Dallas: New shortcomings
emerged Wednesday in the nation's response to the Ebola virus after it
was revealed that a second nurse was infected with Ebola at a hospital
here and that she had traveled on a commercial flight the day before she
showed symptoms of the disease.
The nurse, Amber Joy Vinson, 29,
was on the medical team that cared for the Ebola victim Thomas Eric
Duncan after he was admitted to the hospital on Sept. 28 and put in
isolation. Vinson should not have traveled on a commercial flight,
federal health officials said, when she boarded Frontier Airlines Flight
1143 on Monday, en route from Cleveland to Dallas-Fort Worth.
One
official said Vinson had called federal health officials before
boarding the plane to report having a slightly elevated temperature but
was allowed to fly.
A second case of Ebola among the nearly 100
doctors, nurses and assistants who treated Duncan for 10 days at Texas
Health Presbyterian Hospital was not unexpected. For days, federal
health officials have warned that in addition to Nina Pham, the first
nurse confirmed with the disease, other cases were likely.
But
the appearance of a new Ebola patient replayed a public health drama
that unfolded in this city twice before in a two-week period. The day
also provided more signs of concern about the ability of federal
officials to control the spread of the disease, particularly to health
care workers - and indications that the issue was becoming politicized.
President
Barack Obama Wednesday canceled his travel to a fundraiser in New
Jersey and a campaign rally in Connecticut so he could convene a meeting
of officials to coordinate the government's response to the spread of
the Ebola virus. Cities and states adopted heightened security measures,
and Vinson was being treated at Emory University Hospital in Atlanta
rather than in Dallas - all signs of the heightened focus on the disease
and the fears it has stirred.
House Speaker John Boehner on
Wednesday became the most high-profile Republican to urge Obama to
consider a travel ban on those traveling to the United States from West
African countries where the Ebola virus is spreading rapidly. The same
point has been raised by several Republican candidates in tight Senate
races, including David Perdue of Georgia, Mike Rounds of South Dakota
and Joni Ernst of Iowa.
At Kent State University in Ohio, where
Vinson studied nursing and her mother and two other relatives worked,
officials issued a statement asking her three family members to stay off
campus for the next three weeks, "out of an abundance of caution."
Frontier Airlines said it had put the two pilots and four flight
attendants on Flight 1143 on paid leave.
Obama on Wednesday
directed his aides to monitor the spread of Ebola in the United States
"in a much more aggressive way," but said the U.S. people should remain
confident of the government's ability to prevent a widespread outbreak.
He
promised that a review of the recent Ebola cases in Dallas would
discover what allowed the two hospital workers to be infected, but he
said that he himself had come into close contact with the nurses who
treated Ebola patients at the Emory University hospital, and that he had
felt safe doing so.
"I want people to understand that the
dangers of you contracting Ebola, the dangers of a serious outbreak, are
extraordinarily low, but we are taking this very seriously at the
highest levels of government," Obama said.
Still, there was widespread unease.
The
Frontier jet that carried Vinson on Monday made five flights after her
trip before it was taken out of service, according to Flightaware.com, a
flight tracking website. Frontier, which is based in Denver, said it
had grounded the plane as soon as the company was notified at about 1
a.m. Wednesday about the Ebola patient.
The first nurse infected,
Pham, 26, remained in "good condition," the hospital said. Vinson was
ill but stable, as she was transferred Wednesday to Emory, one of four
hospitals in the U.S. that have special high-containment units for
isolating patients with dangerous infectious diseases. Emory officials
said both the federal Centers for Disease Control and Prevention and
Texas Health Resources, the Dallas hospital's parent company, had
specifically requested that she be transferred there.
Though
Vinson had traveled on Monday, the day before she reported symptoms on
Tuesday, she had been among a group of hospital workers at Presbyterian
who were being monitored following the diagnosis on Sunday of the first
nurse, Pham. And although her temperature did not meet the fever
threshold of 100.4, Vinson reported to health officials that her
temperature at the time she traveled was 99.5 degrees.
"Because
at that point she was in a group of individuals known to have exposure
to Ebola, she should not have traveled on a commercial airline," CDC
Director Dr. Thomas R. Frieden said. "The CDC guidance in this setting
outlines the need for what is called 'controlled movement.' That can
include a charter plane, that can include a car but it does not include
public transport." Hours after Frieden spoke, a federal health official
who spoke on condition of anonymity because he was not authorized to
speak publicly, said that because it was thought that Vinson's
protective gear would have kept her safe and because the temperature was
only mildly elevated, she fell into a category not covered by CDC
guidelines and therefore was not forbidden to board the plane.
"I don't think we actually said she could fly, but they didn't tell her she couldn't fly," the official said.
He said the error was on the part of the CDC, not the nurse. "She called us," he said. "I really think this one is on us."
Because
of the proximity between the evening flight Monday and her first report
of being ill on Tuesday morning, the CDC asked all 132 passengers on
the flight to call a CDC hotline. The flight landed at 8:16 p.m. Monday
at Dallas/Fort Worth International Airport.
Frieden stressed that
the passengers were a low-risk group. Because Vinson did not have a
fever and did not experience nausea or vomiting on the plane, the risk
"to any around that individual on the plane would have been extremely
low," he said.
On Tuesday evening, a nurses' union, National
Nurses United, released a scathing statement that it said was composed
by nurses at Presbyterian Hospital. The statement told of "confusion and
frequently changing policies and protocols," of inadequate protection
against contamination and spotty training among the nurses who treated
Duncan when he arrived by ambulance at the emergency room on Sept. 28.
Frieden
said the critical period at Presbyterian was the first three days of
Duncan's care at Presbyterian before he was confirmed to have Ebola and
before the CDC team arrived in Dallas - Sept. 28, 29 and 30. Both Pham
and Vinson had extensive contact with Duncan at that time, and both had
interacted with him while he was producing a large amount of fluids from
vomiting and diarrhea.
Although officials have not yet
determined how the two nurses became infected, they were focusing on
their use of personal protective equipment, known as PPE.
"We see
a lot of variability in the use of personal protective equipment, and
when our team arrived, the same day the case was diagnosed, we noticed,
for example, that some health care workers were putting on three or four
layers of protective equipment in the belief that this would be more
protective," Frieden said. "But in fact by putting on more layers of
gloves or other protective clothing, it becomes much harder to put them
on and much harder to take them off, and the risk of contamination
during the process of taking these gloves off gets much higher."
Vinson
traveled to Cleveland on Friday from Dallas/Fort Worth, on Frontier
Airlines Flight 1142, officials said. At that point, she was part of a
group of health care workers that had been on a so-called
self-monitoring regimen, as Pham had been. Pham was diagnosed on Sunday
while Vinson was in Ohio. Following Pham's diagnosis, CDC officials put
the health care workers who had been self-monitoring under more
intensive evaluation.
Tara Mosley-Samples, a longtime friend of
Vinson's mother and a city councilwoman in Akron, Ohio, said Vinson had
studied nursing at Kent State and moved to Texas about a year ago.
"They're just good people," Mosley-Samples said. "Her daughter, Amber, is the sweetest little girl in the world."
Vinson frequently traveled to Ohio from Texas to visit her mother, who works in the president's office at Kent State.
Her
trip last weekend, however, had a more specific purpose. She had
recently become engaged. She flew home to plan for her wedding with her
mother, said Toinette Parrilla, director of the Cleveland Department of
Public Health. "They were doing their bridal shopping and going to the
bridal stores," she said.
© 2014, The New York Times News Service
