Even from nation’s top expert, Ebola advice confuses

A few weeks into the Ebola crisis, it often appears the Clampetts are in charge of the public health system, at least in Texas.

A second nurse who treated an Ebola patient in Dallas — a patient who has since died — has now been diagnosed with Ebola.

Federal officials have chastised the media and public for being unduly concerned about Ebola, but they are being inconsistent — or at least confusing — in assessing individual threats to the public.

Today, officials are scrambling to locate passengers who were on the same Frontier Airlines flight as the latest Ebola patient.

Listen to Tom Frieden of the Centers for Disease Control and Prevention today:

“The patient had traveled to Ohio before it was known that the first healthcare worker was ill. At that point that patient as well as the rest of the healthcare team were undergoing self-monitoring. The second healthcare worker reported no symptoms and no fever. However, because at that point she was in a group of individuals known to have exposure to Ebola, she should not have traveled on a commercial flight.”

He added that the risk to other passengers is “extremely low,” but the search for the passengers betrays his assertion.

Moreover, Frieden gave exactly the opposite assessment when he was asked on CNN the other day about NBC doctor/journalist Nancy Snyderman, who blew off a “self-monitoring” quarantine and went shopping in New Jersey, even though she was exposed to Ebola while reporting from Liberia recently.

“If she was not sick, she was not putting others at risk,” Dr. Thomas Frieden said when he appeared on CNN’s “Situation Room With Wolf Blitzer.”

So on the other one hand, one person who had been exposed to Ebola, was “self monitoring” and showed no symptoms shouldn’t have gone on a commercial flight. But in a second case, a person who been exposed to Ebola, was self monitoring, and showing no symptoms was OK to go shopping?

“We will, from this moment forward, ensure that no individual monitored for exposure undergoes travel in any way other than controlled movement,” Frieden said in a news conference today.

After Snyderman was outed by a local blogger, she was ordered under “mandatory quarantine.”

Writing on Huffington Post today, Linda P. Fried, dean of Columbia University Mailman School of Public Health, said people should just listen to Frieden.

The proven technique is to follow four steps rigorously and consistently: find the cases of disease; isolate and care for the ill people; contact people who were exposed to the ill people, and further isolate and care for those contacts if they develop symptoms. This is standard public health practice and expertise.

The challenge of mobilizing aggressively on the current scale is a daunting one, even without second-guessing from people with no experience in fighting disease. The challenge becomes exponentially greater, if scarce resources are diverted by uninformed demands — for travel bans, for instance — which are difficult to implement and do not contribute to defeating the disease. Wasting resources by following casual advice — even if adamantly spoken and mightily propelled — would make the tragedy of this disease even greater.

Related: Can you get Ebola on a plane? (Vox).

  • jon

    I’m not an expert.
    I am literally just a guy who spent 20-30 minutes researching Ebola via the internet (Wikipedia, WHO, CDC, etc.)

    I’ve read very few (if any) articles on the internet that seem to be portraying all of the facts as we know them (as I know them from 20-30 minutes of research).

    On the one hand you have the people who are outraged that Ebola will kill us all and we need to shut down everything to ensure it doesn’t breach our borders (oops! it already has!) and/or Obama brought Ebola into the country to kill us all and then is doing nothing about it he should be in the hospital treating people for Ebola! and other insanity.

    Then you have what I’d usually consider the rational media (not Facebook or fox news) making claims about direct contact with bodily fluids, shaking some ones hand with Ebola won’t get you sick, and you’d need to wait patiently while some one who is showing symptoms vomited on you to contract the disease. Which best I can tell is also not true, the CDC even says that Ebola can survive on a dry surface for several hours.
    Wikipedia says we aren’t sure if the virus can be aerosolized by coughing of sneezing, though there are reports of monkeys contracting the disease that way… as well as sexual transmission, which is direct bodily fluid contact, but can happen for up to 7 weeks AFTER the disease has run it’s course (maybe).

    So, on the one hand, “WE ARE ALL GOING TO DIE FROM EBOLA!” on the other hand “WE AREN’T ALL GOING TO DIE FROM EBOLA!” Unfortunately I think the truth is some where in the middle though it’s hard to get clicks on the internet with “Some of us will likely succumb to Ebola, however social distancing, not rubbing your eyes, and frequent hand washing can limit your chances of exposure (just like with the flu)” doesn’t get as many clicks on the internet.

    Again I’m not an expert on communicable diseases, my only real qualifications in the field of medicine is a CPR class back in grade school, and once having a bar tender who was working on getting his medical degree.

    • That’s why the rush to find all the other passengers on the plane confuses me. Is there more exchanging of bodily fluids going on in the nation’s skies than I was aware of?

      • Peter @ MSP

        LOL – .

        I’m pretty sure it has to do with “WHY AREN’T YOU DOING ENOUGH?”

        I don’t recall this level of due diligence being followed when people started showing up on planes complaining of symptoms of SARS, and that had a much easier form of transmission.

      • Jack Ungerleider

        I think that falls under “contact people who were exposed to the ill people, and further isolate and care for those contacts if they develop symptoms.” The sooner people know that they may have been exposed the sooner they can self monitor and report in if they exhibit symptoms.

        With respect to the difference in how Dr. Snyderman’s coffee run and the nurse on the airplane, the passengers and crew of the airplane are defined set that are easily contacted. All of the people in the various airports, etc. aren’t be contacted because figuring out who they are is almost impossible. The same is true of the shoppers that may have come into contact with Dr. Snyderman and her colleagues. In that case you have to hope that people pay attention to the news and contact the public health system if they think they are at risk.

        • But I think the instruction being provided offers little guidance to people on the proper course of action. I’m sure there is nuance involved, but it’s unclear why one person without symptoms is not a threat but another person is — at least beyond the logistics involved of trying to find the people they came into contact with.

          • Ben

            To me, the difference is one person has tested positive for Ebola and the other hasn’t. Also, the test was done less than 24 hrs from the time the nurse was on the flight. And I’m pretty sure it’s being reported that the nurse had a fever of 99.5 before her flight back to Dallas. Maybe that’s the nuance.

          • That would make sense and, if true, confirms another flaw in the assurances w.r.t. perfect planning and precautions — the incompetence of people to execute perfect plans and precautions.

      • Andy


        I think that “the rush” is what the media and you are reporting. I fully understand that the CDC would want to contact all those passengers to inform them of the risk, slight but real, that they MAY have been exposed to Ebola so that they know to report any suspected symptoms so that we can STOP the spread of Ebola. Moving quickly seems appropriate because it’s probably a long and confusing task to track down 132 people and ask them a battery of questions to understand if it could spread farther than Texas.

        I don’t understand why that’s confusing.

        I’m not a medical expert by any measure, but I have been reading about Ebola from a variety of news sources and I feel pretty confident that I know enough background information to understand that I am not presently at risk. However, I would certainly want to know as soon as possible if I have been put at risk of contact with this disease. Not so I can freak out, like news headlines want me to, but so I can make better decisions if I start to show symptoms that may indicate Ebola.

        I am a former journalism student (at SJMC at the U), so I know how misleading headlines can be (even on MPR!) and I know how the media can spin things up into much more than they are. So, I’m not buying into the hysteria that some media outlets want to perpetuate or the lack of trust and in and hatred of government that others want to incite. But I am buying into the need for some specific people to be quickly and more fully informed about possible risks. What’s confusing about that?

        My thought is that our number one enemy is not the disease, but the hysteria, mistrust, and panic that follow the disease and prevent us from slowing and ultimately stopping it’s spread.

        • Fine, then. Tell 132 people they “might” get Ebola and to be on the lookout. And then what? What are they supposed to do, stay home? That hasn’t been communicated. And how many people do 132 people come in contact with in a given day? And what about THOSE people?

          I don’t necessarily believe that I’m at risk at the moment. That’s not the question for me.

          If you’re not confused, I think that’s great. But in your response, I don’t necessarily see why a woman without symptoms shouldn’t be on a plane and why a woman without symptoms should go shopping, when both were exposed to Ebola?

          I think if you say “she shouldn’t have been on a plane,” you’re create the impression that being on a plane with someone not showing symptoms carries a certain risk. And I don’t really see how you can have it both ways.

          I’m alright with the fact the nurse got on a plane if she didn’t have any symptoms, based on the assessment that she’s not a threat to anyone. So exactly why SHOULDN’T she have gotten on the plane then?

          I also agree with you that panic and hysteria is dangerous. Today’s Wall St. collapse — particular in airline stocks — shows why.

          But that doesn’t comfort me much, not so much because I hate the government, but because I think the information that’s provided isn’t as complete as it could be BECAUSE people are prone to inflate that information.

          Is that my fault. Maybe. It’s not like officials have ever withheld information before.

          By the way, I’m much more concerned about journalists who just dutifully report what they’re told to report rather than looking at two statements from the same individual and not question those things that don’t add up.

  • kevinfromminneapolis

    “Luckily” this plane sat in Dallas overnight. Had it flown on to Frontier’s main Denver international hub, where its terminal sits right next to baggage claim, well you can see how if an infected person sneezes or something and throws some fluid out there things can get out of hand.

    • But, as I understand it, none of them would have been infected because — according to the CDC gentlemen — they wouldn’t have been showing symptoms and if they didn’t have any symptoms they weren’t dangerous.

      I’m presuming that the reason they want to find all the passengers is not because they think they might have Ebola, but to monitor them in case they eventually develop it.

      That, it seems to me, is an utterly impossible task.

      • jon

        And there is the problem as I see it. The CDC is reporting only about CONFIRMED transmission vectors (direct contact, fluid exchange).

        But the CDC (on their web page link in my comment above) is also saying that “Ebola on dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature.”
        Which makes Kevin’s arguement valid all the sudden (presuming the person is infectious at the time, which we are to believe means they are symptomatic)

        I’m getting mixed messages from what the media is telling me that the CDC is saying and what the CDC’s own website says.

        The transmission rate has to be fairly low in west Africa (the virus is spreading much to slowly for it to be a high transmission rate).
        And if statistics is all I can take solace in then I guess that will have to do.

  • Jack

    So here is my question – at what point do you need to be concerned with an escalated temperature? My normal temperature is not the “98.6” but lower by a couple degrees. When I’m at 98.6, I’m sick. So how does this all work with figuring out who is exhibiting symptoms.

    Not trying to stir the pot – just pointing out that we don’t all have the 98.6 temperature.

  • CHS

    I agree, the information that is coming from the CDC and other government agencies is confusing. However, I don’t think it is inconsistent, just poorly messaged. The problem is that in trying to simplify the message they are not providing the context that would make two seemingly contradictory statements make sense. In this case, two people known to have been exposed to Ebola are being scrutinized for their behavior and being held to seemingly different standards with no real explanation. I suspect that the reason they are saying the nurse should not have flown during the monitoring period is not that it is inherently more risky than going to the store, but that it makes the job of the epidemiologists that much harder and the risk of ‘export’ is significantly higher. In both cases if the person became symptomatic and contagious while they were out, the risk to those around them would be fairly similar (and very low), however it’s the worst nightmare of the CDC to have it be transmitted to someone on a plane, you have no idea where that person is going to be by the time that you figure out who they were. Some of the people could easily be in other countries by that point. That’s how new outbreaks get spread to new unsuspecting places. But that explanation is much longer and harder to convey in a news-bit than saying, if she wasn’t sick she posed no threat for her shopping excursion, but the nurse shouldn’t have flown.

  • davehoug

    Beware the soothing comments. Ask yourself if those haz-mat suits are hung up in the closet and re-used the next day, then ask yourself how that is different from a bill handed to a cashier. How does someone know if they will get a fever that night when they are out that afternoon??? Does the virus die instantly on a doorknob if I sneeze into my hand first??? If a person only gets a microscopic amount of virus does it take longer than 21 days to get sick and show symptoms???

    I bet we can all come up with questions that the CDC can not positively answer, only re-assure the known risk is low.

    • There’s actually quite a lot of Ebola information on the CDC site.