Saturday, October 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.