Thread: Six Reasons to Panic Over Ebola

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Six Reasons to Panic

Jonathan V. Last
Weekly Standard

October 27, 2014, Vol. 20, No. 07

Ebola has the potential to reshuffle American attitudes to immigration. If you agree to seal the borders to mitigate the risks from Ebola, you’re implicitly rejecting the “open borders” mindset and admitting that there are cases in which government has a duty to protect citizens from outsiders.

Some people on the left admit to seeing this as the thin end of the wedge. Writing in the New Yorker, Michael Specter lamented, “Several politicians, like Governor Bobby Jindal, of Louisiana, have turned the epidemic into fodder for their campaign to halt immigration.” And that sort of thing just can’t be allowed.

As a rule, one should not panic at whatever crisis has momentarily fixed the attention of cable news producers. But the Ebola outbreak in West Africa, which has migrated to both Europe and America, may be the exception that proves the rule. There are at least six reasons that a controlled, informed panic might be in order.

(1) Start with what we know, and don’t know, about the virus. Officials from the Centers for Disease Control (CDC) and other government agencies claim that contracting Ebola is relatively difficult because the virus is only transmittable by direct contact with bodily fluids from an infected person who has become symptomatic.

Which means that, in theory, you can’t get Ebola by riding in the elevator with someone who is carrying the virus, because Ebola is not airborne.

This sounds reassuring. Except that it might not be true. There are four strains of the Ebola virus that have caused outbreaks in human populations. According to the New England Journal of Medicine, the current outbreak (known as Guinean EBOV, because it originated in Meliandou, Guinea, in late November 2013) is a separate clade “in a sister relationship with other known EBOV strains.” Meaning that this Ebola is related to, but genetically distinct from, previous known strains, and thus may have distinct mechanisms of transmission.

Not everyone is convinced that this Ebola isn’t airborne. Last month, the University of Minnesota’s Center for Infectious Disease Research and Policy published an article arguing that the current Ebola has “unclear modes of transmission” and that “there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.”

And even if this Ebola isn’t airborne right now, it might become so in the future. Viruses mutate and evolve in the wild, and the population of infected Ebola carriers is now bigger than it has been at any point in history—meaning that the pool for potential mutations is larger than it has ever been. As Dr. Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Army’s Medical Research and Development
Command, explained to the Los Angeles Times last week,

I see the reasons to dampen down public fears. But scientifically, we’re in the middle of the first experiment of multiple, serial passages of Ebola virus in man. .  .  . God knows what this virus is going to look like. I don’t.

In August, Science magazine published a survey conducted by 58 medical professionals working in African epidemiology. They traced the origin and spread of the virus with remarkable precision—for instance, they discovered that it crossed the border from Guinea into Sierra Leone at the funeral of a “traditional healer” who had treated Ebola victims. In just the first six months of tracking the virus, the team identified more than 100 mutated forms of it.

Yet what’s really scary is how robust the already-established transmission mechanisms are. Have you ever wondered why Ebola protocols call for washing down infected surfaces with chlorine? Because the virus can survive for up to three weeks on a dry surface.

How robust is transmission? Look at the health care workers who have contracted it. When Nina Pham, the Dallas nurse who was part of the team caring for Liberian national Thomas Duncan, contracted Ebola, the CDC quickly blamed her for “breaching protocol.” But to the extent that we have effective protocols for shielding people from Ebola, they’re so complex that even trained professionals, who are keenly aware that their lives are on the line, can make mistakes.

By the by, that Science article written by 58 medical professionals tracing the emergence of Ebola—5 of them died from Ebola before it was published.

(2) General infection rates are terrifying, too. In epidemiology, you measure the “R0,” or “reproduction number” of a virus; that is, how many new infections each infected person causes. When R0 is greater than 1, the virus is spreading through a population. When it’s below 1, the contamination is receding. In September the World Health Organization’s Ebola Response Team estimated the R0 to be at 1.71 in Guinea and 2.02 in Sierra Leone. Since then, it seems to have risen so that the average in West Africa is about 2.0. In September the WHO estimated that by October 20, there would be 3,000 total cases in Guinea, Liberia, and Sierra Leone.

As of October 7, the count was 8,376.

In other words, rather than catching up with Ebola, we’re falling further behind. And we’re likely to continue falling behind, because physical and human resources do not scale virally. In order to stop the spread of Ebola, the reproduction number needs to be more than halved from its current rate. Yet reducing the reproduction number only gets harder as the total number of cases increases, because each case requires resources—facilities, beds, doctors, nurses, decontamination, and secure burials—which are already lagging well behind need. The latest WHO projections suggest that by December 1 we are likely to see 10,000 new cases in West Africa per week, at which point the virus could begin spreading geographically within the continent as it nears the border with Ivory Coast.

Thus far, officials have insisted that it will be different in America. On September 30, CDC director Thomas Frieden confirmed the first case of Ebola in the United States, the aforementioned Thomas Duncan. Frieden then declared, “We will stop Ebola in its tracks in the U.S. .  .  . The bottom line here is that I have no doubt that we will control this importation, or this case of Ebola, so that it does not spread widely in this country.”

The word “widely” is key. Because despite the fact that Duncan was a lone man under scrupulous, first-world care, with the eyes of the entire nation on him, his R0 was 2, just like that of your average Liberian Ebola victim. One carrier; two infections. He passed the virus to nurse Pham and to another hospital worker, Amber Joy Vinson, who flew from Cleveland to Dallas with a low-grade fever before being diagnosed.

(3) Do you really want to be scared? What’s to stop a jihadist from going to Liberia, getting himself infected, and then flying to New York and riding the subway until he keels over? This is just the biological warfare version of a suicide bomb. Can you imagine the consequences if someone with Ebola vomited in a New York City subway car? A flight from Roberts International in Monrovia to JFK in New York is less than $2,000, meaning that the planning and infrastructure needed for such an attack is relatively trivial. This scenario may be highly unlikely. But so were the September 11 attacks and the Richard Reid attempted shoe bombing, both of which resulted in the creation of a permanent security apparatus around airports. We take drastic precautions all the time, if the potential losses are serious enough, so long as officials are paying attention to the threat.

(4) Let’s put aside the Ebola-as-weapon scenario—some things are too depressing to contemplate at length—and look at the range of scenarios for what we have in front of us, from best-case to worst-case. The epidemiological protocols for containing Ebola rest on four pillars: contact tracing, case isolation, safe burial, and effective public information. On October 14, the New York Times reported that in Liberia, with “only” 4,000 cases, “Schools have shut down, elections have been postponed, mining and logging companies have withdrawn, farmers have abandoned their fields.” Which means that the baseline for “best-case” is already awful.

In September, the CDC ran a series of models on the spread of the virus and came up with a best-case scenario in which, by January 2015, Liberia alone would have a cumulative 11,000 to 27,000 cases. That’s in a world where all of the aid and personnel gets where it needs to be, the resident population behaves rationally, and everything breaks their way. The worst-case scenario envisioned by the model is anywhere from 537,000 to 1,367,000 cases by January. Just in Liberia. With the fever still raging out of control.

By which point, all might well be lost. Anthony Banbury is coordinating the response from the United Nations, which, whatever its many shortcomings, is probably the ideal organization to take the lead on Ebola. Banbury’s view is chilling: “The WHO advises within 60 days we must ensure 70 percent of infected people are in a care facility and 70 percent of burials are done without causing further infection. .  .  . We either stop Ebola now or we face an entirely unprecedented situation for which we do not have a plan [emphasis added]”.

What’s terrifying about the worst-case scenario isn’t just the scale of human devastation and misery. It’s that the various state actors and the official health establishment have already been overwhelmed with infections in only the four-digit range. And if the four pillars—contact tracing, case isolation, safe burial, and effective public information—fail, no one seems to have even a theoretical plan for what to do.

(5) And by the way, things could get worse. All of those worst-case projections assume that the virus stays contained in a relatively small area of West Africa, which, with a million people infected, would be highly unlikely. What happens if and when the virus starts leaking out to other parts of the world?

Marine Corps General John F. Kelly talked about Ebola at the National Defense University two weeks ago and mused about what would happen if Ebola reached Haiti or Central America, which have relatively easy access to America. “If it breaks out, it’s literally ‘Katie bar the door,’ and there will be mass migration into the United States,” Kelly said. “They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment.”

It isn’t crazy to see how a health crisis could beget all sorts of other crises, from humanitarian, to economic, to political, to existential. If you think about Ebola and mutation and aerosolization and R0 for too long, you start to get visions of Mad Max cruising the postapocalyptic landscape with Katniss Everdeen at his side.

(6) While we’re on the subject of political crisis, it’s worth noting that the politics of Ebola are uncertain and dangerous to everyone involved. Thus far, there’s been only one serious political clash over Ebola, and that’s concerning the banning of flights to and from the infected countries in West Africa. The Obama administration refuses to countenance such a move, with the CDC’s Frieden flatly calling it “wrong”:

A travel ban is not the right answer. It’s simply not feasible to build a wall—virtual or real—around a community, city, or country. A travel ban would essentially quarantine the more than 22 million people that make up the combined populations of Liberia, Sierra Leone, and Guinea.

When a wildfire breaks out we don’t fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.

We don’t want to isolate parts of the world, or people who aren’t sick, because that’s going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak. .  .  .

Importantly, isolating countries won’t keep Ebola contained and away from American shores.

Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries, and that we will have more patients who develop Ebola in the U.S.

Not terribly convincing, is it? Wildfires, in fact, are often fought by using controlled burns and trench digging to establish perimeters. And it’s a straw-man argument to say that a flight ban wouldn’t keep Ebola fully contained. No one says it would. But by definition, it would help slow the spread of the virus. If there had been a travel ban in place, Thomas Duncan would have likely reached the same sad fate—but without infecting two Americans and setting the virus loose in North America. And it’s difficult to follow the logic by which banning travel from infected countries would create more infections in the United States, as Frieden insists. This is not a paradox; it’s magical thinking.

Frieden’s entire argument is so strange—and so at odds with what other epidemiologists prescribe—that it can only be explained by one of two causes: catastrophic incompetence or a prior ideological commitment. The latter, in this case, might well be the larger issue of immigration.

Ebola has the potential to reshuffle American attitudes to immigration. If you agree to seal the borders to mitigate the risks from Ebola, you’re implicitly rejecting the “open borders” mindset and admitting that there are cases in which government has a duty to protect citizens from outsiders. Some people on the left admit to seeing this as the thin end of the wedge. Writing in the New Yorker, Michael Specter lamented, “Several politicians, like Governor Bobby Jindal, of Louisiana, have turned the epidemic into fodder for their campaign to halt immigration.” And that sort of thing just can’t be allowed.

What would happen in the event of an Ebola outbreak in Latin America? Then America would have to worry about masses of uninfected immigrants surging across the border—not to mention carriers of the virus. And if we had decided it was okay to cut off flights from West Africa, would we decide it was okay to try to seal the Southern border too? You can see how the entire immigration project might start to come apart.

So for now, the Obama administration will insist on keeping travel open between infected countries and the West and hope that they, and we, get lucky.

At a deeper level, the Ebola outbreak is a crisis not for Obama and his administration, but for elite institutions.

Because once more they have been exposed as either corrupt, incompetent, or both. On September 16, as he was trying to downplay the threat posed by Ebola, President Obama insisted that “the chances of an Ebola outbreak here in the United States are extremely low.” Less then two weeks later, there was an Ebola outbreak in the United States.

The CDC’s Frieden—who is an Obama appointee—has been almost comically oafish. On September 30, -Frieden declared, “We’re stopping it in its tracks in this country.” On October 13, he said, “We’re concerned, and unfortunately would not be surprised if we did see additional cases.” The next day he admitted that the CDC hadn’t taken the first infection seriously enough: “I wish we had put a team like this on the ground the day the patient, the first patient, was diagnosed,” he said. “That might have prevented this infection. But we will do that from today onward with any case, anywhere in the U.S. .  .  . We could have sent a more robust hospital infection-control team and been more hands-on with the hospital from Day One.”

The day after that Frieden was asked during a press conference if you could contract Ebola by sitting next to someone on a bus—a question prompted by a statement from President Obama the week before, when he declared that you can’t get Ebola “through casual contact, like sitting next to someone on a bus.”

Frieden answered: “I think there are two different parts of that equation. The first is, if you’re a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone? And the answer is no. Second, if you are sick and you may have Ebola, should you get on a bus?

And the answer to that is also no. You might become ill, you might have a problem that exposes someone around you.”

Go ahead and read that again.

We have arrived at a moment with our elite institutions where it is impossible to distinguish incompetence from willful misdirection. This can only compound an already dangerous situation.

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How the microscopic Ebola virus kills thousands

Patients infected with Ebola are most contagious when their bodies are close to collapse and the “viral load” in their organs is at its peak. Time is a crucial factor in the occurrence of new cases of the disease



The fear of Ebola has spread faster in America than the virus itself. Ebola has infected the American psyche, forcing us to do risk analysis of a pathogen we know little about. This is different from the flu scares of recent years, because this virus is novel here, and we have no cultural memory of what we are supposed to do, or think, or believe, when Ebola is on the loose.

People have to wonder: How contagious is this virus — really? Is there something different and more pernicious about this particular strain of Ebola?

The experts can’t answer such questions with certainty. Ebola has been known to science only since 1976. As an exotic disease that until this year affected only Africans in rural villages, Ebola hasn’t been studied as closely as, say, influenza or HIV.

The virus has its quirks: Some people infected with Ebola never get sick at all. Some who become sick shed massive amounts of virus — they’re “super-shedders” — but others do not. Fever is typically the first symptom of Ebola virus disease, but sometimes it’s a lagging indicator or never appears at all.

The virus is mutating, like all viruses, and could conceivably — this is a very remote possibility — change its mode of transmission, a fact that has been much hyped in recent weeks by those with an alarmist frame of mind.

Yet for all these uncertainties, the Ebola emergency in the United States has in a key respect played out exactly as epidemiologists would have expected: The people who have gotten infected, both of them at a Dallas hospital, had close contact with an extremely sick person.

Sunday marks 21 days since Thomas Eric Duncan, who contracted Ebola in Liberia and then flew to the United States, was admitted to Texas Health Presbyterian Hospital Dallas. Officials have been monitoring 48 people potentially exposed to Duncan prior to his hospitalization, his fiancee among them. The incubation period of Ebola, from infection to symptoms, is generally considered to be between two and 21 days. So far, none of these people has shown signs of Ebola disease.

This could change with the next news flash, but so far the virus hasn’t spread wildly in the United States.

“There’s a reason it’s not everywhere. It’s just not as easy to transmit as people think,” said Michael Kinzer, a medical epidemiologist for the Centers for Disease Control and Prevention who spent five weeks in Guinea this summer fighting the outbreak and will return Monday.

Such encouraging words are unlikely to settle the jangled nerves of Americans who fear the virus will spread like dandelion seeds in the wind. Americans have an unsettled relationship with the expert class, admiring the achievements of scientists without fully trusting that they’re immune to fundamental mistakes.

It happened already in this season of Ebola: The CDC assured the public that American hospitals could handle an Ebola patient without permitting secondary infections, and then in Dallas one case became three. Skepticism, for many people, is a form of personal protection.

But Ebola fears have incited overreaction. On Friday, hazmat teams raced to the Pentagon when a woman mistakenly thought to have traveled recently to West Africa threw up in a parking lot; 22 people were quarantined for hours on a shuttle bus because the woman had briefly been on board.

The same day, the Carnival Magic cruise ship was turned away by Mexican authorities at the port at Cozumel because a passenger had potentially handled sealed blood samples from Duncan at the Dallas hospital. Meanwhile, The Washington Post’s Pulitzer Prize-winning photographer Michel du Cille was disinvited to speak at Syracuse University because du Cille had covered the story in Liberia three weeks ago and, as the journalism school’s dean wrote in explaining the decision, “We did not want to create a panic.”


A school district in Northeast Ohio closed a middle school and an elementary school because an employee had flown on the same Frontier Airlines plane on which Ebola-stricken health-care worker Amber Vinson had flown. They weren’t even on the same flight.

That’s an example of Ebola hysteria, said Mark Rupp, an infectious disease doctor at Nebraska Medical Center, where two Ebola patients have been treated.

“You would have to assume that the nurse is contagious at an early stage, which is very limited, then you have to assume there was a contaminated environment on the plane, and that the contamination results in transmission, which is pretty unlikely. Then you have to assume that a person who was not even on the same flight but who flew on the same plane then came into contact with contaminated material and became infected, and then assume that immediately transfers to a child, which is impossible,” Rupp said. “It’s unlikely unlikely unlikely unlikely, and then impossible impossible.”

The two health-care workers who contracted Ebola, Vinson and nurse Nina Pham, had direct contact with Duncan when he was suffering extreme symptoms, including vomiting and diarrhea. They were among the workers who treated him at a precarious time when he had been admitted to the intensive care unit but had not yet tested positive for Ebola. Duncan died Oct. 8.

The CDC and Texas officials have warned that there may be other health-care workers who test positive in the days ahead. There are also hundreds of people being monitored because they flew on the Frontier Airlines plane. So far, secondary infections at a distance from the hospital haven’t materialized, not even among the people who stayed with Duncan in a small apartment after he was feverish.

It’s conceivable there are instances here of “asymptomatic infection.” Researchers say a person can become infected with Ebola, never develop symptoms, never become contagious, and fully recover, becoming virus-free — without knowing any of that had happened.

“Asymptomatic cases are likely to have a little bit of virus for a little bit of time, then fight it off,” said Steve Bellan, a post-doctoral researcher at the University of Texas at Austin.

There have emerged in recent weeks two overlapping scientific narratives about this Ebola outbreak. They might be labeled the microbiology narrative vs. the epidemiology narrative. Call it the small picture vs. the big picture.

The microbiologists study the virus up close, scrutinizing its structure, genetic sequence and behavior as it invades a cell, hijacks cellular machinery, replicates and then spreads through the body. A drop of bodily fluid can potentially contain a million virus particles.

In theory, a single virus particle — a virion — is capable of being infectious and, after replicating billions of times, killing the host. That makes Ebola unusually infectious and virulent.

But that’s not the same thing as contagious. Ebola in humans is spread only through direct contact with virus-laden bodily fluids, and is not as transmissible as such airborne viruses as influenza and measles.

Some scientists have said that perhaps this strain of the virus generates an unusually high “viral load,” with more virus present in any drop of fluid. That would make it more contagious simply as a function of mathematics. So far there is no published data supporting that.

Peter Jahrling, who has studied Ebola for the National Institute of Allergy and Infectious Diseases, said tests on patients in Africa have turned up “a lot of virus,” but he said that could be an artifact of a new type of testing.

Thomas Geisbert, who studies Ebola at the University of Texas Medical Branch at Galveston, said he and other scientists have samples of this Ebola strain in their laboratories. He said it’s difficult to tell if a new strain of the virus is replicating faster than earlier strains, because you’d need very precise data from patients at comparable stages in the course of the disease. The viral load isn’t static. It increases as the disease progresses.

That’s why a person who is infected but without symptoms will not spread the virus initially: There’s very little virus present in the blood, and it is not yet present in other bodily fluids. It can be many days, for example, before it invades the bladder and begins to be detectable in urine, Geisbert said.

“Statistical probabilities come into play,” Geisbert said. “In most cases, people are symptomatic before there are any large quantities of virus in things like urine or feces.”

The question of precisely when a person begins to shed the virus, and in what quantity, is extremely important given that Vinson, the infected Dallas health-care worker, traveled twice on a plane, Oct. 10 and Oct. 13, the second time when she was already symptomatic with a temperature of 99.5 degrees.

“We don’t have it worked out to what exact viral load correlates to the onset of symptoms,” said Daniel Bausch, a researcher at Tulane University. “Think of a bell curve starting from the moment of infection [zero virus], then increasing virus replication to the top of the curve, maybe around 20 days later, when there is a high level of virus and the person is severely ill. Maybe around eight to 10 days after the beginning [i.e. the usual incubation period], a person starts to become symptomatic.”

The virus itself evolves over time, as all viruses do. Whether that evolution will be significant in this outbreak is unknown. Genetic changes could potentially affect the accuracy of diagnostic tests or the effectiveness of vaccines.

What would be even more alarming, scientists say, is if Ebola somehow mutated to become an airborne virus.

“What the hell are we going to do if we suddenly see the potential for transmission that might be respiratory in nature. Do we have a plan?” Michael Osterholm, an outspoken University of Minnesota epidemiologist, said last week at a conference on Ebola at Johns Hopkins University.

Most scientists have said it is extraordinarily unlikely that Ebola will change its mode of transmission. Scientists are wary of absolutes as a rule, but in the annals of medical science, such a major change in transmission has never been observed in a pathogen that already affects human beings.

“If a virus were to acquire the ability to go airborne, it would change the landscape dramatically,” Jahrling said. But he said the likelihood of that is “remote squared.”

Moreover, the Ebola virus does not have an affinity for the cells deep in the lungs.

The scale of this outbreak is like nothing seen before, and that could have implications at the microbiological level, said Peter Piot, director of the London School of Hygiene & Tropical Medicine, and one of the main researchers who discovered the Ebola virus in 1976. He said that all the previous outbreaks combined killed about 1,500 people. This one has killed more than 4,500 people in West Africa, and the virus has many more opportunities to evolve as it passes through the human population, Piot said.

“As it adapts to the human species, it could kill in a slower way, which is paradoxically a bad thing,” Piot said. “If it kills only 30 percent of patients, there is more time for people to be sick and to infect others.”

He suspects the depth and breadth of the current epidemic are attributable not to changes in the virus but rather the lack of a timely international response and the way societies have become more urban and interconnected in recent decades. “A perfect storm,” he said.

This summer Kinzer, the CDC epidemiologist, told members of the Guinea media, “Ebola’s not transmitted by the air. Fear and ignorance are transmitted by the air.”

The big picture is that Ebola is rampant in West Africa because these are very poor countries in which people often lack access to public health care. Ebola victims suffer in unhygienic conditions, and their caregivers struggle to keep themselves clean, Kinzer said. Burial traditions include close contact with the bodies. Under such conditions, a pathogen is not under pressure to evolve in a way that enables a new mode of transmission.

Someday there could be a widely distributed vaccine for Ebola, but for now the best hope for Ebola patients is staying hydrated and nourished.

“Ebola is a disease that is basically leaky pipes,” Kinzer said. “Your vessels are leaking, you’re losing water, electrolytes, protein, nutrients. You’re losing the things you need to fight off the viral infection. You feel terrible. You don’t feel like taking care of yourself. If you can counteract that, you can vastly increase your chances of survival.”



The World Health Organization on Friday sent out its latest update on the West Africa outbreak, officially listing the United States as having three cases (Duncan, Pham and Vinson) and one death (Duncan). Liberia, Sierra Leone and Guinea have had 9,191 cases and 4,546 deaths.

Lenny Bernstein, Abby Phillip and Lena H. Sun contributed to this report.

http://www.washingtonpost.com/nation...773_story.html


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Published on Oct 15, 2014
President Barack Obama vowed Wednesday that his administration would respond in a "much more aggressive way" to cases of Ebola in the United State . (Oct. 15)

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Specific Laws and Regulations Governing the Control of Communicable Diseases

The Secretary of the Department of Health and Human Services has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases in the United States. Under its delegated authority, the Division of Global Migration and Quarantine works to fulfill this responsibility through a variety of activities, including

• the operation of Quarantine Stations at ports of entry
• establishment of standards for medical examination of persons destined for the United States, and
• administration of interstate and foreign quarantine regulations, which govern the international and interstate movement of persons, animals, and cargo.

The legal foundation for these activities is found in Titles 8 and 42 of the U.S. Code and relevant supporting regulations.
Legal Authorities for Isolation and Quarantine

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution. Read more on the Legal Authorities for Isolation and Quarantine page.
United States Federal Laws and Regulations for Control of Communicable Diseases

United States Code

The United States Code is a consolidation and codification by subject matter of the general and permanent laws of the United States. Sections 264-272 of the following portion of the code apply: Title 42 - The Public Health and Welfare, Chapter 6A - Public Health Service, Subchapter II - General Powers and Duties, Part G - Quarantine and Inspection. Links are provided by the Government Printing Office.

• 42 USC Part G - Quarantine and Inspection; Introductory page
  
  • PDF version[PDF - 6 pages]
  
  
• Sec. 264. Regulations to control communicable diseases
  
  • PDF version[PDF - 3 pages]
  
  
• Sec. 265. Suspension of entries and imports from designated places to prevent spread of communicable diseases
  
  • PDF version[PDF - 1 page]
  
  
• Sec. 266. Special quarantine powers in time of war
  
  • PDF version[PDF - 1 page]
  
  
• Sec. 267. Quarantine stations, grounds, and anchorages
  
  • PDF version[PDF - 2 pages]
  
  
• Sec. 268. Quarantine duties of consular and other officers
  
  • PDF version[PDF - 2 pages]
  
  
• Sec. 269. Bills of health
  
  • PDF version[PDF - 1 page]
  
  
• Sec. 270. Quarantine regulations governing civil air navigation and civil aircraft
  
  • PDF version[PDF - 2 pages]
  
  
• Sec. 271. Penalties for violation of quarantine laws
  
  • PDF version[PDF - 1 pages]
  
  
• Sec. 272. Administration of oaths by quarantine officers
  
  • PDF version[PDF - 1 page]
  
  

Code of Federal Regulations

The Code of Federal Regulations (CFR) is the official and complete text of the general and permanent rules published in the Federal Register. These regulations are established by the executive departments and agencies of the Federal Government. The CFR is divided into various titles that represent broad subject areas of Federal regulation. CDC's regulations fall under Title 42: Public Health, Chapter 1 - Public Health Service, Department of Health and Human Services.
Links are from the Office of the Federal Register, National Archives and Records Administration on the United States Government Printing Office web site. Specifically, Parts 70 and 71 of the following portion of the CFR apply:

• 42 CFR, Part 70: Interstate Quarantine
  
  • PDF version[PDF - 3 pages]
  
  
• 42 CFR, Part 71: Foreign Quarantine
  
  • PDF version[PDF - 12 pages]
  
  

Recent Updates

Issuance and Enforcement Guidance for Dog Confinement Agreements expanded

On July 10, 2014, the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) posted guidance on the issuance and enforcement of dog confinement agreements. This guidance describes the factors that HHS/CDC will consider in deciding whether to issue a dog confinement agreement or deny entry of a dog being imported into the United States that has not been adequately vaccinated against rabies. Dog confinement agreements are covered under 42 CFR 71.51. This guidance becomes effective on August 11, 2014 (30 days after publication).
More


Final Rule on Regulations for the Importation of Nonhuman Primates collapsed

Regulations to Establish a User Fee for Filovirus Testing of Nonhuman Primates collapsed

Regulations to Establish a User Fee for Filovirus Testing of Nonhuman Primates collapsed



Executive Orders

Executive Orders specify the list of diseases for which federal quarantine is authorized, which is required by the Public Health Service Act. On recommendation of the HHS Secretary, the President may amend this list whenever necessary to add new communicable diseases, including emerging diseases that are a threat to public health.

Amendment to Executive Order 13295: Quarantinable Communicable Diseases
Federal Register Archives, signed April 4, 2003, amended by 13375 on April 1, 2005 and and by 13674 on July 31, 2014.


Related Links

• Additional Public Health Law Resources
  
  • Center for Law and the Public's Health
  • The Model State Emergency Health Powers Act
    A draft for discussion, prepared by The Center for Law and the Public's Health, 2001[PDF - 39 pages]
  
  
• For animal importation and quarantine regulations, please see the Laws and Regulations page on the Animal Importation site

http://www.cdc.gov/quarantine/specif...gulations.html

Military preps team for Ebola response in US

By Ben Brumfield and Eliott C. McLaughlin, CNN
updated 3:08 PM EDT, Sun October 19, 2014

VIDEO

(CNN) -- The U.S. military is forming a 30-person "quick strike team" equipped to provide direct treatment to Ebola patients inside the United States, a Defense Department official told CNN's Barbara Starr on Sunday.

A Pentagon spokesman later confirmed portions of the official's information.

The team will be under orders to deploy within 72 hours at any time over the next month, the official said.

The Department of Health and Human Services requested the military team, and the Pentagon has given verbal approval, the official said.

The team will include five doctors, 20 nurses and five trainers, Pentagon press secretary Rear Adm. John Kirby said in a statement.

The Pentagon has been working to determine what assistance it could offer the civilian health care sector following a White House meeting last week during which President Barack Obama said he wanted a more aggressive response, according to two Defense officials.

"In response to a request by the Department of Health and Human Services -- and as an added prudent measure to ensure our nation is ready to respond quickly, effectively, and safely in the event of additional Ebola cases in the United States -- (Defense Secretary Chuck Hagel) today ordered his Northern Command Commander, Gen. Chuck Jacoby, to prepare and train a 30-person expeditionary medical support team that could, if required, provide short-notice assistance to civilian medical professionals in the United States," Kirby said.

Jacoby is already working with the military to source and to form the joint team, Kirby said, and once formed, it will head to Fort Sam Houston in Texas for up to seven days of training in infection control and personal protective equipment. The training, provided by the U.S. Army Medical Research Institute of Infectious Diseases, will begin "within the next week or so," Kirby said.

The team will remain in "prepare-to-deploy" status for 30 days, he said. It will be able to respond anywhere in the U.S. if "deemed prudent by our public health professionals," he said.

Cruise passenger cleared

Sunday's news out of the Pentagon came as acruise ship plowed through the waters of a Texas port with precious cargo on board -- the end of a small Ebola scare. A passenger had been loosely linked to the only patient to die from the disease in the United States, but health authorities cleared her after an odyssey at sea.

After voluntarily isolating herself in her cabin, she remained symptom-free, and her lab tests looked good, the Galveston County Health Authority said. She and a travel partner were allowed to disembark.
The drama goes back to the woman's work as a lab supervisor at Texas Health Presbyterian Hospital in Dallas, the center of a maelstrom of Ebola fears in the United States.

It's where Liberian patient Thomas Eric Duncan was misdiagnosed and later died, and where two nurses became the first people to contract Ebola in America.

Seventy-five health workers and 48 people in the community are under monitoring after coming into contact with Duncan. The monitoring period for the 48 community members ends at midnight Sunday night, said Dallas County Judge Clay Jenkins, who is overseeing response efforts in Dallas.

"Thankfully they are all asymptomatic and it looks like none of them will get Ebola," Jenkins said, expressing hope that they would be welcomed home with no issues. "The community needs to reach out and envelop them in compassion and acceptance because we cannot have the community stigmatizing people. ... They have been through a terrible ordeal."

As for the other 75 people, they are in Day 11 of 21 since Duncan's death and Jenkins said, "Today is a crucial day for them because is one of the last high-likelihood days that we will see more cases."

Hospital apologizes

On Sunday, the hospital took out a full-page newspaper ad, once again offering an apology.

We slipped up; we're deeply sorry; we'll do better.

That could serve as a summary of the open letter from Texas Health Resources CEO Barclay Berdan in the Sunday editions of the Dallas Morning News and Fort Worth Star-Telegram.

The turmoil started in September, when Duncan went to the hospital with Ebola symptoms, and health care workers initially sent him home with antibiotics.

They recorded his travel history to West Africa, where a raging Ebola outbreak has killed more than 4,500 people. But they didn't give that detail the necessary attention, the hospital said.

"As an institution, we made mistakes in handling this very difficult challenge," Berdan wrote. The hospital is analyzing the errors and will make changes, he said.

Hopefully others will also learn from those mistakes and the first cases of Ebola contagion in the country, and its first death, will also be its last, Berdan wrote.

White House eyes Dallas

At the White House late Saturday, President Barack Obama and Vice President Joe Biden pursued the same goal, together with a roster of top security and health leaders -- including Secretary of Defense Chuck Hagel, Secretary of Homeland Security Jeh Johnson, national security adviser Susan Rice and director of the Centers for Disease Control and Prevention Thomas Frieden.
They zeroed in on Dallas and the process of tracing anyone who may have come into contact with any of the infected people, a White House statement said.
And after Duncan's misdiagnosis, the administration said it intends to "ensure that Dallas has all of the appropriate and necessary resources to diagnose any additional cases safely and effectively."

WHO to review Ebola response amid criticism

Employeetravel scares
The cruise ship incident and a second travel scare came about in a bureaucratic loophole.

In an abundance of caution to avoid any possible spread of the Ebola virus, about 50 people associated with Texas Health Presbyterian have signed a document legally restricting where they can go until they are cleared of Ebola.

But before the voluntary travel ban existed, the lab supervisor and a nurse, who later came down with Ebola, went on trips and triggered hefty responses.

The cruise ship carrying the lab supervisor headed to the Central American country of Belize.

She had had no direct contact with Duncan but may have handled one of his lab specimens. A doctor on board the ship observed her to make sure she was symptom-free as the incubation period within which the disease would manifest itself approached its end.

She appeared to be home free.

But in an abundance of caution, the State Department planned to fly the lab supervisor back to the United States from Belize City's airport. Then the country's government declined to let her onto land and, in the same week, imposed strict travel bans on anyone who has had contact with Ebola-affected areas.

Chopper fetches blood samples

The ship hauled the lab worker back toward Texas and on Saturday, a day before its set arrival time, the U.S. Coast Guard sent down a chopper to collect blood samples for lab testing. It lowered a hoist basket to pick them up.

"The samples, which are in a container, so the USCG members are not exposed, were taken by Carnival's onboard doctor," said Petty Officer Andy Kendrick, U.S. Coast Guard spokesman.
The other travel scare was set off by one of the nurses who contracted Ebola after treating Duncan. Before her illness was apparent, Amber Vinson took a Frontier Airlines flight to Cleveland, then a flight back to Dallas.

After her contagion became known, the air carrier reached out to some 800 passengers, advising them to contact the CDC.
Frontier Airlines also took the plane out of service temporarily.

In Ohio, 29 people who came into contact with Vinson between October 10 and 13 are being monitored. The nurse has been transferred to Emory University Hospital's isolation unit in Atlanta for treatment.
Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told CNN on Sunday that he didn't know much about Vinson's condition, but he said Nina Pham, the other Dallas nurse who contracted the illness, was in fair condition and doing "fine."

Also, as questions persist regarding the matter of Ebola in domestic animals, Dallas Animal Services announced that Pham's dog, Bentley, will transition to a special kennel for waste monitoring and testing. The dog is being monitored 21 days, as humans are.

Tears shed for Duncan

On Saturday, loved ones honored Duncan's memory in North Carolina, where his mother lives.

In a memorial service at Rowan International Church in Salisbury, his nephew Josephus Weeks and others eulogized Duncan as a kind, compassionate man.

Weeks said he wished Duncan would be remembered for his acts of kindness "as opposed to the person who brought this disease to America, because he didn't know he was sick."
Duncan's willingness to help others may have led to his death at age 42.

Former neighbors in Monrovia, Liberia, have said he may have contracted Ebola while rushing to the aid of a woman who collapsed under duress from the disease. She was pregnant, and Duncan did not know she was sick, they said.

There is good news

There are hopeful signs that some of the Ebola contagion scare in the United States could be winding down. Of the four patients currently being treated, at least two appear to be making a recovery.

And the monitoring of 48 people who came into contact with Duncan should draw to a close soon.

Duncan was admitted to Texas Health Presbyterian on September 28, when he went there the second time. That was the last day the monitored people could have had contact with him.
The maximum incubation period for Ebola is 21 days. That period runs out on Monday.

Contrast that with West Africa, where the disease continues to spread exponentially, as the international response remains anemic.

With predictions that Ebola could infect an additional 5,000 to 10,000 people there per week by December, and given the mobility of world travel, the whirlwind of angst surrounding Duncan's case might not be the last.

http://www.cnn.com/2014/10/19/health...ola/index.html

White House Ebola Czar Was ‘Key Player’ In Solyndra Scandal

10/17/2014
ALEX GRISWOLD
Media Reporter The Daily Caller

Ron Klain, the newly appointed White House Ebola response coordinator, was one of the senior White House officials who advised that President Obama should visit solar power company Solyndra in 2011, despite an auditor raising red flags about the company’s finances

.(RELATED: Obama Appoints Anti-Ebola Czar, Then Hits Campaign Trail)

According to The Washington Post, Klain was one of the “key players” in the scandal while he worked for Vice President Joe Biden: “Ron Klain, then Biden’s chief of staff, dismissed auditor’s concerns about Solyndra’s solvency, reasoning that all innovative companies come with risk.”

Another Solyndra email, reported by Fox News, indicated that Biden’s office were all fans of Solyndra, and that the staff “about had an orgasm” at the prospect of an Energy Department loan.

Klain, a Democratic operative who also served as chief of staff to Vice President Al Gore, had a hand in pushing for President Obama’s visit to a Solyndra factory in California during the 2010 midterms. ”Sounds like there are some risk factors here — but that’s true of any innovative company that POTUS would visit,” Klain wrote in an email the day before. “It looks like it is OK to me, but if you feel otherwise, let me know.”

In another email to Obama adviser Valerie Jarrett, he again stood up for Solyndra. “The reality is that if POTUS visited 10 such places over the next 10 months, probably a few will be belly-up by election day 2012.”

According to CNN’s Jake Tapper, Klain will report to National Security Advisor Susan Rice and homeland security adviser Lisa Monaco.

http://dailycaller.com/2014/10/17/wh...yndra-scandal/

Solyndra Emails Claim Biden Team 'About Had an Orgasm' About Energy Loans to Firm



By Chad Pergram
Published November 09, 2011
FoxNews.com

NOW PLAYING VIDEO AT LINKSolyndra E-mails: Biden Staff Big Fans

A series of emails provided to the House Energy and Commerce Committee from individuals tied to Solyndra offer striking characterizations about running strategy with the White House to secure assistance for the now-bankrupt solar energy firm.

Emails among George Kaiser, head of the George Kaiser Family Foundation; Ken Levit, the executive director of the Foundation; and Steve Mitchell, who manages Argonaut Private Equity and was a member of Solyndra's board; show that Vice President Joe Biden's office were very gung-ho.

"They about had an orgasm in Biden's office when we mentioned Solyndra," reads a Feb. 27, 2010, email from Levit to Mitchell. A follow-up email from Mitchell to Levit later that day responds with: "That's awesome! Get us a (Department of Energy) loan."

According to exchanges obtained by Fox News, in an email from Mitchell to Kaiser on March 5, 2010, Mitchell writes that "it appears things are headed in the right direction and (Energy Secretary Steven) Chu is apparently staying involved in Solyndra's application and continues to talk up the company as a success story."

In a Feb. 27, 2010, message from Levit to a party whose name has been redacted, Levit writes that there was a meeting with a group of people in "Biden's office -- they seemed to love our Brady Project -- also all big fans of Solyndra."

In an email from Mitchell to Kaiser on March 5, 2010, Mitchell writes that "it appears things are headed in the right direction and Chu is apparently staying involved in Solyndra's application and continues to talk up the company as a success story."

White House spokesman Eric Schultz said the document dump from the House Energy and Commerce Committee offers only "cherry-picked" emails.

"Even the documents cherry-picked by House Republicans today affirm what we have said all along: this loan was a decision made on the merits at the Department of Energy. Nothing in the 85,000 pages of documents produced thus far by the administration or in these four indicate any favoritism to political supporters. We wish that House Republicans were as zealous about creating jobs as they were about this oversight investigation," he said.

Solyndra received a half billion dollars in loans from the Department of Energy even as questions were raised over whether the California-based firm would stay afloat. The company filed for bankruptcy in September just weeks after the administration weighed a bailout.

One email from Kaiser to Mitchell and Levit on Oct. 6, 2010, reads: "We can possibly reinforce the effort so long as it is in the form of 'I thought you should know, in case it comes up' rather than 'can you help with this.'"

In another communique dated Oct. 6, 2010, Kaiser tells Mitchell and Levit that he is "concerned that DOE/Chu would resent the intervention and your problem could get more difficult. I would see an appeal as only as last resort an, even then, questionable. We need to discuss."

In an email between Mitchell and Kaiser, Mitchell notes that the White House has "started a policy discussion as to whether a company should be able to get a second loan."

House Republicans received the emails after subpoenaing the White House last week. Lawmakers say they want to know how much influence the White House put on the Energy Department to approve the loans. The administration denies anyone tried to influence the decision.

Writing to White House Counsel Kathryn Ruemmler regarding the panel's recent subpoenas, Energy and Commerce Committee Chairman Fred Upton, R-Mich., and Oversight and Investigations Subcommittee Rep. Cliff Stearns, R-Fla., suggested seeming inconsistencies in White House responses.

"The White House has repeatedly stated that no political influence was brought to bear with regard to Solyndra, and that Mr. George Kaiser, a Solyndra investor and Obama fundraiser, never discussed Solyndra during any of his 17 visits to the White House. Documents recently obtained by the committee directly contradict those statements," they wrote.

A well-placed source told Fox News that Kaiser was interviewed by investigators for the House Energy and Commerce Committee on Tuesday. GKFF spokeswoman Renzi Stone on Wednesday told Fox News that Kaiser never was directly involved in the deal.

"To reaffirm our previous public statements, George Kaiser had no discussions with the government regarding the loan to Solyndra," she said in a statement.

http://www.foxnews.com/politics/2011...loans-to-firm/