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Nurses’ complaints, another Ebola diagnosis fuel doubts about U.S. response

An ambulance carrying Amber Vinson, the second health care worker to be diagnosed with Ebola in Texas, arrives at Emory University Hospital on Wednesday, Oct. 15, 2014 in Atlanta. A joint emergency isolation unit administered by Emory University Hospital and the Centers for Disease Control and Prevention has successfully treated two Americans and is currently treating a third.
An ambulance carrying Amber Vinson, the second health care worker to be diagnosed with Ebola in Texas, arrives at Emory University Hospital on Wednesday, Oct. 15, 2014 in Atlanta. A joint emergency isolation unit administered by Emory University Hospital and the Centers for Disease Control and Prevention has successfully treated two Americans and is currently treating a third. AP

The second nurse at Texas Health Presbyterian Hospital Dallas to contract Ebola was transferred to Emory University Hospital in Atlanta on Wednesday as questions about patient and worker safety at the embattled Texas facility grew louder and threatened to undermine public confidence in the Obama administration’s efforts to contain the deadly virus.

Health officials now are trying to contact 132 passengers on an Oct. 13 Frontier Airlines flight from Cleveland to Dallas who traveled with the nation’s newest Ebola patient. She has been identified in media reports as 29-year-old Amber Joy Vinson of Dallas.

While Vinson had a low-grade temperature of 99.5 degrees when she boarded the flight, she was still below the 100.4-degree threshold that requires her to seek medical attention as a person who had been exposed to the Ebola virus.

But she shouldn’t have been on the plane at all because of federal travel restrictions, said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention.

He described her condition as “ill, but clinically stable.”

The airline incident is the latest breach of CDC protocol designed to keep Ebola from spreading in the United States.

The airline scare, the new hospital infection – and Frieden’s warning that more staffers at the Dallas hospital could also become infected – prompted President Barack Obama to cancel travel plans Wednesday afternoon and assess the administration’s Ebola strategy with top health and security advisers.

“What we’ve been doing here today is reviewing exactly what we know about what’s happened in Dallas and how we are going to make sure something like this is not repeated,” Obama said after the meeting. “We are monitoring, supervising, overseeing in a much more aggressive way exactly what’s happening.”

Health and Human Services Secretary Sylvia Mathews Burwell said the decision to transfer Vinson to Emory was “part of an ongoing clinical decision about patient care.” She did not elaborate.

But the move came the same day that nurses at the Dallas hospital complained through representatives of a national nursing union that the facility failed to provide emergency room staff with proper personal safety equipment on Sept. 28 as they cared for Thomas Eric Duncan.

Duncan is the Liberian man whose visits to the Dallas hospital and ultimate death there have spawned the nation’s first true Ebola crisis.

In a statement from National Nurses United, the unidentified Dallas nurses said Duncan sat with other patients for several hours at the hospital before he was isolated on Sept. 28, even though hospital officials initially resisted doing so. They said Duncan’s infected blood specimens weren’t properly sealed or hand-delivered and may have contaminated the transport system that carries them to the lab.

The nurses said they wore only basic gowns that left their necks and parts of their heads exposed while they treated Duncan during his violent bouts of vomiting and diarrhea on Sept. 28. The nurses said their gloves weren’t taped to cover their wrists and they wore basic surgical masks with no respirators.

“After they recommended that the nurses wear isolation suits, the nurses raised questions and concerns about the fact that the skin on their neck was exposed. They were told to use medical tape and had to use four to five pieces of medical tape wound around their neck,” according to the nurses’ statement, as read by a representative from Nurses United.

In a statement, hospital spokesman Wendell Watson did not directly address the nurses’ accusations.

“We take compliance very seriously,” Watson wrote. “We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting.”

The CDC is investigating the circumstances of the infection of Vinson and that of her colleague, 26-year-old Nina Pham, also a nurse at the hospital. Frieden said the probe is focusing on Duncan’s time in the hospital on Sept. 28, 29 and 30, when he had not yet been diagnosed with Ebola. CDC personnel were not at the hospital during that three-day stretch.

“Our investigations increasingly suggest that the first several days before the patient was diagnosed appear to be the highest-risk period” for infection from Duncan, Frieden said. “Those two health care workers both worked on those days and both had extensive contact with (Duncan) when the patient had extensive production of body fluids because of vomiting and diarrhea.”

Fifty other hospital workers who had contact with Duncan also are being monitored for Ebola symptoms, as are three people who had contact with Vinson after she became symptomatic and one other person who had contact with Pham after she became ill. None of these individuals have developed Ebola symptoms, but Frieden said some very well could in the near future.

Frieden said Pham’s condition had improved Wednesday and that officials will continue to assess her condition to see if she, too, will be transferred to Emory, one of only four hospitals in the nation with a bio-containment unit designed to handle Ebola patients safely.

Vinson traveled to Ohio to visit her mother and plan her wedding before it was known that her hospital colleague, Pham, had tested positive for the virus on Saturday after caring for Duncan.

At the time of her flight, Vinson was among dozens of other hospital staffers who had also treated Duncan and were monitoring themselves for possible Ebola symptoms, such as fever, diarrhea and nausea.

Vinson reportedly showed no symptoms during the flight, but because “she was in a group of individuals known to have exposure to Ebola, she should not have traveled on a commercial airline,” Frieden said.

Under CDC guidelines, Vinson was supposed to be under a “controlled movement” designation that requires people to notify public health officials about their travel plans for 21 days after their last known Ebola virus exposure. It forbids travel by commercial means, such as planes, ships, long-distance buses or trains. If public travel is approved, the exposed individual must have access to medical care in case symptoms develop while traveling.

Local public transportation, such as buses and taxis, by people without symptoms should be worked out in advance with local health officials.

Certain charter plane trips and personal automobile trips are allowed, “but it does not include public transport,” Frieden said. “We will from this moment forward ensure that no other individual who’s being monitored for exposure undergoes travel in any way other than controlled movement.”

Passengers on the Frontier Airlines Flight 1143 are thought to be at “extremely low risk” of infection, Frieden said, because only symptomatic carriers can spread the virus through contact with infected body fluids.

But in an abundance of caution, the CDC is asking all 132 passengers to call 800-232-4636 so health professionals can interview them and arrange for them to be monitored if they’re determined to be at risk of exposure.

The Obama administration has come under fire from Democrats and Republicans for refusing to impose tough travel restrictions on airline travelers to and from Ebola-ravaged countries in West Africa.

On the eve of a congressional hearing at which Frieden will testify about the federal response to the Ebola outbreak, House Speaker John Boehner repeated a familiar call for a temporary ban on travel to the U.S. from Ebola-stricken nations in West Africa.

The Obama administration has resisted those calls, saying a travel ban would make it harder to get assistance and volunteer medical personnel to go to Africa.

Instead, Customs and Border Protection officers at four U.S. airports were slated to begin screening passengers on Thursday for Ebola symptoms upon their arrival in the U.S. from Sierra Leone, Guinea and Liberia, where the disease is rampant. Checks at John F. Kennedy International Airport in New York began last week.

But critics say travelers without symptoms could easily pass the checks and develop full-blown Ebola after traveling throughout the United States and potentially infecting untold numbers of Americans.

That’s what happened with Duncan, who was initially sent home from Texas Health Presbyterian Hospital Dallas on his first visit there even after hospital staff noted his high temperature and his recent arrival from Liberia.

It was only after Duncan returned to the hospital several days later on Sept. 28 that he was admitted and diagnosed with Ebola.

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