TIME ebola

Dallas Hospital No Longer Blaming Technical Glitch for Sending Ebola Patient Home

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

Texas Health Presbyterian Hospital acknowledged Friday there was "no flaw" in its health records

The Texas hospital that initially released the first Ebola patient diagnosed in the United States acknowledged Friday evening that medical staff had access to the fact that he had just arrived from Liberia, one of the countries worst hit by the outbreak, raising questions about the hospital’s procedures.

Texas Health Presbyterian Hospital in Dallas first admitted Liberian national Thomas E. Duncan in its emergency room on Sept. 25. Duncan was then sent away on the mistaken belief that he had a low-grade fever from a viral infection, allowing him to come in potential contact with dozens of people, some of whom are now being monitored for the virus. A nurse initially failed to tell a doctor that Duncan had just come from Liberia, and a physician didn’t ask. Duncan was readmitted to the hospital three days later when his symptoms worsened.

Initially, on Thursday, Texas Health blamed a technical flaw in its electronic health records system for its decision to send Duncan home. But on Friday evening, the hospital took back that statement and said “there was no flaw” in its records, the New York Times reports, and that hospital staff could see Duncan had been in Liberia.

The “patient’s travel history was documented and available to the full care team in the electronic health record (E.H.R.), including within the physician’s workflow,” acknowledged the hospital.

“In a well-functioning emergency department, doctors and nurses talk to each other,” Dr. Ashish Jha, a professor at Harvard University’s School of Public Health, told the Times. “Also, why didn’t the physician think to ask the question separately? Anyone who comes in with a febrile illness, a travel history, that’s a fundamental part of understanding what might be going on.”

More than 3,000 people have already died of Ebola in Africa. In the U.S., health officials have narrowed down the list of people considered most at risk of contracting Ebola to 10 while moving the four people with whom Duncan shared an apartment from their potentially contaminated quarters.

[NYT]

TIME Infectious Disease

LIVE: White House Addresses Spread of Ebola

The briefing comes days after the first Ebola diagnosis in the United States

Now that the first case of Ebola in the United States has been confirmed and 50 others are currently being monitored for the disease in the country, White House officials are addressing the U.S. response to the outbreak. Homeland Security advisor Lisa Monaco and Health and Human Services Secretary Sylvia Burwell, among others, are expected to speak.

TIME ebola

U.S. May Send Up to 4,000 Troops to Liberia to Help Contain Ebola

Pentagon Press Secretary John Kirby speaks during a briefing at the Pentagon in Washington on Sept. 23, 2014.
Bao Dandan—Xinhua Press/Corbis Pentagon Press Secretary John Kirby speaks during a briefing at the Pentagon in Washington on Sept. 23, 2014.

Obama had previously announced a commitment of 3,000 troops

Defense Secretary Chuck Hagel has approved 4,000 troops for potential deployment to Liberia to help fight the spread of the deadly Ebola outbreak, the Pentagon announced Friday. President Barack Obama had previously announced a commitment of 3,000 troops.

“As we continue our support to the broader U.S. government response to the Ebola crisis, I want to emphasize that our operations remain focused on four lines of effort: command and control, logistics support, training, and engineering support,” said Pentagon spokesperson Rear Admiral John Kirby at a press conference.

While 4,000 troops have been approved, the number that will actually be deployed to West Africa remains unclear. There are currently just over 200 troops working to fight Ebola in the region.

“I want to make one thing real clear, that that’s a potential deployment. That doesn’t mean it is going to get to that number,” Kirby said.

The United States has already made deep financial commitments to help thwart the Ebola outbreak, committing $500 million to a global effort that the World Health Organization estimated that would cost $1 billion. The Bill & Melinda Gates Foundation has pledged an additional $50 million toward both immediate treatment and long-term research into the disease, which has claimed more than 3,000 lives in West Africa.

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

Howard University Students ‘Shocked’ By Possible Ebola Case

Howard University Monitoring Patient With Ebola-Like Symptoms
Chip Somodevilla—Getty Images Howard University Hospital has admitted a patient with Ebola-like symptoms according to a hospital spokesperson October 3, 2014 in Washington, D.C.

Some students are skeptical, though others are 'freaking out'

Typically at the start of October, freshman students like Quencey Hickerson, 18, would be preparing for their first Howard University homecoming. But on Friday, Hickerson and her fellow students were preoccupied with news of a possible case of Ebola virus being treated at the Howard University Hospital, which lies on the southern end of the Washington, D.C. school’s campus.

Hickerson, who heard the news via social media, told TIME she was “shocked” by the news. “I didn’t expect [the virus] to spread so quickly,” Hickerson said.

Though the patient might not actually have Ebola and hospital officials say they have taken the necessary steps to isolate the patient, the virus’ potential spread was on the minds of many students at the historically black college.

“Campus is freaking out and this isn’t even confirmed,” said Blake Newby, 19, who also found out via social media. The sophomore student said the news of the possible case at Howard was a double whammy, as the first person to develop Ebola in the United States during the recent outbreak is being treated in her home state of Texas.

Howard University and its hospital have been reluctant to share further details about the case on Friday afternoon. In a statement, university spokesperson Dr. Kerry Ann Hamilton said the university would “provide periodic updates as information becomes available,” but the hospital is being careful to avoid running afoul of patient privacy laws.

For Newby, the university’s precaution was appreciated. “The second people see Ebola and Howard in the same sentence they assume it means there’s Ebola on Howard’s campus.” And that’s nowhere near accurate.

TIME Companies

This Hotel Allegedly Blocked Your Wi-Fi Hotspot

The Opryland Hotel and complex in Nashville, Tennessee on July 13, 2013.
Cameron Davidson—Corbis The Opryland Hotel and complex in Nashville, Tennessee on July 13, 2013.

According to FCC allegations, the chain prevented users from operating personal hotspots at a Nashville hotel

Marriott has agreed to pay a civil penalty of $600,000 to resolve Federal Communications Commission allegations that the chain’s Nashville, Tenn. hotel used Wi-Fi “jammers” to prevent customers from creating hot spots with their smart phones or other devices. According to terms of the settlement, Marriott has agreed to pay the fine without admitting to any specific violation.

By blocking personal hot spots, the Gaylord Opryland Resort & Convention Center, operated by Marriott, allegedly raked in thousands of dollars in Wi-Fi fees from hotel patrons who had no other option but to use the hotel’s Wi-Fi for internet access, according to an FCC announcement released Friday. The jammers targeted the hotel’s convention center, where rates for internet access range from $250 to $1,000 per device.

“Consumers who purchase cellular data plans should be able to use them without fear that their personal Internet connection will be blocked by their hotel or conference center,” said Travis LeBlanc, head of the FCC’s enforcement bureau. “It is unacceptable for any hotel to intentionally disable personal hotspots.”

According to the terms of the consent decree, Marriott will also implement procedures to improve its handling of IT issues at the Nashville hotel.

Marriott did not immediately reply to Time’s request for comment on the settlement.

TIME ebola

Patient Admitted to D.C. Hospital With Ebola-Like Symptoms

The patient had recently traveled to Nigeria

A patient with Ebola-like symptoms who recently traveled to Nigeria has been admitted to Howard University Hospital in Washington D.C., according to a Howard spokesperson, but the person has not yet been confirmed to be infected with the disease.

“In an abundance of caution, we have activated the appropriate infection control protocols, including isolating the patient,” said Howard spokesperson Kerry-Ann Hamilton in a statement.

Hamilton declined to identify the patient, citing privacy concerns. The hospital is working closely with the Centers for Disease Control and Prevention and other health officials, she said.

This week marks a dramatic escalation in the spread of the deadly Ebola outbreak, which has killed more than 3,000 people in West Africa. If confirmed, the D.C. patient would be the second person diagnosed with Ebola in the United States. Earlier this week, a Liberian man was diagnosed with the disease and is currently being treated at a hospital in Dallas.

TIME Research

Why Climate Change Affects Poor Neighborhoods The Most

city aerial
Getty Images

Scientists frequently tout new evidence that climate change will drive some of the most populated cities in the United States underwater. New York, Boston and Miami are all at risk. But the impact of climate change varies even within cities, putting residents of poor neighborhoods at greatest risk of suffering from heat-related ailments, researchers say.

“Cities tend to be warmer, but it’s spatially variable within cities,” says Joyce Klein Rosenthal, a researcher at Harvard who published a recent study on the impact of climate change in cities. “Generally, higher poverty neighborhoods are warmer and wealthier neighborhoods are cooler.”

This difference in neighborhood temperatures affects senior citizens and correlates with a disparity in their mortality rates due to heat-related causes, a study of New York City led by Rosenthal suggests.

This higher rate in poor neighborhoods isn’t just because lower-income families aren’t always able to afford owning and operating an air conditioner, though that certainly contributes to the problem. Poor neighborhoods often have few trees and have buildings that tend to be constructed from materials that retain heat, Rosenthal said.

Climate change also affects these areas more because of the professions of some of the residents, according to Olga Wilhelmi, a researcher at the University Corporation for Atmospheric Research. Laborers who work outside all day in extreme temperatures and return home to a hot apartment are more likely to experience heat stroke or another heat-related ailment.

“It’s not just your housing conditions but whether or not you have a choice to modify your daily behaviors and routine to better cope with extreme temperatures,” says Wilhelmi.

As scientists grapple with long-term solutions to climate change, policymakers need to consider a entirely new set of solutions to address the health risks posed by extreme heat in cities.

Ironically, many of the methods used to address climate change broadly are ineffective, if not problematic, for handling heat stroke at the neighborhood level. For one, while public awareness campaigns encourage people to use less electricity, residents of poor neighborhoods should probably turn up the air conditioning while their counterparts in wealthier, cooler neighborhoods may not.

Wilhelmi says that some cities including Chicago have begun to implement measures like heat warning systems to warn vulnerable populations about extreme heat conditions.

Still, changing factors like building codes and urban design isn’t always easy, making fundamental improvements potentially generations away.

TIME Crime

Behind the Messy Science of Police Lineups

Thomas Haynesworth answers questions from the media after he was released from the Greensville Correctional Center in Jarratt, Va., on March 21, 2011.
P. Kevin Morley—Richmond Times-Dispatch/AP Thomas Haynesworth answers questions from the media after he was released from the Greensville Correctional Center in Jarratt, Va., on March 21, 2011.

A National Academy of Sciences report recommends sweeping changes to how police departments conduct lineups as researchers remain at odds

In 1984, Thomas Haynesworth—an 18-year-old resident of Richmond, Va.—was accused of rape by five women, one of whom had identified Haynesworth by spotting him on the street. Later, four other victims picked his face out of a police lineup. That was the man who raped them, they said. One of them even told the jury, “He had a face I couldn’t forget.”

Haynesworth was convicted in three of the attacks and sentenced to 74 years in prison. But he was innocent.

In 2009, DNA testing linked Leon Davis, who had been convicted of other assaults in the Richmond area around the same time, to one of the women who initially accused Haynesworth of rape. Several attorneys eventually investigated the cases involving Haynesworth and reached the conclusion that in fact Davis was responsible for all three rapes. In March 2011, Haynesworth was released from prison after almost 30 years behind bars. In December, he was fully exonerated.

The Haynesworth case is one of the most egregious to emerge from the fallibility not only of human memory but of police lineups and the way they’re often conducted around the country.

Most people think of the lineup the way it’s often shown in movies or on TV: You bring a handful of unsavory guys into the police station. One of them is the real suspect while the others are just fillers. Then the witness immediately points and says, That’s him!

But few departments conduct lineups today with live suspects. Most use photo arrays, sometimes on a computer, that are presented to a witness. Over the last few decades, a handful of researchers have studied the way those lineups are administered with troubling conclusions: Too often, police lineups lead to eyewitness misidentifications, put innocent people in prison and allow the real culprits to go free.

According to the Innocence Project, eyewitness misidentification has been a factor in 72% of convictions that have been overturned by DNA testing. The National Registry of Exonerations, which works in conjunction with the University of Michigan, traces 507 of the 1,434 exonerations back to mistaken witness identification. But according to researchers, many police departments don’t know the underlying problems associated with troublesome lineups, don’t have the resources to conduct better ones, or are confused as to the best way to go about them.

On Thursday, the National Academy of Sciences, a non-profit organization of experts and academics around the U.S., released the first comprehensive report to review decades of literature on lineups while offering sweeping recommendations on how they should be conducted, including ensuring that those administering them are not aware of the suspect’s identity, developing standard instructions for witnesses so as to not bias their pick, videotaping the ID process and recording confidence statements from witnesses at the time of an identification.

“Eyewitnesses that lead to erroneous convictions are very disturbing,” says Tom Albright, a professor at the Salk Institute for Biological Studies, who co-chaired the committee. “It’s bad for society if the bad guys go free, and it undermines the criminal justice system, which is a serious long-term problem potentially.”

A number of factors can affect a person’s memory, especially in a charged moment like when a crime is taking place. If someone has a gun, for example, we’re more likely to pay attention to the weapon than the face of the person holding it. Our emotions and internal biases can alter the way we remember an incident. Or maybe the problem comes from something as simple as the angle from where someone witnesses a crime and an inability to get a good look at the perpetrator.

“I argued that what we should be concentrating on are the variables over which the justice system has some control and help advise the legal system about how they might reduce the likelihood of mistaken identifications,” says Gary Wells, an Iowa State University professor who has been the leading researcher on lineups for years.

Wells was essentially a one-man shop of eyewitness research through the 1980s and into the 1990s. He helped introduce the idea of the double-blind procedure, in which officers who were administering a lineup didn’t know the real suspect from the filler picks. By doing so, officers couldn’t ask leading questions that could bias the witness. He championed sequential lineups (photos shown one at a time) over simultaneous lineups (photos shown together and often six at a time), arguing that it was a more difficult task for eyewitnesses and would provide a higher standard for IDing a suspect.

But his research often went unnoticed, remaining stuck in the halls of academia and not taken seriously by law enforcement or merely unknown to officers in the field.

“I think we’d still have this huge gap where the work we’ve done would be written off as pointy-headed researchers in the lab,” Wells says, “until the DNA exonerations came.”

Around the late 1990s, as DNA testing took off, it turned out that a number of false convictions could be traced back to witness misidentification. Soon after, then-Attorney General Janet Reno created a working group that included Wells to produce some basic guidelines for how police departments in the U.S. should conduct lineups.

In the last 15 years, a number of police departments have begun taking those reforms seriously. Baltimore, Boston, Dallas, Denver, Minneapolis, Philadelphia and San Diego have all changed the way they conduct them in the last several years, and most of those agencies have implemented blind, sequential procedures.

For the most part, the recommendations released by NAS on Thursday endorsed many of the things for which Wells has been long arguing. The report calls for law enforcement agencies to provide officers with training on vision and memory as well as guidance on how to prevent contamination of a witness with leading questions that could affect their decision-making. It also calls for double-blind lineups and standardized instructions to inform witnesses that the suspect may or may not be in the lineup. It pushes agencies to document confidence judgments from witnesses at the time of an identification, confidence that can often irrationally grow in strength by the time they’re called to the witness stand. And it urges agencies to videotape the entire ID process.

However, it doesn’t recommend sequential or simultaneous lineups, in part because the academic debate over the two has gotten messy.

A new way of studying the accuracy of a lineup has emerged in the last few years, most prominently by John Wixted of the University of California-San Diego, who uses something called a “receiver operating characteristic,” or an ROC curve, which takes into account witness confidence in an identification. Eyewitness confidence numbers are plotted along the curve and appear to show that administering a simultaneous lineup has produced more accurate IDs than sequential ones. Other ROC studies appear to have similar findings.

Another study conducted by Wixted and Karen Amendola of the Police Foundation has analyzed lineup selections as they relate to the strength of evidence in actual cases over time in Austin, Texas. That study also appears to have found that sequential lineups are not superior to simultaneous ones and that, in fact, innocent suspects are less likely to be mistakenly identified from simultaneous lineups.

Some researchers, however, dispute those studies. Among the naysayers is Jennifer Dysart, an associate professor of psychology at John Jay College of Criminal Justice.

“They’re getting these really crazy data that are completely inconsistent with the general pattern of results,” Dysart says.

She says she believes Amendola has incorrectly analyzed her numbers regarding the Austin evidence-based findings and didn’t have a sample size big enough to conclude that simultaneous lineups are a superior method. But she also believes there may be ulterior motives at work in the new ROC analyses done by Wixted and others.

“I think they want to take down Gary because he’s been the lead researcher in the field of eyewitness identification for over 35 years,” she says.

“There’s a lot of noise out there,” Wells acknowledges, referring to the ongoing simultaneous/sequential debate. “I think it’s fair to say that it’s unresolved at the moment. I have a feeling that in the end, we’re going to end up discovering that there’s not a huge difference between them.”

The NAS recommendations steer clear of the back-and-forth entirely. But most lineups researchers praised the report’s findings overall, including Wells.

“This is a huge shot in the arm,” Wells says. “It’s a ringing endorsement of the science. And now we have the task of bridging the gap between the science and the legal system.”

TIME Pentagon

The Pentagon Doesn’t Know What to Call Its Operation Against ISIS

Lt. General William Mayville Jr. Briefs The Media At Pentagon On Recent Strikes Against ISIL In Syria
Mark Wilson—Getty Images Lt. Gen. William C. Mayville Jr. speaks about the Syrian bombing campaign September 23, 2014 in Washington, D.C.

Operation Inherent Resolve was deemed “just kind of bleh” by one military officer

After two months of military operations against or related to the Islamic State of Iraq and Greater Syria (ISIS), the Pentagon still doesn’t known what, exactly, to call the mission.

Top military brass is still trying to find a fitting name for the operation as classified Pentagon PowerPoint slides tentatively call “Operations in Iraq and Syria,” the Wall Street Journal reports.

Officials rejected the latest name nomination, “Operation Inherent Resolve.”

“It is just kind of bleh,” said one officer.

The ISIS mission name search is in keeping with an operations nicknaming tradition extending back in the U.S. to World War II. The 1989 invasion of Panama added another layer to the military mission naming question after officials realized the propaganda value of a name; that mission was called “Operation Blue Spoon” until it was renamed “Operation Just Cause.”

[WSJ]

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