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Lawmakers slam health officials on Ebola response

 Centers for Disease Control and Prevention Director Dr. Tom Frieden testified at a House hearing Thursday on Capitol Hill.
Centers for Disease Control and Prevention Director Dr. Tom Frieden testified at a House hearing Thursday on Capitol Hill.J. Scott Applewhite/AP

WASHINGTON — At a congressional hearing Thursday in which they faced sharp questioning about the flawed handling of Ebola cases in the United States, federal health officials said a nurse infected with Ebola at a Dallas hospital would be transferred to a specialized unit at the National Institutes of Health in Maryland. The hospital is straining its efforts to monitor dozens of other health care workers who may have been exposed to the virus, the officials said.

The nurse, Nina Pham, was part of the medical team at Texas Health Presbyterian Hospital that cared for Thomas Eric Duncan, a Liberian who died of Ebola last week. She is to be moved to the NIH facility in Bethesda, Maryland, on Thursday evening at the request of the hospital, officials said.

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Pham is in stable condition. A second nurse infected at Texas Presbyterian was moved Wednesday to Emory University Hospital in Atlanta, which has successfully treated two American Ebola patients.

Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention in Atlanta, told members of the House Energy and Commerce Committee on Thursday that the Dallas hospital was consumed with monitoring dozens of employees for signs of illness.

“Texas Presbyterian is dealing with a difficult situation,” Frieden said. “They are now dealing with at least 50 health care workers who may potentially have been exposed. That makes it quite challenging to operate, and we felt it would be more prudent to focus on caring for any patients who come in with symptoms.”

At the hearing on Capitol Hill, which placed the government’s halting response to the virus in the United States into the realm of politics, Rep. Tim Murphy, R-Pa., opened with scathing criticism.

“Mistakes have been made,” he said. “Trust and credibility of the administration and government are waning. That trust must be restored.”

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One sharp line of questioning from lawmakers dealt with travel. Duncan had flown to Dallas from Liberia, where Ebola has killed hundreds, and on Wednesday it was revealed that a second nurse infected at the Dallas hospital had traveled on a commercial flight from Cleveland to Dallas the day before she showed symptoms of the disease.

Rep. Fred Upton, R-Mich., reiterated calls for a full travel ban from affected countries; Frieden and other public health officials have said such measures would be counterproductive.

Upton asked how the second nurse, Amber Joy Vinson, was able to board a commercial flight even after she reported having a fever.

“On this issue, there is no time to wait,” he said. “People are scared. We need all hands on deck. We need a strategy.”

Rep. Henry A. Waxman, D-Calif., called on federal health officials to reassure the public.

“Put this in perspective,” Waxman said. “We’ve had three recent cases of Ebola in this country. We should be concerned about these cases — we need to act urgently, but we need not to panic.”

Ebola is one of the world’s most lethal diseases, but is contagious only through contact with bodily fluids, and health officials say it is highly unlikely that passengers on Vinson’s flight were at risk.

In one heated exchange, Frieden said he had not seen a transcript of a telephone call made to the CDC by Vinson as she was about to board a flight from Dallas to Cleveland on Oct. 8.

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Vinson had an elevated temperature, but it was not known yet that she had contracted the virus.

“We’re you part of those conversations?” Murphy asked Frieden.

“No, I was not,” Frieden responded.

“I have not seen the transcript of that conversation,” he added. “My understanding is that she reported no symptoms to us.”

Murphy said later to Frieden in an exchange over protective gear:

“You just told us that if she was wearing appropriate protective gear she was OK to travel. If she was not, she was not OK. We need to find that out.”

Also on Thursday, Dr. Daniel Varga, the chief clinical officer for Texas Health Resources, the medical group that oversees Texas Health Presbyterian Hospital, apologized for what he said were mistakes made by the hospital in the original diagnosis of Ebola and in providing inaccurate information

“Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team we made mistakes,” he said in remarks prepared for the hearing.

“We did not correctly diagnose his symptoms as those of Ebola. And we are deeply sorry.”

Varga also gave new details about the early days of care provided to Duncan, a period that is reported to have been marked by some confusion and is potentially when the nurses became infected.

On Tuesday, a union representing nurses accused hospital authorities of lacking strict protocols for protective equipment and alleged that the suits they were given left skin exposed. They said Duncan had initially been left for several hours in an area around other patients.

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“There was no advanced preparedness on what to do with the patient, there was no protocol, there was no system,” unnamed nurses at the hospital said in a statement released by the union, National Nurses United.

Varga said that Duncan “met several of the criteria of the Ebola algorithm,” when he arrived at the hospital Sept. 28, and that the CDC was notified at that time. He said CDC protocols for basic protective gear had been followed, although Wednesday he had acknowledged that workers did not start wearing full biohazard suits for two days. He also said in his prepared remarks that, since the patient was having diarrhea, “shoe covers were added shortly thereafter,” implying that caretakers had not initially been wearing them.

“Protective equipment included water, impermeable gowns, surgical masks, eye protection and gloves,” he said. A CDC team arrived at the hospital Oct. 1, shortly after Duncan tested positive for the virus, he added.

Before the hearing, Dr. Paul E. Jarris, the executive director of the Association of State and Territorial Health Officials, said the CDC as well as state and local agencies had been sending out materials on Ebola for months, but that it was up to each of the 5,000 hospitals to prepare and drill. Next week, the CDC is scheduled to hold a large Ebola training session at the Javits Center in New York for thousands of health workers.

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“The tools were there but the challenge is getting the horse to drink,” Jarris said, adding that the task was complicated by federal budget cuts.

Funds for hospital preparedness are down by 40 percent since 2010, he said.

Many health workers said that Ebola was on the radar, but that real preparation would take more than a single training exercise or an emailed brochure. Hospitals with specialty units, such as Emory University Hospital in Atlanta, where the second infected nurse was transferred Wednesday, regularly hold drills to keep up the skills that make treatment consistently safe.

“There’s a big difference between knowing what to do and being really good at executing it,” said Dr. Brad Spellberg, chief medical officer of Los Angeles County-University of Southern California Medical Center. “How many times do you need to drill before there are no operational errors? That’s the next level of expertise.”