Lawmakers Want Answers on U.S. Ebola Cases

Hearing Thursday will examine whether the country is prepared to cope with the virus.

DALLAS, TX - OCTOBER 14: The Texas Health Presbyterian Hospital, where health care worker Nina Pham, is being treated for the Ebola virus is seen on October 14, 2014 in Dallas, Texas. Pham contracted the virus when she provided treatment to Thomas Eric Duncan, the West African man who later died from the disease. (Photo by Mike Stone/Getty Images)
National Journal
Oct. 14, 2014, 1:11 p.m.

Amid rising anxi­ety over the Ebola out­break, a con­gres­sion­al pan­el is to con­vene Thursday in Wash­ing­ton to hear de­tails of the two con­firmed cases in Dal­las and wheth­er Amer­ica’s ports of entry, hos­pit­als, and health care work­ers are ad­equately pre­pared to pre­vent a fur­ther spread of the vir­us.

The law­makers’ in­quiry will in­clude the ques­tion of why screen­ing pro­ced­ures did not pre­vent Thomas Duncan from en­ter­ing the U.S. from Liber­ia on Sept. 20, the hand­ling of his dia­gnos­is, and his treat­ment pri­or to his death last week, ac­cord­ing to a memo re­leased Tues­day by ma­jor­ity staffers of the House En­ergy and Com­merce Com­mit­tee.

The com­mit­tee will also be up­dated by of­fi­cials scram­bling to de­term­ine how a nurse who helped treat Duncan at a Texas hos­pit­al has be­come the first per­son to con­tract Ebola in the U.S.

The hear­ing by the En­ergy and Com­merce sub­com­mit­tee on Over­sight and In­vest­ig­a­tions, chaired by GOP Rep. Tim Murphy of Pennsylvania, had been sched­uled for Thursday, even pri­or to Duncan’s death and the news Sunday that the health care work­er had been in­fec­ted.

“The pre­pared­ness of the United States ports, point of entry, health­care fa­cil­it­ies and oth­er in­sti­tu­tions to identi­fy, dia­gnose, isol­ate, and treat Ebola pa­tients in a safe and ap­pro­pri­ate man­ner will also be eval­u­ated,” ac­cord­ing to the memo re­leased Tues­day by the En­ergy and Com­merce ma­jor­ity staff.

The memo at one point notes that that Cen­ters for Dis­ease Con­trol and Pre­ven­tion Dir­ect­or Thomas Frieden has at­trib­uted the health care work­er’s in­fec­tion to “a breach in pro­tocol,” but that of­fi­cials do not yet know what pro­tocol was breached.

Head­ing the list of sched­uled wit­nesses at the hear­ing Thursday are to be Frieden, and Daniel Varga, the chief clin­ic­al of­ficer and seni­or vice pres­id­ent of Texas Health Re­sources. Also set to ap­pear are An­thony Fauci, dir­ect­or of the Na­tion­al In­sti­tute of Al­lergy and In­fec­tious Dis­eases at the Na­tion­al In­sti­tutes of Health; Lu­ciana Bor­io, as­sist­ant com­mis­sion­er for coun­terter­ror­ism policy at the Food and Drug Ad­min­is­tra­tion; and oth­ers.

The 10-page ma­jor­ity memo re­leased Tues­day lists spe­cif­ic is­sues the pan­el plans to ex­am­ine, and back­ground about the Ebola vir­us and the 2014 epi­dem­ic, treat­ment op­tions, and what is known so far about the two con­firmed cases in the U.S.—Duncan and the nurse.

Law­makers are ex­pec­ted to be told there is no FDA-ap­proved vac­cine or ther­apy avail­able for Ebola, but that ex­per­i­ment­al products have been and are un­der de­vel­op­ment. The FDA can au­thor­ize ac­cess to po­ten­tially prom­ising products through vari­ous mech­an­isms, such as an Emer­gency In­vest­ig­a­tion­al New Drug ap­plic­a­tion.

The memo dis­cusses Duncan’s in­dir­ect flight to Dal­las from Liber­ia on Sept. 19, via Brus­sels and Dulles Air­port out­side Wash­ing­ton D.C., ar­riv­ing in Texas on Sept. 20. It also notes that he sought treat­ment at Texas Pres­by­teri­an Hos­pit­al on Sept. 25, only to be sent home on Sept. 26 with an­ti­bi­ot­ics after “a four-hour eval­u­ation and nu­mer­ous tests.”

But Duncan was re­turned to the hos­pit­al by am­bu­lance on Sept. 28, ex­tremely ill, with symp­toms now in­clud­ing severe vomit­ing. The memo says hos­pit­al of­fi­cials test­i­fied that he was kept in the emer­gency de­part­ment un­til he was of­fi­cially ad­mit­ted to the hos­pit­al and put in­to isol­a­tion.

The hos­pit­al no­ti­fied Dal­las County health of­fi­cials on Sept. 29, and they ar­rived on site soon af­ter­wards. CDC of­fi­cials also were no­ti­fied on Sept. 29, but did not ar­rive un­til Oct. 1, ac­cord­ing to the memo. Lab test­ing had con­firmed Ebola on Sept. 30.

The sub­sequent in­vest­ig­a­tion in­to Duncan’s con­tacts while he was con­ta­gious has so far iden­ti­fied 48 people out of what the memo says is a broad­er group with risk of ex­pos­ure. Ten of those are con­sidered to be at high risk, in­clud­ing four close fam­ily mem­bers.

The fam­ily mem­bers ini­tially failed to com­ply with a re­quest to stay at home through Oct. 19 (when a 21-day in­cub­a­tion peri­od for the vir­us would have lapsed), and were sub­sequently forced to re­main for days in an apart­ment that was con­tam­in­ated with Duncan’s bod­ily flu­ids. The fam­ily has since been moved to an un­dis­closed loc­a­tion.

As of the memo’s re­lease Tues­day, there re­mained ques­tions about why the nurse—iden­ti­fied in news ac­counts as Nina Pham but in the memo only as a health care work­er—tested pos­it­ive for Ebola, des­pite her hav­ing worn a mask, gown, shield, and gloves as she helped care for the dy­ing Duncan.

The memo says that since test­ing pos­it­ive on Sat­urday even­ing, she has been isol­ated and in­ter­viewed by CDC per­son­nel to identi­fy any con­tacts or com­munity ex­pos­ures. So far, one such con­tact has been iden­ti­fied and mon­itored for fever and oth­er symp­toms.

(Ac­cord­ing to the As­so­ci­ated Press, Texas Health Pres­by­teri­an Hos­pit­al Dal­las re­leased a state­ment on Pham’s be­half Tues­day. “I’m do­ing well and want to thank every­one for their kind wishes and pray­ers,” Pham said.)

The memo quotes Frieden as say­ing the work­er’s in­fec­tion was due to a “breach in pro­tocol,” as the CDC in­vest­ig­a­tion in­to ex­actly what pro­tocol was breached is on­go­ing.

“What have we learned from the two Ebola cases in Dal­las, and how can we use this in­form­a­tion to im­prove pro­to­cols, train­ing, guid­ance, hos­pit­al pre­pared­ness, pa­tient care and safety go­ing for­ward, both in the U.S. and West Africa?” the memo poses as an is­sue to be ex­amined by law­makers.

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