TIME ebola

CDC to Send Dallas Healthcare Worker Infected with Ebola to Special Hospital

CDC Atlanta Ebola
Exterior of the Center for Disease Control (CDC) headquarters in Atlanta on Oct. 13, 2014. Jessica McGowan—Getty Images

Officials are weighing the possibility in the wake of failures in Dallas, but there is only room for 19 patients

Thomas Eric Duncan, the first Ebola case diagnosed in the U.S., was a warning to hospitals that a patient infected with the deadly virus could walk into their emergency room at any time. Hospitals from New York City to Seattle are now running Ebola drills, testing their staffs to ensure they are prepared to diagnose the disease without putting healthcare workers at risk of contracting it.

“Every hospital in the country needs to be ready to diagnose Ebola,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention (CDC), said at a news conference on Tuesday.

The question is whether every hospital is equipped to care for a patient who tests positive for the disease, which has killed nearly 4,500 people in West Africa. During this outbreak, the most deadly since the disease was first discovered in 1976, the mortality rate is about 70%, according to statistics compiled by the World Health Organization. Health care workers are at particular risk for infection, which is transmitted through contact with a symptomatic patient’s bodily fluids, like blood or vomit.

Those risks have been born out in Texas Health Presbyterian Hospital in Dallas, where Duncan was admitted on Sept. 28 and died on Oct. 8. Early Wednesday, the hospital said a second healthcare worker who administered care to Duncan had tested positive for the disease. The hospital’s stumbles have prompted critics to question whether the additional infections were avoidable—and whether future patients should be cared for at specialized hospitals with the expertise and facilities to treat Ebola cases.

Frieden said Tuesday that the second healthcare worker would be transported to Emory University Hospital in Atlanta, which has a specialized isolation unit for treating diseases like Ebola and has successfully cared for patients with the virus in the past.

Some doctors say moving future Ebola patients to specialized hospitals makes sense. “Given some of the complexities, patients who have this disease are probably best cared for by those who have experience caring for it, and whose healthcare workers are highly trained and drilled in self-protection,” says Dr. Gabe Kelen, the director of the Johns Hopkins Office of Critical Event Preparedness and Response. “It’s not appropriate to think that each and every hospital in the country could bring the resources, the intense training for the healthcare workers that is required.”

There are four hospitals in the U.S. with special isolation units designed to contain biohazards like Ebola. In addition to Emory, they are the National Institutes of Health Clinical Center, in Bethesda, Md., a hospital at the University of Nebraska in Omaha and St. Patrick Hospital in Missoula, Mt. The facilities in Atlanta and Omaha have successfully treated Americans infected with Ebola overseas without any healthcare workers contracting the virus.

Though transporting future cases to these facilities may be prudent, they have limited beds: only 19 between them, according to CNN. Exclusively using specialized hospitals to treat Ebola is only an option so long as the number of cases in the U.S. remains extremely low.

A CDC spokesman said the agency may announce further measures for Ebola on Wednesday.

-Additional reporting by Zeke J. Miller

TIME 2014 Election

Democrats Eye a South Dakota Senate Surprise

U.S. Senate candidate Rick Weiland speaks at the Democratic Convention on June 27, 2014 in Yankton, S.D.
U.S. Senate candidate Rick Weiland speaks at the Democratic Convention on June 27, 2014 in Yankton, S.D. Dave Eggen—AP

Could a second upset be brewing on the prairie?

If Democrats hold the Senate in November, it could be due to surprising success in states the party never expected to be competitive.

Just weeks after independent candidate Greg Orman surged in a Kansas Senate race that had been chalked into the Republican column, Democrats have spied another unlikely opening on the prairie. The Democratic Senatorial Campaign Committee (DSCC) on Wednesday pumped $1 million into the surprisingly competitive South Dakota Senate race.

The DSCC poured in the cash just hours after a new poll showed Republican Mike Rounds locked in a three-way contest with independent candidate Larry Pressler and Democrat Rick Weiland. The SurveyUSA poll released Wednesday showed Rounds with 35%, Pressler with 32% and Weiland with 28%. The race also includes a Tea Party candidate who could siphon votes from the GOP frontrunner.

The survey could be an outlier. Rounds still boasts an average 12-point lead in recent polling, and South Dakota is a conservative state. “If I was a betting man, I would still put money on Rounds,” says Bob Burns, a veteran political analyst in the state.

But the DSCC’s move, first reported by Bloomberg Politics, underlines the dramatic changes in a race that both sides had written off as a cakewalk. Even this summer, as Democrats desperately searched for ways to hold their majority together, Senate Majority Leader Harry Reid was frank about the party’s chance in South Dakota. “We are going to lose,” the Nevada Democrat said.

But as in neighboring Kansas, something strange is happening in South Dakota. Rounds, a former governor, has been dogged by a controversy over the state’s EB-5 program, a federal visa program that grants green cards to wealthy immigrants who invest at least $500,000 in economic development project. As governor, Rounds was a booster of the program, which has drawn criticism for mismanagement and lack of transparency after it was privatized by one of the governor’s allies.

Democrats believe the issue may have made Rounds vulnerable. The Republican’s campaign did not immediately return a request for comment.

The Democratic money will go toward field operations and ads attacking Rounds. In a sign of how strange the three-way entanglement is becoming, Mayday PAC, the quixotic super PAC whose stated goal is to reverse the tide of big-money politics, has dumped $1 million into the race in support of Weiland, whom not even Reid is supporting. Meanwhile, the wild card is Pressler, 72, a three-term former U.S. senator who represented the state as a Republican from 1979 through 1996.

Nearly 20 years later, after stints as a college professor in the U.S., Italy and France, Pressler has launched the kind of quixotic campaign that is typically run by quirky obsessives, not former senators. He has one paid staffer, slaps together homemade yard signs with magic markers, and relies on his wife as his driver when he barnstorms the state. When he returned a reporter’s call himself Wednesday, he had just been informed that his campaign website did not include a mailing address for supporters to send in contributions.

“It’s bare bones,” he says. “My wife was very doubtful.”

In part that’s because of his fundraising deficit. According to data compiled by the Center for Responsive Politics, Pressler has spent just $50,000, a sum dwarfed by Rounds’ $3 million. “I’m like a sitting duck with no clothes on out on the firing range,” he says. “We won’t be able to answer any negative ads.”

Pressler says he hasn’t decided which party he would caucus with if elected. But with the GOP’s lurch to the right, the former moderate Republican now sounds more like a Democrat. He voted for Barack Obama. He supports balancing the budget in part by raising taxes on millionaires, a new gas tax and the elimination of some corporate deductions. He wants to raise the minimum wage and teacher salaries, supports gay marriage, and says the U.S. should pare back its military spending. “I’m not an isolationist,” he adds. “I know we have to do some bombing.”

Pressler says he will limit himself to a “one glorious term” if elected, freeing him from the demands of the contemporary senatorial practice of dialing for dollars. Though his shoestring campaign may still be a long shot, Pressler says the moment is right for a post-partisan candidate. “We’ve seeing something very significant happening in American politics,” he says.

At the very least, something strange is stirring out on the prairie.

-Additional reporting by Alex Rogers

TIME 2014 Election

Union Chief Frets Foreign Policy and Ebola Are Distracting Voters from the Economy

Richard Trumka
AFL-–CIO president Richard Trumka addresses members in Los Angeles on Sept 9, 2013. Nick Ut—Associated Press

Richard Trumka says 2014 momentum is finally starting to build for the labor movement

The head of one of the nation’s most powerful labor federations said Tuesday that it has been a struggle to motivate workers ahead of the midterm elections, but that momentum was growing among the union members that Democrats will need to vote in droves for the party to retain control of the Senate and win a slew of tight gubernatorial races.

Richard Trumka, the president of the AFL-CIO, said global events such as tumult in the Middle East and the Ebola virus scare had diverted workers’ attention from the economic issues that form the cornerstone of the movement’s message.

“It took more effort this time to break through,” Trumka told reporters at the labor giant’s headquarters in Washington. “Our job is made a little more difficult by all those external things: the Middle East, Ebola.”

The AFL-CIO has shelled out more than $6 million in political contributions so far in 2014, according to data compiled by the Center for Responsive Politics. Most of that has been funneled through the AFL-CIO Workers’ Voices PAC. Members are working to drive turnout through traditional ground-game efforts like phone banks, door knocks and leafleting. As a result, Trumka said, voters were beginning to “connect the dots” between Republican policies and the flat wages and slashed pensions that have buffeted middle-class union members.

“The momentum is starting to build,” Trumka said.

Returning from a tour of battleground states, Trumka said he saw candidate after candidate on the Republican side running against the policies of President Barack Obama, rather than enumerating specific policies of their own. If Republicans seize the Senate, Trumka said, it would result in stalled executive appointments, judicial vacancies and a fresh round of doomed efforts to repeal the Affordable Care Act. “There’s a sense of urgency,” he added.

At least there should be. Unions’ power has been curbed in recent years by a broad campaign to restrict collective bargaining and impose right-to-work legislation. The effort to enact comprehensive immigration reform, one of the labor movement’s top priorities, has been stalled since the summer of 2013; Obama’s decision to punt on the issue until after the midterms incensed labor leaders and has the potential to trim turnout. Looking ahead, many labor leaders aren’t particularly enthused about the potential presidential candidacy of Hillary Clinton, with concerns that the former New York senator is too close to Wall Street spurring a push for a populist candidate like Elizabeth Warren.

Trumka said he saw positive momentum for pro-labor candidates like Alison Lundergan Grimes, the Democratic Senate candidate in Kentucky. But he was circumspect about his predictions for November. “It’s going to be an interesting election,” he said. “We have our work cut out for us.”

TIME ebola

Meet a Disease Detective Hunting Ebola in Dallas

Alex Altman for TIME

A small team of epidemiologists is leading the fight to stem the spread of Ebola in Dallas

Matt Karwowski is a disease detective. That’s what the Centers for Disease Control and Prevention (CDC) calls the tiny team of epidemic intelligence officers dispatched to stem the spread of the Ebola virus in Dallas. You won’t see him on television, and you’ve never heard his name, but at this moment, Karwowski and his colleagues are the most important sleuths in the country.

As Thomas Eric Duncan was diagnosed with Ebola on Sept. 30, Karwowski was scrambling to pack up his gear and hop a plane from Atlanta. Since arriving that night, he’s spent 18-hour days zigzagging through north Dallas, tracing Duncan’s spiderweb of contacts. One of four CDC disease detectives roaming the community, he was assigned at the outset to tackle the high-priority cases: the handful of people at the greatest risk of getting sick.

That means knocking on doors at the Ivy Apartments, where four of Duncan’s family members are under quarantine, sleeping in the living room as they waited days until a cleaning service finally collected the infectious sheets the patient slept on. It means visiting the medical professionals who may have been exposed to the virus while treating or transporting Duncan. It means explaining containment techniques to frightened parents, and helping to pass out crayons and coloring books to soothe a child who’s too young to know what’s happening but old enough to sense his family’s fear.

Karwowski is what’s known in the medical community as a contact tracer. It is the shoe-leather process of canvassing all the people who may have encountered the virus, a job that is part medicine, part social work and part investigator. “The whole idea with contact tracing is to interrupt the chain of transmission,” says Karwowski, 34, who spoke to TIME at Texas Health Presbyterian hospital, in the first interview granted by a member of the CDC’s contact tracing team in Dallas. “I can’t characterize how important this is.”

Beginning with the patient, the tracers in Dallas divided into teams—usually one CDC detective and one county or state-level tracer—to map the contours of the community’s contact with Ebola. Their task is to identify the people who encountered Duncan while he was sick, and conduct interviews to find the next links in the chain of human contact. Then they locate those people and interview them. The process unfolds in concentric circles, with the original patient at the center. Once the tracers piece together the full network, they conduct daily check-ups to monitor symptoms, take temperatures, answer questions and allay fears. Then rinse and repeat for 21 days, the virus’s incubation period.

Contact tracing may sound simple, but it’s the linchpin in the U.S. government’s strategy to stop the spread of Ebola. As scary as it may seem, there are few ways to prevent the virus from arriving stateside. Experts are leery of cutting off flights from stricken West African countries, because doing so would prevent health workers from snuffing the outbreak at its source. The U.S. can’t stop patients incubating the virus from boarding those planes, because there’s no way to screen for it effectively; Ebola can’t be detected in the blood until its symptoms erupt. So health experts rely on contract tracing, which contained the spread of the virus in Nigeria and Senegal. “Contact tracing is a core public health function,” said CDC director Dr. Thomas Frieden. The CDC believes the method can “stop the virus in its tracks.”

The CDC’s 10-member team in Texas is led by Dr. David Kuhar, a senior epidemiologist and infectious-disease specialist. In total, it has three senior scientists specializing in infection control, a communications officer, a public health adviser, and five epidemic intelligence officers like Karwowski. The community contact-tracing operation is led by Dr. Stephanie Schrag, a top epidemiologist, and also includes other young disease detectives like Charnetta Smith and Michelle Chevalier, both OB/GYNS. “I think it’s really every young medical epidemiologist’s dream to have this kind of experience,” Karwowski says.

He may seem an unlikely choice to pull the assignment. Originally a pediatrician, Karwowski joined the CDC on July 1. This is not just his first encounter with Ebola; it’s his first field deployment. On Sept. 1, he was assigned to a month-long rotation at the agency’s emergency operations center in Atlanta, crunching data alongside hundreds of staffers working with the CDC’s response to the outbreak in West Africa. On the final afternoon of the rotation, as word broke that Duncan was positive for the virus, Karwowski got the call that he was headed to Dallas. “He is a mature and experienced clinician,” explains Dr. Stephanie Bialek, an epidemiologist helping to lead the CDC’s Ebola response, who says Karwowski was selected in part for his “high level of diplomacy” and communication skills.

Though new to the job, he seems suited to the role. Slim and soft-spoken, with short brown hair and stylish glasses, Karwowski has the kind of calm, empathetic quality that you’d expect to forge trust in a frantic setting. “You want to make sure you develop a good relationship with the contacts,” he says. “You approach them with cultural sensitivity. You want to make sure to develop good rapport, that you convey the impression that you truly are there to safeguard them and the community. That’s a critical portion of contact tracing.” On the job, he wears normal clothes—chinos and a button down. It’s hard to get people to trust you when you greet them in a medical moon suit.

Trust is key, because contact tracing only works if the contacts tell the truth. Eliciting information became a harder task this week, when local officials chose to place four of Duncan’s family members under quarantine. The prospect of being penned up inside for three weeks might dissuade potential contacts from coming forward with information.

“It definitely weighs into the equation,” Karwowski says. “We have to be very sensitive to the message that [quarantine] sends, and make sure that we are communicating why this decision was made, so that folks who are potential contacts are honest with us when we ask them questions about their exposure history. So that they understand that we are not doing this with the intention of putting them into quarantine, but so that we can put an end to this.”

Since they’re asymptomatic, and therefore not contagious, the people being monitored for Ebola are permitted to circulate in their neighborhoods as usual. They’re exhibiting all the emotions you’d expect: concern and confusion and even some chagrin. “They’re not just scared about getting Ebola,” Karwowski says. “They’re scared about how they’re perceived by the community, what it’s going to be like to reenter the community when it’s all over. They’re worried for their children.” People in Dallas are understandably concerned, and the media spotlight has magnified the crisis, making it harder for the epidemiologists and perhaps more likely for locals to shun the afflicted.

The job is grueling for the disease detectives as well. The old saw around the CDC is that the fight against Ebola is a marathon, but at this point in the marathon it’s a sprint. Karwowski is preparing for a two- or three-week deployment that could stretch on longer. More disease detectives will cycle in as the CDC, county and state health officials conduct the painstaking work. Karwowski, who has a wife and two young sons, calls home in his few moments of respite. Asked by a reporter of what the situation was like for his family, he choked up.

“We’re going to be able to contain” Ebola, he promises. But that doesn’t mean there won’t be more cases. “I hope there isn’t,” he says, but “I wouldn’t be surprised if there was.”

TIME ebola

Dallas Hospital Scrambles to Explain Initial Release of Ebola Patient

A hospital staffer walks up to the emergency room at Texas Health Presbyterian Hospital, Oct. 1, 2014 in Dallas.
A hospital staffer walks up to the emergency room at Texas Health Presbyterian Hospital, Oct. 1, 2014 in Dallas. G.J. McCarthy—Dallas Morning News/Corbis

Hospital says patient did not acknowledge being around anyone ill in Africa

The Dallas hospital treating Thomas Eric Duncan, the first diagnosed case of Ebola in the U.S., suggested Thursday night that a technical flaw contributed to the decision not to admit Duncan on his first visit despite his declared history of travel to West Africa.

Under pressure for its role in potentially exposing scores of Americans to the deadly virus, the hospital said in a statement that a flaw in its electronic health-records system prevented the doctor attending Duncan from seeing that he had recently traveled from Liberia, which was noted by the nurse who screened him.

“Protocols were followed by both the physician and then nurses,” the hospital said, adding that the system, designed to help nurses administer flu vaccines, prevented the note on Duncan’s travel history from automatically appearing for the doctor.

The hospital said it would amend the system to highlight whether patients had traveled to Ebola-stricken regions. “We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola,” the statement said.

The statement comes as the hospital faces criticism for its decision not to immediately admit Duncan late on the night of Sept. 25, when he arrived with a 100.1°F fever, complaining of abdominal pains and experiencing decreased urination. Three days later, Duncan returned to the hospital far sicker, and was placed in isolation as a possible Ebola case. He tested positive for the virus on Sept. 30.

The hospital’s decision broadened the pool of people who may have come into contact with the virus. Federal, state and local officials are now assessing about 100 people for possible direct or indirect contact with Ebola. At least four people with direct contact with Duncan have been quarantined in their apartment by order of Texas state officials.

Facing criticism, the hospital in its statement defended its actions, noting that Duncan’s symptoms were “not severe” on his initial visit and “could be associated with many” other afflictions.

The hospital also seemed to be scrambling to cast some blame on Duncan. “When Mr. Duncan was asked if he had been around anyone who had been ill, he said that he had not,” the hospital said. Duncan is thought to have contracted the virus while aiding an Ebola patient in Liberia shortly before embarking on his trip to the U.S. on Sept. 19.

TIME ebola

4 People Quarantined Over Ebola Fears, About 100 More Being Assessed

But health officials are reminding the public Ebola is extremely difficult to spread

Updated 3:08 p.m. ET

Health officials in Dallas were assessing about 100 people for possible contact with the Ebola virus Thursday, while four family members of the Texas hospital patient diagnosed with the disease were placed under quarantine Wednesday night to stem its potential spread.

Thomas Eric Duncan’s close family members, who spent time with Duncan in an apartment near the north Dallas hospital where he is now battling the virus, received hand-delivered orders from Texas and Dallas County officials not to leave the apartment or to receive visitors without approval until at least Oct. 19, the end of the virus’s 21-day incubation period.

The order was given after health officials grew worried about their ability to carry out necessary monitoring of the family members, which includes twice-daily check-ups to take the individuals’ temperatures. Dr. David Lakey, commissioner of the Texas Department of State Health Services, cited “concern about our ability to be confident that monitoring was going to take place the way we needed it to take place.” The order is being enforced by a law enforcement official stationed outside the apartment.

The quarantined family members have taken rudimentary measures to prevent themselves from exposure to the disease, including placing Duncan’s bedding and clothing in a trash bag, said health officials. The officials said they have been working to arrange a professional cleaning service for the family, which is receiving deliveries of groceries.

“There is no perfect response,” said Dallas County Judge Clay Jenkins. “People are doing their best here.”

Duncan remains in “serious” condition, according to a spokesperson for the hospital, Texas Health Presbyterian. He is being kept in a private ward under the care of top doctors. Duncan has access to a phone to communicate with family members, but is not allowed to receive visitors. Operations elsewhere in the hospital are unaffected.

The number of people being assessed for Ebola symptoms swelled overnight as local, state and federal officials scrambled to compile a list of anyone who had immediate or indirect contact with Duncan, the first person to develop Ebola in the United States. None of the people being monitored have exhibited any signs of the virus.

Of the roughly 100 people on the list of individuals being assessed for possible contact with the virus, only a “handful” are thought to have had potential exposure, said Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention (CDC). There are no plans to isolate additional people, officials said.

Health officials will use a technique known as contact tracing to identify the circle of people who are potentially at risk. It involves finding everyone who came into close contact with the patient and then interviewing them to identify additional potential contacts, who are subsequently tracked down and interviewed themselves. This form of shoe-leather epidemiology will continue until officials are confident that no one is at risk for contracting or spreading the virus, health officials said.

Compiling a list of possible contacts is the preliminary phase of a technique known as contact tracing. The contact tracing will be carried out by a team of five epidemiologists with the Centers for Disease Control and Prevention (CDC) in concert with county and state health officials. The process involves both phone calls and in-person visits, during which interviews are conducted and possible contacts are provided with information about the virus and informed about best practices to prevent its spread. Health officials will check in with those contacts daily to monitor for symptoms of the virus, which include high fever, severe headache, vomiting and diarrhea.

It is no surprise the tally of possible contacts has grown. Health officials are casting a very wide net, and the number of people on the list of possible contacts is expected to shrink dramatically as the investigation continues and contacts are divided into high-risk, low-risk and no risk categories, health officials said.

The majority of people being monitored did not necessarily have contact with Duncan himself, but rather with someone who Duncan encountered. “No one is symptomatic as of yet,” said Erikka Neroes, a spokeswoman for Dallas County Health and Human Services, “either in the first group or that second group.” Apart from the four family members under quarantine, all the people being monitored are able to move freely. Ebola is not contagious until a person shows symptoms of the virus.

Health officials are not ruling out the possibility that more Ebola cases will emerge, but they say they are confident in their ability to contain the situation. While extremely deadly, Ebola is difficult to transmit. It is communicated through bodily fluids like vomit or blood, but cannot travel through the air.

“The bottom line here is we remain confident that we can contain any spread of Ebola within the US,” said Frieden. Still, he added, “there could be additional cases.”

TIME ebola

Mistake Led to Ebola Patient’s Initial Release

Texas Hospital Patient Confirmed As First Case Of Ebola Virus Diagnosed In US
A general view of Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on Sept. 30, 2014 in Dallas. Mike Stone—Getty Images

Texas officials are scrambling to trace Ebola patient's contacts after he was sent home from the hospital

Updated 7:45 p.m. Wednesday

The Dallas hospital patient who has tested positive for Ebola virus indicated on his first visit that he had traveled to the city from West Africa, but was released after that information was not communicated to the entire medical team who treated him.

The patient first arrived at Texas Health Presbyterian Hospital in Dallas late on Sept. 25, complaining of a fever and abdominal pains, hospital officials said at a news conference. A nurse administered a checklist, on which the patient indicated that he had recently traveled from Liberia. Nevertheless, the hospital sent him home.

“The overall clinical presentation was not typical at that point yet for Ebola,” said Dr. Mark Lester, vice president and zone clinical leader with Texas Health Resources, noting that the patient lacked some traditional hallmarks of the disease, which include vomiting and diarrhea. “Regretfully, that information was not fully communicated throughout the full team.”

The patient, who was confirmed Tuesday as the first direct case of Ebola on U.S. soil, was re-admitted two days later and placed immediately in isolation. On Wednesday, the hospital said he was in serious but stable condition. He is being held in a private ward under round-the-clock care.

The Associated Press, citing the patient’s sister, reported that his name was Thomas Eric Duncan. Local officials would not confirm the report in accordance with patient confidentiality requirements.

In a statement Wednesday afternoon, United Airlines said the Centers for Disease Control and Prevention (CDC) told the airline the patient flew two legs of his flight from Liberia to Dallas on Sept. 20 United flights, one from Brussels to Washington, D.C., and then from Washington to Dallas-Fort Worth. The director of the CDC said there is “zero risk” of any Ebola transmission to anybody who was traveling on either flight.

The patient’s initial release will raise questions about whether the miscommunication between hospital staff may have increased the chance of additional people becoming infected. Local, state and federal officials have launched a broad effort to trace the contacts made by the patient between the time he began suffering symptoms and his second trip to the hospital, on Sept. 28.

“This is all hands on deck,” Texas Governor Rick Perry said, flanked by a battery of doctors and political officials.

Dr. Christopher Perkins, Dallas County Health and Human Services Medical Director, said 12 to 18 people were being monitored after possibly coming into contact with the sick patient. Of that number, five were members of his immediate household and five were school-aged children.

Mike Miles, the superintendent of the Dallas Independent School District, said the children may have come into contact with the patient over the weekend. The children are being kept out of school, but attended earlier this week, Miles said. None of the potential contacts are currently being quarantined.

The ambulance workers who transported the Ebola patient on his second trip to the hospital are in isolation as a precaution. The hospital is still deciding what precautions to take with the medical staff who had contact with the patient. “Contact and exposure are not the same,” said Dr. Edward Goodman, an epidemiologist at the hospital, who stressed that there was little likelihood that anybody at the hospital has been exposed.

Officials cautioned the public not to panic. While deadly, Ebola is not easy to transmit. It is passed on through contact with bodily fluids, such as blood or vomit, but it cannot be transmitted through the air. Patients carrying Ebola are not contagious unless they are presenting symptoms of the disease.

This story has been updated to reflect new information about the patient’s trip to Dallas and the timing of his visit to the hospital.

TIME 2014 Election

How 2014 Became the ‘Gotcha’ Election

Bruce Rauner
Illinois Republican gubernatorial candidate Bruce Rauner speaks at an event where he was endorsed by a group of African American ministers on Sept. 22, 2014, in Chicago. M. Spencer Green—AP

"Fowl play" could decide the fate of the Senate

The story starts with chickens.

Last spring, four hens wandered from an adjacent property onto the lawn of Iowa Democratic Rep. Bruce Braley’s lakeside vacation home. Irked by the smell, the Braleys brought the issue to the local homeowners’ association, whose lawyer got involved. No lawsuit was filed, and the neighborly squabble might have ended there—were it not for an enterprising Republican researcher who caught wind of the dispute.

To the GOP, the chickens were a gift. Republicans were looking for ways to attack the character of Braley, the early front-runner in the fight for the Iowa Senate seat being vacated by Democrat Tom Harkin. In short order, the GOP had built a website chronicling the Great Chicken Affair. Operatives handed out giveaway rubber-chicken stress balls to visitors at the Iowa State Fair. The conservative Super PAC American Crossroads cut a Web ad tweaking Braley’s brusqueness. “A true Iowan would have just talked to his neighbors, but not trial lawyer Bruce Braley,” the ad crowed.

The episode cemented a storyline Republicans had been pushing for months: that Braley might be something of a litigious jerk. The suggestion was sparked by an earlier opposition-research score—a video, captured by a conservative tracker, in which Braley questioned whether the state’s Republican Senator, Charles Grassley, would be a suitable Senate Judiciary Chairman given his lack of a law degree. Knocked off kilter, the Democrat’s campaign hasn’t fully recovered: Braley, once a strong favorite, has fallen behind GOP challenger Joni Ernst in recent polls.

Fowl play can make the difference in a close election, and in 2014, it might even determine who controls the Senate. Like Iowa, many of the country’s most important races have been dominated by an emphasis on petty issues and an absence of substantive policy debates. In an election about nothing, one of the dark arts of campaign combat—opposition research, or “oppo” in political parlance—has taken center stage.

Opposition research has become “a lot more important,” says Jeff Patch, the freelance researcher who broke the story of the stray chickens, and who has since become the communications director of the Iowa GOP. “It’s increasingly the way that tech and media play a role in campaigns.”

Growing armies of opposition researchers, employed by campaigns, the two parties and their allies, have exploited a diminished media’s appetite for dishy stories by feeding reporters tips that reshape close contests. It can be hard to determine which hits are the result of journalistic spadework and which are uncovered by outside mercenaries. But many of the most consequential revelations this year have oppo written all over them.

Montana Democratic Sen. John Walsh dropped his re-election bid after the New York Times revealed he had plagiarized sections of a paper he wrote at the U.S. Army War College. Plagiarism allegations have also rocked the campaign of Mary Burke, the Democratic gubernatorial candidate in Wisconsin. And they dinged GOP Senate candidate Monica Wehby, who also had to fend off a story that surfaced—with the help of a Democratic researcher—alleging she had “stalked” an ex-boyfriend. (No charges were filed in that incident.)

In Illinois, GOP gubernatorial candidate Bruce Rauner has wrestled with the revelation that he belongs to an exclusive wine club which costs up to $150,000 to join. In Georgia, Democratic Senate candidate Michelle Nunn was the victim of a leaked memo laying out the campaign’s political calculations in all their clinic ugliness.

In Louisiana, Democratic Sen. Mary Landrieu was the subject of a Washington Post investigation that noted she didn’t own a residence in the state and crashes with her parents on trips home. Similarly, the New York Times revealed that Kansas Republican Sen. Pat Roberts lives in Virginia and shacks up with a donor when he visits. Roberts managed to escape his primary with the help of an oppo hit that noted challenger Milton Wolf, a radiologist, had posted dead patients’ X-rays on Facebook.

Opposition research has been a “growing force” in national politics for some time, says political expert Norm Ornstein, a resident scholar at the American Enterprise Institute. “My guess is it seems more visible now because we have so many high-stakes, high-profile Senate races out there,” Ornstein says. “And because you have no shortage of incumbents who do bonehead things.”

Credit also goes to rival partisan research shops that were formed to fight in the trenches of oppo warfare. On the left, the dominant player is American Bridge 21st Century, a super PAC founded in 2010 by the liberal activist David Brock. In the 2014 cycle, American Bridge has an $18 million budget, which pays for 44 trackers in 41 states, plus more than 20 researchers in the group’s Washington office. It has caught Rauner on video opposing the minimum wage, captured Louisiana Republican Sen. David Vitter extolling the billionaire Koch brothers, and documented Michigan Senate candidate Terri Lynn Land arguing that women are “more interested in flexibility in a job than pay.”

“American Bridge has been at the forefront of using research and tracking to define Republican candidates,” says spokesman Jesse Lehrich. “As we have demonstrated time and time again, our extensive archive of video footage and army of researchers are here to ensure that Republicans from Terri Lynn Land to Bruce Rauner to Rand Paul are no longer able to hide.”

On the right, the top practitioner is a for-profit research firm called America Rising, which was created after the 2012 election by three top Republican operatives, including Mitt Romney’s campaign manager. Modeled partly after American Bridge, its goal was to close the oppo edge Democrats enjoyed in 2012 while amassing a research archive that could inform the party’s advertising campaigns.

The group has more than 30 researchers in its northern Virginia headquarters and nearly as many trackers roaming the country. Among its oppo hits this cycle are the original Iowa “lawyer” clip that created the Braley narrative and Senate Majority Leader Harry Reid’s off-color remarks about Asians. But its larger project, says America Rising PAC’s executive director Tim Miller, has been to build an opposition-research database that campaigns and super PACs can harness in ads and on the stump.

“You can hit gold on some of these opposition research hits, like we did with Braley, and have it be very impactful in the races,” Miller says, but “there’s a whole ‘nother level of work we’re spending a lot of time on, which is trying to make the paid media more dynamic.”

It’s no coincidence that the role of opposition research has increased as media outlets scale back their resources, and amid the constant churn of a 24-hour news cycle that covets juicy controversy over dry policy debates. With fewer reporters able to comb through transcripts or attend obscure events, outside mercenaries dig through through public records and feed scraps to eager journalists. American Bridge, for example, has filed more than 1,100 records requests this cycle.

This was the void that Patch, a freelance reporter turned party flack, was filling when he filed the chicken scoop. He got a tip, hopped in his car and drove to the Braleys’ vacation house on Holiday Lake in Brooklyn, Iowa. It took parts of three days on the ground for Patch to talk to canvass neighborhood residents, obtain relevant documents, and post his story on the website of The Iowa Republican. In many ways, it was basic journalism—and it offers a glimmer of hope that journalists can steer the political conversation back to more substantive matters.

But don’t count your chickens.

TIME 2014 Election

GOP Dubs Democrats the Party of the Rich in 2012 Turnabout

Hillary Clinton gives a speech at the 37th Harkin Steak Fry in Indianola, Iowa on Sept. 14, 2014. ; Mitt Romney speaks to supporters at an election-night rally on April 3, 2012 in Milwaukee, Wisconsin.
Hillary Clinton gives a speech at the 37th Harkin Steak Fry in Indianola, Iowa on Sept. 14, 2014. ; Mitt Romney speaks to supporters at an election-night rally on April 3, 2012 in Milwaukee, Wisconsin. Jim Young—Reuters/Corbis; Scott Olson—Getty Images

What worked against Mitt Romney is now being wielded against Democrats

Republicans are turning the Democrats’ own playbook against them.

Two years after Democrats held the White House by painting Mitt Romney as a callous plutocrat, the GOP is borrowing a page from the same populist playbook. In close contests around the country, Republicans are hoping to gain an edge in the battle for control of the Senate by hammering Democrats as the party of the rich.

In Iowa, the Republican Super PAC American Crossroads has run three TV ads this month highlighting Democratic Senate candidate Bruce Braley’s fundraising links to liberal billionaire Tom Steyer. In Colorado, another outside GOP group, American Commitment, slammed Democratic Sen. Mark Udall for the same ties. In Kansas, advisers to Republican Sen. Pat Roberts are attacking a wealthy independent challenger (who Democrats tacitly support) for insufficient financial disclosures, and are raising questions about his “business dealings in the Middle East and the Cayman Islands.”

Sound familiar? In 2012, Democrats cast Romney as a rapacious “vulture” capitalist who was cocooned in the C-suite and blind to the challenges buffeting the middle class. Perhaps the most memorable ad of the election cycle was a brutal takedown of Romney’s Swiss bank account and tax havens in Bermuda and the Caymans, all set to the former private equity executive’s off-key crooning of “America the Beautiful.” Senate Majority Leader Harry Reid pummeled Romney with unsubstantiated charges that he had used accounting gimmicks to skirt 10 years of tax payments.

The attacks succeeded. As political scientists John Sides and Lynn Vavreck wrote in their book The Gamble, in surveys conducted throughout the race voters described themselves as ideologically closer to Romney than to President Barack Obama. But some of them voted for Obama anyway. The caricature that Democrats created—reinforced by Romney’s own tone-deaf remarks—was part of the reason. Obama regularly trounced Romney on “empathy” polling questions, such as which candidate cares more about “people like me.” Among voters who cited this as the trait that mattered most in a President, Obama won in exit polling by a margin of 81-18.

The strategy worked well enough that Republicans have dusted it off and put it use themselves. The campaign team dispatched to rescue Roberts in Kansas has seized on the vast wealth of independent challenger Greg Orman as a potential liability. They have attacked Orman, a businessman whose campaign filings indicate he is worth up to $86 million, as “another millionaire politician” with ties to a tainted Goldman Sachs exec and a private-equity partnership in the Caymans. In normal times, a seven-figure income and affiliation with high-flying financiers are badges of honor in the party. In campaign season, they are cudgels.

The GOP is hardly the only team trotting out this attack. Democrats have made the lavish political spending of the billionaire Koch brothers a centerpiece of their national strategy. In races around the country, they are painting conservative candidates as pawns of the Kochs’ political empire. It’s not clear whether the tactic will work when half the country has never heard of them. But this year, Republicans have found a foil of their own. They’re elevating Steyer, a liberal billionaire who has pledged to fork over $50 million to candidates this year, as the Democrats’ own billionaire bogeyman. That’s why he’s showing up in ads in multiple states, and why the Republican Governors Association has created a website introducing voters to a man they dubbed “Steyer the Liar.”

The truth beneath all the rhetoric is that both parties are desperate to recruit wealthy donors and candidates alike. But in a nation with rising inequality and millions of anxious voters, pitchfork populism will remain a staple of both parties’ campaign playbook before and after the midterm elections. The early rumblings of the 2016 race have focused on Hillary Clinton’s wealth: her massive book advance, her family’s speaking fees, her spacious homes. The media spent a month this summer chewing over how a multimillionaire could consider herself “dead broke.” In national politics these days, everybody seems to be cashing in at the polls on someone else’s money.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser