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Story 1: Obama Asserts Executive Privilege Claim Over Holder’s Wife Emails Pertaining To Fast and Furious — Cover up Of Crimes — Article 1 of Impeachment Bill — What are They Hiding? — Aiding and Abetting Homicides –Videos
President Obama Evokes Executive Privilege for Eric Holder – 2007 v. 2012
Obama announces Eric Holder’s resignation
Is Obama involved in Fast and Furious, obstructing a congressional investigation or both?
Congress Votes to Hold Eric Holder in Contempt Perjury Lied to House Congress Vote Passes
Jon Stewart Slams Obama Executive Privilege, Fast & Furious, and Eric Holder
Remember Brian Terry, the murdered Border Patrol Agent
Judge Napolitano: Executive Privilege Only Applies If Obama Involved
Mark Levin Explains How GOP Should Handle Holder Contempt Charge & Executive Privilege Claim
Issa on Fast and Furious, Holder Contempt, Obama Executive Privilege on Fox News Sunday
Obama Perpetuates The ’90 Percent Of Mexico’s Weapons Come From The U.S.’ Lie — In Mexico!
Eric Holder – We Must “Brainwash” People Against Guns! – (1995)
Holder on 2nd Amendment
Eric Holder Attacking The Second Amendment To Help Mexico?
“Operation Fast & Furious: The Other Side of the Border” Part 1
“Operation Fast & Furious: The Other Side of the Border” Part 2
“Operation Fast & Furious: The Other Side of the Border” Part 3
Fast and Furious: Management Failures at the Department of Justice – Part 1
Eric Holder Choking on his Testimony
Michael Savage offers concise summary of “Fast and Furious”, describes his own love of guns
Congress: Eric Holder Should Be In Jail!
Obama Asserts Fast and Furious Executive Privilege Claim for Holder’s Wife
OCTOBER 23, 2014
Judicial Watch announced today that it received from the Obama Department of Justice (DOJ) a “Vaughn index” detailing records about the Operation Fast and Furious scandal. The index was forced out of the Obama administration thanks to JW’s June 2012 Freedom of Information Act (FOIA) request and subsequent September 2012 FOIA lawsuit (Judicial Watch v. Department of Justice (No. 1:12-cv-01510)). A federal court had ordered the production over the objections of the Obama Justice Department.
The document details the Attorney General Holder’s personal involvement in managing the Justice Department’s strategy on media and Congressional investigations into the Fast and Furious scandal. Notably, the document discloses that emails between Attorney General Holder and his wife Sharon Malone – as well as his mother – are being withheld under an extraordinary claim of executive privilege as well as a dubious claim of deliberative process privilege under the Freedom of Information Act. The “First Lady of the Justice Department” is a physician and not a government employee.
This is the first time that the Obama administration has provided a detailed listing of all records being withheld from Congress and the American people about the deadly Fast and Furious gun running scandal. The 1307-page “draft” Vaughn index was emailed to Judicial Watch at 8:34 p.m. last night, a few hours before a federal court-ordered deadline. In its cover letter, the Department of Justice asserts that all of the responsive records described in the index are “subject to the assertion of executive privilege.”
The Vaughn index explains 15,662 documents. Typically, a Vaughn index must: (1) identify each record withheld; (2) state the statutory exemption claimed; and (3) explain how disclosure would damage the interests protected by the claimed exemption. The Vaughn index arguably fails to provide all of this required information but does provide plenty of interesting information for a public kept in the dark for years about the Fast and Furious scandal.
Based on a preliminary review of the massive document, Judicial Watch can disclose that the Vaughn index reveals:
Numerous emails that detail Attorney General Holder’s direct involvement in crafting talking points, the timing of public disclosures, and handling Congressional inquiries in the Fast and Furious matter.
President Obama has asserted executive privilege over nearly 20 email communications between Holder and his spouse Sharon Malone. The administration also claims that the records are also subject to withholding under the “deliberative process” exemption. This exemption ordinarily exempts from public disclosure records that could chill internal government deliberations.
Numerous entries detail DOJ’s communications (including those of Eric Holder) concerning the White House about Fast and Furious.
The scandal required the attention of virtually every top official of the DOJ and the Bureau of Alcohol, Tobacco and Firearms (ATF). Communications to and from the United States Ambassador to Mexico about the Fast and Furious matter are also described.
Many of the records are already publicly available such as letters from Congress, press clips, and typical agency communications. Ordinarily, these records would, in whole or part, be subject to disclosure under the Freedom of Information Act. Few of the records seem to even implicate presidential decision-making and advice that might be subject to President Obama’s broad and unprecedented executive privilege claim.
Judicial Watch President Tom Fitton criticized President Obama and his disgraced Attorney General in a statement today:
This document provides key information about the cover-up of Fast and Furious by Attorney General Eric Holder and other high-level officials of the Obama administration. Obama’s executive privilege claims over these records are a fraud and an abuse of his office. There is no precedent for President Obama’s Nixonian assertion of executive privilege over these ordinary government agency records. Americans will be astonished that Obama asserted executive privilege over Eric Holder’s emails to his wife about Fast and Furious.
Once again, Judicial Watch has proven itself more effective than Congress and the establishment media in providing basic oversight of this out-of-control Administration. This Fast and Furious document provides dozens of leads for further congressional, media, and even criminal investigations.
On June 28, 2012, Attorney General Eric Holder was held in contempt by the House of Representatives over his refusal to turn over records explaining why the Obama administration may have lied to Congress and refused for months to disclose the truth about the gun running operation. It marked the first time in U.S. history that a sitting Attorney General was held in contempt of Congress.
A week before the contempt finding, to protect Holder from criminal prosecution and stave off the contempt vote, President Obama asserted executive privilege over the Fast and Furious records the House Oversight Committee had subpoenaed eight months earlier. Judicial Watch filed its FOIA request two days later. Holder’s Justice Department wouldn’t budge (or follow the law), so JW filed a FOIA lawsuit on September 12, 2012.
But then the Justice Department convinced U.S. District Court Judge John D. Bates to stay our lawsuit, in part to allow ongoing settlement discussions between the Holder’s government lawyers and the House Committee to continue. Unsurprisingly, the “negotiations” between politicians running the House and the Justice Department went nowhere.
Fed up with the interminable delay caused Holder’s gamesmanship and stonewalling, JW renewed its request to the Court to allow our transparency lawsuit to continue. Thankfully, this past July, Judge John D. Bates ended the 16-month delay and ordered the Obama administration to produce a Vaughn index of the alleged “executive privilege” records by October 1. Judge Bates noted that no court has ever “expressly recognized” President Obama’s unprecedented executive privilege claims in the Fast and Furious matter.
Unhappy with having to produce the records prior to the elections, Justice lawyers asked the judge to give them one extra month, until November 3 (the day before Election Day!) to produce the info. Judge Bates rejected this gambit, suggested that the Holder’s agency did not take court order seriously. Rather than a month, Judge Bates gave Justice until yesterday to cough up the Vaughn index. Judge Bates issued his smack down on September 23.
Attorney General Eric Holder announced his resignation two days later.
Many share our opinion it was “no coincidence” that Holder’s resignation came “on the heels of another court ruling that the Justice Department must finally cough up information about how Holder’s Justice Department lied to Congress and the American people about the Operation Fast and Furious scandal, for which Eric Holder was held in contempt by the House of Representatives.”
The House had been separately litigating to obtain the records but had gotten nowhere until after Judge Bates ruled that the DOJ finally had to disclose information to Judicial Watch.
On September 9, U.S. District Court Judge Amy Berman Jackson, citing Judicial Watch’s success, ordered the Justice Department to produce information to Congress by November 3.
Fast and Furious was a DOJ/Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) “gun running” operation in which the Obama administration reportedly allowed guns to go to Mexican drug cartels hoping they would end up at crime scenes, advancing gun-control policies. Fast and Furious weapons have been implicated in the murder of Border Patrol Agent Brian Terry and hundreds of other innocents in Mexico. Guns from the Fast and Furious scandal are expected to be used in criminal activity on both sides of the U.S.-Mexico border for years to come.
Guns from the Fast and Furious scandal continue to be used in crimes. Just last week, Judicial Watch disclosed that a Fast and Furious gun was used in gang -style assault on a Phoenix apartment building that left two people wounded. We figured this out from information we uncovered through another public records lawsuit against the City of Phoenix.
Congress officially confirmed the AK-47 was used in the assault that terrorized residents in Phoenix. In an October 16 letter sent from Sen. Charles Grassley (R-IA) and Rep. Darryl Issa (R-CA) to Deputy Attorney General James Cole discloses that “we have learned of another crime gun connected to Fast and Furious. The [Justice] Department did not provide any notice to the Congress or the public about this gun….This lack of transparency about the consequences of Fast and Furious undermines public confidence in law enforcement and gives the impression that the Department is seeking to suppress information and limit its exposure to public scrutiny.”
We have many other active lawsuits over the Fast and Furious scandal:
On October 11, 2011, Judicial Watch sued the DOJ and the ATF to obtain all Fast and Furious records submitted to the House Committee on Oversight.
On June 6, 2012, Judicial Watch sued the ATF seeking access to records detailing communications between ATF officials and Kevin O’Reilly, former Obama White House Director of North American Affairs at the U.S. National Security Council.
On September 5, 2013, Judicial Watch sued the DOJ seeking access to all records of communications between DOJ and the Oversight Committee relating to settlement discussions in the Committee’s 2012 contempt of Congress lawsuit against Holder. The contempt citation stemmed from Holder’s refusal to turn over documents to Congress related to the Fast and Furious gunrunning scandal.
On May 28, 2014, Judicial Watch sued the DOJ on behalf of ATF Special Agent John Dodson, who blew the whistle on Operation Fast and Furious and was then subjected to an alleged smear campaign designed to destroy his reputation.
Obama used executive privilege to shield Holder emails
President Obama used executive privilege to withhold the contents of more than 20 emails sent between Attorney General Eric Holder, his wife and his mother that a conservative watchdog group sought in connection with the federal government’s botched “Fast and Furious” gun-running operation.
The document, according to the conservative watchdog group Judicial Watch, “details the Attorney General Holder’s personal involvement in managing the Justice Department’s strategy on media and Congressional investigations into the Fast and Furious scandal.”
Judicial Watch said the White House is withholding the contents of the Holder emails between his wife and mother citing not only the executive privilege, but the “deliberative process” exemption, which is normally used to exclude from public disclosure any information “that could chill internal government deliberations.”
Holder’s wife, Sharon Malone, is a Washington, D.C., gynecologist.
The Republican-led House has been dueling with Holder for years in an effort to get documents and emails related to Fast and Furious.
In 2012, the House voted to find Holder in contempt of Congress for refusing to turn over documents related to the operation and has sued to obtain them. Democrats have accused the GOP of a politically motivated witch hunt against Holder, who recently announced plans to step down.
The Fast and Furious program ran from 2006 to 2011 out of an Arizona division of the Bureau of Alcohol, Tobacco, Firearms and Explosives. It involved U.S. agents selling guns to Mexican drug traffickers in an effort to trace the weapons to the drug cartels. But agents lost track of the weapons and some of them were used to kill people, including U.S. Border Patrol agent Brian Terry.
“Obama’s executive privilege claims over these records are a fraud and an abuse of his office,” Judicial Watch President Tom Fitton said in a statement. “There is no precedent for President Obama’s Nixonian assertion of executive privilege over these ordinary government agency records. Americans will be astonished that Obama asserted executive privilege over Eric Holder’s emails to his wife about Fast and Furious.”
“This list of documents was provided in order to fulfill a procedural step in this case,” Justice Department spokesman Brian Fallon told theExaminer. “We will make a further submission, related to these same materials, on Nov. 3 in connection to the case brought by the House Oversight Committee.”
Editor’s note: Judicial Watch is representing the Washington Examiner in the newspaper’s federal lawsuit seeking access to Consumer Financial Protection Bureau records under FOIA.
Operation Fast and Furious Fast Facts
Here’s some background information about Operation Fast and Furious. From 2009 – 2011, under Operation Fast and Furious, the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) Phoenix Field Division, along with other partners, allowed illegal gun sales believed to be destined for Mexican drug cartels in order to track the sellers and purchasers.
An estimated 1,400 weapons were lost by the ATF in Mexico. Two of the missing weapons linked to the operation turned up at the Arizona murder scene of United States Border Patrol agent Brian Terry.
Whistle-blowing leads to a Congressional investigation by the Senate Judiciary Committee and the House Oversight and Government Reform Committee, and Attorney General Eric Holder is cited for contempt.
Operation Fast and Furious was one of the operations under Project Gunrunner, part of the Department of Justice’s broader Southwest Border Initiative, an “inter-agency effort to combat Mexico-based trafficking groups.” (DOJ)
“Straw purchasers (also called straw buyers) buy firearms on behalf of others without disclosing that fact on the forms required by the Bureau of Alcohol, Tobacco and Firearms.” (DOJ)
The operation lasted approximately 15 months, resulting in grand jury indictments of 34 suspects in drug and firearms trafficking organizations.
Operation Fast and Furious was not the first “gun walking” investigation by ATF; it was preceded by Operation Wide Receiver, which began in 2006.
April 2006 - Official launch of Project Gunrunner.
October 2009 – Operation Fast and Furious begins, based on a review of Project Gunrunner by the ATF Organized Crime Drug Enforcement Task Force (OCDETF).
January 2010 – Bureau of Alcohol, Tobacco, Firearms agents tell the staff of Senator Charles Grassley (R-Iowa), member of the Senate Judiciary Committee, that the ATF allowed straw buyer Jaime Avila to make repeated purchases of guns after his name had been entered into a “suspect person database” on January 13, 2009.
December 14, 2011 - Border patrol agent Brian Terry is killed in the Arizona desert, and two weapons the ATF allowed to be purchased earlier in 2010 by purported “straw buyer” Jaime Avila are found near the shooting scene. It is unknown whether any of the guns were used as the murder weapon.
January 25, 2011 – The Department of Justice announces the end of Operation Fast and Furious, with the indictments of 34 drug and firearm trafficking suspects.
March 3, 2011 – ATF Acting Director Kenneth Melson announces the formation of a panel to “review the bureau’s current firearms trafficking strategies employed by field division managers and special agents.”
April 1, 2011 - Acting Director Melson is issued a subpoena from the House Oversight and Government Reform Committee.
May 3, 2011 – Attorney General Eric Holder testifies for the first time before the House Judiciary Committee that he had first heard of Operation Fast and Furious only over the past few weeks.
June 2011 - Whistleblowers testify before the House Oversight committee. ATF agent John Dodson tells lawmakers, “I cannot begin to think how the risk of letting guns fall into the hands of known criminals could possibly advance any legitimate law enforcement interest.”
July 26, 2011 – The House Oversight and Government Reform Committee holds a second hearing.
August 30, 2011 – Melson is reassigned to the Justice Department, and is replaced by B. Todd Jones.
October 12, 2011 – Congressional investigators issue a subpoena for communications from Attorney General Holder relating to the federal gunrunning operation.
October 2011 - Investigators uncover memos indicating Attorney General Holder had known about Operation Fast and Furious for close to a year, not a few weeks as he had stated in May 2011.
November 7, 2011 - A federal grand jury in the District of Arizona hands up an 11-count indictment. It alleges that on December 14, 2010, five of the defendants (Manuel Osorio-Arellanes, Jesus Rosario Favela-Astorga, Ivan Soto-Barraza, Heraclio Osorio-Arellanes and Lionel Portillo-Meza) were involved in a firefight with Border Patrol agents during which Terry was fatally shot. The men are charged with first-degree murder, second-degree murder, conspiracy to interfere with commerce by robbery, attempted interference with commerce by robbery, carrying and using a firearm during a crime of violence, assault on a federal officer and possession of a firearm by a prohibited person. The indictment is unsealed on July 9th, 2012.
November 8, 2011 - Attorney General Holder testifies before the Senate Judiciary Committee that, “this operation was flawed in concept, as well as in execution.”
February 1, 2012 – The family of ATF agent Brian Terry files a $25 million wrongful death claim against the United States.
February 2, 2012 – Attorney General Holder testifies before the House Oversight and Government Reform Committee that firings and charges against Justice Department officials who oversaw Fast and Furious are likely to come in the next six months. He also denies any cover-up.
June 12, 2012 – Attorney General Holder testifies before the U.S. Senate Committee on the Judiciary, and rejects calls for his resignation.
June 20, 2012 – The House Oversight and Government Reform Committee recommends that Attorney General Holder be cited for contempt of Congress for failing to turn over documents relating to the Fast and Furious operation.
June 20, 2012 – President Barack Obama asserts executive privilege over the documents sought by the investigating committee. This prevents future prosecution of Holder.
June 28, 2012 – The House of Representatives votes 255-67 to hold Holder in criminal contempt. This is the first time in American history that the head of the Justice Department has been held in contempt by Congress.
July 31, 2012 - The first of a three-part joint staff Congressional report is released, Fast and Furious: Anatomy of a Failed Operation, which lays blame for the failed gun-running probe on Acting ATF Director Kenneth Melson and Deputy Director William Hoover.
July 31, 2012 – ATF Deputy Director William Hoover resigns.
August 13, 2012 – The House Oversight Committee files a civil lawsuit against Holder over Operation Fast and Furious documents.
September 6, 2012 - Mexican authorities arrest Leonel Sanchez Jesus Meza, wanted in the killing of Border Patrol agent Brian Terry.
September 19, 2012 – Department of Justice Inspector General Michael Horowitz releases a report on the operation. The report finds 14 employees of the ATF and the Justice Department responsible for management failures. After the release, former acting ATF head Kenneth Melson retires and former Deputy Assistant Attorney General Jason Weinstein resigns.
December 13, 2012 – Jaime Avila is sentenced to 57 months in prison for his role in buying weapons that were found at the site of the killing of patrol agent Brian A. Terry.
June 17, 2014 – Lionel Portillo Meza, a suspect in the death of Border Patrol Agent Brian Terry, is extradited from Mexico to the U.S.
ATF gunwalking scandal
From Wikipedia, the free encyclopedia
Weapons recovered by Mexican military in Naco, Sonora, Mexico on November 20, 2009. They include weapons bought two weeks earlier by Operation Fast and Furious suspect Uriel Patino, who bought 723 guns during the operation.
“Gunwalking“, or “letting guns walk“, was a tactic of the Arizona Field Office of the United States Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), which ran a series of sting operations between 2006and 2011 in the Tucson and Phoenix area where the ATF “purposely allowed licensed firearms dealers to sell weapons to illegal straw buyers, hoping to track the guns to Mexican drug cartel leaders and arrest them.” These operations were done under the umbrella of Project Gunrunner, a project intended to stem the flow of firearms into Mexico by interdicting straw purchasers and gun traffickers within the United States. The Chambers case began in October 2009, and eventually became known in February 2010 as “Operation Fast and Furious” after agents discovered some of the suspects under investigation belonged to a car club.
The stated goal of allowing these purchases was to continue to track the firearms as they were transferred to higher-level traffickers and key figures in Mexican cartels, with the expectation that this would lead to their arrests and the dismantling of the cartels. The tactic was questioned during the operations by a number of people, including ATF field agents and cooperating licensed gun dealers. During Operation Fast and Furious, the largest “gunwalking” probe, the ATF monitored the sale of about 2,000:203 firearms, of which only 710 were recovered as of February 2012.:203 A number of straw purchasers have been arrested and indicted; however, as of October 2011, none of the targeted high-level cartel figures had been arrested.
Guns tracked by the ATF have been found at crime scenes on both sides of the Mexico–United States border, and the scene where United States Border Patrol Agent Brian Terry was killed December 2010. The “gunwalking” operations became public in the aftermath of Terry’s murder. Dissenting ATF agents came forward to Congress in response. According to Humberto Benítez Treviño, former Mexican Attorney General and chair of the justice committee in the Chamber of Deputies, related firearms have been found at numerous crime scenes in Mexico where at least 150 Mexican civilians were maimed or killed. Revelations of “gunwalking” led to controversy in both countries, and diplomatic relations were damaged.
As a result of a dispute over the release of Justice Department documents related to the scandal, Attorney General Eric Holder became the first sitting member of theCabinet of the United States to be held in contempt of Congress on June 28, 2012. Earlier that month, President Barack Obama had invoked executive privilegefor the first time in his presidency over the same documents.
One 20-year veteran of ATF’s Tucson office told us that before Operation Wide Receiver, all of ATF’s trafficking cases were very similar in their simplicity: ATF would get a tip from an FFL[Federal Firearms Licensee] about a buyer who wanted a large number of firearms and information about when the transaction was scheduled to take place, and would set up surveillance and arrest the buyer when he headed southbound or at the border. Sometimes the initial buyer would cooperate with ATF, and agents would arrest the actual buyer when he showed up to take possession of the guns. If the guns went to a stash house, agents would speak with subjects at the stash house or conduct a search of the stash house. This agent told us that ATF interdicted guns as a matter of course and had been “content to make the little cases,” but that Wide Receiver represented a “different direction” from ATF’s typical practice.
—Report by the Office of the Inspector General on the Review of ATF’s Operation Fast and Furious and Related Matters, September 2012
ATF “gunwalking” operations were, in part, a response to longstanding criticism of the bureau for focusing on relatively minor gun violations while failing to target high-level gun smuggling figures. U.S. firearms laws currently govern the possession and transfer of firearms and provide penalties for the violation of such laws. “Gun trafficking”, although not defined by statute, essentially includes the movement or diversion of firearms from legal to illegal markets.:Summary A 2009 GAO report on efforts to combat arms trafficking to Mexico notes that straw purchasing is not in itself illegal, although it is illegal to provide false information in connection with a purchase.
Four federal statutes govern U.S. commerce of firearms domestically and internationally. Many states supplement these federal statutes and have firearms laws of their own that are stricter. For example, some states require permits to obtain firearms and impose a waiting period for firearm transfers. Domestic commerce and importations into the United States are generally regulated under the National Firearms Act of 1934 (NFA) and the Gun Control Act of 1968 (GCA). The exportation of firearms from the United States is regulated by the Arms Export Control Act of 1976 and, to a lesser extent, the Export Administration Regulations (EAR).:3
Defendants are often prosecuted and convicted under provisions of statutes such as the GCA that make it unlawful for certain persons to be in possession of firearms, govern the transaction process of obtaining firearms (e.g., straw purchases), and contain penalties for the use of a firearm in a crime of violence or a drug trafficking crime, or penalties for knowingly or fraudulently smuggling goods that would be contrary to U.S. law and regulation.:18
In a 2012 case in San Juan, Texas, under existing 1968 Gun Control Act provisions on straw purchasing (Title 18 United States Code, Section 924(a)(1)(A)), straw purchaser Taisa Garcia received 33 months and buyer Marco Villalobos received 46 months, plus two years supervision after release. In another Texas gun trafficking case, Oscar Bravo Hernandez received a sentence of 84 months for buying and sending to Mexico at least 55 firearms from a ring of nine straw purchasers who received sentences from 51 months for the most involved down to three years probation for the least involved.
According to twenty-year ATF veteran Jay Wachtel, letting guns “walk” has been a practice done in a controlled manner that involved surveillance and eventual seizure of the weapons. “The idea was that you would follow it long enough until you were sure you had enough probable cause” to initiate an arrest, Wachtel said.According to ATF field agents involved in Operation Fast and Furious, a part of Project Gunrunner, “ATF agents were trained to interdict guns and prevent criminals from obtaining them” and not to allow guns to walk and then disappear. ATF agents assigned to Phoenix from other districts to work on Fast and Furious were critical of the operation.
There have been allegations of “gunwalking” in at least 10 cities in five states. The most widely known and controversial operations took place in Arizona under the ATF’s Phoenix, Arizona field division.
2006–2008: Operation Wide Receiver and other probes
Operation Wide Receiver
The suspicious sale of AR-15s led to Operation Wide Receiver.
The first known ATF “gunwalking” operation to Mexican drug cartels, named Operation Wide Receiver, began in early 2006 and ran into late 2007. Licensed dealer Mike Detty of Mad Dawg Global informed the ATF of a suspicious gun purchase that took place in February 2006 in Tucson, Arizona. In March he was hired as a confidential informant working with the ATF’s Tucson office, part of their Phoenix, Arizona field division.
With the use of surveillance equipment, ATF agents monitored additional sales by Detty to straw purchasers. With assurance from ATF “that Mexican officials would be conducting surveillance or interdictions when guns got to the other side of the border”, Detty would sell a total of about 450 guns during the operation. These included AR-15s, semi-automatic AK-pattern rifles, and Colt .38s. The majority of the guns were eventually lost as they moved into Mexico.
As the later DOJ OIG Report documented, under Wide Receiver coordination of ATF Tucson with the ATF Mexico City Office (MCO) and with Mexican law enforcement had been haphazard. Discussions of getting tracking devices from Raytheon were not followed up. ATF field agents and the cooperating gun dealer had been told by ATF supervisors that the guns were being interdicted before they could reach Mexico, but only 64 of the 474 guns had actually been seized. The kingpin sought by walking the guns, Israel Egurrola-Leon, turned out to be the target of a larger drug case Operation Iron River run by OCDETF. After Operation Wide Receiver was ended, several attorneys at the Phoenix USAO who reviewed the Wide Receiver cases for prosecution found the cases had been so poorly managed that they were reluctant to bring any of them to trial.
At the time, under the Bush administration Department of Justice (DOJ), no arrests or indictments were made. After President Barack Obama took office in 2009, the DOJ reviewed Wide Receiver and found that guns had been allowed into the hands of suspected gun traffickers. Indictments began in 2010, over three years after Wide Receiver concluded. As of October 4, 2011, nine people had been charged with making false statements in acquisition of firearms and illicit transfer, shipment or delivery of firearms. As of November, charges against one defendant had been dropped; five of them had pled guilty, and one had been sentenced to one year and one day in prison. Two of them remained fugitives.
The Hernandez case
Another, smaller probe occurred in 2007 under the same ATF Phoenix field division. The Fidel Hernandez case began when the ATF identified Mexican suspects who bought weapons from a Phoenix gun shop over a span of several months. The probe ultimately involved over 200 guns, a dozen of which were lost in Mexico. On September 27, 2007, ATF agents saw the original suspects buying weapons at the same store and followed them toward the Mexican border. The ATF informed the Mexican government when the suspects successfully crossed the border, but Mexican law enforcement were unable to track them.
Less than two weeks later, on October 6, William Newell, then ATF’s Special Agent in Charge (SAC) of the Phoenix field division, shut down the operation at the behest of William Hoover, ATF’s assistant director for the office of field operations. No charges were filed. Newell, who was Phoenix ATF SAC from June 2006 to May 2011, would later play a major role in Operation Fast and Furious.
The Hernandez case was referenced in a briefing paper prepared for Attorney General Michael Mukasey prior to his meeting with the Mexican Attorney General Medina Mora on November 16, 2007. The paper stated, “ATF has recently worked jointly with Mexico on the first-ever attempt to have a controlled delivery of weapons being smuggled into Mexico by a major arms trafficker” and that “the first attempts at this controlled delivery have not been successful.” The paper also stated, “ATF would like to expand the possibility of such joint investigations and controlled deliveries — since only then will it be possible to investigate an entire smuggling network, rather than arresting simply a single smuggler.”
Investigators regarded the Hernandez Case as an example of “controlled delivery” with surveillance and involvement of Mexican authorities rather than “gunwalking” or failure to attempt interdiction.
The Medrano case[
The 2008 Alejandro Medrano case involved both ATF SAC William Newell and cooperating Tucson gun dealer Mike Detty of Operation Wide Receiver. ATF Phoenix allowed about 100 guns to be taken into Mexico over the objections of U.S. Immigration and Customs Enforcement (ICE) personnel who became aware of the case. Phoenix ATF SAC Newell acknowledged to ICE “that letting guns cross the border was part of ATF’s plan”. In August 2010, Medrano was sentenced to 46 months, his associate Hernan Ramos received 50 months and their fellow conspirators received prison terms from 14 to 30 months, but the target, a Sinaloa Cartel kingpin, Javier Elenes Ruiz, nicknamed “Rambo,” remained untouched inside Mexico.
2009–2011: Operation Fast and Furious
On October 26, 2009, a teleconference was held at the Department of Justice in Washington, D.C. to discuss U.S. strategy for combating Mexican drug cartels. Participating in the meeting were Deputy Attorney General David W. Ogden, Assistant Attorney General Lanny A. Breuer, acting ATF Director Kenneth E. Melson, Drug Enforcement Administration (DEA) Administrator Michele Leonhart, Director of the Federal Bureau of Investigation Robert Mueller and the top federal prosecutors in theSouthwestern border states. They decided on a strategy to identify and eliminate entire arms trafficking networks rather than low-level buyers. Those at the meeting apparently did not suggest using the “gunwalking” tactic, but Phoenix ATF supervisors would soon use it in an attempt to achieve the desired goals.
The strategy of targeting high-level individuals, which was already ATF policy, would be implemented by Bill Newell, special agent in charge of ATF’s Phoenix field division. In order to accomplish it, the office decided to monitor suspicious firearms purchases which federal prosecutors had determined lacked sufficient evidence for prosecution, as laid out in a January 2010 briefing paper. This was said to be allowed under ATF regulations and given legal backing by U.S. Attorney for the District of Arizona Dennis K. Burke. It was additionally approved and funded by a Justice Department task force. However, long-standing DOJ and ATF policy has required suspected illegal arms shipments to be intercepted.
The operation began on October 31, 2009, when a local gun store reported to the Phoenix ATF that four individuals had purchased multiple AK47 style rifles. In November 2009, the Phoenix office’s Group VII, which would be the lead investigative group in Fast and Furious, began to follow a prolific gun trafficker. He had bought 34 firearms in 24 days, and he and his associates bought 212 more in the next month. The case soon grew to over two dozen straw purchasers, the most prolific of which would ultimately buy more than 600 weapons. The effort would come to be called Operation Fast and Furious for the successful film franchise, because some of the suspects under investigation operated out of an auto repair store and street raced.
Under the previous Operation Wide Receiver, there had been a formal ATF contract with the cooperating gun dealer and efforts were made to involve the ATF Mexico City Office (MCO) and Mexican law enforcement. Under Operation Fast and Furious, at Newell’s insistence the cooperating gun dealers did not have contracts with ATF, and MCO and Mexican police were left in the dark.
According to internal ATF documents, the operation was initially run in conjunction with the Phoenix DEA Organized Crime Drug Enforcement Task Force(OCDETF). On January 26, 2010, ATF formally applied to the Justice Department in Washington for funding through the OCDETF program. When it won approval and received additional funding, Operation Fast and Furious was reorganized as a Strike Force that included agents from ATF, FBI, DEA, and the ICE component of the Department of Homeland Security, which would be run through the U.S. Attorney’s office rather than the ATF. This new Strike Force designation allowed the operation to take advantage of sophisticated surveillance techniques such as federal wiretaps, which would require court orders and interaction from Justice Department officials in Washington, D.C. since federal law requires certain individuals to review evidence and certify the necessity of such techniques.
The dealers involved became concerned as months went by and the same individuals they reported to ATF as suspected straw purchasers returned and repeatedly bought identical weapons. As they later told the DOJ OIG, their previous experience was that after they reported a suspected straw to ATF, they did not see the straw again unless subpoenaed to testify against the straw at trial. One cooperating dealer expressed his concerns in a series of emails in April and June 2010 to GS David Voth, who assured the dealer that ATF was monitoring the suspects using a variety of techniques that he could not discuss in detail.
The tactic of letting guns walk, rather than interdicting them and arresting the buyers, led to controversy within the ATF. As the case continued, several members of Group VII, including John Dodson and Olindo Casa, became increasingly upset at the tactic of allowing guns to walk. Their standard Project Gunrunner training was to follow the straw purchasers to the hand-off to the cartel buyers, then arrest both parties and seize the guns. But according to Dodson, they watched guns being bought illegally and stashed on a daily basis, while their supervisors, including David Voth and Hope MacAllister, prevented the agents from intervening.
However, other accounts of the operation insist that ATF agents were prevented from intervening not by ATF officials, but rather by federal prosecutors with the Attorney General’s office, who were unsure of whether the agents had sufficient evidence to arrest suspected straw-buyers. According to some reports, many agents insisted they were prevented from making arrests because prosecutors were unwilling to engage in what could become a potentially contentious political battle over Second Amendment rights during an election year, particularly given the difficult nature of prosecuting straw buyers, and the weak penalties associated with it, even if successful. Instead, prosecutors instructed ATF agents not to make arrests, but rather continue collecting evidence in order to build a stronger case. One tactic proposed for doing so was a wiretap of suspected straw-buyers, in an attempt to link the suspects to criminal activities taking place on the Mexican side of the border. Between March 20 and July 30, 2010, nine wiretaps were sought and approved by Justice Department officials, resulting in a significant delay in concluding the case.:247,274
One of the central targeted individuals was Manuel Fabian Celis-Acosta. By December 2009, Celis-Acosta was being investigated by the ATF, which had placed a secret pole camera outside his Phoenix home to track his movements. Around this time, apparently by chance, ATF agents discovered Celis-Acosta was also a potential criminal target of the DEA, which was operating a wire room to monitor live wiretaps in order to track him. On April 2, 2010, Celis-Acosta was arrested on possession of cocaine and found in possession of a weapon purchased by Uriel Patino, who had already purchased at least 434 guns from cooperating gun dealers in the Phoenix area. By this time about a dozen ATF agents regularly surveilled Celis-Acosta as he recruited 20 friends and family to buy guns for him and regularly traveled to Texas to obtain funds from cartel associates to purchase firearms. On May 29, 2010, Celis-Acosta was detained in Lukeville, Arizona with 74 rounds of ammunition and 9 cell phones. He was then released by the chief ATF investigator on Fast and Furious, Hope MacAllister, after he promised to cooperate with her to find two specific Sinaloa cartel associates. After the redetention and arrest of Celis-Acosta in February 2011, the ATF learned that the associates they were after were FBI/DEA paid informants, and one of them was Celis-Acosta’s financier. Since they were informants, they were unindictable under Operation Fast and Furious.
Later, the DOJ inspector General concluded: “We did not find persuasive evidence that agents sought to seize firearms or make arrests during the investigative stage of the case and were rebuffed by the prosecutor. … We found that the lack of seizures and arrests was primarily attributable to the pursuit of a strategic goal shared by both the [Phoenix] ATF and the U.S. Attorney’s Office—to eliminate a trafficking organization—and the belief that confronting subjects and seizing firearms could compromise that goal.”
Weapons bought by Fast and Furious suspect Uriel Patino, seized by Border Patrol and Tucson ATF agents on the Tohono O’odham Reservation from a vehicle headed toward the Mexican border, February 20, 2010.
By June 2010, suspects had purchased 1,608 firearms at a cost of over US$1 million at Phoenix-area gun shops. At that time, the ATF was also aware of 179 of those weapons being found at crime scenes in Mexico, and 130 in the United States. As guns traced to Fast and Furious began turning up at violent crime scenes in Mexico, ATF agents stationed there also voiced opposition.
On the evening of December 14, 2010, U.S. Border Patrol agent Brian Terry and others were patrolling Peck Canyon,Santa Cruz County, Arizona, 11 miles from the Mexican border. The group came across five suspected illegal immigrants. When they fired non-lethal beanbag guns, the suspects responded with their own weapons, leading to a firefight. Terry was shot and killed; four of the suspects were arrested and two AK-pattern rifles were found nearby. The Attorney General’s office was immediately notified of the shooting incident by email. The rifles were traced within hours of the shooting to a Phoenix store involved in the Fast and Furious operation, but the bullet that killed Terry was too badly damaged to be conclusively linked to either gun. Acting Deputy Attorney General Gary Grindler and Deputy Chief of Staff Monty Wilkinson were informed about the guns, but they didn’t believe the information was sufficiently important to alert the Attorney General about it or to make any further inquiry regarding the development.:297
After hearing of the incident, Dodson contacted ATF headquarters, ATF’s chief counsel, the ATF ethics section and the Justice Department’s Office of the Inspector General, none of whom immediately responded. He and other agents then contacted Senator Chuck Grassley of Iowa (R–IA), ranking member of the Senate Judiciary Committee, who would become a major figure in the investigation of “gunwalking.” At the same time, information began leaking to various bloggers and Web sites.
On January 25, 2011, Burke announced the first details of the case to become officially public, marking the end of Operation Fast and Furious. At a news conference in Phoenix, he reported a 53-count indictment of 20 suspects for buying hundreds of guns intended for illegal export between September 2009 and December 2010. Newell, who was at the conference, called Fast and Furious a “phenomenal case,” while denying that guns had been deliberately allowed to walk into Mexico.
Altogether, about 2,000 firearms were bought by straw purchasers during Fast and Furious.:203 These included AK-47 variants, Barrett .50 caliber sniper rifles, .38 caliber revolvers, and FN Five-sevens. As of October 20, 2011, 389 had been recovered in the US and 276 had been recovered in Mexico. The rest remained on the streets, unaccounted for. As of February 2012, the total number of recovered firearms was 710.:203 Most of the guns went to the Sinaloa Cartel, while others made their way to El Teo and La Familia.
Although most weapons were purchased by suspects under investigation by the program, there have been reports of at least one instance of ATF agents being directly involved in the transfer of weapons. On April 13, 2010, ATF Agent John Dodson, with assistance from Agents Casa and Alt, directed a cooperating straw purchaser to give three guns to Isaiah Fernandez, a suspected gun trafficker, and had taped the conversations without prosecutor approval.
After being instructed by his superiors to obtain approval from prosecutors (albeit retroactively), Dodson’s proposal was later rejected by his immediate superior David Voth, although he later received permission from Voth’s supervisor after submitting a written proposal for the program. On June 1, 2010, Dodson used $2,500 of ATF funds to purchase six AK Draco pistols from local gun dealers, which he then gave to Mr. Fernandez, who reimbursed him for the expense of the guns, plus $700 for his assistance. Two days later, Agent Dodson went on a scheduled vacation without interdicting the weapons. As a result, the weapons were never recovered, no arrests were ever made, and the case was closed without charges being filed.
According to the DOJ OIG report, Agent Dodson, as the undercover posing as a straw buyer, was not expected to surveil the weapons after hand-off to Fernandez. Other ATF agents followed the weapons to a storage facility; then surveillance was terminated without interdiction. The Fernandez case was dropped from Fast and Furious after it was determined that Fernandez was not connected to Mexican cartels and had ceased buying guns for resale.
Aftermath and reaction
Fate of walked guns
Since the end of Operation Fast and Furious, related firearms have continued to be discovered in criminal hands. As reported in September 2011, the Mexican government stated that an undisclosed number of guns found at about 170 crime scenes were linked to Fast and Furious. U.S. Representative Darrell Issa (R–Calif.–49) estimated that more than 200 Mexicans were killed by guns linked to the operation. Reflecting on the operation, Attorney General Eric Holder said that theUnited States government is “…losing the battle to stop the flow of illegal guns to Mexico,” and that the effects of Operation Fast and Furious will most likely continue to be felt for years, as more walked guns appear at Mexican crime scenes.
In April 2011, a large cache of weapons, 40 traced to Fast and Furious but also including military-grade weapons difficult to obtain legally in the US such as an anti-aircraft machine gun and grenade launcher, was found in the home of Jose Antonio Torres Marrufo, a prominent Sinaloa Cartel member, in Ciudad Juárez, Mexico. Torres Marrufo was indicted, but evaded law enforcement for a brief time. Finally, on February 4, 2012, Marrufo was arrested by the Mexican Police.
On May 29, 2011, four Mexican Federal Police helicopters attacked a cartel compound, where they were met with heavy fire, including from a .50 caliber rifle. According to a report from the House Committee on Oversight and Government Reform, this rifle is likely linked to Fast and Furious.
There have been questions raised over a possible connection between Fast and Furious and the death of U.S. Immigration and Customs Enforcement agent Jaime Zapata on February 15, 2011. The gun used to kill Zapata was purchased by Otilio Osorio in the Dallas/Fort Worth Metroplex, Texas (outside the area of responsibility for the ATF Phoenix field division which conducted Fast and Furious), and then smuggled into Mexico. Congressional investigators have stated that Osorio was known by the ATF to be a straw purchaser months before he purchased the gun used to kill Zapata, leading them to question ATF surveillance tacticsand to suspect a Texas-based operation similar to Fast and Furious.
In addition to Otilio Osorio, a Texas-based drug and gun trafficker, Manuel Barba, was involved trafficking another of the guns recovered in the Zapata shooting. The timeline of this case, called “Baytown Crew”, shows guns were allowed to walk during surveillance that began June 7, 2010. On August 20, 2010, Barba received a rifle later recovered in the Zapata ambush and sent it with nine others to Mexico. The warrant for Barba’s arrest was issued February 14, 2011, the day before Zapata was shot. On January 30, 2012, Barba, who claimed to be working with Los Zetas in illegally exporting at least 44 weapons purchased through straw buyers, was sentenced to 100 months in prison.
On November 23, 2012, two firearms linked to the ATF were found at the scene of a shootout between Sinaloa cartel members and the Mexican military. One of the weapons was an AK-47 type rifle trafficked by Fast and Furious suspect Uriel Patino, and the other was an FN Herstal pistol originally purchased by an ATF agent. Mexican beauty queen Maria Susana Flores Gamez and four others were killed.
Investigations and fallout
In the U.S. Congress, Representative Darrell Issa (R–CA–49), chairman of the House Committee on Oversight and Government Reform, and Senator Chuck Grassley(R–IA), ranking member of the Senate Judiciary Committee, have been leading investigations of “gunwalking” operations. There have also been investigations by the United States Department of Justice Office of the Inspector General and others.
On January 27, 2011, Grassley wrote a letter to ATF Acting Director Kenneth E. Melson requesting information about the ATF-sanctioned sale of hundreds of firearms to straw purchasers. The letter mentioned a number of allegations that walked guns were used in the fight that killed Border Patrol Agent Brian Terry. A second letter from Grassley on January 31 accused the ATF of targeting whistleblowers.
On February 4, after review and comment from dozens of officials in the Justice Department Criminal Division, the Office of the Deputy Attorney General, the U.S. Attorney’s Office in Phoenix, and ATF Headquarters,:332 Assistant Attorney General Ronald Weich sent a response to Grassley regarding his two letters. Weich said claims “…that (the) ATF ‘sanctioned’ or otherwise knowingly allowed the sale of assault weapons to a straw purchaser who then transported them to Mexico [are] false. ATF makes every effort to interdict weapons that have been purchased illegally and prevent their transportation to Mexico.” On February 28, Attorney GeneralEric Holder requested that the Department of Justice‘s Inspector General begin an investigation of Fast and Furious.
On March 23, President Barack Obama appeared on Univision and spoke about the “gunwalking” controversy. He said that neither he nor Attorney General Holder authorized Fast and Furious. He also stated, “There may be a situation here in which a serious mistake was made, and if that’s the case then we’ll find out and we’ll hold somebody accountable.”
On May 3, Attorney General Holder testified to the House Judiciary Committee that he did not know who approved Fast and Furious, but that it was being investigated. He also stated that he “probably heard about Fast and Furious for the first time over the last few weeks,” a claim which would later be questioned as explained below.
In June, ATF Agent Vince Cefalu, who helped to publicize Fast and Furious, was served with termination papers, in a move by the agency he described as politically motivated retaliation. He had been at odds with ATF management since he filed a complaint over tactics in an unrelated case in 2005. The ATF denied that the firing was retaliation, and Cefalu’s termination letter noted that he leaked documents to the Internet and showed a “lack of candor” in other operations.
On June 14, 2011, a preliminary joint staff report was released by Representative Issa and Senator Grassley. Among the findings: agents were told to stand down rather than interdict weapons, they complained about the strategy and were ignored, and Fast and Furious led to increased violence and death in Mexico. Agents were panicked, certain that “someone was going to die.”
Representative Issa continued to hold hearings in June and July where ATF officials based in Phoenix and Mexico, and at headquarters in Washington, testified before the committee. ATF agent John Dodson stated that he and other agents were ordered to observe the activities of gun smugglers but not to intervene. He testified:
Over the course of the next 10 months that I was involved in this operation, we monitored as they purchased hand guns, AK-47 variants, and .50 caliberrifles almost daily. Rather than conduct any enforcement actions, we took notes, we recorded observations, we tracked movements of these individuals for a short time after their purchases, but nothing more. Knowing all the while, just days after these purchases, the guns that we saw these individuals buy would begin turning up at crime scenes in the United States and Mexico, we still did nothing. …
I cannot begin to think of how the risk of letting guns fall into the hands of known criminals could possibly advance any legitimate law enforcement interest.
A second joint staff report was released by the Republicans on July 26.
In August, three important Fast and Furious supervisors were transferred to new management positions at ATF headquarters in Washington: William Newell and David Voth, field supervisors who oversaw the program from Phoenix, and William McMahon, an ATF deputy director of operations. The transfers were initially reported as promotions by the Los Angeles Times, but the ATF stated that they did not receive raises or take on greater responsibilities. In late August, it was announced that Acting ATF Director Melson had been reassigned to the Justice Department, and U.S. Attorney Burke announced his resignation after being questioned by Congressional investigators earlier that month.
In October, documents showing that Attorney General Holder’s office had been sent briefings on Fast and Furious as early as July 2010, prompted questions about his May statement that he wasn’t sure of the exact date, but had known about it for only a few weeks. The briefings were from the National Drug Intelligence Center andAssistant Attorney General Lanny Breuer. The Justice Department said that those briefings were about a different case started before Holder became Attorney General, and that while he had known about Fast and Furious, he didn’t know the details of the tactics being used.
On October 31, 2011, after the release of subpoenaed documents, Assistant Attorney General Lanny Breuer stated he found out about gunwalking in Operation Wide Receiver in April 2010, and that he wished he had alerted the deputy or the attorney general at the time. The following day, in testimony before the Senate Judicial Committee in a hearing on International Organized Crime, when asked if he had reviewed the letter before it was sent to Senator Charles Grassley on February 4, 2011 denying gunwalking, Breuer replied, “I cannot say for sure whether I saw a draft of the letter that was sent to you. What I can tell you, Senator, is that at that time I was in Mexico dealing with the very real issues that we’re all so committed to.”
On November 8, Holder stated for the first time in Congressional testimony that “gunwalking” was used in Fast and Furious. He remarked that the tactic is unacceptable, and that the operation was “flawed in its concept and flawed in its execution.” He further stated that his office had inaccurately described the program in previous letters sent to Congress, but that this was unintentional. Reiterating previous testimony, he said that he and other top officials had been unaware that the “gunwalking” tactic was being used. Holder stated that his staff had not showed him memos about the program, noting, “There is nothing in any of those memos that indicates any of those inappropriate tactics that are of concern. Those things were not brought to my attention, and my staff, I think, made the correct decision in that regard.”
That same month, ex-US Attorney Burke admitted to leaking sensitive documents about ATF agent and whistleblower Dodson. Senator Grassley expressed concern that the Justice Department was using Burke as a scapegoat to protect higher officials and vowed to continue his probe.
On December 2, 2011, the Justice Department formally withdrew its statement from February 4, 2011 denying gunwalking due to inaccuracies.
Later that month, documents showed that some ATF agents discussed using Fast and Furious to provide anecdotal cases to support controversial new rules about gun sales. The regulation, called Demand Letter 3, would require 8,500 firearms dealers in Arizona, California, New Mexico and Texas that “have a significant number of crime guns traced back to them from Mexico” to report multiple rifle sales.
Investigations by Congress and the DOJ Inspector General continued into 2012. In January, Patrick Cunningham, who was the criminal division chief at the Phoenix office of the U.S. Attorney’s Office for the District of Arizona and has since resigned, asserted his innocence and his constitutional right against self-incrimination to avoid testifying. Cunningham worked directly under Burke during Fast and Furious. He was subpoenaed because of the role he might have played in the operation, and in the letter sent from the DOJ to Senator Grassley in February 2011 that claimed the ATF did not allow weapons to be trafficked to Mexico.
On January 31, 2012, Democrats on the House Oversight and Government Reform Committee released a report titled, “Fatally Flawed: Five Years of Gunwalking in Arizona”. The report concluded that there was no evidence of involvement by high-ranking appointees at the Justice Department in “gunwalking.” Rather, Operation Fast and Furious was just one of four such operations conducted over five years during the Bush and Obama administrations, and was only “the latest in a series of fatally flawed operations run by ATF agents in Phoenix and the Arizona U.S. Attorney’s Office.”
In May, it was reported that the Department of Homeland Security (DHS) Office of Inspector General had begun to investigate Fast and Furious, with a report expected in October. The DHS had Immigration and Customs Enforcement agents assigned to the operation after becoming involved in late 2009.
On May 3, 2012, Congressman Issa released a letter to the Committee on Oversight and Government Reform that included a draft of a resolution to hold Attorney General Holder in contempt. In the letter, Issa described the connection between Operation Fast and Furious and the OCDETF program since at least January 2009, which would involve multiple executive agencies including the ATF, DOJ, DEA, FBI, ICE, and DHS. He questioned how, why, or if oversight by high level Justice Department did not occur in such an important case. He further described the tragic death of Brian Terry, the whistleblowers and their mistreatment, and the damage the operation had to US-Mexico relations.
On June 7, 2012, under the threat of being held in contempt of Congress for not turning over additional requested documents, Attorney General Holder appeared at his seventh Congressional hearing, where he continued to deny knowledge of “gunwalking” by high-level officials. By then, the Justice Department had turned over more than 7,000 pages of documents.
During the June 12, 2012, Senate hearing, Eric Holder stated, “If you want to talk about Fast and Furious, I’m the Attorney General that put an end to the misguided tactics that were used in Fast and Furious. An Attorney General who I suppose you would hold in higher regard was briefed on these kinds of tactics in an operation called Wide Receiver and did nothing to stop them—nothing. Three hundred guns, at least, walked in that instance.” Holder cited a briefing paper on “Wide Receiver”; the DOJ Office of Legislative Affairs later clarified that the briefing paper was about the Fidel Hernandez case, prepared for Holder’s predecessor, U.S. Attorney General Michael Mukasey before his meeting with Mexican Attorney General Mora on November 16, 2007. The Hernandez Case had ended October 6, 2007,before Mukasey entered office November 9, 2007. The office further explained, “As Attorney General Holder also noted in his testimony, and as we have set forth in prior correspondence and testimony, he took measures and instituted a series of important reforms designed to ensure that the inappropriate tactics used in Fast and Furious, Wide Receiver, Hernandez, and other matters about which the Department has informed Congress are not repeated.” The later DOJ OIG investigation concluded “Attorney General Mukasey was not briefed about Operation Wide Receiver or gun “walking,” but on a different and traditional law enforcement tactic that was employed in a different case.”
On June 20, the House Oversight and Government Reform Committee voted along party lines to recommend that Holder be held in contempt. At issue were 1,300 pages of documents that had not been turned over to Congress by the DOJ. Earlier that day, President Obama had invoked executive privilege over those documents, marking the first time the privilege has been asserted during his presidency. Issa contends that the Obama executive privilege claim is a cover-up or an obstruction to the congressional probe. Issa said the department has identified “140,000 pages of documents and communications responsive to the committee’s subpoena.”
On Thursday, June 28, 2012, Holder became the first sitting member of the Cabinet of the United States to be held in criminal contempt of Congress by the House of Representatives for refusing to disclose internal Justice Department documents in response to a subpoena. The vote was 255–67 in favor, with 17 Democrats voting yes and a large number of Democrats walking off the floor in protest and refusing to vote. A civil contempt measure was also voted on and passed, 258–95. The civil contempt vote allows the House Committee on Oversight and Government Reform to go to court with a civil lawsuit to look into the US Justice Department’s refusal to turn over some of the subpoenaed documents and to test Obama’s assertion of executive privilege. Holder dismissed the votes as “the regrettable culmination of what became a misguided—and politically motivated—investigation during an election year,” and the White House called it “political theater rather than legitimate congressional oversight.” The National Rifle Association controversially lobbied for Holder to be held in contempt.
In June 2012, a six-month long investigation by Fortune magazine stated that the ATF never intentionally allowed guns to fall into the hands of Mexican drug cartels, in contrast to most other reports. Agents interviewed during the investigation repeatedly asserted that only one isolated incident of “gunwalking” ever occurred, and was performed independently by ATF Agent John Dodson (who later appeared on CBS News as a whistleblower to denounce the gunwalking scandal) as part of an unauthorized solo action outside the larger Fast and Furious operation.
On July 31, the first part of a new three-part report, Fast and Furious: The Anatomy of a Failed Operation, was released by Republican lawmakers. The report singled out five ATF supervisors for responsibility in Fast and Furious, all of whom had been previously reassigned. The report also said that Fast and Furious resulted from a change in strategy by the Obama Administration. The Justice Department was dismissive of the report, saying that it contained “distortions” and “debunked conspiracy theories,” and that “gunwalking” tactics dated back to 2006. DOJ spokeswoman Tracy Schmaler, while critical of the report, did credit it for acknowledging that the idea for “gun walking”—allowing illegal sales of weapons on the border—originated under the Republican administration before Eric Holder took office in 2009. Schmaler noted that Holder moved swiftly to replace the ATF’s management and instill reforms. On the same day, ATF Deputy Director William Hoover, who was one of the five blamed in the Congressional report, officially retired. The report included an appendix disputing claims in the Fortune article.Following its publication, Dodson’s lawyer wrote the managing editor of Fortune stating the article was “demonstrably false” and that a retraction was in order. AfterFortune did not retract the article, Dodson sued for libel on October 12, 2012.
On September 19, the Department of Justice Inspector General Michael Horowitz publicly released a 471-page report detailing the results of the Justice Department’s own internal investigations. The Inspector General’s report, which had access to evidence and interviews with witnesses not permitted in previous Congressional reports, recommended 14 federal officials for disciplinary action, ranging from ATF agents to federal prosecutors involved in the Fast and Furious operation. It found “no evidence” that Attorney General Holder knew about Fast and Furious before early 2011. It found no evidence that previous Attorneys General had been advised about gunwalking in Operation Wide Receiver.
While the OIG report found no evidence that higher officials at the Justice Department in Washington had authorized or approved of the tactics used in the Fast and Furious investigations, it did fault 14 lower officials for related failures, including failures to take note of “red flags” uncovered by the investigation, as well as failures to follow up on information produced through Operation Fast and Furious and its predecessor, Operation Wide Receiver. The report also noted ATF agents’ apparent frustrations over legal obstacles from the Phoenix Attorney’s Office to prosecuting suspected “straw-buyers,” while also criticizing the agents’ failure to quickly intervene and interdict weapons obtained by low-level suspects in the case. The 14 Justice Department employees were referred for possible internal discipline. The Justice Department’s Criminal Division head Lanny Breuer, an Obama administration presidential appointee, was cited for not alerting his bosses in 2010 to the flaws of Operation Wide Receiver. Deputy Assistant Attorney General Jason Weinstein, who was responsible for authorizing a portion of the wiretap applications in Operation Fast and Furious and faulted in the report for not identifying the gunwalking tactics, resigned on the day of the report.
On December 4, 2012, the ATF Professional Review Board delivered its recommendations to high-level ATF managers, who will decide whether to accept them. The recommendations included firing William McMahon, ATF Deputy Assistant Director; Mark Chait, ATF Assistant Director for Field Operations; William Newell, Phoenix ATF Special Agent in Charge; and George Gillett, Newell’s second in command. Two additional ATF employees, Phoenix supervisor David Voth and lead agent Hope McAllister, received recommendations for demotion and disciplinary transfer to another ATF post, respectively. It was reported the next day that McMahon had been fired. It was also announced that Gary Grindler, Eric Holder’s chief of staff who was faulted in the OIG report, would be leaving the Justice Department. Later that month, the family of Brian Terry sued seven government officials and a gun shop involved in Operation Fast and Furious for negligence and wrongful death.
Agent John Dodson’s book on his experiences in Operation Fast and Furious was released by Simon and Schuster on December 3, 2013.
Related criminal prosecutions
On July 9, 2012, an indictment charging five men in the death of U.S. Border Patrol Agent Brian Terry was unsealed. The FBI offered a reward of $250,000 per fugitive for information leading to their arrests. The indictment, originally handed up on November 7, 2011, charges Manuel Osorio-Arellanes, Jesus Rosario Favela-Astorga, Ivan Soto-Barraza, Heraclio Osorio-Arellanes and Lionel Portillo-Meza with first-degree murder, second-degree murder, and other crimes. Manuel Osorio-Arellanes pled guilty to avoid the death penalty and is expected to be sentenced in March 2013. As of December 12, 2012, another of the suspects is in custody, and three remain fugitives.
On October 15, 2012, Danny Cruz Morones, one of the twenty individuals indicted as a result of Fast and Furious, was sentenced to 57 months in prison. He was the first of the twenty to be sentenced. He pled guilty to straw purchasing and recruiting others to buy guns. According to prosecutors, he bought 27 AK-47s, and his recruits bought dozens more.
On December 12, Jaime Avila, Jr. received the maximum penalty of 57 months in prison for gun dealing and conspiracy. He pled guilty after two AK-47 type rifles purchased by him were found at the scene of Border Patrol Agent Brian Terry’s death. Federal prosecutors stated that, in addition to gun trafficking, he had recruited others to do the same. He was under ATF surveillance at the time.
As more information on Operations Fast and Furious and Wide Receiver was revealed in 2011, Mexican officials, political commentators and media reacted with anger. Mexican officials stated in September that the U.S. government still had not briefed them on what went wrong nor had they apologized.
Due to several failed attempts at coordinating with Mexican law enforcement in the apprehension of suspected arms traffickers in the Wide Receiver and Hernandez cases, and concerns about widespread corruption, details of Operation Fast and Furious were not shared with Mexican government officials, and they were deliberately kept out of the loop after related firearms began turning up at crime scenes and in criminal arsenals in 2010. The U.S. Embassy in Mexico and the ATF Mexico City Office (MCO) were also kept in the dark. According to Attorney General of Mexico Marisela Morales, the Mexican government was told about the undercover program in January 2011, but they were not provided details at the time.
Morales stated, “At no time did we know or were we made aware that there might have been arms trafficking permitted. In no way would we have allowed it, because it is an attack on the safety of Mexicans.” In addition, she expressed that allowing weapons to “walk” would represent a “betrayal” of Mexico. Morales said that her office would search “to the end” in order to clarify what happened in Fast and Furious. In November 2011, it was reported that the Mexican Attorney General’s office was seeking the extradition of six citizens of the United States implicated with smuggling weapons.
Mexican Senator Arturo Escobar stated after hearing about Operation Wide Receiver, “We can no longer tolerate what is occurring. There must be condemnation from the state,” and that the Mexican Senate condemned the actions of the ATF.
Jorge Carlos Ramírez Marín, president of the Chamber of Deputies of Mexico from the Institutional Revolutionary Party, said “This is a serious violation of international law. What happens if next time they need to introduce trained assassins or nuclear weapons?”
Chihuahua state prosecutor Patricia Gonzalez, who had worked closely with the US for years, said, “The basic ineptitude of these officials [who ordered the Fast and Furious operation] caused the death of my brother and surely thousands more victims.” Her brother, Mario, had been kidnapped, tortured and killed by cartel hit men in fall 2010. Later, two AK-47 rifles found among the several weapons recovered after a gunfight between police and cartel members were traced to the Fast and Furious program.
Mexican Congressman Humberto Benítez Treviño, a former attorney general, called Fast and Furious “a bad business that got out of hand.” He had also characterized it as “an undercover program that wasn’t properly controlled.”
Like many politicians, Mexican pundits across the political spectrum expressed anger at news of both operations. La Jornada, a left-leaning newspaper, asked “US: ally or enemy?” The paper also argued that after news about Wide Receiver, the Mérida Initiative should be immediately suspended. A right-leaning paper accused the US of violating Mexican sovereignty. Manuel J. Jauregui of the Reforma newspaper wrote, “In sum, the gringo (American) government has been sending weapons to Mexico in a premeditated and systematic manner, knowing that their destinations were Mexican criminal organizations.”
- ^ Jump up to:a b c d e f g h i j k l m n o p q r s t u “A Review of ATF’s Operation Fast and Furious and Related Matters”. U.S. Department of Justice Office of the Inspector General. November 2012. Retrieved 6 February 2013.
- ^ Jump up to:a b c d e f g Jonsson, Patrik. “How Mexican killers got US guns from ‘Fast and Furious’ operation”. The Christian Science Monitor. Retrieved October 16, 2011.
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- Jump up^ “ATF Fact Sheet – Project Gunrunner”. ATF. Retrieved October 16, 2011.
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- Jump up^ Attkisson, Sharyl. “Attorney General Holder subpoenaed for documents in ATF Gunwalker Fast and Furious case”. CBS News. Retrieved October 24, 2011.
- ^ Jump up to:a b Jason Ryan, “Documents Highlight Bush-Era Incident Pre-Dating ‘Fast and Furious’“, ABC News, October 14, 2011.
- ^ Jump up to:a b c The Department of Justice’s Operation Fast and Furious: Accounts of ATF Agents, JOINT STAFF REPORT, Prepared for Rep. Darrell E. Issa and Senator Charles E. Grassley, 112th Congress, June 14, 2011.
- ^ Jump up to:a b c d Steller, Tim (October 12, 2011). “Newell’s role, Mexico’s participation and more on ATF’s Tucson operation”. Arizona Daily Star. Retrieved October 24, 2011.
- Jump up^ Sharyl Attkisson, “Gun shop owner expressed concerns early on in “gunwalker” scandal”, CBS News Investigates, April 14, 2011 1:19 pm.
- ^ Jump up to:a b c Letter from Senator Charles Grasseley to Attorney General Eric Holder, Apr 13, 2011, on e-mails between “Cooperating FFL” and ATF David Voth.
- ^ Jump up to:a b Yost, Pete. “2007 Justice memo mentioned gun-walking probe”. Yahoo! News. Retrieved June 20, 2012.
- Jump up^ Sharyl Attkinsson, “Gunrunning scandal uncovered at the ATF”, CBS Evening News, February 23, 2011.
- Jump up^ “memo Feb 3, 2011 to ATF SAC Dallas from Gary M. Steyers, ATF SA Lubbock.” (PDF). Retrieved 2012-07-14.
- Jump up^ Murphy, Kim (March 11, 2011). “Mexico demands answers on guns”. Los Angeles Times. Retrieved June 26, 2012.
- ^ Jump up to:a b “House holds Holder in contempt”. CNN.com. June 28, 2012.
- ^ Jump up to:a b House Finds Holder in Contempt Over Inquiry on Guns; New York Times; Jonathan Weisman and Charlie Savage; June 28, 2012
- ^ Jump up to:a b Jackson, David (June 20, 2012). “Obama claims executive privilege; Holder held in contempt”. USA Today. Retrieved 22 June 2012.
- ^ Jump up to:a b Dwyer, Devin; Parkinson, John R. (June 20, 2012). “Committee Votes Attorney General Eric Holder in Contempt of Congress After Obama Asserts Executive Privilege”. ABC News. Retrieved 22 June 2012.
- ^ Jump up to:a b Yost, Pete (October 5, 2011). “AP sources: Bush-era probe involved guns ‘walking'”. The Seattle Times. Associated Press. Retrieved June 25, 2012.
- ^ Jump up to:a b c “Gun Trafficking and the Southwest Border”. Congressional Research Service. September 21, 2009.
- Jump up^ United States Government Accountability Office (June 2009). “Firearms Trafficking: U.S. Efforts to Combat Arms Trafficking to Mexico Face Planning and Coordination Challenges”. p. 29. Retrieved 28 June 2012. “While straw purchasing is not in itself illegal, it is illegal to intentionally provide false information in connection with the acquisition of a firearm. 18 U.S.C. § 922(a)(6). See also U.S. v. Moore, 109 F.3d 1456, 1460-63 (9th Cir. 1997) (explaining the straw man doctrine and applying it to a factual case).”
- Jump up^ “Two San Juan residents get federal prison time for firearms straw purchases”, YourValleyVoice.com, McAllen Texas, January 18, 2012.
- Jump up^ “10 Sentenced for Involvement in Straw Purchase and Export Ring”, USAO Southern District of Texas press release, March 1, 2012.
- Jump up^ Arrillaga, Pauline (July 30, 2011). “What Led to ‘Project Gunwalker’?”. ABC News. Retrieved October 24, 2011.
- Jump up^ “The Department of Justice’s Operation Fast and Furious: Accounts of ATF Agents” Joint Staff Report Prepared for Rep. Darrell E. Issa and Senator Charles E. Grassley, 112th Congress, June 14, 2011.
- ^ Jump up to:a b “Informant: ATF “gun walking” went on for years”. CBS news. Retrieved October 16, 2011.
- ^ Jump up to:a b c d Barrett, Paul. “The Guns That Got Away”. Bloomberg Businessweek. Retrieved December 21, 2011.
- ^ Jump up to:a b Horwitz, Sari (October 7, 2011). “Earlier ATF gun operation ‘Wide Receiver’ used same tactics as ‘Fast and Furious’”. The Washington Post. Retrieved October 16, 2011.
- Jump up^ Attkisson, Sharyl. “Documents point to ATF “gun running” since 2008″. CBS News. Retrieved January 7, 2012.
- Jump up^ “ATF Emails Discuss Bush-Era ‘Gun Walking’ Program”. Talking Points Memo. Retrieved October 16, 2011.
- ^ Jump up to:a b c Letters of 14 Jun 2012 from Senator Charles E. Grassley to U.S. Attorney General Eric H. Holder, Jr. and 18 Jun 2012 from U.S. DOJ Office of Legislative Affairs to Senator Charles E. Grassley.
- ^ Jump up to:a b c d Fatally Flawed: Five Years of Gunwalking in Arizona (Report of the Minority Staff, Rep. Elijah E. Cummings, Ranking Member; Committee on Oversight and Government Reform, U.S. House of Representatives, January 2012)
- ^ Jump up to:a b “Fast and Furious: The Anatomy of a Failed Operation”. United States Congress. Retrieved 3 August 2012.
- Jump up^ “Department of Justice Cartel Strategy, October 2009″. The Washington Post. Retrieved October 23, 2011.
- Jump up^ “Judicial Watch Sues Department of Justice and ATF for Documents Pertaining to ATF’s “Fast and Furious” Gun-Running Operation”. Judicial Watch. Retrieved October 24, 2011.
- Jump up^ Serrano, Richard (August 11, 2011). “ATF’s gun surveillance program showed early signs of failure”. Los Angeles Times. Retrieved October 24, 2011.
- ^ Jump up to:a b c “The Department of Justice’s Operation Fast and Furious: Fueling Cartel Violence”. United States Congress. Retrieved January 15, 2012.
- Jump up^ Statement of Michael E. Horowitz, Inspector General, before the House Committee on Oversight and Government Reform, 20 Sep 2012.
- Jump up^ Savage, Charlie (August 30, 2011). “Gun Inquiry Costs Officials Their Jobs”.The New York Times. Retrieved October 24, 2011.
- Jump up^ Charles Grassley, “Charles Grassley Congressional testimony documents”U.S. House of Representatives Committee on Oversight and Government Reform, June 15, 2011.
- ^ Jump up to:a b c Darrell Issa, “Update on Operation Fast and Furious” House of Representatives Committee on Oversight and Government Reform, May 3, 2012.
- Jump up^ Savage, Charlie (July 18, 2011). “Facts Sought on D.E.A. Informants”. The New York Times. Retrieved October 24, 2011.
- ^ Jump up to:a b c d e f g Katherine Eban, “The truth about the Fast and Furious scandal”, Fortune Magazine, June 27, 2012.
- Jump up^ Richard A. Serrano, “Drug lords targeted by Fast and Furious were FBI informants” Los Angeles Times, March 21, 2012.
- Jump up^ Richard A. Serrano, “‘Fast and Furious’ probe: Chief suspect released more than once” Los Angeles Times, March 22, 2012.
- Jump up^ Richard A. Serrano, “Informant helped smuggle guns to Mexico, investigators say” Los Angeles Times, September 27, 2011.
- Jump up^ William La Jeunesse, “Main suspect in Operation Fast and Furious arrested twice before, report shows Fox News, April 14, 2012.
- Jump up^ Carrie Johnson, “Emails Show How ‘Fast And Furious’ Ambush News Unfolded At Justice Dept.” NPR, January 27, 2012.
- ^ Jump up to:a b Joint Staff Report Part I Appendix III PDF “The Whole Truth About the Fast and Furious Scandal”, 7-31-12.
- Jump up^ Serrano, Richard A. (September 11, 2011). “Gun store owner had misgivings about ATF sting”. Los Angeles Times. Retrieved 23 June 2012.
- Jump up^ “200 mexicanos murieron por armas de ‘Rápido y Furioso': congresista de EU”.CNN Mexico. October 28, 2011.
- Jump up^ “Eric Holder: Effects of Fast and Furious will linger”. Politico LLC. November 7, 2011. Retrieved November 8, 2011.
- Jump up^ Frieden, Terry (November 7, 2011). “El gobierno de EU admite que pierde la batalla contra el tráfico de armas”. CNN Mexico. Retrieved November 8, 2011.
- Jump up^ Longbottom, Wil (October 13, 2011). “U.S. Attorney General issued with subpoena in probe over ‘Fast and Furious’ gun trafficking”. Daily Mail (London). Retrieved October 24, 2011.
- Jump up^ Serrano, Richard (October 8, 2011). “Fast and Furious weapons were found in Mexico cartel enforcer’s home”. Los Angeles Times. Retrieved October 24, 2011.
- Jump up^ Ugarte, Marco (February 4, 2012). “Mexico arrested Jose Antonio Torres Marrufo, the reputed enforcer for the Sinaloa drug cartel.”. Los Angeles Times. Retrieved April 23, 2012.
- Jump up^ Serrano, Richard (July 17, 2011). “Family of U.S. agent slain in Mexico demands to know gun source”. Los Angeles Times. Retrieved November 15, 2011.
- Jump up^ Carroll, Susan. “Slain ICE agent’s family still searching for answers”. The Houston Chronicle. Retrieved November 15, 2011.
- ^ Jump up to:a b Perez-Trevino, Emma. “Straw purchaser of guns pleads guilty in Dallas; defendant linked to Zapata death”. The Brownsville Herald. Retrieved November 15, 2011.
- Jump up^ “Phoenix Field Division”. ATF. Retrieved November 15, 2011.
- Jump up^ Titus, Elizabeth. “Cornyn Presses Holder on Alleged Texas Operation”. The Texas Tribune. Retrieved November 15, 2011.
- Jump up^ “Timeline of “Baytown Crew” case.” (PDF). CBS News. Retrieved 2012-07-14.
- Jump up^ Sharyl Attkisson, “Second gun used in ICE agent murder linked to ATF undercover operation”, CBS News, February 22, 2012.
- Jump up^ Attkisson, Sharyl (19 December 2012). “Pistol purchased by ATF agent found at alleged cartel crime scene in Mexico”. CBS News. Retrieved 14 January 2013.
- Jump up^ Attkisson, Sharyl (18 December 2012). “Fast and Furious gun found at Mexican crime scene”. CBS News. Retrieved 14 January 2013.
- ^ Jump up to:a b Serrano, Richard (August 16, 2011). “Supervisors in ATF gun operation are promoted”. Los Angeles Times. Retrieved January 13, 2012.
- Jump up^ Wagner, Dennis. “Phoenix-area gun store, ATF sting may be linked to shootout”. The Arizona Republic. Retrieved December 25, 2011.
- Jump up^ Lott, Maxim (February 2, 2011). “Senator Calls ATF on Allegations Agency Is Allowing Guns Into Mexico”. Fox News. Retrieved January 12, 2012.
- Jump up^ Salant, Jonathan (December 2, 2011). “Erroneous Gun Letter Based on U.S. Attorney, Documents Show”. Bloomberg. Retrieved January 13, 2012.
- Jump up^ Weich, Ronald. “Judiciary ATF 02-04-11 letter from DOJ deny allegations”. United States Senate. Retrieved January 13, 2012.
- Jump up^ Serrano, Richard (December 24, 2011). “Angry former ATF chief blames subordinates for Fast and Furious”. Los Angeles Times. Retrieved January 12, 2012.
- Jump up^ Attkisson, Sharyl. “Obama on “gunwalking”: Serious mistake may have been made”. CBS News. Retrieved January 13, 2012.
- Jump up^ Attorney General Eric Holder Testimony Before the House Judiciary Committee; CSPAN; May 3, 2011.
- ^ Jump up to:a b Hennessey, Kathleen (November 9, 2011). “Senate grills Holder on Fast and Furious gun-trafficking sting”. Los Angeles Times. Retrieved November 9, 2011.
- Jump up^ Attkisson, Sharyl. “Attorney General Eric Holder grilled by Congress on ATF “Gunwalker” controversy”. CBS News. Retrieved January 7, 2012.
- ^ Jump up to:a b Attkisson, Sharyl. “ATF Fast and Furious: New documents show Attorney General Eric Holder was briefed in July 2010″. CBS News. Retrieved January 7, 2012.
- Jump up^ Lott, Maxim (June 27, 2011). “‘Project Gunrunner’ Whistleblower Says ATF Sent Him Termination Notice”. Fox News. Retrieved July 26, 2011.
- Jump up^ Lajeunesse, William (June 15, 2011). “House Panel Releases Scathing Report on ‘Fast and Furious’ Gun Operation, Sure to Anger Mexico”. Fox News. Retrieved January 13, 2012.
- Jump up^ Murphy, Kim (June 14, 2011). “Report describes gun agents’ ‘state of panic'”.Los Angeles Times. Retrieved January 13, 2012.
- Jump up^ La Jeunesse, William (June 10, 2011). “Justice Officials in ‘Panic Mode’ as Hearing Nears on Failed Anti-Gun Trafficking Program”. Fox News. Retrieved January 13, 2012.
- Jump up^ Johnson, Kevin (June 16, 2011). “ATF agent calls gun-tracking program a ‘disaster'”. USA Today. Retrieved January 13, 2012.
- Jump up^ Holub, Hugh. “Statement of John Dodson about ATF gunwalker scandal: “The very idea of letting guns walk is unthinkable to most law enforcement.””. Tucson Citizen. Retrieved January 13, 2012.
- Jump up^ Serrano, Richard (August 17, 2011). “ATF denies it promoted Fast and Furious supervisors”. Los Angeles Times. Retrieved January 13, 2012.
- Jump up^ Attkisson, Sharyl. “Gunwalker scandal: ATF director out of top job”. CBS News. Retrieved January 7, 2012.
- Jump up^ Terry Frieden, Top Justice official expresses regret for failure to warn on ‘gun walking’ CNN, November 1, 2011.
- Jump up^ Carrie Johnson, “Official Admits ‘Mistake’ In Gun-Trafficking Case” NPR, November 1, 2011.
- Jump up^ “Senate Committee Hearing on International Organized Crime” CSPAN, November 1, 2011.
- Jump up^ Attkisson, Sharyl. “Eric Holder calls “gunwalking” unacceptable, regrets tactic as part of Fast and Furious”. CBS News. Retrieved January 7, 2012.
- Jump up^ “Holder emails” (PDF). Retrieved 2012-07-14.
- Jump up^ Dennis Wagner, “Ex-U.S. Attorney Burke admits to leaking whistle-blower’s records” The Arizona Republic, November 10, 2011.
- Jump up^ Carrie Johnson, “Justice Withdraws Inaccurate ‘Fast And Furious’ Letter It Sent To Congress” NPR, December 2, 2011.
- Jump up^ Sharyl Attkisson, “Documents: ATF used “Fast and Furious” to make the case for gun regulations”, CBS News, December 7, 2011.
- Jump up^ Savage, Charlie (January 31, 2012). “Report by House Democrats Absolves Administration in Gun Trafficking Case”. The New York Times. Retrieved January 31, 2012.
- Jump up^ Yager, Jordy. “Federal officer invokes Fifth in ‘Fast and Furious’ investigation”. The Hill. Retrieved January 22, 2012.
- Jump up^ Yost, Pete (February 1, 2012). “Dems: Fast & Furious just 1 of 4 misguided probes”. Associated Press. Retrieved March 11, 2012.
- Jump up^ Attkisson, Sharyl (May 22, 2012). “Homeland Security IG Investigates Fast and Furious”. CBS News. Retrieved 5 August 2012.
- Jump up^ http://oversight.house.gov/wp-content/uploads/2012/05/Update-on-Fast-and-Furious-with-attachment-FINAL.pdf
- Jump up^ Frieden, Terry (June 7, 2012). “Holder rejects GOP assertions on Fast and Furious at House hearing”. CNN. Retrieved 22 June 2012.
- Jump up^ “ATF Emails Discuss Bush-Era ‘Gun Walking’ Program” Page 2 email from William Newell to Carson W. Carroll 6 Oct 2007.
- Jump up^ Laurie Kellman (AP), “Mukasey confirmed as attorney general”, Washington Post, November 9, 2007.
- Jump up^ Issa: Obama executive privilege claim is cover-up or obstruction; Washington Times; June 26, 2012
- Jump up^ NRA sends Democrats a message over Holder contempt vote; CNN; July 2, 2012
- Jump up^ NRA Letter to the committee – June 20; National Rifle Association; June 20, 2012
- Jump up^ “House votes to hold attorney general in contempt”. Fox News. June 28, 2012. Retrieved 29 June 2012.
- Jump up^ Grant, David (June 27, 2012). “Why NRA wants Congress to vote Attorney General Eric Holder in contempt”. The Christian Science Monitor. Retrieved 29 June 2012.
- Jump up^ Hoyer Challenges Issa to Show E-Mails; New York Times; June 26, 2012
- Jump up^ Issa’s right: Tougher gun laws Fast and Furious goal; National Rifle Association; June 27, 2012
- Jump up^ “Justice Dept: Fast and Furious report distorted”. CBS News. August 1, 2012. Retrieved 3 August 2012.
- Jump up^ Serrano, Richard A. (July 31, 2012). “Justice Department shrugs off Fast and Furious report”. Los Angeles Times. Retrieved 3 August 2012.
- Jump up^ Frieden, Terry (August 2, 2012). “Deputy Director William Hoover resigns from ATF in wake of critical report”. CNN. Retrieved 3 August 2012.
- Jump up^ “Letter from Robert N. Driscoll to Andy Serwer re: The truth about the Fast and Furious scandal”. Politico. September 27, 2012. Retrieved 2014-06-25.
- Jump up^ Dylan Byers, “Exclusive: Fast and Furious whistleblower sues Time Inc. for libel”, Politico, 24 Oct 2012.
- Jump up^ “Libel Complaint, John Dodson v Time Inc., 6:12-294-MGL”. Documentcloud.org. Retrieved 2014-06-25.
- ^ Jump up to:a b c d Charlie Savage, “Guns Inquiry Urges Action Against 14 in Justice Dept.”,New York Times, 19 Sep 2012.
- Jump up^ Kevin Johnson (September 19, 2012). “Review: Holder did not know about ‘Fast and Furious'”. USA Today.
- ^ Jump up to:a b Attkisson, Sharyl (5 December 2012). “Heads roll after Fast and Furious investigation”. CBS News. Retrieved 14 January 2013.
- Jump up^ “Probe faults US agents over Mexico gunrunning”, Al Jazeera, 20 Sep 2012.
- Jump up^ Mary Jacoby, “Criminal Division Deputy Weinstein Resigns In Wake of Fast and Furious Report” Main Justice, September 19, 2012.
- Jump up^ Evan Perez, “Firings Set Over ‘Fast and Furious'”, The Wall Street Journal, 4 Dec 2012. Subscription required.
- Jump up^ Chuck Neubauer (2012-12-05). “Firings advised for 4 ATF leaders tied to Fast and Furious”. Washington Times. Retrieved 2014-06-25.
- Jump up^ Sharyl Attkisson, “Brian Terry family sues ATF officials in Fast and Furious”CBS, December 17, 2012.
- Jump up^ John Dodson, The Unarmed Truth: My Fight to Blow the Whistle and Expose Fast and Furious Hardcover, Threshold Editions, 3 Dec 2013, ISBN 978-1476727554. Hardcover: 304 pages.·
- Jump up^ Phillips, Whitney. “Feds name 4 suspects linked to Fast and Furious”. Independentmail.com. Retrieved 9 July 2012.
- Jump up^ “Feds unveil indictments in Border Patrol Agent Brian Terry’s slaying”. CNN. July 9, 2012. Retrieved 9 July 2012.
- ^ Jump up to:a b “Fast and Furious suspect sentenced”. CBS/AP. 12 December 2012. Retrieved 14 January 2013.
- Jump up^ Perry, Tony (15 October 2012). “‘Fast and Furious’ defendant gets prison for buying guns”. Los Angeles Times. Retrieved 11 March 2013.
- ^ Jump up to:a b c Hernandez, Daniel (October 6, 2011). “MEXICO: News of another U.S. gun-tracking program stirs criticism”. Los Angeles Times. Retrieved October 17, 2011.
- ^ Jump up to:a b c d e Ellingwood, Ken (September 19, 2011). “Mexico still waiting for answers on Fast and Furious gun program”. Los Angeles Times. Retrieved October 17, 2011.
- Jump up^ “México pide la extradición de seis estadounidenses por tráfico de armas”. CNN Mexico. November 16, 2011.
- Jump up^ “Busca PGR extradición de implicados en ‘Rápido y furioso'”. Noticieros Televisa. November 16, 2011. Retrieved November 17, 2011.
- Jump up^ “Exige Senado mexicano reclamo a EE.UU por armas ilegales”. Prensa Latina. Retrieved October 17, 2011.
- Jump up^ MEXICO: News of another U.S. gun-tracking program stirs criticism; Los Angeles Times; October 6, 2011
- ^ Jump up to:a b Murphy, Kim (March 10, 2011). “Mexico lawmakers demand answers about guns smuggled under ATF’s watch”. Los Angeles Times. Retrieved November 6, 2011.
- Jump up^ “EU: ¿aliado o enemigo?”. La Jornada. Retrieved October 17, 2011.
From Wikipedia, the free encyclopedia
In the United States government, executive privilege is the power claimed by the President of the United States and other members of the executive branch to resist certain subpoenas and other interventions by the legislative and judicial branches of government to access information and personnel relating to the executive branch. The concept of executive privilege is not mentioned explicitly in the United States Constitution, but the Supreme Court of the United States ruled it to be an element of the separation of powers doctrine, and/or derived from the supremacy of executive branch in its own area of Constitutional activity.The Supreme Court confirmed the legitimacy of this doctrine in United States v. Nixon, but only to the extent of confirming that there is a qualified privilege. Once invoked, a presumption of privilege is established, requiring the Prosecutor to make a “sufficient showing” that the “Presidential material” is “essential to the justice of the case” (418 U.S. at 713-14).Chief Justice Burger further stated that executive privilege would most effectively apply when the oversight of the executive would impair that branch’s national security concerns.
Historically, the uses of executive privilege underscore the untested nature of the doctrine, since Presidents have generally sidestepped open confrontations with the United States Congress and the courts over the issue by first asserting the privilege, then producing some of the documents requested on an assertedly voluntary basis.
Executive privilege is a specific instance of the more general common-law principle of deliberative process privilege and is believed to trace its roots to the English Crown Privilege.
In the context of privilege assertions by US Presidents, “In 1796, President George Washington refused to comply with a request by the House of Representatives for documents related to the negotiation of the then-recently adopted Jay Treaty with the Kingdom of Great Britain. The Senate alone plays a role in the ratification of treaties, Washington reasoned, and therefore the House had no legitimate claim to the material. Therefore, Washington provided the documents to the Senate but not the House.”
President Thomas Jefferson continued the precedent for this in the trial of Aaron Burr for treason in 1807. Burr asked the court to issue a subpoena duces tecum to compel Jefferson to provide his private letters concerning Burr. Chief Justice John Marshall, a strong proponent of the powers of the federal government but also a political opponent of Jefferson, ruled that the Sixth Amendment to the Constitution, which allows for these sorts of court orders for criminal defendants, did not provide any exception for the president. As for Jefferson’s claim that disclosure of the document would imperil public safety, Marshall held that the court, not the president, would be the judge of that. Jefferson complied with Marshall’s order.
In 1833, President Andrew Jackson cited executive privilege when Senator Henry Clay demanded he produce documents concerning statements the president made to his cabinet about the removal of federal deposits from the Second Bank of the United States during the Bank War.
During the period of 1947-49, several major security cases became known to Congress. There followed a series of investigations, culminating in the famous Hiss-Chambers case of 1948. At that point, the Truman Administration issued a sweeping secrecy order blocking congressional efforts from FBI and other executive data on security problems. Security files were moved to the White House and Administration officials were banned from testifying before Congress on security related matters. Investigation of the State Department and other cases was stymied and the matter left unresolved.
During the Army–McCarthy hearings in 1954, Eisenhower used the claim of executive privilege to forbid the “provision of any data about internal conversations, meetings, or written communication among staffers, with no exception to topics or people.” Department of Defense employees were also instructed not to testify on any such conversations or produce any such documents or reproductions. This was done to refuse the McCarthy Committee subpoenas of transcripts of monitored telephone calls from Army officials, as well as information on meetings between Eisenhower officials relating to the hearings. This was done in the form of a letter from Eisenhower to the Department of Defense and an accompanying memo from Eisenhower Justice. The reasoning behind the order was that there was a need for “candid” exchanges among executive employees in giving “advice” to one another. In the end, Eisenhower would invoke the claim 44 times between 1955 and 1960.
U.S. v. Nixon
The Supreme Court addressed ‘executive privilege’ in United States v. Nixon, the 1974 case involving the demand by Watergate special prosecutor Archibald Cox that President Richard Nixon produce the audiotapes of conversations he and his colleagues had in the Oval Office of the White House in connection with criminal charges being brought against members of the Nixon Administration. Nixon invoked the privilege and refused to produce any records.
The Supreme Court did not reject the claim of privilege out of hand; it noted, in fact, “the valid need for protection of communications between high Government officials and those who advise and assist them in the performance of their manifold duties” and that “[h]uman experience teaches that those who expect public dissemination of their remarks may well temper candor with a concern for appearances and for their own interests to the detriment of the decisionmaking process.” This is very similar to the logic that the Court had used in establishing an “executive immunity” defense for high office-holders charged with violating citizens’ constitutional rights in the course of performing their duties. The Supreme Court stated: “To read the Article II powers of the President as providing an absolute privilege as against a subpoena essential to enforcement of criminal statutes on no more than a generalized claim of the public interest in confidentiality of nonmilitary and nondiplomatic discussions would upset the constitutional balance of ‘a workable government’ and gravely impair the role of the courts under Article III.” Because Nixon had asserted only a generalized need for confidentiality, the Court held that the larger public interest in obtaining the truth in the context of a criminal prosecution took precedence.
“Once executive privilege is asserted, coequal branches of the Government are set on a collision course. The Judiciary is forced into the difficult task of balancing the need for information in a judicial proceeding and the Executive’s Article II prerogatives. This inquiry places courts in the awkward position of evaluating the Executive’s claims of confidentiality and autonomy, and pushes to the fore difficult questions of separation of powers and checks and balances. These ‘occasion[s] for constitutional confrontation between the two branches’ are likely to be avoided whenever possible. United States v. Nixon, supra, at 692.”
The Clinton administration invoked executive privilege on fourteen occasions.
In 1998, President Bill Clinton became the first President since Nixon to assert executive privilege and lose in court, when a Federal judge ruled that Clinton aides could be called to testify in the Lewinsky scandal.
Later, Clinton exercised a form of negotiated executive privilege when he agreed to testify before the grand jury called by Independent Counsel Kenneth Starr only after negotiating the terms under which he would appear. Declaring that “absolutely no one is above the law”, Starr said such a privilege “must give way” and evidence “must be turned over” to prosecutors if it is relevant to an investigation.
George W. Bush administration
The Bush administration invoked executive privilege on six occasions.
President George W. Bush first asserted executive privilege to deny disclosure of sought details regarding former Attorney General Janet Reno, the scandal involving Federal Bureau of Investigation (FBI) misuse of organized-crime informants James J. Bulger and Stephen Flemmi in Boston, and Justice Department deliberations about President Bill Clinton’s fundraising tactics, in December 2001.
Bush invoked executive privilege “in substance” in refusing to disclose the details of Vice President Dick Cheney‘s meetings with energy executives, which was not appealed by the GAO. In a separate Supreme Court decision in 2004, however, Justice Anthony Kennedy noted “Executive privilege is an extraordinary assertion of power ‘not to be lightly invoked.’ United States v. Reynolds, 345 U.S. 1, 7 (1953).
Further, on June 28, 2007, Bush invoked executive privilege in response to congressional subpoenas requesting documents from former presidential counsel Harriet Miers and former political director Sara Taylor, citing that:
The reason for these distinctions rests upon a bedrock presidential prerogative: for the President to perform his constitutional duties, it is imperative that he receive candid and unfettered advice and that free and open discussions and deliberations occur among his advisors and between those advisors and others within and outside the Executive Branch.
On July 9, 2007, Bush again invoked executive privilege to block a congressional subpoena requiring the testimonies of Taylor and Miers. Furthermore, White House Counsel Fred F. Fielding refused to comply with a deadline set by the chairman of the Senate Judiciary Committee to explain its privilege claim, prove that the president personally invoked it, and provide logs of which documents were being withheld. On July 25, 2007, the House Judiciary Committee voted to cite Miers andWhite House Chief of Staff Joshua Bolten for contempt of Congress.
On July 13, less than a week after claiming executive privilege for Miers and Taylor, Counsel Fielding effectively claimed the privilege once again, this time in relation to documents related to the 2004 death of Army Ranger Pat Tillman. In a letter to the House Committee on Oversight and Government Reform, Fielding claimed certain papers relating to discussion of the friendly-fire shooting “implicate Executive Branch confidentiality interests” and would therefore not be turned over to the committee.
On August 1, 2007, Bush invoked the privilege for the fourth time in little over a month, this time rejecting a subpoena for Karl Rove. The subpoena would have required the President’s Senior Advisor to testify before the Senate Judiciary Committee in a probe over fired federal prosecutors. In a letter to Senate Judiciary ChairmanPatrick Leahy, Fielding claimed that “Mr. Rove, as an immediate presidential advisor, is immune from compelled congressional testimony about matters that arose during his tenure and that relate to his official duties in that capacity….”
Leahy claimed that President Bush was not involved with the employment terminations of U.S. attorneys. Furthermore, he asserted that the president’s executive privilege claims protecting Josh Bolten, and Karl Rove are illegal. The Senator demanded that Bolten, Rove, Sara Taylor, and J. Scott Jennings comply “immediately” with their subpoenas, presumably to await a further review of these matters. This development paved the way for a Senate panel vote on whether to advance the citations to the full Senate. “It is obvious that the reasons given for these firings were contrived as part of a cover up and that the stonewalling by the White House is part and parcel of that same effort”, Leahy concluded about these incidents.
As of July 17, 2008, Rove still claimed executive privilege to avoid a congressional subpoena. Rove’s lawyer wrote that his client is “constitutionally immune from compelled congressional testimony.”
House Investigation of the SEC
Leaders of the U.S. Securities and Exchange Commission testified on February 4, 2009 before the United States House Committee on Financial Servicessubcommittee including Linda Chatman Thomsen S.E.C. enforcement director, acting General Counsel Andy Vollmer, Andrew Donohue, Erik Sirri, and Lori Richards and Stephen Luparello of FINRA. The subject of the hearings were on why the SEC had failed to act when Harry Markopolos, a private fraud investigator from Boston alerted the Securities and Exchange Commission detailing his persistent and unsuccessful efforts to get the SEC to investigate Bernard Madoff, beginning in 1999.Vollmer claimed executive privilege in declining to answer some questions. Subcommittee chairman Paul E. Kanjorski asked Mr. Vollmer if he had obtained executive privilege from the U.S. attorney general. “No … this is the position of the agency,” said Vollmer. “Did the SEC instruct him not to respond to questions?” Mr. Kanjorski asked. Vollmer replied that it was the position of the Commission and that “the answer is no.” The SEC announced Vollmer would “leave the Commission and return to the private sector,” just 14 days after making the claim.
On June 20, 2012, President Barack Obama asserted executive privilege, his first, to withhold certain Department of Justice documents related to the ongoingOperation Fast and Furious controversy ahead of a United States House Committee on Oversight and Government Reform vote to hold Attorney General Eric Holder inContempt of Congress for refusing to produce the documents. Later the same day, the United States House Committee on Oversight and Government Reform voted 23-17 along party lines to hold Attorney General Holder in contempt of Congress over not releasing documents regarding Fast and Furious.
- Jump up^ Chief Justice Burger, writing for the majority in US v. Nixon noted: “Whatever the nature of the privilege of confidentiality of Presidential communications in the exercise of Art. II powers, the privilege can be said to derive from the supremacy of each branch within its own assigned area of constitutional duties. Certain powers and privileges flow from the nature of enumerated powers; the protection of the confidentiality of Presidential communications has similar constitutional underpinnings.United States v. Nixon, 418 U.S. 683 (1974) (Supreme Court opinion at FindLaw)
- Jump up^ Proper Assertion of the Deliberative Process Principle, S Narayan, p 6
- Jump up^ FindLaw’s Writ – Dorf: A Brief History Of Executive Privilege, From George Washington Through Dick Cheney
- Jump up^ David and Jeanne Heidler, Henry Clay: The Essential American (2010) p.264
- Jump up^ Blacklisted by History, p. 23
- Jump up^ Blacklisted by History p.575
- Jump up^ Holding, Reynolds. Time, March 21, 2007. Holding, Reynolds (March 21, 2007). “The Executive Privilege Showdown”. Time. Retrieved 2007-03-27.
- Jump up^ Baker, Peter; and Schmidt, Susan. “President is Denied Executive Privilege”. The Washington Post. July 22, 1998. Retrieved 2007-03-27. Washington Post, May 6, 1998.
- Jump up^ Lewis, Neil A. (2001-12-14). “Bush Claims Executive Privilege in Response to House Inquiry”. New York Times. Retrieved 2007-07-17.
- Jump up^ 
- Jump up^ “House inches toward constitutional showdown with contempt vote”. Politics (CNN). July 25, 2007. Retrieved 2007-07-25.
- Jump up^ “House Judiciary Reports Contempt Citations to the House of Representatives” (Press release). U.S. House of Representatives Committee on the Judiciary. July 25, 2007. Retrieved 2007-07-26.
- Jump up^ “White House Rebuffs Congress on Tillman Papers”. Politics (The Seattle Times). August 1, 2007. Retrieved 2008-08-01.
- Jump up^ “Bush won’t let aide Rove testify to Congress”. Politics (Reuters). August 1, 2007. Retrieved 2008-08-01.
- Jump up^ “Leahy: Bush not involved in firings”. Yahoo! News. Retrieved 2008-11-30.
- Jump up^ “Leahy: Rove, others must comply with subpoenas”. CNN. Retrieved 2008-11-30.
- Jump up^ “Leahy again orders Karl Rove to appear”. Bennington Banner. Retrieved 2008-11-30.
- Jump up^ “Leahy again demands U.S. attorney info”. Earth Times. Retrieved 2008-11-30.
- Jump up^ “Rove ignores committee’s subpoena, refuses to testify”. CNN. July 10, 2008. Retrieved 2008-07-10.
- Jump up^ Henriques, Diana (February 4, 2009). “Anger and Drama at a House Hearing on Madoff”. The New York Times.
- ^ Jump up to:a b c d e Jamieson, Dan (February 4, 2009). “SEC officials dodge questions; one claims privilege”. InvestmentNews.
- Jump up^ Ahrens, Frank (February 5, 2009). “Lawmakers Sink Teeth Into the SEC: Agency Mocked for Not Catching Madoff”. The Washington Post. pp. D01.
- Jump up^ “Acting General Counsel Andrew Vollmer to Leave SEC”. Washington, D.C.: U.S. Securities and Exchange Commission. Feb 18, 2009. Retrieved 6 March 2009.
- Jump up^ Jackson, David (June 20, 2012). “Obama team: ‘Fast and Furious’ documents are privileged”. USA Today. Retrieved 20 June 2012.
- Jump up^ Madhani and Davis, Aamer and Susan (June 20, 2012). “House panel votes to cite Holder for contempt of Congress”. USA Today. Retrieved 20 June 2012.
President Asserts Executive Privilege in Bid to Forestall Contempt Vote By JOHN H. CUSHMAN Jr. Published: June 20, 2012 NY Times
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Story 1: Obama Recklessly Endangers The Health of The American People By Allowing West Africans From Ebola Infected Countries To Fly Into United States — Open Borders To Illegal Aliens Fleeing Ebola Pandemic — Obama Panics And Appoints New Ebola Czar — Another Political Elitist Establishment (PEE) Washington Insider With No Executive Leadership or Medical Experience — Videos
Biosafety Level 4 Laboratory Spacesuits
Biosafety Level 4 Hospital Spacesuits
CDC warns against travel ban on Ebola-affected countries
Bill Johnson Discusses the Congressional Ebola Hearing with Fox News’ Gretchen Carlson
Ebola outbreak: Nebraska Medical Center ready at moment’s notice
Activation- A Nebraska Medical Center Biocontainment Unit Story
NEIDL: Biosafety Level 4
A Mission of Safety
In the Hot Zone with Virus X – Richard Preston
Elbows-Deep in Ebola Virus – Richard Preston
CNN Reporter To WH: What Does Obama’s Ebola Czar Know About Ebola?
Dr Nicole Lurie on National Health Security and Resiliency
Nicole Lurie, HHS: Flu Pandemic Lessons for Future Biothreats
How to Prioritize Flu Vaccine in Future (Panel discussion)
How Influenza Pandemics Occur
Hospitals “Full-Up”: The 1918 Influenza Pandemic
Dr. Nicole Lurie – HHS Assistant Secretary for Preparedness & Response
Ebola Czar hides away in bunker — Dr. Nicole Lurie
Weekly Examiner: Obama appoints Ebola czar
Obama Appoints Ebola ‘czar’ As Anxiety Mounts
Source: Obama to name Ron Klain as Ebola czar
President Obama appoints Ron Klain as Ebola “czar”
Remarks of Ron Klain
Actor Kevin Spacey, Georgetown’s Ron Klain Discuss Politics and Ethics
Obama’s New Ebola ‘Czar’ Has NO Health or Medical Background!
Krauthammer: Obama Is a Narcissist ‘Surrounded by Sycophants’
President Obama Speaks on Ebola
Fast Facts on US Hospitals
The American Hospital Association conducts an annual survey of hospitals in the United States. The data below, from the 2012 AHA Annual Survey, are a sample of what you will find in AHA Hospital Statistics, 2014 edition. The definitive source for aggregate hospital data and trend analysis, AHA Hospital Statistics includes current and historical data on utilization, personnel, revenue, expenses, managed care contracts, community health indicators, physician models, and much more.
AHA Hospital Statistics is published annually by Health Forum, an affiliate of the American Hospital Association. Additional details on AHA Hospital Statistics and other Health Forum data products are available at www.ahadataviewer.com. To order AHA Hospital Statistics, call (800) AHA-2626 or click on www.ahaonlinestore.com.
For further information or customized data and research, contact the AHA Resource Center at (312) 422-2050 or firstname.lastname@example.org.
Total Number of All U.S. Registered * Hospitals
| Number of U.S. Community ** Hospitals
| Number of Nongovernment Not-for-Profit Community Hospitals
| Number of Investor-Owned (For-Profit) Community Hospitals
| Number of State and Local Government Community Hospitals
| Number of Federal Government Hospitals
| Number of Nonfederal Psychiatric Hospitals
| Number of Nonfederal Long Term Care Hospitals
| Number of Hospital Units of Institutions
(Prison Hospitals, College Infirmaries, Etc.)
| Total Staffed Beds in All U.S. Registered * Hospitals
| Staffed Beds in Community** Hospitals
| Total Admissions in All U.S. Registered * Hospitals
| Admissions in Community** Hospitals
| Total Expenses for All U.S. Registered * Hospitals
| Expenses for Community** Hospitals
| Number of Rural Community** Hospitals
| Number of Urban Community** Hospitals
| Number of Community Hospitals in a System ***
| Number of Community Hospitals in a Network ****
*Registered hospitals are those hospitals that meet AHA’s criteria for registration as a hospital facility. Registered hospitals include AHA member hospitals as well as nonmember hospitals. For a complete listing of the criteria used for registration, please see Registration Requirements for Hospitals.
**Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries.
***System is defined by AHA as either a multihospital or a diversified single hospital system. A multihospital system is two or more hospitals owned, leased, sponsored, or contract managed by a central organization. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital preacute or postacute health care organizations. System affiliation does not preclude network participation.
**** Network is a group of hospitals, physicians, other providers, insurers and/or community agencies that work together to coordinate and deliver a broad spectrum of services to their community. Network participation does not preclude system affiliation.
Inside The Isolation Wards That Keep Americans Safe From Ebola
Ebola has officially made it to the US, but there is absolutely no reason to freak out. That’s in large part thanks to Emory University Hospital’s state-of-the-art isolation ward, which is better-equipped to field Ebola cases than any ordinary hospital in the country. Here’s a look at the tech that keeps doctors and nurses safe.
Emory is one of four high-level biocontainment patient care units in the US; the others are located at the National Institutes of Health in Maryland, Rocky Mountain Laboratories in Montana, and the University of Nebraska Medical Center. We spoke with Dr. Angela Hewlett, associate medical director at the Nebraska Biocontainment Patient Care Unit — the largest of the four facilities — about biocontainment suits, wearing three pairs of gloves, and custom air pressure systems.
Perhaps the most comfort Hewlett was able to provide is that none of the super-fancy tech that these four high-level isolation wards have at their disposal is even necessary for Ebola. “There’s a big fear factor with this illness but really, these types of patients can taken care of at any good healthcare facility,” says Dr. Hewlett.
That’s because the Ebola virus easily dies outside of the human body, so unless you’ve been handling a sick person’s blood or feces, you are almost certainly A-OK. Ebola is pretty darn hard to get compared to an airborne disease like SARS or even the regular old flu. But with a mortality rate of up to 90 per cent — and over 50 per cent with the strain in the current outbreak — we still need to keep doctors and nurses as safe as we can. Here’s how Nebraska Biocontainment Unit keeps diseases like Ebola — and much, much worse — from spreading in the hospital.
Negative air pressure. As with Emory in Atlanta, the isolation unit in Nebraska is isolated from the rest of the general hospital. It runs on its own air circulation system, and the air is passed through a high-efficiency particulate air (HEPA) filter before it is vented outside of the building. That’s the same kind of precautions that you would see in a biosafety level 4 lab (the highest) that works with deadly or highly contagious diseases.
In addition, the biocontainment unit has negative air pressure, which means that air pressure inside the isolation rooms is slightly lower than that outside. Essentially, air is gently sucked into the room, so particles from inside the room can’t float out when you open a door. As another line of protection, ultraviolet lights zap any viruses or bacteria in the air or on surfaces.
Full-body suits and THREE pairs of gloves. The Biocontainment Unit is equipped with gear that covers you head to toe, in some places three times over. That includes personal respirators, headgear, full-body suits and gloves. Healthcare workers wear three pairs, including one thick pair that protects against needle accidents, and then two pairs of ordinary gloves so they have an extra pair to work with patients.
Entering and exiting the room becomes an elaborate production because putting on and taking off all the gear can take more than 10 minutes each way. A second person assists to make sure every piece of equipment is put on right and there are no rips or tears in any of the protective gear. Afterwards, every piece of equipment is wiped down to kill the pathogen; in the case of Ebola, simple bleach is enough to do the trick. The full-body suit is discarded after each use.
Training and training and training. Having fancy technology is great but not if you don’t know how to use it properly. “They have to go through really extensive training,” says Hewlett of the the 30-person team that works in the unit. They get 80 hours of training before they can begin, followed by monthly meetings and quarterly drills, where the photos in this post were taken.
It’s worth reiterating that most of this equipment and these procedures go above and beyond protecting for Ebola. The air systems and full-body suits are really there to guard against possible airborne diseases, like smallpox or SARS or some highly contagious avian flu viruses that may emerge in the future.
In fact, the CDC’s current guidelines for treating Ebola in U.S. hospitals require only gloves, goggles, a facemask, and a gown in most situations. Even if someone inadvertently brings Ebola to other hospitals, it’s highly unlikely to spread in the U.S. The situation is different in Africa, where inadequate equipment and fear of healthcare workers has contributed to the worsening situation.
A State Department official did visit Nebraska to see whether the unit would be ready to accept any Ebola patients in the future, though the facility hasn’t yet been used despite being open for nine years. There hasn’t been a disease serious enough to merit it. “This is good thing,” says Dr. Hewlett, “However with world travel the way it is, it is inevitable these things are going to come eventually.” If and when Ebola does come to the U.S. again, we are definitely prepared, which is not something we can say about what else may be coming down the line.
Pictures: University of Nebraska Medical Center
Obama names Ron Klain as Ebola ‘czar’
President Obama tapped veteran government insider Ron Klain to coordinate his administration’s efforts to contain the Ebola virus Friday.
Klain, a former chief of staff to Vice Presidents Joe Biden and Al Gore, is well-known by Obama and White House aides. He was selected for his management experience and contacts throughout the government, White House spokesman Josh Earnest said.
“He is the right person for the job,” Earnest said, particularly the challenge of “integrating the interagency response.”
Klain’s appointment marks a swift turnabout for Obama, who until Thursday had resisted calls to appoint a single official to run the government’s response to Ebola.
Asked Thursday about the prospect of an “Ebola czar,” Obama said, “It may make sense for us to have one person, in part just so that after this initial surge of activity, we can have a more regular process just to make sure that we’re crossing all the t’s and dotting all the i’s going forward.”
Obama did not mention Klain’s appointment during a speech Friday to the Consumer Financial Protection Bureau, but he said his administration is taking an “all-hands-on-deck” approach to fighting Ebola.
The administration has come under increased pressure to name an anti-Ebola coordinator in the wake of news that two nurses in Dallas contracted the deadly virus. Both had treated a man who died of Ebola.
Klain played a high-profile file in Gore’s 2000 presidential campaign. Oscar-winning actor Kevin Spacey portrayed him in an HBO movie on that year’s Florida recount.
The Ebola response includes efforts to screen travelers from West African nations where Ebola has reached epidemic proportions and killed more than 4,500 people. Klain will help coordinate the assistance the U.S. military provides in West Africa.
Some Republican lawmakers criticized Obama for entrusting the job to a former government manager rather than a professional.
Rep. Andy Harris, R-Md., tweeted, “Worst ebola epidemic in world history and Pres. Obama puts a government bureaucrat with no healthcare experience in charge. Is he serious?”
Members of the public health community expressed surprise.
“When are they going to stop making mistakes?” said Robert Murphy, the director of the Center for Global Health at Northwestern University’s Feinberg School of Medicine. “We need a czar, but optimally a strong public health expert. I am so disappointed. This is not what we need.”
Physician Amesh Adalja, a spokesman for the Infectious Diseases Society of America, said, “It’s clear that there’s a desperate desire for an organized approach to dealing with this outbreak. I don’t necessarily think we need a disease-specific czar — we have one for HIV — but more of an emerging infectious diseases/biosecurity coordinator who reports to the president.”
The Ebola position is designed to be more managerial in nature, involving an array of government agencies ranging from the Pentagon to Health and Human Services.
“This is much broader than a medical response,” Earnest said.
As for Republican criticism, Earnest joked, “That’s a shocking development.” He noted that national elections are less than three weeks away.
Klain may weigh in on another question facing the administration: the prospect of a U.S. travel ban from West African nations where there have been Ebola outbreaks.
Obama and aides have disputed the need for a travel ban, questioning whether it would work and arguing that it might create unintended problems.
Thursday, Obama said experts in infectious diseases have told him “a travel ban is less effective than the measures that we are currently instituting that involve screening passengers who are coming from West Africa.”
Klain is likely to take a low key role publicly.
Earnest said Obama wasn’t looking for an Ebola expert but “an implementation expert.”
He confirmed Klain’s title: “Ebola response coordinator.”
Klain will report to two officials involved in the anti-Ebola effort: homeland security adviser Lisa Monaco and national security adviser Susan Rice.
Obama is pleased with the work of Monaco and Rice, but “given their management of other national and homeland security priorities, additional bandwidth will further enhance the government’s Ebola response,” a White House official said, speaking on condition of anonymity.
The president has long known Klain, who helped prepare him for debates with Mitt Romney during the 2012 presidential campaign.
Klain has been out of government since leaving Biden’s staff during Obama’s first term.
Who Do They Think We Are?
By PEGGY NOONAN
The administration’s Ebola evasions reveal its disdain for the American people.
The administration’s handling of the Ebola crisis continues to be marked by double talk, runaround and gobbledygook. And its logic is worse than its language. In many of its actions, especially its public pronouncements, the government is functioning not as a soother of public anxiety but the cause of it.
An example this week came in the dialogue between Megyn Kelly of Fox News andThomas Frieden, director of the Centers for Disease Control.
Their conversation focused largely on the government’s refusal to stop travel into the United States by citizens of plague nations. “Why not put a travel ban in place,” Ms. Kelly asked, while we shore up the U.S. public-health system?
Dr. Frieden replied that we now have screening at airports, and “we’ve already recommended that all nonessential travel to these countries be stopped for Americans.” He added: “We’re always looking at ways that we can better protect Americans.”
“But this is one,” Ms. Kelly responded.
Dr. Frieden implied a travel ban would be harmful: “If we do things that are going to make it harder to stop the epidemic there, it’s going to spread to other parts of—”
Ms. Kelly interjected, asking how keeping citizens from the affected regions out of America would make it harder to stop Ebola in Africa.
“Because you can’t get people in and out.”
“Why can’t we have charter flights?”
“You know, charter flights don’t do the same thing commercial airliners do.”
“What do you mean? They fly in and fly out.”
Dr. Frieden replied that limiting travel between African nations would slow relief efforts. “If we isolate these countries, what’s not going to happen is disease staying there. It’s going to spread more all over Africa and we’ll be at higher risk.”
Later in the interview, Ms. Kelly noted that we still have airplanes coming into the U.S. from Liberia, with passengers expected to self-report Ebola exposure.
Dr. Frieden responded: “Ultimately the only way—and you may not like this—but the only way we will get our risk to zero here is to stop the outbreak in Africa.”
Ms. Kelly said yes, that’s why we’re sending troops. But why can’t we do that and have a travel ban?
“If it spreads more in Africa, it’s going to be more of a risk to us here. Our only goal is protecting Americans—that’s our mission. We do that by protecting people here and by stopping threats abroad. That protects Americans.”
Dr. Frieden’s logic was a bit of a heart-stopper. In fact his responses were more non sequiturs than answers. We cannot ban people at high risk of Ebola from entering the U.S. because people in West Africa have Ebola, and we don’t want it to spread. Huh?
In testimony before Congress Thursday, Dr. Frieden was not much more straightforward. His answers often sound like filibusters: long, rolling paragraphs of benign assertion, advertising slogans—“We know how to stop Ebola,” “Our focus is protecting people”—occasionally extraneous data, and testimony to the excellence of our health-care professionals.
It is my impression that everyone who speaks for the government on this issue has been instructed to imagine his audience as anxious children. It feels like how the pediatrician talks to the child, not the parents. It’s as if they’ve been told: “Talk, talk, talk, but don’t say anything. Clarity is the enemy.”
The language of government now is word-spew.
Dr. Frieden did not explain his or the government’s thinking on the reasons for opposition to a travel ban. On the other hand, he noted that the government will consider all options in stopping the virus from spreading here, so perhaps that marks the beginning of a possible concession.
It is one thing that Dr. Frieden, and those who are presumably making the big decisions, have been so far incapable of making a believable and compelling case for not instituting a ban. A separate issue is how poor a decision it is. To call it childish would be unfair to children. In fact, if you had a group of 11-year-olds, they would surely have a superior answer to the question: “Sick people are coming through the door of the house, and we are not sure how to make them well. Meanwhile they are starting to make us sick, too. What is the first thing to do?”
The children would reply: “Close the door.” One would add: “Just for a while, while you figure out how to treat everyone getting sick.” Another might say: “And keep going outside the door in protective clothing with medical help.” Eleven-year-olds would get this one right without a lot of struggle.
If we don’t momentarily close the door to citizens of the affected nations, it is certain that more cases will come into the U.S. It is hard to see how that helps anyone. Closing the door would be no guarantee of safety—nothing is guaranteed, and the world is porous. But it would reduce risk and likelihood, which itself is worthwhile.
Africa, by the way, seems to understand this. The Associated Press on Thursday reported the continent’s health-care officials had limited the threat to only five countries with the help of border controls, travel restrictions, and aggressive and sophisticated tracking.
All of which returns me to my thoughts the past few weeks. Back then I’d hear the official wordage that doesn’t amount to a logical thought, and the unspoken air of “We don’t want to panic you savages,” and I’d look at various public officials and muse: “Who do you think you are?”
Now I think, “Who do they think we are?”
Does the government think if America is made to feel safer, she will forget the needs of the Ebola nations? But Americans, more than anyone else, are the volunteers, altruists and in a few cases saints who go to the Ebola nations to help. And they were doing it long before the Western media was talking about the disease, and long before America was experiencing it.
At the Ebola hearings Thursday, Rep. Henry Waxman (D., Calif.) said, I guess to the American people: “Don’t panic.” No one’s panicking—except perhaps the administration, which might explain its decisions.
Is it always the most frightened people who run around telling others to calm down?
This week the president canceled a fundraiser and returned to the White House to deal with the crisis. He made a statement and came across as about three days behind the story—“rapid response teams” and so forth. It reminded some people of the statement in July, during another crisis, of the president’s communications director, who said that when a president rushes back to Washington, it “can have the unintended consequence of unduly alarming the American people.” Yes, we’re such sissies. Actually, when Mr. Obama eschews a fundraiser to go to his office to deal with a public problem we are not scared, only surprised.
But again, who do they think we are? You gather they see us as poor, panic-stricken people who want a travel ban because we’re beside ourselves with fear and loathing. Instead of practical, realistic people who are way ahead of our government.
From Wikipedia, the free encyclopedia
Ronald A. “Ron” Klain is an American lawyer and political operative best known for serving as Chief of Staff to two Vice Presidents – Al Gore (1995–1999) and Joseph Biden (2009–2011). He is an influential Democratic Party insider. Earlier in his career, he was a law clerk for Supreme Court Justice Byron “Whizzer” White during the Court’s 1987 and 1988 Terms and worked on Capitol Hill, where he was Chief Counsel to the Senate Judiciary Committee during theClarence Thomas Supreme Court nomination. He was portrayed by Kevin Spacey in the HBO film Recount depicting the tumult of the 2000 presidential election. On October 17, 2014, President Obama named Klain the newly created “Ebola response coordinator” (or, less officially, Ebola “czar”).
Klain was born on August 8, 1961 in Indianapolis, He is a member of the DayBreak Boys Band and grew up in a Jewish home. He graduated from North Central High School in 1979 and was on the school’s Brain Game team, which finished as season runner-up. He graduated summa cum laude from Georgetown University in 1983. In 1987, he graduated magna cum laude from Harvard Law School, where he was one of several to win the Sears Prize for the highest grade point average in 1984–85. While at Harvard Law School, Klain was also an editor of the Harvard Law Review.
Capitol Hill career
Klain’s early experience on Capitol Hill included serving as Legislative Director for U.S. Representative Ed Markey. From 1989 to 1992, he served as Chief Counsel to the U.S. Senate Committee on the Judiciary, overseeing the legal staff’s work on matters of constitutional law, criminal law, antitrust law, and Supreme Court nominations. In 1995, Senator Tom Daschle appointed him the Staff Director of the Senate Democratic Leadership Committee.
Klain joined the Clinton-Gore campaign in 1992. He ultimately was involved in both of Bill Clinton‘s campaigns, oversaw Clinton’s judicial nominations, and was General Counsel to Al Gore’s recount committee in the 2000 election aftermath. Some published reports have given him credit for Clinton’s “100,000 cops” proposal during the 1992 campaign; at a minimum, he worked closely with Clinton aide Bruce Reed in formulating it. In the White House, he was Associate Counsel to the President, directing judicial selection efforts, and led the team that won confirmation of Supreme Court Associate Justice Ruth Bader Ginsburg. Klain left the judicial selection role in 1994 to become Chief of Staff and Counselor to Attorney General Janet Reno. In 1995, he became Assistant to the President, and Chief of Staff and Counselor to Al Gore.
During Klain’s tenure as Gore’s Chief of Staff, Gore consolidated his position as the likely Democratic nominee in 2000. Still, Klain was seen as too loyal to Clinton by some longtime Gore advisors. Feuding broke out between Clinton and Gore loyalists in the White House in 1999, and Klain was ousted by Gore campaign chairmanTony Coelho in August of that year. In October 1999, he joined the Washington, D.C. office of the law firm of O’Melveny & Myers. A year later, Klain returned to the Gore campaign, once Coelho was replaced by William M. Daley. Daley hired Klain for a senior position in the Gore campaign and then named him General Counsel of Gore’s Recount Committee.
In 1994, Time named Klain one of the “50 most promising leaders in America” under the age of 40. In 1999, Washingtonian magazine named him the top lawyer in Washington under the age of 40, and the American Bar Association’s Barrister magazine named him one of the top 20 young lawyers nationwide. The National Law Journal named him one of its Lawyers of the Year for 2000.
Klain helped Fannie Mae overcome “regulatory issues”.Lobbying on “regulatory issues concerning Fannie Mae” in 2004, as disclosure forms indicate Klain did, involved convincing Congress and Fannie Mae’s regulators that Fannie Mae wasn’t doing anything dangerous, and wasn’t exposing taxpayers to risk. In other words, Ron Klain got paid to help fuel the housing bubble up until a couple of years before it popped.
During the 2004 Presidential campaign, Klain worked as an adviser to Wesley Clark in the early primaries. Later, during the General Election, Klain was heavily involved behind the scenes in John Kerry‘s campaign and is widely credited for his role in preparing Senator Kerry for a strong performance in the debates against President George W. Bush, which gave Kerry a significant boost in the polls. He then acted as an informal adviser to Evan Bayh, who is from Klain’s home state of Indiana. Klain has also commented on matters of law and policy on televised programs such as the Today Show, Good Morning America, Nightline, Capital Report,NewsHour with Jim Lehrer, and Crossfire.
In 2005, Klain left his partnership at O’Melveny & Myers to serve as Executive Vice President and General Counsel of a new investment firm, Revolution LLC, launched by AOL co-founder Steve Case.
On November 12, 2008, Roll Call announced that Klain had been chosen to serve as Chief of Staff to Vice President Joe Biden, the same role he served for Gore.Klain had worked with Biden previously, having served as counsel to the United States Senate Committee on the Judiciary while Biden chaired that committee and assisted Biden’s speechwriting team during the 1988 presidential campaign.
Klain was mentioned as a possible replacement for White House Chief of Staff Rahm Emanuel, but opted to leave the White House for a position in the private sector in January 2011.
Klain apparently signed off on President Obama’s support of a $535 million loan guarantee for now-defunct solar-panel company Solyndra. Despite concerns about whether the company was viable, Klain approved an Obama visit, stating, “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.”
On October 17, 2014, Klain was appointed the “Ebola response coordinator” (or, less officially, Ebola “czar”) by President Obama, to help coordinate the nation’s response to the Ebola virus.
Dr. Lurie is the Assistant Secretary for Preparedness and Response (ASPR) at the US Department of Health and Human Services (HHS).
The mission of her office is to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters, ranging from hurricanes to bioterrorism.
Dr. Lurie was previously Senior Natural Scientist and the Paul O’ Neill Alcoa Professor of Health Policy at the RAND Corporation. There she directed RAND’s public health and preparedness work as well as RAND’s Center for Population Health and Health Disparities. She also served as Principal Deputy Assistant Secretary of Health in the US Department of Health and Human Services; in state government, as Medical Advisor to the Commissioner at the Minnesota Department of Health; and in academia, as Professor in the University of Minnesota Schools of Medicine and Public Health. Dr. Lurie has a long history in the health services research field, primarily in the areas of access to and quality of care, mental health, prevention, public health infrastructure and preparedness and health disparities.
Dr. Lurie attended college and medical school at the University of Pennsylvania, and completed her residency and MSPH at UCLA, where she was also a Robert Wood Johnson Foundation Clinical Scholar. She is the recipient of numerous awards, and is a member of the Institute of Medicine.
Finally, Dr. Lurie continues to practice clinical medicine in the health care safety net in Washington, DC. She has three sons.
From Wikipedia, the free encyclopedia
Nicole Lurie, M.D., M.S.P.H., is the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS). Lurie is a Rear Admiral in the U.S. Public Health Service.
The Assistant Secretary for Preparedness and Response serves as the Secretary’s principal advisor on matters related to bioterrorism and other public health emergencies. The ASPR also coordinates interagency activities between HHS, other Federal departments, agencies, and offices, and State and local officials responsible for emergency preparedness and the protection of the civilian population from acts of bioterrorism and other public health emergencies. The mission of her office is to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters. Dr. Lurie was nominated to the position by President Obama on May 12, 2009 and her confirmation by the U.S. Senate was announced by HHS Secretary Kathleen Sebelius on July 10, 2009.
Led by The Federalist website her absence from the media has been noted with regards to the events of the Ebola virus disease affair.
Dr. Lurie has served as the Senior Natural Scientist and the Paul O’ Neill Alcoa Professor of Health Policy at the RAND Corporation. There she directed RAND’s public health and preparedness work as well as RAND’s Center for Population Health and Health Disparities. She has previously served in federal government, as Principal Deputy Assistant Secretary of Health in the US Department of Health and Human Services; in state government, as Medical Advisor to the Commissioner at the Minnesota Department of Health; and in academia, as Professor in the University of Minnesota School of Medicine and the University of Minnesota School of Public Health. Dr. Lurie has a long history in the health services research field, primarily in the areas of access to and quality of care, managed care, mental health, prevention, public health infrastructure and preparedness and health disparities.
Lurie has served as the Senior Editor for Health Services Research and has served on editorial boards and as a reviewer for numerous journals. She has served on the council and was President of the Society of General Internal Medicine, and on the board of directors for Academy Health, and has served on multiple other national committees.
Lurie attended college and medical school at the University of Pennsylvania, and completed her residency and Master of Science of Public Health (MSPH) at UCLA, where she was also a Robert Wood Johnson Foundation Clinical Scholar.
Lurie is the recipient of numerous awards, including the AHSR Young Investigator Award, the Nellie Westerman Prize for Research in Ethics, the Heroine in Health Care Award, the University of Pennsylvania Perelman School of Medicine’s Distinguished Alumni Award, and is a member of the Institute of Medicine.
- Jump up^ Biography of Dr. Lurie
- Jump up^ Emergency Support Function #8. Public Health and Medical Services Annex. Federal Emergency Management Agency
- Jump up^ President Obama Announces More Key Administration Posts
- Jump up^ Nominations Confirmed (Civilian) – United States Senate
- Jump up^ HHS Secretary Sebelius Announces Senate Confirmation of Assistant Secretary for Preparedness and Response Dr. Nicole Lurie
- Jump up^ http://philadelphia.cbslocal.com/2014/10/15/editor-from-the-federalist-as-ebola-outbreak-surges-on-where-is-the-secretary-for-preparedness-and-response/
- Jump up^ RAND Awards Paul O’ Neill Alcoa Chair to Dr. Nicole Lurie. RAND Corporation. January 3, 2002
- Jump up^ Past Presidents. Society of General Internal Medicine.
- Interview with Dr. Lurie
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- Biography of Dr. Nicole Lurie. UPMC Center for Biosecurity.
- Dr. Nicole Luri Testifies on Children and Disasters before the Senate Committee on Homeland Security and Governmental Affairs, Ad Hoc Subcommittee on Disaster Recovery. December 10, 2009
- Dr. Nicole Lurie Testifies on Safeguarding our Nation: HHS Response to the H1N1 Outbreak before Committee on Energy and Commerce, Subcommittee on Oversight and Investigations and Subcommittee on Health, U.S. House of Representatives. November, 2009.
- Nicole Lurie Testifies on Safeguarding our Nation: HHS Response to the H1N1 Outbreak before Committee on Homeland Security, Subcommittee on Emerging Threats, CyberSecurity, and Science Technology, United States House of Representatives. October, 2009.
- Dr. Lurie Testifies on Focusing on Children in Disasters: Evacuation Planning and Mental Health Recovery before Senate Committee on Homeland Security and Governmental Affairs, Ad Hoc Subcommittee on Disaster Recovery. August 4, 2009
- HHS Secretary Sebelius Announces Senate Confirmation of Assistant Secretary for Preparedness and Response. AllBusiness. July 10, 2009
- Testimony by Dr. Nicole Lurie presented before the Senate Health, Education, Labor and Pensions Committee, Subcommittee on Bioterrorism and Public Health Preparedness on March 28, 2006.
- Dr. Nicole Lurie testifies on Public Health Preparedness in California before the California Senate Committee on Health and Human Services on June 2, 2004.
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Story 1: Breaking News: Second Confirmed Ebola Case of Health Care Worker in Dallas Texas Health Presbyterian Hospital — Ebola Is Airborne and Spreading — Center for Disease Control (CDC) Blames It on Breach of Protocol — CDC’s Deep Denial Delusions — World Health Organization (WHO): Aerosolised Ebola Virus droplets produced from coughing or sneezing. –Videos
I beseech you, in the bowels of Christ, think it possible you may be mistaken.
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Marine Corps general who leads America’s Southern Command warned Tuesday that the U.S. could face an unprecedented flood of immigrants from the south if the Ebola virus epidemic hits Central America.
‘If it breaks out, it’s literally, “Katie bar the door”,’ Gen John Kelly told said during a public discussion at the National Defense University. ‘And there will be mass migration into the United States.’
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Lifeline: Dr Kent Brantly (left), who has been cleared of Ebola, has match blood types with Nina Pham (right) and donated so she can receive a blood transfusion to battle the deadly virus she caught treating a patient
Miss Pham has been in quarantine since Friday after catching the disease from ‘patient zero’ Thomas Eric Duncan – the man who brought the deadly virus to America.
About 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Mr Duncan after he was hospitalized, including the 26-year-old.
Brantly is believed to have traveled to Texas Health Presbyterian Hospital, where Pham worked, to make the donation on Sunday night.
Miss Pham’s condition was described as ‘clinically stable’ on Tuesday morning. She is believed to be in good spirits and had spoken to her mother via Skype.
A second person who came in contact with the nurse is being monitored for Ebola symptoms in an isolation unit at Texas Presbyterian. He is reportedly Miss Pham’s boyfriend according to Dallas News.
The individual works at Alcon in Fort Worth, according to a staff email seen by CBS. MailOnline was awaiting confirmation from the global eye care products company.
Those who have survived Ebola have antibodies in their blood which can help new sufferers beat the disease.
Dr Kent Brantly was flown back from Liberia to the U.S. after contracting Ebola during his missionary work for Samaritan’s Purse.
He survived after receiving a dose of the experimental serum Z-Mapp and round-the-clock care at Emory University Hospital in Atlanta, Georgia.
On September 10, Dr Brantly donated blood to a fellow doctor, Dr Rick Sacra, who also contracted Ebola during his work in West Africa and survived the disease.
Last Tuesday, he was on a road trip from Indiana to Texas when he received a call from Ashoka Mukpo’s medical center in Nebraska telling him his blood type matched Mukpo’s.
He also offered his blood to Thomas Eric Duncan but their blood types didn’t match.
Being treated: On Tuesday, Dr Brantly pulled over during a road trip to give blood to NBC’s Ashoka Mukpo
Within minutes, he stopped off at the Community Blood Center in Kansas City, Missouri, and his donation was flown to Omaha.
Pham was diagnosed after admitting herself to hospital on Friday when her temperature spiked – one of the first symptoms of the deadly virus.
HOW COMMON IS IT FOR TWO PEOPLE TO MATCH BLOOD TYPE?
There are four major blood types: A, B, AB, and O. They divide into positive and negative categories.
It is not known what blood type the four Ebola patients have in common.
The most common blood type in the US is O positive, although ethnic groups normally differ.
The majority of African Americans and Hispanics have O positive.
Around 37 per cent of Caucasians do too, but 33 per cent have A positive.
There is more variety among Asian people. A quarter are listed as B positive, according to the Red Cross, but many also have a high number of Os and As.
A blood test confirmed she had the disease and she is now being treated in an isolation ward.
The Emergency Room where she was admitted was cleared and decontaminated.
Nina Pham’s uncle confirmed to MailOnline that she is the nurse who has contracted Ebola while treating patient zero Thomas Eric Duncan.
Jason Nguyen told MailOnline: ‘Nina has contracted Ebola, she is my niece. Her mother called me on Saturday and told me; ‘Nina has caught Ebola.’
‘My sister is very upset, we all are. She said she was going up to the hospital in Dallas and I haven’t heard from her since. I’ve tried to call but I can’t get through. It’s very shocking. I don’t know any of the details, only what I hear on the news. It’s frightening.’
He added: ‘Nina is very hard working. She is always up at the hospital in Dallas.’
A friend added: ‘You always hear it on the news, but you don’t expect someone you know so well to have it.’
HazChem teams spent the weekend fumigating her apartment in Dallas while health officials have ordered an investigation into how she contracted the disease.
Texas nurse with Ebola identified as 26-yr-old Nina Pham
Tragic: Nina Pham, 26, is fighting for her life after contracting Ebola from Thomas Eric Duncan. Here she is pictured with her beloved King Charles Spaniel clled Bentley who is not expected to be destroyed
Kind-hearted: Raised in Vietnamese family in Fort Worth, Miss Pham graduated from Texas Christian University in 2010 with a Bachelor of Science in Nursing
Her beloved King Charles Spaniel Bentley will not be destroyed and is being quarantined, Dallas mayor Mike Rawlings has assured.
Director of the Centers for Disease Control and Protection (CDC) Dr Thomas Frieden has blamed a ‘breach in protocol’ of infection control lead Miss Pham to catch Ebola.
Mr Duncan arrived in Texas from Liberia on September 20. He began showing symptoms of Ebola three days after his arrival and was admitted to Texas Presbyterian Hospital on Sunday 28. He died on Wednesday October 8.
Presbyterian’s chief clinical officer, Dr Dan Varga, said all staff had followed CDC recommended precautions – ‘gown, glove, mask and shield’ – while treating Mr Duncan.
CDC chief backtracks after blaming nurse who got Ebola
And on Monday the CDC said that a critical moment may have come when Miss Pham took off her equipment.
Ebola victims suffer chronic diarrhea and bleeding. But blood and feces from an Ebola patient are considered the most infectious bodily fluids.
Mr Duncan also underwent two surgical procedures in a bid to keep him alive but which are particularly high-risk for transmitting the virus – kidney dialysis and intubation to help him to breathe – due to the spread of blood and saliva.
Nurses’ leader Bonnie Castillo has criticized the CDC for blaming the nurse for the spread of the disease.
Ms Castillo, of the National Nurses United, said: ‘You don’t scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct.’
In response to the criticism, Frieden clarified his comments to say that he did not mean it was an error on Miss Pham’s part that led to the ‘breach of protocol.’
Clean up: A man in full hazmat clothing walks in front of Pham’s home after disinfecting the front porch
The CDC said on Monday it has launched a wholesale review of the procedures and equipment used by healthcare workers.
Dr Frieden added that the case ‘substantially’ changes how medical staff approach the control of the virus, adding that: ‘We have to rethink how we address Ebola control, because even a single infection is unacceptable.’
When she got accepted into nursing school she was really excited. Her mom would tell how it’s really hard and a bunch of her friends quit doing it because it was so stressful. But she was like, “This is what I want to do”
Friends and well-wishers have paid tribute to Miss Pham and praised her as a big-hearted, compassionate nurse dedicated to caring for other.
Raised in Vietnamese family in Fort Worth, she graduated from Texas Christian University in 2010 with a Bachelor of Science in Nursing.
She obtained her nursing license in August 2010 and recently qualified as a critical care nurse.
A friend told the Dallas Morning News: ‘When she got accepted into nursing school she was really excited. Her mom would tell how it’s really hard and a bunch of her friends quit doing it because it was so stressful. But she was like, “This is what I want to do”.’
A devout Christian she regularly attends mass at the Lady of Fatima Church.
Tom Ha, who taught her bible class, told the paper: ‘The family is very dedicated and go out of their way to help people. I expect, with the big heart she has, she went beyond what she was supposed to do to help anyone in need.’
Aid: Miss Pham had treated Mr Duncan multiple times after he was diagnosed with the disease and the CDC has claimed that a ‘breach of protocol’ meant the nurse contracted Ebola. However, nursing leaders attacked the authorities for apparently making Miss Pham a scapegoat
Hung Le, who is president and counselor at Our Lady of Fatima, said parishioners are uniting in prayer for Miss Pham.
He said: ‘Our most important concern as a church is to help the family as they are coping with this. As a parish, we are praying for them.’
Ha, who taught the woman in Bible classes, said he and others are translating health information into Vietnamese to help others learn about the illness.
‘People are more worried for the family than for themselves, but some have questions because they don’t really understand what it is or how it is transmitted.’
SPREAD OF A DEADLY PLAGUE: HOW WILL AMERICA CONTAIN EBOLA?
WHEN IS EBOLA CONTAGIOUS?
Only when someone is showing symptoms, which can start with vague symptoms including a fever, flu-like body aches and abdominal pain, and then vomiting and diarrhea.
HOW DOES EBOLA SPREAD?
Through close contact with a symptomatic person’s bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen. Those fluids must have an entry point, like a cut or scrape or someone touching the nose, mouth or eyes with contaminated hands, or being splashed. That’s why health care workers wear protective gloves and other equipment.
The World Health Organization says blood, feces and vomit are the most infectious fluids, while the virus is found in saliva mostly once patients are severely ill and the whole live virus has never been culled from sweat.
WHAT ABOUT MORE CASUAL CONTACT?
Ebola isn’t airborne. Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has said people don’t get exposed by sitting next to someone on the bus.
‘This is not like flu. It’s not like measles, not like the common cold. It’s not as spreadable, it’s not as infectious as those conditions,’ he added.
WHO GETS TESTED WHEN EBOLA IS SUSPECTED?
Hospitals with a suspected case call their health department or the CDC to go through a checklist to determine the person’s level of risk. Among the questions are whether the person reports a risky contact with a known Ebola patient, how sick they are and whether an alternative diagnosis is more likely. Most initially suspicious cases in the U.S. haven’t met the criteria for testing.
HOW IS IT CLEANED UP?
The CDC says bleach and other hospital disinfectants kill Ebola. Dried virus on surfaces survives only for several hours.
The World Health Organization on Monday called the Ebola outbreak ‘the most severe, acute health emergency seen in modern times’.
It added that economic disruption can be curbed if people are educated so they don’t make any irrational moves to dodge infection.
WHO Director-General Margaret Chan, citing World Bank figures, said 90 per cent of economic costs of any outbreak ‘come from irrational and disorganised efforts of the public to avoid infection.’
‘We are seeing, right now, how this virus can disrupt economies and societies around the world,’ she said, but added that adequately educating the public was a ‘good defense strategy’ and would allow governments to prevent economic disruptions.
Ebola screening of passengers arriving from three West African countries began at New York’s JFK airport on Saturday.
Medical teams equipped with temperature guns and questionnaires are monitoring arrivals from Guinea, Liberia and Sierra Leone – countries at the centre of the Ebola outbreak.
Screening at Newark Liberty, Washington Dulles, Chicago O’Hare and Hartsfield-Jackson Atlanta will begin later this week.
Key Question: How Did Dallas Worker Contract Ebola?
October 12, 2014 4:35 PM
How did it happen?
That’s the big question as U.S. health officials investigate the case of a Dallas health worker who treated an Ebola patient and ended up with the disease herself.
These are professionals and this is the United States, where the best conditions and protective gear are available, unlike in West Africa, where the Ebola epidemic is raging in much poorer conditions.
The health worker wore protective gear while having extensive contact with Thomas Eric Duncan, the Liberian man who died Wednesday of Ebola at Texas Health Presbyterian Hospital.
Officials say she has not been able to pinpoint any breach in infection control protocols, although there apparently was a breach, they say.
Experience shows that health workers can safely care for Ebola patients, “but we also know that it’s hard and that even a single breach can result in contamination,” Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, said Sunday on CBS’ “Face the Nation.”
The situation also raises fresh concerns about whether any U.S. hospital can safely handle Ebola patients, as health officials have insisted is possible.
“A breach in protocol could be anything from not taking your gloves off the right way to taking a dialysis catheter out of a dialysis patient and not disposing of it the right way,” explains Dr. Darrin D’Agostino, Chair of Internal Medicine UNT.
According to Dr. D’Agostino those are just some of the multitude of scenarios.
He says these incidents don’t happen often, but accidents do occur.
“We can be as diligent and meticulous as we want to be but occasionally things happen that expose to risk,” said Dr. D’Agostino.
While the fight to eradicate Ebola in Dallas and internationality Dr. D’Agostino is reminding us the battle will be long.
“The fact of the matter is that we do have a lot to learn about this virus and all the viruses that are in this family…this one is particularly infectious.”
Despite the uncertainty Dr. D’Agostino says he is confident that we have the proper infrastructure and resources to handle these cases.
Some questions and answers about the new case.
Q: What protection do health workers have?
A: The exact gear can vary. A hazardous material type suit usually includes a gown, two sets of gloves, a face mask, and an eye shield. There are strict protocols for how to use it correctly.
“When you put on your garb and you take off your garb, it’s a buddy system,” with another health worker watching to make sure it’s done right, said Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.
Q: How might infection have occurred?
A: Officials are focusing on two areas: How the garb was removed, and the intensive medical procedures Duncan received, which included kidney dialysis and a breathing machine. Both involve inserting tubes — into blood vessels or an airway. That raises the risk a health worker will have contact with the patient’s bodily fluids, which is how Ebola spreads.
“Removing the equipment can really be the highest risk. You have to be extremely careful and have somebody watching you to make sure you remember all the steps,” said Dr. Eileen Farnon, a Temple University doctor who formerly worked at the CDC and led teams investigating past Ebola outbreaks in Africa.
“After every step you usually would do hand hygiene,” washing your hands with antiseptic or being sprayed with a chlorine spray, she said.
Q: How else could infection have happened?
A: Some of the garb the health worker takes off might brush against a surface and contaminate it. New data suggest that even tiny droplets of a patient’s body fluids can contain the virus, Maki said.
“I can have on the suit and be very careful, but I can pick up some secretions or body fluids on a surface” and spread it that way, he said.
Q: Can any U.S. hospital safely treat Ebola patients?
A: Frieden and other health officials say yes, but others say the new case shows the risks.
“We can’t control where the Ebola patient appears,” so every hospital’s emergency room needs to be prepared to isolate and take infection control precautions, Maki said.
That said, “I don’t think we should expect that small hospitals take care of Ebola patients. The challenge is formidable,” and only large hospitals like those affiliated with major universities truly have enough equipment and manpower to do it right, Maki said.
“If we allow it to be taken care of in hospitals that have less than optimal resources, we will promote the spread,” he warned.
The case heightens concern for health workers’ safety, and nurses at many hospitals “are alarmed at the inadequate preparation they see,” says a statement from Rose Ann DeMoro, executive director of the trade union, National Nurses United.
Q: Should Ebola patients be transferred to one of the specialized centers that have treated others in the U.S.?
A: Specialized units are the ideal, but there are fewer than half a dozen in the nation and they don’t have unlimited beds. “It is also a high-risk activity to transfer patients,” potentially exposing more people to the virus, Farnon said.
Q. What is CDC recommending that a hospital do?
A. Training has been ramped up, and the CDC now recommends that a hospital minimize the number of people caring for an Ebola patient, perform only procedures essential to support the patient’s care, and name a fulltime infection control supervisor while any Ebola patient is being cared for. Frieden also said the agency was taking a new look at personal protective equipment, “understanding that there is a balance and putting more on isn’t always safer — it may make it harder to provide effective care.”
Health care worker at Presbyterian Hospital in Dallas tests positive for Ebola
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Story 1: Is The Ebola Dallas Strain (EDS), an airborne, contagious, incurable and lethal virus mutation, now the source of a world-wide pandemic? — The American People Demand To Be Told The Truth — Videos
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CDC: Airborne Ebola possible but unlikely
By Elise Viebeck
The Ebola virus becoming airborne is a possible but unlikely outcome in the current epidemic, Centers for Disease Control and Prevention (CDC) Director Tom Frieden said Tuesday.
The outbreak involves Ebola Zaire, a strain that is passed through bodily fluids, not the air. But some experts have expressed fear about viral mutations due to the unprecedented — and rising — number of Ebola cases.
Frieden sought to allay those fears during a call with reporters.
“The rate of change [with Ebola] is slower than most viruses, and most viruses don’t change how they spread,” he said. Frieden is unofficially spearheading the U.S. response to Ebola.
“That is not to say it’s impossible that it could change [to become airborne],” he continued. “That would be the worst-case scenario. We would know that by looking at … what is happening in Africa. That is why we have scientists from the CDC on the ground tracking that.”
A change in the way Ebola spreads would make the virus significantly more dangerous. The disease kills roughly half the people it infects, and lacking a vaccine or cure, its traceable chain of transmission through bodily fluids is one reason officials believe they can contain it.
Still, there is almost no precedent for a human virus mutating to become transmissible in a different way, a key piece of evidence in weighing whether that kind of shift is likely for Ebola.
“We have so many problems with Ebola, let’s not make another one that, of course, is theoretically possible but is pretty way down on the list of likely issues,” infectious diseases expert William Schaffner of Vanderbilt University told Scientific American.
Frieden touted new progress against Ebola in West Africa and Dallas, where a Liberian man remains in critical condition, but warned that “globally, this is going to be a long, hard fight.”
The Dallas patient interacted with 10 definite and 38 possible interlocturos who are now being monitored, he said. None have shown symptoms.
Some Ebola experts worry virus may spread more easily than assumed
Ebola could be spread through air in tight quarters, some scientists fear
Some Ebola experts worry that the virus may spread more easily than thought — through the air in small spaces, for example.
By DAVID WILLMAN contact the reporter NationMedical ResearchAfricaScientific ResearchDiseases and IllnessesEbolaU.S. Centers for Disease Control and Prevention
Ebola researcher says he would not rule out possibility that the virus spreads through air in tight quarters
‘There are too many unknowns here,’ a virologist says of how Ebola may spread
Ebola researcher says he thinks there is a chance asymptomatic people could spread the virus
U.S. officials leading the fight against history’s worst outbreak of Ebola have said they know the ways the virus is spread and how to stop it. They say that unless an air traveler from disease-ravaged West Africa has a fever of at least 101.5 degrees or other symptoms, co-passengers are not at risk.
“At this point there is zero risk of transmission on the flight,” Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, said after a Liberian man who flew through airports in Brussels and Washington was diagnosed with the disease last week in Dallas.
First Ebola infection outside West Africa
Three more people have been hospitalized in Madrid for possible exposure to the Ebola virus after a Spanish nurse tested positive for the virus.
Other public health officials have voiced similar assurances, saying Ebola is spread only through physical contact with a symptomatic individual or their bodily fluids. “Ebola is not transmitted by the air. It is not an airborne infection,” said Dr. Edward Goodman of Texas Health Presbyterian Hospital in Dallas, where the Liberian patient remains in critical condition.
Yet some scientists who have long studied Ebola say such assurances are premature — and they are concerned about what is not known about the strain now on the loose. It is an Ebola outbreak like none seen before, jumping from the bush to urban areas, giving the virus more opportunities to evolve as it passes through multiple human hosts.
Dr. C.J. Peters, who battled a 1989 outbreak of the virus among research monkeys housed in Virginia and who later led the CDC’s most far-reaching study of Ebola’s transmissibility in humans, said he would not rule out the possibility that it spreads through the air in tight quarters.
“We just don’t have the data to exclude it,” said Peters, who continues to research viral diseases at the University of Texas in Galveston.
Dr. Philip K. Russell, a virologist who oversaw Ebola research while heading the U.S. Army’s Medical Research and Development Command, and who later led the government’s massive stockpiling of smallpox vaccine after the Sept. 11 terrorist attacks, also said much was still to be learned. “Being dogmatic is, I think, ill-advised, because there are too many unknowns here.”
If Ebola were to mutate on its path from human to human, said Russell and other scientists, its virulence might wane — or it might spread in ways not observed during past outbreaks, which were stopped after transmission among just two to three people, before the virus had a greater chance to evolve. The present outbreak in West Africa has killed approximately 3,400 people, and there is no medical cure for Ebola.
“I see the reasons to dampen down public fears,” Russell said. “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.”
A resident looks from behind a gate during the Liberian government’s 11-day Ebola quarantine in the West Point district of Monrovia.
Tom Skinner, a spokesman for the CDC in Atlanta, said health officials were basing their response to Ebola on what has been learned from battling the virus since its discovery in central Africa in 1976. The CDC remains confident, he said, that Ebola is transmitted principally by direct physical contact with an ill person or their bodily fluids.
Skinner also said the CDC is conducting ongoing lab analyses to assess whether the present strain of Ebola is mutating in ways that would require the government to change its policies on responding to it. The results so far have not provided cause for concern, he said.
The researchers reached in recent days for this article cited grounds to question U.S. officials’ assumptions in three categories.
One issue is whether airport screenings of prospective travelers to the U.S. from West Africa can reliably detect those who might have Ebola. Frieden has said the CDC protocols used at West African airports can be relied on to prevent more infected passengers from coming to the U.S.
“One hundred percent of the individuals getting on planes are screened for fever before they get on the plane,” Frieden said Sept. 30. “And if they have a fever, they are pulled out of the line, assessed for Ebola, and don’t fly unless Ebola is ruled out.”
Individuals who have flown recently from one or more of the affected countries suggested that travelers could easily subvert the screening procedures — and might have incentive to do so: Compared with the depleted medical resources in the West African countries of Liberia, Sierra Leone and Guinea, the prospect of hospital care in the U.S. may offer an Ebola-exposed person the only chance to survive.
U.S. To Increase Airport Screening For Ebola
The deteriorating conditions in Africa make it more likely additional cases of Ebola will appear in the United States and officials are pushing for increased screenings at airports.
A person could pass body temperature checks performed at the airports by taking ibuprofen or any common analgesic. And prospective passengers have much to fear from identifying themselves as sick, said Kim Beer, a resident of Freetown, the capital of Sierra Leone, who is working to get medical supplies into the country to cope with Ebola.
“It is highly unlikely that someone would acknowledge having a fever, or simply feeling unwell,” Beer said via email. “Not only will they probably not get on the flight — they may even be taken to/required to go to a ‘holding facility’ where they would have to stay for days until it is confirmed that it is not caused by Ebola. That is just about the last place one would want to go.”
Liberian officials said last week that the patient hospitalized in Dallas, Thomas Eric Duncan, did not report to airport screeners that he had had previous contact with an Ebola-stricken woman. It is not known whether Duncan knew she suffered from Ebola; her family told neighbors it was malaria.
The potential disincentive for passengers to reveal their own symptoms was echoed by Sheka Forna, a dual citizen of Sierra Leone and Britain who manages a communications firm in Freetown. Forna said he considered it “very possible” that people with fever would medicate themselves to appear asymptomatic.
It would be perilous to admit even nonspecific symptoms at the airport, Forna said in a telephone interview. “You’d be confined to wards with people with full-blown disease.”
On Monday, the White House announced that a review was underway of existing airport procedures. Frieden and President Obama’s assistant for homeland security and counter-terrorism, Lisa Monaco, said Friday that closing the U.S. to passengers from the Ebola-affected countries would risk obstructing relief efforts.
CDC officials also say that asymptomatic patients cannot spread Ebola. This assumption is crucial for assessing how many people are at risk of getting the disease. Yet diagnosing a symptom can depend on subjective understandings of what constitutes a symptom, and some may not be easily recognizable. Is a person mildly fatigued because of short sleep the night before a flight — or because of the early onset of disease?
Moreover, said some public health specialists, there is no proof that a person infected — but who lacks symptoms — could not spread the virus to others.
“It’s really unclear,” said Michael Osterholm, a public health scientist at the University of Minnesota who recently served on the U.S. government’s National Science Advisory Board for Biosecurity. “None of us know.”
Russell, who oversaw the Army’s research on Ebola, said he found the epidemiological data unconvincing.
“The definition of ‘symptomatic’ is a little difficult to deal with,” he said. “It may be generally true that patients aren’t excreting very much virus until they become ill, but to say that we know the course of [the virus' entry into the bloodstream] and the course of when a virus appears in the various secretions, I think, is premature.”
The CDC’s Skinner said that while officials remained confident that Ebola can be spread only by the overtly sick, the ongoing studies would assess whether mutations that might occur could increase the potential for asymptomatic patients to spread it.
Finally, some also question the official assertion that Ebola cannot be transmitted through the air. In late 1989, virus researcher Charles L. Bailey supervised the government’s response to an outbreak of Ebola among several dozen rhesus monkeys housed for research in Reston, Va., a suburb of Washington.
What Bailey learned from the episode informs his suspicion that the current strain of Ebola afflicting humans might be spread through tiny liquid droplets propelled into the air by coughing or sneezing.
“We know for a fact that the virus occurs in sputum and no one has ever done a study [disproving that] coughing or sneezing is a viable means of transmitting,” he said. Unqualified assurances that Ebola is not spread through the air, Bailey said, are “misleading.”
Peters, whose CDC team studied cases from 27 households that emerged during a 1995 Ebola outbreak in Democratic Republic of Congo, said that while most could be attributed to contact with infected late-stage patients or their bodily fluids, “some” infections may have occurred via “aerosol transmission.”
Ailing in Monrovia, Liberia
Relatives pray over a weak Siata Johnson, 23, outside the Ebola treatment center at a hospital on the outskirts of Monrovia, Liberia. (John Moore / Getty Images)
Skinner of the CDC, who cited the Peters-led study as the most extensive of Ebola’s transmissibility, said that while the evidence “is really overwhelming” that people are most at risk when they touch either those who are sick or such a person’s vomit, blood or diarrhea, “we can never say never” about spread through close-range coughing or sneezing.
“I’m not going to sit here and say that if a person who is highly viremic … were to sneeze or cough right in the face of somebody who wasn’t protected, that we wouldn’t have a transmission,” Skinner said.
Peters, Russell and Bailey, who in 1989 was deputy commander for research of the Army’s Medical Research Institute of Infectious Diseases, in Frederick, Md., said the primates in Reston had appeared to spread Ebola to other monkeys through their breath.
The Ebola strain found in the monkeys did not infect their human handlers. Bailey, who now directs a biocontainment lab at George Mason University in Virginia, said he was seeking to research the genetic differences between the Ebola found in the Reston monkeys and the strain currently circulating in West Africa.
Though he acknowledged that the means of disease transmission among the animals would not guarantee the same result among humans, Bailey said the outcome may hold lessons for the present Ebola epidemic.
“Those monkeys were dying in a pattern that was certainly suggestive of coughing and sneezing — some sort of aerosol movement,” Bailey said. “They were dying and spreading it so quickly from cage to cage. We finally came to the conclusion that the best action was to euthanize them all.”
No gloves, no masks: Dallas officials send a message of calm amid Ebola fears
Dallas County Judge Clay Jenkins pulled into the Ivy Apartments community late in the evening Friday wearing suit pants and a lavender dress shirt.
There were hazardous materials trucks all around, as cleaning crews had arrived to remove materials that might have been touched by Thomas Duncan, a Liberian man who is hospitalized in Texas with Ebola. The hazmat workers were covered from head to toe in bright yellow body suits, green gloves and breathing masks.
Jenkins walked into the apartment in building No. 6 to greet Louise Troh, her family and others who live with her and had been court-ordered to stay in their home because they were considered high risk after coming into contact with Duncan.
It was time to move, and Troh, her 13-year old son, a relative of Duncan’s and another man — all of whom lived in the apartment — got into the judge’s car for the 45-minute drive to their new, temporary home, in an undisclosed part of Dallas.
Jenkins, the judge, never covered up.
“I’m a married man with a little girl,” Jenkins told reporters later that night. “I’m wearing the same shirt I was when I was in the car with that family.
“I was in their house next to those materials, meeting with them, listening to them, and assuring them last night and again of course today. If there were any risk, I would not expose myself or my family to that risk.”
He added: “There is zero risk.”
In the face of widespread fear — and in some cases misinformation — about Ebola following the first diagnosis of the virus in the United States, Dallas officials have taken a notable visual approach to make the point that, at least right now, the city is safe.
The Ebola outbreak in West Africa has reached the United States, as officials confirm one case in Dallas. Here’s how U.S. health officials plan to stop the virus. (Gillian Brockell and Jorge Ribas/The Washington Post)
On a daily basis, workers monitoring the temperatures and health of as many as nine individuals who they believe might have had direct contact with Duncan have entered those people’s homes with no gloves, no masks and no personal protective equipment whatsoever.
And city officials including Jenkins, Dallas Mayor Mike Rawlings and Dallas County Health and Human Services Director Zachary Thompson have interacted with the family no differently that they might have if the four people who are in a state of semi-isolation had been suspected of having come into contact with somebody sick with the flu.
“Based on our assessment, they were asymptomatic; therefore, I didn’t feel they posed any threat to me,” Thompson said in an interview with The Washington Post on Monday. “There is a standard procedure for when they should be using the PPE’s (personal protective equipment). In this case we knew our nurses, our staff, had assessed that they were asymptomatic.”
So far, none of the people who have potentially had contact with Duncan are showing any symptoms, Thompson said.
Yet concern and stigma are widespread in Dallas.
Photographs from Liberia, Sierra Leone and Guinea — where the epidemic is spiraling out of control — frequently show fully masked health workers carrying infected people to hospitals or burial sites. Those images have become closely associated with the virus and the outbreak in the public’s mind.
And for one day, similar images briefly appeared in Dallas as cleaning crews removed materials from Troh’s apartment that might have come into contact with the virus.
A hazmat team arrives on Oct. 3 to clean a unit at the Dallas apartment complex where the confirmed Ebola patient was staying. (Joe Raedle/Getty Images)
The decision for the crew to wear personal protective equipment was made by the company, the “Cleaning Guys,” according to Dallas officials.
“We train for this type of thing,” company executive Brad Smith told ABC News. “Obviously, we haven’t trained for Ebola because there hasn’t been a situation in Texas until now.”
The Ebola virus is not very hearty outside of the human body.
Still, touching and destroying potentially infected materials is far different from speaking to or being in the same room with people who might have been exposed to the virus.
And public health expert Gavin Macgregor-Skinner, who worked in Nigeria to end that country’s outbreak, said that treating people with a sense of humanity and not feeding hysteria is critical to managing the Dallas Ebola case and others that might occur around the world.
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“Even in West Africa when we do contact tracing, we don’t put on personal protective equipment,” said Macgregor-Skinner, an assistant professor in the Department of Public Health Sciences at the Penn State Milton S. Hershey Medical Center. “We have the six-feet rule: We stay about six feet away from people and I can interview them and I can make them feel like people.
“If they have no symptoms, we need to make them feel normal, like they’re part of the community, like they are still loved.”
Dallas officials have also urged residents to go about their normal activities and attend community gatherings and fairs without fear.
“The broader perspective is that we had done immediate disease tracking and contact tracing and the family had been identified who had had close contact and they had not shown any symptoms,” said Thompson. “Other than that one case, basically, his virus has been contained.”
‘In 1976 I discovered Ebola – now I fear an unimaginable tragedy’
Peter Piot was a researcher at a lab in Antwerp when a pilot brought him a blood sample from a Belgian nun who had fallen mysteriously ill in Zaire
Professor Peter Piot, the Director of the London School of Hygiene and Tropical Medicine: ‘Around June it became clear to me there was something different about this outbreak. I began to get really worried’ Photograph: Leon Neal/AFP
Professor Piot, as a young scientist in Antwerp, you were part of the team that discovered the Ebola virus in 1976. How did it happen?
I still remember exactly. One day in September, a pilot from Sabena Airlines brought us a shiny blue Thermos and a letter from a doctor in Kinshasa in what was then Zaire. In the Thermos, he wrote, there was a blood sample from a Belgian nun who had recently fallen ill from a mysterious sickness in Yambuku, a remote village in the northern part of the country. He asked us to test the sample for yellow fever.
These days, Ebola may only be researched in high-security laboratories. How did you protect yourself back then?
We had no idea how dangerous the virus was. And there were no high-security labs in Belgium. We just wore our white lab coats and protective gloves. When we opened the Thermos, the ice inside had largely melted and one of the vials had broken. Blood and glass shards were floating in the ice water. We fished the other, intact, test tube out of the slop and began examining the blood for pathogens, using the methods that were standard at the time.
But the yellow fever virus apparently had nothing to do with the nun’s illness.
No. And the tests for Lassa fever and typhoid were also negative. What, then, could it be? Our hopes were dependent on being able to isolate the virus from the sample. To do so, we injected it into mice and other lab animals. At first nothing happened for several days. We thought that perhaps the pathogen had been damaged from insufficient refrigeration in the Thermos. But then one animal after the next began to die. We began to realise that the sample contained something quite deadly.
But you continued?
Other samples from the nun, who had since died, arrived from Kinshasa. When we were just about able to begin examining the virus under an electron microscope, the World Health Organisation instructed us to send all of our samples to a high-security lab in England. But my boss at the time wanted to bring our work to conclusion no matter what. He grabbed a vial containing virus material to examine it, but his hand was shaking and he dropped it on a colleague’s foot. The vial shattered. My only thought was: “Oh, shit!” We immediately disinfected everything, and luckily our colleague was wearing thick leather shoes. Nothing happened to any of us.
In the end, you were finally able to create an image of the virus using the electron microscope.
Yes, and our first thought was: “What the hell is that?” The virus that we had spent so much time searching for was very big, very long and worm-like. It had no similarities with yellow fever. Rather, it looked like the extremely dangerous Marburg virus which, like ebola, causes a haemorrhagic fever. In the 1960s the virus killed several laboratory workers in Marburg, Germany.
Were you afraid at that point?
I knew almost nothing about the Marburg virus at the time. When I tell my students about it today, they think I must come from the stone age. But I actually had to go the library and look it up in an atlas of virology. It was the American Centres for Disease Control which determined a short time later that it wasn’t the Marburg virus, but a related, unknown virus. We had also learned in the meantime that hundreds of people had already succumbed to the virus in Yambuku and the area around it.
A few days later, you became one of the first scientists to fly to Zaire.
Yes. The nun who had died and her fellow sisters were all from Belgium. In Yambuku, which had been part of the Belgian Congo, they operated a small mission hospital. When the Belgian government decided to send someone, I volunteered immediately. I was 27 and felt a bit like my childhood hero, Tintin. And, I have to admit, I was intoxicated by the chance to track down something totally new.
A girl is led to an ambulance after showing signs of Ebola infection in the village of Freeman Reserve, 30 miles north of the Liberian capital, Monrovia. Photograph: Jerome Delay/APWas there any room for fear, or at least worry?
Of course it was clear to us that we were dealing with one of the deadliest infectious diseases the world had ever seen – and we had no idea that it was transmitted via bodily fluids! It could also have been mosquitoes. We wore protective suits and latex gloves and I even borrowed a pair of motorcycle goggles to cover my eyes. But in the jungle heat it was impossible to use the gas masks that we bought in Kinshasa. Even so, the Ebola patients I treated were probably just as shocked by my appearance as they were about their intense suffering. I took blood from around 10 of these patients. I was most worried about accidentally poking myself with the needle and infecting myself that way.
But you apparently managed to avoid becoming infected.
Well, at some point I did actually develop a high fever, a headache and diarrhoea …
… similar to Ebola symptoms?
Exactly. I immediately thought: “Damn, this is it!” But then I tried to keep my cool. I knew the symptoms I had could be from something completely different and harmless. And it really would have been stupid to spend two weeks in the horrible isolation tent that had been set up for us scientists for the worst case. So I just stayed alone in my room and waited. Of course, I didn’t get a wink of sleep, but luckily I began feeling better by the next day. It was just a gastrointestinal infection. Actually, that is the best thing that can happen in your life: you look death in the eye but survive. It changed my whole approach, my whole outlook on life at the time.
You were also the one who gave the virus its name. Why Ebola?
On that day our team sat together late into the night – we had also had a couple of drinks – discussing the question. We definitely didn’t want to name the new pathogen “Yambuku virus”, because that would have stigmatised the place forever. There was a map hanging on the wall and our American team leader suggested looking for the nearest river and giving the virus its name. It was the Ebola river. So by around three or four in the morning we had found a name. But the map was small and inexact. We only learned later that the nearest river was actually a different one. But Ebola is a nice name, isn’t it?
In the end, you discovered that the Belgian nuns had unwittingly spread the virus. How did that happen?
In their hospital they regularly gave pregnant women vitamin injections using unsterilised needles. By doing so, they infected many young women in Yambuku with the virus. We told the nuns about the terrible mistake they had made, but looking back I would say that we were much too careful in our choice of words. Clinics that failed to observe this and other rules of hygiene functioned as catalysts in all additional Ebola outbreaks. They drastically sped up the spread of the virus or made the spread possible in the first place. Even in the current Ebola outbreak in westAfrica, hospitals unfortunately played this ignominious role in the beginning.
After Yambuku, you spent the next 30 years of your professional life devoted to combating Aids. But now Ebola has caught up to you again. American scientists fear that hundreds of thousands of people could ultimately become infected. Was such an epidemic to be expected?
No, not at all. On the contrary, I always thought that Ebola, in comparison to Aids or malaria, didn’t present much of a problem because the outbreaks were always brief and local. Around June it became clear to me that there was something fundamentally different about this outbreak. At about the same time, the aid organisation Médecins Sans Frontières sounded the alarm. We Flemish tend to be rather unemotional, but it was at that point that I began to get really worried.
Why did WHO react so late?
On the one hand, it was because their African regional office isn’t staffed with the most capable people but with political appointees. And the headquarters in Geneva suffered large budget cuts that had been agreed to by member states. The department for haemorrhagic fever and the one responsible for the management of epidemic emergencies were hit hard. But since August WHO has regained a leadership role.
There is actually a well-established procedure for curtailing Ebola outbreaks: isolating those infected and closely monitoring those who had contact with them. How could a catastrophe such as the one we are now seeing even happen?
I think it is what people call a perfect storm: when every individual circumstance is a bit worse than normal and they then combine to create a disaster. And with this epidemic there were many factors that were disadvantageous from the very beginning. Some of the countries involved were just emerging from terrible civil wars, many of their doctors had fled and their healthcare systems had collapsed. In all of Liberia, for example, there were only 51 doctors in 2010, and many of them have since died of Ebola.
The fact that the outbreak began in the densely populated border region between Guinea, Sierra Leone and Liberia …
… also contributed to the catastrophe. Because the people there are extremely mobile, it was much more difficult than usual to track down those who had had contact with the infected people. Because the dead in this region are traditionally buried in the towns and villages they were born in, there were highly contagious Ebola corpses travelling back and forth across the borders in pickups and taxis. The result was that the epidemic kept flaring up in different places.
For the first time in its history, the virus also reached metropolises such as Monrovia and Freetown. Is that the worst thing that can happen?
In large cities – particularly in chaotic slums – it is virtually impossible to find those who had contact with patients, no matter how great the effort. That is why I am so worried about Nigeria as well. The country is home to mega-cities like Lagos and Port Harcourt, and if the Ebola virus lodges there and begins to spread, it would be an unimaginable catastrophe.
Have we completely lost control of the epidemic?
I have always been an optimist and I think that we now have no other choice than to try everything, really everything. It’s good that the United States and some other countries are finally beginning to help. But Germany or even Belgium, for example, must do a lot more. And it should be clear to all of us: This isn’t just an epidemic any more. This is a humanitarian catastrophe. We don’t just need care personnel, but also logistics experts, trucks, jeeps and foodstuffs. Such an epidemic can destabilise entire regions. I can only hope that we will be able to get it under control. I really never thought that it could get this bad.
What can really be done in a situation when anyone can become infected on the streets and, like in Monrovia, even the taxis are contaminated?
We urgently need to come up with new strategies. Currently, helpers are no longer able to care for all the patients in treatment centres. So caregivers need to teach family members who are providing care to patients how to protect themselves from infection to the extent possible. This on-site educational work is currently the greatest challenge. Sierra Leone experimented with a three-day curfew in an attempt to at least flatten out the infection curve a bit. At first I thought: “That is totally crazy.” But now I wonder, “why not?” At least, as long as these measures aren’t imposed with military power.
A three-day curfew sounds a bit desperate.
Yes, it is rather medieval. But what can you do? Even in 2014, we hardly have any way to combat this virus.
Do you think we might be facing the beginnings of a pandemic?
There will certainly be Ebola patients from Africa who come to us in the hopes of receiving treatment. And they might even infect a few people here who may then die. But an outbreak in Europe or North America would quickly be brought under control. I am more worried about the many people from India who work in trade or industry in west Africa. It would only take one of them to become infected, travel to India to visit relatives during the virus’s incubation period, and then, once he becomes sick, go to a public hospital there. Doctors and nurses in India, too, often don’t wear protective gloves. They would immediately become infected and spread the virus.
The virus is continually changing its genetic makeup. The more people who become infected, the greater the chance becomes that it will mutate …
… which might speed its spread. Yes, that really is the apocalyptic scenario. Humans are actually just an accidental host for the virus, and not a good one. From the perspective of a virus, it isn’t desirable for its host, within which the pathogen hopes to multiply, to die so quickly. It would be much better for the virus to allow us to stay alive longer.
Could the virus suddenly change itself such that it could be spread through the air?
Like measles, you mean? Luckily that is extremely unlikely. But a mutation that would allow Ebola patients to live a couple of weeks longer is certainly possible and would be advantageous for the virus. But that would allow Ebola patients to infect many, many more people than is currently the case.
But that is just speculation, isn’t it?
Certainly. But it is just one of many possible ways the virus could change to spread itself more easily. And it is clear that the virus is mutating.
You and two colleagues wrote a piece for the Wall Street Journalsupporting the testing of experimental drugs. Do you think that could be the solution?
Patients could probably be treated most quickly with blood serum from Ebola survivors, even if that would likely be extremely difficult given the chaotic local conditions. We need to find out now if these methods, or if experimental drugs like ZMapp, really help. But we should definitely not rely entirely on new treatments. For most people, they will come too late in this epidemic. But if they help, they should be made available for the next outbreak.
Testing of two vaccines is also beginning. It will take a while, of course, but could it be that only a vaccine can stop the epidemic?
I hope that’s not the case. But who knows? Maybe.
In Zaire during that first outbreak, a hospital with poor hygiene was responsible for spreading the illness. Today almost the same thing is happening. Was Louis Pasteur right when he said: “It is the microbes who will have the last word”?
Of course, we are a long way away from declaring victory over bacteria and viruses. HIV is still here; in London alone, five gay men become infected daily. An increasing number of bacteria are becoming resistant to antibiotics. And I can still see the Ebola patients in Yambuku, how they died in their shacks and we couldn’t do anything except let them die. In principle, it’s still the same today. That is very depressing. But it also provides me with a strong motivation to do something. I love life. That is why I am doing everything I can to convince the powerful in this world to finally send sufficient help to west Africa. Now!
Ebola virus disease
From Wikipedia, the free encyclopedia
Ebola virus disease (EVD), Ebola hemorrhagic fever (EHF), or simply Ebola is a disease of humans and other primates caused by an ebolavirus. Symptoms start two days to three weeks after contracting the virus, with afever, sore throat, muscle pain, and headaches. Typically, vomiting, diarrhea, and rash follow, along with decreased function of the liver and kidneys. Around this time, affected people may begin to bleed both within the bodyand externally.
The virus may be acquired upon contact with blood or bodily fluids of an infected human or other animal. Spreading through the air has not been documented in the natural environment. Fruit bats are believed to be a carrier and may spread the virus without being affected. Once human infection occurs, the disease may spread between people, as well. Male survivors may be able to transmit the disease via semen for nearly two months. To make the diagnosis, typically other diseases with similar symptoms such as malaria, cholera and other viral hemorrhagic fevers are first excluded. To confirm the diagnosis, blood samples are tested for viral antibodies, viralRNA, or the virus itself.
Outbreak control require community engagement, case management, surveillance and contact tracing, a good laboratory service, and safe burials. Prevention includes decreasing the spread of disease from infected animals to humans. This may be done by checking such animals for infection and killing and properly disposing of the bodies if the disease is discovered. Properly cooking meat and wearing protective clothing when handling meat may also be helpful, as are wearing protective clothing and washing hands when around a person with the disease. Samples of bodily fluids and tissues from people with the disease should be handled with special caution.
No specific treatment for the disease is yet available. Efforts to help those who are infected are supportive and include giving either oral rehydration therapy (slightly sweet and salty water to drink) or intravenous fluids. This supportive care improves outcomes. The disease has a high risk of death, killing between 50% and 90% of those infected with the virus. EVD was first identified in an area of Sudan that is now part of South Sudan, as well as in Zaire (now the Democratic Republic of the Congo). The disease typically occurs in outbreaks in tropical regions of sub-Saharan Africa. From 1976 (when it was first identified) through 2013, the World Health Organization reported a total of 1,716 cases. The largest outbreak to date is the ongoing 2014 West African Ebola outbreak, which is affecting Guinea, Sierra Leone, Liberia, and Nigeria. As of 28 September 2014, 7,157 suspected cases resulting in the deaths of 3,330 have been reported. Efforts are under way to develop a vaccine; however, none yet exists.
Signs and symptoms
Signs and symptoms of Ebola.
Signs and symptoms of Ebola usually begin suddenly with an influenza-like stage characterized by fatigue, fever, headaches, joint, muscle, and abdominal pain. Vomiting, diarrhea, and loss of appetite are also common.Less common symptoms include the following: sore throat, chest pain, hiccups, shortness of breath, and trouble swallowing. The average time between contracting the infection and the start of symptoms (incubation period) is 8 to 10 days, but it can vary between 2 and 21 days. Skin manifestations may include a maculopapular rash (in about 50% of cases). Early symptoms of EVD may be similar to those of malaria, dengue fever, or other tropical fevers, before the disease progresses to the bleeding phase.
In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g., gastrointestinal tract, nose, vagina, and gums) has been reported. In the bleeding phase, which typically begins five to seven days after first symptoms, internal and subcutaneous bleeding may present itself in the form of reddened eyes and bloody vomit. Bleeding into the skin may create petechiae, purpura, ecchymoses, and hematomas (especially around needle injection sites). Sufferers may cough up blood, vomit it, or excrete it in their stool.
Heavy bleeding is rare and is usually confined to the gastrointestinal tract. In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. All people infected show some signs of circulatory system involvement, including impaired blood clotting. If the infected person does not recover, death due to multiple organ dysfunction syndrome occurs within 7 to 16 days (usually between days 8 and 9) after first symptoms.
Life cycles of the Ebolavirus
EVD is caused by four of five viruses classified in the genus Ebolavirus, family Filoviridae, order Mononegavirales. The four disease-causing viruses are Bundibugyo virus (BDBV), Sudan virus (SUDV), Taï Forest virus (TAFV), and one called, simply, Ebola virus (EBOV, formerly Zaire Ebola virus)). Ebola virus is the sole member of the Zaire ebolavirus species and the most dangerous of the known Ebola disease-causing viruses, as well as being responsible for the largest number of outbreaks. The fifth virus, Reston virus (RESTV), is not thought to be disease-causing in humans. These five viruses are closely related to the Marburg viruses.
Human-to-human transmission can occur via direct contact with blood or bodily fluids from an infected person (including embalming of an infected dead person) or by contact with objects contaminated by the virus, particularly needles and syringes. Other body fluids with ebola virus include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen. Entry points include the nose, mouth, eyes, or open wounds, cuts and abrasions. The potential for widespread EVD infections is considered low as the disease is only spread by direct contact with the secretions from someone who is showing signs of infection. The symptoms limit a person’s ability to spread the disease as they are often too sick to travel. Because dead bodies are still infectious, traditional burial rituals may spread the disease. Nearly two thirds of the cases of Ebola in Guinea during the 2014 outbreak are believed to be due to burial practices. Semen may be infectious in survivors for up to 7 weeks. It is not entirely clear how an outbreak is initially started. The initial infection is believed to occur after ebola virus is transmitted to a human by contact with an infected animal’s body fluids.
One of the primary reasons for spread is that the health systems in the part of Africa where the disease occurs function poorly. Medical workers who do not wear appropriate protective clothing may contract the disease. Hospital-acquired transmission has occurred in African countries due to the reuse of needles and lack of universal precautions. Some healthcare centers caring for people with the disease do not have running water.
Airborne transmission has not been documented during EVD outbreaks. They are, however, infectious as breathable 0.8– to 1.2-μm laboratory-generated droplets. The virus has been shown to travel, without contact, from pigs to primates, although the same study failed to demonstrate similar transmission between non-human primates.
Bats drop partially eaten fruits and pulp, then land mammals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations, which has led to research towards viral shedding in the saliva of bats. Fruit production, animal behavior, and other factors vary at different times and places that may trigger outbreaks among animal populations.
Bushmeat being prepared for cooking in Ghana, 2013. Human consumption of equatorial animals in Africa in the form of bushmeat has been linked to the transmission of diseases to people, including Ebola.
Bats are considered the most likely natural reservoir of the EBOV. Plants, arthropods, and birds were also considered. Bats were known to reside in the cotton factory in which the first cases for the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980. Of 24 plant species and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected. The absence of clinical signs in these bats is characteristic of a reservoir species. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo, 13 fruit bats were found to contain EBOV RNA fragments. As of 2005, three types of fruit bats (Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata) have been identified as being in contact with EBOV. They are now suspected to represent the EBOV reservoir hosts. Antibodies against Zaire and Reston viruses have been found in fruit bats in Bangladesh, thus identifying potential virus hosts and signs of the filoviruses in Asia.
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and arthropods sampled from outbreak regions, no ebolavirus was detected apart from some genetic traces found in six rodents (Mus setulosus andPraomys) and one shrew (Sylvisorex ollula) collected from the Central African Republic. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high lethality from infection in these species makes them unlikely as a natural reservoir.
Transmission between natural reservoir and humans is rare, and outbreaks are usually traceable to a single case where an individual has handled the carcass of gorilla, chimpanzee or duiker. Fruit bats are also eaten by people in parts of West Africa where they are smoked, grilled or made into a spicy soup.
Like all mononegaviruses, ebolavirions contain linear nonsegmented, single-strand, non-infectious RNA genomes of negative polarity that possesses inverse-complementary 3′ and 5′ termini, do not possess a 5′ cap, are notpolyadenylated, and are not covalently linked to a protein. Ebolavirus genomes are approximately 19 kilobase pairs long and contain seven genes in the order 3′-UTR-NP-VP35-VP40-GP-VP30-VP24-L-5′-UTR. The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV, and TAFV) differ in sequence and the number and location of gene overlaps.
Like all filoviruses, ebolavirions are filamentous particles that may appear in the shape of a shepherd’s crook or in the shape of a “U” or a “6”, and they may be coiled, toroid, or branched. In general, ebolavirions are 80 nm in width, but vary somewhat in length. In general, the median particle length of ebolaviruses ranges from 974 to 1,086 nm (in contrast to marburgvirions, whose median particle length was measured at 795–828 nm), but particles as long as 14,000 nm have been detected in tissue culture.
The ebolavirus life cycle begins with virion attachment to specific cell-surface receptors, followed by fusion of the virion envelope with cellular membranes and the concomitant release of the virus nucleocapsid into the cytosol. The viral RNA polymerase, encoded by the L gene, partially uncoats the nucleocapsid and transcribes the genes into positive-strand mRNAs, which are then translated into structural and nonstructural proteins. Ebolavirus RNA polymerase (L) binds to a single promoter located at the 3′ end of the genome. Transcription either terminates after a gene or continues to the next gene downstream. This means that genes close to the 3′ end of the genome are transcribed in the greatest abundance, whereas those toward the 5′ end are least likely to be transcribed. The gene order is, therefore, a simple but effective form of transcriptional regulation. The most abundant protein produced is the nucleoprotein, whose concentration in the cell determines when L switches from gene transcription to genome replication. Replication results in full-length, positive-strand antigenomes that are, in turn, transcribed into negative-strand virus progeny genome copy. Newly synthesized structural proteins and genomes self-assemble and accumulate near the inside of the cell membrane. Virions bud off from the cell, gaining their envelopes from the cellular membrane they bud from. The mature progeny particles then infect other cells to repeat the cycle. The Ebola virus genetics are difficult to study due to its virulent nature.
Endothelial cells, macrophages, monocytes, and liver cells are the main targets of infection. After infection, a secreted glycoprotein (sGP) known as the Ebola virus glycoprotein (GP) is synthesized. Ebola replication overwhelms protein synthesis of infected cells and host immune defenses. The GP forms a trimeric complex, which binds the virus to the endothelial cells lining the interior surface of blood vessels. The sGP forms a dimeric protein that interferes with the signaling of neutrophils, a type of white blood cell, which allows the virus to evade the immune system by inhibiting early steps of neutrophil activation. These white blood cells also serve as carriers to transport the virus throughout the entire body to places such as the lymph nodes, liver, lungs, and spleen.
The presence of viral particles and cell damage resulting from budding causes the release of chemical signals (to be specific, TNF-α, IL-6, IL-8, etc.), which are the signaling molecules for fever and inflammation. The cytopathic effect, from infection in the endothelial cells, results in a loss of vascular integrity. This loss in vascular integrity is furthered with synthesis of GP, which reduces specific integrins responsible for cell adhesion to the inter-cellular structure, and damage to the liver, which leads to improper clotting.
The travel and work history along with exposure to wildlife are important to consider when the diagnosis of EVD is suspected. The diagnosis is confirmed by isolating the virus, detecting its RNA or proteins, or detecting antibodiesagainst the virus in a person’s blood. Isolating the virus by cell culture, detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) works best early and in those who have died from the disease. Detecting antibodies against the virus works best late in the disease and in those who recover.
During an outbreak, virus isolation is often not feasible. The most common diagnostic methods are therefore real-time PCR and ELISA detection of proteins, which can be performed in field or mobile hospitals. Filovirions can be seen and identified in cell culture by electron microscopy due to their unique filamentous shapes, but electron microscopy cannot tell the difference between the various filoviruses despite there being some length differences.
Phylogenetic tree comparing the Ebolavirus and Marburgvirus. Numbers indicate percent confidence of branches.
The genera Ebolavirus and Marburgvirus were originally classified as the species of the now-obsolete Filovirus genus. In March 1998, the Vertebrate Virus Subcommittee proposed in the International Committee on Taxonomy of Viruses (ICTV) to change the Filovirus genus to the Filoviridae family with two specific genera: Ebola-like viruses andMarburg-like viruses. This proposal was implemented in Washington, DC, on April 2001 and in Paris on July 2002. In 2000, another proposal was made in Washington, D.C., to change the “-like viruses” to “-virus” resulting in today’s Ebolavirus and Marburgvirus.
Rates of genetic change are 100 times slower than influenza A in humans, but on the same magnitude as those of hepatitis B. Extrapolating backwards using these rates indicates that Ebolavirus and Marburgvirus diverged several thousand years ago. However, paleoviruses (genomic fossils) of filoviruses (Filoviridae) found in mammals indicate that the family itself is at least tens of millions of years old. Fossilized viruses that are closely related to ebolaviruses have been found in the genome of the Chinese hamster.
The symptoms of EVD are similar to those of Marburg virus disease. It can also easily be confused with many other diseases common in Equatorial Africa such as other viral hemorrhagic fevers, falciparum malaria, typhoid fever, shigellosis, rickettsial diseases such astyphus, cholera, gram-negative septicemia, borreliosis such as relapsing fever or EHEC enteritis. Other infectious diseases that should be included in the differential diagnosis include the following: leptospirosis, scrub typhus, plague, Q fever, candidiasis, histoplasmosis,trypanosomiasis, visceral leishmaniasis, hemorrhagic smallpox, measles, and fulminant viral hepatitis. Non-infectious diseases that can be confused with EVD are acute promyelocytic leukemia, hemolytic uremic syndrome, snake envenomation, clotting factordeficiencies/platelet disorders, thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease, and even warfarin poisoning.
Infection control and containment
The risk of transmission is increased among those caring for people infected. Recommended measures when caring for those who are infected include isolating them, sterilizing equipment and surfaces, and wearing protective clothing including masks, gloves, gowns, and goggles. If a person with Ebola dies, direct contact with the body of the deceased patient should be avoided.
In order to reduce the spread, the World Health Organization recommends raising community awareness of the risk factors for Ebola infection and the protective measures individuals can take. These include avoiding contact with infected people and regular hand washing using soap and water. Traditional burial rituals, especially those requiring washing or embalming of bodies, should be discouraged or modified. Social anthropologists may help find alternatives to traditional rules for burials. Airline crews are instructed to isolate anyone who has symptoms resembling Ebola virus.
The Ebola virus can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for 5 minutes). On surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants at appropriate concentrations can be used as disinfectants.
In laboratories where diagnostic testing is carried out, biosafety level 4-equivalent containment is required, since Ebola viruses are World Health Organization Risk Group 4 pathogens. Laboratory researchers must be properly trained in BSL-4 practices and wear proper personal protective equipment.
Quarantine, also known as enforced isolation, is usually effective in decreasing spread. Governments often quarantine areas where the disease is occurring or individuals who may be infected. In the United States, the law allows quarantine of those infected with Ebola. During the 2014 outbreak, Liberia closed schools.
Contact tracing is regarded as important to contain an outbreak. It involves finding everyone who had close contact with infected individuals and watching for signs of illness for 21 days. If any of these contacts comes down with the disease, they should be isolated, tested, and treated. Then repeat the process by tracing the contacts’ contacts.
A hospital isolation ward in Gulu, Uganda, during the October 2000 outbreak
No ebolavirus-specific treatment is currently approved. However, survival is improved by early supportive care with rehydration and symptomatic treatment. Treatment is primarily supportive in nature. These measures may include management of pain, nausea, fever and anxiety, as well as rehydration via the oral or by intravenous route. Blood products such as packed red blood cells, platelets or fresh frozen plasma may also be used. Other regulators of coagulation have also been tried including heparin in an effort to prevent disseminated intravascular coagulation and clotting factors to decrease bleeding. Antimalarial medications and antibiotics are often used before the diagnosis is confirmed, though there is no evidence to suggest such treatment is in any way helpful.
Intensive care is often used in the developed world. This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop. Dialysis may be needed for kidney failure while extracorporeal membrane oxygenation may be used for lung dysfunction.
The disease has a high mortality rate: often between 25 percent and 90 percent. As of September 2014, information from WHO across all occurrences to date puts the overall fatality rate at 50%. There are indications based on variations in death rate between countries that early and effective treatment of symptoms (e.g., supportive care to prevent dehydration) may reduce the fatality rate significantly. If an infected person survives, recovery may be quick and complete. Prolonged cases are often complicated by the occurrence of long-term problems, such as inflammation of the testicles, joint pains, muscle pains, skin peeling, or hair loss. Eye symptoms, such as light sensitivity, excess tearing, iritis, iridocyclitis, choroiditis, and blindness have also been described. EBOV and SUDV may be able to persist in the semen of some survivors for up to seven weeks, which could give rise to infections and disease via sexual intercourse.
CDC worker incinerates medical waste from Ebola patients in Zaire in 1976
The disease typically occurs in outbreaks in tropical regions of Sub-Saharan Africa. From 1976 (when it was first identified) through 2013, the World Health Organization reported 1,716 confirmed cases. The largest outbreak to date is the ongoing 2014 West Africa Ebola virus outbreak, which is affecting Guinea, Sierra Leone, Liberia and Nigeria. As of 13 August, 2,127 cases have been identified, with 1,145 deaths.
The first identified case of Ebola was on 26 August 1976, in Yambuku, a small rural village in Mongala District in northern Democratic Republic of the Congo (then known as Zaire). The first victim, and the index case for the disease, was village school headmaster Mabalo Lokela, who had toured an area near the Central African Republic border along the Ebola river between 12–22 August. On 8 September he died of what would become known as the Ebola virus species of the ebolavirus. Subsequently a number of other cases were reported, almost all centered on the Yambuku mission hospital or having close contact with another case. 318 cases and 280 deaths (a 88% fatality rate) occurred in the DRC. The Ebola outbreak was contained with the help of the World Health Organization and transport from the Congolese air force, by quarantining villagers, sterilizing medical equipment, and providing protective clothing. The virus responsible for the initial outbreak, first thought to be Marburg virus, was later identified as a new type of virus related to Marburg, and named after the nearby Ebola river. Another ebolavirus, the Sudan virus species, was also identified that same year when an outbreak occurred in Sudan, affecting 284 people and killing 151.
1995 to 2013
The second major outbreak occurred in 1995 in the Democratic Republic of Congo, affecting 315 and killing 254. The next major outbreak occurred in Uganda in 2000, affecting 425 and killing 224; in this case the Sudan virus was found to be the ebolavirus species responsible for the outbreak. In 2003 there was an outbreak in the Republic of Congo that affected 143 and killed 128, a death rate of 90%, the highest to date.
In August 2007, 103 people were infected by a suspected hemorrhagic fever outbreak in the village of Kampungu, Democratic Republic of the Congo. The outbreak started after the funerals of two village chiefs, and 217 people in four villages fell ill. The 2007 outbreak eventually affected 264 individuals and resulted in the deaths of 187.
On 30 November 2007, the Uganda Ministry of Health confirmed an outbreak of Ebola in the Bundibugyo District in Western Uganda. After confirmation of samples tested by the United States National Reference Laboratories and the Centers for Disease Control, the World Health Organization confirmed the presence of a new species of Ebolavirus, which was tentatively named Bundibugyo. The WHO reported 149 cases of this new strain and 37 of those led to deaths.
The WHO confirmed two small outbreaks in Uganda in 2012. The first outbreak affected 7 people and resulted in the death of 4 and the second affected 24, resulting in the death of 17. The Sudan variant was responsible for both outbreaks.
On 17 August 2012, the Ministry of Health of the Democratic Republic of the Congo reported an outbreak of the Ebola-Bundibugyo variant in the eastern region. Other than its discovery in 2007, this was the only time that this variant has been identified as the ebolavirus responsible for an outbreak. The WHO revealed that the virus had sickened 57 people and claimed 29 lives. The probable cause of the outbreak was tainted bush meat hunted by local villagers around the towns of Isiro and Viadana.
Increase over time in the cases and deaths during the 2014 outbreak
In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea, a western African nation. Researchers traced the outbreak to a two-year old child who died on 28 December 2013. The disease then rapidly spread to the neighboring countries of Liberia and Sierra Leone. It is the largest Ebola outbreak ever documented, and the first recorded in the region.
On 8 August 2014, the WHO declared the epidemic to be an international public health emergency. Urging the world to offer aid to the affected regions, the Director-General said, “Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible.” By mid-August 2014, Doctors Without Borders reported the situation in Liberia’s capital Monrovia as “catastrophic” and “deteriorating daily”. They reported that fears of Ebola among staff members and patients had shut down much of the city’s health system, leaving many people without treatment for other conditions. By late August 2014, the disease had spread to Nigeria, and one case was reported in Senegal.  On 30 September 2014, the first confirmed case of Ebola was diagnosed in the United States at Texas Health Presbyterian Hospital in Dallas, Texas.
Aside from the human cost, the outbreak has severely eroded the economies of the affected countries. A Financial Times report suggested the economic impact of the outbreak could kill more people than the virus itself. As of 23 September, in the three hardest hit countries, Liberia, Sierra Leone, and Guinea, there were only 893 treatment beds available while the current need was 2122. In a 26 September statement, the WHO said, “The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long.”
By 29 September 2014, 7,192 suspected cases and 3,286 deaths had been reported, however the World Health Organization has said that these numbers may be vastly underestimated. The WHO reports that more than 216 healthcare workers are among the dead, partly due to the lack of equipment and long hours.
For more about the outbreak in Virginia, US, see Reston virus
Cases of ebola fever in Africa from 1979 to 2008.
The first recorded outbreak of EBD occurred in Southern Sudan in June 1976. A second outbreak soon followed in the Democratic Republic of the Congo (then Zaire). Virus isolated from both outbreaks was named “Ebola virus” by Belgian researchers after the Ebola River, located near the Zaire outbreak. Although it was assumed that the two outbreaks were connected, scientists later realized that they were caused by distinct species of filoviruses, Sudan virus and Ebola virus.
In late 1989, Hazelton Research Products’ Reston Quarantine Unit in Reston, Virginia suffered a mysterious outbreak of fatal illness (initially diagnosed as Simian hemorrhagic fever virus (SHFV)) among a shipment of crab-eating macaque monkeys imported from the Philippines. Hazelton’s veterinary pathologist sent tissue samples from dead animals to the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland, where a laboratory test known as an ELISA assay showed antibodies to Ebola virus. An electron microscopist from USAMRIID discoveredfiloviruses similar in appearance to Ebola in the tissue samples sent from Hazelton Research Products’ Reston Quarantine Unit.
Shortly afterward, a US Army team headquartered at USAMRIID went into action to euthanize the monkeys which had not yet died, bringing those monkeys and those which had already died of the disease toFt. Detrick for study by the Army’s veterinary pathologists and virologists, and eventual disposal under safe conditions.
Blood samples were taken from 178 animal handlers during the incident. Of those, six animal handlers eventually seroconverted, including one who had cut himself with a bloody scalpel. When the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.
The Philippines and the United States had no previous cases of Ebola infection, and upon further isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin, which they named Reston ebolavirus (REBOV) after the location of the incident.
Society and culture
Ebolavirus is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. It has the potential to be weaponized for use in biological warfare, and was investigated by the Biopreparat for such use, but might be difficult to prepare as a weapon of mass destruction because the virus becomes ineffective quickly in open air.
Richard Preston‘s 1995 best-selling book, The Hot Zone, dramatized the Ebola outbreak in Reston, Virginia.
William Close‘s 1995 Ebola: A Documentary Novel of Its First Explosion and 2002 Ebola: Through the Eyes of the People focused on individuals’ reactions to the 1976 Ebola outbreak in Zaire.
Tom Clancy‘s 1996 novel, Executive Orders, involves a Middle Eastern terrorist attack on the United States using an airborne form of a deadly Ebola virus strain named “Ebola Mayinga” (see Mayinga N’Seka).
It is widely believed that outbreaks of EVD among human populations result from handling infected wild animal carcasses. Some research suggests that an outbreak in the wild animals used for consumption, bushmeat, may result in a corresponding human outbreak. Since 2003, such outbreaks have been monitored through surveillance of animal populations with the aim of predicting and preventing Ebola outbreaks in humans.
Recovered carcasses from gorillas contain multiple Ebola virus strains, which suggest multiple introductions of the virus. Bodies decompose quickly and carcasses are not infectious after three to four days. Contact between gorilla groups is rare, suggesting transmission among gorilla groups is unlikely, and that outbreaks result from transmission between viral reservoir and animal populations.
Ebola has a high mortality among primates. Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas. Outbreaks of Ebola may have been responsible for an 88% decline in tracking indices of observed chimpanzee populations in 420 square kilometer Lossi Sanctuary between 2002 and 2003. Transmission among chimpanzees through meat consumption constitutes a significant risk factor, while contact between individuals, such as touching dead bodies and grooming, is not.
Reston ebolavirus (REBOV) can be transmitted to pigs. This virus was discovered during an outbreak of what at the time was thought to be simian hemorrhagic fever virus (SHFV) in crab-eating macaques in Reston, Virginia (hence the name Reston elabavirus) in 1989. Since the initial outbreak it has since been found in nonhuman primates in Pennsylvania, Texas, and Italy. In each case, the affected animals had been imported from a facility in the Philippines, where the virus had infected pigs. Despite its status as a Level‑4organism and its apparent pathogenicity in monkeys, REBOV has not caused disease in exposed human laboratory workers. In 2012 it was demonstrated that the virus can travel without contact from pigs to nonhuman primates, although the same study failed to achieve transmission in that manner between primates. According to the WHO, routine cleaning and disinfection of pig (or monkey) farms with sodium hypochlorite or other detergents should be effective in inactivating the Reston ebolavirus. If an outbreak is suspected, the area must be immediately quarantined.
While pigs that have been infected with REBOV tend to show symptoms of the disease, it has been shown that dogs may become infected with EBOV and remain asymptomatic. Dogs in some parts of Africa scavenge for their food and it is known that they sometimes eat infected animals and the corpses of humans. Although they remain asymptomatic, a 2005 survey of dogs during an EBOV outbreak found that over 31.8% showed a seroprevalence for EBOV closest to an outbreak versus 9% a farther distance away.
A number of experimental treatments are being studied. In the United States, the Food and Drug Administration (FDA)’s animal efficacy rule is being used to demonstrate reasonable safety to obtain permission to treat people who are infected with Ebola. It is being used as the normal path for testing drugs is not possible for diseases caused by dangerous pathogens or toxins. Experimental drugs are made available for use with the approval of regulatory agencies under named patient programs, known in the US as “expanded access”. On 12 August 2014 the WHO released a statement that the use of not yet proven treatments is ethical in certain situations in an effort to treat or prevent the disease.
Researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them.
As of August 14, 2014, the United States Food and Drug Administration (FDA) has not approved any drugs to treat or prevent Ebola and advises people to watch out for fraudulent products. The unavailability of experimental treatments in the most affected regions during the 2014 outbreak spurred controversy, with some calling for experimental drugs to be made more widely available in Africa on a humanitarian basis, and others warning that making unproven experimental drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies.
The FDA has allowed three drugs: ZMapp, an RNA interference drug called TKM-Ebola, and brincidofovir to be used in people infected with Ebola under these programs during the 2014 outbreak. BioCryst’s BCX4430 small molecule is undergoing further animal testing as a possible therapy in humans. Another drug favipiravir has been used with apparent success in a patient medically evacuated to France.
ZMapp is a monoclonal antibody vaccine. The limited supply of the drug has been used to treat a small number of individuals infected with the Ebola virus. Although some of these have recovered the outcome is not consideredstatistically significant. ZMapp has proved effective in a trial involving Rhesus macaque monkeys.
A number of antiviral medications are being studied. Favipiravir, an anti-viral drug approved in Japan for stockpiling against influenza pandemics, appears to be useful in a mouse model of Ebola. On 4 October 2014, it was reported that a French nun who contracted Ebola while volunteering in Liberia was cured with Favipiravir treatment. BCX4430 is a broad-spectrum antiviral drug developed by BioCryst Pharmaceuticals and currently being researched as a potential treatment for Ebola by USAMRIID. The drug has been approved to progress to Phase 1 trials, expected late in 2014. Brincidofovir, another broad-spectrum antiviral drug, has been granted an emergency FDA approval as an investigational new drug for the treatment of Ebola, after it was found to be effective against Ebolavirus in in vitro tests. It has subsequently been used to treat the first patient diagnosed with Ebola in the USA, after he had recently returned from Liberia. The antiviral drug lamivudine, which is usually used to treat HIV / AIDS, was reported in September 2014 to have been used successfully to treat 13 out of 15 Ebola-infected patients by a doctor in Liberia, as part of a combination therapy also involving intravenous fluids and antibiotics to combat opportunistic bacterial infection of Ebola-compromised internal organs. Western virologists have however expressed caution about the results, due to the small number of patients treated and confounding factors present. Researchers at the NIH stated that lamivudine had so far failed to demonstrate anti-Ebola activity in preliminary in vitro tests, but that they would continue to test it under different conditions and would progress it to trials if even slight evidence for efficacy is found.
Other promising treatments rely on antisense technology. Both small interfering RNAs (siRNAs) and phosphorodiamidate morpholino oligomers (PMOs) targeting the Zaire Ebola virus (ZEBOV) RNA polymerase L protein could prevent disease in nonhuman primates. TKM-Ebola is a small-interfering RNA compound, currently being tested in a Phase I clinical trial in humans. Sarepta Therapeutics has completed a Phase I clinical trial with its Morpholino oligo targeting Ebola.
Two selective estrogen receptor modulators used to treat infertility and breast cancer (clomiphene and toremifene) have been found to inhibit the progress of Ebola virus in infected mice. Ninety percent of the mice treated with clomiphene and fifty percent of those treated with toremifene survived the tests.
A 2014 study found that three ion channel blockers used in the treatment of heart arrhythmias, amiodarone, dronedarone and verapamil, block the entry of Ebolavirus into cells in vitro. Given their oral availability and history of human use, these drugs would be candidates for treating Ebola virus infection in remote geographical locations, either on their own or together with other antiviral drugs.
Melatonin has also been suggested as a potential treatment for Ebola based on promising in vitro results.
The WHO has stated that transfusion of whole blood or purified serum from Ebola survivors is the therapy with the greatest potential to be implemented immediately, although there is little information as to its efficacy. At the end of September, WHO issued an interim guideline for this therapy. The blood serum from those who have survived an infection is currently being studied to see if it is an effective treatment. During a meeting arranged by WHO this research was deemed to be a top priority. Seven of eight people with Ebola survived after receiving a transfusion of blood donated by individuals who had previously survived the infection in an 1999 outbreak in the Democratic Republic of the Congo. This treatment, however, was started late in the disease meaning they may have already been recovering on their own and the rest of their care was better than usual. Thus this potential treatment remains controversial. Intravenous antibodies appear to be protective in non-human primates who have been exposed to large doses of Ebola.The World Health Organisation has approved the use of convalescent serum and whole blood products to treat people with Ebola.
As of September 2014, no vaccine was approved for clinical use in humans. It was hoped that one would be initially available by November 2014. The most promising candidates are DNA vaccines or vaccines derived from adenoviruses, vesicular stomatitis Indiana virus (VSIV) or filovirus-like particles (VLPs) because these candidates could protect nonhuman primates from ebolavirus-induced disease. DNA vaccines, adenovirus-based vaccines, and VSIV-based vaccines have entered clinical trials.
Vaccines have protected nonhuman primates. Immunization takes six months, which impedes the counter-epidemic use of the vaccines. Searching for a quicker onset of effectiveness, in 2003, a vaccine using an adenoviral (ADV) vector carrying the Ebola spike protein was tested on crab-eating macaques. Twenty-eight days later, they were challenged with the virus and remained resistant. A vaccine based on attenuated recombinant vesicular stomatitis virus (VSV) vector carrying either the Ebola glycoprotein or the Marburg glycoprotein in 2005 protected nonhuman primates, opening clinical trials in humans. The study by October completed the first human trial, over three months giving three vaccinations safely inducing an immune response. Individuals for a year were followed, and, in 2006, a study testing a faster-acting, single-shot vaccine began; this new study was completed in 2008. Trying the vaccine on a strain of Ebola that more resembles one that infects humans is the next step. On 6 December 2011, the development of a successfulvaccine against Ebola for mice was reported. Unlike the predecessors, it can be freeze-dried and thus stored for long periods in wait for an outbreak. An experimental vaccine made by researchers at Canada’s national laboratory in Winnipeg was used, in 2009, to pre-emptively treat a German scientist who might have been infected during a lab accident. However, actual EBOV infection was never demonstrated beyond doubt. Experimentally, recombinant vesicular stomatitis Indiana virus (VSIV) expressing the glycoprotein of EBOV or SUDV has been used successfully in nonhuman primate models as post-exposure prophylaxis. The CDC’s recommendations are currently under review.
Simultaneous phase 1 trials of an experimental vaccine known as the NIAID/GSK vaccine commenced in September 2014. GlaxoSmithKline and the NIH jointly developed the vaccine, based on a modified chimpanzee adenovirus, and contains parts of the Zaireand Sudan ebola strains. If this phase is completed successfully, the vaccine will be fast tracked for use in West Africa. In preparation for this, GSK is preparing a stockpile of 10,000 doses.