Flawed Ebola protocols left U.S. nurses vulnerable, health official says

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By Valerie Richardson – The Washington Times 

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Photo by: Kjell Gunnar Beraas Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said the original Centers for Disease Control and Prevention instructions for dealing with the virus were taken from the World Health Organization’s protocol for Africa, where conditions are much different from those in U.S. hospitals. (Associated Press)

WASHINGTON D.C. -An Obama administration health official said Sunday that U.S. protocols on Ebola failed because they originally were intended for African field hospitals, while the White House came under another round of attacks for its refusal to restrict travel from nations suffering epidemic outbreaks.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said the original Centers for Disease Control and Prevention instructions for dealing with the virus were taken from the World Health Organization’s protocol for Africa, where conditions are much different from those in U.S. hospitals.

Two nurses caring for an Ebola patient flown into the U.S. from Africa have contracted the virus as a result of those flawed rules, and dozens more people are under observation or could be threatened by contact with those nurses.

“The answer is that the protocol that was originally recommended was a protocol that’s a WHO protocol that’s best fitted for out in the field. It doesn’t cover every single aspect of your skin,” Dr. Fauci said on “Fox News Sunday.”

“That worked in the field,” Dr. Fauci said. “What’s very clear now, if you’re in an intensive care setting, doing things you would never do in the bush or in the field in Africa, very invasive-type procedures, that that is not the optimal way.”

Officials at Texas Health Presbyterian Hospital took out full-page ads in two newspapers Sunday to apologize for “mistakes” in their treatment of Ebola patient Thomas Duncan of Liberia, who died Oct. 8 after flying to Dallas to visit family.

Dr. Fauci said the CDC will issue new guidelines soon to state explicitly that no part of the skin should be exposed to the air.

“Very clearly, when you go into a hospital, have to intubate somebody, have all of the body fluids, you’ve got to be completely covered. So that’s going to be one of the things to be complete covering with no skin showing whatsoever,” he said Sunday.

The American Nurses Association and other groups have called for clearer guidelines, though the association’s president lamented the delay in issuing them — they were expected this weekend.

“We’re disappointed that the recommendations are still not available,” Pamela Cipriano said. “Having a lag in official direction from the CDC doesn’t instill the greatest confidence in their ability to rapidly respond.”

The exact means through which Dallas nurses Nina Pham and Amber Joy Vinson caught the disease remains unknown.

Republican lawmakers said Sunday that those missteps could have been prevented with a temporary travel ban on those with visas from Ebola hot zones such as Guinea, Liberia and Sierra Leone.

“The first mistake that was made was allowing Thomas Duncan to get on an airplane and fly to the United States,” Sen. Ted Cruz, Texas Republican, said on CNN’s “State of the Union.” “If he hadn’t flown to the United States, none of the other mistakes would have happened.”

More than two dozen countries in Africa, the Caribbean and elsewhere have instituted Ebola-related travel bans, but public health officials continued to insist Sunday that entry restrictions would do little to prevent an outbreak on U.S. soil.

Dr. Fauci, who made the rounds on the Sunday talk shows, said a travel ban would have downsides.

“The strongest argument against it is that when people are coming into the country, you know exactly, you can track them,” Dr. Fauci said. “If you say, ‘Nobody comes in from Sierra Leone, Liberia or Guinea,’ there are so many other ways to get into the country. You can go to one of the other countries and then get back in. So when they come in from a place where you know you can track them, you know.”

Rep. Tim Murphy, the Pennsylvania Republican who helped lead an oversight hearing Thursday on the Ebola outbreak, argued that a travel restriction was needed to “protect and defend the people of the United States.”

“The president has sealed off Israel in the past. We’ve sealed off other areas temporarily. We can have travel restrictions until we get the rest right, and the rest is not right,” Mr. Murphy said on “Fox News Sunday.” “Assumptions that they have — for example, that it will lead to the collapse of the economy in Africa — I don’t agree with.”

The International SOS website reports that 28 countries have implemented entry restrictions on those with visas from Guinea, Liberia and Sierra Leone, and in some cases Nigeria.

Most of the travel bans are within Africa, and they include land neighbors of the three most afflicted countries. Other countries with restrictions include several Caribbean nations, including Jamaica, as well as Belize and Guyana.

The Ivory Coast has closed its land borders, but recently lifted its prohibition on passenger flights from Guinea, Liberia and Sierra Leone, according to International SOS.

Mr. Cruz argued that the current method of checking the temperatures of passengers from affected nations works only if those individuals are exhibiting symptoms. The incubation period for Ebola can last up to 21 days.

“Mr. Duncan would have traveled right through the screenings,” Mr. Cruz said. “The screenings wouldn’t have stopped him because he wasn’t presenting symptoms at that time.”

Dr. Fauci noted that Sunday marks the end of the 21-day incubation period for Ebola since Duncan arrived at Texas Health Presbyterian Hospital, meaning that the people who first cared for him there now either have become sick with Ebola or will not get the disease.

“The ones now today that are going to be ‘off the hook’ are the ones that saw him initially in the emergency room,” he said. Other workers and nurses will move off the danger list in the coming week.

Dr. Michael Osterholm of the University of Minnesota School of Public Health said a travel ban would “seriously impact our ability to get people in and out of that area.”

“If you’re prepared today to give us hundreds of military planes that will fly in and out at will when we need them to move not only material, but people, then I’ll say, ‘Maybe we ought to reconsider this,'” Dr. Osterholm said on “Fox News Sunday.” “But I don’t see anyone in Congress telling us today that we’re going to get hundreds of military planes.”

Mr. Murphy, a member of the Republican Doctors Caucus, said he and other lawmakers have urged the Obama administration to provide Congress with an authorization request for any additional support.

“I’ve already asked Dr. [Tom] Frieden and I’ve sent a letter to President Obama saying, ‘Tell us what Congress needs to authorize.’ We’re sending thousands of troops over there through ships, through also planes,” Mr. Murphy said. “We could do a lot here. The ability of the U.S. military to move goods and supplies is pretty massive. We all want to stop Ebola in Africa, but we also don’t want it to come here.”

Mr. Obama said Saturday that a travel ban “could actually make the situation worse,” but Democrats are increasingly joining Republicans in calling for a temporary halt to commercial travel from the region. An ABC News/Washington Post poll released last week showed 67 percent of those surveyed favoring restricting entry to people from affected countries.

The issue is also cropping up on the campaign trail. Sen. Kay R. Hagan, North Carolina Democrat, who is locked in a tight re-election contest, announced Friday that she now favors travel restrictions.

“We’ve now seen both Democrats and Republicans coming together saying, ‘Listen, this is a basic, common-sense step,'” Mr. Cruz said. “While there is an active epidemic raging, we should not be having commercial airline flights with up to 150 people a day coming to the United States. For whatever reason, the Obama White House is digging in and not listening to the voices of common sense coming from both sides of the aisle.”