A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Oct. 25, 2014 - An important meeting today Situation Room of White House. We discussed the topic of what the movement and monitoring protocol would be for the United States Government regarding HCWs who are returning from service in the 3 African countries. . The CDC has been changing their guide old journals and in a 27 June two lines trying to keep up with the evolving situation. I heard from the White House and Sylvia Burwell that the White House and Sylvia herself were very keen on my being at the meeting at the White House in order to help develop a coherent policy. This was in gun just a wallpapers response to the fact that , a Doctors Without Borders emergency medicine physician working in Guinea had come back to New York and was self-monitoring for symptoms and fever according the MSF protocol. This is the ongoing protocol if someone at low but nonzero risk for infection returns to their country of origin after serving in West Africa taking care of Ebola patient. However since there were previous infections in the Ebola treatment unit where he worked, the evolving guidelines put him in the category of a high risk person. Nonetheless, he was following the doctors without Borders protocol which means that when you come back to your country of origin after being in a West African country you should monitor yourself with fever and symptoms and if you develop a fever call MSF and then report yourself to state health authorities. As it turned out, felt fatigued the previous day but nonetheless went out for a run. The following day as mentioned above he took several New York City subway rides to Brooklyn where he bowled and then went back and ate at a restaurant in Manhattan. The next day he developed a fever of 103 F. Technically he is a for you you just tell me and I can't go to a and the same thing you stop. Exposed 2 friends at the bowling alley and the Uber driver who drove him back to his apartment in Harlem. . Once he got a fever, proper protocol of hazmat transportation to Bellevue took place as mentioned above. However, because of the concern about risk to New Yorkers and people from New Jersey, Gov. Christie of New Jersey and Gov. Cuomo of New York State surprised and shocked the New York City public health authorities as well as the CDC and the US government (including President Obama) by declaring an absolute quarantine on all healthcare workers coming back to the United States through New York or Newark airports who had any contact with an Ebola patient. They either did not think this out fully or it was a pure political move. This violates all of the principles that indicate that people without symptoms are clearly not of danger or inffectious to others. This is becoming a political issue without a doubt since both Governors Christie and Cuomo are up for reelection and there is an outcry that we are worried too much about people's rights than we are about the safety of the public. However, as I have had to emphasize multiple times in the Press the danger of transmitting from an infected but asymptomatic individual is vanishingly small. However the President asked Lisa Monaco and Chief of Staff Denis McDonough to hold a principals policy committee meeting to sort out what kind of response we should have to this declaration of quarantining by the governors. This was a very important meeting for me to be at since it is very clear that we need to do more than just passive monitoring since there needs to be some clinical judgment and whether or HCWs, as well-meaning as they are, should actually leave their apartment and enter into public transportation such as subway, bus or even airplane. And so the PC meeting was held in the Situation Room at 2:30 PM on a beautiful crisp fall day. At the meeting besides me and Tom Frieden by video from Atlanta, Chief of Staff Denis McDonough, John Podesta, Gayle Smith, Leslie Dach, Sylvia Burwell, Susan Rice, Defense Secretary Chuck Hagel, Ron Klain, USAID administrator Rajiv Shah, Attyorney General Eric Holder, Amb. Samantha Power, DHS Sec. Jeh Johnson, Amb. Powell from the Department of State, Presidential Counsel Eggleston, Valerie Jarrett, Larry Kerr, among others. The discussions centered around modifying the guidelines for monitoring and movement of returning health care providers who have served in West African countries. The CDC continues to be shakey. They in my mind are not definitive or clear enough with their guidelines. However, at the meeting,we at least decided that we would have to scale up from passive monitoring to active monitor and in many cases ultimately to direct monitoring. The definitions of these are as follows: passive monitoring - you take your temperature and evaluate your symptoms and do not tell anyone unless there is a problem; active monitoring - you do the same as passive but you tell someone; direct active monitoring is when you have someone else visit you at least once a day and folow-up with a phone call, take your temperature evaluate your symptoms and make a determination has to the degree of restriction that you might have on a daily basis. In this way, you have a repetitive clinical judgment concering restriction as opposed to a broad sweeping quarantine for evryone. We all decided that we need to point out that healthcare workers are heroes and that if we in fact quarantine them indiscriminately regardless of their stratification of risk that we would clearly disincentivize them for wanting to volunteer as well as stigmatize them, which is already occurring anyway. The White House has decided that I will be the face of the administration in explaining this to the public and have now put me out today (Sunday) on all five major Sunday morning shows. This includes ABC This Week (Martha Raddatz), CBS Face the Nation (Charlie Rose), Fox News with Chris Wallace, CNN State of the Union with Candy Crowley, and Meet the Press ( Chuck Todd). It is interesting and ironic after all of the aggravation I have received from media people that I am now their hero and they want me out there. This includes Jen Palmieri the head of White House communications, Andrea Purse the director of media broadcast of the White House, and this gets translated now down to the HHS level. There is still a lingering distrust by the public in the government largely because of the missteps and lack of firm, definitive, clear, concise and understandable guidelines of the CDC. I feel very badly for Tom Frieden since he is an extraordinarily fine person and an outstanding public health official. However I believe that his staff does not serve him well and the White House and HHS are now giving me the extra burden of having to check their documents which makes it very difficult since I have a lot of work to do and I am getting quite exhausted by all of this.
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Oct. 26, 2014 - Today I did all five of the Sunday morning TV shows. As indicated above this is referred to as the "Full Ginsburg" related to the fact Ginsburg, the lawyer/family friend for Monica Lewinsky at the time that she blew the whistle on President Clinton related to the now famous sex scandal appeared on all 5 Sunday TV shows. I did this last week. Since I had done a "Full Ginsburg" last week several of the producers of the TV shows told me that this is the first time in their memory that any individual has done all five TV shows for two weeks in a row. And so they are now referring to this as a "Full Fauci". The shows went very well; however, it became clear that I was at odds with what Gov. Christie and Gov. Cuomo had done two days ago by initiating a full quarantine for flights into New Jersey and New York. On each of the shows I articulated two fundamental principles: 1) the safety of the American people comes first and is the major goal; 2) all of our policy decisions relating monitoring movement and restrictions should be based on sound scientific principles and scientific evidence. I reiterated that all scientific data show that a person who is without symptoms does not transmit Ebola and that one must come into contact with bodily fluids of a person who is sick with Ebola in order to contract people. Therefore, the principles leading to a broad general quarantine for returning health care workers is deeply flawed. Immediately following the shows, other shows and blogs and tweets pitted me against Christie and Cuomo. In my discussions on the five TV shows, I did not criticize them. I mentioned that I understood why they may feel that this is the best way to go; however, I mentioned that if they had asked my advice I would have told them not to institute a broad sweeping quarantine. I am being praised by people who are standing up for scientific evidence and data and I'm getting hate mail from people who feel I am trying to protect Obama. I am listing below cuts and pastes from a couple of representative e-mails that I have received: ----------------------------------------------------- From: M G <libssuckitraw@yahoo.com> Doctor, As you parrot the bullshit that came out of The Obomination, it makes you sound like a moron. No quarantining these infected boobs because it might hamper them volunteering? Are you fucking serious? Do you KNOW how STUPID that sounded? Yeah, we should just let them walk around, coughing, spewing,. sweating, touching other people until we have a serious Ebola outbreak in the USA! If pray that if Ebola DOES break out in the USA that somehow it only attacks dumbass liberals like you and removes you from your misery. Idiot. No wonder you're a member of Ovomit's Kakistocracy. ------------------------------------------------------------------ From: Unarmed Civilian <wes_t-one1@outlook.com> Where did you get your degree from North Korea? You love Africa and Ebola so much you go there. And don't come back. NO QUARANTINES....its the answer you'd expect from a government agency whose greatest accomplishments are in the areas of corruption and incompetence. Does half of America have to come down with Ebola and be standing there bleeding from there eyes before the EXPERTS know they are wrong. Fuck you and Fuck your Opinions. Go take your expertise somewhere else. LD ----------------------------------------------------------------------- It is really rather disturbing that people feel so strongly about this, with all the undertones of racism and what clearly is Hate for president Obama. During the times between shows, I exchanged e-mails with checking on how she was doing. Below are some of those e-mails: From Sunday, 26 Oct., 2014 at 10:41 AM: I just saw you on Meet the Press! You did so great :) I will definitely keep you posted with everything. Sent from Mailbox On Sun, Oct 26, 2014 at 8:39 AM, Fauci, Anthony (NIH/NIAID) [E] <AFAUCI@niaid.nih.gov> wrote: The aches are to be expected. You have been through a lot. This will gradually resolve, but it might take a little time. Keep me posted and do not hesitate to call or e-mail if you have any questions or if you just want to talk. Sending love back at you. Tony On Oct 26, 2014, at 9:32 AM, > wrote: Dr. Fauci! I miss you and everyone at NIH so much! I'm doing well. Just occasional joint pain and aches which I'm sure is to be expected right? I've just been relaxing at home (well my parent's home) the past few days. My family is doing well and they say hi and they miss you as well! Sending my love Sent from Mailbox<https://www.dropbox.com/mailbox> On Sun, Oct 26, 2014 at 5:56 AM, Fauci, Anthony (NIH/NIAID) [E] <AFAUCI@niaid.nih.gov<mailto: AFAUCI@niaid.nih.gov>> wrote: How are you doing? We miss you. Keep me posted on how you feel. Say hi to Mom and Kathy. Everyone here sends their best wishes. Warm regards, Tony (aka Dr. Fauci) ituation Room with 'he attendees at the n(@nsc.eop. gov 30 p.m. President has been 1 the White House 'm attendance to DL- "you have any ited ntal r of rism 30r Following the five TV shows I was invited to a meeting in the Situation Room with President Obama and senior cabinet officials and other staff. The attendees at the meeting were:
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Oct. 27, 2014 - Furor against Governors' decision on quarantine. I am in the eye of the storm due to my 5 appearances on Sunday TV giving scientific reasons against blanket quarantine. 2 days ag, nurse returned to Newark from West Africa after taking care of Ebola patients. She got caught in the quarantine issue and was put in an old hospital tent in New Jersey and (as she says) was treated like a criminal/prisoner. Officials at airport initially thought that she had fever since they did a skin tem while she was flushed. Turned out she had no fever and ultimately tested negative. Christie looking real bad on this one. She is playing it out by suing and being very vocal that her human rights were violated. Ultimately, she was let go to drive to Maine to see her boyfriend. Cuomo now backing off a bit and leaning towards direct, active monitoring. CDC revising M and M document. Tom and I want the "direct" part of the monitoring to be able to be done by Skype or Face Time. However, Ron Klain thinks that the POTUS and Jeh Johnson want actual physical presence of monitor (health official, nurse, etc.). Trying to reconcile. Had important conversation with Jen Cohn of MSF Switzerland who kindly got on a teleconference reps from MSF of many countries (Brussels, Paris, Geneva) to discuss the RCT Ebola vaccine trial that Cliff is actively planning to start in Monrovia in December following completion of the Phase 1 trial that started in Maryland in Sept. (ChAd3) and Oct (VSV). Looks like MSF wants to be helpful. They are asking good questions about supply for post-trial distribution, etc. They seem to not be against an RCT. CDC came out with new interim guidelines for Monitoring and Movement of people (including HCWs) returning from West African Ebola countries. Now based a lot on what I and Tom have been articulating at the recent White House meetings. First stratification of risks to the person; and then matching the risk to the degree of monitoring and then using clinical judgment when needed to determine level of restriction. All based on knowledge of how virus is spread. Risks: high, some, low but not zero. Monitoring: passive - take your own temperature and sxs and no need to actively tell anyone; active - take your own temp and sxs and report to a health official; direct, active - someone else takes your temp at least 1x per day and evaluates sxs and then makes clinical judgment as to your restriction on a daily basis Immediately following their release of guidance and the press briefing by Tom Frieden, the White House put my out on all the evening TV shows that were either taped or live from studio in Building 10: PBS NewsHour; CNN Situation Room; ABC, CBS, and NBC Evening News.
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Oct. 28, 2014 - The political issues are heating up around Ebola with the elections only 1 week away. Gov. Christie is standing firm in saying that the US government, particularly the CDC, are playing catch-up with Ebola and that his initiation of a quarantine for 21 days for healthcare workers and other travelers returning from West Africa is the way to go. I have been on multiple television programs specifically indicating that I respect the opinion of the governors and that I understand that they are trying in good faith to do the best for their constituents. However, several TV commentators have now pitted me against Gov. Christie, feeding him with somewhat out-of-context quotes from TV interviews indicating that I am directly challenging him as being unscientific. He is lashing back saying that I am just defending the administration. He sometimes mixes me up with CDC. However, he has mentioned me by name several times in discussions on TV interviews. I am very concerned about this politicizing of an important global health problem. I was on Good Morning America with George Stephanopoulos, CNN with Sanjay Gupta, and MSNBC with Morning Joe early this morning. In fact the ABC producer came all the way into the NIH to make sure that the interview with George Stephanopoulos went well. Immediately after I appeared on GMA, Gov. Christie appeared and Matt Lauer was instigating him telling him that scientists like me was saying that he "got it wrong on" thus instigating Christie to lash back at the scientific and public health community including me. This is really a very unfortunate evolution of events since as has always been the case, I stay out of politics and try to just do the right thing for public health. I appeared via Skype on the Diane Rehm Show this AM and made it clear that I was not criticizing Christie. The POTUS made a brief speech in front of Marine 1 as he was about to take off reaffirming what I said on Sunday TV (without invoking my name) that we are driven by science and not by fear and so there is no reason to do a blanket quarantine on all returning HCWs since they are heroes and we do not want to discourage them from volunteering. Ben Bradlee died at age 93 a few days ago and I have been invited to the service at National Cathedral and to the family reception at Ben and Sally Quinn's home in Georgetown. However, with the Ebola AM calls and the fact that I have to be at the WH later for the POTUS greeting and honoring the HCWs (see below), I cannot make the service. Too bad. I really liked Ben. I am completely exhausted now and I have hundreds and hundreds of e-mails to catch up on. It feels like I'll never catch up since the White House, the department, and the media are making extraordinary demands on me. The White House has decided because of my ability to be quick on my feet and articulate a clear and concise message in front of the TV camera that they are putting me out on TV for virtually every issue that comes up regarding Ebola. What a change of pace from just a short while ago when for one reason or another HHS and/or the White House never approved any big TV for me. Now they actually set up shows and have Andrea Purse working closely with me. Such is life. The POTUS came out today and reiterated the reasons (my reasons) for following the science and not having a quarantine for returning HCWs. Typically, HHS shut me down on the many requests for TV appearances for me since they never let anyone out there when the POTUS speaks. Believe it or not, I am glad since I am exhausted. Today and yesterday, there have been a considerable number of false alarms with people from West Africa (just arriving) having fever, vomiting, etc. and getting worked up only to have any of a number of other diseases from malaria to rhinovirus. Still getting much hate mail! Got e-mail from Andrea Purse asking about the safety of returned HCWs from West Africa (USA people) who have been invited to the WH tomorrow to be congratulated by the POTUS (with handshakes). Some came back less than 21 days ago and so they wanted to be sure it was OK. Cannot violate our own principles, but people are somewhat nervous. I looked at list and said it was OK. Then Sylvia Burwell called me up and wanted me to speak with Ronny Jackson to make sure that Ronny asks them if they were in high risk category.
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2014-10-29 00:00
Anthony S. Fauci
Oct. 29, 2014 - Eventful day today with another visit to the White House and once again meeting with the President. The President wanted to show his support for health care workers who have returned from West Africa, those who will be going soon to West Africa, and the NIH nurses and doctors who had taken care of There were several events. At approximately 3 PM the president met in the Green Room with Kent Brantly, myself, and a group of healthcare workers including Dan Chertow from NIH who had returned from Liberia about 1 month ago, people from Hopkins, people from Samaritan's purse, as well as three NIH nurses - Glory Inwang, and Anitra FitzgeraldMonroe, and Kimberly Jeffries. He congratulated everyone, took individual pictures with each of us and then went into the East Room where he was introduced by Brantly and gave a compassionate speech on how healthcare workers were heroes, and how we should treat them with respect and how we should monitor and allow them to move about according to principles consistent with the scientific data. This was obviously a reiteration of what he had said before and what I have been saying continually on national TV. However, it was clearly also a thinly veiled jab at Gov. Christie who has instituted the quarantine of returning health care workers in New Jersey. Following the ceremony I adjourned to the Roosevelt Room with Raj Shah, Sylvia Burwell, Gayle Smith, and Ron Klain, to meet with the cohort of healthcare workers for the purpose of learning from them about their experiences in getting suggestions from them about how to improve our effort in response to the Ebola epidemic in Africa and at home. I had interesting discussions with . He told me that there was no way the he got infected while in the ETUs treating Ebola patients since he was completely covered with PPEs, he is experienced and there were no breaches. He believes that he got infected when he was called to the ER to see a potential Ebola patient (woman). He was dressed in "contact" dress (not full PPE) but he did not touch the patient and called for a nurse to admit the patient since she clearly had Ebola. Accompanying the woman was her adolescent daughter who was crying and very upset that her mother was sick. took the girl outside to comfort her. He took off his gloves so as not to contaminate the girl and put his arm around her shoulder. When he looked at her, it became clear that she was likely also sick. She ultimately ran away and was never documented to have Ebola, but feels that this was the likely incident that go him infected, i.e. touching without gloves an Ebola patient. He did not fully realize this until he later reflected on that incident in the ER. After that I came back to the NIH and I practiced putting on personal protective equipment with Rick Davey. The purpose of the practice was because we are hosting a group of TV doctors tomorrow brought to the NIH by the White House to demonstrate to them our Special Clinical Studies Unit and how we Don and Doff our PPE's. It should be a good day tomorrow.
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Oct. 30, 2014 - Started the day with a 6:40 AM interview on WTOP. Another interesting day today. I was a panelist at the Washington Ideas Forum sponsored by The Atlantic magazine that took place at the Harmon Center for the Performing Arts on F and 6th Street, N.W. I was interviewed on stage by David Brooks, well-known columnist for the New York Times. The panel was broadcast live on C-SPAN as well as streamed online on their website. Of the people involved in this forum were Secretary of State John Kerry, Chris Matthews of NBC, and a large number of other notables. After that I went back to the NIH and hosted a whole group of network producers with full camera TV coverage on the process of donning and doffing for personal protective equipment. I demonstrated to them what we do in the process of taking care of patients with Ebola, in this case specifically Following the demonstration which was done by nurse specialist Kevin Barrett and hospital epidemiologist Tara Palmore, I did a long series of TV interviews with the cameras that were there during my step-by-step demonstration of the donning and doffing. Clips appeared on a variety of news outlets. An extraordinary situation occurred last night in which the state of Louisiana made an announcement that certain scientists and others who were planning to attend the annual meeting of the American Society of Tropical Medicine and Hygiene during the first week of November in New Orleans would not be allowed to attend the meeting. In essence they said that these people need to be quarantined if they came from a West African country or if they had taken care of the patient with Ebola within the last 21 days. This is an extension of the quarantine craziness that was started by Governors Christie and Cuomo. In essence, they are barring scientists from a meeting where their expertise and experience is most needed. Finally, I have been informed that I have been named in the civil action lawsuit against Pres. Obama, me, Thomas Friedman, Secretary Burwell, and DHH Secretary Jeh Johnson for promoting terrorism and discrimination. They are accusing us of colluding with president Obama who is a Muslim citizen of Kenya and trying to destroy African countries by introducing Ebola into society. You just cannot make this stuff up. Received a note today (dated Oct. 16, 2014) from Hilary Rodham Clinton saying that she was thinking of me and cheering me on saying that "The American people are fortunate to have your leadership at NIH as we face the challenge of Ebola".
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Oct. 31, 2014 - Jeff Drazen, Editor of NEJM, contacted me to put him in touch with some of the trusted AIDS activists with whom I have worked over the years to get them to write a piece in the NEJM on the similarities between the stigma of HIV/AIDS and the current "stigma" against HCWs (regarding the quarantine discussed above). I pointed him to Peter Staley and Gregg Gonsalves and they are willing to do this. Kaci Hickox still defying orders from the Governor of Maine to remain in quarantine. A court judge upheld her right to not be quarantined. I did an interview for yahoo.com and refused to get into the battle between Kaci and the State of Maine. HHS does not want me to do TV since the news is focused on Kaci and it would be better for me not to get into that battle.
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Nov. 1, 2014 - Things calming down. Reports of decreased infections in Liberia, particularly Monrovia. Not sure if this is real or if the infections are now occurring in remote areas without good reporting. Also, the issue of second waves in Guinea and Sierra Leone. CDC having to put much effort into investigating Person Under Investigation (PUIs). These are people who are from West Africa who get a fever or nausea or vomiting for any of a number of benign reasons. Since they are from West Africa, these are being investigated, sometimes using PPEs, which is an "abundance of caution", but a major investment (?waste) of effort. Cliff Lane is in Monrovia doing spade work for the hopefully upcoming RCT for the Ebola vaccine. Heard on Secretary's call this AM (8:30 AM on Saturday) that now WHO (likely MariePaule Kieny) wants WHO to be responsible for the DSMBs of all clinical trials in West Africa. This is an egregious attempt on the part of WHO to stay "relevant" in an area in which they have no expertise. It is "stunning" to me how they just want to insert themselves into things where they quite frankly are incompetent. They already have made it clear that they just want to distribute unproven interventions (vaccines and treatments) and even though we seem to be winning the argument, they keep coming back in insidious ways to try to derail the scientific clinical trials process. Amazing!!
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Nov. 2, 2014 - Quiet Sunday. Trying to catch up on piles on my desk. Election on Tuesday. Concern that the GOP will take the Senate, which means Obama is in trouble with both House and Senate in GOP control. Despite reports that the number of cases in Liberia are decreasing rapidly, new reports today indicate that the cases in Sierra Leone are sharply increasing. I have warned that Ebola comes in waves and that we should not be complacent and the WH should refrain from saying that things are "turning around".