Update on Ebola in U.S.: New CDC Protocols, Rapid Response Team, Czar

By and Lisa Marie Garza | October 21, 2014

The United States issued stringent new protocols on Monday for health workers treating Ebola victims, directing medical teams to wear protective gear that leaves no skin or hair exposed to prevent medical workers from becoming infected.

The new guidelines from the U.S. Centers for Disease Control and Prevention in Atlanta come as 43 people who were exposed to the first patient diagnosed in the United States were declared risk free, easing a national sense of crisis that took hold after two Texas nurses who treated him contracted the disease.

Under new protocols, Ebola healthcare workers also must undergo special training and demonstrate competency in using protective equipment. Use of the gear, now including coveralls, and single-use, disposable hoods, must be overseen by a supervisor to ensure proper procedures are followed when caring for patients with Ebola, which is transmitted through direct contact with bodily fluids but is not airborne. (See CDC protocols on CDC website here.)

The hemorrhagic fever has killed more than 4,500 people, mainly in the West African nations of Liberia, Sierra Leone and Guinea.

“Even a single healthcare worker infection is unacceptable,” CDC Director Tom Frieden said in a teleconference with reporters outlining the new regulations.

The old guidelines for health workers, based on World Health Organization protocols, said they should wear masks or goggles but allowed some skin exposure.

Out of Quarantine; Monitoring Continues

More than 40 people exposed to the first Ebola patient diagnosed in the United States, Thomas Eric Duncan, emerged from isolation with a clean bill of health on Monday.

Among those released from monitoring on Monday were the only four individuals quarantined by official order – Duncan’s fiancée and three other people who shared an apartment with him in Dallas before he was hospitalized. Duncan died on Oct. 8.

Texas officials said 120 other potentially exposed people in the state, more than half of them medical workers who had contact with Duncan after he was hospitalized, were still being monitored for Ebola symptoms for the remainder of a 21-day incubation period.

That group includes the two nurses who became infected while treating him at Texas Health Presbyterian Hospital in Dallas, presumably because they were wearing flimsy protective gear that left some of their skin exposed.

The Obama administration, drawing sharp criticism for a government response to the Ebola crisis widely seen as inadequate, was also taking steps aimed at ensuring a swifter action in the future.

Later this week, 30 military medical personnel are due to begin training at Fort Sam Houston in San Antonio, Texas, to move quickly to help deal with any possible case of Ebola in the United States, military officials said. They include 20 critical care nurses, five infectious disease doctors, and five trainers with “great knowledge” of infectious disease protocol, said Major Beth Smith, a spokeswoman for the U.S. Northern Command in Colorado Springs, Colorado.

The man newly appointed by President Barack Obama to coordinate the response to Ebola inside the country, lawyer Ron Klain, will start work on Wednesday.

Klain was invited to testify at a House of Representatives oversight hearing on Friday, but he will not attend. His mandate is to reduce fears and work on improving federal coordination with states to control the spread of the virus.

Meanwhile, there were signs that fears over Ebola and a series of false alarms reported in the past few weeks had tapered off.

In the financial markets, it was evident that investors were growing more sanguine over the Ebola threat. Several of the stocks that were hit hardest – including airlines and hotels – bounced back sharply Monday. Shares of small biotech companies, medical equipment makers and drugmakers related to Ebola research and preparedness were down.

Dr. Mark Rupp, an infectious disease specialist at the Nebraska Medical Center in Omaha, which is treating Ebola-infected cameraman Ashoka Mukpo, told a news conference on Monday he hoped the removal of people from watchlists in Dallas would help quell some of what he called irrational fear surrounding Ebola.

“Simply being on a bus, being on a plane, closing schools, preventing cruise ships from docking – these are all just examples of irrational fear,” Rupp said.

The Nebraska hospital said Monday that Mukpo, diagnosed in Liberia, is doing “quite well” and that depending on test results he could be discharged in days.

A patient who was admitted to Emory University Hospital in Atlanta on Sept. 9 after being infected in West Africa was released on Sunday, the hospital said in a statement on Monday. The patient asked not to be identified but will make a statement at a later date, Emory said.

Hundreds Monitored

Ohio health authorities said 142 people were still being monitored in that state for symptoms. Three people remained under quarantine because they had direct skin contact with one of the two nurses infected by Duncan after she visited the state by airliner.

At the Catholic Conference Center in Dallas where Duncan’s fiancée Louise Troh and the other three people closest to Duncan had been in quarantine, Bishop Kevin Farrell said they were relieved the isolation period had ended. “They felt like they were being persecuted,” Farrell said.

Four of five Dallas school students who have been cleared by health authorities to resume regular activities following exposure to the virus returned to school on Monday, one day earlier than expected.

The United States and some European governments are checking selected airports for passengers traveling from Liberia, Sierra Leone and Guinea, the three West African countries worst hit by Ebola.

In a similar move on Monday, Carnival Cruise Lines said passengers will be asked to fill out a questionnaire on whether they have experienced symptoms of fever or vomiting and if they have recently traveled to West Africa or had contact with someone known or suspected to have Ebola.

One Carnival cruise was denied docking by Belize and Mexico last week because a Texas hospital lab worker on board might have come in contact with test samples from Liberian visitor Duncan. The worker has tested negative for the virus.

(Additional reporting by Colleen Jenkins in Winston-Salem, North Carolina, Karen Brooks and Jon Herskovitz in Austin, Texas, Jim Forsyth in San Antonio, David Morgan, Susan Heavey and Doina Chiacu in Washington and David Bailey; Writing by Jim Loney and Grant McCool; Editing by Bernadette Baum, Howard Goller, Toni Reinhold and Lisa Shumaker)
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