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COMMENTARY: When the next shoe drops — Ebola crisis communication lessons from October

CENTER FOR INFECTIOUS DISEASE AND POLICY                                                                   Dec. 9, 2014          
By  Peter M. Sandman, PhD, and Jody Lanard, MD  

In contrast to the Ebola crisis in West Africa, which started in late 2013 and will last well into 2015 or longer, the US "Ebola crisis" was encapsulated in a single month, October 2014. But there may well be US Ebola cases to come, brought here by travelers or returning volunteers. And other emerging infectious diseases will surely reach the United States in the months and years ahead.

So now is a propitious time to harvest some crisis communication lessons from the brief US Ebola "crisis."

We're putting "crisis" in quotation marks because there was never an Ebola public health crisis in the United States, nor was there a significant threat of one. But there was a crisis of confidence, a period of several weeks during which many Americans came to see the official response to domestic Ebola as insufficiently cautious, competent, and candid—and therefore felt compelled to implement or demand additional responses of their own devising....

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ER doctor discusses role in Ebola patient’s initial misdiagnosis

DALLAS MORNING NEWS 

The Dallas emergency-room doctor who missed signs of Ebola in a Liberian man who later became the first to die of the disease in the U.S. describes the fateful night for the first time.

Dr. Joseph Howard Meier told The Dallas Morning News that when he treated Thomas Eric Duncan in the early morning hours of Sept. 26, he was unaware that Duncan had recently arrived from a country ravaged by the Ebola outbreak in West Africa. He also said he did not realize Duncan had such a high fever.

"I was unaware of a 103-degree fever," Meier said in written answers to questions from the paper, released by his attorney. "It appears in the chart, but I did not see it...."

Read complete story

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New CDC report offers insight into Dallas County Ebola outbreak

THE DALLAS MORNING NEWS                                                                               Nov. 15, 2014

By Sherry Jacobson

The “Ebola cluster” in Dallas County is the subject of the Morbidity and Mortality Weekly Report published Friday by the Centers for Disease Control and Prevention.

...the report offers a detailed timeline of what happened, starting with Thomas Eric Duncan’s arrival in Dallas from Liberia on Sept. 20. His Ebola symptoms were misdiagnosed Sept. 25 at Texas Health Presbyterian Hospital Dallas as sinusitis and he was sent home with antibiotics. He returned to the hospital Sept. 28, underwent 10 days of treatment and died Oct. 8.

Two of Duncan’s caretakers, both registered nurses, were also infected and were treated successfully for the disease. Protocols required public health workers to monitor 177 people who had contact with the three Ebola patients.

A dozen people in that group, however, were tested for Ebola after developing fever or other symptoms compatible with the disease during the monitoring period. None were found to have Ebola. By last Friday, all contacts had cleared 21 days of monitoring and the county’s outbreak was declared over.

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Military names 5 U.S. bases for troop Ebola quarantines

ASSOCIATED PRESS                                              Nov. 7, 2014
WASHINGTON -- The top U.S. military officer has designated five U.S. bases where American troops would be housed and isolated for 21 days upon returning from Africa after serving in the Ebolaresponse mission, U.S. officials said Friday.

Army Gen. Martin Dempsey, the chairman of the Joint Chiefs of Staff, signed a plan that lists Fort Hood and Fort Bliss, Texas; Fort Bragg, North Carolina; Joint Base Lewis-McChord, Washington; and Joint Base Langley-Eustis, Virginia, as bases where troops would be quarantined.

The U.S. also will use two bases in Italy and Germany for returning troops based in that region....

The plan exempts military personnel who travel to Africa for short-term visits and have very limited contact with people there, such as military staff traveling with a senior official who only stops in the country for a day or two...

In a related announcement, U.S. Northern Command has decided to train 30 more medical support personnel who will be available to help U.S. hospitals with any future Ebola cases. The personnel will begin training in San Antonio, Texas, later this month and will supplement a 30-member team that has already been trained and is ready to respond.

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Last Person Completes Ebola Monitoring in Texas

ABC NEWS                                                                                                            Nov 7, 2014

by  Sydney Ludkin 

DALLAS The final person in Texas being monitored for Ebola has passed the virus's 21-day incubation period, marking the end of the state's Ebola crisis.

None of the 177 people who had contact with the state's Ebola patients -- Liberian national Thomas Eric Duncan, the first person to be diagnosed with Ebola in the United States, and two of the Dallas nurses who cared for him, Nina Pham and Amber Vinson -- have contracted Ebola, state officials said. The list included health care workers, people who shared the same households as the Ebola patients and other community contacts.

"Hopefully, Americans will be relieved and fear will be eased," said Dr. Richard Besser, ABC News chief health and medical editor. "In Dallas, not even the people who lived with a very sick person with Ebola became ill."

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http://abcnews.go.com/Health/person-completes-ebola-monitoring-texas/story?id=26742640

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UT nasal spray vaccine for Ebola effective in monkeys

By Todd Ackerman                                                                           Nov. 5, 2014

... researchers at the University of Texas-Austin have developed a nasal spray vaccine that has protected monkeys against the deadly Ebola virus even a year after immunization.

The vaccine, a genetically engineered cold virus containing a tiny portion of Ebola DNA, saved 100 percent of monkeys who got a single spray through the nose in a new UT study. Injecting the vaccine only saved the lives of about 50 percent.

 
 
 Maria Croyle, a professor of pharmaceutics and the study's principal investigator, said an inhaled Ebola vaccine is more attractive because it would be cheaper and safer than needle-delivered vaccines.

"The main advantage is the long-lasting protection after a single inhaled dose," Maria Croyle, a  professor of pharmaceutics and the study's principal investigator, said in a statement. "This is important since the longevity of other vaccines for Ebola (hasn't been) fully evaluated....

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357 people now being monitored for Ebola in New York

LOS ANGELES TIMES                                                                                        Nov.5, 2014
By Michael Muskal                                      
The number of people who are being actively monitored for Ebola in New York has tripled to 357 people, none of whom has displayed any symptoms, city health officials announced Wednesday.

The vast majority of those being monitored arrived in New York in the last 21 days from West Africa, the New York City Health and Hospitals Corporation said in a statement. Those under monitoring are being checked out of “an abundance of caution,” the statement said.

The latest announcement comes as Ohio said it was officially Ebola-free and Texas prepared to end its observation period for the last 27 healthcare workers. The Texas group will complete its 21-day monitoring period on Friday, according to state officials.

Read complete story
http://www.latimes.com/nation/nationnow/la-na-nn-ohio-ebola-free-monitoring-20141105-story.html

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US Health Care Unprepared for Ebola

      

The U.S. health care apparatus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clusters of cases could overwhelm parts of the system, according to an Associated Press review of readiness at hospitals and other components of the emergency medical network.

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Texas nurse to leave Emory University Hospital free of Ebola virus

REUTERS                                          Oct. 28, 2014
By Colleen Jenkins and Doina Chiacu

A Texas nurse who contracted Ebola in the United States will be released from Emory University Hospital in Atlanta on Tuesday after being found free of the virus, the hospital said.

An ambulance transporting Amber Joy Vinson arrives at Emory University Hospital in Atlanta, Georgia October 15, 2014.Credit: Reuters/Tami Chappell

Amber Vinson was one of two nurses at a Dallas hospital who had treated Thomas Eric Duncan, a Liberian visiting Texas who died of Ebola on Oct. 8 and was the first patient diagnosed with the virus in the United States.

She was admitted to Emory's hospital for treatment on Oct. 15. The other nurse, Nina Pham, also was declared virus-free last week and left the Maryland hospital where she had been treated

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Seeking Unity, U.S. Revises Ebola Monitoring Rules

UPDATE WITH DETAILS OF MARYLAND AND VIRGINIA MONITORING  (Scroll down)

ROUNDUP OF DEVELOPMENTS IN THE QUARANTINE  DISPUTE
NEW YORK TIMES                        Oct. 28, 2014

By , and

The federal government on Monday tried to take charge of an increasingly acrimonious national debate over how to treat people in contact with Ebola patients by announcing guidelines that stopped short of tough measures in New York and New Jersey and were carefully devised, officials said, not to harm the effort to recruit badly needed medical workers to West Africa.

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