Ebola protocols: 'Learning on the fly'

It was the first circle of worry: the 48 Dallas residents who’d had direct or indirect contact with Thomas Duncan as the Liberian national became progressively sicker with Ebola.

But on Tuesday, 76 health care workers were added to the list. And now public health officials want to hear from 132 passengers on an airplane that carried an infected nurse.

It’s still very uncertain how much bigger the circle could grow.

The country’s response to Ebola wasn’t supposed to go this way. Yet the supposedly clear protocols to prevent an Ebola outbreak have been turned on their head thanks to the events transpiring in Dallas, where the symptoms of the first U.S. Ebola case were initially missed and the disease has now spread to two of the workers who cared for him at Texas Health Presbyterian Hospital.

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Just this week, the CDC changed its recommendations on the protective gear that facilities should have for their staffs. It also lowered the temperature threshold that should trigger a provider’s suspicion of possible Ebola.

“We’re really learning on the fly,” said Jonathan Zenilman, chief of the infectious disease department at Johns Hopkins Bayview Medical Center in Baltimore. “There are a lot of people who want certainty. That doesn’t exist right now.”

On Wednesday, CDC Director Tom Frieden acknowledged that the third patient had been on a flight the night before she began feeling ill. Nurse Amber Vinson had been monitoring herself, as had dozens of coworkers who’d also been potentially exposed to the virus after Thomas Duncan was admitted to Texas Health Presbyterian.

Since Vinson was not experiencing symptoms, the risk to other passengers would have been “extremely low,” Frieden said. Even so, “she should not have traveled on a commercial airline.”

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And from here on, he declared, CDC will ensure that “no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.”

None of the 48 people in the CDC’s early surveillance group has become sick — and as all near the end of the disease’s 21-day incubation period, their risk is dropping markedly. That should reassure the other people on the Frontier Airlines flight from Cleveland to Dallas on Monday evening. Ebola is only transmitted by the bodily fluids of a person with symptoms.

Yet Vinson and fellow nurse Nina Pham are sick — despite all the assumed precautions and protections of their institution’s intensive care unit. They’re part of an entirely different circle, one that public health officials seem to have not fully appreciated until this week.

“Everyone tends to deal with what’s immediately at hand,” said Jesse Goodman, an infectious disease specialist at Georgetown University Medical Center in Washington. And given the initial missteps with Duncan’s diagnosis, which raised fears that people in the community had been put in danger, “that was the first concern and where people focused.”

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The developments this week, however, reveal clearly who is in most danger. It’s similar to what has played out with the Ebola outbreak in West Africa, Goodman noted. Health care workers are at greatest risk. “Routine contacts are not that likely to spread the disease,” he said....