Pham arrives at National Institutes of Health center in Bethesda, Maryland for treatment in a specialized isolation unit, with staff that specialize in infectious disease and critical care. The NIH facility has one of four isolation units in the nation. NIH says staff specializing in infectious disease and critical care will treat the 26-year-old nurse. Pham left the Dallas hospital in an ambulance about 6 p.m. as dozens of nurses cheered and waved signs bearing messages of affection and good wishes. She was taken to Dallas Love Field, where she boarded the same executive jet used to fly a co-worker to an Atlanta hospital on Wednesday. The jet took off shortly after 7 p.m. Hospital spokesman Wendell Watson said Pham’s transfer is necessary because numerous employees are being monitored for symptoms and aren’t available to work.
Pham appears in a YouTube video taken before she was transferred to the National Institutes of Health clinical center in Bethesda, Md. The video was made by the physician who was treating her, Dr. Gary Weinstein and released with Pham’s permission.
I love you guys.
The county’s top health epidemiologist, Dr. Wendy Chung, confirms she is being monitored after treating Duncan:
Yes, I have been alongside other physicians and nurses in addressing this patient. I am under the same monitoring protocols which are currently recommended for my clinical colleagues who are in the same exposure category as mine.
The CDC advises residents of New York City to prepare in a report titled Surveillance and Preparedness for Ebola Virus Disease — New York City, 2014. (Report available here) . It says the city remains Ebola-free but advises officials on what to look for and what to do if the virus is detected. The Department of Health and Mental Hygiene has identified 88 people arriving from the Ebola nations thought to have symptoms of the virus. All were cleared, but some diagnoses were delayed as lab workers were reluctant to handle specimens. Report:
New York City is a frequent port of entry for travelers from West Africa, a home to communities of West African immigrants who travel back to their home countries, and a home to healthcare workers who travel to West Africa to treat Ebola patients
Texas Health Presbyterian apologizes to the House Energy and Commerce Committee for mishandling Duncan’s case (written testimony here.) Chief clinical officer:
Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes. We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry.
A photo shows an unidentified passenger at Washington Dulles wearing a hazmat suit while waiting for a flight. The transparent blue plastic suit does not cover her wrists.
A person seen escorting Vinson onto her transfer flight to Emory University without hazmat gear is reported to be likely a CDC employee. Officials with AMR, the ambulance company that transported her from Texas Health Presbyterian Dallas to Dallas Love Field Airport, say that the man is not their employee. Emory also says that they do not know who the man is. CBS helicopter footage reports that the man appeared to leave with Vinson on the plane, indicating that he may be a CDC overseer.
Dallas County Judge Clay Jenkins, who is overseeing the Ebola response, says the county Medical Director will sign a control order that will follow minimum guidelines outlined by the CDC blocking people being monitored for Ebola symptoms from using public transportation, including buses and airliners. He says workers weren’t instructed by Presbyterian or the CDC to stay away from the public during the 21-day monitoring period.
No one told them, which is something that is profoundly disappointing to me, but this is something that we’ve got to fix quickly. We cannot have people on common carriers like DART trains, airplanes or buses who might get sick.
A group of parents pull their children out of Hazlehurst Middle School in Mississippi after the school principal traveled to Africa. Principal Lee Wannik traveled to attend his brother’s funeral in Zambia, located in southern Africa several thousand miles from the Ebola outbreak. The CDC says Wannik does not have the virus. He will take paid vacation, and has offered to seek any medical advice that will help the situation. Candice Swan, a parent:
As soon as I got word on Facebook I came and got my (children). I don’t know about anybody else, but I am coming to get min.
The BBC launches a service for users of the messaging app in west Africa. It will provide audio, text message alerts and images to spread the latest public health information. Content will be limited to three items a day, and the service will be in English and French. It says users can subscribe by sending JOIN to +44 7702 348 651 and opt out by sending STOP to the same number.
A Fort Worth family is reported to be in quarantine for 21 days after a family member may have had contact with Vinson. A letter sent to parents in the Eagle Mountain-Saginaw Independent School District (full text here) says a family member of a Lake Pointe Elementary School student was on the flight from Cleveland. The district says the family member is in the military and is stationed at the Naval Air Station Joint Reserve Base in Fort Worth.
Upon advisement from the military and as a precautionary measure, the family will be isolated for 21 days. This family has one child who attends Lake Pointe Elementary.
The Giants receive a primer on the virus before traveling to Dallas to take on the Cowboys. Eli Manning:
With what we’re doing and where we’re staying, I think we’ll be OK.
The UN’s global famine warning system is indicating that Ebola may cause a food crisis. The World Food Program says it needs to reach 1.3 million people in Liberia, Sierra Leone and Guinea, but has only provided food to 534,000 people, and may reach 600,000 to 700,000 this month, WFP official in North America:
And we are working hard to reach and scale up to 1.3 million eventually.
A letter from Frontier Airlines CEO David Siegel to employees states that Frontier was notified by the CDC that Vinson may have been symptomatic earlier than initially suspected, including the possibility of possessing symptoms while onboard the flight.
Since we were notified by the CDC, we’ve proactively placed six crew members (two pilots; four flight attendants) on paid leave for 21 days out of an abundance of caution as the safety and security of our employees is our number one priority. This was over and above CDC guidance that stated that our flight crews were safe to fly. We have also been working in close cooperation with our unions and appreciate their support on this issue.
Experts warn that panic over Ebola can be more harmful than the virus itself. They say that public concerns over previous health scares have have led to heightened anxiety, avoidance of public places, to hysteria. They cite the fact that the flu virus has at times killed 30,000 people in a single year in the U.S., and say that statistics make the risk of Ebola very small. To address this, health officials need to show competence and fairness: communicating risks clearly, reporting all cases as quickly as possible, and treating each infection with the maximum level of care.Carnegie Mellon University professor of economics and psychology George Loewenstein:
The system often flips from one extreme to another, from ignoring risks altogether and then overreacting
A Washington Post-ABC News poll finds that two thirds of Americans are worried about an Ebola epidemic in the United States, and more than 4 in 10 are very or somewhat worried that they or a close family member might catch the virus. Michael Luke-Anthony, who cleans the cabins of airplanes at John F. Kennedy International Airport:
My fear is, the whole Ebola situation, it can get anywhere. It got from Liberia to Texas. It’s traveling quick. It could be in one of those planes.
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
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.
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
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.
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.
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.
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.
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
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 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 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 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.
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.
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.”
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.
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.
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
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.
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.
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.
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.
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.
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 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.
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.
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%.
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
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
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.
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
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.
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.
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.