all made sense.

TheRuddSki
TheRuddSki topcommenter

@wcvemail

More Mormon persecution. Will it ever end?

TheRuddSki
TheRuddSki topcommenter

@holmantx

You're probably white.

holmantx
holmantx topcommenter

@TheRuddSki

I personally plagiarized his self-effacing, self-depreciating style, in hopes of being credentialed so when the government issues regulatory licenses for free speech, I won't be prosecuted.

I just hope I don't have to be fingerprinted, continually educated at my own expense, and constantly threatened by the government should I dare to weave off the beaten path.

I know of no other way to rid ourselves of these damnable blogs.

wcvemail
wcvemail

@mavdog @roo_ster

Although CDC wouldn't be delivering training, they seem to dictate the level of protocol mentioned by Rooster. That means they dictate the learning objectives and the proofs (exams, exercises) to measure successful training. Since that's most likely so, CDC would also issue some sort of certification level. 


Enforcing those standards and general infection control every day would indeed be the hospital's responsibility, of course.

TheRuddSki
TheRuddSki topcommenter

@TPFKAP

We're not allowed to know that.

TheRuddSki
TheRuddSki topcommenter

@holmantx

When/if ebola gets to our southern border in the pockets of folks from the zone, it's going to be a whole new ball game, a paradigm shift, and if the administration has to fumble for a strategy, the racism epidemic will be the worst in modern history - even worse than when we blamed Spain for the Flu back in WW1.

holmantx
holmantx topcommenter

@TheRuddSki

Just not more than 1/8 or more of anything worth claiming on a government form.

mavdog
mavdog topcommenter

@holmantx

I just hope I don't have to be fingerprinted, continually educated at my own expense, and constantly threatened by the government should I dare to weave off the beaten path.

yep, that is the current situation with State professional licensing. you described it to a "T"...

mavdog
mavdog topcommenter

@wcvemail 

There is no ability by CDC to force a hospital to perform in any specific manner, they do not regulate hospitals (that is a State function) and there is no established certification in place.

there is a discussion ongoing about the ability of these hospitals, such as THR Presby, to deal with a virus as communicable as Ebola. My opinion has shifted and it seems there is enough reason to have every Ebola infected individual transported to one of the 4 facilities who are equipped and prepared- with adequate training of their staff- to deal with the virus.

holmantx
holmantx topcommenter

@mavdog @holmantx

Blame Congress.  They're the one who, in the Paperwork Reduction Act of 1980, allowed the federal government to mandate regulatory action but force the states to administer it.

wcvemail
wcvemail

@mavdog


Point taken, but back to my point about the four levels, which are indeed defined by CDC with very specific instructions and policies for each level. I say again, if the CDC is defining the protocols and processes, they're defining the training. If they're defining the training, they're also issuing some sort of certification of training, whether at the hospital level or the individual trainee level. In fact, I'll bet that the 4 facilities you refer to are certified to that level of equipment and preparation, by the CDC.

So it DOES come back to the CDC.

http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf

mavdog
mavdog topcommenter

I blame the Texas Legislature. They made the rules.

Guesty
Guesty

@wcvemail "If they're defining the training, they're also issuing some sort of certification of training"  -- I don't think that necessarily follows.  The CDC might not have the staff or authority to observe or certify implementation of its standards, which in reality may not be anything more than recommendations. 

mavdog
mavdog topcommenter

@wcvemail 

The 4 levels of biosafety were not defined by the CDCP, they are responsible for certifying the facility meets the standards. The standards were promulgated by the ABSA.

The CDC can "define" the training, yet they do not perform the training at US hospitals, do not monitor the hospital training to ascertain the training was not only done but the staff successfully learned what the training meant to communicate.

Long and short, the CDC has no power. They do not regulate hospitals. They do not enforce any mandates on hospitals. Hospitals are not required to obtain anything from CDC to open for business, or to continue to admit patients.

ThePosterFormerlyKnownasPaul
ThePosterFormerlyKnownasPaul topcommenter

@everlastingphelps @ThePosterFormerlyKnownasPaul @holmantx @TheRuddSki 

"Sir, the man said two n%%%%%s.  To be honest with you, my grandmother was Dutch." -- B. Bart  Blazing Saddles


"Why do they call me Red?  I guess its because I'm Irish." -- Ellis Boyd "Red" Redding  The Shawshank Redemption

wcvemail
wcvemail

@Guesty

I take your points, Mav and Guesty, in the lack of a clear follow-on responsibility. Sadly, that adds to the murkiness of "who's in charge?"

However, I spent a couple of decades as a corporate and government instructional designer, and I'd bet my last paycheck in that field that (a) levels-and-protocols classes are considered regulatory compliance training, the highest priority; (b) the classes are titled something like "CDC Levels and Protocols", and (c) the CDC logo appears somewhere on the end-of-class certificate of completion.


This is all my follow-on to what Rooster said about CYA blather. I believe that CDC must own their protocols and not blame the victim, at least not until it's known that victim fell out of compliance/hospital didn't train properly. Then it's incumbent on CDC to send out the alert about a particular deviation from their recommendations.

mavdog
mavdog topcommenter

@wcvemail @Guesty

Sadly, that adds to the murkiness of "who's in charge?"
In Texas, it's this:
https://www.dshs.state.tx.us/hfp/hospital.shtm

Hospital regulation and supervision is a State responsibility.

There are Federal guidelines on care but those are contained within disbursement/repayment programs (Medicare etc).

wcvemail
wcvemail

@mavdog @wcvemail @Guesty

There I go, Mav, thank you. OK, we've excluded CDC from primary responsibility for those protocols. Now it's on the State of Texas to respond to the questions about whether it was bad procedure or incorrect preparation that spread the infection. 


I can tell you that if the ball is in the court of the Texas Health and Human Services Commission, the state's highest health authority, there won't be any response for years at least. Ironically and as a sign of what to expect, the Tx Sunset Commission just recommended that HHSC split into at least two parts due to bureaucratic inefficiency.

mavdog
mavdog topcommenter

@wcvemail

I believe it is an indictment of our structure frankly.

We have the CDC who is chock full of health experts, with research facilities as good as it gets, who are given the ability issue items such as the much discussed "protocols".

and we give them zero ability to make sure the items are followed. leaving it up to the State regulators...good luck with that.

I saw on the news that the remediation of the victim's residence has been taken from Dallas County by TCEQ. That's an OH NO!

There are likely many people who will strongly object, but give the Feds the power to regulate the hospitals. With so many of the hospitals consolidating, many with multi-state presence, many being for-profit corps, it is time to get rid of the archaic structure that has brought us to this point.

wcvemail
wcvemail

@mavdog @wcvemail

The plot thickens. CDC guy misspoke when he said originally that any U.S. hospital could handle this. There has been no training.

"...the case shows how many hospitals are inadequately trained to handle the virus...Bonnie Castillo of National Nurses United told Reuters on Sunday. "We have a system failure. That is what we have to correct." 

"We haven't provided [caregivers] with a national training program..." said Dr. Gavin McGregor-Skinner of Penn State University.

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