TIME ebola

Governors Spar With Feds on Ebola Quarantine Policy

Andrew Cuomo, Chris Christie
New York Governor Andrew Cuomo, left, speaks as New Jersey Governor Chris Christie listens at a news conference, Oct. 24, 2014, in New York City Mark Lennihan—AP

Quarantine decision prioritizes politics over policy

The decision to impose a mandatory quarantine in New York and New Jersey for health care workers arriving from Ebola-stricken nations has opened a rift between the Obama Administration and the governors of those states.

Governors Chris Christie of New Jersey and Andrew Cuomo of New York on Friday ordered doctors and nurses returning to be isolated for 21 days, the incubation period for the lethal pathogen that has killed nearly 5,000 in Guinea, Liberia and Sierra Leone. That was just a day after New York City physician Dr. Craig Spencer, who had been volunteering at a Doctors Without Borders clinic for Ebola patients in Guinea, was diagnosed with the virus. He is in isolation at a Manhattan hospital. The first health worker quarantined under the new provision was the nurse Kaci Hickox, who landed at Newark Liberty International Airport on Friday and is being monitored at a Newark Hospital. She has tested negative for Ebola.

To the White House, the governors’ decision represents politics trumping public-health policy. With voters spooked by the specter of Ebola and supportive of tougher measures to prevent its spread, Cuomo and Christie say they are trying to assuage panic and protect the citizens of their states. But health officials say that health care workers who follow federal guidelines pose no threat to the public. And they worry that a mandatory quarantine will dissuade desperately needed medical personnel from volunteering to battle the virus at the source of the epidemic in West Africa.

The dispute simmered over the weekend, as Administration officials pressed the states to reverse the decision. “We have let the governors of New York, New Jersey, and others states know that we have concerns with the unintended consequences of policies not grounded in science may have on efforts to combat Ebola at its source in West Africa,” a senior Administration official tells TIME.

Christie and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, sparred over the policy on Fox News Sunday. Fauci, a top federal health official, defended the government’s existing protective protocols and argued that a forced quarantine for health care workers who pose a “vanishingly small” risk of transmitting the virus could be a disincentive to volunteers.

“The best way to protect us is to stop the epidemic in Africa, and we need those health care workers. So, we do not want to put them in a position where it makes it very, very uncomfortable for them to even volunteer to go,” Fauci said. “If we don’t have our people volunteering to go over there, then you’re going to have other countries that are not going to do it, and then the epidemic will continue to roar.”

But for the governors, science may be secondary to politics. Polls show that many voters, in the grips of Ebola panic, favor measures to restrict the possible spread of Ebola, even those — like a ban on travel to and from virus-stricken nations — that medical experts say would make things worse.

As a result, Christie and Cuomo stand to benefit from going beyond the safety guidelines set forth by the Centers for Disease Control and Prevention. So does Illinois Governor Pat Quinn, an embattled Democrat embroiled in a tough re-election fight, who also ordered a mandatory quarantine of health workers flying into that state.

Like Quinn, Cuomo is up for re-election on Nov. 4. His Republican opponent, Rob Astorino, has sought to harness the panic to gain ground, pummeling Cuomo’s preparation for the virus as “gross negligence.”

Christie is positioning himself for a possible White House run next year, and his advisers believe that his confrontational style of crisis management underscores his appeal to voters. Picking a fight with the feds over Ebola, even when the science doesn’t support his position, may be a way to resurrect the tactics that earned him bipartisan plaudits after Hurricane Sandy.

Appearing on the same program as Fauci, Christie defended the mandatory quarantine. “I don’t believe when you’re dealing with something as serious as this that we can count on a voluntary system,” he said. “The government’s job is to protect the safety and health of our citizens.”

Hickox, the nurse quarantined in New Jersey, wrote an essay for the Dallas Morning News on Saturday that slammed the decision. “We need more health care workers to help fight the epidemic in West Africa,” she wrote. “The U.S. must treat returning health care workers with dignity and humanity.” She has hired a lawyer, who has been cleared to visit her in the hospital. The American Civil Liberties Union has also inquired about the state’s legal right to quarantine her given her negative Ebola diagnosis.

In New York City, Mayor Bill de Blasio called the way that Hickox has been treated “inappropriate.”

— With reporting by Zeke J. Miller

TIME ebola

Ebola: World Bank Chief Calls for Health Workers in West Africa

World Bank President Dr. Jim Kim speaks to reporters in Washington about Ebola on Oct. 24 Michael Bonfigli—The Christian Science Monitor

Says thousands needed to stop the spread of Ebola

The global health community needs “thousands” more health-care workers in West Africa to tame the Ebola virus epidemic that has so far killed nearly 5,000 people, the president of the World Bank told reporters Friday.

Dr. Jim Yong Kim, chief of the international financial institution, said a lack of trained medical personnel in Guinea, Liberia and Sierra Leone is one of the main challenges hampering the international effort to control an outbreak that has ravaged three West African countries and risks spreading to its neighbors.

Kim said the global community has stepped up its response to Ebola, but conceded that the World Bank, like other international organizations, was late to recognize the severity of the epidemic. The spread of the virus in the three stricken nations at the heart of the epidemic has left healthcare workers in triage mode. As a result, they are often unable to use “the ideal techniques” for combating an epidemic, such as contact tracing—the process of identifying and isolating the contacts of infected patients.

“We are now on a war footing,” Kim said, “but it took us a long time to get there.”

Kim said that international organizations have ratcheted up levels of support to West Africa after a sluggish start, but said more must be done. “We’ve got to get beyond these sort of nihilists notions that nothing can be done,” he said. The World Bank has pumped $400 million into West Africa to fight Ebola.

Kim praised Dr. Craig Spencer, the physician who was diagnosed with Ebola Thursday night in New York City. Spencer contracted the virus while treating Ebola patients in Guinea as a volunteer for the international organization Doctors Without Borders, or Medicins Sans Frontieres.

“Dr. Spencer is a hero,” Kim said, urging more doctors to follow his lead and fight the epidemic at its source. He added that both the patient and city officials executed a textbook response to Spencer’s symptoms.

Kim said he hoped that the cases in Dallas and New York would help open the eyes of the world to a disease gutting large swaths of West Africa and prompt the global community to spring into action more quickly in the future. “I think this is a wakeup call,” he said, pausing slightly. “I hope this is a wakeup call.”

TIME Crime

What the Ferguson Leaks Tell Us About Michael Brown’s Death

Police face off with demonstrators outside the police station as protests continue in the wake of 18-year-old Michael Brown's death on Oct. 22, 2014 in Ferguson, Missouri.
Police face off with demonstrators outside the police station as protests continue in the wake of 18-year-old Michael Brown's death on Oct. 22, 2014 in Ferguson, Missouri. Scott Olson—Getty Images

A guide to the latest news from the Ferguson case and grand jury investigation

As a St. Louis County grand jury weighs whether to indict Ferguson, Mo. police officer Darren Wilson in the shooting death of Michael Brown, a series of leaks have provided new information about the skirmish that led to Brown’s death and ignited a national debate about race and police violence. A lot has happened since Brown died after a confrontation with Wilson on Aug. 9. Here’s a guide to making sense of it:

What’s new?

The St. Louis Post-Dispatch obtained Brown’s official autopsy report on Oct. 22, which indicates he was shot near the right thumb at very close range. Medical experts interviewed by the paper said the findings may support Wilson’s contention that Brown was reaching for the officer’s gun inside the police SUV where their original struggle occurred. A separate autopsy conducted for Brown’s family by Dr. Michael Baden, a well-known forensic pathologist, concluded that none of the teen’s wounds indicated he was shot at such close range.

Wilson told investigators that Brown punched him in the face through the open window of the vehicle, according to the Post-Dispatch. In Wilson’s version of events, the punch prompted him to draw his gun and Brown grabbed for it. As they struggled over the weapon, Brown was shot in the hand. According to Wilson, Brown then ran away from the vehicle, so the officer jumped out to give chase. Wilson reportedly told investigators that Brown defied the officer’s command to stop, then turned and ran at him, at which point Wilson fired the fatal shots.

According to the Washington Post, “a half-dozen unnamed black witnesses” have provided testimony to the grand jury that supports Wilson’s version of events. Brown’s blood was found on the gun, on Wilson’s uniform and spattered on an inside door panel of the car, according to the New York Times. Other witnesses have provided divergent accounts of the incident, alleging that Brown was shot with his hands in the air or while fleeing. Protesters pictured with their hands-up became one of the iconic images of the unrest that wracked Ferguson in the weeks after Brown’s death.

What’s not?

In many ways, the leaks amplify what we already knew. From the beginning, the Ferguson police department has said publicly that Wilson shot Brown after the teen instigated a struggle in the SUV that made the officer fear for his safety. Independent witnesses have said there was a scuffle, though they differ on whether it happened in or near Wilson’s vehicle. Apart from detailed forensic information about Brown’s wounds, the autopsy includes a toxicology report indicating the presence of marijuana in Brown’s system. Previously released surveillance video shows Brown stealing a pack of Swisher Sweets, cheap cigars that are commonly used to roll blunts, from a convenience store shortly before the altercation with Wilson. But that incident had nothing to do with the confrontation, which occurred after Wilson ordered Brown and a friend to move onto the sidewalk as they walked down the middle of a street.

How important is this information?

The details of the struggle in the SUV matter. In Missouri, as elsewhere, a police officer has wide latitude to use deadly force if he has justifiable reason to feel his life is in danger. If forensic information and witness testimony support Wilson’s account that Brown grabbed for his gun, the grand jury—or, in the event of an indictment, a trial jury—would ostensibly be more likely to determine that the use of force was justified.

What don’t the leaks tell us?

They don’t explain the origin of the skirmish, which seems to have escalated abruptly. In describing the toxicology report, the Post’s sources say “the levels in Brown’s body may have been high enough to trigger hallucinations,” but there is no scientific link between marijuana and violent behavior.

Most importantly, the leaks do not provide new forensic information about the sequence of fatal shots. “What we want to know is why Officer Wilson shot Michael Brown multiple times and killed him even though he was more than 20 feet away from his patrol car,” Benjamin Crump, an attorney for Brown’s family, said in a statement. “This is the crux of the matter!” The autopsy does not offer any answers.

What’s going on with the grand jury?

Robert McCulloch, the St. Louis County prosecuting attorney, has said that he expects the deliberations to wrap up this month or next. The grand jury process has been unusual in a number of ways, as TIME reported last month.

Prosecutors declined to recommend a specific charge for Wilson, which is rare. Instead, they are presenting evidence as it becomes available, and allowing the grand jury members to determine whether it warrants charges of murder or manslaughter. (There are two options for each charge: first- or second-degree murder; and voluntary or involuntary manslaughter.)

All testimony in the case is being transcribed, which is unusual because it exposes witnesses to future legal proceedings. McCulloch has delegated the task of presenting evidence to two attorneys in his office in an attempt to neutralize allegations that he lacks objectivity. (McCulloch’s father, a police officer, died in the line of duty, and African Americans have criticized his handling of past police shootings.) In another rare move, McCulloch has pledged to immediately release transcripts of the proceedings. According to the prosecutor’s office, these decisions were made in the interest of transparency, though it may also be an attempt to head off criticism in the event that the grand jury declines to indict Wilson.

Is there a motive for the leaks?

It’s a criminal act to leak information about grand jury proceedings, so the number of leaks the investigation has sprung in recent days is conspicuous. The Department of Justice, which is conducting its own inquiry into the shooting, has condemned the trickle of information.“There seems to be an inappropriate effort to influence public opinion about this case,” it said on Oct. 22.

The leaks have also raised questions about whether sources connected to the investigation are spreading this information to prepare the community for the possibility that the grand jury declines to indict. The information that has leaked suggests the likelihood of that may be greater than protesters realize.

How is Ferguson reacting?

The daily demonstrations are ongoing. Protests tapered off in the weeks after Brown’s death, but the Oct. 8 killing of Vonderrit Myers, a black 18-year-old shot by an off-duty St. Louis police officer, rekindled the community’s fury. (Cops say Myers fired at the officer first; forensic evidence released by the police department, including lab results that reportedly show gunpowder residue on Myers’ hand and in the waistband of his jeans, appear to corroborate that version of events. Myers’ family says they believe he was unarmed.)

Thousands of people massed in St. Louis in mid-October for coordinated protests following Myers’ death. There were some arrests and sporadic clashes between demonstrators and law enforcement, but nothing on the scale of the August riots. But it was enough to upset the fragile peace that had set in during September and on Oct. 21, Missouri Gov. Jay Nixon announced the formation of a commission to address issues like race relations.

The recent autopsy and other leaks have fanned the flames in Ferguson. That anger is likely a mere preview of how the community will react if Wilson is cleared. “If there is no indictment,” said one protester, “all hell is going to break loose.”

Read next: Mourning Ferguson

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.”

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