Nina Pham
   HOME

TheInfoList



OR:

Four laboratory-confirmed cases of Ebola virus disease (commonly known as "Ebola") occurred in the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
in 2014. Eleven cases were reported, including these four cases and seven cases medically evacuated from other countries. The first was reported in September 2014. Nine of the people contracted the disease outside the US and traveled into the country, either as regular airline passengers or as medical evacuees; of those nine, two died. Two people contracted Ebola in the United States. Both were nurses who treated an Ebola patient; both recovered. On September 30, 2014, the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) announced that Thomas Eric Duncan, a reportedly 42-year-old (later corrected by CDC reports as a 45-year-old) Liberian national visiting the United States from Liberia, had been diagnosed with Ebola in
Dallas, Texas Dallas () is the third largest city in Texas and the largest city in the Dallas–Fort Worth metroplex, the fourth-largest metropolitan area in the United States at 7.5 million people. It is the largest city in and seat of Dallas County ...
.
Duncan, who had been visiting family in Dallas, was treated at Texas Health Presbyterian Hospital Dallas. By October 4, Duncan's condition had deteriorated from "serious but stable" to "critical". On October 8, Duncan died of Ebola.
The other three cases diagnosed in the United States were: * October 11, 2014, a nurse, Nina Pham, who had provided care to Duncan at the hospital. * October 14, 2014, Amber Joy Vinson, another nurse who treated Duncan. * October 23, 2014,
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
Craig Spencer, diagnosed in
New York City New York, often called New York City or NYC, is the most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the most densely populated major city in the Un ...
; he had just returned from working with
Doctors Without Borders Doctor or The Doctor may refer to: Personal titles * Doctor (title), the holder of an accredited academic degree * A medical practitioner, including: ** Physician ** Surgeon ** Dentist ** Veterinary physician ** Optometrist *Other roles ** ...
in Guinea, a country in West Africa. He was treated at Bellevue Hospital in New York City. Hundreds of people were tested or monitored for potential
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
infection, but the two nurses were the only confirmed cases of locally transmitted Ebola. Public health experts and the
Obama Barack Hussein Obama II ( ; born August 4, 1961) is an American politician who served as the 44th president of the United States from 2009 to 2017. A member of the Democratic Party (United States), Democratic Party, Obama was the first Af ...
administration opposed instituting a travel ban on Ebola endemic areas, stating that it would be ineffective and would paradoxically worsen the situation. No one who contracted Ebola while in the United States died from it. No new cases were diagnosed in the United States after Spencer was released from Bellevue Hospital on November 11, 2014.


Cases diagnosed in the U.S.


First case: Thomas Eric Duncan


Thomas Eric Duncan in Liberia

Thomas Eric Duncan
was from Monrovia, Liberia, to date the country hit hardest by the Ebola virus epidemic. Duncan worked as a personal driver for the general manager of Safeway Cargo, a FedEx contractor in Liberia. According to manager Henry Brunson, Duncan had abruptly quit his job on September 4, 2014, giving no reason.
On September 15, 2014, the family of Marthalene Williams, who later died of Ebola virus disease, could not call an ambulance to transfer the pregnant Williams to a hospital. Duncan, their tenant, helped to transfer Williams by taxi to an Ebola treatment ward in Monrovia. Duncan rode in the taxi to the treatment ward with Williams, her father and her brother."Thomas Eric Duncan timeline"
''The New York Times''; accessed October 8, 2014.
On September 19, Duncan went to
Monrovia Airport Roberts International Airport , informally also known as ''Robertsfield'', is an international airport in the West African nation of Liberia. Located near the town of Harbel in Margibi County, the single runway airport is about outside of ...
, where, according to Liberian officials, Duncan lied about his history of contact with the disease on an airport questionnaire before boarding a Brussels Airlines flight to
Brussels Brussels (french: Bruxelles or ; nl, Brussel ), officially the Brussels-Capital Region (All text and all but one graphic show the English name as Brussels-Capital Region.) (french: link=no, Région de Bruxelles-Capitale; nl, link=no, Bruss ...
. In Brussels, Duncan boarded
United Airlines United Airlines, Inc. (commonly referred to as United), is a major American airline headquartered at the Willis Tower in Chicago, Illinois.
Flight 951 to
Washington Dulles Airport Washington Dulles International Airport , typically referred to as Dulles International Airport, Dulles Airport, Washington Dulles, or simply Dulles ( ), is an international airport in the Eastern United States, located in Loudoun County and Fa ...
. From Dulles, he boarded
United Airlines United Airlines, Inc. (commonly referred to as United), is a major American airline headquartered at the Willis Tower in Chicago, Illinois.
Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT on September 20, 2014, and stayed with his partner and her five children, who lived in the Fair Oaks apartment complex in the
Vickery Meadow Vickery Meadow is an ethnically-diverse neighborhood consisting almost exclusively of apartment complexes in Northeast Dallas, Texas, United States. The Vickery Midtown Public Improvement District states the neighborhood is bounded by Northwest ...
neighborhood of Dallas.
Vickery Meadow Vickery Meadow is an ethnically-diverse neighborhood consisting almost exclusively of apartment complexes in Northeast Dallas, Texas, United States. The Vickery Midtown Public Improvement District states the neighborhood is bounded by Northwest ...
, the neighborhood in Dallas where Duncan resided, has a large African immigrant population and is Dallas's densest neighborhood.


Duncan's illness in Dallas

Duncan began experiencing symptoms on September 24, 2014, and arrived at the Texas Health Presbyterian Hospital emergency room at on September 25. At , a triage nurse asked Duncan about his symptoms, and Duncan reported feeling "abdominal pain, dizziness, nausea and headache (new onset)". The nurse recorded a fever of , but did not inquire as to his travel history as this was not triage protocol at the time. At , Duncan was admitted into a treatment area room where the on-duty physician accessed the electronic health record (EHR). The physician noted nasal congestion, a runny nose, and abdominal tenderness. Duncan was given paracetamol (acetaminophen) at CT scan results came back noting "no acute disease" for the abdominal and pelvic areas and "unremarkable" for the head. Lab results returned showing slightly low
white blood cells White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from mult ...
, low platelets, increased
creatinine Creatinine (; ) is a breakdown product of creatine phosphate from muscle and protein metabolism. It is released at a constant rate by the body (depending on muscle mass). Biological relevance Serum creatinine (a blood measurement) is an importa ...
, and elevated levels of the liver enzyme AST. His temperature was noted at at and at Duncan was diagnosed with
sinusitis Sinusitis, also known as rhinosinusitis, is inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain. Other signs and symptoms may include fever, head ...
and abdominal pain and sent home at with a prescription for
antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
, which are not effective for treating
viral disease A viral disease (or viral infection) occurs when an organism's body is invaded by pathogenic viruses, and infectious virus particles (virions) attach to and enter susceptible cells. Structural Characteristics Basic structural characteristics, ...
s.
Duncan's condition worsened, and he was transported on September 28 to the same Texas Health Presbyterian Hospital emergency room by ambulance. Duncan arrived in the emergency room at , experiencing diarrhea, abdominal pain, and fever. Within fifteen minutes, a doctor noted that Duncan had recently come from Liberia and needed to be tested for Ebola. The doctor described following "strict DCprotocol" including wearing a mask, gown, and gloves. At , the doctor called the CDC directly. By , Duncan was experiencing explosive diarrhea and projectile vomiting. At the next morning, the doctor noted that Duncan "appeared to be deteriorating". By , Duncan was severely fatigued, enough to prevent him from using the bedside toilet. Later that day, Duncan was transferred to an
intensive care unit 220px, Intensive care unit An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensi ...
(ICU) after all other patients had been evacuated. The next day, September 30, Duncan was diagnosed with Ebola virus disease after a positive test result. Duncan's diagnosis was publicly confirmed during a CDC news conference the same day.
That evening, Duncan reported feeling better and requested to watch a movie. The following morning, Duncan was breathing rapidly and complaining of "pain all over". By the afternoon, however, he was able to eat, and the doctor noted that he was feeling better. The next day, October 3, Duncan again reported feeling abdominal pain. That evening, the hospital contacted Chimerix, a biotechnology company developing
Brincidofovir Brincidofovir, sold under the brand name Tembexa, is an antiviral drug used to treat smallpox. Brincidofovir is a prodrug of cidofovir. Conjugated to a lipid, the compound is designed to release cidofovir intracellularly, allowing for higher int ...
to combat the disease. The next day, Duncan's organs were failing, and he was intubated to help him breathe. In the afternoon, the hospital began administering Brincidofovir. Nurses Nina Pham and Amber Joy Vinson continued to care for Duncan around the clock. On October 7, the hospital reported that Duncan's condition was improving. However, Duncan died at on October 8, becoming the first person to die in the United States of Ebola virus disease and the index patient for the later infections of nurses Pham and Vinson.


Contact tracing

On October 5, the CDC announced it had lost track of a homeless man who had been in the same ambulance as Duncan. They announced efforts were underway to find the man and place him in a comfortable and compassionate monitoring environment. Later that day, the CDC announced that the man had been found and was being monitored. Up to 100 people may have had contact with those who had direct contact with Duncan after he showed symptoms. Health officials later monitored 50 low- and 10 high-risk contacts, the high-risk contacts being Duncan's close family members and three ambulance workers who took him to the hospital. Everyone who came into contact with Duncan was being monitored daily to watch for symptoms of the virus, until October 20, when health officials removed 43 out of the 48 initial contacts of Thomas Duncan from isolation. On November 7, 2014, Dallas was officially declared "Ebola free" after 177 monitored people cleared the 21 day threshold without becoming ill.


Reactions

On October 2, Liberian authorities said they could prosecute Duncan if he returned because before flying he had filled out a form in which he had falsely stated he had not come into contact with an Ebola case. Liberian President
Ellen Johnson Sirleaf Ellen Johnson Sirleaf (born Ellen Eugenia Johnson, 29 October 1938) is a Liberian politician who served as the 24th president of Liberia from 2006 to 2018. Sirleaf was the first elected female head of state in Africa. Sirleaf was born in Monro ...
told the
Canadian Broadcasting Corporation The Canadian Broadcasting Corporation (french: Société Radio-Canada), branded as CBC/Radio-Canada, is a Canadian public broadcaster for both radio and television. It is a federal Crown corporation that receives funding from the government. ...
she was angry with Duncan for what he had done, especially given how much the United States was doing to help tackle the crisis: "One of our compatriots didn't take due care, and so, he's gone there and in a way put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him. ... The fact that he knew (he might be a carrier) and he left the country is unpardonable, quite frankly." Before his death, Duncan brazenly claimed that he did not know at the time of boarding the flight that he had been exposed to Ebola; he said he believed the woman he helped was having a miscarriage, which contradicts corroborated accounts from family members who also helped transport the woman to an Ebola ward. Duncan's family said the care Duncan received was at best "incompetent" and at worst "racially motivated". Family members threatened legal action against the hospital where Duncan received treatment. In response, Texas Health Presbyterian Hospital issued a statement, "Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care. We have a long history of treating a multicultural community in this area."
The hospital spent an estimated $500,000 to treat the uninsured Duncan. Officials at Texas Presbyterian Hospital reported that patients' cancellation of elective surgeries and potential emergency patients' preference for other hospitals' emergency rooms had left their hospital looking like a "ghost town". The reaction to the care and treatment of Thomas Duncan, and the subsequent transmission to two of the nurses on his care team, caused several hospitals to question the extent to which they are obligated to treat Ebola patients. Their concern surrounds the reality that understaffed and poorly equipped hospitals performing invasive procedures, like renal dialysis and intubation, both of which Duncan received at Texas Presbyterian, could put staff at too much risk for contracting the virus. Emory University Hospital in Atlanta also used renal dialysis in treating patients at their biocontainment unit, but no health care workers became infected. In October 2014 Vickery Meadow residents stated that people were discriminating against them because of the incident.


Second case: Nina Pham

On the night of October 10, Nina Pham, a 26-year-old nurse who had treated Duncan at Texas Health Presbyterian Hospital, reported a low-grade fever and was placed in isolation. On October 11, she tested positive for Ebola virus, becoming the first person to contract the virus in the U.S. On October 12, the CDC confirmed the positive test results.
Hospital officials said Pham had worn the recommended protective gear when treating Duncan on his second visit to the hospital and had "extensive contact" with him on "multiple occasions". Pham was in stable condition as of October 12. On October 16, Pham was transferred to the
National Institutes of Health Clinical Center The NIH Clinical Center is a hospital solely dedicated to clinical research at the National Institutes of Health campus in Bethesda, Maryland. The Clinical Center, known as Building 10, consists of the original part of the hospital, the Warren Gr ...
in
Bethesda, Maryland Bethesda () is an unincorporated, census-designated place in southern Montgomery County, Maryland. It is located just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House (1820, rebuilt 1849), which in ...
. On October 24, the NIH declared Pham free of the Ebola virus. That day Pham traveled to the White House where she met with President Obama.


Controversies and lawsuit

Tom Frieden Thomas R. Frieden (born December 7, 1960) is an American infectious disease and public health physician. He serves as president and CEO of Resolve to Save Lives, a $225million, five-year initiative to prevent epidemics and cardiovascular disease ...
, director of the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
, initially blamed a breach in protocol for the infection. The hospital's chief clinical officer, Dr. Dan Varga, said all staff had followed CDC recommendations. Bonnie Costello of
National Nurses United National Nurses United (NNU) is the largest organization of registered nurses in the United States. With more than 225,000 members, it is the farthest-reaching union and professional association of registered nurses in the U.S. Founded in 2009 th ...
said, "You don't scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct." Frieden later spoke to "clarify" that he had not found "fault with the hospital or the healthcare worker". National Nurses United criticized the hospital for its lack of Ebola protocols and for guidelines that were "constantly changing". Briana Aguirre, a nurse who had cared for Nina Pham, criticized the hospital in an appearance on NBC's ''Today Show''. Aguirre said that she and others had not received proper training or
personal protective equipment Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, e ...
, and that the hospital had not provided consistent protocols for handling potential Ebola patients into the second week of the crisis. A report indicated that healthcare workers did not wear hazmat suits until Duncan's test results confirmed his infection due to Ebola, two days after his admission to the hospital. Frieden later said that the CDC could have been more aggressive in the management and control of the virus at the hospital. On March 2, 2015 ''
The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid d ...
'' reported that Pham filed a suit against
Texas Health Resources Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States and the largest in North Texas in terms of inpatients and outpatients served. The health system includes Texas Health Physicians Group and hos ...
, her hospital's parent company, accusing it of "negligence, fraud and invasion of privacy".Richard Perez-Pena
"Nurse Who Contracted Ebola in the U.S. Sues Her Hospital Employer"
''The New York Times''. Retrieved on March 3, 2015.
Pham was described as still experiencing numerous physical and psychological problems, listing lack of proper training as the reason for her illness.


Third case: Amber Vinson

On October 14, a second nurse at the same hospital, identified as 29-year-old Amber Vinson, reported a
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
. Amber Joy Vinson was among the nurses who had provided treatment for Duncan. Vinson was isolated within 90 minutes of reporting the fever. By the next day, Vinson had tested positive for Ebola virus.
On October 13, Vinson had flown Frontier Airlines Flight 1143 from Cleveland to Dallas, after spending the weekend in Tallmadge and
Akron, Ohio Akron () is the fifth-largest city in the U.S. state of Ohio and is the county seat of Summit County. It is located on the western edge of the Glaciated Allegheny Plateau, about south of downtown Cleveland. As of the 2020 Census, the city prop ...
. Vinson had an elevated temperature of before boarding the 138-passenger jet, according to public health officials. Vinson had flown to Cleveland from Dallas on Frontier Airlines Flight 1142 on October 10. Flight crew members from Flight 1142 were put on paid leave for 21 days. During a press conference, CDC Director Tom Frieden stated she should not have traveled since she was one of the health care workers known to have had exposure to Duncan. Passengers of both flights were asked to contact the CDC as a precautionary measure. It was later discovered that the CDC had, in fact, given Vinson permission to board a commercial flight to Cleveland. Before her trip back to Dallas, she spoke to Dallas County Health Department and called the CDC several times to report her temperature before boarding her flight. A CDC employee who took her call checked a CDC chart, noted that Vinson's temperature was not a true fever – a temperature of or higher – which the CDC deemed as "high risk", and let her board the commercial flight. On October 19, Vinson's family released a statement detailing her government-approved travel clearances and announcing that they had hired a Washington, DC, attorney,
Billy Martin Alfred Manuel Martin Jr. (May 16, 1928 – December 25, 1989), commonly called "Billy", was an American Major League Baseball second baseman and manager who, in addition to leading other teams, was five times the manager of the New York Yan ...
. As a precaution, sixteen people in Ohio who had had contact with Vinson were voluntarily quarantined. On October 15, Vinson was transferred to the Emory University Hospital in Atlanta. Seven days later, Vinson was declared Ebola free by Emory University Hospital.


Monitoring of other health care workers

, there were 76 Texas Presbyterian Hospital health care workers being monitored because they had had some level of contact with Thomas Duncan. On October 16, after learning that Vinson had traveled on a plane before her Ebola diagnosis, the
Texas Department of State Health Services Texas Department of State Health Services is a state agency of Texas. The department was created by House Bill 2292 of the 78th Texas Legislature in 2003 through the merging of four state agencies: the Texas Department of Health, Texas Department ...
advised all health care workers exposed to Duncan to avoid travel and public places until 21 days after their last known exposure.


Fourth case: Craig Spencer

On October 23, Craig Spencer, a physician who treated Ebola patients in West Africa, tested positive for Ebola at
Bellevue Hospital Center Bellevue Hospital (officially NYC Health + Hospitals/Bellevue and formerly known as Bellevue Hospital Center) is a hospital in New York City and the oldest public hospital in the United States. One of the largest hospitals in the United States b ...
after having a
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
. Officials said he was hospitalized with fever, nausea, pain, and fatigue. He had flown to
New York City New York, often called New York City or NYC, is the most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the most densely populated major city in the Un ...
from Guinea within the previous ten days, and contacted the city's
Department of Health A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
and
Doctors without Borders Doctor or The Doctor may refer to: Personal titles * Doctor (title), the holder of an accredited academic degree * A medical practitioner, including: ** Physician ** Surgeon ** Dentist ** Veterinary physician ** Optometrist *Other roles ** ...
after showing symptoms. Dr. Spencer traveled to Guinea to treat Ebola victims on September 16 and returned on October 16. He had been self-monitoring for symptoms of the disease, and began to feel sluggish on October 21, but did not show any symptoms for two days. His case was the first to be diagnosed in New York. The city was trying to find people who may have been in contact with Dr. Spencer between October 21 and 23. On October 22, the day before he had symptoms, Dr. Spencer rode the New York City Subway, walked on the
High Line The High Line is a elevated linear park, greenway and rail trail created on a former New York Central Railroad spur on the west side of Manhattan in New York City. The High Line's design is a collaboration between James Corner Field Opera ...
park, went to a bowling alley and a restaurant in
Brooklyn Brooklyn () is a borough of New York City, coextensive with Kings County, in the U.S. state of New York. Kings County is the most populous county in the State of New York, and the second-most densely populated county in the United States, be ...
, took an
Uber Uber Technologies, Inc. (Uber), based in San Francisco, provides mobility as a service, ride-hailing (allowing users to book a car and driver to transport them in a way similar to a taxi), food delivery (Uber Eats and Postmates), packa ...
to his home in
Manhattan Manhattan (), known regionally as the City, is the most densely populated and geographically smallest of the five boroughs of New York City. The borough is also coextensive with New York County, one of the original counties of the U.S. state ...
, and took a jog in
Harlem Harlem is a neighborhood in Upper Manhattan, New York City. It is bounded roughly by the Hudson River on the west; the Harlem River and 155th Street on the north; Fifth Avenue on the east; and Central Park North on the south. The greater Ha ...
near where he lived. Three other people who were with Dr. Spencer in the previous few days were quarantined as well. Dr. Spencer's apartment and the bowling alley he went to were cleaned by hazmat company Bio Recovery Corporation. Health officials stated it was unlikely that Dr. Spencer could have transmitted the disease through subway poles, hand railings, or via bowling balls. New York hospitals, health-workers, and officials had conducted weeks of drills and training in preparation for patients like Dr. Spencer. Upon arrival at the hospital, he was put in a specially designed isolation center for treatment. Not many details about the treatment were given, except that he participated in decisions relating to his medical care. On October 25, the ''
New York Post The ''New York Post'' (''NY Post'') is a conservative daily tabloid newspaper published in New York City. The ''Post'' also operates NYPost.com, the celebrity gossip site PageSix.com, and the entertainment site Decider.com. It was established ...
'' reported that an anonymous source had said that nurses at Bellevue had been calling in sick to avoid having to care for Spencer. A hospital spokesperson denied there was a sick out. On November 1, his condition was upgraded to "stable", and on November 7 the hospital announced he was free of Ebola. Spencer was released from the hospital on November 11. He was cheered and applauded by medical staff members, and hugged by the Mayor of New York, Bill de Blasio as he walked out of the hospital. The Mayor also declared: "New York City is Ebola free". As a result of Dr. Spencer's Ebola case, U.S. Senator
Charles Schumer Charles Ellis Schumer ( ; born November 23, 1950) is an American politician serving as Senate Majority Leader since January 20, 2021. A member of the Democratic Party, Schumer is in his fourth Senate term, having held his seat since 1999, and ...
(D-NY), proposed an Ebola fund in an
omnibus bill An omnibus bill is a proposed law that covers a number of diverse or unrelated topics. ''Omnibus'' is derived from Latin and means "to, for, by, with or from everything". An omnibus bill is a single document that is accepted in a single vote by a ...
to be considered in fiscal year 2015. Schumer said the funds were needed to compensate New York City, as well as other cities treating Ebola patients, in the same way the federal government covers communities that suffer after a natural disaster. Schumer said Dr. Spencer's care at Bellevue Hospital involved around 100 health care workers. In addition, the city's health department established a 24-hour-a-day operation involving 500 staffers to keep track of the approximately 300 persons from West Africa hot spots who arrive in New York every day.


Medical evacuations from West Africa

By the time the
Ebola virus epidemic in West Africa The 2013–2016 epidemic of Ebola virus disease, centered in Western Africa, was the most widespread outbreak of the disease in history. It caused major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and S ...
was over in June 2016, seven Americans had been evacuated to the U.S. for treatment after contracting
Ebola virus ''Zaire ebolavirus'', more commonly known as Ebola virus (; EBOV), is one of six known species within the genus '' Ebolavirus''. Four of the six known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and o ...
while working with medical teams trying to stop the epidemic.
Kent Brantly Kent Brantly is an American doctor with the medical mission group Samaritan's Purse. While treating Ebola patients in Liberia, he contracted the virus. He became the first American to return to the United States to be treated for the disease. Li ...
, a physician and medical director in Liberia for the aid group
Samaritan's Purse Samaritan's Purse is an Evangelicalism, evangelical Christian humanitarian aid organization that provides aid to people in physical need as a key part of its Christian missionary work. The organization's president is Franklin Graham, son of Chri ...
, and co-worker Nancy Writebol were infected in July 2014, while working in
Monrovia Monrovia () is the capital city of the West African country of Liberia. Founded in 1822, it is located on Cape Mesurado on the Atlantic coast and as of the 2008 census had 1,010,970 residents, home to 29% of Liberia’s total population. As th ...
. Both were flown to the United States at the beginning of August via the CDC's
Aeromedical Biological Containment System The Aeromedical Biological Containment System (ABCS) is an aeromedical evacuation capability devised by the U.S. Centers for Disease Control and Prevention (CDC) in collaboration with the U.S. United States Department of Defense, Department of Def ...
for further treatment in
Atlanta Atlanta ( ) is the capital and most populous city of the U.S. state of Georgia. It is the seat of Fulton County, the most populous county in Georgia, but its territory falls in both Fulton and DeKalb counties. With a population of 498,715 ...
's Emory University Hospital. On August 21, Brantly and Writebol recovered and were discharged. Brantly has since donated blood to three others with Ebola (Sacra, Mukpo and Pham). On September 4, a Massachusetts physician, Rick Sacra, was airlifted from Liberia to be treated in
Omaha, Nebraska Omaha ( ) is the largest city in the U.S. state of Nebraska and the county seat of Douglas County. Omaha is in the Midwestern United States on the Missouri River, about north of the mouth of the Platte River. The nation's 39th-largest cit ...
at the Nebraska Medical Center. Working for
Serving In Mission SIM is an international, interdenominational Evangelical Christian mission organization. It was established in 1893 by its three founders, Walter Gowans and Rowland Bingham of Canada and Thomas Kent of the United States. The initials originally ...
(SIM), he was the third U.S. missionary to contract Ebola. He thought that he probably contracted Ebola while performing a Caesarean section on a patient who had not been diagnosed with the disease. While in hospital, Sacra received a blood transfusion from Brantly, who had recently recovered from the disease. On September 25, Sacra was declared Ebola-free and released from the hospital. On September 9, the fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. On October 16, he released a statement saying he had improved and expected to be discharged in the near future. The doctor was identified as Ian Crozier, and according to the hospital, the sickest patient treated. He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease. In addition, on September 21, a CDC employee, who showed no symptoms of the disease, was flown back to the United States as a preventive measure after low-risk exposure with a healthcare worker; he posed no risks to his family or the United States, and he is not known to have died. On September 28, a fourth American doctor was admitted to National Institutes of Health hospital. On October 2,
NBC News NBC News is the news division of the American broadcast television network NBC. The division operates under NBCUniversal Television and Streaming, a division of NBCUniversal, which is, in turn, a subsidiary of Comcast. The news division's var ...
photojournalist Ashoka Mukpo, covering the outbreak in Liberia, tested positive for Ebola after showing symptoms."US Journalist Believes He Got Ebola While Cleaning Infected Car"
''ABC News'', October 6, 2014
Four other members of the NBC team, including physician Nancy Snyderman, were being closely monitored for symptoms. Mukpo was evacuated on October 6 to the
University of Nebraska Medical Center The University of Nebraska Medical Center (UNMC) is a public academic health science center in Omaha, Nebraska. Founded in 1869 and chartered as a private medical college in 1881, UNMC became part of the University of Nebraska System in 1902. R ...
for treatment in their isolation unit."Journalist With Ebola Being Evaluated at US Hospital"
''Voice of America'', October 6, 2014.
On October 21, Mukpo was declared Ebola-free and allowed to return to his home in Rhode Island. A government official in Sierra Leone announced on November 13, that a doctor from Sierra Leone, a
permanent resident Permanent residency is a person's legal resident status in a country or territory of which such person is not a citizen but where they have the right to reside on a permanent basis. This is usually for a permanent period; a person with suc ...
of the United States married to a U.S. citizen, would be transported to the Nebraska Medical Center for treatment for Ebola. The doctor, identified later as Martin Salia, became symptomatic while in Sierra Leone. His initial Ebola test came back negative, but his symptoms persisted. He attempted to treat his symptoms, which included vomiting and diarrhea, believing he had malaria. A second test for Ebola came back positive. His family expressed concern that the delay in diagnosis might have impacted his recovery. Salia arrived at
Eppley Airfield Eppley Airfield , also known as Omaha Airport, is an airport in the midwestern United States, located northeast of downtown Omaha, Nebraska. On the west bank of the Missouri River in Douglas County, it is the largest airport in Nebraska, wi ...
in Omaha on November 15, and was transported to the Nebraska Medical Center. According to the team that assisted in the transport, he was critically ill and considered to be the sickest patient to be evacuated, but stable enough to fly. On November 17, Salia died from the disease. Dr. Philip Smith, medical director of the biocontainment unit at Nebraska Medical Center, said Salia's disease was already "extremely advanced" by the time he arrived in Omaha. By then, Salia's kidneys had failed and he was in acute respiratory distress. Salia's treatment included a blood plasma transfusion from an Ebola survivor, as well as the experimental drug
ZMapp ZMapp is an experimental biopharmaceutical drug comprising three chimeric monoclonal antibodies under development as a treatment for Ebola virus disease. Two of the three components were originally developed at the Public Health Agency of Canada ...
. Salia had been working as a general surgeon in
Freetown Freetown is the capital and largest city of Sierra Leone. It is a major port city on the Atlantic Ocean and is located in the Western Area of the country. Freetown is Sierra Leone's major urban, economic, financial, cultural, educational and po ...
, Sierra Leone when he fell ill. It was not clear when or where he had had contact with Ebola patients. A U.S. clinician contracted Ebola while working in Port Loko, Sierra Leone. He collapsed in the hospital and colleagues who assisted him were monitored for exposure. He was diagnosed with Ebola on March 10, 2015, and medically evacuated to the National Institutes of Health in Bethesda, Maryland on March 13. His condition was downgraded from serious to critical on March 16. The ten exposed colleagues were flown back to the U.S., going into isolation near the Ebola-rated hospitals at Nebraska, Georgia, and Maryland. On March 26, 2015, the NIH upgraded the medically evacuated health worker being treated in Bethesda from critical to serious. A further 16 volunteers were monitored for possible exposure. On April 9, 2015, the clinician was upgraded to good condition and discharged. He was treated by Dr. Anthony Fauci, who later said he was "the sickest person he had ever treated, who recovered." This patient wished to remain anonymous until late 2019, when he revealed his identity: Preston Gorman, a physician assistant.


Containment efforts


Operation United Assistance

The U.S. military released plans to send up to 4,000 troops to West Africa to establish treatment centers starting September 29. The troops are tasked with building modular hospitals known as
Expeditionary Medical Support System The Expeditionary Medical Support System (EMEDS) is a modular field hospital system developed by the U.S. military for mobile deployment of medical treatment facilities in any location. EMEDS consists of a variety of modular, medical response pa ...
s (EMEDS). Plans included building a 25-bed hospital for health care workers and 17 treatment centers with 100 beds each in Liberia. By the end of September 2014 150 military personnel were helping USAID in the capital, Monrovia. U.S. Army Chief of Staff Ray Odierno ordered on October 27 a 21-day quarantine of all soldiers returning from Operation United Assistance. Up to 12 soldiers were quarantined in a U.S. base in Italy.


Revised CDC guidelines

Since 2007, US hospitals have relied on
CDC The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
infection control protocols to contain Ebola virus disease. Until October 20, 2014, the CDC guidelines allowed hospitals wide latitude to select gear based on interaction between healthcare workers and patients and on the mode of transmission of the disease being handled. The guidelines suggested gowns with "full coverage of the arms and body front, from neck to the mid-thigh or below, will ensure that clothing and exposed upper body areas are protected", and additionally recommend masks and goggles. Some infection control experts said that many American hospitals improperly trained their personnel to handle Ebola cases because they were following federal guidelines that were too lax. US officials abruptly changed their guidelines on October 14. ''
The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid d ...
'' stated that this was an effective acknowledgment that there were problems with the procedures for protecting health care workers. Sean Kaufman, who oversaw infection control at Emory University Hospital while it treated Ebola patients, has said the previous CDC guidelines were "absolutely irresponsible and dead wrong". Kaufman called to warn the agency about its lax guidelines but, according to Kaufman, "They kind of blew me off." A
Doctors Without Borders Doctor or The Doctor may refer to: Personal titles * Doctor (title), the holder of an accredited academic degree * A medical practitioner, including: ** Physician ** Surgeon ** Dentist ** Veterinary physician ** Optometrist *Other roles ** ...
representative, whose organization has been treating Ebola patients in Africa, criticized a CDC poster for lax guidelines on containing Ebola, saying, "It doesn't say anywhere that it's for Ebola. I was surprised that it was only one set of gloves, and the rest bare hands. It seems to be for general cases of infectious disease." The national nursing union
National Nurses United National Nurses United (NNU) is the largest organization of registered nurses in the United States. With more than 225,000 members, it is the farthest-reaching union and professional association of registered nurses in the U.S. Founded in 2009 th ...
criticized the CDC for making the guidelines voluntary. There were complaints at the Texas hospital that healthcare professionals had to use tape to cover their exposed necks. According to Frieden, the CDC is appointing a hospital site manager to oversee Ebola containment efforts and are making "intensive efforts" to retrain and supervise staff. On October 14, the WHO reported that 125 contacts in the United States were being traced and monitored.Ebola Response Roadmap Update-October 15, 2014
World Health Organization, who.int.
On October 20, the CDC updated its guidance on
Personal Protective Equipment Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, e ...
with new detailed instructions that include specifying that no skin should be exposed and adding extensive instructions for donning and doffing the equipment. On October 20 CDC updated its guidance to add clarification that Ebola may spread through wet droplets such as sneezes.


Ebola response coordinator

In mid-October 2014, President Barack Obama appointed Ron Klain as the "Ebola response coordinator" of the United States. Klain is a lawyer who previously served as Joe Biden's and
Al Gore Albert Arnold Gore Jr. (born March 31, 1948) is an American politician, businessman, and environmentalist who served as the 45th vice president of the United States from 1993 to 2001 under President Bill Clinton. Gore was the Democratic no ...
's chief of staff. Klain had no medical or health care experience. After previous criticism, Obama said, "It may make sense for us to have one person ... so that after this initial surge of activity, we can have a more regular process just to make sure that we're crossing all the T's and dotting all the I's going forward". Klain reported to White House Homeland Security Adviser
Lisa Monaco Lisa Oudens Monaco (born February 25, 1968) is an American attorney, former federal prosecutor and national security official who has served as the 39th deputy attorney general of the United States since April 2021. Monaco previously served as ...
and National Security Advisor Susan Rice. Klain did not coordinate with hospitals and the
United States Public Health Service The United States Public Health Service (USPHS or PHS) is a collection of agencies of the Department of Health and Human Services concerned with public health, containing nine out of the department's twelve operating divisions. The Assistant ...
, as this is the responsibility of
Nicole Lurie Nicole Lurie is an American physician, professor of medicine, and public health official. During the administration of President Barack Obama, she was Assistant Secretary for Preparedness and Response (ASPR) at the United States Department of Healt ...
, Assistant Secretary for Preparedness and Response (ASPR). President Barack Obama attempted to calm public fears by hugging nurse Nina Pham who had been cured of Ebola.


Rapid response teams

President Obama announced the formation of rapid response teams to travel to hospitals with newly diagnosed patients. A second set of teams will prep hospitals in cities deemed most likely to see an Ebola virus case. Three of those teams are already operating. In announcing the formation of the teams, President Obama explained, "We want a rapid response team, a SWAT team essentially, from the CDC to be on the ground as quickly as possible, hopefully within 24 hours, so that they are taking the local hospital step by step through what needs to be done." The CDC has developed two sets of teams, identified by the acronyms CERT (CDC Ebola Response Team) and FAST (Facility Assessment and Support Teams). The CERTs have 10 to 20 people each, who can be sent to a hospital with a suspected and/or laboratory confirmed Ebola virus case. The teams are drawn from 100 CDC workers and others. The FAST teams assist hospitals that have indicated they are willing to take on Ebola cases.


Airport screening

Starting in October 2014, U.S. government officials began questioning airplane passengers and screening them for fever at five U.S. airports:
John F. Kennedy International Airport John F. Kennedy International Airport (colloquially referred to as JFK Airport, Kennedy Airport, New York-JFK, or simply JFK) is the main international airport serving New York City. The airport is the busiest of the seven airports in the Avia ...
in New York, Newark Liberty International Airport in New Jersey, O'Hare International Airport in Illinois,
Washington Dulles International Airport Washington Dulles International Airport , typically referred to as Dulles International Airport, Dulles Airport, Washington Dulles, or simply Dulles ( ), is an international airport in the Eastern United States, located in Loudoun County and Fa ...
in Virginia, and
Hartsfield–Jackson Atlanta International Airport Hartsfield–Jackson Atlanta International Airport , also known as Atlanta Hartsfield–Jackson International Airport, Atlanta Airport, Hartsfield, Hartsfield–Jackson and, formerly, as the Atlanta Municipal Airport, is the primary internatio ...
in Georgia. Combined, these airports receive more than 94% of passengers from Guinea, Liberia, and Sierra Leone, the three countries most affected by Ebola. Although no plans have been announced for other airports, screening in the U.S. represents a second layer of protection since passengers are already being screened upon exiting these three countries. However, the risk can never be eliminated. On October 21, the
Department of Homeland Security The United States Department of Homeland Security (DHS) is the U.S. federal executive department responsible for public security, roughly comparable to the interior or home ministries of other countries. Its stated missions involve anti-terr ...
announced that all passengers from Liberia, Sierra Leone, and Guinea will be required to fly into one of these five airports. On October 23, the CDC announced that all passengers from these countries would receive 21-day monitoring. A physician with the
WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...
,
Aileen Marty Aileen Maria Marty is an infectious disease expert and a professor at the FIU Herbert Wertheim College of Medicine. Early life and education Born in Havana, Cuba, Marty moved to the United States, at the age of four years old, when her family l ...
, who had spent 31 days in
Nigeria Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
, criticized the complete lack of screening for Ebola on her recent return to the United States through
Miami International Airport Miami International Airport , also known as MIA and historically as Wilcox Field, is the primary airport serving the greater Miami metropolitan area with over 1,000 daily flights to 167 domestic and international destinations, including most c ...
on October 12. There have also been calls by congressional leaders, including U.S. Representative
Ed Royce Edward Randall Royce (born October 12, 1951) is an American politician who served as a member of the United States House of Representatives from California from 1993 to 2019. A member of the Republican Party, Royce served as Chairman of the United ...
, Chairman of the House Foreign Relations Committee, and U.S. Representative
Michael McCaul Michael Thomas McCaul Sr. (born January 14, 1962) is an American attorney and politician serving as the U.S. representative for since 2005. A member of the Republican Party, he chaired the House Committee on Homeland Security during the 113th ...
of Texas, Chair of the Homeland Security Committee, to suspend issuing visas to travelers from the affected West African countries, including Liberia, Sierra Leone, and Guinea.


Mandatory 21-day quarantine

On October 7, 2014,
Connecticut Connecticut () is the southernmost state in the New England region of the Northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, New York to the west, and Long Island Sound to the south. Its capita ...
governor Dannel Malloy signed an order authorizing the mandatory
quarantine A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
for 21 days of anyone, even if asymptomatic, who had direct contact with Ebola patients. Nine people were quarantined on October 22, in accordance with the Connecticut order. At a joint news conference on October 24, New York Governor
Andrew Cuomo Andrew Mark Cuomo ( ; ; born December 6, 1957) is an American lawyer and politician who served as the 56th governor of New York from 2011 to 2021. A member of the Democratic Party, he was elected to the same position that his father, Mario Cu ...
and
New Jersey New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delaware ...
Governor
Chris Christie Christopher James Christie (born September 6, 1962) is an American politician, lawyer, political commentator, lobbyist, and former federal prosecutor who served as the 55th governor of New Jersey from 2010 to 2018. Christie, who was born in N ...
announced that they were imposing a mandatory 21-day quarantine on all air travelers returning to New York and New Jersey from West Africa who have had contact with Ebola patients. In explaining the move from the CDC's voluntary quarantine to a state ordered mandatory one, Cuomo cited the case of Dr. Spencer. "In a region like this, you go out three times, you ride the subway, you ride the bus, you could affect hundreds of people." Cuomo praised Dr. Spencer's work but stated, "He's a doctor and even he didn't follow the voluntary quarantine. Let's be honest." Governors Cuomo and Christie stated that their two states needed to go beyond the federal CDC guidelines. Cuomo said Dr. Spencer's activity in the days before his diagnosis showed the guidelines, which includes urging health care workers and others who have had contact with Ebola patients to voluntarily quarantine themselves, were not enough. Late on October 26, Cuomo modified the state's quarantine procedure, stating that people entering New York who have had contact with Ebola patients in West Africa will be quarantined in their homes for the 21 days, with twice daily checks to ensure their health has not changed and that they are complying with the order, and would receive some compensation for lost wages, if any.Matt Flegenheimer, Michael D. Shear, and Michael Barbaro
"Ebola quarantine guidelines for NY and NJ"
''The New York Times'', October 27, 2014.
President Obama and his staff had been attempting to persuade New York Governor Cuomo, New Jersey Governor Christie, and the government of Illinois to reverse their mandatory quarantines.
Illinois Illinois ( ) is a state in the Midwestern United States. Its largest metropolitan areas include the Chicago metropolitan area, and the Metro East section, of Greater St. Louis. Other smaller metropolitan areas include, Peoria and Rockf ...
Governor Pat Quinn issued a similar quarantine authorization the same day as New York and New Jersey initially did, with
Florida Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, and to ...
Governor Rick Scott on October 25, authorizing mandatory twice daily monitoring for 21 days of people identified as coming from countries affected by Ebola.Florida Governor Rick Scott on October 25 authorized mandatory twice daily monitoring for 21 days of people identified as coming from countries affected by Ebola
, abc7news.com; accessed October 26, 2014.
Illinois health officials later said that only people at high risk of Ebola exposure, such as not wearing protective gear near Ebola patients, will be quarantined.
Pennsylvania Pennsylvania (; ( Pennsylvania Dutch: )), officially the Commonwealth of Pennsylvania, is a state spanning the Mid-Atlantic, Northeastern, Appalachian, and Great Lakes regions of the United States. It borders Delaware to its southeast, ...
,
Maryland Maryland ( ) is a state in the Mid-Atlantic region of the United States. It shares borders with Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware and the Atlantic Ocean to ...
, and
Georgia Georgia most commonly refers to: * Georgia (country), a country in the Caucasus region of Eurasia * Georgia (U.S. state), a state in the Southeast United States Georgia may also refer to: Places Historical states and entities * Related to the ...
have all authorized mandatory twice daily health monitoring and/or temperature reporting for 21 days for people exposed to people with Ebola.
Virginia Virginia, officially the Commonwealth of Virginia, is a state in the Mid-Atlantic and Southeastern regions of the United States, between the Atlantic Coast and the Appalachian Mountains. The geography and climate of the Commonwealth ar ...
has also implemented mandatory twice daily temperature reporting and daily monitoring from health authorities, but has also authorized mandatory quarantine for higher risk patients. California mandated a 21-day quarantine for all health workers who have had contact with Ebola patients. Kaci Hickox, an American nurse who treated Ebola patients in
Sierra Leone Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierr ...
became the first person placed under the new mandatory quarantine rules on her arrival at Newark Liberty International Airport, in New Jersey. A low-accuracy (forehead) thermometer indicated Hickox developed a fever on Friday night and was taken to University Hospital in Newark. She later tested negative for the Ebola virus but remained quarantined in a medical tent. Hickox and Doctors Without Borders criticized the condition of the quarantine in a tent with a bed and a
portable toilet A portable or mobile toilet (colloquial terms: thunderbox, portaloo, porta-john or porta-potty) is any type of toilet that can be moved around, some by one person, some by mechanical equipment such as a truck and crane. Most types do not require ...
, but without shower facility. Hickox expressed that it was inhumane. The hospital responded that they tried their best to accommodate Hickox by allowing her to have computer access, cell phone, reading materials, and providing take-out food and drink. On October 27, after being symptom free for an additional 24-hour period, testing negative for Ebola, and after the state's quarantine policy was relaxed the night before, Hickox was released from quarantine in New Jersey. She has filed suit. Hickox was escorted out of New Jersey and into Maine the following day by a private convoy of SUVs.
Maine Maine () is a state in the New England and Northeastern regions of the United States. It borders New Hampshire to the west, the Gulf of Maine to the southeast, and the Canadian provinces of New Brunswick and Quebec to the northeast and ...
Governor
Paul LePage Paul Richard LePage (; born October 9, 1948) is an American politician who served as the 74th Governor of Maine from 2011 to 2019. A member of the Republican Party, LePage served two terms as a city councilor in Waterville, Maine, before being ...
announced he was joining with his state's health department in seeking legal authority to enforce the quarantine after Hickox announced she would not comply with the isolation protocols in Maine. She left her house on October 29 and 30. The governor said: "She's violated every promise she's made so far, so I can't trust her. I don't trust her." A Maine judge ruled against a mandatory quarantine on October 31, but required Hickox to comply with "direct active monitoring", to coordinate her travel with Maine health officials, and to notify health officials if she develops symptoms of Ebola. On October 29, Texas Governor Rick Perry announced that a Texas nurse returning from Sierra Leone where she treated Ebola patients, had agreed to self-quarantine at her Austin home for 21 days following her return to Texas, and undergo frequent monitoring from state health officials. although she did not have any symptoms of Ebola virus. The nurse was not named to protect her privacy. Perry spoke with the nurse over the phone to thank her for work to fight Ebola. U.S. Army Chief of Staff Ray Odierno also ordered on October 27 a 21-day quarantine of all soldiers returning from
Operation United Assistance Operation United Assistance was a 2014 United States military mission to help combat the Ebola virus epidemic in West Africa, including the part of the epidemic occurring in Liberia. The 101st Airborne Division headquarters was responsible for le ...
in Liberia. Up to 12 soldiers have been quarantined so far in a U.S. base in Italy.


Legal protection for government contractors

On November 13, 2014, President Obama issued a presidential memorandum, invoking a federal law to immunize contractors hired by the
U.S. Agency for International Development The United States Agency for International Development (USAID) is an independent agency of the U.S. federal government that is primarily responsible for administering civilian foreign aid and development assistance. With a budget of over $27 ...
(USAID) from liability "with respect to claims, losses, or damage arising out of or resulting from exposure, in the course of performance of the contracts, to Ebola" during the emergency period.


School closures

There were numerous overreactions to the perceived threat of an Ebola outbreak, particularly on the part of school officials. On October 16, a building housing two schools in the Solon City School District near
Cleveland Cleveland ( ), officially the City of Cleveland, is a city in the U.S. state of Ohio and the county seat of Cuyahoga County. Located in the northeastern part of the state, it is situated along the southern shore of Lake Erie, across the U.S. ...
, Ohio, was closed for a single day of disinfection procedures after finding that a staff member may have been on the aircraft that
Amber Vinson Four laboratory-confirmed cases of Ebola virus disease (commonly known as "Ebola") occurred in the United States in 2014. Eleven cases were reported, including these four cases and seven cases medically evacuated from other countries. The first ...
used on a previous flight. Another school in the
Cleveland Metropolitan School District Cleveland Metropolitan School District, formerly the Cleveland Municipal School District, is a public school district in the U.S. state of Ohio that serves almost all of the city of Cleveland. The district covers 79 square miles. The Cleveland ...
was disinfected overnight due to similar concerns but remained open. In both cases, affected staff were sent home until cleared by health officials. School officials said that they had been assured by city health officials that there was no risk and that the disinfection was "strictly precautionary". Three schools in the
Belton Independent School District Belton Independent School District is a public school district based in Belton, Texas ( USA). Finances As of the 2010–2011 school year, the appraised valuation of property in the district was $1,975,956,000. The maintenance tax rate was $0.1 ...
in Belton, Texas, were also closed. Infectious disease experts considered these closures to be an overreaction and were concerned that it would frighten the public into believing that Ebola is a greater danger than it actually is. In Hazlehurst, Mississippi, in response to numerous parents keeping their children from attending school, a principal at Hazlehurst Middle School, agreed to take personal vacation time after he had traveled to Zambia, a country with no current Ebola cases and away from West Africa.


Treatment


Biocontainment units in the U.S.

The United States has the capacity to isolate and manage 11 patients in four specialized biocontainment units. These include the
University of Nebraska Medical Center The University of Nebraska Medical Center (UNMC) is a public academic health science center in Omaha, Nebraska. Founded in 1869 and chartered as a private medical college in 1881, UNMC became part of the University of Nebraska System in 1902. R ...
in Omaha, Nebraska, the
National Institutes of Health The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
in Bethesda, Maryland,
St. Patrick Hospital and Health Sciences Center Providence St. Patrick Hospital, is a health care facility in Missoula, Montana. Overview Providence St. Patrick Hospital is the only level II trauma center in western Montana, northern Idaho, and Southwest Montana. The hospital employs more than ...
in Missoula, Montana and Emory University Hospital in Atlanta, Georgia.


Experimental treatments

There is as yet no medication or vaccine for Ebola approved by the U.S.
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA). The director of the US
National Institute of Allergy and Infectious Diseases The National Institute of Allergy and Infectious Diseases (NIAID, ) is one of the 27 institutes and centers that make up the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services (HHS). NIAID's ...
, Dr. Anthony Fauci, has stated that the scientific community is still in the early stages of understanding how infection with the Ebola virus can be treated and prevented.Roberts, Dan â€
News World news Ebola CDC director warns Ebola like 'forest fire' as Congress readies for hearing
– Ebola crisis live updates – The Guardian. Retrieved October 16, 2014.
There is no cure or specific treatment that is currently approved. However, survival is improved by early supportive care with rehydration and symptomatic treatment. Treatment is primarily supportive in nature. A number of experimental treatments are being considered for use in the context of this outbreak, and are currently or will soon undergo
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
s. In late August 2014, both Kent Brantly and Nancy Writebol became the first people to be given the experimental drug
ZMapp ZMapp is an experimental biopharmaceutical drug comprising three chimeric monoclonal antibodies under development as a treatment for Ebola virus disease. Two of the three components were originally developed at the Public Health Agency of Canada ...
. They both recovered, but there was no confirmation or proof that the drug was a factor."What Cured Ebola Patients Kent Brantly and Nancy Writebol?"
''NBC News'', August 21, 2014
A Spanish priest with Ebola had taken ZMapp but died afterward. Up until that time, ZMapp had only been tested on primates and looked promising, causing no serious side effects and protecting the animals from infection."12 Answers To Ebola's Hard Questions"
''Time'', October 23, 2014.
The Bill & Melinda Gates Foundation has donated $150,000 to help
Amgen Amgen Inc. (formerly Applied Molecular Genetics Inc.) is an American multinational biopharmaceutical company headquartered in Thousand Oaks, California. One of the world's largest independent biotechnology companies, Amgen was established in T ...
increase its production, and the U.S.
Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
has asked a number of centers to also increase production. There have been at least two promising treatments for those already infected. The first is
brincidofovir Brincidofovir, sold under the brand name Tembexa, is an antiviral drug used to treat smallpox. Brincidofovir is a prodrug of cidofovir. Conjugated to a lipid, the compound is designed to release cidofovir intracellularly, allowing for higher int ...
, an experimental antiviral drug, which was given to Duncan, Mukpo, and Spencer. Treatment using a transfusion of plasma from Ebola survivors, a form of "passive immunotherapy","Immune Response Key to Beating Ebola"
''UConn Today'', Univ. of Connecticut, October 30, 2014
since it contains antibodies able to fight the virus, has been used with apparent success on a number of patients. Survivor Kent Brantly donated his blood to Rick Sacra, Ashoka Mukpo and nurse Nina Pham."The decades-old treatment that may save a young Dallas nurse infected with Ebola"
''The Washington Post'', October 14, 2014
The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) has made it a priority to try the treatment, and has been telling affected countries how to do it.


Experimental preventive vaccines

Many Ebola
vaccine A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified.
candidates had been developed in the decade before 2014, but none has yet been approved for clinical use in humans. Several promising vaccine candidates have been shown to protect nonhuman primates (usually macaques) against lethal infection, and some are now going through the
clinical trial Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, diet ...
process. In late October 2014, Canada planned to ship 800 vials of an experimental vaccine to the WHO in Geneva, the drug having been licensed by NewLink Genetics Corporation, of Iowa. British drugmaker GlaxoSmithKline also announced it had expedited research and development of a vaccine, which, if successful, could be available in 2015. Although it's still unknown which ones will be approved, WHO hopes to have millions of vaccine doses ready sometime in 2015, and expects that five more experimental vaccines will start being tested in March 2015.


Public reactions

In October 2014,
Navarro College Navarro College is a public community college in Texas with its main campus in Corsicana and branches in Fairfield, Mexia, Midlothian, and Waxahachie. The college has an annual student enrollment of more than 9,000 students. The Corsica ...
, a two-year public school located in Texas, received media attention for admission rejection letters sent to two prospective students from Nigeria. The letters informed the applicants that the college was "not accepting international students from countries with confirmed Ebola cases". On October 16, Navarro's Vice-President Dewayne Gragg issued a statement confirming that there had indeed been a decision to "postpone our recruitment in those nations that the Center for Disease Control and the U.S. State Department have identified as at risk". Nigeria's outbreak was among the least severe in West Africa and was considered over by the WHO on October 20; the Nigerian health ministry had previously announced on September 22 that there were no confirmed cases of Ebola within the country. In October 2014, the S. I. Newhouse School of Public Communications at Syracuse University withdrew an invitation it had extended to Pulitzer Prize winning photojournalist
Michel du Cille Michel du Cille (January 24, 1956 – December 11, 2014) was a Jamaican-born American photojournalist who won three Pulitzer Prizes. He shared the 1986 Pulitzer Prize for Spot News Photography with fellow ''Miami Herald'' staff photographer Carol ...
because he'd returned three weeks earlier from covering the Ebola outbreak in Liberia. In October 2014, Case Western Reserve University withdrew their speaking invitation to Dr. Richard E. Besser, chief health editor at
ABC News ABC News is the news division of the American broadcast network ABC. Its flagship program is the daily evening newscast ''ABC World News Tonight, ABC World News Tonight with David Muir''; other programs include Breakfast television, morning ...
and former director of the CDC. Besser had recently returned from a trip to Liberia. On October 17,
Harvard University Harvard University is a private Ivy League research university in Cambridge, Massachusetts. Founded in 1636 as Harvard College and named for its first benefactor, the Puritan clergyman John Harvard, it is the oldest institution of high ...
imposed limits on travel to Ebola-affected countries (Sierra Leone, Guinea and Liberia) for its students, staff, and faculty. All travel to these countries is "strongly discourage , and such travel as part of a Harvard program requires approval from the provost. On October 25, CDC allowed state and local officials to set tighter control policies and Barbara Reynolds, a CDC spokeswoman released a statement saying "we will consider any measures that we believe have the potential to make the American people safer". On November 1, Ohio tightened restrictions on people travelling to Western African countries impacted by Ebola.''
Time Time is the continued sequence of existence and events that occurs in an apparently irreversible succession from the past, through the present, into the future. It is a component quantity of various measurements used to sequence events, ...
'' magazine's 2014 Person of the Year issue honored health professionals dedicated to fighting Ebola, including Kent Brantly. On October 28, future president
Donald Trump Donald John Trump (born June 14, 1946) is an American politician, media personality, and businessman who served as the 45th president of the United States from 2017 to 2021. Trump graduated from the Wharton School of the University of P ...
tweeted that governors backing off from the Ebola quarantine would lead to more mayhem. In 2020, during the COVID-19 pandemic in the United States, these tweets were contrasted with Trump's then-opposition to mandatory quarantines.


See also


Notes


References


Further reading

* * *


External links


Ebola: How it spreads


* ttps://www.cdc.gov/vhf/ebola/ Ebola Hemorrhagic Fever — CDC.gov {{Portal bar, United States, Current events, Medicine, Viruses
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
Ebola 2010s in Dallas Health in Texas Disasters in Texas Disease outbreaks in the United States Ebola