Thursday, October 16, 2014

CDC Lets Feverish Ebola Nurse Board Commercial Flight From Cleveland to Dallas

From Caretaker to Patient: Nurse Amber Vinson
Ebola Nurse and Victim:
Amber Vinson
October 16, 2014 - Nurse Amber Vinson, 29, the second nurse to contract Ebola in Dallas, TX was told by a federal health staffer that it was okay to board a commercial in Cleveland on October 13. Vinson told the staffer at the Centers for Disease Control and Prevention (CDC), that she was running a fever of 99.5 Fahrenheit.  The CDC staffer considered that to be non-threatening.

According to WSBTV Atlanta, CDC spokesman David Daigle said that Vinson spoke with a CDC official responsible for monitoring her health before she boarded the flight Monday. In other words, the CDC person that Vinson spoke to knew that she was one of the people who had cared for Thomas Eric Duncan, the Liberian man who died of Ebola eight days ago at Texas Health Presbyterian Hospital in Dallas.  

Reuters reports that "a federal source" said that Vinson "was not told not to fly" because her slight fever was below 100.4F, the CDC's temperature threshold that would indicated infectious Ebola. But CBS News Medical Correspondent Dr. John LaPook reports that Vinson called the CDC several times before boarding the plane concerned about her fever. "Nurse Vinson,  did in fact call the CDC several times before taking that flight and said she has a temperature, a fever of 99.5, and the person at the CDC looked at a chart and because her temperature wasn’t 100.4 or higher she didn’t officially fall into the category of high risk," said Dr. LaPook on the CBS Evening News.

How could the CDC not consider Vinson to be high risk, knowing that she'd had close contact with a man who just days ago died of Ebola -- and one of her own co-workers had also contracted the virus? It makes us wonder just how incompetent the CDC actually is. The CDC is now trying to contact all of the passengers who flew with Vinson on Frontier Airlines flight 1143 from Cleveland to Dallas/Fort Worth on Monday evening.

Fine, but why did the CDC let Vinson travel out of Dallas in the first place? Should she, and her coworkers at the Dallas hospital, have been told to not travel and been monitored during the 21-day Ebola incubation period just in case they did become infected? Which, of course, at least two did. Nina Pham, another nurse at the Dallas hospital, is currently being treated for Ebola after helping care for Duncan.

"While in Ohio," reports CBS, "Vinson visited relatives, who are employees at Kent State University.  The university is now asking Vinson’s three relatives stay off campus and self-monitor per CDC protocol for the next 21 days out of an 'abundance of caution'."

If the CDC had followed it's own  protocol, they would not now be frantically hunting down the potentially hundreds of people (the 132 on Flight 1143 plus those in airport terminals, etc.) who came in contact with Vinson  while she had a "slight fever." The CDC official displayed anything but an abundance of caution. For that matter, Nurse Vinson acted recklessly as a healthcare professional who should have acted more responsibly.

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About that fever: It's a symptom of infection. The CDC official should have told Vinson to report to the nearest suitable hospital for isolation and observation. The media, in their usual, sloppy way, are reporting that Vinson boarded Frontier flight 1143 "before she became symptomatic" even as they note her fever. But fever is a symptom, so she was already symptomatic on Monday when she boarded the plane in Ohio.

NBC News reports that the CDC staffer who spoke with Vinson "looked on the agency's website for guidance," according to a spokesperson. "The category for 'uncertain risk' had guidance saying that a person could fly commercially if they did not meet the threshold of a temperature of 100.4." The spokesperson also told NBC that, "These two nurses who are infected as well as the others who cared for Duncan but were wearing protective gear — a lot of them are falling into the category of 'uncertain risk'", the spokesperson said. "She represents uncharted water for us ... She did not fall into a clear category." 

Say what? "Uncertain risk?" Not a "clear category?" A nurse, who just days ago was caring for a man dying of Ebola, projectile vomiting and highly contagious says she has a fever, but THAT'S not a "clear category?" "Medical records provided to The Associated Press by Duncan's family show Vinson inserted catheters, drew blood, and dealt with Duncan's body fluids before he died last week," says WLTX Atlanta. "It's not clear how she contracted the virus."

The Director of the CDC, Dr. Tom Frieden, said that Vinson should not have gotten on Flight 1143. CNN reports that he said, "The CDC guidance in this setting outlines the need for what is called controlled movement. That can include a charter plane, a car, but it does not include public transport," and, "We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement."

A suggestion for Dr. Frieden: From this moment forward, please ensure that your staff -- and every damned hospital in America -- understands those guidelines. Frieden on Wednesday said because she had been exposed to the virus and had a low fever, she shouldn’t have boarded the flight. "So by both of those criteria, she should not have been on that plane," he said. True, but by other criteria all CDC staffers should have known this before Amber Vinson was given permission to get on that plane.  

CDC news conference, October 12, 2014

But here's the real kicker: Frieden himself is somewhat guilty of incompetence. On Sunday, the day before feverish Amber Vinson got CDC permission to fly on a commercial flight, Frieden said that the CDC "is deeply concerned" to learn that "a breach in protocol" at Texas Health Presbyterian Hospital Dallas resulted in nurse Nina Pham becoming sick with Ebola. Frieden referred to "a breach in protocol," but it seems there were multiple breaches at Presbyterian.

"At some point, there was a breach in protocol," Dr. Frieden said at an Atlanta press conference on Monday. "And that breach in protocol resulted in [Nina Pham's] infection." Yes, Dr. Frieden, and your breaches have resulted in another infected nurse from that hospital getting on a plane with 132 passengers. "It is possible that other individuals were exposed," Frieden said. That was Monday. Amber Vinson flew on Monday evening. (Watch the full Oct. 12 Frieden CDC press conference.)

Knowing that the Dallas hospital violated protocol, why did Frieden not make certain that all CDC staff were up to speed on that protocol? Why did CDC not immediately track down and isolate all 50 people who known to have had contact with Duncan from the time of his first ER visit and while he was symptomatic. "There were seven other patients in the ER at Presbyterian Hospital when Duncan was first examined that are now under observation," reports "Normal hygiene and good fortune may have prevented any of these people from contracting Ebola."

Amber Vinson was flown from Dallas to Atlanta on Wednesday evening for treatment at Emory University Hospital. Pray for Vinson that the staff at Emory is more competent than the fools at Texas Health Presbyterian in Dallas, which should probably be renamed "Texas Breaches of Protocol." While we're at it, let's rename the CDC the "Competence Deficiency Center."

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