Ask Me Anything with CDC Director Tom Frieden

Tom Frieden optimizedThe Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American health care workers infected with Ebola while working in West Africa were successfully treated at Emory University Hospital.  Their health care team used the proper infection control practices and there was no transmission of the virus to the health care team or others in the hospital and community.

Now two more American health care workers working in West Africa have become infected with Ebola virus and are being treated in the United States.

CDC has already consulted with state and local health departments on almost 100 cases where travelers had recently returned from West Africa and showed symptoms that might have been caused by Ebola. Of those cases, only eleven of were considered to be truly at risk. Specimens from all eleven patients were tested and fortunately Ebola was ruled out in all cases.

There is understandably a lot of fear surrounding Ebola. The health care workers who might need to care for Ebola patients are right to be concerned – and they should use that concern to increase their awareness and motivation to practice the meticulous infection control measures we know will prevent transmission of the virus.

Hospitals and health care facilities must review their infection control practices, including how they’re handling environmental infection control.

When we issued our infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease , we began hearing from those concerned that standard environmental infection control procedures might not be sufficient.

Part of the concern is that no EPA-registered disinfectant has a labeling claim specifying that it is effective against the Ebola virus. You cannot go to the shelf and find a product that says it will be effective in killing Ebola. However, because Ebola is readily killed by soap and water, bleach, or hospital disinfectants that are labeled as being effective against non-enveloped viruses, standard infection control procedures are indeed sufficient.

There has been no evidence of Ebola virus transmission from either the environment, or from surfaces such as bed rails, door knobs, and laundry that could be contaminated during patient care. The Ebola virus is a fragile virus – once the envelope of the virus is destroyed, it cannot survive long-term in the environment.  This is unlike non-enveloped viruses such as norovirus, rotavirus, and adenovirus, which do survive and transmit from person-to-person off environmental surfaces.

Early recognition of patients is critical for implementing infection control measures that will ensure other patients and staff are protected.  Diligent environmental cleaning and disinfection as well as safe handling of potentially contaminated materials are of paramount importance.

CDC has now issued further specific guidance and answers to frequently asked questions on environmental infection control procedures where there is a confirmed case of Ebola virus disease, such as how to handle disposable materials and patient waste.

Review these guidelines with your staff. Any U.S. hospital that is following CDC’s infection control recommendations, and can isolate a patient in a private room,‎ is capable of safely managing a patient with Ebola virus disease.

Whether for Ebola or any other infectious disease, it is essential to be prepared.

Dr. Thomas Frieden is CDC Director.

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13 replies »

  1. “”I wish we had put a team like this on the ground the day the first patient was diagnosed.”

    We appreciate your belated candor, but it still leaves the very important question Dr Frieden as to why with months to prepare for this event, you DIDN’T ALREADY have a team of experts prepared, and why they weren’t on the ground in Dallas very quickly after Mr. Duncan’s admission.

    Especially after telling the whole world over and over that we had everything covered and we were all prepared for Ebola.

    Surely anyone with an ounce of commonsense could have, and should have anticipated the need for the response team that you are just NOW putting together.

    Clearly you are a very oor manager – even a fool could have seen that this very first case in Dallas was a top, top, top priority situation, and yet you and your staff were mostly asleep at the wheel apparently. Honestly, it’s pretty unbelieveable.

    As far as I can see, you are mainly good at making blase announcements such as ‘ we’re going to stop ebola in it’s tracks’, which is then followed by a complete lack of follow thru, or your ridiculous assertions that stopping infected people from coming into the US is somehow preventing the fight against ebola in Africa.

    The airlines can do charter flights and the US government has plenty of planes to fly aid workers in and out, so that bogus argument is an insult to our intelligence. Stopping tourists like Mr. Duncan from entry into the US in no way prevents us from treating ebola in Africa. It’s a nonsensical argument.

    We can land a man on the moon, but we can’t get aid workers to and from Africa?? – give me a break.

    Perhaps the $500,000 required to treat Mr Duncan and the unknown amount for the new patient should come out of your salary doctor since you think it’s such a great idea to have a lax entry protocol that allows infected people like Mr. Duncan into the country.

    Not to mention the cost of the numerous lawsuits which are in the works, and perhaps yet unknown future Ebola cases that may surface because of the lack of support the Dallas hospital received from you and the CDC during those critical first days.

    This is a serious disease Dr Frieden, and we need a very competent, commonsense, take-charge manager, not a pretty suit and a politician’s smile like yourself managing this crisis.

    Please resign, this is too serious a problem to be left in your hands, please be honest with yourself… – you’re simply not up to the job.

  2. I would like to understand the economics of Ebola. When I go another country and don’t have insurance, I am limited in my accessibility. I realize Ebola is a real threat to all of us and its for the public good for everyone to be treated, but who pays for this?

  3. As a physician I believe it would be helpful if the cdc posted a full patient chart with the names redacted for us to use as a guide in treatment. I would like to see labs and imaging of these patients as well as treatments.

  4. I’m sure this has been considered, but in case it hasn’t I thought I’d ask… ebola Reston has been demonstrated to infect humans without creating illness (though it’s lethal for monkeys). My understanding is that the workers at the Reston facility did in fact contract the disease from the monkeys in their care, developed anti-bodies, and did not get sick. Would deliberately exposing at-risk populations to Ebola Reston create an antibody boost that might aid a patient’s response to Ebola Zaire?

    It would seem to me that the danger could be that if a patient had live Reston infection – with its airborne capabilities – mixing genes with the current strains of Zaire, it could create a superbug.

    Just curious if this approach has been attempted and where I might find more information about this…

    Any response appreciated.

    Jon H
    Steamboat Springs, CO

  5. Follow the ARTIFICIAL nails worn by RNs, BSNs and other healthcare workers inside hospital to see that their dirty, filthy artificial nails are a hot bed for MRSA. A study shows that nurses RNs, BSNs who work in hospitals and where artificial nails, are HIGH risk for transferring MRSA from patient to patient. So much for accreditation standards….instead of seeking to be “magnet” status with BSNs why don’t these brilliant people running hospitals think about putting together a policy that says NO NURSE shall have FAKE NAILS since research shows MRSA colonizes under the nail bed…helloooooooooooooooooooooooooooooooostupid people running things again

  6. Thank you for your questions, Jiten.

    CDC recognizes that biosurveillance is important to national security and supports the updated National Strategy for Biosurveillance. CDC’s role is to continue making the best use of electronic health data, integrating biosurveillance data so health-related information can be shared rapidly, and strengthening global disease detection and cooperation with global health partners. There’s more information about the National Strategy for Biosurveillance here:

    In response to the Ebola epidemic, we’re enhancing surveillance and laboratory testing capacity in West Africa and the U.S. to detect cases and developing guidance and tools for U.S. health departments to identify possible cases of Ebola. We’ve provided guidance on Ebola infection control for health care facilities, and guidance for flight crews and emergency medical units at airports about reporting ill travelers.

    All three West African countries at the center of the epidemic now have an Incident Manager, reporting to the President of the country, to lead efforts. CDC staff are deployed to Guinea, Liberia, Nigeria, Senegal, and Sierra Leone to assist with response efforts, including surveillance, contact tracing, data management, laboratory testing, and health education.

  7. Dr. Frieden, thanks for an insightful post.

    What is the CDC’s position on the new National Biosurveillance Strategy? Using Ebola as an example, what types of data would be collected for early detection and prevention of the disease under this strategy? How will this effort be different from what was being done thus far?

  8. Not quite sure if we need ebola-specific soap (good one!), but it does make one wonder how an enveloped virus that is so fragile has been able to create the kind of damage it has.

    To that end, it does make one wonder about what we don’t know or aren’t being told. Is it simply that basic hygiene and sanitation systems in Western Africa are so bad, that all it takes is receiving better supportive care and cleaner management in Atlanta to rid the virus? Or am I missing something and people are actually being treated by a ebola anti-virus?

    If this virus can’t even survive transmission through inanimate objects, what about it is so strong and why are basics of negative pressure rooms, hand washing, (double) gloving, and standard respiratory precautions not enough?

    And if it is enough, then why are people needing to be cared for at the central CDC facility instead of in their local hospital?

  9. Why take the risk of allowing patients to be treated in hospitals in other parts of the country?

  10. I think Ebola might be the viral, or virus, version of Streisand effect. The more we speak about how much we should not fear it, the more people will fear it.

    An interesting analogy is insurance. Behavioural psychologists have shown that we are willing to pay more for flight-specific insurance than all-purpose insurance.

    So may be we should start manufacturing Ebola-specific soap.

    • Saurabh raises an important point about the more we talk about don’t be afraid, the more afraid people become. This is in part because of the breakdown of trust in government and large institutions. People have come to instinctively believe that people in power withhold facts and, even when under oath, don’t tell the whole truth and nothing but the truth.

      I am not sure how to overcome this except to be willing to address skeptics, like Angry Nurse below, more directly.

      Although I am inclined to agree with the points in this post about how Ebola is easily destroyed with simple techniques (given my very rudimentary knowledge of viruses), it does not take too much of a stretch for me to envision as well that there are story elements missing. Where is the other shoe, who does it belong to, and when will it drop?

  11. As always, thanks for posting Dr. Frieden.

    Given the number of health care workers who have been infected in the field and the disturbingly high mortality rates, I think a lot of people are a bit nervous and wondering about the specifics are in the new cases.

    Can you go into detail at all about what we know about how these infections were acquired? Presumably, the physicians involved were well aware of the appropriate infection control procedures to follow and were being as careful as possible under the circumstances.. Is CDC interviewing the patients involved to deconstruct what wrong?

    • Thanks for working with CDC to share this important information, John. I’ve asked our Emergency Operation Center to respond to your question.

      We may never know for sure how these healthcare workers are becoming infected, but they are working under tremendously difficult, and exhausting, circumstances. There is also the potential to be exposed in medical clinics outside the Ebola treatment units or even in the community. It could be a tiny misstep that could open the door to infection.

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