The CDC's big mistake re: Vinson's flight was its reaction to the media

[morningfog]

The CDC should have responded, but not reacted. The CDC should have said why Vinson was not a serious risk with a temperature of 99.5 degrees. The CDC should have repeated that infections are only through direct contact with bodily fluids and that infections are less likely in the early symptoms. It would have been more effective to educate the public on the risks, rather than adapt policy based on media and public reaction.

Instead, the CDC reacted and has now put contradictory messages out there that fuel confusion and panic.

[liberal N proud]

1. Contact with bodily fluids

How can one riding in a airplane come in contact with bodily fluids?

All it takes is a sneeze or a cough! Bodily fluids don't just mean blood, shit and piss!

[morningfog]

2. But ask yourself what changed in the 24 hours?

Media hype and nothing more.

[pnwmom]

20. She could have vomited for the first time on the plane. They're just lucky she didn't.

Duncan's fever escalated to 103 in the span of a few hours. That often happens in an illness. She could have suddenly become much sicker too, while on the airplane.

The CDC gave her terrible advice. This wasn't just a possible flu, or some other virus with a low fever. It was possible Ebola and they knew it.

[boston bean]

3. Frieden used weasel words.

He had to have known the CDC allowed her get on a plane.

Yet, he makes it seem like it was her fault for getting on the plane by saying, "And if she was being monitored correctly, I think she should have never gotten on that flight."

She wasn't being monitored correctly and that is the CDC's responsibility, and come to find out she contacted them and allowed her on the plane.

He said what he said to cause confusion and take focus off his organizations fuck ups. Now, it has the opposite effect.

CDC fucked up royally.

[MerryBlooms]

5. Frieden will testify up on the hill today

October 16, 2014
U.S. Response to Ebola Outbreak

Centers for Disease Control and Prevention Director Dr.?Tom Frieden and other witnesses testify before a House Energy and Commerce subcommittee on U.S. efforts to control the ongoing Ebola outbreak.

This program has not yet aired

Airing LIVE Thursday, Oct 16 12:00pm EDT on C-SPAN

[morningfog]

6. I hope a representative asks point blank:

What is the risk when the only symptom is low grade fever?

[MerryBlooms]

7. The mixed messaging has been ridiculous.

Supposedly the risk is extremely low, but some of the actions being taken seem so over-the-top.
Crazy.

[sendero]

10. If you have been exposed...

... to ebola and develop a fever, ANY fever within the incubation time period - YOU SHOULD CEASE CONTACT WITH OTHERS EXCEPT HEALTH CARE PROS AND YOU MOST CERTAINLY SHOULD NOT GET ON A PLANE, BUS or ANY PUBLIC CONVEYANCE.

A nurse should know better. The reason ebola IS a threat is the constant stream of idiotic actions taken by people who are supposed to know better. And another reason we are seeing ebola cases that we should not be seeing is the absurd overstatement of how difficult it is to get infected. This has resulted in COMPLACENCE.

[cherokeeprogressive]

47. YUP. Any other attitude is simply whistling past the graveyard. n/y

[pnwmom]

21. The risk is that the fever will suddenly escalate, and the patient will

also develop other symptoms.

[liberalhistorian]

17. I agree with your basic premise, but she bears a lot of responsibility

also. She should have known the incubation period and should have known better than to fly halfway across the damned country and back after being directly exposed to and caring for someone with a deadly, usually fatal, disease. She was a medical professional, after all. So she is certainly not blameless, either, although there's plenty of criticism that should be aimed at the CDC also.

[LisaL]

42. CDC allowed her to go on the trip.

They certainly should know incubation period. They are medical professionals. Why have they been acting this way?

[Tweedy]

55. public health officials do the hands on monitoring

The cdc tracks people down. If warranted, public health officials take temperatures, etc. of those being monitored.

[Erich Bloodaxe BSN]

4. I simply can't imagine taking even the slightest chance of infecting my own family.

If I had been in her shoes, I would have used 'skype' to visit my family for the first month after contact, not immediately hopped a flight to go visit them in person WHILE I was still self-monitoring. Her decision to hop on a plane at that point was simply shocking all the way round.

[Nuclear Unicorn]

9. " Her decision to hop on a plane at that point..."

Supposedly the purpose of the CDC is to backstop these things when personal reason fails. She reached out to them repeatedly and they assured her she was OK to fly each time they talked to her.

Here you are giving her the advice the CDC should have given her. You can see it, why can't they? Either they know what they're doing or they don't.

[Yo_Mama]

13. She went on the trip before the first HCW infection.

CDC had assured them the risk was very low. They were not quarantined. They were told to self-monitor. They were not advised of any activity restrictions AT ALL. They were allowed to continue with patient care.

So then the lady is out there with her family, planning her wedding, and the day she gets up to go back to Dallas (her home and her job), she finds she has a slight temp and, knowing the news about the other nurse, she calls the CDC (apparently TWICE), concerned. They tell her to go on and get on the plane.

She relied on the information she was given about the risks when she left, and she relied on the information she was given about the risks when she returned.

If she knew when she was assigned to care for Mr. Duncan what she knows now, I'm sure she would have called in sick. Developed a stress disorder, whatever. Now she is in Emory fighting for her life.

Up until the first nurse tested positive, this is what we were all told in the US would not happen. Those nurses followed CDC protocol. CDC has been assuring us all that would take care of it, although their information was strongly questioned by multiple doctors.

CDC has now changed their protocol, which means that hospitals that thought they were properly equipped for this are not, and must order new supplies.

[KingCharlemagne]

22. Excellent post. Who in his or her right would consent to

Last edited Thu Oct 16, 2014, 02:47 PM - Edit history (1)

care for known Ebola patients if they now know the scorn and opprobrium to which they will be subject EVEN HERE ON A NOMINALLY DEMOCRATIC, I.E., PRO-WORKER, SITE?

[Yo_Mama]

23. I have been horrified at the dynamic here

The surge to blame the lowest person on the totem pole for all the failures of the ones on top ... I can't think it bodes well either for a successful disease response effort or for the cultural/political life of the nation.

The fact that so little distress is caused by seeing this play out in front of our eyes is even more distressing and confounding to me.

Many people on this site are willing to condemn the nurse for not ignoring the CDC's advice. I cannot think that's helpful, and truthfully, if she had ignored it and gone to another local hospital, the consequences might have been worse. So I do not necessarily trust the CDC for the implication that the advice was in error or given by an underling. I think by her second call that excuse is gone. I think they made a judgment call to which they are now not willing to confess.

The probability was that she just had a mild virus. Unless she had indeed contracted Ebola, the political optic of having an HCW walk into a hospital in other state saying "Put me in isolation and test me, I think I may have Ebola," would have been unfortunate. If she did have Ebola, then the chances that another hospital would have ensuing cases would be far MORE unfortunate. So I think the decision was made to quietly route her back to Dallas. Then when she tested positive and they decided they had to inform the passengers and airline, the media shit hit the fan and the nurse got hung out to dry.

Theoretically DU culture is feminist, science-based, willing to question authority, and in favor of unions. What I am seeing playing out here on this forum is exactly the opposite. If I have to read one more post by some jerk claiming that the hospital was at fault for not using Hazmat suits to take care of Duncan I think I'll scream. CDC's protocols were followed, as they now admit. Although those protocols have gotten a lot more detailed now, they still aren't mandating equipment that hospitals don't have. This is public information, yet everyone ignores it.

Of all the players in this most unfortunate national drama, it seems to me that right now the nurse's unions are forcing the best changes, i.e., they are most functional. Should that surprise DU? If change has to come from the bottom up, shouldn't we be helping that change along?

[Aerows]

28. Thank you for saying this

and for stating it so well!

[Lns.Lns]

30. Why are we blaming anyone at all?

Scapegoating and fear mongering... why not stop discussing who's fault it is was and look at how to fix it. There are so many factors of error on all sides of this argument... what's the point. Just fix it. Stop playing the Republican game to freak people out.

[Yo_Mama]

32. Yes, we have to address the real risks and help the victims.

Anything else is useless and harmful. However, the reality is that the CDC is blaming the nurse victims, so there does have to be some accountability for that.

I am not convinced that the decision to tell her to get on that plane was wrong from a risk-mitigation standpoint. She either didn't have the virus, or she did. If she did have the virus, she was in the very early stages when risk to the public was very low, and getting her into a controlled environment ASAP was the safest course.

The other option would have been to tell her to go to a local hospital, and for the CDC to then engage with that local hospital to try to prevent a repeat of HCW transmission. Well, it had the team on the ground at Dallas and the risk of trying to treat her was by far the lowest there.

What is not acceptable is to then blame the woman publicly for following the advice your agency has given her. That shit must stop.

[LisaL]

43. Her fever could have spiked during the flight.

Like Mr. Duncan's did the first time he went into the ER. In fact, how do we know it didn't?
Now we have people who can not go to work, and children who can not go to school, simply because she was on the plane.
Allowing her on the plane was ludicrous.
Cleveland has excellent medical facilities.

[Yo_Mama]

44. I happen to agree with you

But neither of us was involved in the decision-making process.

I don't think she should have been on that flight. I think the proper procedure would have been to direct her to a well-equpped hospital locally, warn the hospital, and then hold her in isolation until she got the WHO-recommended two negative tests 48 hours apart. Which she would not have gotten. Once the first nurse was known positive, that was, to my mind, the only possible correct procedure.

I have, and a lot of people have, been agitating for a slightly more serious standard since early September, long before Mr. Duncan ever showed up at that hospital.

In late August, CDC revealed that they had had 57 or 58 requests for Ebola testing and that they had actually tested only 7 or eight times. So, I just don't want to hear the nurse blamed for this. It is not at all clear to me that if the nurse had gone to a local hospital that the CDC would have tested her. They might have told her just to go, and then I guess she could have hung out at a local motel until she got really sick.

Maybe a state authority would have argued it out and gotten a test, but her symptoms were unclear and doctors have been asking for tests and not getting them, so to me this is just one more in the long line of "mistakes will happen". It could have happened long before now.

Here is the current CDC guidance from their website. Note that there is no monitoring recommendation whatsoever for HCW who were exposed to patients while wearing PPE:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

HCP who develop sudden onset of fever, intense weakness or muscle pains, vomiting, diarrhea, or any signs of hemorrhage after an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with EVD should

Not report to work or should immediately stop working
Notify their supervisor
Seek prompt medical evaluation and testing
Notify local and state health departments
Comply with work exclusion until they are deemed no longer infectious to others

For asymptomatic HCP who had an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with Ebola HF

Should receive medical evaluation and follow-up care including fever monitoring twice daily for 21 days after the last known exposure.
Hospitals should consider policies ensuring twice daily contact with exposed personnel to discuss potential symptoms and document fever checks
May continue to work while receiving twice daily fever checks, based upon hospital policy and discussion with local, state, and federal public health authorities.

That is all. She did not even fall into that last risk category. She was considered extremely low-risk, and was indeed qualified to fly under CDC guidelines.

[LisaL]

45. I think it's obvious CDC guidelines are all kind of wrong.

And CDC knew (or should have known) that she was very high risk after the first nurse tested positive.

[Lns.Lns]

46. Like I said everyone is getting too defensive over this

There are defenders on both sides. The CDC has it's back up against the wall due to all the non stop politicizing of this as well as the nurses. I heard a lady call in from Dallas who said she knew the hospital very well and would never go back there. Went so far as to say she consider having a tattoo saying if I am sick don't take me there. She said a lot, but that is not important. I read an article where an anonymous official said "we didn't actually tell her to fly, but we didn't tell her not to... so it is on us not the nurse". When I am feeling even slightly sick I don't kiss my family members and try to stay out of their vicinity. I personally would not have put my family at that kind of risk. The nurse that originally took care of Duncan sent him home knowing he came from Liberia. A nurse in the hospital supposedly wanted him to be isolated but lost the argument to administrators. So you see these are just a sampling of an endless round of finger pointing, blaming, should haves, could haves, etc. What is the point?

In my little opinion, the effort should be making the health care industry a better place for all involved. I am not saying you do not have a point, but there seems to more important issues than who is right and who is wrong. Big issues like getting the nurses unionized so they have a say in their future and the care that is given rather than being able to be fired because you disagree with some administrator.

Hey, this is just my two cents. It doesn't necessarily mean anything more than anyone else.

[Yo_Mama]

50. Doctor sent him home, not the nurse.

I think your basic point is entirely correct and should be shouted from the rooftops.

However, there is a medical dispute going on about how these cases can be safely treated and what risk guidelines should be, and that's a real and important debate. It has not to do so much with blame, but how we will go forward.

If we think Ms. Vinson should not have gotten on that plane, then shouldn't we be changing official guidelines to reflect that? Shouldn't there be a risk category for this purpose?

So I agree with you that some just want to assign blame, and that is a counter-productive approach. The world has never had an Ebola epidemic before, and expectations must adapt to experience in dealing with one.

The part of the debate that's important and must not be shut down is how we do that?

I think shifting the cases to high-level hospitals is a very good first step. Assembling teams that can go into hospitals upon first diagnosis is an excellent step. Learning from the actual experience of those who have been working with these patients in Africa is an IMPERATIVE step, and is where we went wrong in the first place.

But the last step - very important - is to listen to the concerns of the line HCWs in the ERS and in the ambulances to hear if they feel like they know what to do, have the facilities and equipment and have the authority. Just blaming nurses doesn't get that done.

Because even if we adopt a policy of transferring cases to specially trained and well-equipped hospitals, there is still the crucial first step, which is testing every person with possible exposure and handling all those cases properly in the initial presentation, and that didn't happen in Dallas.

There's a lot that must be amended.

[Lns.Lns]

52. Now that is what I agree with

Solution based conversations. That is the way forward... that and getting people to vote for people who will fund these endeavors.

Good conversation.

[TexasMommaWithAHat]

53. Well stated!

I've been supporting the nurses from the beginning. I have worked in a hospital, and have nurses in the family. Overworked, too many patients, scared of some of the doctors, and on and on...

The nurses were told they didn't need to quarantine him, and I don't think a nurse's aid is the one who told them that!

[Yo_Mama]

37. She wasn't quarantined. None of them were.

They were perfectly free, according to the CDC, to treat patients, go about any daily activities, use public transport or whatever.

None of them were in quarantine. In quarantine you are supposed to isolate yourself. They weren't in quarantine. They were just supposed to take their temps once a day and call if they ran fevers. That's all.

She followed the instructions she was given, entirely.

[Schema Thing]

8. Do we know she really called? Do we know if she explained clearly who she was

and why she was calling, if indeed she did call?


Did her supervisors at the hospital know she was taking this trip?



This might be out there in the media, I don't watch closely, so I'm just asking - but these are the questions that first came to mind when I heard that she had claimed to have called the CDC.

[apples and oranges]

12. Yes. the CDC has already confirmed.

Though this confession came after throwing her under the bus for several hours.

[Schema Thing]

14. thx

[GeorgeGist]

18. You're supposing the CDC didn't provide ...

a toll-free number that these self-monitoring folks could call to get competent advice.

[LisaL]

48. They gave them the number to call.

She called the number. She was not told to not fly.
Now CDC told frontier airlines that she may have been symptomatic during the trip (it's on breaking news forum).
So now they removed the plane from circulation.
What other symptoms did she have already?

[apples and oranges]

11. 'not a serious risk,' 'less likely' is not comforting to the person(s)

who sat next to her.

[Fumesucker]

15. That's lawyer speak for "You are about as likely to get hit by a meteor"

How many of us seriously worry about a meteor hitting them?

[jwirr]

16. Also they should have told the media that the Texas hospital was no longer taking ebola patients.

[GeorgeGist]

19. The CDCs big mistake was not taking charge.

Apparently no one in authority knows what the acronym CDC means.
And so it goes.

[Yo_Mama]

24. That's true in a way, but clearly CDC decided that they had to contact the passengers,

so it was inevitable.

Once you start the passenger-contacting exercise, the contradictory message is obvious. The CDC decided that there WAS some risk after Vinson tested positive.

So the message is in the actions, not in what they said. In fact there is some risk, just very little risk.

This isn't fueling confusion and panic. It's clarifying the situation in people's minds.

[Yo_Mama]

31. What BS. The nurse was calling the CDC to get expert advice.

Who the fuck was she supposed to call? Rush Limbaugh?

The hospital administration? They would just have put her on hold and called CDC, and if they hadn't, you'd now be blaming her for not calling the CDC.

The nurse either had to decide she was at risk and should go to a local hospital and get tested, or get on the plane, go home, and report at the Dallas hospital. It wasn't like she had other options.

Renting a car and driving for hours and hours when you may be infected with a lethal disease would have been the least safest option for the public (that's why they have convoys with all the police vehicles for the ambulances carrying cases), and oh, guess what - nurses don't have access to chartered planes. I did not know whether to laugh or destroy my computer when I saw that clip.

I think many are just pissed that she did the right thing and called the CDC because the CDC DOES have to take the responsibility for that call. Well it does.

There is nothing - NOTHING - that makes an institution look worse than continually dodging responsibility. The hospital administration doesn't look good right now, but the CDC doesn't either. What will make the CDC look better is to get on top of this and to take responsibility for its own decisions.

[Yo_Mama]

34. SHE WASN'T IN QUARANTINE NONE OF THEM WERE

They were considered low-risk, and were just supposed to monitor daily. They had no restrictions on their movements whatsoever.

[LisaL]

40. She dd ask CDC.

They allowed her to fly to OH.

[Yo_Mama]

41. THEY WERE TREATING PATIENTS

Do you not get it? Over 70 staff came in contact with this guy. They didn't take them all out of action. They were considered very low-risk. The current total is 76 HCW exposed.

Do you seriously think that going to the grocery store or taking a plane is higher-risk than treating a patient?

They were not being actively monitored. They were merely supposed to report if they got sick. Since the two HCW infections now they are on daily monitoring. They can still treat patients, as far as I know.

The first nurse who was diagnosed had called in or been off work for the two previous days. Only after the HCW was diagnosed did they begin daily monitoring:
http://www.ehospitalistnews.com/news/single-view/cdc-76-hcws-being-monitored-for-ebola-in-dallas/a813be63a18bea98ea35d01a34c87d1e.html

Dr. Frieden said that 76 health care workers at Texas Health Presbyterian were now being actively monitored for symptoms of Ebola infection because of possible exposure to Mr. Duncan or his blood. This is in addition to 48 contacts of Mr. Duncan prior to his admission, and one contact of Ms. Pham’s, none of whom have shown evidence of infection.

That's from the 14th.

Please stop slandering this woman in public. She was not in quarantine, she did not violate quarantine, and she could in fact have been in Dallas treating a patient when she felt the same first signs.

And guess what - some of the people exposed to these nurses and to Duncan are STILL treating patients. Most of them won't get sick, but your theories here are wildly off base so I can't understand why you are so convinced of them.

Now they are moved both HCW cases to other facilities, maybe Pham isn't gone yet but she is supposed to be going today to Bethesda.

[KingCharlemagne]

49. Slight technical note: "slander" is spoken language; "libel" is the written variant. But

I would like to add my voice to your request that the nurse stop being libelled\slandered. It's reprehensible, no less so for happening on what is ostensibly a worker-friendly Demcoratic message board.

[Yo_Mama]

51. You're right, but there is plenty of slander on the airwaves.

Which is totally counterproductive. It's the nurses and doctors that are the front lines here. They just can't be made to feel that they are wrong no matter what. For it to be happening here of all places is shaking me up.

In order to contain this disease - and we will surely have a few more cases over the next few months - we need them, therefore we need to listen to them. They have the most to lose and without them, all the brilliant epidemiologists and infectious disease specialists are just whistling in the wind. They also are, in the main, truly dedicated to their jobs. They WANT to do it right.

[KMOD]

25. Spot On, morningfog!

Great post.

[LisaL]

39. How can the nurse know better if cdc doesn't know better?

[LisaL]

38. It would be a height of irresponsibility

to allow person wih Ebola to fly because risk is supposedly low. Low risk does not equal no risk.
CDC knew this nurse was at high risk for Ebola.
How could they have allowed her to get on the plane?

[Nuclear Unicorn]

54. At this point nobody knows how ebola spreads and what the risks are because

the CDC is so intent on feeding lines of ridiculous -- ostensibly to quell panic. Instead they are doing the exact opposite and instilling panic.

Either they know what they are doing and are prepared to do so in a professional, non-political, non-gamesmanship manner or they need to be replaced by people who can be trusted. They shot their credibility. They have no one to blame for themselves and the fact the American people are on to them shows the American people aren't in the mood to be BS'ed to.

They can't feed us lies of obvious nonsense and then lecture us about a our lack of emotional maturity because we refused to believe the obvious nonsense.

[morningfog]

56. We've been quite familiar with Ebola for nearly 40 years.

This is a known virus, and it is not airborne, more infectious, or doing anything different than it has in outbreaks for the past 40 years. We know EXACTLY how it spreads.

The CDC is fucking up the message and the education. They fucked up in ensuring local hospitals were prepared and trained properly. Local hospitals have fucked up too.

They have the knowledge and the means to get this right, and in short time. They have a problem with messaging and organization that I hope they fix yesterday.