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Why U.S. can stop Ebola in its tracks

Posted on by CDC
Tom Frieden is the director of the Centers for Disease Control and Prevention
Tom Frieden

(CNN) — The U.S. health system has been preparing since late March for the news we announced Tuesday: the first case of Ebola diagnosed in the United States.

In this age of global travel, we anticipated that a traveler from a country with an Ebola outbreak would come to the United States and develop symptoms once they arrived. But from everything we know now, there appears to be no risk that anyone on this patient’s flights from Liberia to the United States was exposed to the virus.

Can you catch Ebola on a plane?

Clinicians on the front lines have been one key to our safety: identifying patients with both a history of travel and symptoms indicating they might have Ebola, immediately isolating them, consulting their local or state health departments, and getting the patients tested as needed. Indeed, since the outbreak began in Africa, CDC has consulted with state and local health departments on almost 100 cases in which travelers had recently returned from West Africa and showed symptoms that might have been caused by Ebola. Of those cases, 14 were considered to be truly at risk. Specimens from 13 were tested and Ebola was ruled out in all 13 cases.

But now CDC labs have confirmed our nation’s first U.S.-diagnosed Ebola patient.

I understand this can be deeply troubling news, especially after what we have witnessed Ebola do in West Africa. But there are distinct differences in what will happen here.

The United States has a strong health care system and dedicated public health professionals — all hard at work right now — to make sure this case will not threaten the community at large, or the nation. A person who is sick from Ebola virus disease can be cared for in U.S. hospitals when the patient is isolated in a private room with a private bathroom and contact with them is highly controlled. Every health care worker must meticulously follow every single infection control protection we recommend.

How the Ebola virus spreads

Public health officials, meanwhile, are also identifying people who have had close personal contact with the newly diagnosed patient and will follow up with them for 21 days, the longest known incubation period for Ebola. If they develop any signs of the disease, those people will be isolated, tested and cared for.

The fact is that CDC has been preparing for this day, working around the clock with local and state health departments to enhance surveillance and laboratory testing capacity, provide recommendations for health care infection control and other measures to prevent disease spread, and deliver guidance and tools for health departments to conduct public health investigations.

Your Ebola questions answered

I’m not going to promise that we can stop this at just one case, but I can tell you we have the advantage because the right steps are being taken, and I am therefore confident we will stop Ebola in its tracks here in the United States.

And there is one final thing to remember, even as the first case here grabs the headlines: We must be relentless in stopping its spread in West Africa. After all, after all is said and done here, that is the only way to truly and completely protect the health security of America — and the world.

Complete coverage on Ebola

This post is originally from The CNN Blog.

Posted on by CDC

206 comments on “Why U.S. can stop Ebola in its tracks”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Dear Sir;
    I am respectfully writing concerning the previous fear-mongering concerning the spread of Ebola, as well as the horrible handling of the disease from the moment it was discovered in Liberia until the first actual case in the US, Dallas, TX.

    I was in the military, but I never saw battle. However, I was a combat lifesaver. This is a first responder before a medic and ambulatory appliances are made available. We also had to be trained in reacting to nuclear, biological, and chemical (NBC) elements.

    One of the first things I learned in the military in any hostile environment preparation and training. This is ongoing.

    I learned, also, that in the event of an attack from NBC in this order:
    Self-preservation (MOPP4, self injection, and change of suit every 4-6 hours); reporting of the incident; quarantine; triage (treat those most likely to survive, and set apart a “death” area); and treatment.

    An unprotected person outside the area does not go in. People inside the area, whether they have been affected or not, do not come out until they can be moved to a hasty clean up to return to battle, or to a deliberate clean up, when they are moving from a dirty area to a clean area.

    The same steps are taken for unexpected disease. The key difference is that officials, whether governmental or employees – must not “leak” information to the general public about it, whether that person is the President, member of Congress, or you and your employees. This is to prevent a public panic, because the public barrage of actions could be worse than the disease itself.

    As for travel in and out of the area of Liberia, there should be NONE, except for the medical personnel that have to tend to the victims of the disease. Why hasn’t air travel to and from Liberia been cancelled? Shouldn’t these people have been handled like terrorists, and put on a no-fly list? And do you intend to put this gentleman in jail IF he recovers? He may still be a carrier, so you have to put him in isolation.

    Also, another problem I have – is since you seem to be at the top of the food chain in this area, why haven’t you recommended to the President to close the borders to the entry of illegal aliens? Most are not immunized, they may be carriers of disease, and have been the primary cause of E. Coli outbreaks in the US due to illegal alien workers in the farmer’s fields. The spread of other diseases such as STDs, AIDS, and Strep may be attributed to the great influx of illegal aliens.

    Respectfully,

    William Pittenger

    Isolation is not the question, restriction of travel to the US especially for leisure visit or even for legitimate business is the question. Refusing access of individuals from affected countries or quarantining those individuals until the incubation period has passed is not isolating a country. If an individual coming from a country with a contagious disease with a high mortality, where if he/she became ill would have a at least a 50% chance of death, suspected he/she was exposed would therefore have a good reason to leave for a country where he/she had a higher survival chance, why would we not quarantine that individual? I think the current policy is faulty at best and any one in leadership that does not question that policy should examine their motivation. If people in affected countries have family and friends in other countries there is Skype.

    The current policy is not even logical. You are urging that non-essential travel to stricken countries be curtailed and yet residents from stricken countries can come to our country with impunity. That is not logical. Furthermore, apparently merely taking ibuprofen will easily mask a fever from screeners. Of course no one has even mentioned the possibility of feeling well and then becoming ill on a plane, possibly throwing up and exhibiting symptoms which put other passengers at risk. We are also not equipped to deal with the waste being generated by just one patient with Ebola. He apparently was throwing up outside of his apartment building as well. (The two patients at Emory generated 40 bags of hazardous waste a day at the peak of their illness, and no one knew what to do with it.) It’s hard to even imagine a scenario with hundreds of people ill, when one sick person has put so many others at risk, including schoolchildren who were exposed and then attended four different schools. This is a nightmare in the making. There should be a travel ban immediately, with an exception for the transport of medicine, food, and humanitarian aid. Most African countries already have travel bans in place. This seems to be much more about politics than protecting American citizens.

    Where can I find information about the goods and products currently being imported from West Africa? I found some information about the types of products the US is presently importing on the US Trade Commission website.
    http://www.ustr.gov/countries-regions/africa
    Which I copied and pasted below.
    I’m sure my concerns are obvious, and I am hopeful the trades and imports out of West Africa have been stopped. It’s scary to think that a cup of coffee, hot cocoa or mango from my produce department could be contaminated with Ebola. My daughter and I were listening to NPR on the way to school this morning and the report is certainly alarming. I told her I would see if I could find some info today so we could understand more about this epidemic and its potential, and I assured her that everything possible would be done to make sure safety and protection is being handled properly.

    I make every effort to stay away from message boards that seek to alarm, and by the same token, I seek out information that is straightforward (free from smoke and mirrors). Out in the real world, its often a challenge to decipher the truth being shared with the public, since we first need to sort through the exhausting “ee-gotcha’s” and dramatic theatrics that run in a tireless stream out of Washington.
    I’d really appreciate a current and valid information source where I’m able to learn about what’s really happening and what is being done to ensure our protection and safety. Should we be concerned?

    Imports

    U.S. goods imports from sub-Saharan Africa totaled $39.3 billion in 2013, a 20.8% decrease ($10.3 billion) from 2012, but up 53% from 2003. U.S. imports from sub-Saharan Africa accounted for 1.7% of total goods imports in 2013.

    Approximately 30% of U.S. imports from sub-Saharan Africa were from Nigeria and 22% from Angola. The top U.S. import suppliers from sub-Saharan Africa for 2013 were: Nigeria ($11.7 billion), Angola ($8.7 billion), South Africa ($8.5 billion), Chad ($2.5 billion), and Congo ($1.2 billion).

    The five largest import categories in 2013 were: Mineral Fuel (crude) ($26.3 billion), Precious Stones (platinum and diamonds) ($3.2 billion), Vehicles ($2.3 billion), Cocoa ($1.0 billion), and Ores, Slag, Ash (titanium, chromium, and uranium) ($968 million).

    U.S. imports of agricultural products from sub-Saharan Africa totaled $2.0 billion in 2013. Leading categories include: cocoa beans ($828 million), Rubber and Allied Products ($241 million), cocoa paste and cocoa butter ($200 million), and coffee (unroasted) ($196 million).

    AGOA

    AGOA imports for 2013 totaled $26.8 billion, more than four times the amount in 2001. Petroleum products continued to account for the largest portion of AGOA imports with an 86 percent share of overall AGOA imports. AGOA non-oil imports were $4.8 billion in 2013, more than triple the amount in 2001. Several non-oil sectors experienced sizable increases during this period, including apparel, footwear, vehicles and parts, and fruits and nuts. South Africa is the largest non-oil AGOA beneficiary.

    Top AGOA suppliers were Nigeria ($11.7 billion; mainly crude oil), Angola ($8.7 billion; mainly crude oil), South Africa, ($8.5 billion; mainly vehicles and parts, iron/steel, fruits and nuts), Chad ($2.6 billion; mainly crude oil), and the Congo ($1.2 billion; mainly crude oil). Other leading AGOA beneficiaries included the Gabon, Lesotho, Kenya, Mauritius, and Cameroon.

    Leading AGOA import categories were Crude Oil ($30.1 billion; down 38%), Transportation Equipment ($2.1 billion), Minerals and Metals ($865.5 million; down 15%), Textile and Apparel ($815.3 million; down 5%), Agricultural Products ($520.8 million, up 28%), and Chemicals and Related Products ($428.8 million, down 9%).

    When the children across the street had colds, we never allowed them to come over and play with our kids.
    When thousands of US citizens are sick or dying, your political correctness and lack of common sense will be remembered.
    Doing every possible thing to limit travel from West Africa to other parts of the world is obviously one of the first steps that should have been taken. The average American knows this and sees his government, once more, failing to protect him.

    Why haven’t they completely shut down travel to the infected area’s I tell this is just like the movie outbreak exactly to the t..

    I strongly agree with Mr. Pittenger’s very informed comment! Isolation is paramount! Why in the world are we still flying aircraft from stricken countries into the United States?

    I have read your comments to the press about why our borders should not be closed to travelers from ebola affected nations. None of your comments make sense. They are not logical from any standpoint and are unsupported. France, England, Saudi Arabia, and a host of other nations have closed their borders to travelers *to protect the public* from infection. By refusing to close our borders, you are derelict in your duty to protect the public from disease and infection.

    Ebola is a level 4 infectious disease and should be treated just as a bioweapon would. The laws are still on the books that our borders are to be closed against any level 4 infectious disease, and yet you are flaunting the law and subjecting all Americans to a high level of risk — without offering any rational, logical, or supporting evidence for doing so. I believe you should be held accountable for this this gross violation of human safety and for the protection of the public.

    Jim Brant for President or head of the CDC!! I agree with everything this man posted. I am so disgusted by the lack of common sense from Tom Frieden! Tom, you work for the US government. You are paid through tax dollars from US citizens!! You were hired to protect the US citizens. You will be remembered for bringing Ebola and chaos to the United States! Politically correct will not protect the citizens of the US. How stupid do you think the masses are? Do your job!!

    Shame on you!!!

    What part of this contagious disease do you not understand?
    You say that you don’t want to restrict airline travel because it would limit the ultimate successful containment of this horrible disease as it curtail the transportation of medical supplies and personnel into and out of these countries.
    That is a far cry from commercial airliners with virtually no protection and traveling in and out of busy airports where screening for this disease is virtually nonexistent.
    Are you part of some type of population control for this planet? I am not kidding?
    Your plan is a perfect scenario for the death of a nation.
    Food and medical supplies (and medical personnel) CAN be transported in and out of these countries under CONTROLLED situations. With a limited number of people on board, and who are all trained in proper infectious disease management to eliminate or greatly reduce the likelihood of transmission. Allowing people to get on board United Airlines and fly where ever from these countries is nothing short of murder!
    I am going to personally start a campaign with the airlines to stop these flights themselves. They are putting their crews and all their passengers at risk…..and the liability here is huge.
    You, Director….need to wake up and protect our country and the rest of the free world!

    I don’t think it’s wise to promise that the CDC can beat Ebola – nature is bigger than man, nature doesn’t have to obey any promises made by man. Similarly, nature does not give a hoot about borders. In the next year Ebola could well spread to several other countries and eventually the US would find it was no longer possible to track all the cases showing up in the US.

    In a pandemic, there will not be enough hospital beds for everybody. Therefore, local groups need to be organized, for each group people need to be trained to administer IV and give basic medicine to help the sick survive longer with the hope that that time will allow them to make enough antibodies to stop the virus. Stockpiling glove and cleaners, sheets, garbage bags, IV equipment and medicines can all began soon. Set a target of 1% to 5% of the population trained in their spare time to be Ebola specific health care workers if the crisis occurs.

    If there is a plan, and a crisis occurs, people won’t panic because they know what to do. But if there is no plan they will panic – that is the worst scenario.

    They CDC should have had a a plan in place to stop the 1st patient from reaching the US. What were you waiting for? What are you still waiting for? Make it known that when people from the US go to Ebola stricken countries they will be held in isolation upon their return (at their cost). If they don’t like it stay home. We also need to prohibit people from entering the US from countries stricken with Ebola. They will lie to get into the US thinking they can get better health care here for free. Stop this now CDC!!!!

    An ounce of prevention is worth a pound of cure

    In times of crisis, it is necessary to take some unprecedented – even difficult – decisions such as refusing U.S. entry to Liberian nationals or others from Ebola-infested areas. In my opinion, it seems reasonable to do this until we can offer the aid West Africans need to contain this illness on their soil. The only people allowed re-entry into the US should be those who are honorably volunteering their lives and expertise to this cause. Those US citizens should be appropriately isolated until incubation period expires and they are deemed to pose no threat to others. It is a common sense approach which in my opinion would actually ease the public’s fears. Your words say one thing, but your actions are doing the opposite!

    As a public health professional, I understand the importance of relaying accurate information to dispel fears and prevent hysteria. But, I believe it is absolutely absurd and very dangerous to rely on people to truthfully report their exposure to Ebola (or even know what that looks like) or instruments and/or airport officials to take accurate readings of people’s temperatures before leaving Liberia. Who’s to say that someone won’t take fever-reducing meds to get on a plane if they have some at their disposal?

    In times like this, our trusted leaders need to think of all the possible scenarios (some perhaps even cynical of human kind) and take all necessary precautions. Don’t assume people will do the right thing. Don’t assume that thermometers are working or officials are accurately reading people’s temps. West Africans are rightfully so scared for their lives and will try anything to come to the country that is boasting it can contain Ebola. This kind of rhetoric is irresponsible.

    The airline industry is corrupt – always has been and they continue to show their incompetence with respect to safety and health of their paying costumers. So far, Brussels Air, and subsequently United Airlines, have continued to take Liberian nationals with definite Ebola exposure out of West Africa to other parts of the world. How is this helping to contain the situation? It is not good enough to explain this because we live in a global society. This is explained by companies who do not want to lose money and a government who won’t make the short-term tough decisions to protect their own and others. This should not be about money and or financial burdens incurred by the airline industry. This is about taking all action to prevent a global pandemic. The airlines need to get on board. We can never presume to be smarter than viruses or nature in general.

    The CDC or White House officials are not easing fears when examples of hospital miscommunication/misreporting are occurring on the ground, in the trenches. Stop creating an illusion of safety and take some practical, difficult, (and perhaps non-PC) action to halt this from growing out of proportion. Enough is enough. This is madness!

    Dr. Frieden,

    According to CNN news the people who were living with Thomas Duncan (“partner, Louise, her 13-year-old son and her two 20-something nephews”) were moved to isolation – and away from the contaminated apartment – on Friday, and will be held in isolation until October 19. If the article is accurate, I believe that the officials in charge of that decision have not calculated the time correctly.

    Duncan is believed to have developed symptoms by September 25th, and should be assumed to have been contagious at that time, but that, or his admission date of September 28, should not be used to calculate the quarantine of those who were exposed. However, October 19 is 21 days after his isolation date, so I deduce that is the start date being used as the isolation Day One for those exposed, because that is the day he went into isolation.

    *** However, even though those in the apartment also began a kind of isolation at that time, they were reportedly isolated with soiled and contaminated materials. For them, the isolation period of 21 days should start on the day they were removed from that condition, as you cannot rule out that any of the four might have avoided infection until the last day, but then acquired infection that last day.

    While this may seem overly exacting, this is not a time to be less than thorough in the way the CDC proceeds. The correct end date of their isolation should be after October 24th; this would be a proper 21-day isolation following their removal from a contaminated environment.

    You idiot. Do you really think you can tax Ebola like you did tobacco?
    I know it’s above your pay grade to understand this because you are a politician, but your job is supposed to be to protect America, and Americans from DISEASES whether by human error or deliberate attack. Didn’t you even read the mission statement of the CDC(P)?
    What about all the diseases flooding across the unsecured Southern border?
    I understand you are a politician and the health of Americans means nothing to you because you have your golden parachute, and you picture for yourself a better world, but can you really sleep at night knowing you may be directly responsible for the deaths of many people just because you want to push forward your cause?

    There are several lessons that should be taken from this first case. First, asking people traveling from Liberia whether they have had contact with a sick person is obviously not going to work. At the least, they need to be re-screened at every travel stage, including entry to the US. You can easily get on a plane in Liberia with no symptoms and get off with symptoms, it’s a long trip. People arriving from West Africa should be registered and monitored for 21 days, it should be pretty simply to do this in conjunction with Immigration. And people coming on vacations should not be given visas, this is just ridiculous. As several others have noted, we routinely voluntarily restrict our own movements for respiratory illnesses, why would we not impose this restriction for Ebola. Second, it has been my experience over and over that nurses and physicians don’t actually listen to the patients, and they certainly don’t talk to each other at all. A checklist is not enough – the discharging physician needs to sign off that he/she has completed the checklist and interviewed the patient personally. Common sense would suggest that someone with symptoms of fever and abdominal pain having come from Liberia in the past week SHOULD HAVE BEEN MONITORED even if discharged. Third, apparently the family was in touch with the CDC before the patient was collected by ambulance. But for unfathomable reasons, no precautions were taken by the ambulance crew. This is unforgivable, the same checklist needs to be in the hands of the EMTs. I can understand that sanitization etc were a bit slow in this first instance, but overall the response was sloppy. Last, the ER physician should be fired, not because he/she missed the Ebola, but because he/she wrote a prescription for antibiotics for no plausible reason. Many more people are going to die of infections if we don’t stop this particular stupidity. In conclusion, I am not impressed with the CDC at the steps that have been taken. Travel doesn’t necessarily need to be stopped, but a lot more care needs to be taken.

    This is a terrible thing the director and CDC is doing to the country. I hope you are held responsible by the next administration.

    The events of the last week or so in Dallas have looked more like the keystone cops than a managed activity by medical professionals. Whatever plans the CDC thought they had in place appear to have worked poorly so far.

    Admittedly many of the events there related to the abysmal handling of the ER visits by Texas Presbyterian Hospital. However the CDC efforts toward managing both the tasks and expectations of the clean up have been completely unacceptable. My impression so far is that the CDC may know medicine well, but is severely lacking at logistics of anything real. It is also lacking in PR, which is an important consideration.

    Human nature is always an important consideration in any activity dealing with the public. Regardless of what ones thinks should happen and the way people should act, it always better to plan and control based on what is expected from people when human nature kicks in.

    When dealing with a contagious disease that kills 50+% of those infected in a few weeks, that generates a great deal of fear and concern in the eyes of the public. In the absence of good information, people tend to assume the worst, which is not the right answer at all.

    How an organization handles PR can make a significant difference in the end result. I watched yesterday on NBC news as a network level journalist interviewed a man from CDC. His answer to most questions was “I don’t know”. He was clueless as to what to say and how to answer. I expect he was not one who was supposed to do interviews at all. Part of PR is making it known who CAN and who CANNOT do any kind of interviews. The CDC needs a PR person in Atlanta who offers high level answers to basic questions and a separate CDC person at each event site who deals with the local issues there. These should be the primary people for information while the CDC director deals with the overall approach. The local person many also be the one who deals with unexpected road blocks and gets them fixed quickly.

    The reason we have a problem in Dallas is because a man was allowed to travel from a hot zone country and enter the US with no isolation time period. While he had no apparent symptoms during travel, they occurred pretty soon after he got here (about 4 days I believe). Without some realistic travel restrictions this is going to happen many many more times. Human nature is again an important consideration here.

    As any number of journalists and medical professionals have already pointed out, the people in hot zone areas are at great risk. Those that have the $ and opportunity will consider traveling to countries where their odds are better, or if they become sick, their odds of being treated with quality medical care is greater. Human nature says many will stretch the truth to get on the plane. Many reports already discuss how they can take OTC medications to reduce a fever to pass temperature screening. To think they will not do this and succeed is just naïve.

    The CDC has published estimates of the expected extent of the infection rate and percentages over the coming months. The most recent show something like 500,000 to 1.4 million infected by sometime in January 2015. Its an out of control problem and getting worse. The CDC estimate is that it doubles every 20 days. The figure estimates for dates past January 2015, using the same mathematical model, get scary fairly fast. It hits 1 billion by some time in late summer 2015 and covers the globe by early 2016. Clearly this has to be stopped.

    These figures imply that whatever escape travel is occurring today may get much worse as the infection rate and percentages go up sharply. Global efforts may eventually find a way to get control of the situation, but thus far this has failed. Clearly a different, more comprehensive, effort is needed at the global level to first control and them resolve this problem. This is not currently occurring and will be difficult at best. In the meantime we need to protect our selves here in the US. We can no longer allow anyone to enter our borders. We need travel restrictions to help in this process.

    US Customs already exists to handle entry into the US. Getting entry for non-waver countries like Canada and Mexico generally requires a passport and/or visa for the US. These documents generally show the current residence location for each traveler. They also tend to show dates and stamps for recent border passings. Travel restrictions would have to deal with a number of basic cases and allow some exceptions in specific cases:

    1. US citizens who are returning after being out of country
    2. Foreign nationals who are coming here to visit for business or pleasure.

    Most restrictions would likely apply to people in category 2. We would also need to consider the travel route used by both categories. Those traveling from hot zone area are higher risk than those from other areas, regardless of country of origin. We would likely need isolation areas for anyone that pass the travel restrictions for entry for those in high risk areas. I believe that a handful of customs people, travel experts, and medical professionals could work out a realistic approach in a few days.

    Isolation is a somewhat different story. I believe the CDC already has a number of these spread across the US. I believe the US has something like 121 international airports. Putting aside the issue of food, housing, medical care, and people control, just basic grouping may be important. The incubation period for Ebola is said to be 2-21 days. However given that people will arrive throughout any given month, it seems a poor concept to put them all in one place as that mixes people who have just arrived with those already there for weeks. This would seem to increase the odds that a new arrival who is not infected would be in an area with others who have been there long enough begin to show symptoms. This is before you consider just keeping track of who came when and how long they need to stay.

    And then there is the issue many don’t like to discuss…costs. None of this is free. The Dallas man arrived and almost immediately began getting medical help from multiple organizations. I somehow doubt he has insurance and the cost of ICU for a Ebola patient may be many times higher than normal ICU costs. The same is true for all the efforts and people involved in cleanup and management. It’s a big issue that gets bigger fast if more such people arrive infected, which most medical expects believe will occur. The same is true for isolation centers. If 100 people a day show up, we are talking about food, housing, medical care, and other areas for 3000 people a month. That’s one isolation center. Its an immense problem.

    What we probably need to do is something along the following:

    1. Impose strict restrictions from anyone coming from a hot zone country, regardless of country of origin.
    2. Make those restrictions more stringent for non US citizens.
    3. Allow for controlled exceptions for clear medical transports and personnel officially associated with CDC or other approved medical groups.
    4.Discourage any travel by US citizens to hot zone areas, as they then will be subject to item 1.
    5. Work with other countries to implement similar restrictions and controls.
    6. Use isolation centers for anyone that fails the restrictions or exceptions from above.

    This will be messy to say the least. But the negative results of the lack of the above has the potential to be much worse, and in the worse case scenario, catastrophic.

    In regards to the Ebola virus, if you want to calm the American public, the CDC should be much more proactive and set up medical isolation camps and make it mandatory that anyone traveling from Africa need to stay at for 2-3 weeks to make certain that they are not affected and spreading the virus. It may sound extreme, however, would there be a better way to prevent the spread of the virus outside of Africa? Keep in mind that the CDC is predicting the virus to spread to 1.3 million cases by years end. If you were in Africa and beginning to feel sick, wouldn’t anyone want to get to America or some other country with better healthcare to save their life? Of course people are going to lie on their questionnaire to get out of the country because it will only increase their chances of survival. Simply put, people should not freely travel back and forth to/from affected countries. If anyone wants to travel into Africa to help, that is great, but be prepared to stay in the isolation camp to prevent the spread outside of the affected areas. Your foolish decision to rely on a questionnaire is ridiculous. You certainly should feel fully responsible for ANY deaths that are caused by people traveling from these affected countries into the US or other parts of the world.

    Since it has now been demonstrated that the screen in Liberia for infected travelers is not effective in preventing the disease from entering the US, the question is what changes are being made to improve the screening process so that it doesn’t happen again. Not doing anything to improve the screening process means that this situation can/will happen again. Where are the “lessons learned”? I agree with earlier posters that a 21 day quarantine for travelers coming into the US is a better way to stop it in its tracks, rather than being in a reactive mode and waiting until it shows up before trying to contain it.

    RE: ebola in west africa

    suggestion: a medical team can speak with the governments of each of the countries involved with the spread of the ebola virus about what religions are practiced in the rural part of their countries with respect with preparation and burial of the dead particularly those dying of ebola virus. be sure to take notes as a step by step process is needed to find out about each religions’ preparation for burial and burial. the medical team can then go over each step and give information about how to do the step safely such that the living can respectfully prepare and bury the dead but not contract a disease in the process. when these steps are completed then it may be translated into native languages and given to the villages throughout the country . perhaps a medical team can train
    some of the villagers to do the process safely. i realize this is something that can be done down the road, as there are more immediate things to be done.

    It is wise of the CDC to disseminate this type of information but their overall attitude towards the whole situation gives off mixed messages. They began by admitting that it is impossible to keep Ebola out of the United States, taking a practical stance. But now that it has arrived the only statements they make are filled with optimism and reassurance that our healthcare system is fully equipped to manage the disease, when in fact there are hospitals admitting that they do not feel at all prepared to handle an Ebola patient if one were to arrive. The CDC has been focusing on developing an action plan for when the disease arrives and possibly begins to spread throughout the U.S., which is important and necessary, but it is just as important, if not more, to develop strategies to keep the disease from entering our country in the first place. This is the area in which the agency is lacking- if stricter preventive measures would have been put in place, such as requiring citizens traveling back from West Africa to be observed for a period of time before allowing them to board a plane in close quarters with hundreds of other people, then the resources we have and will be using to fight Ebola in America could be reduced. Though they did not prevent the disease from spreading to our country, it does no good to dwell on this failure and I hope from this point forward they focus on preventing Ebola from spreading to even one more American. Once this situation is handled, there will be much to be learned in retrospect of the CDC’s actions.

    I wrote on August 10th urging policy makers at the CDC and at HHS to not allow international travel out of Africa. From March 2014 to mid August 2014 there were under 700 cases, now we have more than 3000. If it is true filoviruses can spread better in colder weather and possibly mutate based on climatic conditions, it is time to ACT NOW, and stop allowing travel out of Africa, and time to act quick to quarantine all suspected individuals who traveled to the states. Computers have the capacity to sift airline records to create a name list of all those who traveled out of Africa in the past 6 weeks. Yest, it would be a monumental task, but well worth stopping this from becoming endemic in the US!!!

    Directly from Pro Med Mail, it is possible it can be airborne, so stop lying to people to reduce fear. People are not as dumb as you think. With knowledge, people can act responsibly!

    Communicated by:
    ProMED-mail Rapporteur Mary Marshall

    ******
    [3] Aerosol controversy [This post has been corrected. The original included incorrect images of N95 respirators. – Sr.Tech.Ed.MJ]
    Date: 17 Sep 2014
    Source: CIDRAP [excerpted, edited]
    http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

    Commentary: Health workers need optimal respiratory protection for Ebola
    ——————————————
    Lisa M Brosseau, ScD, and Rachael Jones, PhD

    Editor’s Note: Today’s [17 Sep 2014] commentary was submitted to CIDRAP by the authors, who are national experts on respiratory protection and infectious disease transmission. In May [2014] they published a similar commentary on MERS-CoV. Dr Brosseau is a Professor and Dr Jones an Assistant Professor in the School of Public Health, Division of Environmental and Occupational Health Sciences, at the University of Illinois at Chicago, USA.

    Direct injection and exposure via a skin break or mucous membranes are the most efficient ways for Ebola to transmit. It may be that inhalation is a less efficient route of transmission for Ebola and other filoviruses, as lung involvement has not been reported in all non-human primate studies of Ebola aerosol infectivity. However, the respiratory and gastrointestinal systems are not complete barriers to Ebola virus. Experimental studies have demonstrated that it is possible to infect non-human primates and other mammals with filovirus aerosols.

    Altogether, these epidemiologic and experimental data offer enough evidence to suggest that ebolaviruses and other filoviruses may be opportunistic with respect to aerosol transmission. That is, other routes of entry may be more important and probable, but, given the right conditions, it is possible that transmission could also occur via aerosols.

    Guidance from the CDC and WHO recommends the use of facemasks for healthcare workers providing routine care to patients with Ebola virus disease and respirators when aerosol-generating procedures are performed. (Interestingly, the 1998 WHO and CDC infection-control guidance for viral hemorrhagic fevers in Africa, still available on the CDC Web site, recommends the use of respirators.)

    Facemasks, however, do not offer protection against inhalation of small infectious aerosols, because they lack adequate filters and do not fit tightly against the face. Therefore, a higher level of protection is necessary…

    Implications for protecting health workers in Africa
    ——————————————
    Healthcare workers have experienced very high rates of morbidity and mortality in the past and current Ebola virus outbreaks. A facemask, or surgical mask, offers no or very minimal protection from infectious aerosol particles. As our examples illustrate, for a risk group 4 organism like ebolavirus, the minimum level of protection should be an N95 filtering facepiece respirator.

    This type of respirator, however, would only be appropriate only when the likelihood of aerosol exposure is very low. For healthcare workers caring for many patients in an epidemic situation, this type of respirator may not provide an adequate level of protection…

    For a risk group 4 organism, any activity that has the potential for aerosolizing liquid body fluids, such as medical or disinfection procedures, should be avoided, if possible. Our risk assessment indicates that a PAPR [powered air purifying respirator] with a full facepiece (APF = 50) or a hood or helmet (APF = 25) would be a better choice for patient care during epidemic conditions.

    We recognize that PAPRs present some logistical and infection-control problems. Batteries require frequent charging (which requires a reliable source of electricity), and the entire ensemble requires careful handling and disinfection between uses. A PAPR is also more expensive to buy and maintain than other types of respirators. On the other hand, a PAPR with a loose-fitting facepiece (hood or helmet) does not require fit testing. Wearing this type of respirator minimizes the need for other types of PPE, such as head coverings and goggles. And, most important, it is much more comfortable to wear than a negative-pressure respirator like an N95, especially in hot environments.

    A recent report from a Medecins Sans Frontieres healthcare worker in Sierra Leone notes that healthcare workers cannot tolerate the required PPE for more than 40 minutes. Exiting the workplace every 40 minutes requires removal and disinfection or disposal (burning) of all PPE. A PAPR would allow much longer work periods, use less PPE, require fewer doffing episodes, generate less infectious waste, and be more protective. In the long run, we suspect this type of protection could also be less expensive.

    Adequate protection is essential
    ——————————–
    To summarize, for the following reasons we believe that Ebola could be an opportunistic aerosol-transmissible disease requiring adequate respiratory protection:

    – Patients and procedures generate aerosols, and Ebola virus remains viable in aerosols for up to 90 minutes.
    – All sizes of aerosol particles are easily inhaled both near to and far from the patient.
    – Crowding, limited air exchange, and close interactions with patients all contribute to the probability that healthcare workers will be exposed to high concentrations of very toxic infectious aerosols.
    – Ebola targets immune response cells found in all epithelial tissues, including in the respiratory and gastrointestinal system.
    – Experimental data support aerosols as a mode of disease transmission in non-human primates.
    – Risk level and working conditions suggest that a PAPR will be more protective, cost-effective, and comfortable than an N95 filtering facepiece respirator.

    [Surgical masks are not designed for use as particulate respirators and do not provide as much protection as an N95 respirator. Most surgical masks do not effectively filter small particles from air and do not prevent leakage around the edge of the mask when the user inhales. Surgical masks are adequate for use on a patient to contain droplets and prevent spread of infectious particles. N95 & PAPR masks for use by health workers are discussed above.
    http://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/respsars.html

    Photos:
    N95 respirators with goggles:
    http://www.ojmedical.com/img/prods/large/amd2321_20_n95_respirator_mask_niosh_a_sp.jpg
    Photo of PAPR respirator:
    http://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/images/paprimg1.jpg
    – Mod.JW]

    Not only aircraft….what about oceanliners? There are passengers on these still coming to our shores…..
    AND, of course our borders……we know that these are not secure!
    This administration just does not care!

    Most medical people know you must isolate diseases in place.
    Allowing these Christian groups to fly back and forth spreading the disease is unacceptable.
    History has shown Christian missionaries have spread disease all over the world.
    Whatever mission they have does not include infecting the US.
    It seems they have a free pass including taking unapproved medications and meetings with high level government people including the president.

    This must stop. Period.

    Why aren’t all patients that return with the virus being treated with ZMAPP? Thomas Ducan has not received treatment; however, two patients have previously received treatment and survived. Will the freelance cameraman, Ashoka Mukpo receive treatment? Who are making these decision and based on what criteria? This is a national emergency. The criteria for containment is anyone who has traveled AND exhibit symptoms; however, we see that this can overlook possible infected persons. Are more aggressive approaches going to be taken to reduce the potential spread of this disease to others?

    You make a point that travelers out of West Africa are inspected for signs and symptoms of being infected with the Ebola virus and we are to be comforted by that methodology of diagnosis. Yet the infected person now in Dallas was inspected and cleared and became infectious in the United States. You say infection is not airborne but the virus resides in saliva. You must be a political appointee for no legitimate physician could be so clueless and criminally incompetent.

    Are you for sure this will end? I mean come on people are so relaxed right now about how everything is under control. If it was under control, there would be no more infected people and ended at patient 1. I MEAN REALLY DISINFECT PLANES AND SHUT DOWN AIRPORT SYSTEMS. People are just going anywhere in this country and spreading other states. Then we would all die, the end. You’re the higher ups… Help us! Thats why you’re all in your job positions. So do just that… Your job and finish this quick if you make this seem easier than the alphabet. So dont seem so comfortable about it….

    News that the President won’t close the flights from coming here from the affected counties of Ebola. If he is going to expose the American people to this disease, I think he should be the first one to live out in the public with HIS family and worry whether or not he or his family might be the next person to be affected by ebola. He might change his mind then.

    Ebola patient just walked into Howard University emergency room. You all keep saying Ebola is not contagious until symptoms present. How do YOU determine what symptoms need to be present and at what level in order to make an Ebola positive patient contagious? Mild fever without vomiting or other fluid expression, high fever without any fluid expression, high fever with sweat and coughing (by the way coughing up contagious fluids into the face of a seat mate on an airplane doesn’t meet the CDC definition of airborne contagion – although if I were the seatmate, I might argue the point), involuntary expulsion of bodily fluids on various surfaces not normally cleaned with chlorine, like an airplane for instance). I believe the CDC is being disengenuous (lying) when talking about the threat of contagion of an Ebola patient. I agree about the threat once an Ebola patient is ID’d and isolated, however I believe there is a large threat of contagion between the onset of symptoms and the admission of the Ebola patient. There are also numerous ways to screw up the isolation phase by the care givers. Just ask the nurse assistant in Spain, the care givers in Dallas, and all the dead care givers in West Africa. The military care giver who posted earlier is right about the lack of your planning for all levels of the medical system, Dallas being the star of bad Ebola case management. As a former Medical Brigade Chief of Staff, we practiced war time exposure to bio weapons and nerve agents. We failed almost every time to keep the care givers in the operating rooms and in the wards from starting to twitch (hypothetically, by tracking powders that flouresced under black light). This was despite some of the best de-contamination processes available at the time. Please come “clean” about when exactly Ebola is contagious. You have not done that so far.

    I agree with the post by concerned Healthcare provider, you are failing us not only as a representative of health but you are failing YOUR family and loved ones as well. You know Ebola is a highly contagious level 4 and the results are horrific. I have studied this myself extensively. For every 1 person infected there is at least 5 still out there, and the fact that you try and blow us off as ignorant to the disease is non the less arrogant on your part. Do you not think your fellow colleagues are not as knowledgeable as you or received less training. We ALL took a oath to protect the health and well being of others and you my good man a nation as well. So step up and do the honorable thing and close our borders not indefinitely but until this epidemic is contained and go down in history as the man that had courage to do the right thing. Our for father’s fought for a liberty to do just that and the bible tells of a man sacrificing his son for ours. Stop lying and treating the situation with such arrogance that you are too blind to see the truth. All healthcare workers already know what is occurring and is intended to take place. Population control is not the answer!!!

    What is going to stop people exposed to Ebola in W. Africa from taking ibuprofen to get on a plane to get better health care in the USA? It’s time to close the borders and only allow health care people to fly back and forth to the 3 countries in W Africa. Stop endangering our lives!

    To not instigate a full flight ban and mandatory quarantine for those traveling from at risk countries is reckless in the extreme. When major corporations that operate in Liberia are restricting travel to and from the area, why does the CDC think they they can spot at risk passengers on arrival? To continue the current policy is a complete failure of your mission statement which is copied below to remind you of it.

    CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

    CDC increases the health security of our nation. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.

    WHY IS THE CDC PUTTING POLITICAL CORRECTNESS AHEAD OF SCIENTIFIC METHOD?

    Dr. Frieden, the average American–even without knowledge of medicine and epidemiology–KNOWS the CDC is failing the American people.

    Our borders are breached, not only by Ebola. WHERE did ENTEROVIRUS 68– that is infecting and taking the lives of our children– come from? YOU KNOW IT CAME OVER THE SOUTHERN BORDER and are failing acknowledging the truth!

    WE HAVE NO IDEA ABOUT EBOLA. I have a hard time believing all these doctors and health care workers would be dead in West Africa if we did, and now Spain, and the USA. Humans breed Error; that is why we are human. ANd viruses KILL. Please WAKE UP, you can not be so naive….Please urge President Obama to do the right thing for HUMANITY. That man needs to WAKE UP. The entire globe needs to WAKE UP. IT all started with one small family people. The international community needs to stop flights OUT OF WEST AFRICA. IT is about containment. IT is common sense. Take temperatures? are we insane? So we import sick people into other communities to infect how many? We have no idea how this virus is mutating. IT is HIGHLY contagious. The Doctors sounded the alarm in March to the WHO which did Not do the right thing. The international community needs to shut down flights out of West Africa and maybe even the continent of Africa until the virus has burned out. historically, sick people did not travel so the virus was contained. But now? we have global trade, global people, global disease. I do not need to hear what the EXPERTS have to say. COMMON SENSE SAYS CONTAIN; otherwise why do we have ISOLATION units here in hospitals? PLEASE DO THE RIGHT THING FOR HUMANITY. FORGET POLITICs. I am so sick of the ‘D’ and the ‘R’. All it takes is a few stand up guys to get the ball rolling and put the pressure on. I am SO SICK OF EXPERTS.

    Protect my children now. Stop travel from ebola-infected countries. You are letting ticking time bombs walk our streets, ride mass transit. I now feel the need to cancel our travel plans WITHIN the U.S. There is no way we will be getting on a plane. I have seen first-hand how poorly they are cleaned between flights – and who knows where its last flight was. Now is the time to be cautious. This isn’t about freedom – it is life and death for many innocents. How dare you jeopardize so many!

    It is clear to me that, like many other areas of our Government, common sense has left the CDC HQ Building. Rule #1 should be placing travel restrictions on everyone coming into our Country from those areas where the disease is active. I understand why you would want to be able to allow for health care workers to respond to this situation. However, why not place travel restrictions on those wishing to come to the United States, who are outside our First Responders to the crisis. Also, since we know the incubation period is 21 days, why not set up isolation areas in the affected countries and in the U.S. where people can be placed in a “Wait and See” status prior to boarding an aircraft. The same could be done for those coming into the country.

    It would appear that Ebola CAN and IS spreading or being contracted by means that seem to have been ruled out. All the assurances about our advanced medical care in the US and new drugs being able to stop/cure this disease except in the most advanced cases are probably wild and professionally arrogant boasts. This government has put the American public at horrific risk. It should have already stopped all entry into the US from ANYONE known to have been in any of these West African countries where itis now pervasive. Like other world events spiraling out of control that threaten American interests – this is simply another example.

    I’m sorry but I do not believe what the Director is saying. I think he is clueless. This needs to be stopped in Africa. People are lying and trying to get out with false information. I think patient #0 was a liar. I also think there is another component to this that may be classified as terrorism. We need someone strong who tells the truth. Certainly not the current administration. The stuff coming from the CDC is just not convincing. Thermometers???—- what a joke! Don’t let them in.

    If Ebola is not airborne and can only be transfered by salvia etc. WHY after 4 or 5 days were they disinfecting the man who died in Dallas apartment building he stayed in – IN HAZMAT SUITS? Realy how stupid do you think we are.
    Also your screening system is so faulty.
    1. People can lie as this gentleman that passed today in Dallas.
    2. You would infect a whole plane full of people – if passenger lied, or got sick on plane ( and if they go home and on with there life, the numbers involved would be huge!)
    3. If a person got sick on plane, the plane would then be landing in the USA. A place that you are suppose to be protecting.
    4. If this is so safe why don’t you,Tom Frieden go over to Africia and teach them how to combat this safely. Don’t send our troops over there. You go. I bet you won’t, you are just all talk and will sit and keep yourself safe. They did not sign up for fighting this deadly disease. The simplest thing would be to close the borders, period. The workers in Sira Leone are pulling out and not wanting to be exposed. How stupid are you Tom Frieden? Don’t answer I already know.

    WE CAN END EBOLA IN 90 DAYS BY REMOVING, HOUSING, FEEDING AND PROVIDING THEM A $5 A DAY STIPEND FOR 90 DAYS TO BE SURE.
    .
    WORLD BANK AND IMF DONATED 400 MILLION DOLLARS TO FIGHT EBOLA
    USA TO CONTRIBUTE OVER 500 MILLIONS, EU , UN ETC ALL DONATION
    .
    WHY NOT END EBOLA UNDER $5,MILLION DOLLARS
    BY
    (A) BUY 10,000 LOCALLY MADE BEDS $100 EACH
    (B) SET UP ALL 10,000 BEDS INSIDE A COUPLE OF HIGH SCHOOLS.
    (C) PULL OUT ALL 4000 EBOLA INFECTED PEOPLE OUT OF SOCIETY FOR 90 DAYS
    (D) PROVIDE EACH PERSON, BREAKFAST, LUNCH DINNER & WATER FOR 90 DAYS
    (E) OFFER EACH PERSON A STIPEND OF $5 / DAY. OFFER $5 PER NEW REFERRAL
    MISSION ACCOMPLISH IN 90 DAYS BY REMOVING THE 4,000 INFECTED PEOPLE AND BREAKING THE CYCLE OF EXPONENTIALLY GROWING NEW CASES. FOR LESS THAN 5,000,000 DOLLARS US.

    I have called in to say that I think it is not reassuring to the public that travelers are being screened by being asked if they have been in contact with anyone having ebola. At least one traveler has either not been aware of having been in contact with a person having ebola or has withheld the information that he was in contact with a person having ebola. I understand that travelers will be screened by two interviewers, but this is not reassuring to me that persons who might potentially be infected with the ebola virus will be identified and quarantined to protect the public. What would be better to do is to quarantine anyone having traveled to West Africa. It seems the most sensible approach to the problem of infected travelers spreading this virus. If infected travelers are coming into other countries besides the U.S., en route to the U.S., this is an even greater threat due to the 21-day incubation period.

    What is being done to prevent the spread to other countries?

    Mary Moses, R.N.

    The Ebola patient in Texas has died. The officer that served the warrant to quarantine the patient’s house has now come down with something that seems related to being in the house where the patient was living. We need to know the truth about how this disease spreads. People are very concerned, but we feel like we are not getting the truth.

    We quarentine dogs before they can enter in our country or taking pets into other countris. STOP it now and ban all non-essential travel out of these or into the infected countries. Dr. And director of the cdc. STOPThe LIEs!

    why are you being such an idiot? You tell us it can only be spread while active symptoms then play stupid about patient zero in the village. A 12 yo with no contacts. Dah semen. Months later from a ‘survivor’. Now the deputy …. He wasn’t a contact? Even tho he was in the aprtment? Later scrubbed by folks in mopp 4 who tore out the carpet curtains and bed. If he wasn’t a glorified contact to be tracked by your glorified ‘surveillors’ who was? If a guy who was in the living space was?’t a contact….then the peeps in the er waiting room next to duncan weren’t eiither. Even if they chewed on the same pen. I don’t get how the pple who rode in the ambulance after duncan were ‘contacts’….and the deputy in his aprtment was not. You people are on crack.

    isn’t it cheaper to quarantine pple from the hot spot for 21 days than have all paranoid &merica stay home? I mean it will only take a handful of cases conus and their contacts for us to shut down. Good grief you did ‘t even make the deputy a contact. But you made ppl clean the apt in mopp 4. Hello disconnect?

    Why doesn’t the CDC produce a saliva or nasal swab test detection? It should be fairly simple to produce, one with immediate results;say that changes color for positive. (Ebola can be detected in saliva and nasal mucus, as noted in the article from The Jounal of Infectious Diseases -J Infect Dis. (2007) 196 (Supplement 2): S142-S147.doi: 10.1086/520545)
    To use as an “extra measure” besides laser thermometers in airport screening. Not that this would be a true determining measure, but at least one more precaution in diagnosing if someone has Ebola. Funding could be assessed by having airline passengers pay for the testing, or not allowed to board. Again, not that the testing can
    determine positively an infected/carrier person. Just one more precaution.

    Why not close the border to travelers from Ebola infected areas? (except for medical workers from the US who received the virus when treating patients.) We have shown the ability to keep these people in isolation and bring them to a full recovery. Otherwise, it is best to not let this deadly disease spread throughout our country.

    I am a health care worker and very concerned with the Ebola virus. I continue to read where N95 masks are recommended when procedures maybe conducted that would produce aerosol particles. Just my opinion that it sounds airborne to a degree. I have to wonder are we getting the whole story fro our corrupt government or just what they want us to know. This virus being airborne could make it a whole nother monster within itself.

    DON’T BE CONCERNED WITH PANIC. IT ACCOMPLISHES NOTHING! WITH A DISEASE AT THIS HEIGHTENED SCALE, NO ONE SHOULD BE ENTERING IN OR OUT OF EACH OTHERS COUNTRY. NO AND, IF, OR BUTTS. TILL THIS IS CONTAINED!

    Why aren’t there preventive measures being taken at ALL the airports in the United States including San Francisco? If ever there was a time to secure our borders, it is now more than ever! Other countries have secured their borders. This is in total complete disregard for the well being and safety of the American people. What about protecting and serving the best interests of the citizens of the U.S.A.? This will ultimately & adversely affect each and every one of us if allowed to go unchecked. The lives and health of our wives, husbands, sons, daughters are at risk. PLEASE enforce our current immigration laws, secure our borders, and provide medical screening at all our ports of entry to the USA (including quarantining until vetted by medical professionals.)

    I need advised, my ex travelled to Kenya and I understand during his travel, he travelled to Tanzania, I don’t think those places have been confirmed with Ecola, but I have the fear that people in the African nation cross theborder even without passports, when he came back to the U.S.A he stated he was sick and tats why he could not see his son, now he wants to have his son for the weekend and I told him he needs to see healthcare professional before he picks him up to confirm he did not get the disease. He has even gone back to his work. He has declined to see the health care professional and has also declined to give me the symptoms he has. Personally am a registered nurse and I am very concerned about the well being of my son when he picks him up for the weekend. Kindly advise me. Thank you.

    The Char-Koosta News wrote on October 9, 2014 on their internet page: http:

    http://www.charkoosta.com/2014/2014_10_09/THHS-Ebola_story_a-100914.html

    “Thomas Eric Duncan, died as a result of ebola. Another victim has since contracted the disease while cleaning Duncan’s apartment.”

    I know just because it is on the internet does not make it true, but is the CDC has not confirmed nor denied this case and others. Is it because they do not wish to cause panic or because it has not fully been confirmed as ebola? If they would just let people know it is not true, it may stop the panic.

    So now you are going to compare Ebola to HIV AIDS? As someone living with HIV (successfully I might add) for 29 years it is wrong wrong wrong to compare these two diseases! They are not the same and never will be….the only comparison is they originated in Africa! Because you know the main countries where Ebola is at you, along with WHO and airlines have the responsibility to stop it from leaving the affected countries. And because it has been around so long they why hasn’t there been better ways to quickly diagnose those who may be infected? And why is it a company in the US is the only who had the experimental drug to treat the two patients flown back to US from Africa? Yes perhaps it will become an epidemic if you do not take better measures with finding a way to quickly test people before they board an airplane or have them stay in a holding facility for quarantine, just like they do to people who are not admitted into a country due to insufficient paperwork. We have surely come a long long way since HIV but we know here in the US that our hygiene practices a way better than a lot of developing countries and that is why you haven’t seen anyone develop Ebola in Dallas after being in contact with the now deceased patient. Ebola is not easily transmitted nor is HIV….very specific opportunities must be present…….you have very specific lists of those conditions at CDC.gov

    Please be responsible and stop the PANIC! Stop making people think it is transmitted through sneezing or a handshake….and stop equating it to HIV….trust me, if HIV were spread that easily we would have millions and millions more infected, just as you would Ebola.

    Director of the CDC. You compared this Ebola crisis to the AIDS epedimic. Very ignorant to say publicly, to the entire world! First, as of yet, there is no viable cure for HIV/AIDS. Your statement has resonated with over 1 million living with HIV/AIDS. Far too many have had to fight to live normally under the shroud of stigma. For you to even begin to compare the two is highly irresponsible! ! The modes of transmission are not the same! So many have devoted their lives educating the public with ACCURATE information. In absolute truth, the only thing comparable is the government releasing a statement that perpetuates FEAR amongst the general public. Not only that, the CDC is involved with the HIV/AIDS communities around the world! And your public quote is quickly traveling around the world as I write this.

    DO NOT COMPARE THIS CRISIS TO OUR HIV/AIDS EPIDEMIC THAT CONTINUES TODAY SIR!

    An apology, publicly would be nice. If you have time to make such thoughtless comments, you have a few minutes to apologize.

    And yes, I’m a woman, a mother, that contracted HIV while having sex in a committed relationship. How do you think your comparison resonates in my children’s ears? Think on that. Coming from someone who has been harassed based on stigma for having HIV. I’ll be watching for your apology.

    I just read the survivors of ebolie can’t catch it again for at least ten years. Since west africa has about 3500 survivors….shouldn’t we pay them handsomely to work the front lines? I suspect there is a lot of non technical work they could do after a week or two of training. They could probably do ivs and such after a week of training.

    Dear Mr. CDC Director, I´m a Physician, I want you to take another look at the Protocol for taking off the Protective Uniform used in Ebola, THE GLOVES SHOULD BE THE LAST TO BE TAKEN OFF. They use their bare hands to take off all of the gear that for sure is infected. Hope you pay attention to my suggestion, I think it´s very important, Thank you,
    Sincerely,
    Marcela Solano
    Costa Rica

    Please discontinue comparing this to the AIDS pandemic. AIDS can lay dominant for months, is a primarily sexually transmitted disease and is NOT fatal with treatment of overpriced drugs. If you want a comparison try polio or typhoid, or mumps and measles.
    I’ve been HIV + for 30 years. My drugs have cost over $800,000 alone. Ebola will never cost what HIV/AIDS has. Ebola will never be the money maker HIV/AIDS has become. I abhor the comparison made by your staff. It shows the continued ignorance by even the CDC

    The prospect that the Ebola virus brought into the U.S. by Mr. Thomas Duncan will be contained is mostly due to good fortune rather than anything done by the CDC. This, in spite of assurances from the Director that preparations have been underway since March. I wonder how many more “Thomas Duncans” will get through the new airport screenings, since Mr. Duncan was not experiencing fever or other symptoms at the time of his entry. Since the Director is not in favor of travel bans, apparently he feels that a limited number of infections is acceptable. It seems that public concern is to be more feared than the actual risk of more infections.

    Who is the idiot who keeps comparing the ebola virus to AIDS? Are you kidding me? I don’t think there will be an ebola patient who lives 30-35 years and longer. To compare ebola to HIV/AIDS proves that still after all these years we have health care professionals who do not know diddly about HIV. Stop! You just set the HIV community back 35 years with this rhetoric.
    I find it odd that you compare this virus to AIDS, was able to kill it with an experimental drug for two people and yet many of us have spent upwards of over $800,000 over the course of 25 plus years just on drugs alone to stay alive. This isn’t counting doctor visits, lab tests and hospital stays for opportunistic infections spread by the population that knows not whether they too are infected or not.
    You just showed your hand and the hand of your house man, Mr. Pharmaceutical.
    Get your stories straight.

    We Must Stop The Flights and slow the epidemic while we pour resources into ramping up a vaccine and doing all we can to help West Africa with aid now.

    Nigeria has contained the epidemic but has closed their boarders, we must http://www.stoptheflights.com

    Do the right thing.

    Matt Sylvestre

    3 additional problems with the current strategy:

    1. How is asking patients if they contacted any ebola patients in Africa supposed to work. Even if they do not lie you might as well ask them whether they have touched anyone in the past 3 weeks. And that doesn’t even take care of fluids that may have come from a patient, which could be in any public place over there. We see images of patients in the streets at advanced stages of the disease.

    2. Without a quarantine how is a patient who develops symptoms here in the U.S. supposed to get to an isolation unit at a hospital without risking infecting people along the way. There is no instant bubble suit. Now all our volunteer EMT’s and fire/police personnel and ER workers will have their lives jeopardized.

    3. Even without the newly admitted property of Ebola that it has the “potential” to be airborne, our hospitals cannot prevent the spread of other diseases within the patient population. Now all the sick patients become at risk. I am telling everyone I know not to get sick until this is over.

    And for what? Somehow allowing travelers in for NON-ESSENTIAL travel is more important than protecting our citizens. I have supported this administration from the beginning, but I suddenly feel the urge to MARCH ON WASHINGTON, something I have never done. I am going to reach out to Disney, because I will be cancelling our trip because of this. Maybe getting some monies interests on the CDC’s back will have more of an effect than the voices of all these good citizens speaking out here.

    My letter to Disney corporate offices:
    We are regretfully canceling our upcoming, December trip to WDW. Many concerned citizens have been voicing their concerns about non-essential travel of potentially infected travelers from Ebola-affected countries:

    http://blogs.cdc.gov/cdcdirector/2014/10/02/why-u-s-can-stop-ebola-in-its-tracks/#comment-4072

    We toughed it out in the crowds during the swine flu epidemic (after making sure we got our vaccinations), but Ebola is a completely different beast. Between the planes (our airline, United, flies to West Africa) and the crowds, it is too much of a risk for the sake of recreation. I realize that not than many West Africans are likely to be on a Disney vacation, but with 150 travelers arriving every day with the potential to become infectious any time within 3 weeks, and no quarantine in place, our first responders (police, fire, even volunteer EMT’s) and all health care workers are potentially at risk, and possible sources of disease. Many of those visit Disney parks from all over the country. We find it simply unwise from an epidemiological viewpoint to visit a theme park until we have assurances that we are safe.

    Please use your much more considerable clout to wake up the CDC. Ask your corporate friends to join in the outrage now! The powers that be are now finally admitting the Ebola virus has the “potential” to become airborne, infecting new victims via the respiratory tract. And they have long admitted (although not advertised) that it survives in droplets left behind by a sneeze or sweat. This is even before the possibility of it mutating. Please listen to the many concerned citizens, doctors, scientists posting on the CDC blog, and not the policy makers, who have to take politics, panic, global economies/relations, etc., into account. If the epidemic is not contained by November 23rd at the least we will have 2 very sad little girls. I lose sleep thinking about the worse case scenario. So should anyone who has thought this through carefully.

    I am a Physician Assistant. I’m worried that even medical personnel who have been trained to screen patients on incoming flights will not be able to effectively discern who may be sick with Ebola. I must voice my concerns that this is not an effective means to prevent the spread of Ebola in this country. While I believe that the United States and the rest of the world has a responsibility to respond to the crisis in Africa, I think commercial flights can be limited while allowing very tight control over who brings aid over and returns. I’m surprised that a little PA that is not involved has to write to recommend to terminate all commercial flights out of Africa. It is the only way to prevent any more patients from spreading the disease in this country. I thank you for your service, I do not intend to be disrespectful, but I do intend to firmly make this suggestion. Please listen. It is the only way.

    I’m a former US Army nurse. Unlike 911 let’s not underestimate the enemies of Western Civilization. Our enemies can Weoponize Ebola and slip through the Mexican Border unchallenged.

    With all due respect. Dr. Frieden, your explanation for NOT terminating travel from W. Africa is full of holes and insults our (the public) intelligence. Travel should be terminated. To avoid the isolation of these countries that you so greatly fear, charter planes, military planes and other alternative means of transportation can be provided to carry supplies and caregivers. America has, in all catastrophes around the globe provided these necessities. Yes, the government CAN and SHOULD provide all means of support without putting our citizens at risk.
    If you refuse to terminate transportation, at the very least, all travellers whose flights originated from W. Africa should be quarantined for 21 days upon arrival from the US. This is actually part of our American history. One need only research the experiences of Ellis Island. Immigrants, such as my grandparents, were quarantined to prevent the spread of diseases such as TB.
    Finally Dr. Frieden, I pose these questions:
    1. Would you be comfortable having your children or grandchildren sitting in a movie theater next to people who have arrived from W. Africa perhaps a week before?
    2. Would you be willing to quarantee that these W. African travellers are NOT contagious should they develop a fever within the next few hours of leaving that theatre?
    3. Isn’t it your job to do everything to keep Americans safe? EVERYTHING!

    In spite of the best intentions, Americans are at greater risk of infection as long as anyone can travel from W. Africa to the US.

    The reaction and the lackadaisical attitude the authorities have regarding protocols and risk assessment are appalling when it comes to Ebola and national and public security.
    I would ask those in political power and at the CDC to examine the quarantine protocols used with a Hoof and Mouth outbreak, or what was done with Mad Cow disease.
    The reactions to Ebola despite the obvious risks don’t compare to the government’s reactions to agricultural pathogens. Politically correct attitudes are allowing the Ebola virus to spread and the health care workers are not being vigilant enough to protect the North American public.
    If the current outbreak in Africa was Hoof and mouth disease, there would be a 100 percent quarantine of all animals leaving Africa. Yet, infected or potentially infected persons are still being allowed to leave Continental Africa and also being allowed to return for non -essencial travel.
    The powers that be are either deliberately allowing travel, or are demonstrating colossal incompetence because it is obvious to me that were this an agricultural disease a complete travel ban would be implemented.

    What I don’t understand is that the CDC and WHO have been battling ebola in Africa for decades and successfully stopping and curbing the spread of the disease without bringing health care victims to the states for recovery before. Decades have passed bringing more technological advancements to the medical profession, yet now, per the CDC, bringing victims to the USA and placing them, not in one hospital in one state, but in several throughout the country is necessary? Somehow, this simply doesn’t ring true and begins to smell more like a conspiracy to cull the US population through health care incompetence and spreading of a horrific disease. AFter all is said and done, there is still a monstrous population of citizens with no health care insurance who will submit to illness without seeing any doctor at all, still trying to go to work, take care of their children while spreading more disease and death. Frankly, you appear completely incompetent for the job as Director of the CDC. The borders should be closed to any travel save for those who wish to volunteer their lives to treat ebola in Africa and the medical supplies which they carry. They go there with that risk in mind. They should be treated there as well.

    OK Dr Frieden

    As a registered nurse, I’m here to tell you that I am losing confidence in your “expertise!” YOU CLAIMED THAT US HOSPITALS ARE WELL PREPARED TO CARE FOR EBOLA PATIENTS???
    NOW YOU HAVE TO DO DAMAGE CONROL–YOU— IN YOUR IVORY TOWER OF THE POLITICALLY CORRECT CDC!!!

    YOU COURT POLITICAL FAVOR OVER OBJECTIVE SCIENTIFIC METHOD!!!!!!!!!

    Close our borders to protect the citizens of the USA. There is no reason to allow travel from West Africa except by non infected healthcare workers. People will come here just to receive treatment.

    Just sharing a great idea. A program on PBS indicated to me that production of Zmax would be slow to ramp up due to the unlikely profitability for drug companies. Why not have a campaign on TV or radio where people are asked to purchase their dose preemptively. I think there would be enough public interest to produce enough Zmax to stop the spread before the disease is widely spread. Hopefully most people would never need to be treated.

    For what it’s worth.

    I’ve always said that we (humans) will be our own demise but I never thought it would be from someone who had the authority to control it. I’m at such a loss for words right now. I would be willing to place a friendly wager that if your family member was Mr. Duncan things would be totally different right about now,right? Protect the people as if we are your family. Not a doomed person to experiment on like a rat. Treat others as you would like to be treated because,quite honestly,we ARE all that you have. If you don’t like it then leave. The People of America have stood and spoken. The ball is in your court and has been for six months. Please help the people out and restrict travel. If not,may you live with blood of the deceased on your hands.

    I am extremely disturbed by the actions not being taken. My heart goes out to those who have lost loved ones due to any sickness. However why are we allowing travel to the u.s from infected countries. That’s like an invite into our country. Other countries have closed their borders but we have not? Why not send aide but only allow our citizens back into our country, at least we know where they have been and know what and who to watch. How can we contain anything by allowing free travel… sure a screening is great. But how about when the symptoms don’t start until it’s in the u.s why are we risking our people’s lives. I have little girls that I am terrified for. Please keep us safe…

    So the US takes the stance that we can stop Ebola in in tracks by proper protocol & honesty of those exposed. That attitude is ignorant and portrays a confidence we shouldn’t have. Let’s take honestyon forms-Duncan checked “no” to having been exposed. How many more people will do thesame? As for protocol-that had been mishandled too. Ironically we are told our childrencan’t go to school without proper immunizations but yet no extreme steps have been taken to protect our children’s future from Ebola. All non-essential flights to/from affected countries should be cancelled. Only monitored flights for health care workers should continue with strict monitoring & quarantine processes. Six months from now we can’t turn the clock back & say we should have done this….it will be too late. In a country where we already have too manymental health issues in young people, I have already witnessed the anxiety of kids rapidly increasing over this because theyalready pick up that this is getting out of control. Take a stand & do something valuable for our kids future!

    Entry into the United States should be halted. Anyone traveling for leisure, business, or entering the USA seeking asylum, should not be granted permission at this time. Public hysteria will ensue if local and state health departments do not hold community education programs for citizens. In spite of best efforts, fear will occur regardless but with a lesser impact.
    The most important starting point for education is the airports, and points of entry into the US. A traveler from an infected country may enter through Mexico or Canada, and proceed to enter the US. Would suspicion still be raised ?

    Thank Mr. Frieden for lying about ebola- for bringing It into the US-
    Funny, for a guy who is so sure about ‘ stopping Ebola in it’s tracks’, I see the disease spreading.
    Maybe he should don the hazmat suit and take care of patient #2 and see how transmissible the disease is……
    The expert huh?
    All of his statements defy logic.
    Keep up the pandemic guys, now it’s in Boston.
    But at 150 people a day coming in to the US from ravaged countries, it should only be a matter of time before our already hospitals will breakdown…..
    Then what? We all get quarantined? He’ll, just exterminate us because you’re definitely on the right path..
    Close the borders, stop the flights, make all medical/aid flights a military operation and then you’ll see the numbers get under control, but this looks like something larger is at work here.

    Hi Tom, thank you for your public service. We realize that politics is part of the job, but everyone knows you’re lying to us. If you say “Never …” or “Impossible”, you’re lying. It’s better if you quote Biologist Jeff Goldblum from Jurassic Park: “Life will find a way.”

    Why do you continue to dodge the question of closing the U.S. borders and isolating the disease at the source? Nigeria has closed their border and allegedly stopped the spread of Ebola. You have no good reason for pretending that closing our borders would not make a difference. Please begin working on the front line in the hospital in Dallas if you mean what you say.

    The largest study of the current outbreak found that in nearly 13% of “confirmed and probable” cases in Liberia, Sierra Leone, Guinea and elsewhere, THOSE INFECTED DID NOT HAVE FEVERS.

    The study, sponsored by the World Health Organization and published online late last month by the New England Journal of Medicine, analyzed data on 3,343 confirmed and 667 probable cases of Ebola.

    An article by David Willman in Los Angeles Times on Sunday, October 12, 2014.

    Ebola victims CAN BE NFECTED with Ebola, WITHOUT A FEVER and subsequently infect anyone in their path..

    Dr. Tom Friedem
    Mi opinion es:Dejar en encubacion por 21 dias a todos los pasajeros que necesiten salir de Africa contaminada a cualquier area o pais.
    Si Estados Unidos no se salva menos los otros paises.
    Los pasajeros mienten como el que acaba de morir. Los sintomas pueden empesar despues de haber llegado a su destino y va hacer demaciado tarde.

    I am offended by your comparison of Ebola to AIDS. Thousands of people are working very hard to fight the stigma of HIV by openly disclosing their status putting themselves in vulnerable positions. Speaking out to say we can live healthy lives with HIV and treatment. This fear mongering undermines their efforts. You can’t live a healthy life with Ebola. There is no comparison to be made the dark days of people dying quickly from AIDS are long gone. If you want to do something smart close our
    borders to people coming from Ebola infected areas. No one has to come to the USA it is a privilege and we should have a say in who comes in. We don’t have to accept everyone. The idea that you can just screen someone at certain airports is ridiculous. All of our hospitals are not equipped to deal with Ebola. By not closing our borders we are inviting this deadly disease in to our country.

    Dr. Friedan,
    I am an ER/Urgent Care physician. I have past experience and training in NBC as a Battalion Surgeon with the Marines during Desert Shield/Desert Storm. I have been interested in Ebola since before ever going to medical school. For those of us that have followed Ebola, we have always known that there would be an epidemic that did not spontaneously resolve itself. We are currently in that situation.
    Of 3 medical personnel with previous extensive contact and treatment of patients in Lassa hemorrhagic fever hospitals in Africa that were interviewed after surviving Ebola, each had no idea how they contracted Ebola. They were all certain that they were not exposed while caring for Ebola patients. This is VERY concerning. I am not concerned about respiratory transmission, but feel that Ebola is easily spread through small particles of saliva or sputum from surfaces after sneezing/coughing. With 150 people per day entering our country by air from countries with current Ebola epidemics, there is a serious possibility of seeding every corner of our country with people that have yet to develop symptoms from Ebola. We MUST stop people from countries with Ebola from traveling to the U.S. NOW! These individuals need to be quarantined for 21 days after entering the U.S. from a country with Ebola. There is simply not enough information to prove that the U.S. is capable of caring for patients with Ebola without it becoming widespread. PLEASE, consider this. If we have an onset of Ebola epidemic in this country during Flu season, our country and medical systems will be overwhelmed quickly. I understand the consequences of raising this level of fear. You WILL NOT be able to control the level of fear once Ebola cases are scattered across the U.S.
    “Discretion is the better part of valor”
    Patrick E. Tucker, M.D.

    if the virus can live on surfaces like plastic suits why aren’t ebola patient caregivers wearing a fabric robe over the plastic that’s been soaked in strong beach and wrung out? Like short of dripping on the patient short of dry? Then maybe less of the virus will survive to the plastic making it safer to remove. Plastic etc might be our enemy. Whereas a spongelike bleachy cotton might trap the fliuds and kill the virus. And give our front lines a better chance of not coming into contact with the live virus when they do take off the plastic.

    To stop the spread means to Quarantine people in the countries that have Ebola at least 21 days before flying to any country. Why are the people in power not demanding the Quarantine? We already had someone lie on simple screening and now a nurse is fighting for her life. How many people need to be exposed or die before you insist on containment. Start the 21 day quarantines now.

    This website is improperly censoring public comment. I have attempted several comments calling for Frieden’s resignation and none are posted. I have now written to Bill O’Reilly to expose your censorship.

    The director of the CCDs is a phony with phony medical policies. What is this individual thinking?? An educated individual cannot regard his words only as phony as the policies he says. First taking temperatures is the most idiotic time waiting idea you can have. Does he know medicine because his unethical means to stop an epidemic in the USA is foremost the most effective. This lunatic wants to take a temperature on 1000 individuals on the incubation period that’s as lunatic as a nine year old believing in Santa clause. 1000 individuals will be illness free by his standards. Which create 1000 infected individuals with Ebola. Listen stop the commercial flights or quarantine all people coming to the USA for 21 days. He needs a lesson in infectious disease. Maybe if he didn’t believe in the tooth fairy

    why aren’t they wearing a wet bleach cotton robe on top of plastic to wick awyy and kill the virus? Soak in bleach ring out like dishcloth. Put over moon suits. Then rest of protocol.

    You Sir are an imbecile . If it is more important to not panic the Pubic versus protecting Americans History will CONDEMN YOU !! Please prevent any travel into the U.S. from the high risk area’s. Kind of like a school does when a kid gets head lice and school official’s tell the parents to keep the student home from school as to not cause an out-break,(just one example). Keep high risk people from entering th

    Dear Dr. Frieden:

    The following is from Facebook page and I have been reading up and posting on the Ebola crisis even before Mr. Duncan arrived in Dallas.

    HERE’S SOMETHING ABOUT DR. FRIEDEN, PUBLIC FACE OF CDC AND EBOLA NOW

    He went to top schools.
    He is an achiever.
    He worked in India and helped bring TB under control.
    He led the crusade against tobacco smoking in restaurants.

    Bottom line… he is an achiever so don’t second guess him.

    He is driven by data and numbers and you can leave a message on his website.. he might not see it but if he likes it your phone will ring.

    P. S. I paid attention to all this because HE IS GETTING TO ANNOY ME. The one thing he needs to do is call for a ban of all flights OUT of Ebola hit countries and also call for a ban on US VISAS to anyone traveling OUT of the Ebola hit areas.

    What data do you need Dr. Frieden to make this call?

    http://www.cnn.com/2014/10/14/health/cdc-frieden-facing-criticism/index.html?hpt=hp_t1

    Dear Mr. Friedan,
    Considering there are many people in the US who do not have healthcare, and if they do have it, have high, unaffordable deuctibles, opening the US up to visitors from West Africa who need to be quarantined; need expensive hospital and public services at no cost to them for suspected and then actual Ebola, is utterly irresponsible. Despite statistics, keeping the public in fear of Ebola with these unwanted vistors has eroded pubic confidence in you, and undermined any further announcements about Ebola that you may make. If a nurse in a hazmat outfit can acquire the disease, the temperature taking at airports with a 21 day lag for symptoms, is a ridiculous preventative measure. I am giving you a zero confidence vote. Nobody from West Africa should enter the US without being quarantined for 21 days to insure Ebola doesn’t take hold here.

    Suggestions on limiting Ebola in the US:
    1) Stop Ebola in Africa. 2) Prohibit entry of travelers from Ebola-affected countries until the outbreak is halted. It may not seem “nice” to do so, but our public has been whipped up into an irrational panic and it may be necessary for now. 3) Provide practical and honest on-line videos and direct training for health care workers and public safety personnel on personal protective equipment applications, removal, and disposal and on identifying potential Ebola patients early. 4) Convince Congress or the President to take decisive emergency actions to fully fund research and training, development and deployment of bedside rapid testing for Ebola. 5) Restore public trust by avoiding foolish proclamations to the effect of “we know what we’re doing here in Texas”, “we’ve got it all covered”, and “it just can’t happen”. Of course it can, even if it’s not very likely. The public may be ignorant (thanks to underfunded and poorly managed public schools, underpaid teachers, and poorly supported science education), but on this level they’re not stupid. Most people see right through the charade and the patronizing speeches we have been hearing from public health officials and one governor (who suddenly got all silent now while he’s touring Europe). Talk to some regular folks on the street and get a feel for what people are thinking. The CDC and DC are too insular and it appears that officials have lost touch with reality. 6) Stop the indirect blaming of nurses or other health care workers, physicians included (“there’s been a breach!”). It’s all about the training and supervision, and there probably hasn’t been enough of either. 7) Use this as an opportunity to teach all people about basic hygiene and infection control. No, not alcohol hand cleaners or antibiotic soap. Just basic hand washing/drying, coughing into sleeves, and keeping the hands off the face. It’s flu season and way more people are going to die from the flu than from Ebola. Oh right, and from diabetes, smoking, lack of exercise, and general poor health habits. 8) Remind the Congress about their appalling lapse in leadership here. Yes, while you’re asking for more money. We don’t need an Ebola czar. Where’s our Surgeon General when we really could use one? You are the Director of the CDC and that is what you do best. Point it out publicly. 9) If you are forced to resign, don’t do so quietly. It’s just political cover for Congressional inaction and you were just trying to do your job. Oddly enough, if they keep you, you were probably not doing the right thing for the public. Refer to suggestion #8. Good luck and best wishes. –M

    Dr. Frieden,
    Thank you for dedicating your life to saving others. At times of criticism it is best to stay the course to succeed. You are Winston Churchill in World War II, George Washigton and even Abraham Lincoln. All were faced with strong opposition, but they went with their instincts. Youre the expert, you are in charge, lead us out of this storm.
    Thanks,
    Billy Butcher in NC

    There are many comments about closing our borders. This is and will always be unworkable and was unlikely to have kept ebola out of the US. Not only is sealing the borders likely to be ineffective, it begins a cycle of xenophobia and targeting of innocent populations that is, frankly, unAmerican.

    I believe that our first line of defense should have been set up months ago in western Africa, when we first suspected the scale of this epidemic. For our own self-interest, the best protection that we can buy is to stop the spread in Africa by providing supplies in huge quantities, training and education (if needed), and medical support. But, also from a humanitarian viewpoint, our efforts should have been early and swift, to stop the spread of this disease for the sake of the thousands of Africans who have and will die. Even now, it sounds like our efforts are small compared to the resources that we could bring to this problem and compared to the resources that we have brought to other threats, such as ISIS.

    Dr Frieden, why do you repeatedly insult the intelligence of the American public with your statements? There are plenty of government airplanes and charter flights that can be booked to get medical personnel into and out of West Africa. We don’t need to be importing cases of ebola into the US, as YOUR policy allows, just to get medical personnel to the region. That’s nonsense.
    Your blase, arrogant, overconfident statements about how ebola is no risk to the US, we will stop it in it’s tracks, etc, etc, are just political tripe, and equally insulting.
    The CDC failed miserably in treating just ONE case of ebola. The partner of Duncan was left in an apartment with soiled sheets and garments for days apparently because the CDC had no clue how to handle the waste. The quarantine of the family was violated within 24 hours as I understand it, because they were put on the ‘honor system’ to not leave instead of being forced into a supervised quarantine situation. The disease was transmitted to at least one medical worker and maybe more. You people have screwed up just about everything you’ve touched, yet we’re supposed to believe that it would no problem if you continue to import more and more infected people into the US. Our medical system is already strained by budget problems from uninsured people, yet you seem to think our ‘advanced’ medical system can handle more and more infected people that you want to let in the country. Talk to any nurse and they will tell you they are already charged with treating more people than they can properly handle because of budget cutbacks. The $500,000 spent on Duncan could have been better spent trying to contain the disease in Africa, and I understand the family is sueing, which could result in millions more. Please reconsider your position on a travel ban, and stop insulting us with your ridiculous arguments for your current unjustifiable positions.

    Close the borders already! I do not feel protected by my government. If animals have to be quarantined before entering Hawaii, how is it not logical to quarantine people from affected countries and only allow supplies and aid workers to come and go. We also need to send ebola patients to specially trained hospitals. The lack of common sense and will to implement these necessary but inconvienent strategies is astonishing. Regular hospitals cannot handle ebola and we should not allow possible carriers into the country
    Extreme times call for extreme measures. I pray my son will have a future.

    Dr. Frieden,

    Thank you so much for your leadership, dedication, and commitment to saving lives. I am continually impressed during each of your interviews with the obvious evidence of your medical genius, your patience in communicating information in lay person terms, and your unique ability to address questions honestly, while not creating needless alarm and panic.

    I have a question that I am hoping you will address. I have heard while listening to one of the medical experts on this subject that the possibility of the Ebola virus spreading through aerosolized droplets from an infectious person’s cough could not be ruled out. My limited understanding of this deadly disease would further indicate that Ebola does not typically result in any meaningful amount of coughing for those suffering from infections.

    Can you advise if the CDC however, has conducted studies on the downstream implications of a potential increase in aerosolized droplets as we approach the cold/flu season in combination with this virus? Said another way, is it reasonable to hypothesize that individuals suffering with active Ebola infections and simultaneously a virus like the cold or flu has a much greater capacity to release aerosolized droplets and spread infection?

    Thank you again for your service to our country and the world.

    Since Obama and Frieden are unwilling to stop the West African air travel that puts all Americans at risk for Ebola, perhaps we should direct our attention and petitions toward United Airlines and any other airlines that continue flights originating out of West Africa and connecting on to the U.S. Does our governmental agencies force them to make these flights available? How much fear, suffering and death must occur before our government will wake-up! How much litagation can the airlines endure when a whole plane full of people start showing symptoms. I am hurt, shocked and thoroughly disgusted with our U.S. Government risking our lives. We the people have had enough! The airlines have become terrorists bringing ebola to America!

    I think you should be fired or step down. What part of this deadly disease do you not understand? We should stop all air travel to and from this African region immediately. Merely taking people’s temperatures will not and does not work. You could still fly charter flights in if you need to get medical equipment or personnel in. You could check everyone’s passports and send those people back if they’re on a connecting flight or deny them visas in the first place. You say you are looking after our health but so far the CDC has shown us that we have no confidence in you at all. You are supposed to be on top of this but your every action seems like you WANT us all to get this dreadful disease. No one believes a word you say in your news conferences. And then you give the hospital staff inadequate gear to protect themselves and when a nurse gets Ebola you blame her. These people are not even wearing the type of protective gear that they are wearing in Liberia! I am disgusted and scared to death. You need to move those people who do get Ebola to Emory or Nebraska where they at least know how to treat them. I asked my doctor if he was equipped to handle Ebola in his small hospital in Alabama and he said “no way” so you saying that all hospitals in America can handle this is a flat lie. You are living in some other universe than t he rest of us. What you say about controlling this doesn’t even make any sense.

    Dr. Frieden: Not only does common sense tell us that banning travel, at least as a first step, from West African travelers is indicated, but if your recommendations are politically motivated you can be guilty of unethical behavior as a Physician. None of your “reassurances” have the strength to override the possibility of an epidemic of Ebola in the US. As a physician myself I can say we really do not know enough about the spread, etc., to be as glib as we are being. Bottom line is:”Why are we taking the chances by not restricting travel?”.

    Dr. Frieden:As a physician with several decades in medicine I feel compelled to comment on your approach to the spread of Ebola. Common sense dictates that banning travel for all travelers who have been in the infected countries would, at least reduce the number of cases entering the US. Your reassurances are shallow and do not have the strength to override the actual risk we are taking, and we really do not know all that is necessary about Ebola. Additionally, if your recommendations are politically motivated, you can be guilty of neglecting the health of those you are sworn to protect and guilty of unethical behavior as a physician. Bottom line “Why take the chance?”.

    I have read about Ebola but a question was raised by one of my students. Does temperature hot or cold have any bearing on the Ebola virus?

    Can I use virus inactivation methods on specimens from a PUI for EVD prior to testing?
    Any changes to the standard management of specimens for routine clinical laboratory testing would need to be validated either by the testing laboratory or the test manufacturer. The changes would need to be applied to all specimens, since any specimen could contain a potentially infectious pathogen.
    Heat inactivation is mentioned in several documents as an optional method to inactivate virus; however, while it has been scientifically shown to reduce the amount of virus in a specimen, it is not 100% effective, and is dependent on several variables (i.e., time, temperature, pressure, organic material pH, etc.). All safety procedures as designated above should still be utilized.

    Please see heat inactivation of Ebola, source: http://www.cdc.gov/vhf/ebola/hcp/safe-specimen-management.html

    Dear Dr. Freiden,

    I recognize that the CDC has no enforcement authority. However its recommendations and guidance obviously carry great weight. As I read the CDC’s recommendations for health care worker precautions in caring for patients with ebola infection, I am concerned regarding the lack of rigor in making specific recommendations for the types of personal protective equipment (PPE) and procedures for doffing and donning PPE. Ebola is a CDC-BMBL Biosafety level-4 agent. CDC should at least be strongly recommending Biosafety-level 3 PPE!

    Recommendations posted on the CDC website (most recent dated June 2014) recommend gloves, mask, water resistant gown, face shield. However, given the high infectious titer in fluids (Emesis, urine, fecal, blood) and potential for environmental persistence for days in moist organic matter, as well as low infectious dose, I would hope, that you are upgrading the recommendations and will post them quickly. Meanwhile I respectfully urge the CDC to strengthen its recommendations as follows:

    1. All recommendations should be “musts” [statements such as extra precautions might be considered are just useless!]

    2. All gloving procedures should be double glove procedures with outer gloves decontaminated (bleach) and removed first and then the last pair removed after all other PPE. Gloves should be taped to the cuffs of the gown.

    3. All gowns should be complete coverall types with integrated shoe covers (Tyvek jumpsuits) to cover any clothing that would continue to be worn after leaving the patient’s room!. Why: Because high titer fluids (vomit, blood, urine) splashed onto surfaces (bedrails, floor) may contaminate shoes, pant legs, etc.

    4. Masks should be something better than surgeons masks (these are designed to protect the patient from the HCW more than vice versa). N95 at least is designed for wearer protection from droplet exposure (and required for BSL-3 agents!!!- ebola is level 4!!!).

    5. All PPE should be sprayed with disinfectant prior to exiting the room. A buddy should be required to assist with donning and doffing PPE. The advantage of a full jumpsuit is that it can easily be rolled inside out (contaminated side inward) as it is removed.

    I sincerely hope that the CDC is already making ungraded recommendations based on the unfortunate virus transmissions to nursing staff in Texas and Spain. In my opinion it is not particularly useful to evaluate “accidents” by assuming that an existing SOP would have been 100% effective, if only it had been properly followed. We are wiser to examine this from the perspective that the SOP was followed perfectly and that maybe this virus is not behaving exactly as we expect and then find ways to improve the SOP. Cost of implementing enhanced PPE that is closer in line to BSL-3 / 4 may be more expensive, but those suggested above are not that expensive!

    Our understanding of ebola virus transmission is based on only a few decades experience and a small number of self-limiting outbreaks in that time. This outbreak may be different and our PPE recommendations should respect the fact that we do not know everything about this virus and its behavior in human populations.

    I’m a retired researcher and I’m appalled at how CDC is handling the ebola situation. This is a BSL 4 virus, should be dealt with in this way. Sealed isolation unit with an anteroom connection. Personnel entering should have a full self-contained protective suit with positive air pressure generation. I’ve spoken to current ex coworkers and even the lab techs know this. My friend, an infectious disease specialist doctor agrees. Contact specialists in BSL 4 procedures. There needs to be some travel restrictions.
    CDC is a miserable failure in its actions and advice. There will be more unintended exposures if BSL 4 procedures are not followed immediately in any suspected ebola patient. It won’t be long before some lawyer charges criminal negligence on behalf of an infected person. But you can’t sue the government or its employees without the governments consent so the hospitals and their staff will be named as defendants. Those folks were just following CDC recommendations. Dr. Frieden and those who advised him should be fired.

    Help stop door to door Halloween where trying to isolate ebola I’ve contacted yall twice, homeland, CIA. News, radio. Help spread the word. CDC says to wear 3 micron mask Ebola virus .08. Are kids wont have mask. WHO predicts in a month 10,000. Infected per week Halloween was not figured this could be man made and timed perfectly for the US.. Help slow the spread save a life. Help stop cancel door to door Halloween thanks nurse Chad botello 4795222859

    Dear Dr. Frieden: Nurses and other hospital workers who will be dealing with Ebola patients need to be trained by an expert, from the CDC or Hazmat, in person. Handing out a card with instructions on how to properly wear the protective clothing is not good enough. This needs to be done immediately, nationwide! If it is not done then you could loose many of the hospital staff, just when they are needed most.

    I live in a small town in New England and was quite upset today to learn that the local medical practice affiliated with my hometown hospital does not have any protocols in place to deal with possible Ebola cases. A patient came in for treatment with a fever and headache and stated that she had recently been in Africa. Nobody knew what to do!!!!!!!!!!! I do not think that where I live is an exception…I suspect that it is the rule for smaller rural hospitals. Training has not occurred, and protocols have not been conveyed to staff, at least not here in this hospital.

    Dr. Frieden: Ebola in Africa is not treated with endotracheal intubation and hemodialysis. These so called “high risk” procedures place health care workers at extreme risk in caring for the sick–with little chance to heal. It is not fair to say that health care workers are at low risk even with protective gear on because no one has ever managed an ebola patient with such heroic measures. There is no basis for comparing treatment of ebola in Africa with US treatment measures and supportive care.
    M Price, MD

    Even though I’m nowhere close to being a doctor, but even so I would like to conttribute whatever I can. In addition to an Ebola Team being dispatched at a given notice, is it possible to have those who are the most “PROFICIENT” at training a good numer of healthcare workers in various medical settings (Optometrist, Pediatrician, etc. etc.) to ensure that this disease doesl not become widespread that we’d wished we had did more AFTER the fact. I hope this will be feasible to some extent without any circumstantial obstacles.

    My concern is if these medical facilities are NOT ADEQUATELY trained PROPERLY (AND THAT THIS IS A CONFIRMED AND VERIFYABLE FACT BY SOME TYPE OF MEANS.) in how to combat this epidemic then the obvious possibility of a widespread infection is unavoidable in short. PROFICIENT AND EFFECTIVE TRAINING. CHECK LIST CHECKLIST CHECKLIST. TRUST BUT VERIFY AND SAVE AMERICANS.

    Ok I understand the need for isolation and early detection but what about the treatment?????? Exactly what medicine will patients receive??? But more importantly when will that medicine be sent to Africa to eradicate this disease?????

    Until Thomas Duncan was definitively diagnosed, the CDC’s recommended protocol was: patient in a private room with private bathroom and staff dressed in gown, gloves, mask and protective face shield. Unless the hospital has indicated otherwise, we can assume any emesis basins of vomit and bedpans or commode pans were emptied by the staff in the bathroom and flushed down the toilet. The aerosolized contamination of people and environment with enteric pathogens from flushing a toilet has been well documented for over a decade.

    Staff in this situation could remove their “protective” gear flawlessly, exit the room, and yet have Ebola in their hair, their ears or on their neck. All a nurse has to do is run a hand through her hair and rub her tired eyes. The virus has found its portal of entry.

    Regarding early care, until Thomas Duncan was definitively diagnosed, the CDC’s recommended protocol was: patient in a private room with private bathroom and staff dressed in gown, gloves, mask and protective face shield. Unless the hospital has indicated otherwise, we can assume any emesis basins of vomit and bedpans or commode pans were emptied by the staff in the bathroom and flushed down the toilet. The aerosolized contamination of people and environment with enteric pathogens from flushing a toilet has been well documented for over a decade.

    Staff in this situation could remove their “protective” gear flawlessly, exit the room, and yet have Ebola in their hair, their ears or on their neck. All a nurse has to do is run a hand through her hair and rub her tired eyes. The virus has found its portal of entry

    Travel to the U.S. needs to be banned! It’s the only way to prevent the virus from spreading here too. Obviously hospitals aren’t properly trained or being provided with the proper protective equipment (FULL body suits) that are needed to prevent transmission of the virus. I understand the virus needs to be handled in Africa, yes, but ban travel to the U.S. Why is the U.S. not being proactive about this and instead choosing to be reactive and ‘attempt’ to treat the virus once contracted. I am so frustrated with how the safety of Americans is not being taken seriously. When will with government and health organizations listed to the people. We fear this virus and we fear how its being ‘managed’ and leadership is not stepping in and doing what’s right in banning flights! Since Ebola is spread by indirect contact and can live up to 6 days why is travel even allowed within the states. It’s going to get worse if things are controlled. Air, bus, public transportation is a risk. Screening by taking temperatures is a start to try to eliminate cases in the U.S., but obviously it’s not working. Not everyone with the virus will be symptomatic just in time for the screening. Please, please, listen to the public! We need this virus stopped and the ONLY way is to ban travel.

    How many times has the government said to us “we should have done more”, “we thought it would be different…”? Why can’t you shift to a mode where you tell us next year that “we spent too much to fix the problem but we did it quickly and effectively.”, or “we were too aggressive in stopping the spread”. I would much prefer that.

    It is really scary to hear the CDC say “we can handle this; there is no need to fear” and then say “we expect more health care workers to catch ebola from treating one patient”. All the evidence and past history indicates that you are not being aggressive enough in stopping this problem.

    There are so many many obvious solutions presented in the other comments that I feel are not being done.

    I don’t agree that stopping travel out of the affected area is key. I think the key is to we move the fight to stop the spread to the affected area. Forget about improving our hospitals here because we should focus our efforts to stop it there. Treat ebola as if it is a terrorist organization and declare war on it. Send our biowarfare military divisions there to separate the sick from the rest of the population and isolate the problem there before it spreads here. Our military budget is $600+ billion! Ebola is the biggest threat we have faced in recent decades.

    The problem with stopping it here is that we need to be protected from a person coming from every country on the planet. If we don’t stop ebola in africa, it will spread to other 3rd world countries and then to other 1st world ones. We’ll eventually have to stop all travel everywhere.

    I would guess that there are about 20k infections in africa out of a population of several million people. It is going to take a lot of money to help stop it there but that is a very tiny fraction of the cost to the 1st world if the ebola spreads aggressively to other 3rd world countries and then to the 1st world ones.

    If you tell us next year that “we should have done more to stop it there”, please note that you were warned now and that excuse is not acceptable! We’re the american people. You work for us! We want you to stop this problem immediately and if anyone stands in your way, just let us know who and why. Don’t quietly and peacefully let them stop you when we want you to get the job done!

    Please consider a temporary cease of travel from the affected area. Clearly this is not under control. We were told that the US was equipped to handle this type of disease. Now 2 dedicated healthcare workers have contracted the virus. What do we stand to lose if we just halt travel until this is taken care of. The US has sent aid to assist in containing the virus. Please listen to the American people and stop this. Clearly hospitals don’t have it together.

    Dr. Frieden –

    I would like to thank and encourage you and all who work with you at the CDC – for all that you do.

    A quote from 10/2 CDC Director Blog
    “…from everything we know now, there appears to be no risk that anyone on this patient’s flights from Liberia to the United States was exposed to the virus.”

    I tend to have more confidence if I hear: “extremely low risk” instead of “no risk.” “Always” and “never” statements, especially in the context of science and medicine, tend to cause me to doubt the validity of the statement.

    Although we know a lot, we cannot be 100% certain about when viral shedding occurs in any given patient.

    And as for an infected but not yet symptomatic ebola patient on an airplane – although unlikely, it is possible that they could have contaminant (say, from the viral host who infected them) on their person in the form of viral particles on a pen, on a cell phone, on a belt buckle, on a lap top, under a finger nail.
    Again, somewhat or even highly unlikely, but possible.

    It is my hope that the American public will receive information from the CDC as calmly and as confidently as possible. I hope that the public can reasonably hear and accept statements that include phrases such as “extremely low risk” rather than perhaps needing to hear “no risk.”

    I think people are smart. I think they can handle it.

    Again thank you for the great work that you do on behalf of so many.

    k

    I have taken graduate-level courses in Public Health and Virology. I live in the Dallas area and am appalled that the Dallas Dept. of Health is not mandatorily quarantining the healthcare workers WHO HAD DIRECT CONTACT WITH THE FIRST EBOLA PATIENT.

    They are only monitoring them by taking their temperatures once a day. They said that Ebola is only contagious once symptoms appear but let’s say an individual is walking around a grocery store and starts feeling a little feverish. He continues his shopping for a few more minutes and in the meantime, exposes perhaps 15 people who don’t know he is sick. Then they become sickened and spread the disease.

    Half of my family is here . . . my husband, my son, my daughter-in-law, and my granddaughter. Are we going to have to refugee from Dallas to escape this scourge because our public health officials have not taken the right steps? This is like being in an apocalyptic movie from which you cannot escape.

    Please quarantine the healthcare workers and halt traveling. I think this strain must be more airborne than realized. Perhaps like the 2012 strain was in Uganda????

    Why aren’t healthcare workers being quarantined themselves overnight at isolation rooms in the hospital while working with ebola patients? Doing this for the incubation period could help contain and prevent the spread of this disease. We need to think impact and prevention before ebola gets totally out of control in the US. On another note, I also feel staff who work with these patients and are quarantined should receive some kind of additional compensation.

    One other suggestion is creating an ebola saliva test for home use. If such a quick and easy test were available for purchase (or free) at local pharmacies, the spread of the disease could be checked as people could test themselves before going to the doctor or hospital and sitting hours in waiting or emergency rooms, passing the bug to countless others. If the test showed positive, they could also be instructed to call for medical help to come to the home rather than going out into the general population.

    I am no medical professional, but if a disease is on the rise the only option I would believe is to contain. All flights and any type of travel in and out of these areas should be stopped. With the incubation period how can it be contained with travel to and out of these areas. This takes no medical background to figure out.

    What chemical are you spraying outdoors? You claim it can not live in sunlight? You say animal s cant contract it, but yet you quarantined the 2nd nurses dog. On the news the neighbor asked if it was contagious through dogs, an she brought up the dog poop in the back yard. 2 hours later you guys sprayed the yard. Now I ask is it transmitted through dogs?

    At this time, there have been no reports of dogs becoming sick with Ebola or being able to spread Ebola to people or other animals. There is limited evidence that dogs become infected with Ebola virus, but there is no evidence that they get sick from it.

    CDC recommends that public health officials work with a veterinarian to evaluate a pet’s risk of exposure to Ebola virus (close contact or exposure to blood or body fluids of an Ebola patient). Based on that evaluation and the specific situation, local and state human and animal health officials will determine how the dog should be handled.

    Read more about Ebola and pets: http://www.cdc.gov/vhf/ebola/transmission/qas-pets.html

    Can we please get some answers as to why this person was allowed to travel? I have lost a lot of faith is this system that was supposed to be stopping the spread of this horrible virus.

    I fully agree with Mr. William Pittenger. What exactly were the CDC and the President involved in that was more important than this? The $500,000 spent on Duncan and a potential lawsuit….are you kidding me?

    I am somewhat relieved to see that the CDC has now recognized that the initial assessment of US preparedness to deal with the Ebola virus was in fact overly optimistic. The handling of the first case by the hospital in Dallas was a complete fiasco and it’s not over yet.

    Confidence in the ability of US healthcare systems to limit the spread of Ebola has now been further shaken by a second infected member of the hospital staff who flew on Frontier Airlines just the day before being diagnosed with Ebola. Americans are highly mobile, and our country in some respects seems much more vulnerable to the uncontrolled spread of the virus than the African nations where it originated.

    While CDC willingness to send qualified personnel to the site of any new outbreak is commendable, how many teams are available for this? What if the Frontier flight were to result in several new cases in different geographical areas, some of which spawn new cases as well? Given CDC limitations in staffing and budgets, it’s easy to imagine a scenario where the disease could spin out of control rapidly. We are now approaching the point where potentially hundreds of people will need to be monitored, just from a single case. What if there were 50 cases and we had to monitor 10,000 people, some of whom could spread the disease even farther before they are found? The Frontier passengers are being asked to voluntarily contact the CDC. Shouldn’t there be a little more urgency to this?

    Why did the hospital personnel who cared for Duncan have no travel or other restrictions imposed on them for a 21 day quarantine period? It has become very clear this week that the United States as a whole is quite unprepared to deal with the realities of a possible Ebola outbreak. The Dallas hospital staff apparently had no idea that they were at risk of not only contracting the disease, but also spreading it farther. The handling of this first case has been incompetent at many levels but at least we see opportunities for improvement. Many thanks to the brave nurses in Dallas who not only cared for Duncan under trying circumstances, but came forward to publicly reveal just how unprepared the hospital was for an Ebola case.

    Why are there no travel restrictions on passengers who originate from the affected areas in Africa? UN health agencies are predicting a very rapid increase in the number of cases in Africa in the next few months. Given the circumstances of the first US case, the measures being implemented at several US airports seem likely to be of limited effectiveness. Duncan was reported as not ill when he flew to the US. How would the new measures have prevented his entry? Do they depend on passengers providing information about possible contact with people sick with Ebola? That seems completely unreliable. Passengers may not even be aware that a person they had contact with was in the early infectious stages of the disease, or they may not want to restrict their ability to enter the US.

    Our best hope is that one of the new vaccines or medications proves effective. The limited public health measures proposed so far simply do not inspire confidence. Real travel restrictions seem inevitable. What will be the cost in lives and dollars for delaying more effective public health measures? How bad will things need to get before we set aside misplaced confidence and start dealing with reality?

    It is quite clear to the public that you do not take this crisis seriously and no one is being held accountable for this. Clearly no one is implementing “safety measures” that were meant to keep ebola from spreading to health care workers. Who do these physicians and nurses answer to? Who is stepping up? Who is going to stop this? Why are physicians and nurses being allows to get on an airplane and travel right after working with ebola patients? I can tell you that the public is vastly losing confidence in you because it is evident that no one is doing their jobs nor taking this seriously. When this is all over, and if there is anyone left to review the failures that cause this to be an American, out of control epidemic, you should all be replaced. I fear for everyone’s health and safety until you STEP UP and set serious controls in place.

    Dr. Frieden,

    To add to above comments:

    First, you are rapidly losing credibility both with the public and within agencies that are going to have to deal with the issue – not a good thing! There are now 2 nurses who were in a controlled environment purposefully wearing PPE to prevent infection and still got infected. Not easily transmitted?????

    Second, as you were obviously wrong with your comment “we will stop it in its tracks”, and although maybe too late, it is time to institute travel restrictions. We have now seen what just one case can do in the U.S., what if we get several more in addition to the internal spread now. The comments that travel restrictions will hamper the overall global effort are patently false. Travel restrictions would not be for humanitarian flights, or WHO medical personnel, only for civilian personnel. In addition, any returning health/humanitarian workers should have 21 day quarantine. The second argument against restrictions is that people could come through other countries. Every international traveler has a traceable flight path and also carries a passport, so easily tracked. Intelligence agencies can track trained, intelligent, well funded terrorist suspects attempting flights into to U.S. It would not be hard to trace an average person attempting to come from one of the affected areas.

    Third, as it sits now you and the U.S. government have no centralized control, it is time to put out mandated hospital/first responder protocol, designate specific guidelines and facilities, and staff all of the above appropriately. The next few cases that expose unprepared first responders and hospital workers are what’s going to launch this into a full blown, country wide, pandemic.

    I call upon you to implement travel bans immediately.

    I am not a highly educated person..But I have enough common sense to stop all traffic from ebola infested countries…Anyone coming to the U.S. from a ebola stricken country should have been quarantined out of our country until they are cleared to continue on there journey..There are many islands out in the middle of nowhere that would make great quarantine locations….But what does the U.S.government do??? We allow sick or suspected sick in country and let them run loose…I have a feeling that this disease will play havoc on our citizens….C.D.C….You really dropped the ball on this one…You should be ashamed..

    As a health care worker I would like to comment on all the ” Ebola outbreak” press.
    I would hope to think that you folks have considered the fact to “mandatory” quarantine for 21 days the folks that have requested to leave the African countries/nations that have the virus. If you have thought of this why has it not be initiated! This is not rocket science and would be a very effective way to control exposure!!
    To me it is mindless to take temperatures on folks arriving to the US at multiple airports. There should be one airport as a control that these folks should be flown into. All the information has stated there is a 2-21 day incubation period…In other words, and please correct me if I am wrong, these people could be infected and not show any signs until the 21st day. Again not rocket science and putting many in the population in multiple areas at risk!

    I understand a quarantine is an infringement on ones freedom however if folks choose to travel to these countries they should understand if they do not agree to a quarantine then they would not be allowed to fly. This is a requirement of our pets to travel to other countries!
    Quarantine was the way TB use to be treated!

    Nurses are such good scapegoats. The first thing we heard is that the “nurse didn’t pass on the information to the doctor that the patient was from West Africa,” then we heard, “the nurse became contaminated because there was a breach in procedures.” As a nurse, I find these statements highly offensive.

    A community hospital has isolation rooms with an anteroom for changing into protective gear. However, the same anteroom is used, upon exiting the isolation room, to remove this contaminated gear. For this reason, Ebola victims must go to specialized hospitals where there is a clean anteroom and a dirty anteroom. Otherwise the anteroom is contaminated after the first patient visit.

    Shame on you, it is time to put a scientist in charge instead of a politician from another failed agency. Ebola is a bigger threat than your tobacco and transfat concerns. Politics will kill us after all.

    Dear Dr. Frieden, I am a RN who was pleased when yesterday you apologized for suggesting that Nurse Pham was responsible for her own illness. Now, today, you have announced that Nurse Vinson “should not have flown” as she “had been exposed to Ebola. ” Why would she think that she had been exposed to Ebola if she had been using PPE as recommended?

    Please stop all traveling to and from Africa as we’ll as Texas now!!! We need to keep this outbreak to a minimum in the us. There are several people that are dreaming out now because of the lack of common sense with Ebola. We need to stop all traveling ASAP… Thanks so much.

    Time for a new director at CDC (if that time didn’t pass much earlier). I’m appalled at the wishful thinking of this agency. At this point, I don’t see how we can trust the federal government to look after our safety at all. Quite a shame.

    You, sir, and your boss, are idiots and both should be removed from your positions for the health and well being of the American public.

    So why wasn’t workers who took care of the Dallas patient told that they should not travel or come in contact with too many people until they cleared the incubation period.
    Why were heath care workers allowed to care for other regular patients. Why have we not determined across the country want to do with Ebola waste. Health care workers are complaining that they are not getting the right equipment in all our hospitals and not getting adequate training. CDC posting a card and internet information is just not sufficient. So it started with the CDC saying that we are prepared and something like this cannot happen with such dire consequences here in the U.S. While we are not anywhere in that shape now, I believe the CDC’s action and reaction is proving that they are running way behind this curve. They need to spend less time calming the public and more time using some common sense to think ahead of how and why we become more vulnerable and put better stop gaps in place now.
    Now the CDC is faced with finding and contacting a lot of people who came in contact with these health care workers. The folks who were on the same flight. What about people who might have used the public restrooms in the airport (Did the infected person use one and could fluids have been left on a surface etc.) Mr.Thomas Frieden thinks we are better prepared to handle this but he is running behind this and not thinking way ahead. The evidence so far is showing that the country is not very well prepared at all. If 1 becomes 2 (It has) and 2 becomes 4, than 8, 16,32 etc. we will run out of resources to find all the people that those have become infected came in contact with and might have been contagious. How will all these people be contained in isolation as needed and kept track of. Unlike West Africa where we no doubt have a better health care system we also have a society that travels within this country a great deal more. Just to do daily jobs. So we have a very different unique problem that could cause a much different way to spread and lose this war.

    Subject: Early detection of Ebola infected (open distribution)
    This system will require compulsory adherence for three weeks (incubation period), but should not be a problem, because it could save the monitored person’s life as well as friends, family and casual acquaintances. It is comprised of a worn temperature sensor (possibly with pulse rate, GSR and respiration) which contains a software algorithm to notify the wearer via an alarm and also transmit the data (via any available network; G3, G4 or WiFi) to CDC and local health agencies. The sensor could be in a wristband, wristwatch or a pendant (worn under the shirt). The most probable implementation would be a wristwatch communicating via Bluetooth to a smartphone in one’s pocket or bag. Removal or deactivation of device would also activate ‘alarm’ transmission along with GPS location. An alarm, of course, means ‘get to a health care center’ expeditiously without exposing others. Ebola survivors have had their treatment started early.

    THIS IS DIRECTED TO THE CDC LEADERS, THE PRESIDENT, SENATORS, CONGRESSMEN AND THE CITIZENS OF THE UNITED STATES:

    Homeland security is at stake here. We must all take some very critical important measures to get 3 steps ahead of this outbreak. 6 Steps need to be taken for 100% homeland security. The CDC as reported on CNN expected 1 Million infections by January. Call your representatives and demand action -> 5 part solution.
    1. 21 day quarantine in military installations for anyone exposed (this would have solved the second nurse Amber Vinson from flying)
    2. Anyone coming to the USA from any of the hot zones needs to pass 21 day quarantine protocol. Same as was done at Ellis island when coming into the country in the 1800s. We need to ensure that everyone coming to our homeland is healthy. (This would have kept Duncan from arriving sick)
    3. Those infected treated by the highest trained personnel in regional military installations where the treatment and protocols can be followed stringently, Hazmat, Decontamination (This would have kept the Dallas nurse from contracting)
    4. The risk to the general population when an infected is sent to a public hospital should not be underestimated. (It will not be long until one of these patients moves about from their private room and leave the confines of the hospital)
    5. Fast track government investment and mass production of the medicines and vaccines. (2 health care workers walked from Emory after 1 week. ZMAPP, we have a number of remedies that have appeared to be effective and surely the NIH has been preparing for this day, lets get three steps ahead of this issue before the economy comes to a halt.)Fast track the trials, get the experimental medicine available enmass. re: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-experimental-treatments.html
    6. Above all communicate with the people what exactly is being done to halt this virus in its tracks.

    As US citizens, we must demand action, call your representatives, senators and congressman/woman.

    The airlines are responsible for guaranteeing passenger safety. When are they going to take action to protect their passengers such as not accepting travelers from Ebola-stricken countries unless they have passed a 21 day quarantine screening? Where is their culpability?

    I feel that the CDC and the Government in general need to put the health and saftey of the American people above that of money, or the aid to other countries. Controlled aid to the affected areas is acceptable but the free movement of people into our country is not until the epidemic is under control in the host nations. It is the duty of the CDC and the Government to protect the American people first and foremost.

    We need to explore destroying this virus with another virus. After all, there is a pecking order in the animal kingdom, why would we not think there is not one on the viral level. Perhaps those that survived are infected with this protective virus.

    Ebola virus (EBOV, formerly designated Zaire ebolavirus) is one of five known viruses within the genus Ebolavirus.[1] Four of the five known ebolaviruses, including EBOV, cause a severe and often fatal hemorrhagic fever in humans and other mammals, known as Ebola virus disease (EVD). Ebola virus has caused the majority of human deaths from EVD, and is the cause of the 2013–2014 Ebola virus epidemic in West Africa, which has resulted in at least 4,485 deaths.[2][3]

    Ebola virus and its genus were both originally named for Zaire (now the Democratic Republic of Congo), the country where it was first described,[1] and was at first suspected to be a new “strain” of the closely related Marburg virus.[4][5] The virus was renamed “Ebola virus” in 2010 to avoid confusion. Ebola virus is the single member of the species Zaire ebolavirus, which is the type species for the genus Ebolavirus, family Filoviridae, order Mononegavirales.[6][1] The natural reservoir of Ebola virus is believed to be bats, particularly fruit bats, and it is primarily transmitted between humans and from animals to humans through body fluids.

    The EBOV genome is a single-stranded RNA approximately 19,000 nucleotides long. It encodes seven structural proteins: nucleoprotein (NP), polymerase cofactor (VP35), (VP40), GP, transcription activator (VP30), VP24, and RNA polymerase (L).[7]

    Because of its high mortality rate, EBOV is also listed as a select agent, World Health Organization Risk Group 4 Pathogen (requiring Biosafety Level 4-equivalent containment), a U.S. National Institutes of Health/National Institute of Allergy and Infectious Diseases Category A Priority Pathogen, U.S. CDC Centers for Disease Control and Prevention Category A Bioterrorism Agent, and listed as a Biological Agent for Export Control by the Australia Group.

    I do not care about economies nor should you when it comes to the safety of the American people. This agency should not be affected by political conditions.This agency knows better than what it’s doing here. The travel ban should have been in effect all along, it wasnt, and my children are at risk as you allowed Ebola into the United States. What will you say to me if I ?

    I have a report from CIDRAP out of the University of Minnesota. The report states that Ebola could/is now airborn.
    Given CIDRAP, conducts considerable research for/with CDC, how serious is the CDC taking this recent release of information from CIDRAP?

    Absolutely time for a new direction at CDC; the director is delusional. Easy to see now that when problems arise, your federal agencies are not your friend. Such a shame.

    Emory has proven themselves as the well prepared with the care of Ebola. Emory should share their guidelines, procedures, and policies with the entire US Health Care Systems. We as a nation are not prepared for this pandemic virus.

    “As the director of CDC, one of the things I fear about Ebola is that it could spread more widely in Africa. If this were to happen, it could become a threat to our health system and the healthcare we give for a long time to come,” Frieden said.

    It’s the Center for Disease Control of the UNITED STATES, Mr. Director.

    It is disheartening to see our world government cracking under the threat of a pandemic. While DC directors are wasting time and energy testifying about how they are handling a situation, the situation leaning toward getting out of hand. I am no scientist or even a scholar, but if we do a couple of things right away, we could probably contain this outbreak here in the U.S.
    • Stop all travel from Ebola stricken areas
    • Armed Forces build makeshift hospitals to hold any travelers for the designated time frame (I believe it’s 21 days) to clear them of any possible infection threat. It will be much more efficient and cost effective over trying to set up every airport in the U.S. to screen for it. . .in which case everyone else who is on the flight has now become a possible risk.
    • In order to contain the virus, we must first stop it’s spread
    • Focus should be on protective gear (especially in Africa where from what I read, there are bodily fluids everywhere) for anyone involved with the Ebola patient.
    • In just about every city/area there are army reservists- why not have the CDC train these individuals how to professionally put on the protective gear and then assign them to hospitals as needed, to ensure everyone who is in contact with the Ebola patient is protected. They themselves would not come into contact with the patient.
    • If you could somehow get the press to cooperate in stopping to sensationalize every single step you take that would be helpful. They become a threat to national security when they create unnecessary hype around circumstances of this small outbreak. It can cause people to think and behave irrationally. . .especially when we need people to be clear minded and vigilant with regard to this situation.
    We understand this is something new and we see we were not prepared to handle it, but why dwell there. Let’s learn from the mistakes we have made and shift our focus on eradicating this plague. This is all hands on deck and it is everyone’s responsibility to make sure this does not continue to spread.

    Thank you for your time

    We don’t appreciate your attempts to throw the nurses under the bus for your agency’s mistakes and misrepresentations on Ebola. Have you sense of shame or decency? No, it was not a nurse violating protocol, no, it was not a nurse flying when she shouldn’t have. You really are a jerk as well as an overconfident and incompetent manager.

    Tom Frieden needs to be fired. Remove this “useful idiot puppet” of the Marxist kind. He has lied to the American People, has acted foolishly, neglectfully and dishonestly by refusing to protect us by banning all flights from infected countries!

    Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature

    Please urge Washington to restrict ALL travel in and out of the country from ANYWHERE! And I honestly think Texas borders should be locked down to protect the rest of the country. Isolation is the only way to battle this outbreak and that cannot happen without locking down. And let’s be realistic here, our hospitals cannot care for the mass population if they get Ebola. It’s not feasible. It’s time for the government to step in.

    You are full of garbage when you suggest that a travel ban will drive travelers from W. Africa underground. If they don’t get here on a plane, are they going to swim?

    The surrounding borders are closed, and guess what? They have fewer cases than the US does, as in zero (0) in Ivory Coast, Mali, Senegal.

    How would you protect the military members, military flight crews, aeromedical evac personnel etc… If sent to Africa? How would you protect the military families once members arrived home?

    I do appreciate this public domain comment posting! Cannot say I agree with everything posted, but it is great to read different views. One death from any disease is one too many! When making decisions, envision yourself sitting on the plane beside someone that is traveling from an infected country, envision one of your children in a hospital waiting room with a sick patient that is coughing and sneezing, envision yourself as one of the care givers…What would you be wearing? Now, what do they have issued to wear? When making your decisions, please keep these pictured in your mind so you will make the RIGHT decisions.
    Thank you for your time.

    Dr. Freiden,

    You used a wildfire analogy with respect to the Ebola epidemic. Here in the West, where we actually have wildfires, we use a strategy called containment. As fire break is created. Once contained, the fire continues to burn but cannot spread beyond the area of containment. This is what countries neighboring the effected countries have done and, thank goodness, as they remain unaffected to date. Banning nationals from getting visa to travel to the US would be a start and would not impact the ability to send aid and personnel from the US and Europe. To oppose any restrictions at all is unconscionable.

    And to the extent that this quarantines those countries, please remember that your job is to prevent the spread of disease in the United States, not to cut the best deal you can for West Africa.

    Etiology* not etymology. Wouldn’t setting up isolation areas for all people coming from West Africa not only contain those infected, but also those whom are not? You don’t see that causing a problem? Because I see it as quite possibly causing infection as opposed to stopping it.

    I’m watching the coverage of the EBOLA crisis tonight …. and they are showing all the special rooms that are being used to treat these EBOLA patients. Secure, sealed, special equipment, special air filtration …. and then they span the camera and show the Sink, the Toilet, and the Shower…
    where is that grey and black water going ???? Are we to think these Hospitals have an infrastructure that has an independent plumbing and waste system just for these rooms?? Or are we creating a Sess Pool of Waste Water somewhere where unsuspecting Affluent Water Treatment Workers will come in contact with millions of raging EBOLA cultures whirling around in bodily fluids that have been flushed, rinsed and dumped down toilets, sinks and shower drains ????

    Did I miss something — or is this a glaring omission of concern?
    Looking for an answer from the CDC as to this concern????

    Sanitary sewers (those that transport sewage from houses and commercial buildings) may be used for the safe disposal of patient waste. Additionally, sewage handling processes (e.g., anaerobic digestion, composting, and disinfection) in the United States are designed to inactivate infectious agents (infectious germs).

    If we cannot stop fights in and out of Africa then PLEASE set up a central treatment center for Ebola in the U.S. and send all of these patients there. Stop spreading them out all over the United States. The treatment center could be run by health care workers that have experience with Ebola (i.e. infectious disease doctors and nurses). Years ago there were hospitals just for TB patients that helped to contain the spread of it. Why can we not set this up for the Ebola patients? Even clinics set up on a military base could contain it better than health care workers that have not been trained to do so.

    I would like to thank the CDC, Dr. Frieden and whoever your boss(es) are (Fauci? Obama?) for keeping this comment forum open. It provides an opportunity for the public to communicate with you.

    I hope that Dr. Frieden, Dr. Fauci, President Obama and others are in fact reading these posts. Many posts include sound inquiry and advice.

    Dr. Frieden, keep going. Some are calling for your resignation. Your job is extremely difficult. This is clearly a dynamic situation. Keep on adapting, focusing, listening and discerning. Thank you.

    Dear Sir,
    There is very little compassion shown you, certainly on this forum, in times of fear. A quick look into psych- and sociology can explain not only the facts of what has been happening, but the possibly unfair result. In our culture, “healthy optimism” has long been lauded the standard for viewing the future (sources various and of differing levels of credibility, but for the moment please let’s accept this statement). On the other hand, I’ve seen stats that about 25% of Americans (a long-lost Martha Beck article) 0r 30-35% (a recent Huff Post article) “enjoy the benefits of defensive pessimism”, easy enough to research if someone wants to verify quality of research.
    Recently, I’ve seen that in the UK, it is the approx. 60% majority of people who are conspiracy theorists, though not yet here. Our culture is much in its infancy, perhaps adolescence, and we fully expect to be told everything will be OK whilst turning on our parents/leaders when it’s not- after the fact.
    We all need to be defensive pessimists, and you’re in hot water for, in my individual view at least, following the optimism and fabulous, happy heartbeat of America and not being a pessimist, which otherwise would have landed you at the bottom rung of society for having been such a naysayer.
    Hindsight is 20/20. Americans are all about the Rugged Individual; therefore, there must be ONE person to blame; we are not a society like any in the East or the natives here, in which the collective is the focus.
    I only wish that I had the credentials to stand by you and tell the people that while they are absolutely entitled to and right to fear the situation, it is the entire culture that sets us up for failure. When in the world will psychology become a natural science, taught in high school? It has been a natural science since 2000 at CUNY Queens College. There is so much we could fix if our society collectively considered the facts of our own functioning.
    And yet, considering facts is not what fearful amygdalas do, is it?
    Thank you for your work and dedication in NYC and particularly on the front lines in Africa and in India in times past.
    Respectfully,
    Amy June

    Dear sir
    I am RN at the ICU unit in one of the Northern California hospitals. I am extremely concerned about current CDC guidelines for PPE needed when dealing with Ebola patients. As far as I know EVD is level 4… So how come you recommend just the most Basic equipment that leaves large areas of body uncovered. Why you not suggesting to use the same defense as Doctors without Borders,they have proved the effectiveness of their protocols. How do you think it looks when nurses in the hospital were taking care of the Ebola patients with just most basic PPE but when the patients were transferred by CDC
    personal to special facility,CDC WORKER WERE WEARING FULL HAZMAT GEAR.
    Is their life more valuable then ours?
    At my place of work everybody says that we would do our duty and take care of those patients but only when we will have proper PPE, like the one that is used in West Africa
    By Doctors without borders.
    I do not think that this particular virus becomes less dangerous after it crosses Atlantic ocean. Do you?

    Dr. Frieden I think you are doing great please keep working the issue. I believe people have gotten comfortable believing everything the media puts out without confirming. If they would go to the source of information which is the CDC website they would realize that there is alot of information out there and it has been there for a long time. The has information on the five different strands of Ebola and many other diseases. There is also information on Ebola and what to do to prevent the virus. I am confident that you will do everything in their power to stop whichever strand of Ebola is spreading.
    Ebola Reston: One of the five species the “Ebola-Reston discovered in 1989 as the cause of an outbreak and severe illness and death amoung non-human primates importated from the Phillipines to a quarantine faility in Reston, VA. The small number of confirmed humans with Ebola-Reston in the U.S. and the Phillipines did not result in clinically apparent disease, suggesting that the virus is less pathogenic than the other species of Ebola viruses.” Ref: Information on Ebola Reston found at http://www.cdc.gov/ncidod/dvrd/spb/outbreaks/qaEbolaRestonPhilippines.htm

    Think you hit the nail on the head with that one! Full Hazmat Gear Costs lots of money$$$$ Who is worthy enough??????? Everyone should be!!!!! Keep pushing for ultimate protection! If they were in your shoes, they would be wearing full hazmat gear!!

    A man from Nigeria died on a plane flying into New York, JFK yesterday. He had been vomiting before he died. They called in the hazmat-garbed Ebola team while everyone waited on the plane. Turns out, he died of a heart attack. Vomiting is not uncommon during a heart attack. No one came to his aide during the flight and people were appalled that the hazmat team so quickly det ermined he didn’t have Ebola. A heart attack is a potentially survivable illness. Might he have survived if everyone on that flight hadn’t immediately thought Ebola?

    What kind of director are you? you terrify people about the flu and then tell people to fly. Anti health and anti American. People are risking their lives and you just watch.

    Travel to and from Liberia, Sierra Leone, and any other hot zone countries should be BANNED until this plague is over with. How it could ever make sense to put their economies ahead of American lives is utterly beyond me. You know whose economy gets hurt if we have Ebola running loose in America? EVERYBODY’S!!!

    Sir, with due respect, I know you are doing your very best. But, confidence eroded since this Oct. 2 article. I still think that isolation of the source is the best control or prevention. Ebola deaths are fast and spreads quickly if not managed properly. More power to you and please remember to ask help if it is no longer manageable. Best of luck to you and your team, and to all of us.

    Suggestions for US-CDC:

    TRAVEL BAN TO/FROM HIGH-RISK COUNTRIES: Is to be imposed only to regular passenger flights travelling to/from selected high-risk ebola infected countries. Medical and military missions are to be exempted from the ban.

    In case no travel ban is to be imposed on high-risk countries,
    QUARANTINE: it is imperative that passengers & crew arriving from high-risk countries to be quarantined for a few days more than the ebola incubation period. This is necessary as known incubation period for newly developing ebola would make it impossible to detect even with a serious screening procedure inplace.

    PASSENGER SCREENING ON MEDIUM-RISK COUNTRIES: Since some countries already have their own passenger monitoring/quarantine procedures in operation, it is just a matter of coordination through the WHO (which should already be acting on it or have their guidelines by now) to ensure worldwide implementation of their suggested guidelines. In this way, not all passengers have to be screened thoroughly (to address some related airport concerns), except for those passengers who would volunteer.

    NOTE: In case the ebola becomes an epidemic nationwide, respective states may also adapt this format at their own level, but to also include land travels. Without control as a preventive measure, it is easy for even a normal person to be alarmed and to expect infections to become an epidemic proportion. Time will tell how true this will be.

    This article is not meant to scare or cause panic and is being contributed by a non-medical practitioner to help US-CDC, WHO and the world find a better solution to this crisis, asap.

    BBGutierrez

    Stop air travel to and from the Ebola hotspots.
    Secure the Southern and Northern borders.
    Director Frieden should have been demanding this DAY 1.
    Congress funded the construction of Ellis Island in 1890; the concept of disease control is not new to the U.S. Is the Director worried about upsetting the airlines or the stock market or the political elite. Conflict of interest here? It is a world gone mad and now I’m agreeing with Bill O’Reilly.

    So let us pretend for a moment that one of the passengers on a flight back to Dallas was told there risk and released to self monitor. That person say goes home and takes this lightly. Perhaps in 19 days is at work say Mc Donalds drive threw , when without actually realising there symptoms have begun say 99.5 fever.. They serve numerous people and expand the possibilities of spreading Ebola. That would be a foolish moment for the CDC. Not only that but let’s imagine there are 10+ people suddenly struck with virus . where in this country would we put them? The eragence is disearning.

    As a PhD microbiologist who did some work in aerobiology, I was interested in the CDC comments about Ebola virus not being transmitted by the aerosol route. I did a search in PubMed and quickly found two papers showing that Ebola can be aerosolized and is infectious to primates by the respiratory route. Further, it remains viable for significant periods in droplet nuclei and on surfaces. So this IS a fairly contagious disease. A hearty cough or sneeze, or vomiting (on an airplane?) could easily result in infectious virus in the environment. I think the CDC needs to begin an honest discourse with the American people about this epidemic. Fear of causing panic resulted in the government’s under-response to AIDS in the early 1980’s. Are we going to make that same mistake again?

    Dr. Frieden, Have you no shame? You’re scared. You know that, at this point in time, the epidemic in W. Africa is more likely to burn itself out by exhausting all uninfected hosts than it is to be controlled by anything any one or all of the foreign aid efforts can hope to achieve. The world was too slow to act and now it is virtually impossible to control. The international community has not been able to put enough facilities online, bring in enough beds, or find enough health care workers to meet the need that existed back in August 2014. Today that need has more than doubled. With the number of new cases doubling every 10d to 4wks, the international effort will never catch up. The US has committed to building 1,000 beds, but 10,000 more will be needed PER WEEK by the time the first 1,000 are ready, and for each bed at least 3 people will be needed to staff the facility. You and the WHO and the rest of the world community were asleep at the wheel, and it is now too late.
    The buzz words used like “unprecedented”, “catastrophic”, and “exponential growth” belie the fact that in all reasonable probability 70% of the population of Sierra Leone, Guinea and Liberia will be dead by sometime around June 2015, give or take a few months. I dare you to say otherwise. I hope beyond hope that I’m wrong. But above all, I hope that the US is not next on Ebola’s hit list as a result of a pack of shortsighted bureaucrats.
    Nevertheless, the simple fact that you are now telling the American public that the only way to protect us from Ebola is to halt the spread in W. Africa acknowledges that as the number of cases increases exponentially, the probability that some of those cases will wind up in the US increases proportionately. Yet you refuse to endorse what the vast majority of Americans now have come to vigorously accept as the only reasonable FIRST STEP to keeping Ebola out of the US: bar entrance of foreign nationals who have spent time in the past 21 days in W. Africa from coming to the US. This isn’t an “either or” situation. It is one small but necessary step. It is not forever, but must be for now.
    Your solution is a feeble and ineffectual airport screening process that will at best identify 5-10% of Ebola infected travelers. Amongst the first 9,000 victims of this epidemic was only one infected person, Mr. Duncan, who arrived on US soil. But this is not something to applaud or wave as a banner for the low probability that another will get through. Indeed, Mr. Duncan is just the leading edge of a trend that is sure to explode as the number of infected W. Africans explodes exponentially. 5-10% will simply not be acceptable when a tenth of the people in Liberia, Sierra Leone and Guinea are infected with Ebola as the WHO predicts for the New Year.
    Each day you proffer a different yet equally uncompelling justification against a travel ban. It won’t work, you say, given the porous borders of the affected countries. Yet it has worked in adjacent countries. Take Senegal, for example. The fact that one student made it to Dakar infected with Ebola in August was used in support of the contention that closing borders will not keep Ebola out. Senegal has now been declared Ebola-free BECAUSE it closed its borders. Ditto for Nigeria. In fact, India has now announced it will use Senegal’s model for keeping that country Ebola-free. I can’t understand why you would support such a flawed hypothesis except perhaps in deference to Peter Piot, who opined that “I think it illustrates the ineffectiveness of closing borders and cancelling flights. People will still find a way to get around.” He was wrong and you are wrong.
    In Nigeria, the CDC’s actions in advising health officials are credited with helping that country get its outbreak under control, yet the CDC failed to establish the same systems in the US. Helping Africa is great! But the CDC’s charge is to control disease in the US – in the United States! Shouldn’t we have had as much of your attention as Nigeria? Even the airlines recognize that, before helping others, you must “put on your own oxygen mask first.”
    Another justification is that it will be more difficult to do contact tracing if the individuals arrive here surreptitiously. That is just nonsensical. Again, who does that help? Africa, not the US. Any patient arriving in the US is “Patient Zero” as far as the US is concerned. The only thing that happened in W. Africa that is of value as far as disease control in the US is concerned is that the patient was infected in W. Africa or elsewhere before coming to the US. Other than providing fodder for the news media and the public in declaring him either a victim or a villain, how does contact tracing in W. Africa help the US? If you were truly convinced that contact tracing was essential to controlling Ebola in the US, you would make it a condition of entry. “Hey, buddy, you don’t have Ebola symptoms today, but just in case, keep a log of everywhere you go and everyone you meet for the next 21 days or so. Keep us in the loop, AND WE’LL BE CALLING EVERY DAY TO MAKE SURE YOU REPORT ANY SYMPTOMS. Oh, and by the way, if you do develop symptoms, don’t go to the ER, especially not in Dallas. They might muck it up. You might infect other people doing invasive, high risk procedures on you and screw up their lives for at least the foreseeable future. We’ll come pick you up wearing hazmat garb in our containment controlled vehicle.” Moreover, it is much easier and more accurate for an asymptomatic individual to keep a log, than for a feverish, vomiting profoundly ill person to try to recreate his every move for up to three weeks. Maybe it is just too much to expect that the US would have that much foresight. Maybe it is just too much to expect that the CDC would expend the actual effort. No, instead you prefer the circus of chasing down hundreds of people who took a ride on the same plane as a secondary infectee of the visitor from W. Africa, even if they didn’t fly at the same time. And of course, if necessary, quarantine an entire cruise ship full of thousands on the very slim chance that an asymptomatic lab tech, who you should have identified weeks ago, might be infected 19 days post possible exposure, in an abundance of caution. Nothing about the past 2 months evidences an abundance of caution on the part of the CDC ON BEHALF OF THE AMERICAN PEOPLE!!

    And exactly how are W. Africans supposed, in your opinion, to get into this country without revealing their travel history? If they travel to another country first, won’t they need a passport? A Visa? Evidence of where they’ve been? Are they just going to get on a boat and attempt to cross the Atlantic to get here? That might be a reasonable assumption if they were trying to get to Cape Verde, but in the unlikely event they make it to, say Florida, don’t you think the Coast Guard is going to pick them up? Do you suppose that they will fly to Mexico and then be led across the border by a coyote? Well, no, that doesn’t work, either. Mexico won’t let them in! In reality, keeping flight options open to foreign nationals from W. Africa virtually ensures that the US will be the destination of choice for ANY knowingly Ebola infected W. Africans who attempt to escape their own 3rd world health care system because we will soon be the LAST COUNTRY IN THE WORLD that will let them in, and the barrier to entry is as close at hand as a couple of Tylenol,and a few blatant, unsubstantiated lies. Whether he lied or not, Mr, Duncan demonstrated how easy it would be.
    Is it that you think the world will be better off if Ebola patients wind up in the US rather than somewhere else? Let me put a stop to that idea. The US is clearly not prepared to handle them and it is NOT your job to make that call.
    Another justification is that health care workers won’t be willing to volunteer if they can’t be assured they can return home. I don’t see how that can be a problem if the travel ban applies to nonresidents, unless the health care workers are non-resident aliens from W. Africa that were in the US illegally. As I understand it, there are few flights out of Liberia, Guinea and Sierra Leone as it is – maybe a few per week. If W. Africans are not on those flights, there will be more seats available for health care workers returning home. Of course, the few remaining airlines that fly out of W. Africa may themselves cancel flights, in which case a charter or government transport could be the only way home. I guess I might be a little worried, too, if I had to rely on the US government’s word that it would get me out.
    Finally, I have heard you suggest that the economy of W. Africa will tank if W. Africans are not allowed to travel. In fact I understand that Margaret Chan, Dir. of the WHO, personally asked the US to continue travel to prevent such an occurrence. Well, I think that boat sailed. The economy of W. Africa is going to tank anyway, if it hasn’t already. Based on the CDC’s mission, this really seems far afield and inappropriate when compared to the harm it could do to the country you pledged to protect. Your statements to this effect seem more likely motivated by the favor asked by Dr. Chan, a woman who has misjudged and mismanaged this outbreak from the start and is just trying to do damage control for herself and WHO. Moreover, there are more appropriate ways to bolster the W. African economy than paying the price in US lives.
    It is more than an inconvenience to Nina Pham and Amber Vinson to have become collateral damage in the war you refuse to fight “with everything you’ve got.” They’ve lost their lives as they knew them before, all their belongings and the right to live anonymously if that’s what they wanted. You chose politics and the high profile that comes with it. Time to take your lumps. It is just a shame that you traded your scientific objectivity for a glimpse of the brass ring. You are or will probably be wondering how you went from respected expert to, at best, scapegoat, in a matter of days. It is because you chose to ignore all logic and reason and actually thought you could pull off the campaign speech rhetoric and no one would see through it. The problem with science is that you never really win unless you have the right answer. In the end, Ebola, like all of the secrets of science, will have the last word.

    Dr. Frieden,

    As a member of the American Nurses Association and a U.S citizen, I am very concerned about the spread of Ebola in the U.S, and other countries. Thankfully the nurse traveling on the cruise ship did not have Ebola. However, because of her exposure and potential to develop the disease, her travel within the 21 day period could have put innumerable people at risk.

    It astounds me that CDC was not pro-active in stopping the rise of Ebola in Africa many years ago when it was first diagnosed. Being the head of CDC, you are responsible for overseeing the prevention and containment of communicable diseases in the U.S, and throughout the world, according to the CDC Mission Statement. Your lack of response in this matter has placed not only everyone in the U.S. vulnerable to this deadly disease, but also those throughout the world. If you are not going to take the initiative to control it, who is? By allowing travel to and from known infected areas, across our borders, and not controlling the spread of disease by isolating those carriers and potential carriers, you have failed in the mission of control, which is what you are charged with.

    Respectfully,

    Rebecca S. Hiett, R.N.

    Why is the CDC so far behind now in reporting the number of cases? The numbers were being updated every couple of days, now it’s been over a week since any new case totals have been posted.

    Mr. Frieden. Get a grip! This article is full of politicalese and it’s nothing but crap. Get real and get a handle on the situation.

    1) STOP these death flights from Ebola stricken countries.
    2) Boycott United Airlines—-FOREVER.
    3) Replace Frieden with someone CAPABLE & WILLING to do what’s necessary to protect US Citizens.

    Why , why are we still not quarantining all persons IN COUNTRY for 21 days before they are allowed to travel anywhere?
    This matter is too serious to give deference to complaints about inconvenience and other such protests.
    Thank you.

    I just read on the CDC website that we are allowing people from all 3 places in West Africa that are still fighting the Ebola virus to fly into the United States. Why? To me that is the most irresponsible thing that we could do. Absolutely NO traveling allowed in from any country that is still dealing with Ebola is my thoughts.

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