TIME ebola

Why Ebola Isn’t Really a Threat to the U.S.

Ebola will not likely spread within the United States

Give us this—when Americans overreact, we do it all the way. Over the past week, in response to fears of Ebola, parents in Mississippi pulled their children out of a middle school after finding out that its principal had traveled to Zambia—a nation that is in Africa, but one that hasn’t recorded a single Ebola case. A college sent rejection notices to some applicants from Nigeria because the school wouldn’t accept “international students from countries with confirmed Ebola cases”—even though Nigeria has had less than 20 confirmed cases and the outbreak is effectively over.

The American public is following its leaders, who’ve come down with a bad case of Ebola hysteria. That’s how you get even-tempered politicians like New York Governor Andrew Cuomo musing that the U.S. should “seriously consider” a travel ban on West African countries hit by Ebola, while some of his less restrained colleagues raise the incredibly far-fetched possibility of a terrorist group intentionally sending Ebola-infected refugees into the U.S. It’s little surprise that a Washington Post/ABC News poll found that two-thirds of Americans are concerned about an Ebola outbreak in the U.S.

They shouldn’t be—and two events that happened on Monday show why. WHO officials declared Nigeria officially “Ebola-free.” And in Dallas, the first wave of people being monitored because they had direct contact with Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., were declared free of the diseases.

Nigeria matters because the nation’s is Africa’s most populous, with 160 million people. Its main city, Lagos, is a sprawling, densely populated metropolis of more than 20 million. Nigeria’s public health system is far from the best in the world. Epidemiologists have nightmares about Ebola spreading unchecked in a city like Lagos, where there’s enough human tinder to burn indefinitely.

Yet after a few cases connected to Sawyer, Nigeria managed to stop Ebola’s spread thanks to solid preparation before the first case, a quick move to declare an emergency, and good management of public anxiety. A country with a per-capita GDP of $2,700—19 times less than the U.S.—proved it could handle Ebola. As Dr. Faisal Shuaib of Nigeria’s Ebola Emergency Operation Center told TIME: “There is no alternative to preparedness.”

But Nigeria’s success was also a reminder of this basic fact: If caught in time, Ebola is not that difficult to control, largely because it remains very difficult to transmit outside a hospital. For all the panic in the U.S. over Ebola, there has yet to be a case transmitted in the community. The fact that two health workers who cared for Duncan contracted the disease demonstrates that something was wrong with the treatment protocol put out by the Centers for Disease Control and Prevention (CDC)—something CDC Director Dr. Tom Frieden has essentially admitted—and may indicate that the way an Ebola patient is cared for in a developed world hospital may actually put doctors and nurses at greater risk.

“You do things that are much more aggressive with patients: intubation, hemodialysis,” National Institute of Allergy and Infectious Diseases head Dr. Anthony Fauci said on CBS’s Face the Nation on Sunday. “The exposure level is a bit different, particularly because you’re keeping patients alive longer.” But now that U.S. health officials understand that additional threat, there should be less risk of further infection from the two nurses who contracted Ebola from Duncan—both of whom are being treated in specialized hospitals.

Even the risk of another Duncan doesn’t seem high. For all the demand to ban commercial travel to and from Ebola-hit West Africa, this region is barely connected to the U.S. in any case. Only about 150 people from that area of Africa come to the U.S. every day—less than a single full Boeing 757—and many airlines have already stopped flying. But there have been relatively few spillover cases even in African countries that are much more closer and more connected to Guinea, Sierra Leone and Liberia. Besides Nigeria, only Senegal has had cases connected to the West African outbreak—and that nation was declared Ebola-free today as well. (There have been cases in the Democratic Republic of Congo, but that’s considered a separate outbreak.) The worst Ebola outbreak ever is raging in three very poor nations—but it seems unable to establish itself anywhere else.

None of this is to deny the scale of the challenge facing Guinea, Sierra Leone and Liberia, where the Ebola has fully taken hold and the disease is still outpacing our efforts to stop it. But West Africa is where our fear and our efforts should be focused—not at home, where Ebola is one thing most of us really don’t have to worry about.

TIME ebola

Ebola Vaccine Testing Could Start Soon

WHO hopes for clinical trials to begin in January

An Ebola vaccine could begin testing in the next few weeks and be ready for clinical trials in West Africa by January, the World Health Organization announced Tuesday.

Still, questions remain about when the drug may be available for the public at large and how many doses will be available, according to CNN.

“It will be deployed in the form of trials,” said WHO official Marie Paule Kieny, noting the number of available trials would be in the tens of thousands, not millions.

Initial tests will be available in countries like the United States and England before moving to West Africa, CNN reported.

Currently, there is no vaccine for Ebola, which has killed more than 4,500 people, almost entirely in West Africa, in the latest outbreak. Health officials have been working on a vaccine for years, and now have expedited their efforts in the face of the current crisis.

[CNN]

TIME ebola

CDC Changes Ebola Guidelines

CDC EBOLA TRAINING
Licensed clinician Hala Fawal practices drawing blood from a patient using a dummy on Monday, Oct. 6, 2014, in Anniston, Ala. Brynn Anderson—AP

Now recommending full-coverage for health care workers

Health care workers treating Ebola patients must now wear full-body coverage suits with no skin showing and must undergo significant training prior to treating patients, U.S. health officials said Monday.

“We may never know exactly how [the Dallas infections happened], but the bottom line is the guidelines didn’t work for that hospital,” Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC), said during a news conference announcing the new guidelines for caring for Ebola patients and wearing personal protective equipment (PPE). Prior to the three Ebola infections in Dallas, including two health care workers, the CDC did not recommend full body coverage for Ebola, but instead recommended at least gloves, a gown, eye protection and a face mask. That has changed, in light of the two health care worker infections at Texas Health Presbyterian Hospital.

The new guidelines have three additions:

1. Prior to working with Ebola patients, health care workers must be repeatedly trained and demonstrate competency in treating a patient with Ebola, especially putting on and taking off PPE. “Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment,” the CDC said in a statement.

2. When wearing PPE, no skin can be exposed. The CDC is providing two options for the PPEs, since the University of Nebraska Medical Center and Emory University Hospital, which have both successfully treated Ebola patients, use different versions. Googles are no longer recommended. The recommendations for PPE are now the following:

  • Double gloves
  • Boot covers that are waterproof and go to at least mid-calf or leg covers
  • Single use fluid resistant or imperable gown that extends to at least mid-calf or coverall without intergraded hood.
  • Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
  • Single-use, full-face shield that is disposable
  • Surgical hoods to ensure complete coverage of the head and neck
  • Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea

3. Every step of putting on and taking off PPE must be supervised by a trained observer. There should also be designated areas for where PPE are taken on and off.

“It’s hard to care for Ebola, so every aspect… needs to be overseen,” said Frieden in the press conference, adding that hospitals should limit personnel in health care rooms and should limit procedures to only those that are essential.

The CDC is increasing health care worker training across the country as well as sending out training videos, but Frieden argues that there is no alternative for hands-on training, especially taking on and off PPEs. “We agree with the concern of health care workers,” said Frieden citing anxiety from health care workers nationwide that they felt unprepared for treating patients with Ebola. The new recommendations will be effective immediately, though the CDC does not have the regulatory authority to make hospitals follow the guidelines, Frieden said. The recommendations should be available online later Monday evening.

Earlier on Monday, a Dallas County Judge confirmed that 43 of 48 contacts of Thomas Eric Duncan were considered no longer at risk after the 21-day incubation period passed, and Nigeria was declared Ebola-free.

TIME Laws

The CDC Has Less Power Than You Think, and Likes it That Way

Ebola isn’t likely to lead to a widespread quarantine but it certainly raises interesting constitutional questions

Director of the Centers for Disease Control and Prevention Tom Frieden has come under fire in recent days for what some charge is the agency’s stumbling response to the appearance of Ebola in America. This week, reporters and lawmakers alike grilled Frieden over how two nurses in Texas contracted the virus and how one of them was able to board an airplane even after she reported a raised temperature.

Breakdowns in good practice notwithstanding, it’s important to remember that Ebola in the U.S. is largely contained and very unlikely to lead to any kind of significant outbreak. Still, the charges leveled against Frieden raise a question that leads to a surprisingly complicated answer: just what, exactly, can—and should—the CDC do?

Since time immemorial, public health officials’ main weapon against the outbreak of a disease as been to restrict the ability of people to interact with one another, also known as a quarantine. The term comes from the Latin “quadraginta,” meaning 40, and is derived from the 40-day period ships traveling from plague-stricken regions were kept at bay before being allowed to dock in medieval European ports.

Imposing a quarantine—effectively stripping innocent people of the most basic right to move freely in the world—is one of the most serious actions a government can take against its own citizenry. Partly for this reason, in the American federal system (designed from the outset to check the power of the national government) the power to quarantine resides largely with state and local authorities. Should Texas, or any other state, someday face the threat of a true epidemic, the states have broad authority to restrict the movement of people within their own borders. Public health codes granting the state power to impose quarantine orders vary from state to state, of course. Violating a quarantine order in Louisiana is punishable by a fine of up to $100 and up to a year in prison; in Mississippi the same infraction could cost a violator up to $5000 and up to five years in prison.

The federal government does have its own powers. The CDC, as the U.S.’s primary agency for taking action to stop the spread of disease, has broad authority under the Commerce Clause of the Constitution to restrict travel into the country and between states of an infected person or a person who has come in contact with an infected person, according to Laura Donohue, director of the Center on National Security and the Law at Georgetown Law School. Federal quarantine can be imposed, too, on federal property, like a military base or National Forest land. And as the preeminent employer of experts on public health crises, the CDC is always likely to get involved within any affected state in the event of a looming pandemic.

But its power to act is extremely restricted. The agency traditionally acts in an advisory role and can only take control from local authorities under two circumstances: if local authorities invite them to do so or under the authority outlined in the Insurrection Act in the event of a total breakdown of law and order.

And here the picture becomes murkier yet because authority does not always beget power.

“It’s not a massive regulatory agency,” said Wendy Parmet, a professor in public health law at Northeastern University in Boston. “They don’t have ground troops. They don’t have tons of regulators. They’re scientists. Even if the states asked them to do it it’s not clear how they would do it.

Even in the highly unlikely event that the CDC were called to respond to a—let’s reiterate: extremely-unlikely-to-occur—pandemic, quarantine and isolation would be imposed not by bespeckled CDC scientists but by local or federal law enforcement or troops. Most importantly, the CDC is extremely reluctant to be seen as a coercive government agency because it depends as much as any agency on the good will and acquiescence of citizens in order to respond effectively to a public health emergency. When the bright lights of the Ebola crisis are not on it, the CDC will still need people to get vaccinated, to go to the doctor when they get sick, and to call the authorities if they see trouble.

“Our public health system is built on voluntary compliance,” Donohue tells TIME. “If the CDC starts to become the enemy holding a gun to [someone’s] head and keeping them in their house, they lose insight.”

TIME

Here’s Who’s Blaming Who for Ebola

A guide to the Ebola blame game

Correction appended at 8:35 p.m. ET

The Ebola crisis in Texas has resulted in the death of one patient, the infection of two health care workers, and an endless round of finger-pointing—all of which is yielding a flurry of conflicting news accounts and a very confused public.

Here’s a rundown of who has been blaming who, and when.

The player: Centers for Disease Control and Prevention (CDC)
Who they’re blaming: Texas Health Presbyterian Hospital, an infected nurse, and the CDC itself

  • CDC Director Tom Frieden on Sunday blamed a “breach in protocol” for allowing the infection of nurse Nina Pham.
  • Frieden admitted on Tuesday the CDC could have done more: “We did send some expertise in infection control but think in retrospect, with 20-20 hindsight, we could have sent a more robust hospital infection control team, and been more hands on at the hospital on day one about exactly how this [case] should be managed. We will do that from now on any time we have a confirmed case.”
  • Frieden, commenting on the infection of the second nurse, Amanda Joy Vinson, said: “She should not have flown on [a plane].”
  • But a CDC spokesman later explained to TIME that the agency had actually asked Vinson to travel: As officials widened the net of people who needed to be monitored, Vinson was in Ohio and the CDC told her to go back to Dallas. Her temperature was 99.5°F, the spokesperson said. “Most doctors would call that a slight temperature, not a fever,” he said. “At that point, she was asked by CDC to come back to Dallas so she could be monitored, and she came back.”

The player: Dallas nurse Amber Joy Vinson
Who they’re blaming: The CDC

  • Vinson said she was cleared by the CDC for travel, which a spokesman later confirmed. She traveled to Cleveland to plan her wedding.

The player: Texas Health Presbyterian Hospital
Who they’re blaming: Texas Health Presbyterian Hospital and National Nurses United

  • The hospital originally released Thomas Eric Duncan, the first patient diagnosed in the U.S., who later died. Later, after his diagnosis, the hospital offered a number of reasons for not treating him immediately. At first, the hospital said a computer glitch was responsible for his travel history not being communicated to staff, and then said a nurse did not provide Duncan’s travel history to a physician. Finally, the hospital admitted it made a mistake.
  • The hospital refuted claims from a nurses’ union that nurses weren’t adequately trained: “The assertions [of National Nurses United] do not reflect actual facts learned from the medical record and interactions with clinical caregivers. Our hospital followed the Centers for Disease Control guidelines and sought additional guidance and clarity.”

The player: Doctors Without Borders
Who they’re blaming: The CDC

  • A Doctors Without Borders representative questioned the CDC’s preparation in the New York Times: “I’ve seen the CDC poster. It doesn’t say anywhere that it’s for Ebola. I was surprised that it was only one set of gloves, and the rest bare hands. It seems to be for general cases of infectious disease.”

The player: Emory University Hospital
Who they’re blaming: The CDC

  • Sean G. Kaufman, who oversaw infection control at Emory University Hospital, told the New York Times that the CDC’s guidelines are “absolutely irresponsible and dead wrong,” and that he tried to warn that they were not stringent enough and “they kind of blew me off. I’m happy to see they’re changing them, but it’s late.”

The player: National Nurses United
Who they’re blaming: Texas Health Presbyterian Hospital, the CDC

  • A statement from the union cites “confusion” and “frequently changing policies and protocols” at the hospital: “No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.”
  • RoseAnn DeMoro, the union’s head, contested the CDC’s claim that nurses didn’t follow protocol: “The protocols that should have been in place in Dallas were not in place, and that those protocols are not in place anywhere in the United States as far as we can tell.”

The player: Republicans
Who they’re blaming: Frieden, an open border, Democrats, President Barack Obama

  • Mitt Romney, the 2012 presidential candidate: “Look this administration couldn’t run the IRS right, and it apparently isn’t running the CDC right. And you ask yourself what is it going to take to have a president who really focuses on the interests of the American people.”
  • Republican Rep. Thom Tillis, a Senate candidate in North Carolina: “Ladies and gentlemen, we’ve got an Ebola outbreak, we have bad actors that can come across the border. We need to seal the border and secure it.”
  • New Hampshire Senate candidate Scott Brown addressing his opponent’s record: “I think it’s naive to think that people aren’t going to be walking through here who have those types of diseases and/or other types of intent, criminal or terrorist. And yet we do nothing to secure our border. It’s dangerous. And that’s the difference. I voted to secure it. Senator Shaheen has not.”

The player: Democrats
Who they’re blaming: Republicans

  • The Democratic Congressional Campaign Committee, in an ad targeting GOP congressional candidates: “Republicans voted to cut CDC’s budget to fight Ebola.”

The player: Dallas Nurse Briana Aguirre
Who they’re blaming: Texas Health Presbyterian Hospital

  • Aguirre told NBC that she “can no longer defend [her] hospital at all.” She said infection control was far too lax, waste was not properly taken care of, and the hospital didn’t provide any mandatory education or information about Ebola outside of an optional seminar before Thomas Eric Duncan arrived at the hospital.

The player: National Institutes of Health Director Francis Collins
Who they’re blaming: Budget cuts, Congress

  • “NIH has been working on Ebola vaccines since 2001. It’s not like we suddenly woke up and thought, ‘Oh my gosh, we should have something ready here,'” Collins told The Huffington Post. “Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready.”

Read next: U.S. Scrambles to Contain Ebola

The original version of this story misstated the first name of Amber Joy Vinson.

TIME ebola

#TheBrief: Watch How the CDC Is Changing Its Ebola Protocol

As two nurses who contracted Ebola begin to receive specialized care

As the Ebola virus continues to ravage parts of West Africa and two American health care workers begin to receive specialized care, we have to wonder: Are hospitals in the U.S. well-equipped to contain any further spread at home?

Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, assured Americans in September that the country’s hospitals could control and curb any threat. But after two nurses contracted the virus while helping to treat the first person diagnosed with Ebola in the U.S., who died in Dallas last week, criticism is piling on and answers to this question and more are in high demand.

TIME Disease

A Major Ebola Outbreak in the U.S. or Europe Is Unlikely, Says WHO

The statement comes as the U.S. moves quickly to contain the disease after the reporting of a third case

The World Health Organization (WHO) has said a widespread outbreak of the Ebola virus, which has killed thousands in the West African countries of Guinea, Sierra Leone and Liberia, will probably not be replicated in the U.S. or Europe thanks to the advanced health care systems in the West.

Christopher Dye, the director of strategy for the WHO, told the BBC that the potential spread of Ebola in the West was a matter “for very serious concern,” but added that an epidemic was improbable.

“We’re confident that in North America and Western Europe, where health systems are very strong, that we’re unlikely to see a major outbreak in any of those places,” Dye said.

The U.S., meanwhile, is dealing with its third Ebola case as Amber Vinson, a nurse who treated the country’s first patient who died earlier this month, was diagnosed with the disease.

It was revealed on Wednesday that Vinson was cleared to get on a plane by a Centers for Disease Control and Prevention official just a few days prior, despite having a mild temperature. Officials are attempting to track down and monitor her 131 fellow passengers.

U.S. President Barack Obama, who canceled two consecutive campaign events in order to take firmer action on Ebola, echoed the WHO view in a statement. “The dangers of a serious outbreak are extraordinarily low,” he said, “but we are taking this very seriously at the highest levels of government.”

[BBC]

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 ebola

Second Texas Health Care Worker Tests Positive for Ebola

Third case in the U.S.

A second Texas health care worker involved in treating a Liberian patient who died of Ebola has tested positive for the disease, officials said Wednesday, marking the second such worker and third person overall to be diagnosed with the virus on U.S. soil in the past several weeks.

The worker was identified by a family member as registered nurse Amber Joy Vinson, the Dallas Morning News reports, citing her grandmother. Vinson, 29, helped care for Thomas Eric Duncan, an Ebola patient who died one week ago at Dallas’ Texas Health Presbyterian Hospital after he was diagnosed with the disease following travel from Liberia.

She was isolated within 90 minutes after reporting a fever on Tuesday, whereupon she was tested for Ebola, Dallas County Judge Clay Jenkins told reporters Wednesday, adding “the protocol to find the virus worked well.” The results returned positive from a state lab in Austin around midnight, according to a statement from the Texas Department of State Health Services.

(PHOTOS: See How A Photographer Is Covering Ebola’s Deadly Spread)

“Health officials have interviewed the latest patient to quickly identify any contacts or potential exposures, and those people will be monitored,” said the Texas DSHS in its statement.

Authorities are moving swiftly to decontaminate the newly diagnosed patient’s apartment as well as the area around it. Dallas Mayor Mike Rawlings said Wednesday morning he anticipates the cleaning will be done by Wednesday afternoon. Officials are calling residents and distributing pamphlets in the area of the patient’s apartment to notify them about risks posed by the virus.

(PHOTOS: Inside the Ebola Crisis: The Images That Moved Them Most)

The U.S. Centers for Disease Control and Prevention (CDC) has been roiled by allegations that it bungled setting appropriate safety protocols for treating Duncan after a nurse treating him contracted the Ebola virus last week. A top nurses union has spoken out about the problems that need to be resolved at the hospital where the 26-year-old nurse, Nina Pham, contracted the illness.

The CDC has acknowledged it did not move fast enough to set protocols at the Dallas hospital when the virus was first reported there, and it has pledged to better its response in the event of future cases.

Texas Health Presbyterian has also come under fire after two health workers have contracted Ebola caring for just one patient. No health workers have become ill after treating several patients for Ebola at Nebraska Medical Center and Emory University Hospital in Atlanta.

However, Chief Clinical Officer for Texas Health Resources Dr. Daniel Varga said that the new Texas patient’s speedy isolation is evidence that the local monitoring program is working effectively. “I don’t think we have systematic institutional problem,” Varga said. “The case of this patient here shows that our ability to intake [those affected] and isolate them has been very effective.”

Read next: Ebola Health Care Workers Face Hard Choices

TIME ebola

CDC Deploys Ebola SWAT Team to Dallas

The agency says it will send a team of Ebola experts to any hospital with an Ebola case in the future

A team of experts with experience treating Ebola patients in Africa and containing outbreaks there is now in Dallas working to contain the deadly disease after the first two diagnoses on U.S. soil, a top health official said Tuesday.

Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), said the team is helping officials at Texas Health Presbyterian, and was joined by two nurses from Emory University Hospital, where U.S. aid workers were successfully treated for Ebola. The team’s job is to enhance safety and infection control measures at the hospital.

“A single infection in a health care workers is unacceptable,” Frieden said. “What we are doing at this point is looking at everything we can do to minimize the risk so those caring for her can do so safely and effectively.”

Frieden said that it’s still not clear how a nurse, Nina Pham, got infected while caring for Thomas Eric Duncan, the first patient diagnosed on U.S. soil who later died. But every step in how Ebola patients are handled will be scrutinized and improved, Frieden said.

Asked why the CDC didn’t send a team as soon as Duncan was diagnosed, Frieden said: “We did send some expertise in infection control but think in retrospect, with 20-20 hindsight, we could have sent a more robust hospital infection control team, and been more hands on at the hospital on day one about exactly how this [case] should be managed. We will do that from now on any time we have a confirmed case.”

In an encouraging sign, health officials said Pham has only had direct contact with one person— and that person isn’t sick, but is being monitored. Dozens of people who had direct or indirect contact with Duncan are still being monitored. “It is decreasingly likely that any of them will develop Ebola,” Frieden said.

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