Congress pushes for answers as Ebola response stumbles

Two nurses infected with Ebola at a Dallas hospital are being moved to specialized centers, and federal officials and a hospital executive faced tough questions from Congress today about speed bumps in the response to the quickly evolving Ebola situation.

At a hearing today, members of the US House Energy and Commerce Subcommittee on Oversight and Investigations also covered one of the latest Ebola developments, that the second sick nurse, Amber Joy Vinson, consulted with the US Centers for Disease Control and Prevention (CDC) before she flew back to Dallas from Ohio and was reportedly cleared to fly.

Texas Health Presbyterian Hospital in Dallas announced last night that Vinson had been transferred to Emory University Hospital in Atlanta, which has a specialty unit that has treated three other Ebola patients. Today the Dallas hospital said the first infected nurse, Nina Pham, will be transferred to the National Institutes of Health (NIH) Clinical Care Center in Bethesda, Md., which has isolated and monitored one US doctor who had been exposed to, but was not sickened by, Ebola.

At the hearing, Anthony Fauci, MD, director of the NIH's National Institute of Allergy and Infectious Diseases (NIAID), whose testimony focused on Ebola drug and vaccine development, said the NIH Clinical Center has two beds in the specialty unit, which is designed to provide state-of-the-art care.

The Dallas hospital said that with so many of its intensive care unit (ICU) staff sidelined for continuous monitoring for Ebola because of potential exposure like that of the two sick nurses, transferring the nurses to specialty facilities is in the best interest of the hospital and its employees. A team of more than 20 CDC investigators is at the facility to assess how the two nurses were exposed to the virus and to work with the hospital on shoring up personal protective equipment (PPE) and infection control protocols.

PPE issues continue to reverberate

The two nurses' infections have amplified concerns in the healthcare community that hospitals aren’t prepared to assess and safely manage patients with Ebola. The events were the flashpoint in a conference call yesterday by National Nurses United (NNU), during which the group aired training, PPE, and infection control lapses at the Dallas hospital. The nurses’ infections have spurred more steps by the CDC to help facilities, including a pledge of immediate assistance from an Ebola response team whenever an infection is detected.

The US Department of Health and Human Services (HHS) had a conference call with nurses today on how to safely care for Ebola patients. Also, the hospital responded yesterday to some of the claims made by NNU, the nation’s largest nurses union.

Texas Health Resources, the hospital’s parent company, responded early this morning to some of the allegations made during the NNU call. Based on Duncan’s medical record and the reports from caregivers, it said staff wore CDC-recommended PPE and made all recommended changes to the protocol during its care of Duncan. It said the man’s clinical specimens were placed in the tube system during his initial visit and once during his hospitalization, and that the samples did not leak or spill. During the rest of his stay samples were triple bagged and hand-carried to the lab, the hospital said.

The first Tyvek suits the hospital received were too large, and staff may have used tape to cinch the suits. The hospital said it has since received smaller sizes.

In a related development, the Association for Professionals in Infection Control and Epidemiology (APIC) said in a statement today that it is working with the CDC to determine the best way to prepare facilities and speed training for health workers. It added that that the unfortunate Ebola transmission to nurses caring for a patient with advanced illness shows the need to strengthen protocols, adherence, and protection for healthcare workers in high-risk settings.

The group said it is partnering with the CDC on enhanced tools for correct PPE donning and doffing, recruiting members for teams to help hospitals with confirmed Ebola patients, offering resources on its Web site, and will host an Ebola infection webinar on Oct 21.

Lawmakers seek answers, push for travel ban

The detection of Ebola in a traveler from Liberia, followed by infections in two of his caregivers, has raised questions about the US response to the outbreak, which was the focus of today’s congressional hearing.

Rep Tim Murphy, R-Pa., said errors have been made in the response, but corrections are being made. He said the Ebola threat has been understated and that the nation’s ability to handle the disease has been overstated. Federal health officials, he added, need to restore public confidence with honest and thorough actions.

Rep Henry Waxman, D-Calif., said the events are a wake-up call for the nation to ensure the adequacy of its public health safety net. He said that the challenges the Dallas hospital faced could have happened anywhere. "Many hospitals would have struggled to respond," he asserted.

During today's testimony, Dan Varga, MD, Texas Presbyterian's chief clinical officer, apologized for the facility’s inability to flag Thomas Eric Duncan’s Ebola infection sooner and for inaccurate information that surfaced about the communication breakdown regarding the man’s travel history.

"A lot is being said about what may or may not have occurred," he said regarding the nurses’ infections. "It’s clear there was an exposure somewhere, sometime, and we’re poring over the information."

Committee members pressed Frieden about reports that Vinson called the CDC before she flew from Ohio to Dallas and was cleared to fly. He confirmed that she did call the CDC but said he had not seen the transcript of the call. He said the current protocol stipulates no commercial travel for people who had high-risk exposure to Ebola without wearing PPE.

Several members of the committee pressed federal officials hard on why the nation hasn’t put imposed a travel ban for people coming from the three Ebola-hit countries, with many raising worries that enhanced screening might miss some sick people, given the disease’s long incubation period and the possibility that some could mask their fever or exposure history.

Frieden repeated his assertions that a ban would hamper response activities in West Africa and make it harder to track people coming into the countries, given complex travel patterns and other ways they could enter. He also said federal health officials are open to suggestions and will take steps that are needed to protect Americans.

Many members also told federal officials to let them know what resources they need to address the Ebola threat.

Rep Diana DeGette, D-Colo., said at the end of the 3-hour hearing that after hearing from federal officials, the action priorities seem to be better training, better protective gear, and getting CDC personnel on the ground sooner when a new Ebola case is detected.

In addition, Murphy pressed for a ban on nonessential commercial travel from the outbreak countries, a 21-day quarantine for people returning from theregion, earmarking specialized centers for treating Ebola patients, beefing up authority and funding for federal agencies responding to the outbreak, accelerating the development of drugs and vaccines, and expanding the fleet of planes for evacuating sick responders from West Africa.

The committee said it would hold another hearing in November to gauge progress on the nation’s Ebola response.

Events prompt hotline, school closures

Vinson's recent travel to Ohio, where she visited family, has triggered several response steps there, including an announcement yesterday from Kent State University that three of its staff members have been asked to stay away from campus and self-monitor for 21 days. The staff members are related to Vinson, who recently stayed at their Summit County home.

The Ohio Department of Health (ODH) said it is activating a 24-hour call center to answer residents’ questions about Ebola.

The events prompted a flurry of school closures in Ohio, including in Solon County, which closed a middle school and an elementary school after a staff member flew on the same plane, but not the same flight, as Vinson, USA Today reported.

Also, a school in Summit County closed early after the parent of a student reported contact with Vinson during her visit to the area, the Cleveland Plain Dealer reported today. The Summit County Department of Health released a statement that it doesn’t advocate closing schools or cancelling events, but that it supports Akron Public Schools, based on its assessment of the situation.

Other developments

  • HHS announced today the awarding of a $5.8 million contract to Profectus Biosciences to make trial amounts of an experimental Ebola vaccine and test it in animals. Under the contract, which can be extended to $8.6 million, HHS will also contribute expertise and technical assistance. If the animal tests are promising, the Baltimore-based company is expected to seek the Food and Drug Administration's authorization to conduct human safety trials, HHS reported. In earlier experiments, the vaccine provided 100% protection in non-human primates, the agency said. It noted that two other Ebola vaccines being supported by the government are in phase 1 clinical trials.

  • A contact of Spanish nursing assistant Teresa Romero, the first person to contract Ebola outside West Africa, is being hospitalized in Madrid with a fever and tested for Ebola, according to an Associated Press story today. The person is not a healthcare worker. Romero, who has been in treatment at a Madrid hospital since Oct 6, is in stable condition, and the viral load in her body is declining, says the report. She was exposed to the disease while caring for a priest who returned to Spain from West Africa in September after contracting Ebola.

  • A 1-day workshop at which experts will make recommendations on biomedical and public health research to prepare the United States to safeguard the public from Ebola will be held Nov 3 in Washington, DC, the National Academy of Sciences (NAS) said yesterday. Such research topics as routes of virus transmission, persistence of the virus on environmental surfaces, methods for inactivating the virus and for disinfection, and strategies to protect first responders, healthcare providers, and the public may be considered. As noted in the release, research based on real-world conditions rather than in lab settings can provide valuable information to better manage the disease. The workshop is being convened by the US Department of Health and Human Services, the Institute of Medicine, and the National Research Council.

Consulting editor Marty Swain and news editor Robert Roos contributed to this report.

See also:

Oct 16 House hearing background materials

Oct 15 Texas Health Resource statement on transfer of second nurse

Oct 16 NIH statement on hospitalization of first nurse

Oct 16 NIH press release

Oct 16 APIC statement

Oct 16 Texas Health Resource response to nurses’ charges

Oct 16 Ohio Department of Health statement

Oct 16 USA Today story

Oct 16 Cleveland Plain Dealer story

Oct 16 Summit County Department of Health statement

Oct 16 HHS press release about vaccine contract

Oct 16 AP story on Spain case

Oct 15 NAS press release

 

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