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The Traveling Plague

Nobody intended for Ebola to spread from Dallas. But it is likely happening

About Amber Joy Vinson, the newest Ebola patient:

The latest healthcare worker to contract the virus at Texas Health Presbyterian Hospital had direct contact with three people after becoming symptomatic before she was isolated, said Tom Frieden, director of the Centers for Disease Control and Prevention. Those people are being closely monitored.

Ebola does not spread until a patient develops a fever or other symptoms, such as vomiting or diarrhea. Vinson didn’t develop a “low-grade fever” until Tuesday, a day after she flew back from her native Ohio to Dallas.

Because of that, Frieden said passengers on Frontier Airlines Flight 1143 were at “extremely low risk” of being exposed. Even so, he said, the nurse should have been limited in her travel because she treated Thomas Eric Duncan, the Liberian man who became the nation’s first person diagnosed with the deadly virus.

“She should not have been on that plane,” Frieden said. “We will from this moment forward ensure that no other individual with exposure travels in anything other than a controlled manner.”

Oh? How do they propose to do that? Do you know how many people in Texas Presbyterian hospital became exposed to Ebola via Thomas Duncan? According to the AP, “about 70.” How many people want to have anything to do with that hospital today? Doctors, nurses, staffers, they all have to show up there to work, but patients? Would you go to an appointment in that hospital right now, knowing how lax it was with the Ebola patient? From the NY Daily News:

In the unusual group phone call, arranged by the nation’s largest nurses union, the unidentified caregivers said Duncan, the first person to die in the U.S. of Ebola, was left for hours in the emergency room with up to seven other patients before he was placed in isolation.

Among the other appalling lapses by the hospital that they listed:

– Supervisors walked walk in and out of Duncan’s isolation room without proper protective gear.

– Duncan’s lab specimens were transported through the hospital’s pneumatic tube system instead of being separately sealed and delivered, and thus “the entire tube system was potentially contaminated.”

– Caregivers donned “flimsy” hospital gowns that left their necks, heads and lower legs exposed, with head-to-toe protective gear not being supplied until Duncan’s second day in the intensive care unit.

– Some nurses who treated Duncan were “allowed to do other normal patient care duties” even though he had produced “copious amounts of diarrhea and vomiting” while they treated him.

– The hospital had never issued protocols to handle Ebola cases.

How many other patients in that hospital were exposed inadvertently through the nurses doing “normal patient care duties” after having been shat and vomited on by Duncan? Those patients, do we know their travel schedules? And on and on.

Texas Presbyterian is a big hospital, but I can easily imagine how it must be suffering economically from this. It has to be every hospital’s nightmare. Dallas has lots of hospitals, but what would happen in a town like mine if, say, a traveler came down with Ebola as she was driving through, and pulled into the ER at our little hospital seeking treatment. Of course they would treat her, but would they have the necessary gear and training to protect themselves? If our small-town hospital was out of commission because of this, we would really be hurting.

Assuming Ebola spreads, we have to consider a scenario in which we lose access to our area hospital pending decontamination, or at least have to face down fear before going into it. Have we ever had to deal with anything like this? A virus with a 70 percent mortality rate in American hospitals?

If we get the Dallas outbreak contained, it’s just a matter of time before this thing spreads to big cities in Africa — and beyond. More:

Also on Tuesday, a UN official gave warning that the world was failing to gain the upper hand against the deadly outbreak.

“Ebola got a head start on us,” Anthony Banbury, the British head of the UN Mission for Ebola Emergency Response, said.

Addressing the UN Security Council in New York by remote link from UNMEER headquarters in Accra, Banbury said: “It is far ahead of us, it is running faster than us, and it is winning the race.

“If Ebola wins, we the peoples of the United Nations lose so very much.

“We either stop Ebola now or we face an entirely unprecedented situation for which we do not have a plan.”

What happened at Texas Presbyterian is horrifying — the incompetence and recklessness. But I bet it won’t be the last hospital to bungle in this way. How many hospitals have had adequate training in how to protect its staff from this stuff?

I hope CDC head Tom Frieden is right that no one on that flight with Nurse Amber Vinson, who had a fever while she was in the air (meaning she was viral), is likely to have been infected. After all, how often do airline passengers trade body fluids? But if you were on that plane and used the toilet, how confident would you be feeling right now?

And how confident would you be in the government’s ability to restrict the travel of those known to have been exposed to Ebola? What’s the CDC going to do to keep the exposed from traveling? Depending on how the plague plays out around the globe in the months to come, we could find ourselves in a very challenging legal environment in this country.

UPDATE: So now it turns out that the Amber Vinson called the CDC before she flew and told them she had a fever — and they okayed her getting on that plane!:

“Although she (Vinson) did not report any symptoms and she did not meet the fever threshold of 100.4, she did report at that time she took her temperature and found it to be 99.5,” said CDC Director Tom Frieden.  Her temperature coupled with the fact that she had been exposed to the virus should have prevented her from getting on the plane, he said.  “I don’t think that changes the level of risk of people around her.  She did not vomit, she was not bleeding, so the level of risk of people around her would be extremely low.”

CBS News Medical Correspondent Dr. John LaPook reports that Vinson called the CDC several times before boarding the plane concerned about her fever.

“This nurse, Nurse Vinson,  did in fact call the CDC several times before taking that flight and said she has a temperature, a fever of 99.5, and the person at the CDC looked at a chart and because her temperature wasn’t 100.4 or higher she didn’t officially fall into the category of high risk.”

Well, that’s certainly confidence-building. Earlier, the CDC faulted Nurse Vinson for getting on the plane against its guidelines. Who can trust what these people say?