The Department of Homeland Security announced today that all travelers from Ebola-stricken countries in West Africa will be taken through one of five U.S. airports with enhanced screening starting Oct. 22. The five airports are New York's John F. Kennedy; Washington's Dulles; Chicago's O'Hare; New Jersey's Newark; and Atlanta's Hartsfield-Jackson.
Meanwhile, President Obama has named Ron Klain as Ebola Czar. Klain will coordinate the government’s comprehensive response to Ebola, and will report to White House Homeland Security Adviser Lisa Monaco and National Security Adviser Susan Rice.
As former Chief of Staff to two vice presidents, “Klain comes to the job with extensive experience in overseeing complex governmental operations, and has good working relationships with leading members of Congress as well as senior Administration officials,” said a White House statement.
At a CDC press conference yesterday, CDC director Dr. Thomas Frieden said Klain's appointment as a government-wide coordinator "will help us, as we focus on ... the response here and West Africa and other parts of Africa, to have the coordination, accountability, and trouble-shooting, and keep us moving quickly and on track."
Pentagon Launches 30-Person Ebola Team
In another development, Secretary of Defense Chuck Hagel ordered his Northern Command Commander, Gen. Chuck Jacoby, to prepare and train a 30-person medical support team that could, if required, provide short-notice assistance to civilian medical professionals fighting Ebola in the United States.
Gen. Jacoby is putting together a team of 20 critical care nurses, five doctors trained in infectious diseases, and five trainers in infectious disease protocols.
Team members will be sent to Fort Sam Houston in Texas for up to seven days of specialized training in infection control and the use of personal protective equipment (PPE). That training is expected to start within the next week and will be provided by the U.S. Army Medical Research Institute of Infectious Diseases.
CDC Health Worker Guidelines Emphasize Training
The Centers for Disease Control and Prevention (CDC) announced stricter infection control guidelines for healthcare workers caring for Ebola patients, with special emphasis on preventing skin exposure and on how to put on and take off protective gear.
According to the CDC, recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center are reflected in the guidelines, which focus on three principles:
- All health workers undergo rigorous training and are practiced in the use of PPE, including taking it on and off in a systemic way.
- All workers are supervised by a trained monitor who watches each worker taking PPE on and off.
- No skin exposure when PPE is worn.
The CDC is now also recommending coveralls and single-use, disposable hoods. Goggles are no longer recommended, as they may not provide complete skin coverage. Moreover, goggles are not disposable, may fog after long use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands.
PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:
- double gloves
- boot covers that are waterproof and go to at least mid-calf or leg covers
- single-use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood
- respirators, including either N95 respirators or powered air purifying respirator (PAPR)
- single-use, full-face shield that is disposable
- surgical hoods to ensure complete coverage of the head and neck
- an apron that is waterproof and covers the torso to the level of the mid-calf when Ebola patients have vomiting or diarrhea
The CDC recommendations also call for a trained monitor to observe and supervise each worker taking PPE on and off. This is to ensure each worker follows the step-by-step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any mistakes in real time.
Progress Reported in Vaccine Testing and Development
According to a CBS News report, Dr. Marie Paule Kieny, an assistant director general for the World Health Organization (WHO), said clinical trials either planned or underway in Europe, Africa, and the United States are expected to produce preliminary safety data by December.
Kieny said if the vaccines are deemed safe, tens of thousands of doses will be used in trials in West Africa beginning in January to test their effectiveness. One of those vaccines, developed by the U.S. National Institutes of Health (NIH) and GlaxoSmithKline from a modified chimpanzee cold virus and an Ebola protein, is in clinical trials in Maryland, the U.K., and in Mali. It will be tested in clinical trials in Lausanne, Switzerland, by the beginning of February.
Another vaccine, developed by the Public Health Agency of Canada, called VSV-EBOV, has been sent to the U.S. Walter Reed Army Institute of Research in Maryland for testing on healthy volunteers. The next stage will be to test it more broadly, including among those directly handling Ebola cases in West Africa.
A separate CBS report said that in early January, Johnson & Johnson will begin testing a vaccine combination, developed by its Janssen Pharmaceutical Companies, that protects against an Ebola strain that is very similar to the virus responsible for the West Africa outbreak. J&J also plans to test whether its vaccine protects against the version causing the outbreak, and is spending up to $200 million to speed up and expand production of the vaccine. J&J is developing the vaccine with the Danish biotech company Bavarian Nordic.
Original Ebola Watch List in Texas Cleared; 120 People Still Being Monitored
Meanwhile, officials said 43 of 48 people on a watch list in Texas for having contact with Ebola patient Thomas Eric Duncan have passed the 21-day maximum incubation period for Ebola. On Monday, Duncan's fiancée and three other people who shared an apartment with him in Dallas before he was hospitalized were cleared, after being under official quarantine.
Duncan died on Oct. 8. Others who cared for Duncan remain at risk, including two nurses he infected and their close contacts. That brings the total to 120 people now being monitored. Their waiting period ends on Nov. 7, according to Dallas Mayor Mike Rawlings.
Cameraman Is Ebola-Free; Passenger on Cruise Ship Tests Negative
Ashoka Mukpo, a freelance cameraman diagnosed with Ebola while working with NBC News in Liberia, is Ebola-free and is being released today from Nebraska Medical Center's biocontainment unit.
On Sunday, a Carnival Cruise Lines ship returned to Galveston, Texas, carrying a health worker who was being monitored for Ebola. The passenger was a lab supervisor who had handled a specimen from Duncan. She isolated herself on the ship as a precaution and later tested negative for Ebola. The ship was prohibited from landing in Cozumel, Mexico, because of infection fears.
Nigeria Joins Senegal in Being Declared Ebola-Free
On Monday, the WHO declared the end of the Ebola outbreak in Nigeria. On Oct. 17, Senegal was also declared Ebola-free. The Ebola crisis, which still rages in Guinea, Liberia, and Sierra Leone, has been responsible for at least 4,555 deaths as of this writing.
According to the WHO, the end of an Ebola virus outbreak in a country can be declared once 42 days have passed and no new cases have been diagnosed.
The WHO credited the Nigerian Government's quick establishment of an Emergency Operations Center for stopping the outbreak. When the country's first Ebola case was confirmed in July, health officials immediately repurposed technologies and infrastructure from the WHO and other partners to help find cases and track potential chains of transmission.
In a separate development, in its Morbidity and Mortality Weekly Report, the CDC praised the Firestone company’s success in stemming an Ebola outbreak on its rubber plantation in Liberia. The success was due to the rapid establishment of an incident management system; active and enhanced passive surveillance for Ebola; immediate isolation of Ebola patients in a dedicated unit; and management of contacts according to the nature of their exposure.