Five minutes into a news conference about the first Ebola case in the United States, the head of the Centers for Disease Control and Prevention made a startling gaffe.
“Ultimately, we are all connected by the air we breathe,” said Dr. Tom Frieden, director of the nation’s top public health agency.
A specialist corrected Frieden, a former New York City Health Department commissioner and CDC disease detective.
“Ebola is not transmitted by air. It is not an airborne infection,” said Dr. Edward Goodman, epidemiologist at Texas Health Presbyterian Hospital in Dallas.
Since Ebola arrived in the United States when a patient from Liberia sought treatment in the Dallas hospital, the Atlanta-based CDC has issued confusing, contradictory and erroneous statements, a Tribune-Review examination of public transcripts found.
The missteps prompted lawmakers in both parties to question the CDC’s lack of oversight and its ability to handle a major health crisis.
“Did that shake the American public up? Absolutely,” said Dr. Gus Geraci, chief medical officer at the Pennsylvania Medical Society. “I think they’ll be analyzing cases for the next 10 years for mistakes that were made from the emergency room on.”
The CDC waited for about two weeks to send top experts to assist hospital staff in Dallas, where Thomas Eric Duncan became the first person to die of Ebola in the country.
It allowed one of his nurses to travel on a commercial flight while she had a low-grade fever. Doctors eventually diagnosed two of his nurses with the deadly virus.
A New York doctor who recently returned to the city after treating Ebola patients in West Africa was diagnosed with the disease Thursday.
A Pew Research poll released Tuesday showed 58 percent of Americans trust Ebola information from the CDC and 54 percent are confident the government will prevent an outbreak.
The CDC defended its approach to the virus and to the public, arguing that Frieden often mentions the world’s interconnectedness to illustrate the proximity of infectious diseases. The Dallas cases showed “that taking care of an Ebola patient presents new forms of challenges,” spokeswoman Kristen Nordlund said in a statement.
She said the CDC must receive a state-level invitation before it can help a domestic hospital. The agency had an initial team in Dallas on the day doctors confirmed Duncan’s illness.
“It’s important to say what you know and what you don’t know, and to be clear when there are still questions,” Nordlund said, emphasizing Ebola remains new in the United States and that the government is refining its response plans. “We’ve warned the public when we don’t have all the information or when an outcome is possible.”
Sound bites before facts
Some CDC statements smacked of arrogance when the likely intention was to reassure.
“You know, I’ll just mention CDC has been dealing with Ebola and Ebola outbreaks for over 40 years. We have quite a bit of experience about this. … (It’s) something we’ve seen over and over again, over the course of 40 years,” Beth Bell, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said during an Oct. 3 briefing.
The Ebola outbreak has killed more than 4,800 people in West Africa. Before the American nurses became sick, Frieden said health officials would stop the virus “in its tracks” in this country.
Largely they have, said Matthew Seeger, a professor at Detroit’s Wayne State University who specializes in crisis and health communications and has advised the CDC in the past.
“It appears that any outbreak in the U.S. is highly unlikely,” Seeger said.
Nordlund said the CDC used “language of certainty” only “when we felt it was warranted,” including in scientific statements about how Ebola spreads.
But comments such as Bell’s and Frieden’s are ill-advised, experts said.
“They made a mistake by trying to calm people down without having complete information. They were more concerned with the sound bite than the facts,” said Gene Grabowski, senior strategist in crisis communications at the Washington-based firm Levick.
Seeger added, “There’s always the temptation in crisis situations to over-reassure people.”
Shobita Parthasarathy, associate professor of public policy at the University of Michigan, said institutions often foster unrealistic expectations from the public.
“They say, ‘Trust us. We’re the experts.’ Then in times of crisis, we see that it’s a contingent thing. There are going to be moments when they don’t have it all figured out,” she said.
Guidelines on protection
When Amber Vinson, one of the infected nurses, flew from Dallas to Cleveland, her visit stoked fear that the virus could spread.
Her family said she called the CDC before the trip and that someone at the agency “fully cleared” her for travel. Yet Frieden said Vinson “should not have traveled on a commercial airline.”
Critics demanded tighter restrictions on air travel. Customs and health officials began screening passengers from Guinea, Liberia and Sierra Leone for Ebola symptoms at New York’s John F. Kennedy International Airport on Oct. 11 and expanded to four other airports five days later. The New York doctor went through screening at JFK on Oct. 17 but did not have a fever or other symptoms of illness, the CDC said. The CDC said Tuesday that it would funnel all passengers from the three African nations through the five airports.
“We have to be right 100 percent of the time in protecting our citizens. Ebola needs to get through once,” said U.S. Rep. Tim Murphy, R-Upper St. Clair, who wants a ban on nonessential commercial travel from West Africa.
In early briefings, Frieden expressed confidence that Texas Health Presbyterian, a private, 866-bed medical center, could handle Ebola.
“One thing we want to emphasize is virtually any hospital in the country that can do isolation can do isolation for Ebola. … We don’t see the need to try to move the patient,” Frieden said.
Doctors transferred Vinson and nurse Nina Pham to specialized hospitals in Atlanta and Maryland, suggesting the CDC erred in its assessment.
A nurses union said the Texas hospital lacked adequate supplies and training. Documents obtained by The Associated Press showed Duncan was not properly isolated from the time he was admitted Sept. 28 until Sept. 30, when blood tests confirmed he had Ebola.
Frieden acknowledged errors and conceded there was “variation” in the way hospital employees used protective gear. The CDC ramped up guidelines on protective gear and urged workers to cover all of their skin before treating Ebola patients.
President Obama responded to the missteps by appointing an Ebola response coordinator.
The move provoked criticism. Ron Klain, a former chief of staff to Vice Presidents Joe Biden and Al Gore, has no medical background. He assumed the post on Wednesday but did not appear at an Ebola-related congressional hearing Friday, with the White House declining the committee’s invitation for him to appear, said an aide for Rep. Darrell Issa, R-Calif.
“We don’t need an Ebola czar. We need an Ebola team,” said Gavin Macgregor-Skinner, an assistant professor in public health preparedness at Penn State. “I believe our approach has not met the needs of U.S. health care workers. There’s a lot of anxiety. There’s a lot of concern.
“If you look at the CDC Ebola website for health care workers, it’s just a sea of paper documents,” he said.
The CDC’s Nordlund said the agency is exploring more hands-on training in some cities.
Not a regulatory agency
The agency’s recommendations are not requirements.
“CDC is not a regulatory agency,” Frieden said.
A CDC representative said the Health and Human Services Department regulates hospitals and their ability to enforce CDC guidelines. The department referred questions to the Centers for Medicare and Medicaid Services, which did not answer questions.
The CDC typically defers to state and local health departments to oversee hospitals. Pennsylvania Department of Health spokeswoman Holli Senior said it is working with hospitals to prepare for cases of Ebola.
Samuel Gualardo, director of the Pennsylvania-Occupational Health and Safety Administration Consultation Program, said it was not surprising that the Dallas hospital fell short of CDC recommendations, noting that workers train on computers and not hands-on.
“It’s no fluke that health care is struggling with what to do here,” Gualardo said.
Dr. Robert Keenan, chief quality officer for Allegheny General Hospital in the North Side and West Penn Hospital in Bloomfield, predicts airport measures and the absence of developing cases will calm the American public.
“The level of calmness won’t reach any kind of permanent state until we get the West Africa situation under control,” he said.