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Ebola outbreak in Texas lays bare disjointed government response Ebola outbreak in Texas lays bare disjointed government response
(35 minutes later)
On Wednesday the President of the United States cancelled a fundraising trip, and – seated in a leather-backed chair with the Stars and Stripes behind him – addressed the nation. “I thought it was very important for me to bring together our team,” he said, radiating an air of calm and control, “to hear directly from them in terms of how we are ramping up our efforts here.”On Wednesday the President of the United States cancelled a fundraising trip, and – seated in a leather-backed chair with the Stars and Stripes behind him – addressed the nation. “I thought it was very important for me to bring together our team,” he said, radiating an air of calm and control, “to hear directly from them in terms of how we are ramping up our efforts here.”
“I want people to understand that the dangers of you contracting Ebola, the dangers of a serious outbreak, are extraordinarily low,” he concluded. “But we are taking this very seriously at the highest levels of government.”“I want people to understand that the dangers of you contracting Ebola, the dangers of a serious outbreak, are extraordinarily low,” he concluded. “But we are taking this very seriously at the highest levels of government.”
A casual observer would have been forgiven for seeing, in this picture, a coordinated response: a single, unified government fully in control, with a clear chain of responsibility. But in truth, no such coordination exists.A casual observer would have been forgiven for seeing, in this picture, a coordinated response: a single, unified government fully in control, with a clear chain of responsibility. But in truth, no such coordination exists.
The reasons for this are rooted in the fragmented, federalised nature of the United States. Activists and state governments, especially those controlled by the Republican party, have in recent years fought tooth and nail against what they see as perpetual federal overreach. This is all well and good, right up until a moment like this, when suddenly everyone starts asking: why isn’t the government doing anything?The reasons for this are rooted in the fragmented, federalised nature of the United States. Activists and state governments, especially those controlled by the Republican party, have in recent years fought tooth and nail against what they see as perpetual federal overreach. This is all well and good, right up until a moment like this, when suddenly everyone starts asking: why isn’t the government doing anything?
Nurses at Texas Health Presbyterian hospital, where Thomas Eric Duncan, the first person to be diagnosed with Ebola in the US was treated and died, and where two nurses who cared for him contracted the virus, have reportedly told a nurses’ union that they were not given proper protective gear. The hospital has denied this, but if it is true, why didn’t the Centers for Disease Control and Prevention (CDC) step in and provide it for them?Nurses at Texas Health Presbyterian hospital, where Thomas Eric Duncan, the first person to be diagnosed with Ebola in the US was treated and died, and where two nurses who cared for him contracted the virus, have reportedly told a nurses’ union that they were not given proper protective gear. The hospital has denied this, but if it is true, why didn’t the Centers for Disease Control and Prevention (CDC) step in and provide it for them?
They have also reportedly said that the hospital did not have clear protocols for the treatment of Duncan, and that it kept changing the protocols it did have – so why didn’t the CDC just put protocols in place for it?They have also reportedly said that the hospital did not have clear protocols for the treatment of Duncan, and that it kept changing the protocols it did have – so why didn’t the CDC just put protocols in place for it?
Ebola’s not really the problem. “This has become an issue only because of the missteps,” said Joseph McCormick, the former chief of the special pathogens branch of the division of viral diseases at the CDC and an expert in Ebola. “If there had been no missteps – if they had gotten this guy in, gotten him stabilised – everyone would be saying ‘great job’. [Ebola’s] not a threat to anybody – except the healthcare workers.”Ebola’s not really the problem. “This has become an issue only because of the missteps,” said Joseph McCormick, the former chief of the special pathogens branch of the division of viral diseases at the CDC and an expert in Ebola. “If there had been no missteps – if they had gotten this guy in, gotten him stabilised – everyone would be saying ‘great job’. [Ebola’s] not a threat to anybody – except the healthcare workers.”
Any alleged failings in the hospital’s procedure and preparation were probably compounded by the murky, or even non-existent, chain of command at work in a situation like this one. The system is fragmented – by design – across state lines, and unless and until things get worse, neither the CDC nor Ron Klain – the former chief of staff to Vice-President Joe Biden who is now Obama’s newly appointed “Ebola czar” – have direct authority over hospitals or state health departments, though McCormick said of Klain’s appointment that “if it improves coordination and communication in any way it will help”.Any alleged failings in the hospital’s procedure and preparation were probably compounded by the murky, or even non-existent, chain of command at work in a situation like this one. The system is fragmented – by design – across state lines, and unless and until things get worse, neither the CDC nor Ron Klain – the former chief of staff to Vice-President Joe Biden who is now Obama’s newly appointed “Ebola czar” – have direct authority over hospitals or state health departments, though McCormick said of Klain’s appointment that “if it improves coordination and communication in any way it will help”.
“Unless the president invokes very specific powers of the presidency, all public health is a states’ rights issue,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The CDC doesn’t have the power to just walk into a state and take over.”“Unless the president invokes very specific powers of the presidency, all public health is a states’ rights issue,” said Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The CDC doesn’t have the power to just walk into a state and take over.”
Only if Ebola becomes a national epidemic crossing multiple state borders will federal agencies such as the CDC have any real power over local or state authorities. For now, “the CDC does everything by persuasion,” said Bill Schaffner, an infectious disease specialist at Vanderbilt University medical centre in Nashville, Tennessee. Usually, he said, “they have such status, standing, that essentially everyone falls in line, listens and collaborates with their recommendations.”Only if Ebola becomes a national epidemic crossing multiple state borders will federal agencies such as the CDC have any real power over local or state authorities. For now, “the CDC does everything by persuasion,” said Bill Schaffner, an infectious disease specialist at Vanderbilt University medical centre in Nashville, Tennessee. Usually, he said, “they have such status, standing, that essentially everyone falls in line, listens and collaborates with their recommendations.”
But there is no system for ensuring that this is the case. Each of the country’s more than 6,000 hospitals is responsible for their own internal infection control and training. They are advised – but not supervised – by the CDC.But there is no system for ensuring that this is the case. Each of the country’s more than 6,000 hospitals is responsible for their own internal infection control and training. They are advised – but not supervised – by the CDC.
“The CDC has provided a long list of recommendations about how to do infection control within healthcare facilities, but the execution of that has been left to individual hospitals,” said Schaffner. “I don’t know what went wrong [in Dallas] for a fact,” he said. “But it would appear the hospital never seriously considered that a patient with Ebola would turn up.”“The CDC has provided a long list of recommendations about how to do infection control within healthcare facilities, but the execution of that has been left to individual hospitals,” said Schaffner. “I don’t know what went wrong [in Dallas] for a fact,” he said. “But it would appear the hospital never seriously considered that a patient with Ebola would turn up.”
During a call with reporters on Wednesday, the CDC director, Thomas Frieden, speaking about Duncan and the infection of the two nurses, said: “Our investigations increasingly suggest that the first several days before the patient was diagnosed, appear to be the highest-risk period. That was the 28th, 29th and 30th.” During a call with reporters on Wednesday, the CDC director, Tom Frieden, speaking about Duncan and the infection of the two nurses, said: “Our investigations increasingly suggest that the first several days before the patient was diagnosed, appear to be the highest-risk period. That was the 28th, 29th and 30th.”
During the whole of that crucial period there was no representation from the CDC on site, whether to take command of the situation or simply ensure procedures were being followed. People from the CDC finally arrived after the diagnosis was confirmed on 30 September.During the whole of that crucial period there was no representation from the CDC on site, whether to take command of the situation or simply ensure procedures were being followed. People from the CDC finally arrived after the diagnosis was confirmed on 30 September.
By that time, it appears now, it was already too late: the two nurses, Amber Vinson and Nina Pham, had probably already been infected.By that time, it appears now, it was already too late: the two nurses, Amber Vinson and Nina Pham, had probably already been infected.
“It’s clear to me even that if they thought they had a protocol – they didn’t,” McCormick said of the hospital.“It’s clear to me even that if they thought they had a protocol – they didn’t,” McCormick said of the hospital.
“You can tell that with all the missteps from the moment Mr Duncan walked in: they clearly didn’t have a protocol for when someone walks in and says ‘I’m from west Africa and I’m ill.’ He had come from Monrovia, for Christ’s sake. There’s just so many missteps it’s mind-boggling.”“You can tell that with all the missteps from the moment Mr Duncan walked in: they clearly didn’t have a protocol for when someone walks in and says ‘I’m from west Africa and I’m ill.’ He had come from Monrovia, for Christ’s sake. There’s just so many missteps it’s mind-boggling.”
“We’re talking about them winging it,” he said.“We’re talking about them winging it,” he said.
Even if the CDC does step in and impose its will, its guidelines for the treatment of Ebola patients may not be strict enough, McCormick said. Médecins San Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC), both of which are currently fighting the Ebola outbreak in west Africa, have much stricter operational procedures than those recommended by the CDC.Even if the CDC does step in and impose its will, its guidelines for the treatment of Ebola patients may not be strict enough, McCormick said. Médecins San Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC), both of which are currently fighting the Ebola outbreak in west Africa, have much stricter operational procedures than those recommended by the CDC.
Panu Saaristo, the emergency health coordinator for the IFRC, said the guidelines that it and MSF use include a completely sealed suit, while the CDC’s position on the matter has been murky at best – on Wednesday Frieden told reporters that “some of the forms of [personal protective equipment] used did allow exposure of some parts of the skin”.Panu Saaristo, the emergency health coordinator for the IFRC, said the guidelines that it and MSF use include a completely sealed suit, while the CDC’s position on the matter has been murky at best – on Wednesday Frieden told reporters that “some of the forms of [personal protective equipment] used did allow exposure of some parts of the skin”.
The procedures used by MSF and the IFRC also call for washing suit-gloves and other areas with bleach after any possible contact with the virus. The CDC’s protocols do not include that, which “shocked” McCormick.The procedures used by MSF and the IFRC also call for washing suit-gloves and other areas with bleach after any possible contact with the virus. The CDC’s protocols do not include that, which “shocked” McCormick.
The CDC is now, after the poor response in Texas, planning to send a site manager to assist any new hospitals treating Ebola patients, though Ben Haynes, a spokesman for the CDC, told the Guardian that all their personnel on the ground would still report to state and hospital authorities.The CDC is now, after the poor response in Texas, planning to send a site manager to assist any new hospitals treating Ebola patients, though Ben Haynes, a spokesman for the CDC, told the Guardian that all their personnel on the ground would still report to state and hospital authorities.
In any case, for McCormick this was all too little, and far, far too late. “Somebody needs to be in charge,” McCormick said. “This protocol and the way we’re handling these patients is not working. It needs to be fixed, and it needs to be fixed today.”In any case, for McCormick this was all too little, and far, far too late. “Somebody needs to be in charge,” McCormick said. “This protocol and the way we’re handling these patients is not working. It needs to be fixed, and it needs to be fixed today.”