Yo! POTUS 44! Fire The Top People At The Centers For Disease Control & Replace 'Em With Ebola-Contractors Who Know What They're Doing — The Ebola Training Staff Of Médecins Sans Frontières (Doctors Without Frontiers) — Stat!

This blogger is mad as hell as he's not going to take it any more. POTUS 44! Deep Six your Ebola "Czar" because that hack doesn't know "come here from sic 'em." Send medical armed forces personnel to Ebola World after the troops receive basic training in Ebola-care from trainers from Médecins Sans Frontières. Test the troops at the end of each day's training. Those who fail should be sent home and replaced. Stat! Create a special forces-equivalent for Ebola-care. Nothing less will suffice. When this blogger played golf, a mediocre shot was greeted with "Good enough for government work." Well, that dog won't hunt. Mediocre response to Ebola is U.N.A.C.E.P.T.A.B.L.E. The entire management team of the ER at Texas Health Presbyterian Hospital should go into quarantine for 42 days (double the Ebola-quarantine period). Enough mediocrity. The Ebola virus is merciless. Clean house at the CDC (starting with Thomas Frieden, Director of the CDC). If this is (fair & balanced) dumbass control, so be it.

[x The New Yorker]
Amber Vinson’s Flight: An Ebola Nurse and the C.D.C.
BY Amy Davidson

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act airline authority cared center clear conference controlled dallas disease duncan ebola feel fever flight fly frieden frontier health hospital human isolated knew liberia monitored movement nurses official patient people pham plane planned positive possibly presbyterian problem public risk situation spoke spread system temperature tested texas told travel vinson vomit

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Amber Vinson called the Centers for Disease Control, on Monday, to say that she had a temperature of 99.5 degrees and planned to get on a commercial flight from Cleveland to Dallas; should she? Vinson, a nurse, had cared for Thomas Eric Duncan, a patient with Ebola, in Dallas—she had put a catheter in him and been in close contact when he was vomiting and in the throes of diarrhea. The day before Vinson made her call, one of her colleagues, Nina Pham, had tested positive for Ebola. There was, supposedly, a system in place for monitoring Duncan’s contacts. And yet, as the C.D.C. confirmed late on Wednesday, the official Vinson spoke to cleared her to fly. Vinson got on Frontier Airlines Flight 1143, with a hundred and thirty-two other passengers. She landed in Dallas at 8:16 P.M.. The next morning, her fever was worse; around midnight, she tested positive for Ebola.

There is much that is seriously wrong here. The first is that Pham and Vinson, who are both in their twenties, were so exposed. Their hospital, Texas Health Presbyterian, sent Duncan home the first time he showed up in the emergency room, with a fever and pain and the information that he’d just been in Liberia. But it’s also emerging that, in the first days after he was admitted for the second time, on September 28th—with his family saying that they thought he had Ebola, and all the full-blown symptoms on display, but as yet no laboratory test confirming it—he was not properly isolated, according to records obtained by the Associated Press. The nurses caring for him had to improvise their own protection. On a media conference call on Wednesday, Tom Frieden, the head of the C.D.C., talked about everything that the nurses had done incorrectly—taping their gloves, for example—but was far less clear about why there wasn’t immediately someone at the hospital telling them how to do it right. (He said there would be, going forward: “I wish we had put a team like this on the ground the day the first patient was diagnosed.”)

Frieden has had to apologize for appearing to blame Pham for her infection, after he said, over the weekend, that it must have been due to a “breach of protocol.” One of the more remarkable documents associated with this outbreak is the “Statement from the Nurses at Texas Health Presbyterian Hospital Dallas,” which was provided to National Nurses United, a union for nurses. By their account, there were no real protocols. It describes Duncan’s samples being sent through the pneumatic-tube system, the presence of piles of hazardous waste, and of C.D.C. officials possibly contaminating hallways as they walked in and out of Duncan’s isolation pod: “In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.”

Pham is being treated at Texas Health Presbyterian. Vinson, who had been planning her wedding, was taken to Emory University Hospital, in Atlanta, which has had some success in treating Ebola patients. On Wednesday, Obama praised Emory, which he’s visited. He also cancelled two trips to meet with his cabinet about Ebola.

Why was Vinson told to go ahead and fly? Her fever was not yet at the threshold of 100.4 degrees, but it was higher than normal. Did the C.D.C. official she spoke to at least raise the possibility that she wait until the next morning, to see if her temperature was rising? It’s not clear what her temperature was when she was actually on the plane. “She did not vomit, she was not bleeding,” Frieden said, meaning that to be reassuring—Ebola spreads through bodily fluids. The plane was cleaned after Vinson was on it, just because it happened to be the last flight of the night. But it flew five times the next day.

Frieden himself represents an even bigger problem. His account of how Vinson got on the plane, related in the conference call on Wednesday, was at least evasive and, depending on what he knew and what exactly Vinson was told, may have been worse. He was asked three different ways if Vinson had been told not to fly, and each time dodged the question in a way that left the impression that Vinson was some sort of rogue nurse who just got it into her head that she could fly wherever she wanted. He talked about her “self-monitoring,” and that she “should not have travelled, should not have been allowed to travel by plane or any public transport”—without mentioning that his agency was who allowed it. He added,

She should not have travelled on a commercial airline. The C.D.C. guidance in this setting outlines the need for what is called controlled movement. That can include a charter plane, a car, but it does not include public transport. We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.

When a reporter asked what “legal authority” the C.D.C. had to restrict movement, Frieden said that would be worked out with state and local public-health bodies. There are plenty of such laws on the books—federal ones, too. And there are certainly situations in which legal restraints should apply to people who might spread a disease. But the government doesn’t get to use those powers just to mask its own clumsiness. The C.D.C. can’t act as though this is a matter of a young woman’s recalcitrance if the true problem is the organization’s own incompetence. Otherwise, there’s the risk of a cycle in which distrust of the government does lead to actual non-compliance.

“We know how to stop this,” Sylvia Burwell, the Secretary of Health and Human Services, said in a conference call with reporters. That is all well and good, but the C.D.C. and other health authorities, at every level, can’t just “know”; they also have to act. They can’t just keep repeating that simple competence, prudence, and sympathetic good sense are the answers, while exhibiting none of those traits. Those are the answers: but we have to live them.

The doctors and health workers of Médecins sans Frontières, or Doctors Without Borders, have done so, in heroic, lonesome fashion. The group has been fighting Ebola in the villages of West Africa, where the entire social structure has broken down, since well before the West cared, and with desperately few resources. Pierre Trbovic, an M.S.F. volunteer from Belgium, wrote a few weeks ago about taking on what was regarded as the most awful job at an Ebola center in Liberia: telling people that there were no more beds. “The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car. He was an educated man, and he pleaded with me to take his teenage daughter, saying that while he knew we couldn’t save her life, at least we could save the rest of his family from her. At that point I had to go behind one of the tents to cry,” he said. The center couldn’t admit more without putting all the patients at risk; there was a constant struggle “to keep the tents clean of human excrement, blood, and vomit, and to remove the dead bodies.”

In August, M.S.F. had six hundred and fifty people in the field; now, it has three thousand, in six locations in Liberia, Sierra Leone, and Guinea. “Now we have reached our ceiling,” Brice de le Vingne, the director of operations, said on Tuesday, according to Reuters. The same day, the group noted that sixteen of its workers had tested positive for the Ebola virus, and nine had died. That here, with our bright hospitals, we would allow the disease to spread through simple carelessness feels like a betrayal. Ω

[Amy Davidson is a senior editor at The New Yorker, having joined the magazine in 1995. She focuses on politics and international affairs. She edits profiles and features. Davidson attended Harvard University, graduating magna cum laude (Social Studies). After graduation she worked for about 18 months in Germany. Her editing contributions to The New Yorker have won the National Magazine Award and the George Polk Award. Davidson is a member of the Council on Foreign Relations.]

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