CDC chief: U.S. “rethinking” Ebola strategy after Dallas nurse’s infection

Dr. Joseph McCormick, regional dean of the University of Texas School of Public Health in Brownsville, told the New York Times that he was shocked that none of those monitored by officials in recent days were the hospital workers caring for Duncan after he was put in isolation. Dr. McCormick worked for the CDC in 1976, when he helped investigate the first epidemic of Ebola in Central Africa.

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“You know that once this guy is really ill and he’s hospitalized, there’s going to be a lot of contact, manipulation of blood specimens, cleaning up if he’s vomiting or if he’s got diarrhea,” Dr. McCormick said. “You certainly can’t assume that because he’s hospitalized and in this unit that everything is fine and everything that goes on will be without any risk. I mean, that’s just ludicrous to think that.”

Officials are considering requiring that workers at Presbyterian be sprayed with a disinfectant, like chlorine, after they leave an infected patient, often in a side room that is connected to the patient’s room. The procedure, which is used in Africa, is rarely used in American hospitals.

“Every option is on the table at this moment,” said Abbigail Tumpey, a CDC spokeswoman.

CDC officials will also monitor health workers as they put on their protective gear and take it off in order to reduce the risk that they infect themselves from fluid on gowns or gloves.

The procedures the CDC is now testing as a pilot in Dallas, Tumpey said, and other procedures which are considered most useful will be used to update the CDC’s infection control guidance document, mostly likely next week.

The agency’s guidance is just that – a guidance – since the agency does not have the authority to compel hospitals to follow its recommended procedures.

Dr. Robert L. Murphy, director of the Center for Global Health at Northwestern University, told the Times that the missteps in Texas underscored the need to create a national “Ebola czar” with centralized authority to respond to the crisis, an idea proposed Sunday by Senator John McCain (R-Arizona).

Dr. Murphy said that the American public health system is a “state-oriented” one, in which state public health departments have the primary responsibility for fighting the outbreak of an infectious disease like Ebola. The CDC, he said, acts as “a central clearinghouse and a reference center, and can provide guidelines and recommendations and assist the states in implementing these policies. But it’s strictly up to the states as to whether they follow those guidelines or not.”

The Guardian reports that President Obama was briefed on Monday by members of his public health and national security team on the response to the apparent breach of infection control protocol in Dallas.

Texas health commissioner Dr. David Lakey said all levels of state government are working together to identify and interview the healthcare workers involved in Duncan’s treatment, and anyone the nurse may have made contact with once she began showing symptoms.

Lakey said that so far only one person has been identified as having direct contact with the woman; that person is being monitored, as is the nurse’s dog. Lakey said the woman’s apartment was being cleaned and decontaminated on Monday.

Forty-eight people who came into contact with Duncan outside the hospital are currently under observation by officials in Texas. Frieden said officials will continue to monitor those people, ten of whom are considered “high risk,” for symptoms during the remainder of the virus’s 21-day incubation period.

So far, all those monitored are asymptomatic.

On Sunday, Frieden expressed his concern over a “breach in protocol” which, he said, led to the nurse being infected On Monday, however, he clarified this remark, saying it was wrongly interpreted as blaming the hospital or healthcare worker. He praised the hospital’s staff for their diligent care of Duncan, who died on Wednesday.

“The enemy here is a virus: Ebola. It’s not a person, it’s not a country, it’s not a place, it’s not a hospital. It’s a virus. It’s a virus that’s tough to fight,” Frieden said. “But together, I’m confident that we will stop it. What we need to do is all take responsibility for improving the safety of those on the front lines.”