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Ebola virus cases in the United States

March 04, 2023

This article is about Ebola virus cases in the United States starting in 2014. For the 2013-2016 outbreak in Africa, see Ebola virus epidemic in West Africa. For the U.S. discovery of a different species of the Ebolavirus genus in 1989, see Reston virus.

Four laboratory-confirmed cases of Ebola virus disease (commonly known as "Ebola") occurred in the United States in 2014.[3] Eleven cases were reported, including these four cases and seven cases medically evacuated from other countries.[4] The first was reported in September 2014.[5] 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.[4]

Ebola virus disease in the U.S.
Map of Ebola cases and infrastructure throughout the U.S.
Cases contracted in the U.S.2
Cases first diagnosed in U.S.4[note 1]
Cases evacuated to U.S. from other countries7[1]
Total cases11[note 2]
Deaths2[2]
Recoveries from Ebola9[note 2]
Active cases0

On September 30, 2014, the Centers for Disease Control and Prevention (CDC) announced that Thomas Eric Duncan, a reportedly 42-year-old (later corrected by CDC reports as a 45-year-old[6]) Liberian national visiting the United States from Liberia, had been diagnosed with Ebola in Dallas, Texas.[7][8] Duncan, who had been visiting family in Dallas, was treated at Texas Health Presbyterian Hospital Dallas.[9][10] By October 4, Duncan's condition had deteriorated from "serious but stable" to "critical".[11] On October 8, Duncan died of Ebola.[12] The other three cases diagnosed in the United States as of October 2014 were:

  • October 11, 2014, a nurse, Nina Pham, who had provided care to Duncan at the hospital.[13]
  • October 14, 2014, Amber Joy Vinson, another nurse who treated Duncan.[14]
  • October 23, 2014, physician Craig Spencer, diagnosed in New York City; he had just returned from working with Doctors Without Borders in Guinea, a country in West Africa.[15] He was treated at Bellevue Hospital in New York City.[16]

Hundreds of people were tested or monitored for potential Ebola virus infection,[17] but the two nurses were the only confirmed cases of locally transmitted Ebola. Public health experts and the Obama administration opposed instituting a travel ban on Ebola endemic areas, stating that it would be ineffective and would paradoxically worsen the situation.[18]

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.[19]

Cases diagnosed in the U.S.

Main article: West African Ebola virus epidemic

First case: Thomas Eric Duncan

Main article: 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.[20] Duncan worked as a personal driver for the general manager of Safeway Cargo, a FedEx contractor in Liberia.[21] According to manager Henry Brunson, Duncan had abruptly quit his job on September 4, 2014, giving no reason.[22]

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.[23]

On September 19, Duncan went to Monrovia Airport, 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. In Brussels, Duncan boarded United Airlines Flight 951 to Washington Dulles Airport.[24] From Dulles, he boarded United Airlines Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT[25] on September 20, 2014,[9][10] and stayed with his partner and her five children, who lived in the Fair Oaks apartment complex in the Vickery Meadow neighborhood of Dallas.[26][27] Vickery Meadow, the neighborhood in Dallas where Duncan resided, has a large African immigrant population and is Dallas's densest neighborhood.[28]

Duncan's illness in Dallas

 
Texas Health Presbyterian Hospital, where Duncan was treated

Duncan began experiencing symptoms on September 24, 2014, and arrived at the Texas Health Presbyterian Hospital emergency room at 10:37 p.m. on September 25.[29] At 11:36 p.m., a triage nurse asked Duncan about his symptoms, and Duncan reported feeling "abdominal pain, dizziness, nausea and headache (new onset)".[29] The nurse recorded a fever of 100.1 °F (37.8 °C), but did not inquire as to his travel history as this was not triage protocol at the time.[29] At 12:05 a.m., 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 1:24 a.m.[29] CT scan results came back noting "no acute disease" for the abdominal and pelvic areas and "unremarkable" for the head.[29] Lab results returned showing slightly low white blood cells, low platelets, increased creatinine, and elevated levels of the liver enzyme AST.[29][30] His temperature was noted at 103.0 °F (39.4 °C) at 3:02 a.m. and 101.2 °F (38.4 °C) at 3:32 a.m. Duncan was diagnosed with sinusitis and abdominal pain and sent home at 3:37 a.m. with a prescription for antibiotics, which are not effective for treating viral diseases.[29][31]

What we're seeing now is not an "outbreak" or an "epidemic" of Ebola in America. This is a serious disease, but we can't give in to hysteria or fear. – President Barack Obama on the Ebola outbreak

Duncan's condition worsened, and he was transported on September 28 to the same Texas Health Presbyterian Hospital emergency room by ambulance.[32][33] Duncan arrived in the emergency room at 10:07 a.m., experiencing diarrhea, abdominal pain, and fever.[34] 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 [CDC] protocol" including wearing a mask, gown, and gloves. At 12:58 p.m., the doctor called the CDC directly. By 9:40 p.m., Duncan was experiencing explosive diarrhea and projectile vomiting.[34] At 8:28 a.m. the next morning, the doctor noted that Duncan "appeared to be deteriorating". By 11:32 a.m., Duncan was severely fatigued, enough to prevent him from using the bedside toilet.[34] Later that day, Duncan was transferred to an intensive care unit (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.[34]

Duncan's diagnosis was publicly confirmed during a CDC news conference the same day.[35][36] 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".[34] 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 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.[37][38] 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.[39] However, Duncan died at 7:51 a.m. 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.[40][41]

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.[42]

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.[43] Everyone who came into contact with Duncan was being monitored daily to watch for symptoms of the virus,[44] until October 20, when health officials removed 43 out of the 48 initial contacts of Thomas Duncan from isolation.[45] On November 7, 2014, Dallas was officially declared "Ebola free" after 177 monitored people cleared the 21 day threshold without becoming ill.[46]

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.[47] Liberian President Ellen Johnson Sirleaf told the Canadian Broadcasting Corporation 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."[48] 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.[23][49]

Duncan's family said the care Duncan received was at best "incompetent" and at worst "racially motivated".[50] Family members threatened legal action against the hospital where Duncan received treatment.[51] 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."[52] The hospital spent an estimated $500,000 to treat the uninsured Duncan.[53]

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".[54]

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.[55] In October 2014 Vickery Meadow residents stated that people were discriminating against them because of the incident.[56]

Second case: Nina Pham

 
President Obama hugs Nina Pham at the White House after her treatment at the National Institutes of Health in Bethesda, Maryland.

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.[13] 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.[13][57][58]

On October 16, Pham was transferred to the National Institutes of Health Clinical Center in Bethesda, Maryland.[59] On October 24, the NIH declared Pham free of the Ebola virus.[60] That day Pham traveled to the White House where she met with President Obama.[61]

Controversies and lawsuit

Tom Frieden, director of the Centers for Disease Control and Prevention, initially blamed a breach in protocol for the infection.[62] The hospital's chief clinical officer, Dr. Dan Varga, said all staff had followed CDC recommendations. Bonnie Costello of National Nurses United 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."[63] Frieden later spoke to "clarify" that he had not found "fault with the hospital or the healthcare worker".[64] National Nurses United criticized the hospital for its lack of Ebola protocols and for guidelines that were "constantly changing".[65] 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, and that the hospital had not provided consistent protocols for handling potential Ebola patients into the second week of the crisis.[66] 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.[67] Frieden later said that the CDC could have been more aggressive in the management and control of the virus at the hospital.[68]

On March 2, 2015 The New York Times reported that Pham filed a suit against Texas Health Resources, her hospital's parent company, accusing it of "negligence, fraud and invasion of privacy".[69] Pham was described as still experiencing numerous physical and psychological problems, listing lack of proper training as the reason for her illness.[69]

Third case: Amber Vinson

 
An Aeromedical Biological Containment System (ABCS), the same model used to transport both Nina Pham and Amber Vinson to isolation units

On October 14, a second nurse at the same hospital, identified as 29-year-old Amber Vinson,[70] reported a fever. Amber Joy Vinson[71] 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.[72] On October 13, Vinson had flown Frontier Airlines Flight 1143 from Cleveland to Dallas, after spending the weekend in Tallmadge and Akron, Ohio. Vinson had an elevated temperature of 99.5 °F (37.5 °C) 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.[73] Flight crew members from Flight 1142 were put on paid leave for 21 days.[74]

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.[75] Passengers of both flights were asked to contact the CDC as a precautionary measure.[76][77][78]

It was later discovered that the CDC had, in fact, given Vinson permission to board a commercial flight to Cleveland.[79] Before her trip back to Dallas, she spoke to Dallas County Health Department and called the CDC several times to report her 99.5 °F (37.5 °C) 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 100.4 °F (38.0 °C) or higher – which the CDC deemed as "high risk", and let her board the commercial flight.[80][81] 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.[82] As a precaution, sixteen people[83] in Ohio who had had contact with Vinson were voluntarily quarantined. On October 15, Vinson was transferred to the Emory University Hospital in Atlanta.[84] Seven days later, Vinson was declared Ebola free by Emory University Hospital.[85]

Monitoring of other health care workers

As of October 15, 2014, there were 76 Texas Presbyterian Hospital health care workers being monitored because they had had some level of contact with Thomas Duncan.[86] On October 16, after learning that Vinson had traveled on a plane before her Ebola diagnosis, the Texas Department of State Health Services advised all health care workers exposed to Duncan to avoid travel and public places until 21 days after their last known exposure.[87]

Fourth case: Craig Spencer

On October 23, Craig Spencer,[15] a physician who treated Ebola patients in West Africa, tested positive for Ebola at Bellevue Hospital Center after having a 100.3 °F (37.9 °C) fever. Officials said he was hospitalized with fever, nausea, pain, and fatigue.[88] He had flown to New York City from Guinea within the previous ten days,[89] and contacted the city's Department of Health and Doctors without Borders after showing symptoms.[90][91] 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.[92] His case was the first to be diagnosed in New York.[93] The city was trying to find people who may have been in contact with Dr. Spencer between October 21 and 23.[15]

On October 22, the day before he had symptoms, Dr. Spencer rode the New York City Subway, walked on the High Line park, went to a bowling alley and a restaurant in Brooklyn, took an Uber to his home in Manhattan, and took a 3-mile (4.8 km) jog in Harlem near where he lived.[94][95] Three other people who were with Dr. Spencer in the previous few days were quarantined as well.[96] Dr. Spencer's apartment and the bowling alley he went to were cleaned by hazmat company Bio Recovery Corporation.[97][98] Health officials stated it was unlikely that Dr. Spencer could have transmitted the disease through subway poles, hand railings, or via bowling balls.[99][100]

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.[101] On October 25, the New York Post 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.[102] On November 1, his condition was upgraded to "stable",[103] and on November 7 the hospital announced he was free of Ebola.[104] Spencer was released from the hospital on November 11.[105] 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".[88]

As a result of Dr. Spencer's Ebola case, U.S. Senator Charles Schumer (D-NY), proposed an Ebola fund in an omnibus bill 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.[106]

Medical evacuations from West Africa

 
  Local transmissions – no deaths: Texas
  Initial cases – deaths: Texas
  Initial cases – no deaths: New York
  Medically evacuated cases – no deaths: Georgia, Maryland
  Medically evacuated cases – deaths: Nebraska

By the time the Ebola virus epidemic in West Africa was over in June 2016, seven Americans had been evacuated to the U.S. for treatment after contracting Ebola virus while working with medical teams trying to stop the epidemic.[107]Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan's Purse, and co-worker Nancy Writebol were infected in July 2014, while working in Monrovia.[108][109][110] Both were flown to the United States at the beginning of August via the CDC's Aeromedical Biological Containment System for further treatment in Atlanta's Emory University Hospital.[111] On August 21, Brantly and Writebol recovered and were discharged.[112] Brantly has since donated blood to three others with Ebola (Sacra, Mukpo and Pham).[citation needed]

On September 4, a Massachusetts physician, Rick Sacra, was airlifted from Liberia to be treated in Omaha, Nebraska at the Nebraska Medical Center. Working for Serving In Mission (SIM), he was the third U.S. missionary to contract Ebola.[113] 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.[114]

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.[115][116][117] He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease.[118] 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.[119] On September 28, a fourth American doctor was admitted to National Institutes of Health hospital.[120]

On October 2, NBC News photojournalist Ashoka Mukpo, covering the outbreak in Liberia, tested positive for Ebola after showing symptoms.[121] Four other members of the NBC team, including physician Nancy Snyderman, were being closely monitored for symptoms.[122] Mukpo was evacuated on October 6 to the University of Nebraska Medical Center for treatment in their isolation unit.[107] On October 21, Mukpo was declared Ebola-free and allowed to return to his home in Rhode Island.[123]

A government official in Sierra Leone announced on November 13, that a doctor from Sierra Leone, a permanent resident of the United States married to a U.S. citizen, would be transported to the Nebraska Medical Center for treatment for Ebola.[124][125] 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.[126] Salia arrived at Eppley Airfield 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.[127] 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. Salia had been working as a general surgeon in Freetown, Sierra Leone when he fell ill. It was not clear when or where he had had contact with Ebola patients.[128]

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.[129] His condition was downgraded from serious to critical on March 16.[130] The ten exposed colleagues were flown back to the U.S., going into isolation near the Ebola-rated hospitals at Nebraska, Georgia, and Maryland.[131] 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.[132] On April 9, 2015, the clinician was upgraded to good condition and discharged.[133] 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. [134][135]

Containment efforts

Operation United Assistance

 
The 25-bed Monrovia Medical Unit was constructed for health care workers supporting Operation United Assistance.
Main article: 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 Systems (EMEDS). Plans included building a 25-bed hospital for health care workers and 17 treatment centers with 100 beds each in Liberia.[136] By the end of September 2014 150 military personnel were helping USAID in the capital, Monrovia.[137]

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.[138]

Revised CDC guidelines

Since 2007, US hospitals have relied on CDC 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.[139][140]

Some infection control experts[who?] 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 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."[141]

A Doctors Without Borders 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."[141]

The national nursing union National Nurses United 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.[141] 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.[139]

On October 14, the WHO reported that 125 contacts in the United States were being traced and monitored.[142] On October 20, the CDC updated its guidance on Personal Protective Equipment with new detailed instructions that include specifying that no skin should be exposed and adding extensive instructions for donning and doffing the equipment.[143] On October 20 CDC updated its guidance to add clarification that Ebola may spread through wet droplets such as sneezes.[144][145][146]

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's chief of staff.[147] Klain had no medical or health care experience.[148] 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 and National Security Advisor Susan Rice.[149][150][151][152] Klain did not coordinate with hospitals and the United States Public Health Service, as this is the responsibility of Nicole Lurie, Assistant Secretary for Preparedness and Response (ASPR).[153] President Barack Obama attempted to calm public fears by hugging nurse Nina Pham who had been cured of Ebola.[154]

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.[155]

Airport screening

 
Ebola screening of a passenger who arrived from Sierra Leone at Chicago's O'Hare airport

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 in New York, Newark Liberty International Airport in New Jersey, O'Hare International Airport in Illinois, Washington Dulles International Airport in Virginia, and Hartsfield–Jackson Atlanta International Airport in Georgia.[156] Combined, these airports receive more than 94% of passengers from Guinea, Liberia, and Sierra Leone, the three countries most affected by Ebola.[156][157]

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.[158] On October 21, the Department of Homeland Security announced that all passengers from Liberia, Sierra Leone, and Guinea will be required to fly into one of these five airports.[159] On October 23, the CDC announced that all passengers from these countries would receive 21-day monitoring.[160]

A physician with the WHO, Aileen Marty, who had spent 31 days in Nigeria, criticized the complete lack of screening for Ebola on her recent return to the United States through Miami International Airport on October 12.[citation needed]

There have also been calls by congressional leaders, including U.S. Representative Ed Royce, Chairman of the House Foreign Relations Committee, and U.S. Representative Michael McCaul 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.[161][162]

Mandatory 21-day quarantine

 
  21 day mandatory quarantine for people exposed to people with Ebola: New York, New Jersey, Connecticut, California
  21 day mandatory quarantine for people exposed to people with Ebola without wearing protective gear or otherwise at high risk: Illinois, Virginia
  21 day mandatory twice daily temperature reporting and voluntary in-home quarantine for people exposed to people with Ebola: Maine
  21 day mandatory twice daily health screening or temperature reporting for people who have been in West African Ebola-affected countries: Florida, Georgia, Maryland, Pennsylvania

On October 7, 2014, Connecticut governor Dannel Malloy signed an order authorizing the mandatory quarantine for 21 days of anyone, even if asymptomatic, who had direct contact with Ebola patients.[163][164] Nine people were quarantined on October 22, in accordance with the Connecticut order.[165]

At a joint news conference on October 24, New York Governor Andrew Cuomo and New Jersey Governor Chris Christie 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."[166][167]

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.[166]

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.[168] President Obama and his staff had been attempting to persuade New York Governor Cuomo, New Jersey Governor Christie, and the government of Illinois[169] to reverse their mandatory quarantines.[168]

Illinois Governor Pat Quinn issued a similar quarantine authorization the same day as New York and New Jersey initially did, with Florida Governor Rick Scott on October 25, authorizing mandatory twice daily monitoring for 21 days of people identified as coming from countries affected by Ebola.[170][171] 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.[172]

Pennsylvania, Maryland, and Georgia have all authorized mandatory twice daily health monitoring and/or temperature reporting for 21 days for people exposed to people with Ebola. Virginia has also implemented mandatory twice daily temperature reporting and daily monitoring from health authorities, but has also authorized mandatory quarantine for higher risk patients.[173][174] California mandated a 21-day quarantine for all health workers who have had contact with Ebola patients.[175]

 
Interior of the isolation tent used by University Hospital in New Jersey to quarantine Kaci Hickox

Kaci Hickox, an American nurse who treated Ebola patients in Sierra Leone 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, but without shower facility.[176] Hickox expressed that it was inhumane.[177] 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.[178] 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,[168] Hickox was released from quarantine in New Jersey.[179] She has filed suit.[180]

Hickox was escorted out of New Jersey and into Maine the following day by a private convoy of SUVs.[181] Maine Governor Paul LePage 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.[182] The governor said: "She's violated every promise she's made so far, so I can't trust her. I don't trust her."[183] 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.[184]

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.[185]

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 in Liberia. Up to 12 soldiers have been quarantined so far in a U.S. base in Italy.[186]

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 (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.[187]

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, 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 used on a previous flight.[188] Another school in the Cleveland Metropolitan School District 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".[189] Three schools in the Belton Independent School District 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.[190]

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 3,000 miles (4,800 kilometres) away from West Africa.[191][192]

Treatment

Biocontainment units in the U.S.

 
Corridor of NIH Special Clinical Studies Unit, a specialized biocontainment unit. The negative-pressure anterooms on the left lead to negative-pressure patient rooms (not shown in the picture).[193][194]

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 in Omaha, Nebraska, the National Institutes of Health in Bethesda, Maryland, St. Patrick Hospital and Health Sciences Center in Missoula, Montana and Emory University Hospital in Atlanta, Georgia.[121][195][196][197]

Experimental treatments

Main article: Ebola virus disease treatment research

There is as yet no medication or vaccine for Ebola approved by the U.S. Food and Drug Administration (FDA).[citation needed] The director of the US National Institute of Allergy and Infectious Diseases, 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.[198] There is no cure or specific treatment that is currently approved.[199] However, survival is improved by early supportive care with rehydration and symptomatic treatment. Treatment is primarily supportive in nature.[200] A number of experimental treatments are being considered for use in the context of this outbreak, and are currently or will soon undergo clinical trials.[201][202]

In late August 2014, both Kent Brantly and Nancy Writebol became the first people to be given the experimental drug ZMapp. They both recovered, but there was no confirmation or proof that the drug was a factor.[203] A Spanish priest with Ebola had taken ZMapp but died afterward.[204] 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.[205] The Bill & Melinda Gates Foundation has donated $150,000 to help Amgen increase its production, and the U.S. Department of Health and Human Services has asked a number of centers to also increase production.[206]

There have been at least two promising treatments for those already infected. The first is brincidofovir, an experimental antiviral drug, which was given to Duncan, Mukpo, and Spencer.[207]

Treatment using a transfusion of plasma from Ebola survivors, a form of "passive immunotherapy",[208] since it contains antibodies able to fight the virus, has been used with apparent success on a number of patients.[205] Survivor Kent Brantly donated his blood to Rick Sacra, Ashoka Mukpo and nurse Nina Pham.[209][210] The World Health Organization (WHO) has made it a priority to try the treatment, and has been telling affected countries how to do it.[211]

Experimental preventive vaccines

Main article: Ebola vaccine

Many Ebola vaccine candidates had been developed in the decade before 2014, but none has yet been approved for clinical use in humans.[212] 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 process.[213][214]

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.[215] 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.[216]

Public reactions

In October 2014, Navarro College, 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".[217] 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".[218] 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.[citation needed]

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 because he'd returned three weeks earlier from covering the Ebola outbreak in Liberia.[219][220] In October 2014, Case Western Reserve University withdrew their speaking invitation to Dr. Richard E. Besser, chief health editor at ABC News and former director of the CDC. Besser had recently returned from a trip to Liberia.[220][221][222]

On October 17, Harvard University 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[d]", and such travel as part of a Harvard program requires approval from the provost.[223]

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".[224] On November 1, Ohio tightened restrictions on people travelling to Western African countries impacted by Ebola.[225]Time magazine's 2014 Person of the Year issue honored health professionals dedicated to fighting Ebola, including Kent Brantly.[226]

On October 28, future president Donald Trump tweeted that governors backing off from the Ebola quarantine would lead to more mayhem.[227] In 2020, during the COVID-19 pandemic in the United States, these tweets were contrasted with Trump's then-opposition to mandatory quarantines.[227]

See also

Notes

  1. ^ Duncan contracted Ebola in Liberia and was diagnosed in the U.S.
    • Two of the victims had had direct contact with Duncan.
    • One victim was diagnosed in New York City; his case is unrelated to the Texas cases.
  2. ^ a b This takes into account the seven Americans who were medically evacuated from West Africa with Ebola.

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Further reading

  • (PDF). HHS.gov. Health and Human Services. Archived from the original (PDF) on July 12, 2016. Retrieved July 13, 2016.
  • "Infection Prevention and Control for Ebola in Health Care Settings — West Africa and United States". www.medscape.com. Medscape. Retrieved July 31, 2016.
  • Personal Protective Equipment for Use in a Filovirus Disease Outbreak: Rapid Advice Guideline. World Health Organization. 2016. ISBN 9789241549721. PMID 27929622. Retrieved December 15, 2016.

External links

  • Ebola: How it spreads
  • What gear to wear for protection from Ebola infection
  • Ebola Hemorrhagic Fever — CDC.gov

March 04, 2023
ebola, virus, cases, united, states, this, article, about, starting, 2014, 2013, 2016, outbreak, africa, ebola, virus, epidemic, west, africa, discovery, different, species, ebolavirus, genus, 1989, reston, virus, four, laboratory, confirmed, cases, ebola, vir. This article is about Ebola virus cases in the United States starting in 2014 For the 2013 2016 outbreak in Africa see Ebola virus epidemic in West Africa For the U S discovery of a different species of the Ebolavirus genus in 1989 see Reston virus Four laboratory confirmed cases of Ebola virus disease commonly known as Ebola occurred in the United States in 2014 3 Eleven cases were reported including these four cases and seven cases medically evacuated from other countries 4 The first was reported in September 2014 5 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 4 Ebola virus disease in the U S Map of Ebola cases and infrastructure throughout the U S Cases contracted in the U S 2Cases first diagnosed in U S 4 note 1 Cases evacuated to U S from other countries7 1 Total cases11 note 2 Deaths2 2 Recoveries from Ebola9 note 2 Active cases0On September 30 2014 the Centers for Disease Control and Prevention CDC announced that Thomas Eric Duncan a reportedly 42 year old later corrected by CDC reports as a 45 year old 6 Liberian national visiting the United States from Liberia had been diagnosed with Ebola in Dallas Texas 7 8 Duncan who had been visiting family in Dallas was treated at Texas Health Presbyterian Hospital Dallas 9 10 By October 4 Duncan s condition had deteriorated from serious but stable to critical 11 On October 8 Duncan died of Ebola 12 The other three cases diagnosed in the United States as of October 2014 update were October 11 2014 a nurse Nina Pham who had provided care to Duncan at the hospital 13 October 14 2014 Amber Joy Vinson another nurse who treated Duncan 14 October 23 2014 physician Craig Spencer diagnosed in New York City he had just returned from working with Doctors Without Borders in Guinea a country in West Africa 15 He was treated at Bellevue Hospital in New York City 16 Hundreds of people were tested or monitored for potential Ebola virus infection 17 but the two nurses were the only confirmed cases of locally transmitted Ebola Public health experts and the Obama administration opposed instituting a travel ban on Ebola endemic areas stating that it would be ineffective and would paradoxically worsen the situation 18 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 19 Contents 1 Cases diagnosed in the U S 1 1 First case Thomas Eric Duncan 1 1 1 Thomas Eric Duncan in Liberia 1 1 2 Duncan s illness in Dallas 1 1 3 Contact tracing 1 1 4 Reactions 1 2 Second case Nina Pham 1 2 1 Controversies and lawsuit 1 3 Third case Amber Vinson 1 3 1 Monitoring of other health care workers 1 4 Fourth case Craig Spencer 2 Medical evacuations from West Africa 3 Containment efforts 3 1 Operation United Assistance 3 2 Revised CDC guidelines 3 3 Ebola response coordinator 3 4 Rapid response teams 3 5 Airport screening 3 6 Mandatory 21 day quarantine 3 7 Legal protection for government contractors 3 8 School closures 4 Treatment 4 1 Biocontainment units in the U S 4 2 Experimental treatments 4 3 Experimental preventive vaccines 5 Public reactions 6 See also 7 Notes 8 References 9 Further reading 10 External linksCases diagnosed in the U S EditMain article West African Ebola virus epidemic First case Thomas Eric Duncan Edit Main article Thomas Eric Duncan Thomas Eric Duncan in Liberia Edit Thomas Eric Duncan was from Monrovia Liberia to date the country hit hardest by the Ebola virus epidemic 20 Duncan worked as a personal driver for the general manager of Safeway Cargo a FedEx contractor in Liberia 21 According to manager Henry Brunson Duncan had abruptly quit his job on September 4 2014 giving no reason 22 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 23 On September 19 Duncan went to Monrovia Airport 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 In Brussels Duncan boarded United Airlines Flight 951 to Washington Dulles Airport 24 From Dulles he boarded United Airlines Flight 822 to Dallas Fort Worth He arrived in Dallas at 7 01 p m CDT 25 on September 20 2014 9 10 and stayed with his partner and her five children who lived in the Fair Oaks apartment complex in the Vickery Meadow neighborhood of Dallas 26 27 Vickery Meadow the neighborhood in Dallas where Duncan resided has a large African immigrant population and is Dallas s densest neighborhood 28 Duncan s illness in Dallas Edit Texas Health Presbyterian Hospital where Duncan was treated Duncan began experiencing symptoms on September 24 2014 and arrived at the Texas Health Presbyterian Hospital emergency room at 10 37 p m on September 25 29 At 11 36 p m a triage nurse asked Duncan about his symptoms and Duncan reported feeling abdominal pain dizziness nausea and headache new onset 29 The nurse recorded a fever of 100 1 F 37 8 C but did not inquire as to his travel history as this was not triage protocol at the time 29 At 12 05 a m 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 1 24 a m 29 CT scan results came back noting no acute disease for the abdominal and pelvic areas and unremarkable for the head 29 Lab results returned showing slightly low white blood cells low platelets increased creatinine and elevated levels of the liver enzyme AST 29 30 His temperature was noted at 103 0 F 39 4 C at 3 02 a m and 101 2 F 38 4 C at 3 32 a m Duncan was diagnosed with sinusitis and abdominal pain and sent home at 3 37 a m with a prescription for antibiotics which are not effective for treating viral diseases 29 31 What we re seeing now is not an outbreak or an epidemic of Ebola in America This is a serious disease but we can t give in to hysteria or fear President Barack Obama on the Ebola outbreak Duncan s condition worsened and he was transported on September 28 to the same Texas Health Presbyterian Hospital emergency room by ambulance 32 33 Duncan arrived in the emergency room at 10 07 a m experiencing diarrhea abdominal pain and fever 34 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 CDC protocol including wearing a mask gown and gloves At 12 58 p m the doctor called the CDC directly By 9 40 p m Duncan was experiencing explosive diarrhea and projectile vomiting 34 At 8 28 a m the next morning the doctor noted that Duncan appeared to be deteriorating By 11 32 a m Duncan was severely fatigued enough to prevent him from using the bedside toilet 34 Later that day Duncan was transferred to an intensive care unit 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 34 Duncan s diagnosis was publicly confirmed during a CDC news conference the same day 35 36 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 34 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 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 37 38 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 39 However Duncan died at 7 51 a m 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 40 41 Contact tracing Edit 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 42 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 43 Everyone who came into contact with Duncan was being monitored daily to watch for symptoms of the virus 44 until October 20 when health officials removed 43 out of the 48 initial contacts of Thomas Duncan from isolation 45 On November 7 2014 Dallas was officially declared Ebola free after 177 monitored people cleared the 21 day threshold without becoming ill 46 Reactions Edit 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 47 Liberian President Ellen Johnson Sirleaf told the Canadian Broadcasting Corporation 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 48 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 23 49 Duncan s family said the care Duncan received was at best incompetent and at worst racially motivated 50 Family members threatened legal action against the hospital where Duncan received treatment 51 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 52 The hospital spent an estimated 500 000 to treat the uninsured Duncan 53 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 54 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 55 In October 2014 Vickery Meadow residents stated that people were discriminating against them because of the incident 56 Second case Nina Pham Edit President Obama hugs Nina Pham at the White House after her treatment at the National Institutes of Health in Bethesda Maryland 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 13 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 13 57 58 On October 16 Pham was transferred to the National Institutes of Health Clinical Center in Bethesda Maryland 59 On October 24 the NIH declared Pham free of the Ebola virus 60 That day Pham traveled to the White House where she met with President Obama 61 Controversies and lawsuit Edit Tom Frieden director of the Centers for Disease Control and Prevention initially blamed a breach in protocol for the infection 62 The hospital s chief clinical officer Dr Dan Varga said all staff had followed CDC recommendations Bonnie Costello of National Nurses United 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 63 Frieden later spoke to clarify that he had not found fault with the hospital or the healthcare worker 64 National Nurses United criticized the hospital for its lack of Ebola protocols and for guidelines that were constantly changing 65 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 and that the hospital had not provided consistent protocols for handling potential Ebola patients into the second week of the crisis 66 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 67 Frieden later said that the CDC could have been more aggressive in the management and control of the virus at the hospital 68 On March 2 2015 The New York Times reported that Pham filed a suit against Texas Health Resources her hospital s parent company accusing it of negligence fraud and invasion of privacy 69 Pham was described as still experiencing numerous physical and psychological problems listing lack of proper training as the reason for her illness 69 Third case Amber Vinson Edit An Aeromedical Biological Containment System ABCS the same model used to transport both Nina Pham and Amber Vinson to isolation units On October 14 a second nurse at the same hospital identified as 29 year old Amber Vinson 70 reported a fever Amber Joy Vinson 71 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 72 On October 13 Vinson had flown Frontier Airlines Flight 1143 from Cleveland to Dallas after spending the weekend in Tallmadge and Akron Ohio Vinson had an elevated temperature of 99 5 F 37 5 C 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 73 Flight crew members from Flight 1142 were put on paid leave for 21 days 74 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 75 Passengers of both flights were asked to contact the CDC as a precautionary measure 76 77 78 It was later discovered that the CDC had in fact given Vinson permission to board a commercial flight to Cleveland 79 Before her trip back to Dallas she spoke to Dallas County Health Department and called the CDC several times to report her 99 5 F 37 5 C 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 100 4 F 38 0 C or higher which the CDC deemed as high risk and let her board the commercial flight 80 81 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 82 As a precaution sixteen people 83 in Ohio who had had contact with Vinson were voluntarily quarantined On October 15 Vinson was transferred to the Emory University Hospital in Atlanta 84 Seven days later Vinson was declared Ebola free by Emory University Hospital 85 Monitoring of other health care workers Edit As of October 15 2014 update there were 76 Texas Presbyterian Hospital health care workers being monitored because they had had some level of contact with Thomas Duncan 86 On October 16 after learning that Vinson had traveled on a plane before her Ebola diagnosis the Texas Department of State Health Services advised all health care workers exposed to Duncan to avoid travel and public places until 21 days after their last known exposure 87 Fourth case Craig Spencer Edit On October 23 Craig Spencer 15 a physician who treated Ebola patients in West Africa tested positive for Ebola at Bellevue Hospital Center after having a 100 3 F 37 9 C fever Officials said he was hospitalized with fever nausea pain and fatigue 88 He had flown to New York City from Guinea within the previous ten days 89 and contacted the city s Department of Health and Doctors without Borders after showing symptoms 90 91 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 92 His case was the first to be diagnosed in New York 93 The city was trying to find people who may have been in contact with Dr Spencer between October 21 and 23 15 On October 22 the day before he had symptoms Dr Spencer rode the New York City Subway walked on the High Line park went to a bowling alley and a restaurant in Brooklyn took an Uber to his home in Manhattan and took a 3 mile 4 8 km jog in Harlem near where he lived 94 95 Three other people who were with Dr Spencer in the previous few days were quarantined as well 96 Dr Spencer s apartment and the bowling alley he went to were cleaned by hazmat company Bio Recovery Corporation 97 98 Health officials stated it was unlikely that Dr Spencer could have transmitted the disease through subway poles hand railings or via bowling balls 99 100 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 101 On October 25 the New York Post 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 102 On November 1 his condition was upgraded to stable 103 and on November 7 the hospital announced he was free of Ebola 104 Spencer was released from the hospital on November 11 105 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 88 As a result of Dr Spencer s Ebola case U S Senator Charles Schumer D NY proposed an Ebola fund in an omnibus bill 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 106 Medical evacuations from West Africa Edit Local transmissions no deaths Texas Initial cases deaths Texas Initial cases no deaths New York Medically evacuated cases no deaths Georgia Maryland Medically evacuated cases deaths Nebraska By the time the Ebola virus epidemic in West Africa was over in June 2016 seven Americans had been evacuated to the U S for treatment after contracting Ebola virus while working with medical teams trying to stop the epidemic 107 Kent Brantly a physician and medical director in Liberia for the aid group Samaritan s Purse and co worker Nancy Writebol were infected in July 2014 while working in Monrovia 108 109 110 Both were flown to the United States at the beginning of August via the CDC s Aeromedical Biological Containment System for further treatment in Atlanta s Emory University Hospital 111 On August 21 Brantly and Writebol recovered and were discharged 112 Brantly has since donated blood to three others with Ebola Sacra Mukpo and Pham citation needed On September 4 a Massachusetts physician Rick Sacra was airlifted from Liberia to be treated in Omaha Nebraska at the Nebraska Medical Center Working for Serving In Mission SIM he was the third U S missionary to contract Ebola 113 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 114 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 115 116 117 He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease 118 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 119 On September 28 a fourth American doctor was admitted to National Institutes of Health hospital 120 On October 2 NBC News photojournalist Ashoka Mukpo covering the outbreak in Liberia tested positive for Ebola after showing symptoms 121 Four other members of the NBC team including physician Nancy Snyderman were being closely monitored for symptoms 122 Mukpo was evacuated on October 6 to the University of Nebraska Medical Center for treatment in their isolation unit 107 On October 21 Mukpo was declared Ebola free and allowed to return to his home in Rhode Island 123 A government official in Sierra Leone announced on November 13 that a doctor from Sierra Leone a permanent resident of the United States married to a U S citizen would be transported to the Nebraska Medical Center for treatment for Ebola 124 125 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 126 Salia arrived at Eppley Airfield 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 127 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 Salia had been working as a general surgeon in Freetown Sierra Leone when he fell ill It was not clear when or where he had had contact with Ebola patients 128 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 13 129 His condition was downgraded from serious to critical on March 16 130 The ten exposed colleagues were flown back to the U S going into isolation near the Ebola rated hospitals at Nebraska Georgia and Maryland 131 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 132 On April 9 2015 the clinician was upgraded to good condition and discharged 133 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 134 135 Containment efforts EditOperation United Assistance Edit The 25 bed Monrovia Medical Unit was constructed for health care workers supporting Operation United Assistance Main article 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 Systems EMEDS Plans included building a 25 bed hospital for health care workers and 17 treatment centers with 100 beds each in Liberia 136 By the end of September 2014 150 military personnel were helping USAID in the capital Monrovia 137 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 138 Revised CDC guidelines Edit Since 2007 US hospitals have relied on CDC 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 139 140 Some infection control experts who 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 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 141 A Doctors Without Borders 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 141 The national nursing union National Nurses United 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 141 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 139 On October 14 the WHO reported that 125 contacts in the United States were being traced and monitored 142 On October 20 the CDC updated its guidance on Personal Protective Equipment with new detailed instructions that include specifying that no skin should be exposed and adding extensive instructions for donning and doffing the equipment 143 On October 20 CDC updated its guidance to add clarification that Ebola may spread through wet droplets such as sneezes 144 145 146 Ebola response coordinator Edit 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 s chief of staff 147 Klain had no medical or health care experience 148 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 and National Security Advisor Susan Rice 149 150 151 152 Klain did not coordinate with hospitals and the United States Public Health Service as this is the responsibility of Nicole Lurie Assistant Secretary for Preparedness and Response ASPR 153 President Barack Obama attempted to calm public fears by hugging nurse Nina Pham who had been cured of Ebola 154 Rapid response teams Edit 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 155 Airport screening Edit Ebola screening of a passenger who arrived from Sierra Leone at Chicago s O Hare airport 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 in New York Newark Liberty International Airport in New Jersey O Hare International Airport in Illinois Washington Dulles International Airport in Virginia and Hartsfield Jackson Atlanta International Airport in Georgia 156 Combined these airports receive more than 94 of passengers from Guinea Liberia and Sierra Leone the three countries most affected by Ebola 156 157 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 158 On October 21 the Department of Homeland Security announced that all passengers from Liberia Sierra Leone and Guinea will be required to fly into one of these five airports 159 On October 23 the CDC announced that all passengers from these countries would receive 21 day monitoring 160 A physician with the WHO Aileen Marty who had spent 31 days in Nigeria criticized the complete lack of screening for Ebola on her recent return to the United States through Miami International Airport on October 12 citation needed There have also been calls by congressional leaders including U S Representative Ed Royce Chairman of the House Foreign Relations Committee and U S Representative Michael McCaul 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 161 162 Mandatory 21 day quarantine Edit 21 day mandatory quarantine for people exposed to people with Ebola New York New Jersey Connecticut California 21 day mandatory quarantine for people exposed to people with Ebola without wearing protective gear or otherwise at high risk Illinois Virginia 21 day mandatory twice daily temperature reporting and voluntary in home quarantine for people exposed to people with Ebola Maine 21 day mandatory twice daily health screening or temperature reporting for people who have been in West African Ebola affected countries Florida Georgia Maryland Pennsylvania On October 7 2014 Connecticut governor Dannel Malloy signed an order authorizing the mandatory quarantine for 21 days of anyone even if asymptomatic who had direct contact with Ebola patients 163 164 Nine people were quarantined on October 22 in accordance with the Connecticut order 165 At a joint news conference on October 24 New York Governor Andrew Cuomo and New Jersey Governor Chris Christie 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 166 167 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 166 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 168 President Obama and his staff had been attempting to persuade New York Governor Cuomo New Jersey Governor Christie and the government of Illinois 169 to reverse their mandatory quarantines 168 Illinois Governor Pat Quinn issued a similar quarantine authorization the same day as New York and New Jersey initially did with Florida Governor Rick Scott on October 25 authorizing mandatory twice daily monitoring for 21 days of people identified as coming from countries affected by Ebola 170 171 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 172 Pennsylvania Maryland and Georgia have all authorized mandatory twice daily health monitoring and or temperature reporting for 21 days for people exposed to people with Ebola Virginia has also implemented mandatory twice daily temperature reporting and daily monitoring from health authorities but has also authorized mandatory quarantine for higher risk patients 173 174 California mandated a 21 day quarantine for all health workers who have had contact with Ebola patients 175 Interior of the isolation tent used by University Hospital in New Jersey to quarantine Kaci Hickox Kaci Hickox an American nurse who treated Ebola patients in Sierra Leone 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 but without shower facility 176 Hickox expressed that it was inhumane 177 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 178 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 168 Hickox was released from quarantine in New Jersey 179 She has filed suit 180 Hickox was escorted out of New Jersey and into Maine the following day by a private convoy of SUVs 181 Maine Governor Paul LePage 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 30 182 The governor said She s violated every promise she s made so far so I can t trust her I don t trust her 183 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 184 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 185 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 in Liberia Up to 12 soldiers have been quarantined so far in a U S base in Italy 186 Legal protection for government contractors Edit 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 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 187 School closures Edit 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 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 used on a previous flight 188 Another school in the Cleveland Metropolitan School District 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 189 Three schools in the Belton Independent School District 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 190 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 3 000 miles 4 800 kilometres away from West Africa 191 192 Treatment EditThis section needs to be updated Please help update this article to reflect recent events or newly available information November 2022 Biocontainment units in the U S Edit Corridor of NIH Special Clinical Studies Unit a specialized biocontainment unit The negative pressure anterooms on the left lead to negative pressure patient rooms not shown in the picture 193 194 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 in Omaha Nebraska the National Institutes of Health in Bethesda Maryland St Patrick Hospital and Health Sciences Center in Missoula Montana and Emory University Hospital in Atlanta Georgia 121 195 196 197 Experimental treatments Edit Main article Ebola virus disease treatment research There is as yet no medication or vaccine for Ebola approved by the U S Food and Drug Administration FDA citation needed The director of the US National Institute of Allergy and Infectious Diseases 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 198 There is no cure or specific treatment that is currently approved 199 However survival is improved by early supportive care with rehydration and symptomatic treatment Treatment is primarily supportive in nature 200 A number of experimental treatments are being considered for use in the context of this outbreak and are currently or will soon undergo clinical trials 201 202 In late August 2014 both Kent Brantly and Nancy Writebol became the first people to be given the experimental drug ZMapp They both recovered but there was no confirmation or proof that the drug was a factor 203 A Spanish priest with Ebola had taken ZMapp but died afterward 204 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 205 The Bill amp Melinda Gates Foundation has donated 150 000 to help Amgen increase its production and the U S Department of Health and Human Services has asked a number of centers to also increase production 206 There have been at least two promising treatments for those already infected The first is brincidofovir an experimental antiviral drug which was given to Duncan Mukpo and Spencer 207 Treatment using a transfusion of plasma from Ebola survivors a form of passive immunotherapy 208 since it contains antibodies able to fight the virus has been used with apparent success on a number of patients 205 Survivor Kent Brantly donated his blood to Rick Sacra Ashoka Mukpo and nurse Nina Pham 209 210 The World Health Organization WHO has made it a priority to try the treatment and has been telling affected countries how to do it 211 Experimental preventive vaccines Edit Main article Ebola vaccine Many Ebola vaccine candidates had been developed in the decade before 2014 but none has yet been approved for clinical use in humans 212 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 process 213 214 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 215 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 216 Public reactions EditIn October 2014 Navarro College 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 217 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 218 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 citation needed 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 because he d returned three weeks earlier from covering the Ebola outbreak in Liberia 219 220 In October 2014 Case Western Reserve University withdrew their speaking invitation to Dr Richard E Besser chief health editor at ABC News and former director of the CDC Besser had recently returned from a trip to Liberia 220 221 222 On October 17 Harvard University 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 d and such travel as part of a Harvard program requires approval from the provost 223 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 224 On November 1 Ohio tightened restrictions on people travelling to Western African countries impacted by Ebola 225 Time magazine s 2014 Person of the Year issue honored health professionals dedicated to fighting Ebola including Kent Brantly 226 On October 28 future president Donald Trump tweeted that governors backing off from the Ebola quarantine would lead to more mayhem 227 In 2020 during the COVID 19 pandemic in the United States these tweets were contrasted with Trump s then opposition to mandatory quarantines 227 See also EditEbola virus epidemic in Guinea Ebola virus epidemic in Liberia Ebola virus epidemic in Nigeria Ebola virus epidemic in Sierra Leone Ebola virus disease in Spain List of Ebola outbreaks West Nile virus in the United StatesNotes Edit Duncan contracted Ebola in Liberia and was diagnosed in the U S Two of the victims had had direct contact with Duncan One victim was diagnosed in New York City his case is unrelated to the Texas cases a b This takes into account the seven Americans who were medically evacuated from West Africa with Ebola References Edit Who are the American Ebola patients CNN October 6 2014 Ebola Stricken Surgeon Martin Salia Died Despite ZMapp Plasma Transfusion ABC News November 17 2014 Retrieved November 17 2014 2014 Ebola Outbreak Case Count CDC December 15 2014 Retrieved December 16 2014 a b 2014 2016 Ebola Outbreak in West Africa Centers for Disease Control and Prevention March 8 2019 Archived from the original on June 1 2018 Retrieved August 17 2020 First diagnosed case of Ebola in the U S CNN September 30 2014 Retrieved October 27 2014 New Details About Ebola In Dallas Revealed In CDC Report Huffington Post November 14 2014 Retrieved November 14 2014 CDC confirms first ever Ebola case in United States cdc gov accessed October 9 2014 Fernandez Manny Philipps Dave October 9 2014 Death of Thomas Eric Duncan in Dallas Fuels Alarm Over Ebola The New York Times Retrieved October 9 2014 a b Fernandez Manny Onishi Norimitsu October 1 2014 U S Patient Aided Ebola Victim in Liberia The New York Times a b Thomas Eric Duncan From healthy to Ebola WYFF4 Retrieved October 3 2014 First US Ebola case Thomas Duncan critical BBC News October 4 2014 Retrieved October 4 2014 Texas Ebola patient dies CNN October 8 2014 Retrieved October 8 2014 a b c Fernandez Manny 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October 21 2014 Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U S Hospitals Ebola Hemorrhagic Fever CDC Retrieved October 30 2014 Fredericks Bob October 29 2014 CDC admits droplets from a sneeze could spread Ebola New York Post Retrieved October 30 2014 CDC admits Ebola can be passed to others by sneezing The Washington Times Retrieved October 30 2014 Kuhnhenn Jim October 17 2014 President Obama appoints Ebola czar AP News Retrieved October 17 2014 Obama s New Ebola Czar Does Not Have Medical Health Care Background CBS DC October 17 2014 Retrieved October 17 2014 Davis Julie Hirschfeld Shear Michael D October 17 2014 Ron Klain Chief of Staff to 2 Vice Presidents Is Named Ebola Czar The New York Times Retrieved October 17 2014 Loney Jim October 17 2014 Obama appoints Ebola czar Texas health worker isolated on ship Reuters Retrieved October 17 2014 Tapper Jake October 19 2014 First on CNN Obama will name Ron Klain as Ebola Czar CNN Retrieved October 17 2014 Lavender Paige October 17 2014 Obama To Appoint Ron Klain As Ebola Czar The Huffington Post Retrieved October 17 2014 Kelley Beaucar Vlahos October 17 2014 White House statement Fox News Retrieved October 23 2014 Barack Obama not at all concerned about hugging cured Ebola patient video The Guardian Retrieved October 26 2014 CDC Details New Ebola Response and Prep Teams ABC News a b Sabrina Tavernise Michael D Shear October 8 2014 U S to Begin Ebola Screenings at 5 Airports The New York Times Retrieved October 12 2014 Zeke J Miller Alexandra Sifferlin October 8 2014 U S to Screen Passengers From West Africa for Ebola at 5 Airports Time Retrieved October 12 2014 Karen Matthews October 11 2014 Stepped up Ebola screening starts at NYC airport AP org Retrieved October 12 2014 Already there are 100 percent of the travelers leaving the three infected countries are being screened on exit Sometimes multiple times temperatures are checked along that process Dr Martin Cetron director of the Division of Global Migration and Quarantine for the federal Centers of Disease Control and Prevention said at a briefing at Kennedy The screening will be expanded over the next week to New Jersey s Newark Liberty Washington Dulles Chicago O Hare and Hartsfield Jackson in Atlanta DHS imposes new restrictions on travelers from Ebola stricken countries Fox News October 21 2014 Retrieved October 22 2014 McNeil Donald October 22 2014 U S Plans 21 Day Watch of Travelers From Ebola Hit Nations The New York Times Retrieved October 23 2014 Lawmakers call to halt visas to travelers from Ebola infected nations Fox News October 16 2014 Retrieved October 27 2014 Bart Jansen October 15 2014 Republicans call for West Africa travel ban to curb Ebola usatoday com Retrieved October 26 2014 Malloy signs Ebola emergency declaration WTNH Retrieved October 26 2014 Anemoma Hartocollis Emma G Fitzsimmons October 25 2014 Tested Negative for Ebola Nurse Criticizes Her Quarantine The New York Times Retrieved October 26 2014 Officials A Family of six is Quarantined In West Haven After Returning From West Africa Three other individuals also are being quarantined Hartford Courant October 22 2014 Retrieved October 26 2014 a b Travelers in contact with Ebola patients including returning nurse with fever now face mandatory 21 day quarantine in New York New Jersey NY Daily News October 24 2014 Retrieved October 25 2014 Marchione Marilynn Stobbe Mike October 24 2014 NY NJ Order Ebola Quarantine for Doctors Others ABC News Associated Press Retrieved October 25 2014 a b c Matt Flegenheimer Michael D Shear and Michael Barbaro Ebola quarantine guidelines for NY and NJ The New York Times October 27 2014 Aamer Madhani David Jackson October 26 2014 White House working on new Ebola guidelines USA Today Retrieved November 7 2014 Illinois Ebola quarantine Chicago Tribune October 25 2014 Retrieved October 26 2014 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 Archived October 26 2014 at the Wayback Machine abc7news com accessed October 26 2014 Illinois clarifies mandatory 21 day Ebola quarantine Chicago Tribune October 27 2014 Retrieved October 28 2014 Weiner Rachel October 27 2014 Virginia and Maryland increase Ebola monitoring for travelers from West Africa The Washington Post Retrieved October 28 2014 Protocol outlined for Pennsylvania Ebola monitoring Pittsburgh Post Gazette October 24 2014 Retrieved October 28 2014 Morin Monte Adolfo Flores October 29 2014 State orders quarantine for workers who had contact with Ebola Los Angeles Times Retrieved October 30 2014 Bashan Yoni West Melanie Grayce Haddon Heather October 26 2014 Nurse Detained in New Jersey for Ebola Calls Conditions Really Inhumane The Wall Street Journal Retrieved December 7 2014 Cohen Elizabeth Holland Leslie Ellis Ralph October 27 2014 Nurse describes Ebola quarantine ordeal I was in shock Now I m angry CNN Retrieved December 7 2014 Chappell Bill October 26 2014 Nurse Criticizes Quarantine After Negative Ebola Test Hires Lawyer NPR Retrieved December 7 2014 New Jersey Releases Nurse Quarantined for Suspected Ebola NBC News Retrieved October 27 2014 Rutgers University New Brunswick Shayna Jacobs Sasha Goldstein Corky Siemaszko October 27 2014 Nurse Kaci Hickox heading for Maine after leaving New Jersey Ebola quarantine officials NY Daily News New York Retrieved May 8 2015 Michelle Kaske October 29 2014 Maine Governor Seeks to Make Nurse Abide by Quarantine Bloomberg Julia Bayly Jackie Farwell October 31 2014 After Kaci Hickox wins court reprieve LePage says he doesn t trust her Bangor Daily News Ray Sanchez Catherine E Shoichet Faith Karimi October 31 2014 Maine judge rejects quarantine for nurse Kaci Hickox CNN Retrieved November 1 2014 Nurse working with Ebola patients lands at ABIA KVUE October 29 2014 Luis Martinez October 27 2014 US Army to Quarantine Troops Who Were Fighting Ebola ABC News Retrieved October 28 2014 Presidential Memorandum Authorizing the Exercise of Authority Under Public Law 85 804 November 13 2014 via White House Press Office WKYC Staff October 16 2014 Solon closes two schools Thursday as Ebola precaution wkyc com Retrieved October 16 2014 Kara Sutyak October 16 2014 Ebola precautions taken at Cranwood School in Cleveland fox8 Retrieved October 16 2014 Ohio Texas schools close amid Ebola scare USA Today October 16 2014 Retrieved October 16 2014 Three Central Texas schools were closed Thursday over health concerns surrounding two students who traveled on a Monday flight with Vinson Kids pulled out of class over concerns about principal s trip to Zambia WAPT com October 16 2014 Retrieved October 19 2014 Mendoza Dorrine October 20 2014 Ebola hysteria An epic epidemic overreaction CNN com Retrieved October 21 2014 Design of a Specialized Airborne Infection Isolation Suite PDF HPAC Engineering 25 33 February 2011 Retrieved November 15 2014 Pre application Webinar Agenda Opportunities for Collaborative Research at the NIH Clinical Center X02 PAR 13 357 and U01 PAR 13 358 PDF NIH Office of Extramural Research Archived from the original PDF on January 5 2014 Retrieved November 15 2014 ABC News US Has Capacity for 11 Ebola Patients at Specialized Hospitals ABC News Rob Chaney St Patrick Hospital 1 of 4 sites in U S ready for Ebola patients Missoulian com Retrieved October 8 2014 CDC director at today s Biocontainment Unit unveiling University of Nebraska Medical Center March 7 2005 Roberts Dan 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 Choi JH Croyle MA December 2013 Emerging targets and novel approaches to Ebola virus prophylaxis and treatment BioDrugs 27 6 565 83 doi 10 1007 s40259 013 0046 1 PMC 3833964 PMID 23813435 Clark DV Jahrling PB Lawler JV September 2012 Clinical management of filovirus infected patients Viruses 4 9 1668 86 doi 10 3390 v4091668 PMC 3499825 PMID 23170178 Briggs Helen August 7 2014 Ebola Experimental drugs and vaccines BBC News Health Retrieved August 8 2014 Rush James November 13 2014 Ebola virus Clinical trials of three new treatments for disease to start in West Africa The Independent London Retrieved November 13 2014 What Cured Ebola Patients Kent Brantly and Nancy Writebol NBC News August 21 2014 Moffett Matt August 13 2014 Ebola Virus Infected Priest Has Died in Spain The Wall Street Journal Retrieved October 26 2014 a b 12 Answers To Ebola s Hard Questions Time October 23 2014 Amgen works with Gates Foundation to ramp up Ebola drug ZMapp production Puget Sound Business Journal October 20 2014 Ebola patient Dr Craig Spencer enters next phase of illness despite treatment with experimental drug Brincidofovir NY Daily News October 25 2014 Immune Response Key to Beating Ebola UConn Today Univ of Connecticut October 30 2014 Ebola survivor Kent Brantly donates blood to help treat NBC cameraman Ashoka Mukpo The Washington Post October 8 2014 The decades old treatment that may save a young Dallas nurse infected with Ebola The Washington Post October 14 2014 A Plan to Use Survivors Blood for Ebola Treatment in Africa The New York Times October 3 2014 Alison P Galvani with three others August 21 2014 Ebola Vaccination If Not Now When Annals of Internal Medicine 161 10 749 50 doi 10 7326 M14 1904 PMC 4316820 PMID 25141813 Fausther Bovendo H Mulangu S Sullivan NJ June 2012 Ebolavirus vaccines for humans and apes Curr Opin Virol 2 3 324 29 doi 10 1016 j coviro 2012 04 003 PMC 3397659 PMID 22560007 Walsh Fergus January 6 2015 Ebola New vaccine trial begins BBC News Retrieved January 6 2015 Americans can t give in to hysteria or fear over Ebola Obama Reuters October 18 2014 WHO Millions of Ebola Vaccine Doses Ready in 2015 BBC News October 24 2014 Dan Mangan Texas College Rejects Nigerian Applicants Cites Ebola Cases NBC News NBCNews com Retrieved October 17 2014 Navarro College says in a new statement it will postpone recruitment of students from countries at risk for Ebola Corsicana Daily Sun Local News Corsicana Daily Sun Retrieved October 17 2014 Bever Lindsay October 17 2014 Syracuse University disinvites Washington Post photographer because he was in Liberia 3 weeks ago The Washington Post Retrieved October 18 2014 a b Kingkade Tyloe October 17 2014 Colleges Isolate Disinvite People Out Of An Abundance Of Caution Over Ebola Huffington Post Retrieved October 18 2014 Rice Chelsea Ebola Today Boston com Retrieved October 18 2014 Besser Richard E October 15 2014 Fight fear of ebola with the facts The Washington Post Retrieved October 18 2014 Harvard update on West Africa Ebola outbreak October 2014 PDF Harvard University Office of the Provost October 16 2014 Retrieved October 24 2014 Spencer S Hsu Nia Malika HendersonSpencer S Hsu Nia Malika Henderson October 25 2014 No mandatory Ebola quarantine for health workers coming to Washington area The Washington Post Retrieved October 25 2014 Jen Christensen Out of control How the world reacted as Ebola spread CNN Time Magazine Honors Ebola Fighters Samaritan s Purse doctor Kent Brantly is among those honored as Time s Person of the Year December 10 2014 Retrieved December 10 2014 a b Did Trump Criticize Governors for Backing off Ebola Quarantines in 2014 Snopes com April 22 2020 Retrieved May 4 2020 Further reading Edit Report of the Independent Panel On HHS Ebola Response PDF HHS gov Health and Human Services Archived from the original PDF on July 12 2016 Retrieved July 13 2016 Infection Prevention and Control for Ebola in Health Care Settings West Africa and United States www medscape com Medscape Retrieved July 31 2016 Personal Protective Equipment for Use in a Filovirus Disease Outbreak Rapid Advice Guideline World Health Organization 2016 ISBN 9789241549721 PMID 27929622 Retrieved December 15 2016 External links EditEbola How it spreads What gear to wear for protection from Ebola infection Ebola Hemorrhagic Fever CDC gov Portals United States Current events Medicine Viruses Retrieved from https en wikipedia org w index php title Ebola virus cases in the United States amp oldid 1133376994 Medically evacuated to the United States, wikipedia, wiki, book, books, library,

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