Containment efforts Ebola virus cases in the United States

1 containment efforts

1.1 operation united assistance
1.2 revised cdc guidelines
1.3 ebola response coordinator
1.4 rapid response teams
1.5 airport screening
1.6 mandatory 21-day quarantine
1.7 legal protection government contractors
1.8 school closures

containment efforts
operation united assistance

the 25-bed monrovia medical unit constructed health care workers supporting operation united assistance.

the u.s. military released plans send 4,000 troops west africa establish treatment centers starting september 29. troops tasked building modular hospitals known expeditionary medical support systems (emeds). plans included building 25-bed hospital health care workers , 17 treatment centers 100 beds each in liberia. end of september 2014 150 military personnel helping usaid in capital, monrovia.

u.s. army chief of staff ray odierno ordered on october 27 21-day quarantine of soldiers returning operation united assistance. 12 soldiers have been quarantined far in u.s. base in italy.

revised cdc guidelines

since 2007, hospitals have relied on cdc infection control protocols contain ebola virus disease. until october 20, 2014, cdc guidelines allowed hospitals wide latitude select gear based on interaction between healthcare workers , patients , on mode of transmission of disease being handled. guidelines suggested gowns full coverage of arms , body front, neck mid-thigh or below, ensure clothing , exposed upper body areas protected , , additionally recommend masks , goggles.

some infection control experts said many american hospitals improperly trained personnel handle ebola cases because following federal guidelines lax. officials abruptly changed guidelines on october 14. new york times stated effective acknowledgment there problems procedures protecting health care workers. sean kaufman, oversaw infection control @ emory university hospital while treated ebola patients, has said previous cdc guidelines absolutely irresponsible , dead wrong . kaufman called warn agency lax guidelines but, according kaufman, “they kind of blew me off.”

a doctors without borders representative, organization has been treating ebola patients in africa, criticized cdc poster lax guidelines on containing ebola, saying, “it doesn t anywhere it’s ebola. surprised 1 set of gloves, , rest bare hands. seems general cases of infectious disease.”

the national nursing union national nurses united criticized cdc making guidelines voluntary. there complaints @ texas hospital healthcare professionals had use tape cover exposed necks. according frieden, cdc appointing hospital site manager oversee ebola containment efforts , making intensive efforts retrain , supervise staff.

on october 14, reported 125 contacts in united states being traced , monitored. on october 20, cdc updated guidance on personal protective equipment new detailed instructions include specifying no skin should exposed , adding extensive instructions donning , doffing equipment. on october 20 cdc updated guidance add clarification ebola may spread through wet droplets such sneezes.

ebola response coordinator

in mid-october 2014, president barack obama appointed ron klain ebola response coordinator of united states. klain lawyer served joe biden s , al gore s chief of staff. klain has no medical or health care experience. after previous criticism, obama said, may make sense have 1 person ... after initial surge of activity, can have more regular process make sure re crossing t s , dotting s going forward . klain report white house homeland security adviser lisa monaco , national security advisor susan rice. klain not coordinate hospitals , united states public health service, responsibility of nicole lurie, assistant secretary preparedness , response (aspr). president barack obama attempted calm public fears hugging nurse nina pham had been cured of ebola.

rapid response teams

president obama announced formation of rapid response teams travel hospitals newly diagnosed patients. second set of teams prep hospitals in cities deemed see ebola virus case. 3 of teams operating. in announcing formation of teams, president obama explained, want rapid response team, swat team essentially, cdc on ground possible, within 24 hours, taking local hospital step step through needs done.” cdc has developed 2 sets of teams, identified acronyms cert (cdc ebola response team) , fast (facility assessment , support teams). certs have 10 20 people each, can sent hospital suspected and/or laboratory confirmed ebola virus case. teams drawn 100 cdc workers , others. fast teams assist hospitals have indicated willing take on ebola cases.

airport screening

ebola screening of passenger arrived sierra leone @ chicago s o hare airport

starting in october 2014, u.s. government officials began questioning airplane passengers , screening them fever @ 5 u.s. airports: john f. kennedy international airport in new york, newark liberty international airport in new jersey, o hare international airport in illinois, washington dulles international airport in virginia, , hartsfield–jackson atlanta international airport in georgia. combined, these airports receive more 94% of passengers guinea, liberia, , sierra leone, 3 countries affected ebola.

although no plans have been announced other airports, screening in u.s. represents second layer of protection since passengers being screened upon exiting these 3 countries. however, risk can never totally eliminated. on october 21, department of homeland security announced passengers liberia, sierra leone, , guinea required fly 1 of these 5 airports. on october 23, cdc announced passengers these countries receive 21-day monitoring.

a physician who, aileen marty, had spent 31 days in nigeria, criticized complete lack of screening ebola on recent return united states through miami international airport on october 12.

there have been calls congressional leaders, including u.s. representative ed royce, chairman of house foreign relations committee, , u.s. representative michael mccaul of texas, chair of homeland security committee, suspend issuing visas travelers affected west african countries, including liberia, sierra leone, , guinea.

mandatory 21-day quarantine

on october 7, connecticut governor dannel malloy signed order authorizing mandatory quarantine 21 days of anyone, if asymptomatic, had direct contact ebola patients. 9 people quarantined on october 22, in accordance connecticut order.

at joint news conference on october 24, new york governor andrew cuomo , new jersey governor chris christie announced imposing mandatory 21-day quarantine on air travelers returning new york , new jersey west africa have had contact ebola patients. in explaining move cdc s voluntary quarantine state ordered mandatory one, cuomo cited case of dr. spencer. in region this, go out 3 times, ride subway, ride bus, affect hundreds of people. cuomo praised spencer s work stated, s doctor , didn t follow voluntary quarantine. let s honest.

governors cuomo , christie stated 2 states needed go beyond federal cdc guidelines. cuomo said dr. spencer s activity in days before diagnosis showed guidelines, includes urging health care workers , others have had contact ebola patients voluntarily quarantine themselves, not enough.

late on october 26, governor cuomo modified state s quarantine procedure, stating people entering new york have had contact ebola patients in west africa quarantined in homes 21 days, twice daily checks ensure health has not changed , complying order, , receive compensation lost wages, if any. president obama , staff had been attempting persuade new york governor cuomo, new jersey governor christie, , government of illinois reverse mandatory quarantines.

illinois governor pat quinn issued similar quarantine authorization same day new york , new jersey did, florida governor rick scott on october 25, authorizing mandatory twice daily monitoring 21 days of people identified coming countries affected ebola. illinois health officials later said people @ high risk of ebola exposure, such not wearing protective gear near ebola patients, quarantined.

pennsylvania, maryland, , georgia have authorized mandatory twice daily health monitoring and/or temperature reporting 21 days people exposed people ebola. virginia has implemented mandatory twice daily temperature reporting , daily monitoring health authorities, has authorized mandatory quarantine higher risk patients. california mandated 21-day quarantine health workers have had contact ebola patients.

interior of isolation tent used university hospital in new jersey quarantine kaci hickox

kaci hickox, american nurse treated ebola patients in sierra leone became first person placed under new mandatory quarantine rules on arrival @ newark liberty international airport, in new jersey. low-accuracy (forehead) thermometer indicated hickox developed fever on friday night , taken university hospital in newark. later tested negative ebola virus remained quarantined in medical tent. hickox , doctors without borders criticized condition of quarantine in tent bed , portable toilet, without shower facility. hickox expressed inhumane. hospital responded tried best accommodate hickox allowing have computer access, cell phone, reading materials, , providing take-out food , drink. on october 27, after being symptom free additional 24-hour period, testing negative ebola, , after state s quarantine policy relaxed night before, hickox released quarantine in new jersey. has filed suit.

hickox escorted out of new jersey , maine following day private convoy of suvs. maine governor paul lepage announced joining state s health department in seeking legal authority enforce quarantine after hickox announced not comply isolation protocols in maine. left house on october 29 , october 30. governor said: s violated every promise s made far, can t trust her. don t trust her. maine judge ruled against mandatory quarantine on october 31, required hickox comply direct active monitoring, coordinate travel maine health officials, , notify health officials if develops symptoms of ebola.

on october 29, texas governor rick perry announced texas nurse returning sierra leone treated ebola patients, had agreed self-quarantine @ austin home 21 days , undergo frequent monitoring state health officials. nurse not named protect privacy. governor perry said agreed self-quarantine despite not having symptoms of ebola virus. texas health officials met nurse after landed @ austin–bergstrom international airport. perry spoke nurse on phone thank working fight ebola. in texas, have great tradition of welcoming our heroes home, , heroic individual deserves our appreciation, our compassion , our utmost respect, said in statement. tremendous work , many other health care workers doing in west africa making life better in afflicted countries , helps protect rest of world spread of terrible disease; doing vitally important work makes proud.

u.s. army chief of staff ray odierno ordered on october 27 21-day quarantine of soldiers returning operation united assistance in liberia. 12 soldiers have been quarantined far in u.s. base in italy.

legal protection government contractors

on november 13, president obama issued memorandum protects contractors hired u.s. agency international development (usaid) liability should import ebola virus united states. authority may exercised solely purpose of holding harmless , indemnifying contractors respect claims, losses, or damage arising out of or resulting exposure, in course of performance of contracts, ebola, memorandum stated.

school closures

there numerous overreactions perceived threat of ebola outbreak, particularly on part of school officials. on october 16, building housing 2 schools in solon city school district near cleveland, ohio, closed single day of disinfection procedures after finding staff member may have been on aircraft amber vinson used on previous flight. school in cleveland metropolitan school district disinfected overnight due similar concerns remained open. in both cases, affected staff sent home until cleared health officials. school officials said had been assured city health officials there no risk , disinfection strictly precautionary . 3 schools in belton independent school district in belton, texas, closed. infectious disease experts considered these closures overreaction , concerned frighten public believing ebola greater danger is.

in hazlehurst, mississippi, in response numerous parents keeping children attending school, principal @ hazlehurst middle school, agreed take personal vacation time after had traveled zambia, country no current ebola cases , 3,000 miles away west africa.