A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Oct. 14, 2014 - USG criticism high. Bill O'Reilly calling for resignation of Tom Frieden. I meet by phone with the New York Times Editorial Board. Also, I do NBC Nightly News, Fox News with Greta Van Susteren and MSNBC with Rachel Maddow. After I got off the air, Rachel tells her audience how proud she was of herself to have gotten me on her show since I was such an icon in medicine and public health.
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Oct. 14 -21, 2014 - From October 14 through October 21, the situation was so intense that I do not have time to document historical notes on a day by day basis. I am only doing this retrospectively now and will give dates as I recall. However over this period of time in light of the crisis of confidence against CDC and Tom Frieden related to a number of issues culminated by the fact that was allowed to fly back from Cleveland to Dallas, this was clear that Tom Frieden was in significant trouble over several days Sec. Burwell would call me usually in the late evening and nighttime asking for my advice about what we should do the CDC. At one point, I believe on October 14 or 15, she called me at night as I was in my car driving home. I parked the car in front of my house and continued to speak with her. Approximately 9 o'clock at night. She asked me what I thought about the possibility of removing Frieden from the job and wanted my advice about who could be a leading global health figure who could take Tom's place. I discussed forcibly with her that I believe that Tom was an outstanding public health official and a man of great integrity. However, I told her that I have to frankly tell her that Tom's staff is not serving him well. For example many of the people from CDC who of gone to Dallas to oversee the situation in the care of are people who know Ebola from behind the desk but left even never taking care of the patient or have done so many years ago. I told her to give Tom a chance and that I would try to speak to Tom about relying less on advice from his staff and more on his own judgment. Again during this time I have had multiple conversations, on a daily basis usually late at night with Tom Frieden. I will refer to these specifically below. In general, I was trying to convince him that it is possible that the CDC protocols as they exist on their website are not adequate for the tertiary care setting that we have in large hospitals such as Texas Presbyterian and elsewhere in the United States. Tom keeps on insisting that the CDC protocols have worked for decades in the field in Africa and that his staff tells him that the reason why the Dallas nurses got infected was likely be cost they had some breach in the protocol. I literally begged him over the phone that he should not say this and that we should re-examine the CDC protocols. This will all become clear after we admit to NIH Special Clinical Studies Unit (SCSU) at the NIH Clinical Center on Oct. 16, 2014 (see below).
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Oct. 15, 2014 - Media frenzy continues. I do CNN New Day, Morning Joe early in the AM. Talk of shipping patients out of Texas Presbyterian Health Hospital since they have had 2 infections of their nurses and they expect possibly more infections due to exposure of other hospital staff. Since got infected, others who were doing the same things that they were doing might also wind up infected and they wanted to clear out and transfer them. Today it is made public that CDC told Vinson she could fly back to Dallas from Cleveland. Very bad press for CDC and Tom.
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Oct. 16, 2014 - A truly transforming and important day here at NIH. First I testified before the House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations chaired by Mr. Timothy Murphy (R-PA). Tom Frieden testified with me as did Luciana Borio of FDA, Robin Robinson of BARDA, and someone from Customs and Border Protection. Tom got hammered somewhat by the committee and was not strong and firm in his answers. He continues unfortunately to give a poor public appearance suggesting that he is not in control of the situation. He has shown the same slow deliberative response in the media which is costing him dearly since it is making him out to be less than he really is, which in my opinion is quite good. However, the most important event of the day was the fact that at 11:54 PM today, Thursday, October 16, 2014, Dallas nurse and now patient was transferred by air evacuation from Dallas to the NIH Clinical Center to be taking care of by us in the Special Clinical Studies Unit (SCSU). I had stopped off at Accura automobile showroom on Wisconsin Avenue where Diane Baker, Francis Collins's wife, was hosting a Friends of Patients at the NIH gala. I stayed there with Christine for an hour or so and then went back to the Clinical Center to await the arrival of i. I gathered with the SCSU staff at the ambulance entrance to the Clinical Center. Anthony Suffredini had accompanied [ij in the ambulance which drove from Frederick airport when the plane landed to the Clinical Center in Bethesda. Anthony was dressed in full personal protective equipment (PPE). When J Arrived Cliff Lane, Rick Davey, head of the SCSU, John Gallin, and I awaited her together with Tara Palmore who was dressed in full PPE gear. By the time we got settled upstairs in the SCSU it was in the middle of the night. I remember walking through the atrium at the Clinical Center to get on the elevator to go up to the SCSU, I had this extraordinary déja vu feeling of walking the halls late at night as an intern, resident, and chief resident at the New York HospitalCornell Medical Center where I often stayed up throughout the night taking care of patients. It was in fact an extraordinarily positive feeling that I had. I was doing something that I have always loved to do and continue to love to do - talking care of a sick patient in the middle of the night when there were only essential people around. Quiet, but intense.
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2014-10-17 00:00
Anthony S. Fauci
Oct. 17, 2014 (Friday) -- We (John Gallin, Cliff Lane, and I hold an incredibly well attended Town Hall meeting in Masur auditorium explaining to the NIH staff what we had done in admitting land why we felt that this was an important duty of ours. The crowd overflowed to Lipsett Auditorium and other rooms and still more people watched. on the webcast. Most people were supportive, but some objected such as Wyndom Wilson (NCI) who was concerned about our staff getting infected and then infecting others in the hospital. Typical Wyndom. Importantly, I did a press conference in front of the Clinical Center with dozens of TV cameras and reporters explaining why we admitted I a what the SCSU was all about. Intensive media interest. Staring from the night of| admission through Oct. 31, due to a number of crises and briefing that I needed to do and prepare for, I averaged about 3 to at the most 4 hours of sleep per night. I usually awoke at 3:00 AM to 4:00 AM having gone to sleep at midnight or later. The adrenaline surge must have awakened me, but that is what I did for several nights. Interesting situation arose. While cliff Lane was walking down a hall in the Clinical Center he ran into . They told Cliff that they were concermed since after the first night tha care of] in Dallas, she called her mother and sister and tried not to worry them, but did mention to them that she was unsure if they were properly protected with the PPE protocol that they were on. When ven! o Das i and tried to explain to a CDC person(s) who were there and they got the impression that the Texas Presbyterian Hospital people did not really want them to speak with the CDC. Cliff told me this and confirmed this in a conversation with Diana and Cathy as did John Gallin in a separate conversation.
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Oct. 18, 2014 --I talk to Nina through speaker phone. She is pleasant and I do not want to tire her since she is rather weak and worn out. Still have some diarrhea and has LFT abnormalities likely due to the experimental meds she received in Dallas. Besides a plasma transfusion from Kent Brantly she received ZMapp, Tekmira drug (siRNA), and Brincidofovir. Both brincidofvir and Tekmira could give LFT abnormalities. I appear on Good Morming America (weekend edition)
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Oct. 19, 2014 (Sunday)- I appear on all 5 Sunday morning TV shows > NBC Meet the Press with Chuck Todd; CBS Face the Nation with Bob Shieffer; ABC This Week interviewed by Martha Raddatz; CNN State of the Union with Candy Crowley; and FOX Sunday with Chris Wallace. Having one person on all 5 Sunday AM Shows is called a "Full Ginsburg" named after Mr. Ginsburg, the lawyer for Monica Lowinski during the Bill Clinton Sex scandal. Very few people have done a "Full Ginsburg". I would set the new record next Sunday (see below). I was accompanied in a limo jumping from studio to studio with Andrea Purse, Director of Media Broadcast for White House Communications. She was great in getting me to studios in time. She did not at all hint at what I should be saying. The White House is now putting me out on all the major TV shows since Tom has been giving "weak" performances on TV and at Hearings. And so now the White House wants me out there. That evening, I went to the SCSU and questioned Nina about her taking care of As it turned out, when| came in she wore a regular gown, boots, face mask and shield, double gloves. I asked her whether there was any open skin and she said that her neck was exposed front and back and that all of her hair was exposed. She did his for 2 sessions with and she did not shower out the first time, but did the second time. Also, when PCR came back positive, she switched to PPEs with no skin exposed. However, that was on the 3 day of her taking care of| In other words, she worked with open skin even though it was highly suspect that had Ebola. Bad news for the administration of Texas Presbyterian. I would subsequently go back and re-question her tomorrow (Monday) evening. Of Note, Amber Vinson the other infected nurse did the night shift after Nina on the first day of "open skin" and actually relived Nina who did the day shift
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Oct. 20, 2014 (Monday) -- Am on a panel with WTOP in the Newseum together with Jesse Goodman and Joh Sharfstein, Commissioner of Health of State of Maryland. Sylvia Burwell calls me up and I explain to her that Nina was working for 2 days with open skin showing before converting to more strict PPEs. Sylvia burst into tears on the phone. She asks me to help her figure out what the hell is going on here as she is totally losing faith in CDC. That evening I question Nina more and she tells me that during those first days of working with with the less stringent PPE (open skin), that on a couple of occasions a CDC person (a woman) came by and looked at what they were doing and what they were wearing and said: "You are good-to-go; you are doing everything ria, correctly; you are not at risk of infection.". I was horrified to hear this. Now comes the revelation. Cliff Lane and I stop off at Chris Grady's office on 1st floor of the Clinical Center, now late at night and I tell Chris the story about the CDC person. While Cliff and I are talking, Chris pulls up the CDC website and to my amazement she reads what its guidelines are for PPE. It is exactly what said she was wearing including the fact that it resulted in open skin. And so the CDC recommendations are much less stringent than the MSF and the NIH PPEs. In other words, the CDC guideliens are in fact inadequate and was following them when she likely got infected. I got goosebumps. I was incorrectly assuming that the CDC guidelines were like the NIH strict PPEs. In fact they are not. That night I e-mail Tom Frieden to call me and I explain the situation and he says that his people tell him that if you follow the guidelines even with that PPE protocol, the experience in Africa says that you are protected unless you break protocol. He then says that we really cannot tell exactly how and when got infected. We could not distinguish between the first 2 days and the days after they went to more stringent protocols. I went ballistic over the phone. I begged him to please not listen to his staff. I told him frankly as a friend and as someone who care about him that his staff "had no fucking idea of what they were talking about since none of them who are advising him have ever taken care of a patient, or if they have it was 10 years ago". I pleaderd with him not to say that the nurses must have had a breach of protocol and to realize that the CDC protocol was entirely inadequate for a tertiary hospital intensive care setting which is where got infected. I told him that common sense tells you that open skin is much more dangerous than full PPE and that it is essential to change the CDC recommended PPE to insist on no open skin. He agreed somewhat reluctantly and said he would have to check with his staff. I told him that I love him, but I really do not give a shit what his staff says, he must change the protocol. In fact, within the next couple of days with help from me and Cliff and others, the CDC did change the protocol.
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Oct. 21, 2014 - Jey Johnson, Secertary of DHS, announces that all flights from Liberia, Sierra leone and Guinea must now enter the USA at one of the 5 designated airports (O'Hare, Newark, IAD, JFK and Atlanta) that are now having entry screening. CDC issues the new PPE guidelines emphasizing the 3 principles that I have insisted upon during my many discussions with CDC (Frieden): 1) Training and drilling in procedure of donning/doffing; 2) no exposed skin anywhere; 3) trained monitors for donning and especially a WATSAN for doffing. Did Weill Cornell Grand Rounds by video to an SRO audience. Also, the White House now wants me to instruct physicians around the country on Ebola via White House run teleconferences. Now I am a press coach. Did one today and now they want me to do one tomorrow or next day. On the call were Rich Carmona, Zeke Emanuel, among others. It actually worked out quite well and was well-received. Interesting how history repeats itself. First, the White House gets the standard people out such as CDC, HHS on health emergencies and the PR is horrible. Example is my friend Tommy Thompson with the Anthrax attacks of 2001 (he said it could come from drinking water from a stream - bad briefing from CDC). Another example was Jeff Coplan, then Diretor of CDC who arrogantly refused to brief Tommy Thompson or even answer his calls. Recall that Stewart Simonson, who subsequently became my very close friend convinced Tommy to fire Coplan and then I was the PR face of the USG to "calm the nation" together with Julie Gerberding who replaced Coplan as CDC Director. Now, after all of the misteps and the poor performance of Tom Frieden in the press and at Hearings, the White House is falling all over themselves to get me on TV and elsewhere educating the public and validating what the administration is doing. Hence, my "Full Ginsburg" on all of the Sunday TV Shows last weekend (October 8) Getting many, many e-mails from colleagues around the country telling me how proud they are of me and what an amazing job I am doing in the press with calming the country and bringing scientific rigor to the situation in my explanations. I get into Contact PPEs and visit in her room with Cliff and Rick Davey. She was in good spirits. She is so sweet I told her that she looked good and she came back with "You look great, yourself, Dr. Fauci." She was obviously glad to see me. I believe it is the happiness of knowing that she is getting better. If note, her Ebola PCR is now completely undetectable, and importantly, her Ebola specific IgM is >1600. It had previously been <400, which is actually undetectable. The IgM means that she is in immunological protection area. Also, her LFTs are coming down. We feel the hepatotoxicity is due to the Brincidofovir. We move her out of isolation room tomorrow and hopefully, home on Friday. Her labs are contained below: 1st Tx nurse Nena Rar SPB # Collection Date Specimen Ebola qRT-PCR Ebola IgM Ebola IgG 201403293 {11-Oct-14 blood CT =32 < 100 < 100 201403294 |12-Oct-14 blood CT =30 < 100 < 100 201403305 {13-Oct-14 blood CT = 36 < 100 = 400 201403318 {14-Oct-14 blood CT =36 < 100 2 400 201403325 {15-Oct-14 blood Undet/CT=38 > 400 > 6400 201403333 {16-Oct-14 blood Undet/CT=39 21600 > 1600 201403355 = |20-Oct-14 blood undet pending pending plasma XT ow o/iz 2. tsp * \ dete ou 10/\4 K) ma, thorn Subject: SPL 14.066 samples from 21 October 2014 (UNCLASSIFIED) Date: Tuesday, October 21, 2014 at 5:52:15 PM Eastern Daylight Time