The NBC News crew including chief medical correspondent Nancy Snyderman that worked with Mukpo are placed in mandatory isolation in New Jersey after a 21-day voluntary isolation agreement was breached. The state Health Department says the crew remains symptom-free and there is no reason for concern of exposure to the virus to the community. It doesn’t give details on the breach of the voluntary agreement.
Liberia bans journalists from Ebola treatment units due to concerns over privacy. Deputy information minister Isaac Jackson:
Journalists are no longer allowed to enter ETUs. These journalists enter the ETUs and cross red lines. They violate people’s privacy, take pictures that they will sell to international institutions. We are putting an end to that.
Checks by Reuters show that state and city plans for handling Ebola are based on generic recommendations for disasters from measles to floods, hurricanes and dirty bombs. Health departments in Philadelphia, Boston, New York City, Minnesota, New Jersey, Maryland and Rhode Island are scrambling to adapt the generic plans. They must adapt hospital drills, 911 emergency operator guidelines, quarantine rules, and details such as checking that plastic body bags meet the minimal thickness of 150 micrometers recommended by the CDC. Rand Corp public health expert Chris Nelson:
It takes a certain amount of reverse engineering to get the plan to where it can respond to new, emerging threats.
Liberia’s armed forces are leading anti-Ebola efforts including building 18 treatment centres across the country, and are working with U.S. Africa Command forces to rejuvenate their image after the country’s civil war. Joseph F. Johnson, a deputy minister at Liberia’s Defense Ministry:
We’re trying to rebrand the A.F.L. as a force for good. Piggyback on this.
CDC director Frieden says the centre is considering several possibilities as to how the Dallas nurse became infected with the virus. One possibility is that the infection spread when protective equipment was removed or when Duncan received kidney dialysis or respiratory intubatution in last-ditch efforts to save his life:
Both of those procedures may spread contaminated materials and are considered high-risk procedures… When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material … touching you and being then on your clothes or face or skin … is not easy to do right.
Another possibility is out-of-protocol precautions taken by healthcare workers worried about safety, but which can actually increase risks, such as wearing three pairs of surgical gloves instead of two.
Health experts are rushing to determine how Pham contracted the virus. They propose several scenarios, including that she was infected while Duncan was being intubated or receiving kidney dialysis, both procedures with a high risk of contact with infected materials. Templeton University doctor Eileen Farnon, who formerly worked at the CDC and led teams investigating past Ebola outbreaks in Africa:
Removing the equipment can really be the highest risk. You have to be extremely careful and have somebody watching you to make sure you remember all the steps.
Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist:
I can have on the suit and be very careful, but I can pick up some secretions or body fluids on a surface
State Attorney General Buddy Caldwell is seeking a temporary restraining order to block the disposal of incinerated waste from Duncan’s apartment at a Louisiana landfill:
We certainly share sadness and compassion for those who have lost their lives and loved ones to this terrible virus, but the health and safety of our Louisiana citizens is our top priority. There are too many unknowns at this point, and it is absurd to transport potentially hazardous Ebola waste across state lines.This situation is certainly unprecedented and we want to approach it with the utmost caution. We just can’t afford to take any risks when it comes to this deadly virus.
A passenger on a flight from JFK is investigated at LA International after showing Ebola-like symptoms. Officials say the cause is air sickness. Los Angeles Fire Captain Jamie Moore:
[It was] simple airline illness. If you were on a boat for a long time and you were going up and down, those are the same symptoms that this patient would have been exhibiting … Being in a confined space, not being able to get fresh air, not being able to see outside, just feeling general motion sickness.
Health experts criticize CDC Director Frieden’s remark that a ‘protocol breach’ caused the Dallas nurse’s infection. They say that hospital staff need to be coached on each step of the process of dealing with Ebola patients, and that given the level of training needed to do the job safely, the government should consider designating a hospital in each region as the go-to facility for Ebola. National Nurses United disaster relief expert Bonnie Castillo:
You don’t scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct.
The WHO warns that the virus is ‘the most severe acute health emergency in modern times.’ Director-General Margaret Chan:
I have never seen a health event threaten the very survival of societies and governments in already very poor countries. I have never seen an infectious disease contribute so strongly to potential state failure.
Director General Margaret Chan warns that 90% of the economic costs of any outbreak stem from…
irrational and disorganized efforts of the public to avoid infection.
She adds that the treatment of patients spotlights growing global inequalities:
The outbreak spotlights the dangers of the world’s growing social and economic inequalities. The rich get the best care. The poor are left to die.
The Dallas nurse diagnosed with the virus is identified as 26-year-old Nina Pham. Her family confirm the identification. Pham graduated from Texas Christian University’s nursing program in 2010.
Brantly donates plasma to Pham, the third patient who has been given his blood in the hope that antibodies he developed in his recovery from the virus can cure others. Brantly is believed to have traveled to Texas Health Presbyterian Hospital to make the donation on Sunday night.
Frieden says that a breach in safety protocols led to the infection of the nurse in Dallas, and warns of more infections:
We’re deeply concerned. Unfortunately, it is possible that in the coming days we will see additional cases of Ebola.
The driver is isolated and his bus is taken out of service after a masked passenger began shouting threats:
Don’t mess with me, I have Ebola!
Metro officials and the LA County sheriff’s transit authorities are reviewing surveillance tapes from inside the bus to determine the identity of the passenger, who was accompanied by a woman.
CDC Director Frieden says hospitals across the U.S. must know how to handle patients who have been in affected areas, and be prepared for the possibility they have the virus.
We have to rethink the way we address Ebola infection control, because even a single infection is unacceptable.
In a statement released by Texas Health Presbyterian, Pham says she is “doing well.”
I’m doing well and want to thank everyone for their kind wishes and prayers. I am blessed by the support of family and friends and am blessed to be cared for by the best team of doctors and nurses in the world.
Pham is listed as “clinically stable,” according to the director of the CDC Dr. Tom Frieden.
Snyderman, NBC’s Chief Medical Editor, apologizes for violating voluntary quarantine under which she and her crew are placed when her cameraman Ashoko Mukpo is diagnosed with Ebola in Africa. Snyderman and two of her crew members are allegedly seen in public picking up a take out order.
While under voluntary quarantine guidelines, which called for our team to avoid public contact for 21 days, members of our group violated those guidelines and understand that our quarantine is now mandatory until 21 days have passed. We remain healthy and our temperatures are normal. As a health professional I know that we have no symptoms and pose no risk to the public, but I am deeply sorry for the concerns this episode caused. We are thrilled that Ashoka is getting better and our thoughts continue to be with the thousands affected by Ebola whose stories we all went to cover.
The CDC says a plan to designate a hospital in each state is still in the discussion plan. One issue is that there are only four hospitals nationwide that have top-level bio-containment units. Abbigail Tumpey, who heads the CDC’s education outreach:
We’d like to have at least one hospital in every state that does feel they could manage a patient from start to finish
A total of 16 Medecins sans Frontieres (MSF) doctors have contracted the virus, and nine have died. The head of Doctors Without Borders in South Africa, Sharon Ekambaram, says medical workers have received inadequate assistance from the international community.
Medical records show that around 70 Texas Health Presbyterian staffers cared for Duncan, and some of them may have had direct contact with his body or fluids. The CDC says there were breaches in protection protocol at the hospital, and is investigating to identify them. WHO doctor Aileen Marty says no amount of protection will help if hospital workers do not put on and take off their protective layers carefully:
The first thing in caring for someone with Ebola is to do everything in your power to never become a victim
WHO assistant director-general Dr. Bruce Aylward gives the figure at a press conference in Geneva. He outlines what will happen if the global response isn’t stepped up within 60 days:
A lot more people will die
A model by Northeastern University based on flight patterns shows that the U.S. is at highest risk of more Ebola cases both without a travel reduction from west Africa and with a travel reduction of of 80%.
The CDC creates a mobile team to respond to any cases of infection. CDC Director Frieden:
I wish we had put a team like this on the ground the day the patient – the first patient – was diagnosed. That might have prevented this infection. But we will do that from today onward with any case anywhere in the U.S.
The person, reported to be Pham’s boyfriend, is reported to be in isolation at Texas Health Presbyterian. An internal company email indicates that he works at global eye care products company Alcon in Forth Worth, Tx.
WHO assistant director-general Dr. Bruce Aylward says in Geneva that the new rate confirms Ebola is ‘a high mortality disease.’ Previously, the WHO had estimated the death rate around 50%.
The CDC is monitoring 11 people who had contact with Duncan and 114 people who may have had contact. None of the people are showing signs of Ebola. It says that 48 have been monitored since before Duncan was admitted to Texas Health Presbyterian, 75 are people who worked in the hospital, and one is someone who had contact with Pham.
Denver-based Corgeniz develops a device called a lateral flow dipstick-type test that can identify the virus in 10 minutes. The company has received a government grant to study Ebola. The test device is already being used to detect the Lassa virus in west Africa. CEO Douglass Simpson expects the test to be available in about a year depending on the green-lighting process by the government.
What if the CDC said we need to speed this process up. Could you do that? We’re in sixth gear now. We’re going as fast as we possibly can.
CBS reports that Navarro may have denied entry to two Nigerian men. Letter to student:
Unfortunately, Navarro College is not accepting international students from countries with confirmed Ebola cases.
The school responds that it is focusing on students from other countries:
As part of our new honors program, the college restructured the international department to include focused recruitment from certain countries each year. Our focus for 2014-15 is on China and Indonesia. Other countries will be identified and recruitment efforts put in place once we launch our new honors program fall 2015.
The global body says 70% of patients need to be placed in care facilities by Christmas, without infecting others, and 70% of those who have died from the virus must be buried. UN deputy Ebola coordinator Anthony Banbury:
We need to do that within 60 days from 1 October. If we reach these targets then we can turn this epidemic around. We either stop ebola now or we face an entirely unprecedented situation for which we do not have a plan.
Liberian families are reported to be paying for birth certificates stating that people who have died of Ebola did not have the virus, in order to allow traditional burial rites that include touching and kissing the dead. Prof. Columbia University epidemiology expert:
Unfortunately, the bodily fluid of recently passed victims continues to carry Ebola virus for up to three days following death. The body’s immune system stops fighting the disease, allowing virus to replicate unabated.
National Nurses United says Duncan was kept in a non-isolated area of the ECU for several hours and potentially exposed up to seven other patients to Ebola. Among other claims about the protocols used are that nurses did not have proper protective gear, were treating Duncan as well as other patients, and that preparation for the virus was limited to an optional seminar for staff. Union official Deborah Burger:
There was no advance preparedness on what to do with the patient, there was no protocol, there was no system
After earlier appearing to downplay the extent of the resources needed to deal with the virus, Frieden says the CDC could have done more to contain the outbreak in Texas:
We could’ve sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed.
Texas Health Presbyterian had to adapt its Ebola protocols on the fly as it treated Duncan, adding more layers of protective gear. CDC epidemiologist Pierre Rollin:
They kept adding more protective equipment as the patient [Duncan] deteriorated. They had masks first, then face shields, then the positive-pressure respirator. They added a second pair of gloves.
A Nurses United statement says that workers at Texas Health Presbyterian were left to train each other, and were told to call the Infectious Diseases Department about procedures, only to learn that the department had no advice.
There was no advanced preparedness on what to do with the patient. There was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.”
Rawlings says the outbreak may get worse before it gets better, but says the state has the capability to combat it.
There are two things that I harken back to this. The only way that we are going to beat this is person by person, moment by moment, detail by detail. We have those protocols in place, the city and county, working closely with the CDC and the hospital. The second is we want to minimize rumors and maximize facts. We want to deal with facts, not fear.
The global body says deaths have risen to 4,447, and there have been 8,914 cases overall. It says total cases are expected to rise above 9,000 by the end of the week. The WHO estimates figures by taking the numbers of confirmed cases and multiplying them to account for under-reporting. It multiplies figures from Guinea by 1.5, from Sierra Leone by 2 and from Liberia by 2.5.
The Frontier Airlines plane that Vinson traveled on may have stayed in service after the flight. Flighttracker shows that it was used for five further flights the same day, but the airline denies this. Frontier Air statement:
The flight landed in Dallas/Fort Worth at 8:16 p.m. local and remained overnight at the airport having completed its flying for the day at which point the aircraft received a thorough cleaning per our normal procedures which is consistent with CDC guidelines prior to returning to service the next day. It was also cleaned again in Cleveland last night.
The CDC asks all 132 passengers on the flight to call 1 800-CDC INFO (1 800 232-4636). Public health professionals will begin interviewing passengers about the flight after 1 p.m. ET.
The Texas Department of State Health Services says a second worker at Texas Health Presbyterian who treated Duncan has contracted the virus. Tests to confirm the result of the local test are being conducted at the CDC in Atlanta. The person isn’t identified but authorities say interviews have been done to allow contact tracing. CDC statement:
An additional health care worker testing positive for Ebola is a serious concern, and the CDC has already taken active steps to minimize the risk to health care workers and the patient
The second nurse to contract the virus while treating Duncan is identified by her family as Amber Vinson. She is reported to live alone with no pets, and was placed in isolation within 90 minutes of her temperature spiking. Dallas County Judge Clay Jenkins:
We are preparing contingencies for more. That is a very real possibility
Shares of the major U.S. airlines were down between 4% and 6% midday after the news broke that Vinson boarded a flight the day before her diagnosis.
Obama cancels a trip to raise funds for Democrats before the November elections. White House:
The President’s travel today to New Jersey and Connecticut has been postponed. Later this afternoon, the President will convene a meeting with cabinet agencies coordinating the government’s Ebola response.
The CDC says that Vinson recorded a temperature of 99.5 before traveling, below the fever threshold of 100.4 but an elevated level. Frieden:
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.
A White House pool report says Obama stated that the administration is confident of preventing a serious outbreak. He added that he has met, hugged, and even kissed healthcare workers at Emory who have treated Ebola patients. Obama:
We are going to have to make sure that we do not lose sight of the importance of the international response to what is taking place. I’m confident that we can prevent a serious outbreak of the disease here in the U.S.
Vinson called the CDC after registering a temperature of 99.5, but was allowed to fly as the reading was below the high-risk threshold of 100.4. Unnamed health official:
Somebody dropped the ball
Vinson is taken to Emory University, which has successfully treated two other patients. Footage shows a police motorcade escorting her from the charter flight to the hospital. Statement:
As a result of the virus, my condition worsened and I became critically ill soon after I arrived at Emory. Through rigorous medical treatment, skillful nursing, and the full support of a healthcare team, I am well on the way to a full recovery.
[The Ebola unit is] physically separate from other patient areas and has unique equipment and infrastructure that provides a high level of clinical isolation.
Dallas Fort Worth airport contractor Pablo Medina says he was threatened with being fired for being out of uniform and made to remove a mask and latex gloves. He was directing passengers at the airport exit that Vinson passed through following her flight before her diagnosis.
One of the supervisors told me I wasn’t allowed to wear that because it’ll cause a panic for people and they’ll start tripping out and stuff. It makes me mad, it makes me terrified that they’re denying me to wear safety precautions. And they told me that if go out, they’ll let me go – and that just makes me more mad