Obama names Ebola chief; search is on for more contacts

Two days after calling a Cabinet meeting on Ebola, President Barack Obama today appointed Ron Klain to lead the government's domestic and foreign response to the outbreak, as federal and state officials grappled with identifying more possible contacts of a sick nurse.

In related development yesterday, Obama signed an executive order that would allow National Guard and Reserve forces to help battle the Ebola outbreak in West Africa.

Ebola czar, authority for more troops

Klain is a former chief of staff to two vice presidents, Al Gore and Joe Biden, has extensive experience coordinating complex governmental operations, and has good working relationships with members of Congress, according to a White House blog post. He will report to Obama's Homeland Security Advisor Lisa Monaco and National Security Advisor Susan Rice.

Since at least September, some members of Congress have been calling for Obama to name a point person to direct all US Ebola response efforts, which have become more complex over the past few weeks with the Dallas hospitalization and death of Liberian Thomas Eric Duncan from the disease and its transmission to two nurses.

Obama's executive order gives the Department of Defense authority to activate duty National Reserve troops to help with Operation United Assistance, the US military's humanitarian mission to assist the response to West Africa's Ebola outbreak. In September Obama announced that the United States would send 3,000 troops, a number that has been increased to as many as 4,000, if needed.

Passenger tracking for second flight, Ohio identifies more contacts

In new contact-tracing developments, the US Centers for Disease Control and Prevention (CDC) said last night that due to new information it uncovered in identifying possible contacts of Amber Joy Vinson, the second nurse infected with the virus, it has launched passenger notification regarding the flight she took from Dallas to Cleveland on Oct 10.

Initially, passenger notification was only under way for the Frontier Airlines flight Vinson took back to Dallas the evening of Oct 13, just hours before she reported a fever the next morning. Her temperature the day of the flight was reported to be 99.5  degrees F. The CDC has said Vinson didn't show any symptoms on the flight, but it was conducting passenger notifications out of extra caution because of the short interval between her flight and her fever report.

The Oct 10 outbound flight subject to the latest round of passenger notification is Frontier Airlines Flight 1142.

It's not clear what additional information prompted the expanded passenger notification. Christopher Braden, MD, with the CDC's National Center for Emerging Infectious and Zoonotic Diseases, told reporters at a media briefing in Ohio yesterday that Vinson may have had Ebola symptoms as early as Oct 10, the Cleveland Plain Dealer reported. He said investigators received information that she had symptoms going back to Oct 11 and that the CDC couldn't rule out the possibility that her symptoms began on Oct 10.

So far eight people in the Akron area who may have had contact with Vinson are under quarantine, and Summit County is asking people who shopped at a local bridal store the afternoon of Oct 11 to call the health department, according to the Plain Dealer. Braden told reporters that Vinson did not have typical Ebola symptoms when her infection was detected on Oct 14.

Ohio health officials have taken several steps to respond to possible exposures, according to statements on the Ohio Department of Health (ODH) Web site. On Oct 15 the state activated an Ebola phone hotline, and yesterday it enhanced its quarantine protocols and recommended that the state's hospitals conduct Ebola readiness drills, including practicing personal protective equipment (PPE) donning and doffing techniques.

Today the ODH announced that it would beef up its PPE stockpiles for healthcare workers who need it in the event of detection of an Ebola case in Ohio.

Possible contact took cruise

Vinson is one of Duncan's possible contacts, and her travel on a commercial airline triggered confusion and clarification on the restrictions for people who have been asked to monitor their fevers. In a related development, the State Department announced today that another employee of Texas Health Presbyterian Hospital in Dallas had traveled, leaving Galveston Oct 12 on a cruise ship.

The State Department said the hospital employee may have had contact with Duncan's clinical specimens and was out of the country before being notified of updated CDC requirements for active monitoring. It said when she left the country, the CDC required only self-monitoring, which the employee has been doing since Oct 6. It said the last time the passenger may have processed Duncan's samples was 19 days ago and that he or she has shown no symptoms.

The CDC has been in contact with the cruise line, and the ship's doctor is monitoring the hospital employee and has confirmed that he or she is in good health. The traveler and companion are in voluntary isolation and plans are under way to bring them back to the United States out of caution, according to the state department.

A spokeswoman for Carnival Cruise Lines said Mexican officials have denied permission for the ship to dock off the coast of Cozumel, so the ship is on its way back to Galveston, where it is due on Oct 19, the Washington Post reported today.

Yesterday the Texas Department of State Health Services (TDSHS) clarified issues related to the movements of possible Ebola contacts. It said no workers who entered Duncan's room can travel by commercial transportation or congregate in public places such as restaurants or theaters for 21 day since last exposure. It said the temperature of healthcare workers who directly cared for Duncan must be monitored twice a day, with at least one check being a face-to-face session with a health provider.

The TDSHS said those who directly cared for Duncan have the option of being monitored in the hospital, and those who don't adhere to monitoring and other measures may be subject to a communicable disease control order.

As of today, the TDSHS is monitoring 143 contacts, 11 with definite contact and 132 with possible contact.

Other developments

  • The United States' recent experience with Ebola shows that safely managing the patients can be challenging for conventional hospitals, and the nation should have a network of regional referral centers to handle such cases, according to an editorial yesterday in the Annals of Internal Medicine. Two of the four authors are doctors at Nebraska Medical Center in Omaha, one of four high-level containment care centers in the United States. Though regular hospitals can safely manage patients with Ebola and other viral hemorrhagic fevers, training and logistics can't be assumed to be optimally in place when the need arises. They noted there is no margin of error for Ebola and similar diseases. They argued that a network of facilities can be linked to major medical centers, quickly be converted to high containment units when needed, and operate with support from the federal government.

  • The state of New York has designated eight hospitals to treat any Ebola cases that are identified, CBS News reported today. Gov Andrew Cuomo said that although all of the states roughly 200 hospitals should be prepared, eight have extra preparations and have conducted Ebola drills. They include Mount Sinai, New York-Presbyterian, and Bellevue Hospital Center in Manhattan; North Shore/Long Island Jewish Health System in Nassau County; Montefiore Medical Center in the Bronx; SUNY Upstate University Hospital in Syracuse; Stony Brook University Hospital on Long Island; and the University of Rochester Medical Center in Rochester.

See also:

Oct 17 White House blog post

Oct 16 White House executive order

Oct 16 CDC statement on passenger notification for second flight

Oct 16 Cleveland Plain Dealer story

ODH Ebola updates

Oct 16 TDSHS statement on Dallas contact tracing, enhance directive for healthcare workers

Oct 17 US State Department press statement

Oct 17 Washington Post story

Ohio Department of Health Ebola updates

Oct 16 Annals of Internal Medicine editorial

Oct 17 CBS News story

 

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