A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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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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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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2014-10-19 00:00
Anthony S. Fauci
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
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Oct. 23, 2014 - Today was another hectic day regarding the possibility of implementing a randomized controlled trial for a Ebola vaccine. As mentioned several times above there is a nefarious attempt on the part of Jeremy Farrar of the Wellcome Trust to derail plans for an RCT of vaccine in Liberia. Cliff Lane has known him for a long time from when he was in Vietnam with the Pasteur Institute. Jeremy feels that we should do open access for distribution of vaccines particularly to healthcare workers without doing a controlled trial. Jeremy has been a self-promoter and in my mind a hypocritical advocate for fairness in global health. He completely does not get the fact that if we widely distribute a vaccine to a black African country we run the risk of never knowing if it works and possibly having a paradoxical harmful effect similar to what we saw in the STEP trial of an HIV vaccine where the trial looked good in phase 1 following good animal data and when we went into a double-blind, placebo-controlled trial, we found out that the people who received the vaccine had a 41% greater chance of getting infected with HIV. If the same happened with Ebola this would be a catastrophe. Yet the WHO, mostly in the form of Marie-Paule Kieny, are acting in an extraordinarily unscientific way, even going so far as to say that a randomized controlled trial is unethical. In fact, we feel that a wide distribution of an unproven and potentially harmful vaccine would in fact be unethical. In addition, they want to give it to the healthcare workers on open access and then possibly do a randomized controlled trial on the rest of the people at risk such as family members. I cannot imagine how they do not realize that this in and of itself is unethical and violates ethical equipoise. There is a big struggle going on with the USA led by Cliff Lane the FDA, and Glaxo Smith Kline to be able to do a randomized controlled trial to as quickly as possible determine efficacy so that we can ultimately distribute the vaccine to the people who need it. WHO, who was been wrong on almost everything they have done with this epidemic, is arguing that we really should distribute the vaccine according to how they want to do it. We already have designed a phase 2/3 trial and it is ready to go. We have buy-in from the Ministry of Health of Liberia. Glaxo Smith Kline is on board. Yet WHO wants to be deeply involved in deciding how we do it vaccine trial. There is a meeting in Geneva today which is going to discuss this. I am intensively briefing Sylvia Burwell who will be speaking with the UK minister of policy. His name is....... How this turns out remains to be seen. More later. The day gets even more interesting. There was supposed to have been a meeting at Sylvia Burwell's office with Ron Klain, myself, Tom Frieden, and the HHS team. It was supposed to be aimed at briefing Ron about our activities. However, the President called an emergency meeting in the Roosevelt Room in the White House with OSTP to brief him regarding their mandate of applying rigorous science and technology to the Ebola response effort. Sylvia was supposed to represent HHS at the meeting. However, because she was committed to meeting with Ron, she asked me to represent her at the meeting. Her concern and the concern of all of us is that OSTP, particularly John Holdren, who has very little appreciation of biology in the health sciences, might get in the way and complicate what we at HHS and others are doing in the Ebola response. Eric Lander is a member of PCAST group at OSTP and although Eric is a great friend, he sometimes gets overambitious about what he thinks can and cannot be done. My job was to go to the White House and make sure that OSTP does not get out of their lane and into our lane. It was an extraordinary visit at the White House that took place at 1:45 PM in the Roosevelt Room. As soon as I walked in Denis McDonough, Chief of Staff to the POTUS, greeted me at the West Wing lobby and told me how excited the White House was about what an extraordinary job I was doing with the press by putting a calm, reassuring, and intelligent face on the response to the Ebola epidemic. The same thing holds true when I entered the Roosevelt Room Lisa Monaco, Homeland Security Advisor, as well as Cecelia Munoz, domestic policy advisor were extraordinarily laudatory to me about my performance in explaining to the American public the details of the Ebola response. Gathered in the room for the meeting were all the PCAST individuals as well as OSTP. I am including below printouts of PDF on the attendees and the purpose of the meeting. The President referred to me frequently during the meeting, asking questions about what I think should be done regarding the response. Denis McDonough was acutely aware of our concern that PCAST/OSTP might "get in the CDC/NIH/HHS lane" and cause more problems than they solve. He checked with me after the meeting to make sure that I was OK with the discussion that PCAST and OSTP would help with non USG issues like getting pharmaceutical companies to help with vaccine production if it is shown to be effective and to lend some outside science and technology (S & T) to the mix as long as they do not make stupid suggestions about how to do public health and research. The POTUS also asked me on the side if I was "OK with how the meeting went". All in all it was a great meeting. Then a dark cloud came over the day. However, there will be a big lebate now about quarantining any healthcare worker who takes care of an Ebola patient be that in West Africa or, as we are concerned about, even here in the United States. This has implications for our own staff who if quarantined and not allowed to travel would find it very difficult to volunteer for our special clinical studies unit since this would mean they would not be able to travel home for holidays such as the upcoming Thanksgiving holiday. Tn addition to all of this we met again with in preparation for discharge from the hospital tomorrow. There has been talk that the POTUS himself might want to come and say goodbye to. This is still in flux. In addition to all of this, Andrea Purse, media broadcast director for White House COMMS is my new best friend. She hooked me up with two teleconferences to educate physicians throughout the country. All of this taking place well into the night. This has been an amazing frenzy. EVENT MEMO THE WHITE HOUSE Washington
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October 23, 2014 PRESIDENT'S COUNCIL OF ADVISORS ON SCIENCE AND TECHNOLOGY MEETING DATE: October 23, 2014 LOCATION: Roosevelt Room TIME: 1:45-2:45 FROM: John P. Holdren PURPOSE At your request, YOU will be meeting with a special session of your Council of Advisors on Science and Technology (PCAST) to tap the group's expertise and ideas about science, technology, and innovation for addressing the Ebola challenge in both its West African and U.S. domestic components. The possibilities range from approaches for accelerating the development, testing, production, and distribution of effective vaccines, diagnostics, and therapeutics, to uses of systems thinking to improve practices on the ground in ways that reduce numbers of new infections, to applications of information technology for connecting researchers and practitioners and educating the public. PCAST has been preparing intensively for this meeting. Many of the members have convened brainstorming sessions drawing on their own organizations and networks; e-mail circulation of ideas and group conference calls are ongoing; and the PCAST Executive Office in OSTP is compiling the results for use in the group's final prep, starting at 9 am Thursday. (Of course, as well as presenting its own ideas, the group will want to hear YOUR thoughts about how PCAST can be most helpful going forward.) As further background for the meeting, my OSTP colleagues and I have prepared a Briefing Memo for YOU that surveys the landscape of existing Administration activities and plans on science, technology, and innovation for the Ebola challenge. It is appended here. PARTICIPANTS PCAST Members e Co-Chair John Holdren, Assistant to the President for Science and Technology and Director of the White House Office of Science and Technology Policy e Co-Chair Eric Lander, Director of the MIT-Harvard Broad Institute and Professor of Biology at MIT Vice-Chair William Press, Professor of Computer Sciences at the University of Texas at Austin and former Deputy Director of the Los Alamos National Laboratory Rosina Bierbaum, Professor (and former Dean) of Natural Resources and Environment, University of Michigan, and OSTP Associate Director for Environment in the Clinton administration Christine Cassel, President and CEO of the National Quality Forum Christopher Chyba, Professor of Astrophysical Sciences and International Affairs and Director, Program on Science & Global Security, Princeton University 8. James Gates Jr., John 8. Toll Professor of Physics and Director of the Center for String and Particle Theory at the University of Maryland, College Park Mark Gorenberg, Managing Director of Zetta Venture Partners Susan L, Graham, Professor of Electrical Engineering and Computer Science Emerita, University of California, Berkeley J. Michael McQuade, Senior Vice President, Science & Technology, United Technologies Corporation Craig Mundie, Senior Advisor to the CEO, Microsoft Corporation Ed Penhoet, Director, Alta Partners Barbara Schaal, Dean of Arts and Sciences and Professor of Biology at Washington University in St Louis Daniel Schrag, Hooper Professor of Geology and Professor of Environmental Science and Engineering, Harvard University, and Director of the Harvard University Center for Environment (invited in furtherance of your wish to have PCAST's deliberations more closely integrated into the work of EOP Policy Councils) * ££ &£# &# «& Denis McDonough Valerie Jarrett John Podesta Kristie Canegallo Lisa Monaco Cecilia Muiioz OSTP Staff Patricia Falcone Jo Handelsman Tom Kalil Megan Smith May Chu Andrew Hebhbeler Claudia Williams Cristin Dorgelo Marjory 8. Blumenthal Ashley Predith Diana Pankevich Bo Ill. IV. VI. PRESS PLAN Closed press. SEQUENCE OF EVENTS « YOU meet in the Oval Office with PCAST Co-Chairs John Holdren and Eric Lander for a 5-minute bnefing prior to meeting the full group. ® YOU proceed to the Roosevelt Room and take your seat at the meeting table. * YOU make opening remarks (suggested talking points follow below). « John Holdren thanks you and lays out the overall meeting agenda. ® Eric Lander adds introductory comments about the ways PCAST could be helpful in responding to the Ebola crisis. e Other members of PCAST will contribute other ideas in brainstorming fashion.. e YOU provide your reactions to the ideas aired and offer thoughts on potential additional PCAST engagement that would be of interest to you. John Holdren offers brief closing observations. YOU make closing remarks. REMARKS Suggested Opening: I want to thank you all--collectively and individually--for your service on PCAST. Your early work on pandemic flu plus your capacity to approach problems from multiple disciplines and sectors lead me to look to you at this time of need. * [appreciate your willingness to come and talk with me on very short notice about an extremely important national and international concem. Suggested Closing: ® Thank you again for your service, dedication, and most importantly for your insights and ideas. e =I look forward to reflecting on this discussion, and will plan to get back to the group on my thoughts through the Co-Chairs. « I appreciate your input and guidance on so many high-priority Sé&T topics, all important to our economy and society as well as our global leadership on many fronts, ATTACHMENTS * PCAST Member Bios # OSTP memorandum trom John Holdren discharged our