Obama, Officials Confer on Tighter Infection Controls

Obama, Officials Confer on Tighter Infection Controls

By Alexis Simendinger - October 14, 2014

As an American nurse received treatment after contracting Ebola in Texas, President Obama conferred Monday with federal experts about how a virus that killed a Liberian man hospitalized in Dallas last week infected one of his caregivers, despite elaborate precautions.

Fearing that local hospitals and clinicians are ill-prepared to manage Ebola infections -- even with help from the Centers for Disease Control and Prevention -- some lawmakers urged the federal government to rethink its confidence that spread of the disease will be limited in the United States because of high-quality medical facilities and personnel.

Some Republicans have urged Obama to improve management of the Ebola situation by creating a coordinator for bio-defense, or a single point person to command the multidisciplinary U.S. effort to combat the virus, which involves the White House, Defense Department, Health and Human Services, the State Department, and HHS’s medical teams at the CDC and the National Institutes of Health.

On the Democratic side of the aisle, the hand-wringing and second-guessing is about how deeply federal budgets were slashed by both parties over the years, and at what risk to public safety and disease control.

“We have to ensure that hospitals and medical facilities have the resources they need to protect public health,” Pennsylvania Sen. Bob Casey said. He recommended additional federal funding for the Hospital Preparedness Program, which is part of the Pandemic and All-Hazards Preparedness Reauthorization law, enacted last year. Casey said that over the last decade, Congress has cut in half the hospital training resources aimed expressly at thwarting pandemics.

“The drastic cuts that have hit the Hospital Preparedness Program should be reversed,” he said in a statement Monday.

The political umbrage aimed at federal budget cuts began when National Institutes of Health Director Francis Collins, a geneticist, suggested during a media interview that years of NIH funding reductions hampered progress toward the development of a vaccine for Ebola, a viral hemorrhagic disease almost entirely confined to Africa since its emergence in 1976.

“Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready,” Collins told the Huffington Post.

The CDC has resisted calls from some quarters to consider ordering that all confirmed Ebola patients in the United States be transferred to hospitals specially equipped and staffed to handle the rare infection and patient containment. Over decades, Ebola in Africa has been fatal in 50 percent to 90 percent of cases.

Medical experts became alarmed over the weekend that exacting procedures necessary to care for Ebola patients broke down in Dallas somehow, leaving a 26-year-old nurse infected.

“We have to rethink the way we address Ebola infection control, because even a single infection is unacceptable, CDC Director Thomas Frieden told reporters Monday, before speaking with the president later in the day. 

Obama’s afternoon discussion with Frieden (who participated from Atlanta by phone) and National Security Adviser Susan Rice, HHS Secretary Sylvia Matthews Burwell, and White House homeland security adviser Lisa Monaco was added to his Columbus Day schedule after a similar session Sunday.

According to a White House statement, the president emphasized to Frieden that the probe of what went wrong in Dallas to infect a nurse “should proceed as expeditiously as possible and that lessons learned should be integrated into future response plans and disseminated to hospitals and healthcare workers nationwide.”

Frieden told reporters that while 48 people who had direct and indirect contact with Thomas Eric Duncan, the Liberian patient who died, are being monitored by CDC personnel for symptoms of Ebola (none are currently ill), the doctors, nurses and clinicians who cared for Duncan were not part of that initial group. The CDC-monitored group has now almost doubled in size.

“If this one individual was infected, and we don't know how within the isolation unit, then it is possible that other individuals could have been infected as well, so we consider them to potentially be at risk and we're doing an in-depth review and investigation,” Frieden said.

The CDC team altered its procedures at the hospital in Dallas overnight, without waiting to uncover with certainty exactly how nurse Nina Pham became infected, he added. Her symptom, which was fever, emerged Friday and a test confirmed Ebola over the weekend. She has told CDC investigators she does not know how she became infected during Duncan’s care.

The level of urgent retraining underway in one hospital after one death and one new infection underscored why there are doubts in the public and among some in the nursing community that the U.S. health care system is adequately prepared. In some hospitals around the country, personnel have said they are confused about whether local public health authorities or the CDC have front-line control over suspected Ebola cases as patients seek help after reporting symptoms or travel itineraries they believe posed a risk. Some sources told RCP there are anecdotal reports of blood tests for suspected Ebola that have been handled or stored with some confusion about protocol, while the mechanics of safely shipping specimens that could be infectious for Ebola produced more hurdles in some communities. 

“Each time we identify a process or training or equipment or protocol that can be improved there, we are improving it right there on the site,” Frieden explained.

In Dallas, the federal experts are scrutinizing hospital personnel as they don protective gear, and as they remove it, to eliminate the possibility of contamination while treating the infected Pham. They are looking at the array of personal protective equipment being used. Experts are examining how health-care personnel step out of the Dallas isolation unit, and how they decontaminate themselves and their equipment when they end their medical assignment. They are trying to limit the number of clinicians in contact with the Ebola patient, and simplifying the treatments administered, to eliminate potential risks.

But the new exposure to Ebola -- its transmission still a mystery -- could recur in Dallas or emerge in other hospital communities, which is a prospect that concerns the president and the government’s 24/7 Ebola-response team.

Obama also spoke Monday with world leaders about Ebola in Africa, expanding on some conversations that also covered coalition efforts to combat the Islamic State fighters in Iraq and Syria.

After speaking with Obama, French President François Hollande, in a statement released in Paris Monday, said France would increase aid in Guinea to expand Ebola health centers. He told Obama that France was “considering” the introduction of new airport screenings for passengers arriving from Ebola-infected countries. (The United States and the United Kingdom have already added such entry screenings.)

Obama has repeatedly called on countries -- including France -- to increase assistance to countries in West Africa where Ebola has killed more than 4,000 people and the infection rate is doubling in size every few weeks. The president also spoke with Ban Ki-moon, the United Nations secretary-general, about “the need for more robust commitments and rapid delivery of assistance by the international community.”

Authorities have predicted that France and the U.K., like Spain and the United States, are likely to experience an Ebola infection within their borders. Canadian authorities said Monday they have isolated two patients who traveled from West Africa and await test results after the patients developed symptoms that could indicate Ebola infection.   

According to a White House statement, Obama underscored that all U.N. member states should provide “personnel, equipment and supplies” to halt the alarming spread of the epidemic in West Africa.

Alexis Simendinger covers the White House for RealClearPolitics. She can be reached at Follow her on Twitter @ASimendinger.

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