Diary Prequel Package — page 388

Oct. 22, 2014 - I together with Dan Chertow (who just returned from Liberia), David Mariner (Bioethics), give Clinical Center Grand Rounds to the largest audience (with overflows and webcast) in the history of NIH. Meet with Fred Hiatt and the Washington Post Editorial Board at their DC headquarters. Meet with| room in SCSU without PPEs and discuss discharge There still is considerable media frenzy regarding perception that the US government is "dropping the ball" with infected HCWs, getting into the country, the diagnosis being missed by the first ER visit. The public, the Congress, and the media are conflating all these issues, which are separate. Two HCWs getting infected is terrible, but that is not a public outbreak. The media, public, etc. have been very sharply criticizing Tom Frieden for saying that "we will stop Ebola in its tracks" and yet with only 1 imported case two of our HCWs in Dallas have gotten infected. The confuse inadequate protection of HCWs (see above) with an "outbreak". Ihave been trying to make this distinction with the press. Conservative members of Congress are pushing very hard for closing the borders and not allowing any travelers from West Africa to enter the United States. There is already exit screening at the point of exit from the African countries of Liberia, Sierra Leone, and Guinea. The push has been to initiate exit screening at the five major airports where people come in from connecting flights to either JFK, Dulles, Newark, Atlanta, Chicago. These five airports receive 94% of all travelers from West Africa. They will be screened upon entry for fever, symptoms, and potential exposure to patients with Ebola. If any of these signals come up, they will be further screened by a CDC quarantine officer. If that officer deems that they need further work up, they will be sent to a facility for further screening and any bola PCR. If they are positive they will be sent to one of the designated hospitals which include the NIH, Emory, or Nebraska. This new exit screening was installed on October...., 2014. Today there was a scaling up and tightening up of the screening. The new regulations indicate that from now on, the only ports of entry to the United States will be the five airports mentioned above in order to eliminate the possibility of "slipping through" of the 6% of travelers who might go to other airports. In addition there will be active monitoring of everyone entering from West Africa, which means that these individuals will have to give e-mail address, contact information, phone numbers and their travel plans. They must actively report each day to a public health official. Failure to do so would result in arrest and prosecution. As we can see things are getting tighter and tighter. In multiple conversations that I have had with Sylvia Burwell and Leslie Dach, it has become clear if there is another slip up such as a person getting through from West Africa with undetected Ebola, this would create a crisis of confidence whereby the Congress would likely pressure even more the president to close the borders completely. As stated several times, we feel that closing the borders would have an ultimate deleterious effect on controlling the epidemic. The reasons we give is that if we close the borders people will find indirect ways to get into the country and it would be more difficult to track them. In addition it would have serious negative economic consequences on the country and would therefore hinder their capability of being able to control their own epidemic which