Story 1: Obama’s Cadillac Tax Crashes and Burns Killing Obamacare and Injuring MIT Professor Gruber — Rest In Peace — Obamacare Is Shovel Ready — Videos
ObamaCare a Trojan Horse for Single-Payer
Obama lies about “cadillac” plan taxation
36 Times Obama Said You Could Keep Your Health Care Plan | SuperCuts #18
ACA Architect Confession: Created Lies For Obama
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
What is the “cadillac tax?”
Obamacare’s Cadillac Tax Pushing People To Plans With High Deductible- Union You Got What You Wanted
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
The Five: Large Employers Cite ObamaCare “Cadillac” Tax In Reducing Benefits
SMOKING GUN! Gruber Admits Obama Was in Room During Planning of Cadillac Lie
GRUBER: “Lack of transparency is a huge political advantage.”
GRUBER; Deceive Americans Critical to Pass Obamacare-Calls us ‘Stupid Americans'; Part 1 of 3
Gruber Remarks Puts Obama Administration on Scramble; Part 2 of 3
Jonathan Gruber: States Which Do Not Set Up an Exchange Do Not Get Tax Subsidies
BookTV: Jonathan Gruber, “Health Care Reform: What It Is, Why It’s Necessary, How It Works”
Jonathan Gruber admits Obamacare is inherently unaffordable
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
Krauthammer rips Jonathan Gruber: “We’re hearing the true voice of liberal arrogance”
Megyn Slams ObamaCare Architect Who Declined to Appear on ‘Kelly File’
Democrats Loved Jonathan Gruber Before They Forgot Who He Was
Sen. Harry Reid, 2009: Gruber Is One Of The ‘Most Respected Economists’ Out There
Sen. Harry Reid (D-NV) in a December 2009 floor speech on Capitol Hill lauded Jonathan Gruber as one of the most “respected economists in the world” as Reid cited facts defending the Senate’s Obamacare bill.
Nancy Pelosi In 2009: Americans Should Read Jonathan Gruber’s ObamaCare Analysis
Nancy Pelosi In 2009: Americans Should Read Jonathan Gruber’s ObamaCare Analysis (November 5, 2009)
AHEC 2013 Conference
As part of the 24th Annual Health Economics Conference hosted by PennLDI, Mark Pauly and Jonathan Gruber were featured in the Plenary Panel discussing the role of economics in shaping (and possibly reshaping) the ACA. See below for the conference agenda with links to working papers. See the full AHEC agenda: http://ldi.upenn.edu/ahec2013/agenda
Jonathan Gruber at Noblis – January 18, 2012
The Noblis Technology Tuesday speaker series covers a broad spectrum of political, technical and innovative ideas. Noblis is a nonprofit science, technology, and strategy organization that brings the best of scientific thought, management, and engineering expertise with a reputation for independence and objectivity. The opinions expressed in this video are those of the speaker and do not necessarily reflect the views or opinions of Noblis.
Jonathan Gruber spoke to a Noblis audience on January 18, 2012 Few experts know more about America’s dire need of health care reform than Gruber. And of that short list, he is the only one prepared to enter the pages of a comic book to make the case. To be clear: Gruber is not an expert; he is “the” expert. An award-winning MIT economist and the director of the Health Care Program at the National Bureau of Economic Research, he was a key architect of the ambitious health care reform effort in Massachusetts and is a member of the Health Connector Board now implementing it; in 2006 he was named by “Modern Healthcare” as the nineteenth most powerful person in health care in the United States. In 2008 he was a consultant to the Clinton, Edwards, and Obama presidential campaigns. The national legislation passed by Congress in 2009 derives directly from Gruber’s insights learned during the Massachusetts health care debate.
Honors Colloquium 2012 – Jonathan Gruber
Dr. Jonathan Gruber is a Professor of Economics at the Massachusetts Institute of Technology, where he has taught since 1992. He is also the Director of the Health Care Program at the National Bureau of Economic Research, where he is a Research Associate. He is an Associate Editor of both the Journal of Public Economics and the Journal of Health Economics. In 2009 he was elected to the Executive Committee of the American Economic Association. He is also a member of the Institute of Medicine, the American Academy of Arts and Sciences, and the National Academy of Social Insurance.
Dr. Gruber received his B.S. in Economics from MIT, and his Ph.D. in Economics from Harvard University. Dr. Gruber’s research focuses on the areas of public finance and health economics. He has published more than 140 research articles, has edited six research volumes, and is the author of Public Finance and Public Policy, a leading undergraduate text, and Health Care Reform, a graphic novel. In 2006 he received the American Society of Health Economists Inaugural Medal for the best health economist in the nation aged 40 and under. During the 1997-1998 academic year, Dr. Gruber was on leave as Deputy Assistant Secretary for Economic Policy at the Treasury Department. From 2003-2006 he was a key architect of Massachusetts’ ambitious health reform effort, and in 2006 became an inaugural member of the Health Connector Board, the main implementing body for that effort. In that year, he was named the 19th most powerful person in health care in the United States by Modern Healthcare Magazine.
BookTV: Jonathan Gruber, “Health Care Reform: What It Is, Why It’s Necessary, How It Works
Jonathan Gruber, economics professor at the Massachusetts Institute of Technology and director of the health care program at the National Bureau of Economic Research, presents his thoughts on health care. Mr. Gruber a leading architect of Massachusetts’ health care reform also consulted with Congress and President Obama on the creation of the Affordable Care Act, signed into law by the President in 2010.
Obamacare architect Jonathan Gruber suddenly recast as bit player after uproar
Nancy Pelosi, fellow Democrats scramble to distance themselves from MIT professor, economist
For years, Massachusetts Institute of Technology professor Jonathan Gruber was deemed an architect of Obamacare and his economic modeling was cited regularly by the health care law’s defenders on Capitol Hill and in legal briefs defending the Affordable Care Act in federal courts.
But after tapes surfaced of the economist saying “stupid” voters needed to be bamboozled and the books cooked to get the legislation passed in 2010, Democrats are scrambling to reduce Mr. Gruber to a bit player — and raising questions about whether he needs to be expunged from their defense strategy as they face yet another Supreme Court review.
House Minority Leader Nancy Pelosi, who as speaker in 2009 posted an Obamacare “myth buster” citing Mr. Gruber, vehemently distanced herself from him Thursday.
“I don’t who he is. He didn’t help write our bill,” she said, but added that Mr. Gruber’s comments were a year old and he had recanted them.
In the comments that have just come to light, Mr. Gruber said the health care bill was written in a “tortured” way to ensure the Congressional Budget Office didn’t score the individual mandate as a tax, even though the U.S. Supreme Court ultimately upheld the mandate as constitutional under Congress’ taxing power.
“Lack of transparency is a huge political advantage,” Mr. Gruber said at the time. “And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical to get the thing to pass.”
Mr. Gruber said this week that he regretted the remarks. But House Speaker John A. Boehner, Ohio Republican, said Thursday that American voters are “anything but stupid” and oppose the health care system’s overhaul for valid reasons.
Mitch McConnell, the Kentucky Republican selected as the next Senate majority leader, said Mr. Gruber made a classic “Washington gaffe — when a politician mistakenly tells you what he really thinks.”
However, Mr. Gruber’s explanation in 2012 of how Obamacare’s subsidies should be paid put the Justice Department in a tough spot.
In legal briefs submitted last year to a federal district court in Virginia, Obama administration attorneys cited Mr. Gruber in a case defending their ability to pay subsidies to enrollees regardless of whether they are part of state-run or federally run health care exchanges.
“According to the calculations of one health care economist, without the minimum coverage provision and subsidized insurance coverage, premiums for single individuals would be double the amount anticipated under the ACA,” the Justice Department wrote in a legal brief last November, citing Mr. Gruber’s work in a footnote.
The Supreme Court decided this month to take up the case, King v. Burwell, after the challengers lost to the administration in the 4th U.S. Circuit Court of Appeals.
Neither the Justice Department nor the White House responded to questions about Mr. Gruber — who declined to comment for this story — and his role in their legal strategy.
But Sam Kazman, general counsel for the Competitive Enterprise Institute, which is funding the administration’s opponents in the King case, said Mr. Gruber’s 2012 remarks about subsidies bolster their own arguments.
Mr. Gruber at the time said subsidies would flow only to states that set up their own exchanges.
“What’s important to remember politically about this is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits — but your citizens still pay the taxes that support this bill,” the economist told an audience.
That would mean consumers in most states wouldn’t be eligible for subsidies, which would puncture a big hole in Obamacare. The Obama administration has argued that even though the law says subsidies go to state exchanges, they also should include states that have opted for the federal exchange.
Mr. Kazman said the Gruber comments create a major problem for Mr. Obama.
“He’s not toxic to us,” Mr. Kazman said in an interview Thursday. “We may give him an award for public service.”
In a parallel case before the D.C. Circuit, the administration tried to downplay Mr. Gruber in its latest court filings. On Nov. 3, the Justice Department said in a footnote that “post-enactment statements by a non-legislator are entitled to no weight.”
“In any event, Professor Gruber has since clarified that the remarks on which plaintiffs rely were mistaken,” the attorneys told the D.C. Circuit, which has suspended its proceedings until the Supreme Court weighs in.
“Tellingly,” Mr. Carvin said in a reply brief, “the government also ignores that Jonathan Gruber — the ACA architect whose work it cited in every brief below but is nowhere mentioned now — articulated the incentive purpose of [subsidies] as early as 2012.”
Mr. Gruber has made hundreds of thousands of dollars off Obamacare, serving as a consultant to the Department of Health and Human Services and to states that used health care grant money to pay him for his services.
Timothy Jost, a law professor at Washington and Lee University who closely tracks the health care law, said the controversy has been overblown.
“This whole thing just puzzles me,” he said. “He wasn’t a legislator. He didn’t write the bill. He didn’t vote on the bill.”
Transcending Obamacare: An Introduction To Patient-Centered, Consumer-Driven Health Reform
Avik Roy
Today, the Manhattan Institute is publishing my 20,000-word, 68-page health reform proposal entitled “Transcending Obamacare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Solvency.” It represents a novel approach to health reform: neither accepting Obamacare as is, nor requiring the law’s repeal to move forward. And yet its ambition is to permanently solve our health care entitlement problem, while also expanding coverage for the uninsured.
As most Apothecary readers know, I’ve long been critical of Obamacare, the so-called Affordable Care Act. The law expands Medicaid, the worst health insurance program in the developed world. It significantly drives up the underlying cost of health insurance for those who shop for coverage on their own. And regardless of what John Roberts has to say about it, Obamacare’s individual mandate—forcing most Americans to buy government-certified health coverage—is an injury to the Constitution.
But I’ve also long supported the principle of universal coverage. Universal coverage, done right, is a core part of a conservative worldview that values equality of opportunity for the sick and the poor. If 10 of the 11 freest economies in the world can establish universal coverage, it’s not impossible for the United States to do so in a way that is consonant with economic freedom.
Switzerland and Singapore: Market-based health reform models
The most market-oriented health care systems in the developed world—those ofSwitzerland and Singapore—have much to teach us about how to achieve universal coverage in a way that spends far less than what the U.S. does. In 2012, U.S. government entities spent $4,160 per capita on health care. That’s more than twice as much as Switzerland, and nearly five times as much as Singapore.
And that brings us right back to Obamacare. The vast majority of the law is misguided and misconceived. But a handful of its provisions can provide the basis of constructive health care reform: in particular, its use of Swiss-style means-tested tax credits to subsidize private health insurance premiums. Most importantly, those tax credits are applied to insurance plans that people shop for on their own, substantially expanding the market for individually purchased health coverage.
The Swiss system is far from perfect, as I have discussed on many occasions. But the basic idea in Switzerland is to offer premium subsidies to the people who really need them. In Switzerland, one-fifth of the population gets subsidized health coverage. In the U.S., around four-fifths do. That’s the difference between a safety net and an entitlement leviathan.
Conservative health reform after Obamacare
One of the fundamental flaws in the conservative approach to health care policy is that few—if any—Republican leaders have articulated a vision of what a market-oriented health care system would look like. Hence, Republican proposals on health reform have often been tactical and political—in opposition to whatever Democrats were pitching—instead of strategic and serious.
Those days must come to an end. The problems with our health care system are too great. Health care is too expensive for the government, and too expensive for average Americans.
In 2012, as the Romney campaign came to a close, Rich Lowry, the editor ofNational Review, asked me to write an article with my thoughts about the best path forward for conservative health care reform. I outlined a four-step plan to take the entire gamish of government health care programs and reform them into something consumer-driven and fiscally sustainable: (1) deregulate Obamacare’s insurance exchanges, including repeal of the individual mandate, while preserving guaranteed issue for individuals with pre-existing conditions; (2) migrate future retirees onto the reformed exchanges; (3) repeal Obamacare’s employer mandate; (4) migrate Medicaid acute-care and dual-eligible enrollees onto the exchanges.
“After these four relatively simple steps,” I wrote, “we would be left with a health-care system that would look a lot like Switzerland’s. Rises in premium subsidies could be held to a sustainable growth rate to ensure their long-term fiscal stability. And Americans might finally have the opportunity to purchase insurance for themselves, gain control of their own health-care dollars, and enjoy a wide range of low-cost, high-quality coverage options.”
A few months later, former Congressional Budget Office director Douglas Holtz-Eakin and I wrote a similar piece for Reuters, which elicited a broad range of responses from both the left and the right.
It became clear that I had to do more than write op-eds, that I had to develop this idea in detail, with credible fiscal and economic modeling.
Modeling market-based health reform
So, over the last 18 months, I’ve done just that. Stephen Parente, a health economist at the University of Minnesota, and his team modeled the fiscal and coverage impact of the bulk of my proposed set of reforms. (I then modeled the remainder, using analyses from the Congressional Budget Office, the Centers for Medicare and Medicaid Services, and the like.)
The Manhattan Institute for Policy Research, where I am a Senior Fellow, raised money to fund Parente’s work on this project. Steve and his team and I went back and forth for months, refining and tweaking the proposal until it met five non-negotiable goals. The end result had to:
Reduce the deficit without raising taxes
Expand coverage meaningfully above ACA levels
Repeal the individual mandate
Reduce the cost of private health insurance
Improve health outcomes for the poor
Based on our modeling, the plan, over a thirty-year period, reduces federal spending by $10.5 trillion and federal revenue by $2.5 trillion, for a net deficit reduction of $8 trillion. We project that it will expand coverage by more than 12 million individuals over its first decade, despite the fact that it repeals the individual mandate. It reduces the cost of private-sector insurance policies by 17 percent for single policies and 4 percent for family policies.
But the most dramatic improvement, we estimate, is in the Medicaid population. A group that today receives substandard care and substandard access to care will see a dramatic increase in provider access and health outcomes, based on Parente-developed indices that measure these things.
Breaking free of the repeal-or-reform debate
Importantly, while this plan is compatible with “repealing and replacing” Obamacare, it does not require the repeal of Obamacare. To achieve the former, you would repeal Obamacare and replace it with a universal system of state-based health insurance exchanges. To achieve the latter, you’d reform the pre-existing ACA exchanges, and gradually migrate future retirees and Medicaid enrollees onto the reformed exchanges.
In this way, perhaps the plan can attract interest from both the right and the center.
Both clips reveal a gleefully dismissive attitude toward public concerns about the law, and offer a telling reminder of the attitude that played a crucial role in shaping and selling the law to the public.
In the first video, recorded in March of 2010, just a few days before the law would pass the House, Gruber argues that the public does not really care about the uninsured. What it cares about is cost control. Therefore, he says, the law had to be sold on the basis of its cost control.
Yet as Gruber admits in the video, the bill was not primarily focused on cost control—the bill “is 90% health insurance coverage and 10% about cost control.” Indeed, the problem with cost control, he says, is that “we don’t know how” to do it.
“Barack Obama’s not a stupid man, okay?” Gruber said in his remarks at the College of the Holy Cross on March 11, 2010. “He knew when he was running for president that quite frankly the American public doesn’t actually care that much about the uninsured….What the American public cares about is costs. And that’s why even though the bill that they made is 90% health insurance coverage and 10% about cost control, all you ever hear people talk about is cost control. How it’s going to lower the cost of health care, that’s all they talk about. Why? Because that’s what people want to hear about because a majority of American care about health care costs.”
Elsewhere in the same speech, Gruber says:
“The only way we’re going to stop our country from being a latter day Roman Empire and falling under its own weight is getting control of the growth rate of health care costs. The problem is we don’t know how.”
Remember, this is what Gruber was saying as the law was still being debated. It didn’tpass in the House, the critical step before hitting President Obama’s desk, until more than a week later. And what Gruber was saying, even before the bill was law, was that supporters had intentionally emphasized parts of the bill that were relatively minor, and that were not certain to even produce their intended effects.
This is not lying, exactly; the bill did in fact include some attempts at cost control, although as Gruber said, it was unclear at the time if or how well they would work. And Gruber may well have been right that the public was more concerned with cost control than expanding coverage. But, especially in combination with the other video released this week, it indicates that Gruber believed that the law’s advocates were not being completely straight with the public, that supporters of Obamacare were telling the public what they believed the public wanted to hear instead of giving them the full story, and that they were doing so on the understanding that telling the full story would make the bill impossible to pass.
What it shows, in other words, is Gruber openly embracing a strategy of messaging manipulation and misleading emphasis even while the bill was still being debated. If the public understood the bill clearly, he believed, they would reject it. It was more important to pass the bill.
Another video, posted today by The Daily Signal, shows Gruber taking a similarly dismissive attitude toward public concerns about the bill. At a meeting with the Vermont House Health Care Committee, Gruber is presented with a question about whether systems like those described in a report by Gruber and Harvard health economist William Hsiao, might result in “ballooning costs, increased taxes and bureaucratic outrages” as well “shabby facilities, disgruntled providers” and destructive price controls.
Gruber’s response begin with: “Was this written by my adolescent children by any chance?” The Signal quotes two-term Vermont state senator and Reagan-adviser John McClaughry as saying that the question had been submitted “by a former senior policy adviser in the White House who knew something about health care systems.”
Gruber’s response is intended as a joke, and it reveals little about the health care law (the reforms in question are specific to Vermont). But it says plenty about Gruber, and the flippant, arrogant way he treats concerns and criticism.
This is the person whom the White House relied on to help craft the bill; he was paid handsomely to model its effects (a fact he did not disclose, even when asked), and he was in the room when important decisions were made about how it would work. He claims to have helped write specific portions of the law himself. Gruber was not the sole architect of the law, but he was one of its biggest single influences on both its design and on how the media, which quoted him repeatedly, reported and understood the law.
The White House and its allies are desperately trying to distance themselves from Gruber right now by downplaying his role in the law’s creation. But the record of his involvement is clear enough: At The Washington Post, Ezra Klein has variously described Gruber as “one of the key architects behind the structure of the Affordable Care Act” and “the most aggressive academic economist supporting the reform effort.” The New York Times in 2012 described his role as helping to design the overall structure as well as being “dispatched” by the White House to Congress to write the legislative text. Gruber’s work was cited repeatedly by the White House, Democratic leadership, and the media.
So when he describes the thinking about how the law was crafted and sold to the public, it’s worth taking note. This is the posture of one of the law’s authors and chief backers. It’s part of the spirit in which the law was created and passed. Gruber’s ideas were embedded in the law’s structure and language, and so was his attitude.
The White House is denouncing comments from key Obamacare architect Jonathan Gruber that a lack of transparency and the stupidity of voters helped in the passage of the health care law and is instead pointing a finger at Republicans.
“The fact of the matter is, the process associated with the writing and passing and implementing of the Affordable Care Act has been extraordinarily transparent,” White House press secretary Josh Earnest said during a news briefing in Myanmar, according to a transcript provided by the White House.
Story Continued Below
“I disagree vigorously with that assessment,” Earnest responded when asked about Gruber’s claim that Obamacare wouldn’t have passed if the administration was more transparent and voters more intelligent.
He added, “It is Republicans who have been less than forthright and transparent about what their proposed changes to the Affordable Care Act would do in terms of the choices are available to middle class families.”
Earnest said the president “is proud of the transparent process that was undertaken to pass that bill into law.”
The response from the White House comes as a third video of Gruber criticizing the intelligence of American voters has surfaced.
“We just tax the insurance companies, they pass on higher prices that offsets the tax break we get, it ends up being the same thing. It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter,” Gruber said in remarks from 2012 that aired Wednesday evening on “On the Record with Greta Van Susteren.”
Gruber has been causing headaches for the White House as conservatives have had a field day that began with comments the MIT professor made in 2013.
“Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter, or whatever, but basically that was really, really critical for the thing to pass,” Gruber said at the time, according to one of the videos that has recently come to light.
In another video clip of a separate event, while talking about tax credits in the Affordable Care Act, he said, “American voters are too stupid to understand the difference.”
Gruber apologized for the comments during an appearance earlier this week on MSNBC’s “Ronan Farrow Daily”:
(Also on POLITICO: Ted Cruz out on a limb on Obamacare repeal)
“I was speaking off the cuff, and I was basically speaking inappropriately, and I regret having made those comments.”
Meanwhile, House Minority Leader Nancy Pelosi dismissed Gruber’s role in Obamacare on Thursday, telling the press, “I don’t know who he is. He didn’t help write our bill.”
Many outlets were quick to point out that Pelosi cited Gruber in a “Health Insurance Reform Mythbuster” on her official website in 2009.
House Speaker John Boehner released a statement Thursday, slamming Gruber for his comments.
“If there was ever any doubt that ObamaCare was rammed through Congress with a heavy dose of arrogance, duplicity, and contempt for the will of the American people, recent comments by one of the law’s chief architects, Jonathan Gruber, put that to rest,” the top Republican said.
The statement continues, “The American people are anything but ‘stupid.’ They’re the ones bearing the consequences of the president’s health care law and, unsurprisingly, they continue to oppose it.” http://www.politico.com/story/2014/11/jonathan-gruber-obamacare-voters-white-house-response-112856.html
Informally, a Cadillac plan is any unusually expensive health insurance plan, usually arising in discussions of medical-cost control measures in the United States.[1][2][3][4] The term derives from the Cadillac automobile, which has represented American luxury since its introduction in 1902,[1] and as a health care metaphor dates to the 1970s.[1] The term gained popularity in the early 1990s during the debate over the Clinton health care plan of 1993,[1] and was also widespread during debate over possible excise taxes on “Cadillac” plans during the health care reforms proposed during the Obama administration.[1] (Bills proposed by Clinton and Obama did not use the term “Cadillac”.)
Criticisms of these plans generally center on the small or nonexistent co-pays, deductibles, or caps that encourage the overuse of medical care, driving the cost up for the uninsured or those on other plans, which some say necessitates aCadillac tax.[citation needed]
A study published in Health Affairs in December 2009 found that high-cost health plans do not provide unusually rich benefits to enrollees. The researchers found that only 3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only 6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.). The employer’s industry and regional variations in health care costs explain part of the variation, but most is unexplained. The researchers conclude “…that analysts should not equate high-cost plans with Cadillac plans, but that in fact other factors—industry and cost of medical inputs—are as important in predicting whether a plan is a high-cost plan. Without appropriate adjustments, a simple cap may exacerbate rather than ameliorate current inequities.”[5]
How ObamaCare Taxes Affect You: New Taxes, Hikes, Breaks, Credits, and Other Changes
Here’s a full list of ObamaCare Taxes. The 21 new ObamaCare tax hikes and breaks impact us all, but which ObamaCare taxes will you actually pay? Find out how the tax related provisions in the Affordable Care Act (ObamaCare) will affect you, your family, your business, and your tax returns for 2013 and beyond.
The Bottom Line on the ObamaCare Tax Plan
The new tax related provisions in theAffordable Care Act(ObamaCare) include tax hikes, limits to deductions, tax credits, tax breaks, and other changes. While a few of the changes directly affect the average American, tax increases primarily affect high earners (those making over $200,000 as an individual or $250,000 as a family), large businesses (those making over $250,000), and the health care industry, while tax credits primarily affect low-to-middle income Americans and small businesses.
Here are some quick facts to help you understand how ObamaCare affects taxes:
• For the majority of the 85% of Americans with health insurance the percentage of income paid in taxes won’t change much, if at all. However, some of the changes may directly or indirectly affect specific groups.
• The majority of the 15% of Americans without health insurance will primarily be affected by the Individual Mandate (the requirement to buy health insurance), the Employer Mandate (the requirement for large employers to insure full-time employees), and Tax Credits (tax credits reduce premium costs for individuals, families, and small businesses).
• Many Americans will be affected by changes to new limits on medical tax deduction thresholds MSAs, FSAs, and HSAs.
• Small businesses will not be required to provide health insurance, but will gettax credits to reduce premium costs if they choose to offer group plans.
• Even if you won’t see higher taxes under the Affordable Care Act, it doesn’t mean there aren’t costs associated with the law. You’ll still need to buy health insurance, unless you qualify for Medicaid or an exemption, and that will cost you money.
• As a rule of thumb those who make less pay less and those who make more pay more, both in regard to health insurance costs and taxes under theAffordable Care Act.
• The Congressional Budget Office has shown that the revenue generated from the new taxes, along with cuts to spending, will help to pay for the Affordable Care Act’s many provisions, fund tax credits and lower the deficit by 2023.Learn More.
Why Does ObamaCare Create New Taxes?
ObamaCare includes many new benefits, rights, and protections including the requirement for health insurers to cover people with pre-existing conditions. It also expands access to affordable health insurance to almost 50 million low-to-middle income men, women, and children across the country by offering reduced premiums via tax credits and expanding Medicaid and CHIP. Expanding the quality, affordability and availability of health insurance (along with other aspects of the law) come at a high cost. Assuming all tax provisions remain in place, the revenue generated from these new taxes help to cover the costs of the program and reduces the deficit. Learn more about the new benefits, rights, protections offered by the Affordable Care Act.
A Quick Overview of Key Taxes in the Affordable Care Act
Before we get to the full list of taxes here is a quick overview of the key tax related provisions that may affect those without insurance, those who plan to go without insurance, and those who are struggling to afford insurance now.
Individual Mandate (new tax): Americans who can afford to must obtain minimum essential health coverage for 2014, get an exemption or pay a per month fee.
Employer Mandate (new tax): Come 2015 large employers must insure full time employees or pay a per employee fee. Over half of Americans get their insurance through work and the largest group of uninsured is currently the working poor.
Taking all the tax provisions in the ACA into account ObamaCare technically provides the greatest middle class tax cut to healthcare in history.
Full List of All Taxes in ObamaCare / All Taxes in the Affordable Care Act
The following list of new ObamaCare taxes collectively raise over $800 billion by 2022. Here is a complete list of new fees and taxes contained withinObamaCare:
ObamaCare Taxes That Most Likely Won’t Directly Affect the Average American
• 2.3% Tax on Medical Device Manufacturers 2014
• 10% Tax on Indoor Tanning Services 2014
• Blue Cross/Blue Shield Tax Hike
• Excise Tax on Charitable Hospitals which fail to comply with the requirements of ObamaCare
• Tax on Brand Name Drugs
• Tax on Health Insurers
• $500,000 Annual Executive Compensation Limit for Health Insurance Executives
• Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D
• Employer Mandate on business with over 50 full-time equivalent employees to provide health insurance to full-time employees. $2000 per employee $3000 if employee uses tax credits to buy insurance on the exchange (marketplace). (pushed back to 2015)
• Medicare Tax on Investment Income 3.8% over $200k/$250k
• Medicare Part A Tax increase of .9% over $200k/$250k
• Employer Reporting of Insurance on W-2 (not a tax)
• Corporate 1099-MISC Information Reporting (repealed)
• Codification of the “economic substance doctrine” (not a tax)
ObamaCare Taxes That (may) Directly Affect the Average American
• 40% Excise Tax “Cadillac” on high-end Premium Health Insurance Plans 2018
• An annual $63 fee levied by ObamaCare on all plans (decreased each year until 2017 when pre-existing conditions are eliminated) to help pay for insurance companies covering the costs of high-risk pools.
• Medicine Cabinet Tax
Over the counter medicines no longer qualified as medical expenses for flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs), and Archer Medical Saving accounts (MSAs).
• Additional Tax on HSA/MSA Distributions
Health savings account or an Archer medical savings account, penalties for spending money on non-qualified medical expenses. 10% to 20% in the case of a HSA and from 15% to 20% in the case of a MSA.
• Flexible Spending Account Cap 2013
Contributions to FSAs are reduced to $2,500 from $5,000.
• Medical Deduction Threshold tax increase 2013
Threshold to deduct medical expenses as an itemized deduction increases to 10% from 7.5%.
• Individual Mandate (the tax for not purchasing insurance if you can afford it) 2014
Starting in 2014, anyone not buying “qualifying” health insurance must pay an income tax surtax at a rate of 1% or $95 in 2014 to 2.5% in 2016 on profitable income above the tax threshold. The total penalty amount cannot exceed the national average of the annual premiums of a “bronze level” health insurance plan on ObamaCare exchanges.
• Premium Tax Credits for Small Businesses 2014 (not a tax)
• Advanced Premium Tax Credits for Individuals and Families 2014 (not a tax)
• Medical Loss Ratio (MRL): Premium rebates (not a tax)
The link below provides a full list of ObamaCare Taxes by the IRS.
Let’s take a look at how ObamaCare’s taxes affect certain income groups.
ObamaCare Taxes for High Earners and Large Businesses
Most of the new taxes are on high-earners (individuals making over $200,000 and families making over $250,000), large businesses (over 50 full-time equivalent employees making over $250,000), and industries that profit from healthcare. Essentially those who will see gains under ObamaCare are required to put money back in the program via taxes.
FACT: Tax increases generally affect single filers with an adjusted gross income (AGI) above $200,000 and married couples filing jointly above $250,000. Some of the tax increases don’t kick in until single AGI hits $400,000 and married filing jointly AGI hits $450,000.
ObamaCare Taxes for the Average American With Health insurance
For most of the 85% of Americans with health insurance, making less than $250,000, most of the new taxes won’t mean much of anything although certain taxes below will affect specific individuals and families.
ObamaCare Taxes for the Average American Without Health insurance
The 15% of Americans without health insurance will be required to obtain health insurance (Individual Mandate) or will face a “tax penalty”.
The good news is that many uninsured will be exempt from the Individual mandate due to income, offered cost assistance through the marketplaceincluding Tax Credits (also available to small businesses), qualify for Medicaid, or will get insurance through work (the Employer Mandaterequires large employers to insure full-time employees by 2015). Adults who are under 26 will be able to stay on their parents plan as well, this will help to limit the number of young people who will pay the fee. Both the employer and individual mandates are part of our “shared responsibility” to expand the quality and affordability of health insurance in the United States as a trade for our new benefits, rights and protections.
ObamaCare Taxes for Small Businesses
Small businesses with less than 25 full-time equivalent employees will have access to tax credits to reduce premium costs of group plans.
ObamaCare Taxes for Specific Groups With Health Insurance
Here are a few changes that my affect specific groups of Americans with health insurance:
• Other tax provisions such as changes medical deduction thresholds, HSAs, MSAs, and FSAs may impact some Americans by limiting tax deductions.
• The Medical Loss Ratio (MLR or 80/20 rule) will mean that some Americans may get rebates if health insurance companies spend on non-healthcare related expenses.
• Tax provisions like the 10% tanning bed tax, taxes on drug companies, taxes on medical devices and taxes on health insurance companies selling insurance on and off the exchange may affect the amount of money we pay for some health care related goods and services, but will not have a significant impact on our daily lives.
• The employer mandate has caused some companies to cut down full-time workers to part-time to avoid providing benefits, however major employers like Disney and Walmart have actually increased their full-time workforce in response to the looming 2015 deadline.
• Overall the benefits tend to outweigh the costs for the average American as even those who pay a little more, get a lot more in return due to the increased quality of their health insurance.
Will I pay More Taxes and High Premiums Because of ObamaCare?
As mentioned above premium rates and the taxes you will have to pay are primarily based on income. Aside from income premium prices are based on which plan you choose, family size, age, smoking status and geography. Subsidies reduce the overall rate of your premiums (however smoking is calculated after subsidies). Come 2018 there will be a 40% excise tax on high end health insurance plans.
Aside from the tax provisions that require Americans to obtain insurance and subsidize it’s costs, ObamaCare also includes a few tax related provisions that work as consumer protections including requirements for better reporting and the Medical Loss Ratio.
ObamaCare Tax Rebates
Some consumers in both individual and group markets will see tax rebates due to ObamaCare’s Medical Loss Ratio (MLR). Health insurance companies will have to provide rebates to consumers if they spend less than 80 to 85% of premium dollars on medical care.
Medical Loss Ratio (MLR)
The Medical Loss Ratio (MLR) means that Insurance companies are now required to spend at least 80% of premium dollars (85% in large group markets) on medical care and quality improvement activities. Insurance companies that are not meeting this standard will be required to provide rebates to their consumers. The MLR isn’t a tax, but it does have implications in regards to filing taxes and rebates can be given in the form of reduced premiums. See our page on ObamaCare Health Insurance Regulations for more details.
ObamaCare Income Tax Penalty For Not Having Insurance “Individual Mandate”
Starting in 2014, most people will have to have insurance or pay a “penalty deducted from your taxable income”. For individuals, penalty starts at $95 a year, or up to 1% of income, whichever is greater, and rise to $695, or 2.5% of income, by 2016.
For families the tax will be $2,085 or 2.5% percent of household income, whichever is greater. The requirement can be waived for several reasons, including financial hardship or religious beliefs. If the tax would exceed 8% of your income you are exempt, also some religious groups are exempt. That tax cannot exceed the cost of a “bronze plan” bought on the exchange.
Many individuals who are exempt from the mandate to buy insurance will still be eligible for free or low-cost insurance through the health insurance marketplace.
While some states, including Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law. Get more information on the ObamaCare Individual Mandate.
The Individual Mandate is officially called the “individual shared responsibility provision”.
What Are ObamaCare Tax Credits?: Advanced Premium Tax Credits
Premium tax credits are a form of cost assistance that reduce premium costs for coverage purchased onyour State’s “health insurance marketplace” for individuals, families, and small businesses.
Advanced Premium Tax Credits for Individuals and Families
Individuals and families will have access to Advanced premium tax credits on the marketplace. Tax Credits are deducted from your premium cost by your health insurance provider and are adjusted on your Modified Adjusted Gross Income (MAGI). You can choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.
Aside from premium tax credits individuals and families can also get lower cost sharing on out-of-pocket expenses like coinsurance, copays, deductibles and out-of-pocket maximums through the marketplace.
Eligibility for Tax Credits
In general, you may be eligible for the credit if you meet all of the following:
buy health insurance through the Marketplace;
are ineligible for coverage through an employer or government plan;
are within certain income limits;
file a joint return, if married; and
cannot be claimed as a dependent by another person.
If you are eligible for the credit, you can choose to:
Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums during 2014; or
Get It Later: wait to get all of the credit when you file your 2014 tax return in 2015.
How Will Advanced Premium Tax Credits Affect My Health Insurance Costs?
Under the Affordable Care Act health insurance that costs less than 8% of your MAGI is considered affordable. Although the law doesn’t guarantee lower costs, premium tax credits help to ensure that more Americans will have access to affordable insurance.
s a rule of thumb most Americans will pay between 1.5% and 9.5% on their Modified Adjusted Gross Income (MAGI) when using tax credits to buy a basic Silver Plan on the marketplace.
If the lowest-priced coverage available to you would cost more than 8% of your household income are exempt from the individual mandate.
The amount you pay is on a sliding scale based on your income. Use the chart below to get an idea of what you and your family may pay for insurance purchased through the Health Insurance Marketplace. Make sure to check outObamaCare Subsidies for more detailed information on Premium Tax Credits.
The 2013 Federal Poverty Level Guidelines below are used to Determine if your percentage of the poverty level for both taxes and cost-assistance.
Household Size
100%
133%
150%
200%
300%
400%
1
$11,170
$14,856
$16,755
$22,340
$33,510
$44,680
2
15,130
20,123
22,695
30,260
45,390
60,520
3
19,090
25,390
28,635
38,180
57,270
76,360
4
23,050
30,657
34,575
46,100
69,150
92,200
5
27,010
35,923
40,515
54,020
81,030
108,040
6
30,970
41,190
46,455
61,940
92,910
123,880
7
34,930
46,457
52,395
69,860
104,790
139,720
8
38,890
51,724
58,335
77,780
116,670
155,560
For each additional person, add
$3,960
$5,267
$5,940
$7,920
$11,880
$15,840
This following table is an example of how premium tax credits work. Please note that the numbers below are purely for example and don’t reflect your personal rates.
Health Insurance Premiums and Cost Sharing under PPACA for Average Family of 4
For “Silver Plan”
Income % of federal poverty level
Premium Cap as a Share of Income
Income $ (family of 4)
Max Annual Out-of-Pocket Premium
Premium Savings
Additional Cost-Sharing Subsidy
133%
3% of income
$31,900
$992
$10,345
$5,040
150%
4% of income
$33,075
$1,323
$9,918
$5,040
200%
6.3% of income
$44,100
$2,778
$8,366
$4,000
250%
8.05% of income
$55,125
$4,438
$6,597
$1,930
300%
9.5% of income
$66,150
$6,284
$4,628
$1,480
350%
9.5% of income
$77,175
$7,332
$3,512
$1,480
400%
9.5% of income
$88,200
$8,379
$2,395
$1,480
In 2016, the FPL is projected to equal about $11,800 for a single person and about $24,000 for family of four. Use the Kaiser ObamaCare Cost Calculator for more information. DHHS and CBO estimate the average annual premium cost in 2014 to be $11,328 for family of 4 without the reform. Source: Wikipedia
ObamaCare Employer / Employee Taxes
ObamaCare’s taxes mean large employers will have to provide health insurance to their employees and will see a raised Medicare part A tax, small businesses may be eligible for tax breaks.
Medicare part A Tax Hike for Employers and Employees
The Medicare part A tax is paid by both employees and employers who earn over a certain amount. ObamaCare’s Medicare tax hike is a .9% increase (from 2.9% to 3.8%) on the current total Medicare part A tax. This tax is split between the employer and employee meaning that they will both see a .45% raise. Small businesses making under $250,000 are exempt from the tax. Employees making less than $200,000 as an individual or ($250,000) as a family are also exempt. Employers must withhold and report an additional 0.9 percent total on employee wages or compensation that exceed $200,000.
Tax Penalty for Not Providing Full-time Workers with Health Insurance the “Employer Mandate”
Employers with over 50 full-time equivalent employees must either insure their full-time employees or pay a penalty or “employer shared responsibility fee”. The penalty is $2000 per employee. If however, at least one full-time employee receives a premium tax credit because coverage is either unaffordable or does not cover 60 percent of total costs, the employer must pay the lesser of $3,000 for each of those employees receiving a credit or $750 for each of their full-time employees total.
Employers with under 25 full time employees, whose average income doesn’t exceed $50,000, can apply for tax credits of up to 50% for insuring their employees.
Tax Credits for Small Businesses
Small businesses with under 25 full-time equivalent employees with average annual wages of less than $50,000 can apply for tax breaks of up to 50% of their share of employee premium costs via ObamaCare’s Small Business Health Options Program (accessible through your State’s Health Insurance Marketplace). The credit can be as much as 50% of employer premiums (35% for not-for-profits in 2014). The credit is only available if the employer is paying at least 50% of the total premiums.
Small Business Health Options Program
Employers with 50 or fewer employees, you can purchase affordable insurance through the Small Business Health Options Program (SHOP) even if they don’t qualify for tax credits.
Reporting
Along with the new law there are new requirements for reporting.
Effective for calendar year 2015, you must file an annual return reporting whether and what health insurance you offered your employees. This rule is optional for 2014. Learn more.
Effective for calendar year 2015, if you provide self-insured health coverage to your employees, you must file an annual return reporting certain information for each employee you cover. This rule is optional for 2014. Learn more.
Beginning Jan. 1, 2013, you must withhold and report an additional 0.9 percent on employee wages or compensation that exceed $200,000. Learn more.
Aside from having to adhere to the “employer mandate” ObamaCare also imposes taxes and fees that are unique to big business. ObamaCare taxes some medical device manufactures, drug companies and health insurance companies. Beginning in 2013, medical device manufacturers and importers must pay a 2.3% tax on the sale of a taxable medical device. This raises $29 billion over a 10 years. However, many states are asking to delay the medical device excise tax to protect jobs in states that produce the devices. An annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.
Employers that have employees who earn more than $200,000 will have to look at the potential for additional Medicare withholding due to the Medicare part A tax.
Employers that issued 250 or more W-2 forms in 2012 must report the cost of employer-sponsored health coverage for 2013 on the 2013 W-2 forms.
Medical Device Excise Tax
There is a 2.3% medical excise tax on medical device manufacturers and importers on the sale of taxable medical devices. Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device. The tax applies to sales of taxable medical devices after Dec. 31, 2012. You can learn more from the official IRS page on the Medical Device Tax.
What Increases Do the ObamaCare Taxes Include for The $200k/$250k Earners?
ObamaCare Medicare Part A Payroll Tax
Starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 will see an increase in the Medicare part A payroll tax. It’s an increase of 2.35%, up from the current 1.45% ( a .9% Medicare part A payroll tax hike), on adjusted income over the threshold.
ObamaCare Unearned Income Tax
This group will also pay a 3.8% unearned income (capital gains) tax on interest, dividends, annuities, royalties, rents, and gains on the sale of investments over the threshold.
Taxable income under the $200,000 for individuals and $250,000 threshold for families is subject to the same benefits and tax cuts as those who make under the threshold.
ObamaCare Home Sales Tax / ObamaCare Real Estate Tax Increase
ObamaCare increases taxes on unearned income by 3.8% and this can add additional taxes to the sales of some homes, but many limitations apply which means it won’t affect most sellers. The 3.8% capital gains tax typically doesn’t apply to your primary residence. It also doesn’t usually apply to homes you have owned for over 5 years or on profits of less than $250,000 for individuals and $500,000 for couples due to a capital gains tax exclusion rule for sales of a primary home.
In short the ObamaCare home sales tax isn’t something that most of us will pay, it is a tax is aimed at those selling non-primary residences in short term periods for profit and not at the average American buying and selling their primary residence.
ObamaCare Medical Expense Deductions
ObamaCare increases the medical expense deduction threshold. Unreimbursed medical expense deductions will now be available only for those medical expenses in excess of 10% of AGI, which has been raised from 7.5%. There is a temporary exemption for individuals ages 65 and older and their spouses from 2013 through 2016.
ObamaCare “Cadillac” Tax
Starting in 2018, the new health care law imposes a 40% excise tax on the portion of most employer-sponsored health coverage (this excludes dental and vision) that exceed $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits only high-end “gold”, “platinum” and high-end health care plans not purchased on the exchange. The tax raises over $150 billion over the next 10 years.
New ObamaCare Taxes Summary
Going through the new ObamaCare taxes line by line is, in itself, taxing. The bottom line is that a majority of Americans will find themselves paying less for better healthcare, while higher-earners will pay tax rates closer to what they did in the Clinton years. ObamaCare pays for most of itself via the above taxes, reforms to Medicare, and health care as a whole, as well as cutting out billions in wasteful spending.
ObamaCare Taxes Moving Forward into 2014
We hope this helps you to understand the new ObamaCare taxes and how they work. Many of the ObamaCare’s taxes won’t be fully implemented until 2022, but most will be in effect by 2014. ObamaCare helps all Americans get access to quality affordable healthcare, and new benefits, rights and protections. Make sure to look out for ObamaCare tax breaks, credits, subsidies and breaks on up front costs moving forward into 2014. As we learn more we will update our full ObamaCare tax list.
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You Decide
Frank Sinatra-New York,New York
Frank Sinatra-New York,New York-Lyrics
Start spreadin’ the news, I’m leavin’ today
I want to be a part of it
New York, New York
These vagabond shoes, are longing to stray
Right through the very heart of it
New York, New YorkI want to wake up, in a city that never sleeps
And find I’m king of the hill
Top of the heapThese little town blues, are melting away
I’ll make a brand new start of it
In old New York
If I can make it there, I’ll make it anywhere
It’s up to you, New York..New YorkNew York…New York
I want to wake up, in a city that never sleeps
And find I’m A number one, top of the list
King of the hill, A number one….These little town blues, are melting away
I’ll make a brand new start of it
In old New York
If I can make it there, I’ll make it anywhere
It’s up to you, New York..New York New York!!!
Frank Sinatra – New York New York Song **Lyrics** [HD]
My Kind of Town (Chicago) – Frank Sinatra
“My Kind Of Town”
Now this could only happen to a guy like me
And only happen in a town like this
So may I say to each of you most gratef’lly
As I throw each one of you a kissThis is my kind of town, Chicago is
My kind of town, Chicago is
My kind of people, too
People who smile at youAnd each time I roam, Chicago is
Calling me home, Chicago is
Why I just grin like a clown
It’s my kind of town[brief instrumental]My kind of town, Chicago is
My kind of town, Chicago is
My kind of razzmatazz
And it has all that jazzAnd each time I leave, Chicago is
Tuggin’ my sleeve, Chicago is
The Wrigley Building, Chicago is
The Union Stockyard, Chicago is
One town that won’t let you down
It’s my kind of town
New York, New Jersey Set Up Mandatory Quarantine Requirement Amid Ebola Threat Christie: New Policy Has Already Been Used At Newark Liberty International Airport
As CBS 2’s Alice Gainer reported, no other states have yet set up increased screening procedures for Ebola.
“We believe it’s appropriate to increase the current screening procedures from people coming from affected countries from the current (Centers for Disease Control and Prevention screening procedures),” Gov. Andrew Cuomo said Friday afternoon. “We believe it within the State of New York and the State of New Jersey’s legal rights.”
Under the new rules, state officials will establish a risk level by considering the countries that people have visited and their level of possible exposure to Ebola.
The patients with the highest level of possible exposure will be automatically quarantined for 21 days at a government-regulated facility. Those with a lower risk will be monitored for temperature and symptoms, Cuomo explained.
The New York and New Jersey health departments will determine their own specific procedures for hospitalization and quarantine, and will provide a daily recap to state officials on the status of screening, New York State Health Commissioner Dr. Howard Zucker said at the news conference.
The new procedures already have been put into use at Newark Liberty International Airport.
On Friday, a health care worker landed at Newark after treating Ebola patients in West Africa, New Jersey Gov. Chris Christie said at the news conference. A legal quarantine was issued for the woman, who was not a New Jersey resident and was set to go on to New York afterward.
“This woman, while her home residence is outside the area, said her next stop was going to be here in New York,” Christie said. “Governor Cuomo and I discussed it before we came out here, and a quarantine order will be issued.”
The woman will be quarantined in either New York or New Jersey, Christie said.
In discussing the new plan, Cuomo and Christie said a policy of voluntary quarantine simply does not go far enough.
“Voluntary quarantine – you know it’s almost an oxymoron. This is a very serious situation.” Cuomo said. “Voluntary quarantine – raise your right hand and promise you’re going to stay home for 21 days. We’ve seen what happens.”
The new rules were announced a day after Dr. Craig Spencer, a member of Doctors Without Borders, became New York City’s first Ebola patient.
He reported Thursday morning coming down with a fever and diarrhea and is being treated in an isolation ward at Bellevue Hospital, a designated Ebola center.
Spencer returned from West Africa last Friday after treating Ebola patients in Guinea with Doctors Without Borders. He arrived at John F. Kennedy International Airport, passing the extensive CDC screening process.
“When he arrived in the United States, he was also well with no symptoms,” said New York City Health Commissioner Mary Travis Bassett.
Doctors Without Borders said per the guidelines it provides its staff members on their return from Ebola assignments, “the individual engaged in regular health monitoring and reported this development immediately.” But Spencer also took the subway, walked the High Line, and went bowling in Williamsburg, Brooklyn the day before he became sick.
“He was a doctor, and even he didn’t follow the guidelines,” Cuomo said.
With that in mind, the states have to lay down the law, the governors said.
“It’s too serious a situation to leave it to the honor system,” Cuomo said.
The CDC is reviewing its policy for health care workers returning from West Africa, but anyone flying into a Port Authority of New York and New Jersey airport will need to abide by the new procedures.
Ebola Arrives in New York. How Prepared Is the City to Handle It?
Dr. Craig Spencer, the health care worker who recently returned from Guinea and tested positivefor the Ebola virus, is now the first patient to be treated at New York’s Bellevue Hospital.
But the hospital, as well as city, state and federal officials, have been working for weeks or more to ensure the city is ready to identify and treat Ebola cases.
This preparation reflects the now-proven fact that the longer the outbreak rages on in West Africa, the more likely it was that a patient would wind up in Western cities, including New York.
On Oct. 15, the state designated Bellevue Hospital Center as the facility to receive Ebola patients from among the city’s 11 public hospitals, and to receive transferred patients from other hospitals as well, in the event that any Ebola cases occur in the city.
According to a statement from the New York City Health and Hospitals Corporation, the hospital has four single-bed rooms in its infectious disease ward to treat “high probability or confirmed Ebola cases.” This part of the hospital also has a new laboratory that can test for Ebola, separate from the rest of the hospital’s labs, to handle Ebola blood samples.
Because the virus can be spread through contact with an infected person’s bodily fluids, careful handling of blood and other samples is necessary.
The hospital is particularly well suited due to its long history of being on the front lines of epidemics and emerging public health threats, and managing an isolation unit for diseases, such as TB, for many years with support from and collaboration with the City Health Department.
Three other hospitals in New York City have also been designated by the state to treat suspected and confirmed Ebola cases, including Mt. Sinai and New York Presbyterian in Manhattan and Montefiore in the Bronx, according to Governor Cuomo’s Ebola preparedness plan.
None of these hospitals, including Bellevue, has an isolated biocontainment unit like those that have treated patients at Emory University Hospital in Atlanta, Georgia, and Nebraska Medical Center in Omaha, Nebraska.
The American public may not have much faith in ordinary hospitals to treat Ebola, considering that the only non-specialized hospital to treat Ebola patients, Texas Health Presbyterian Hospital Dallas, allowed the virus to spread to two nurses who worked on the original patient, Thomas Eric Duncan, who died of Ebola on Oct. 8. Both of the nurses are now being treated in a biocontainment unit.
The probability of an Ebola case in New York was always considerably higher than it was for many other cities in the U.S., given that two of the city’s international airports — JFK and Newark — are key gateways for travelers to and from West Africa, via stops in Europe or elsewhere in Africa.
“New York City is a frequent port of entry for travelers from West Africa, a home to communities of West African immigrants who travel back to their home countries, and a home to health care workers who travel to West Africa to treat Ebola patients,” The Centers for Disease Control and Prevention (CDC) said in a report on Oct. 17.
“Ongoing transmission of Ebola virus in West Africa could result in an infected person arriving in NYC,” the report said. However, the chance that a New Yorker who has not traveled to an Ebola hotspot would come down with the virus is “extremely slim,” since the disease is only spread through direct contact with an infectious person’s bodily fluids.
Ultimately, it was a doctor who lived in the city who would bring the virus home.
In recent weeks, the New York Health Commissioner issued a “Commissioner’s Order” to all hospitals and ambulance services in the state, “requiring that they follow protocols for identification, isolation and medical evaluation of patients requiring care.”
The state has been conducting “unannounced drills” at hospitals and health care facilities to test preparedness for handling possible Ebola cases. The state has also involved the Metropalitan Transit Authority, which operates the city’s subways and buses, in training for encountering possible Ebola patients.
And a mass Ebola training for health care workers, which included demonstrations for putting on and taking off protective equipment, took place in the city on Oct. 21.
According to new guidelines the CDC issued on Monday, there are now 30 steps health care workers have to take every time they treat a patient with Ebola or Ebola-like symptoms.
At hospitals like Bellevue, actors have played the role of patients with Ebola symptoms have been part of the drills, and the city’s 911 operators have been told to ask people who call in with Ebola-like symptoms if they have recently traveled to West Africa, according to the Guardian.
As of Thursday, there have been nearly 10,000 cases of Ebola in West Africa, along with about 4,900 deaths. However, these figures are likely to be underestimates, since the lack of treatment facilities and other circumstances are causing many patients to go uncounted.
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Immigration Professor, Unlawful Presence and Unlawful Presence Waivers, Part 2 of 3
Immigration Professor, Unlawful Presence and Unlawful Presence Waivers, Part 3 of 3
EXCLUSIVE: OBAMA ADMINISTRATION QUIETLY PREPARES ‘SURGE’ OF MILLIONS OF NEW IMMIGRANT IDS
Despite no official action from the president ahead of the election, the Obama administration has quietly begun preparing to issue millions of work authorization permits, suggesting the implementation of a large-scale executive amnesty may have already begun.
Unnoticed until now, a draft solicitation for bids issued by U.S. Citizenship and Immigration Services (USCIS) Oct. 6 says potential vendors must be capable of handling a “surge” scenario of 9 million id cards in one year “to support possible future immigration reform initiative requirements.”
The request for proposals says the agency will need a minimum of four million cards per year. In the “surge,” scenario in 2016, the agency would need an additional five million cards – more than double the baseline annual amount for a total of 9 million.
“The guaranteed minimum for each ordering period is 4,000,000 cards. The estimated maximum for the entire contract is 34,000,000 cards,” the document says.
The agency is buying the materials need to construct both Permanent Residency Cards (PRC), commonly known as green cards, as well as Employment Authorization Documentation (EAD) cards which have been used to implement President Obama’s “Deferred Action for Childhood Arrivals” (DACA) program. The RFP does not specify how many of each type of card would be issued.
Jessica Vaughan, an immigration expert at the Center for Immigration Studies and former State Department official, said the document suggests a new program of remarkable breadth.
The RFP “seems to indicate that the president is contemplating an enormous executive action that is even more expansive than the plan that Congress rejected in the ‘Gang of Eight’ bill,” Vaughan said.
Last year, Vaughan reviewed the Gang of Eight’s provisions to estimate that it would have roughly doubled legal immigration. In the “surge” scenario of this RFP, even the relatively high four million cards per year would be more than doubled, meaning that even on its own terms, the agency is preparing for a huge uptick of 125 percent its normal annual output.
It’s not unheard of for federal agencies to plan for contingencies, but the request specifically explains that the surge is related to potential changes in immigration policy.
“The Contractor shall demonstrate the capability to support potential ‘surge’ in PRC and EAD card demand for up to 9M cards during the initial period of performance to support possible future immigration reform initiative requirements,” the document says.
A year ago, such a plan might have been attributed to a forthcoming immigration bill. Now, following the summer’s border crisis, the chances of such a new law are extremely low, giving additional credence to the possibility the move is in preparation for an executive amnesty by Obama.
Even four million combined green cards and EADs is a significant number, let alone the “surge” contemplated by USCIS. For instance, in the first two years after Obama unilaterally enacted DACA, about 600,000 people were approved by USCIS under the program. Statistics provided by USCIS on its website show that the entire agency had processed 862,000 total EADs in 2014 as of June.
Vaughan said EADs are increasingly coming under scrutiny as a tool used by the Obama administration to provide legalization for groups of illegal aliens short of full green card status.
In addition to providing government approval to work for illegal aliens, EADs also cost significantly less in fees to acquire, about $450 compared to more than $1000. In many states, EADs give aliens rights to social services and the ability to obtain drivers’ licenses.
Vaughan noted there are currently about 4.5 million individuals waiting for approval for the green cards having followed immigration law and obtained sponsorships from relatives in the U.S. or otherwise, less than the number of id cards contemplated by the USCIS “surge.”
USCIS officials did not provide additional information about the RFP by press time.
Card Consumables
Solicitation Number: HSSCCG-14-R-00028
Agency: Department of Homeland Security
Office: Citizenship & Immigration Services
Location: USCIS Contracting Office
Note:
There have been modifications to this notice. You are currently viewing the original synopsis. To view the most recent modification/amendment, click here
USCIS Contracting will be posting a solicitation for the requirement of Card Stock used by the USCIS Document Management Division. The objective of this procurement is to provide card consumables for the Document Management Division (DMD) that will be used to produce Permanent Resident Cards (PRC) and Employment Authorization Documentation (EAD) cards. The requirement is for an estimated 4 million cards annually with the potential to buy as many as 34 million cards total.The ordering periods for this requirement shall be for a total of five (5) years. This is a Firm Fixed Price (FFP) supply purchase for commercial items, utilizing North American Industry Classification System (NAICS) code 325211 and Product / Service Code (PSC) 9330. This requirement is for the acquisition of 100% polycarbonate solid body card stock with Radio Frequency Identification (RFID) and holographic images embedded within the card construction substrate layers, card design service, and storage.
The solicitation will be posted at this FedBidOpps webpage.
United States Citizenship and Immigration Services
United States Citizenship and Immigration Services (USCIS) is a component of the United StatesDepartment of Homeland Security (DHS). It performs many administrative functions formerly carried out by the former United States Immigration and Naturalization Service (INS), which was part of the Department of Justice. The stated priorities of the USCIS are to promote national security, to eliminate immigration case backlogs, and to improve customer services. USCIS is headed by a director, currently Leon Rodriguez, who reports directly to the Deputy Secretary for Homeland Security.[1]
Functions
Atlanta, Georgia
USCIS is charged with processing immigrant visa petitions, naturalization petitions, and asylum and refugeeapplications, as well as making adjudicative decisions performed at the service centers, and managing all other immigration benefits functions (i.e., not immigration enforcement) performed by the former INS. Other responsibilities include:
Administration of immigration services and benefits
Adjudicating asylum claims
Issuing employment authorization documents (EAD)
Adjudicating petitions for non-immigrant temporary workers (H-1B, O-1, etc.)
While core immigration benefits functions remain the same as under the INS, a new goal is to process applications efficiently and effectively. Improvement efforts have included attempts to reduce the applicant backlog, as well as providing customer service through different channels, including the National Customer Service Center (NCSC) with information in English and Spanish, Application Support Centers (ASCs), the Internet and other channels. The enforcement of immigration laws remain under CBP and ICE.
USCIS focuses on two key points on the immigrant’s journey towards civic integration: when they first become permanent residents and when they are ready to begin the formal naturalization process. A lawful permanent resident is eligible to become a citizen of the United States after holding the Permanent Resident Card for at least five continuous years, with no trips out of the United States that last for 180 days or more. If, however, the lawful permanent resident marries a U.S. citizen, eligibility for U.S. citizenship is shortened to three years so long as the resident has been living with the spouse continuously for at least three years and the spouse has been a citizen for at least three years.
Forms
USCIS handles all forms and processing materials related to immigration and naturalization. This is evident from USCIS’s predecessor, the INS, (Immigration and Naturalization Service) which is defunct as of May 9, 2003.
USCIS currently handles two kinds of forms: those relating to immigration, and those related to naturalization. Forms are designated by a specific name, and an alphanumeric sequence consisting of one letter, followed by two or three digits. Forms related to immigration are designated with an I (for example, I-551, Permanent Resident Card) and forms related to naturalization are designated by an N (for example, N-400, Application for Naturalization).
Also, USCIS runs an online appointment scheduling service known as INFOPASS. This system allows people with questions about immigration to come into their local USCIS office and speak directly with a government employee about their case and so on. This is an important way in which USCIS serves the public. USCIS maintains a blog entitled “The Beacon” as well as the “@uscis” Twitter account.
Funding
Unlike most other federal agencies, USCIS is funded almost entirely by user fees.[3] Under President George W. Bush’s FY2008 budget request, direct congressional appropriations made about 1% of the USCIS budget and about 99% of the budget was funded through fees. The total USCIS FY2008 budget was projected to be $2.6 billion.[4]
Staffing
USCIS consists of 18,000 federal employees and contractors working at 250 offices around the world.[5]
On March 1, 2003, the INS ceased to exist and services provided by that organization transitioned into USCIS. Eduardo Aguirre was appointed the first USCIS Director by President Bush. In December 2005, Emilio T. Gonzalez, Ph. D., was confirmed by the U.S. Senate as the Director of USCIS, and he held this position until April 2008.[8] Nominated by President Barack Obama on April 24 and unanimously confirmed on August 7 by the U.S. Senate, Alejandro Mayorkas was sworn in as USCIS Director on August 12, 2009.
USCIS History: Major milestones of USCIS and other immigration agencies, from the 19th century to 2003
Employment authorization document
From Wikipedia, the free encyclopedia
This article includes a list of references, but its sources remain unclear because it has insufficient inline citations.Please help to improve this article by introducing more precise citations.(November 2010)
An employment authorization document (EAD, Form I-766), EAD card, known popularly as a “work permit”, is a document issued by United States Citizenship and Immigration Services (USCIS) that provides its holder a legal right to work in the US. It is similar to, but should not be confused with the green card.
Certain ‘aliens’ (non-residents) who are temporarily in the United States may file a Form I-765, application for employment authorization, to request an EAD. An EAD is issued for a specific period of time based on alien’s immigration situation. Foreign nationals with an EAD can lawfully work in the United States for any employer.
Aliens who are sponsored by US employers and issued temporary work visas for such as H, I, L-1 or O-1 visas are authorized to work for the sponsoring employer, through the duration of the visa . This is known as ‘employment incident to status’. Aliens on such work visas do not qualify for an EAD according to the US Citizenship and Immigration Service regulations (8 CFR Part 274a).[1]
Currently the EAD is issued in the form of a standard credit card-size plastic card enhanced with multiple security features. The EAD card contains some basic information about alien: name, birth date, sex, immigrant category, country of birth, photo, alien registration number (also called “A-number”), card number, restrictive terms and conditions, and dates of validity.
Restriction
The eligibility for employment authorizations are detailed in the Federal Regulations at 8 C.F.R. §274a.12.[2] Only aliens who fall under the enumerated categories are eligible for an employment authorization document.
There are more than 40 types of immigration status that make their holders eligible to apply for an EAD.[3] Some are nationality-based and apply to a very small number of people. Others are much broader, such as those covering the spouses of E-1, E-2, E-3 or L-1 visa holders.
USCIS issues EADs in the following categories:
Renewal EAD: Renewal cannot be filed more than 120 days before the current employment authorization expires.
Replacement EAD: Replaces a lost, stolen, or mutilated EAD. A replacement EAD also replaces an EAD that was issued with incorrect information, such as a misspelled name.
Obtaining an EAD
Applicants would file Form I-765 (application for employment authorization) by mail with the USCIS Regional Service Center that serves the area where they live. They may also be eligible to file Form I-765 electronically (seeUSCIS Electronic Filing). For employment based green card applicants, your priority date needs to be current to apply for Adjustment of Status (I485) at which time you can apply for EAD. Typically, it is recommended to apply for Advance Parole (AP) at the same time so that you do not have to get a visa stamping when re-entering US from a foreign country.
Interim EAD
An interim EAD is an EAD issued to an eligible applicant when USCIS has failed to adjudicate an application within 90 days of receipt of a properly filed EAD application or within 30 days of a properly filed initial EAD application based on an asylum application filed on or after January 4, 1995. The interim EAD will be granted for a period not to exceed 240 days and is subject to the conditions noted on the document.
An interim EAD is no longer issued by local service centers. One can however take an INFOPASS appointment and place a service request at local centers, explicitly asking for it if the application exceeds 90 days and 30 days for asylum applicants without an adjudication .
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Americans want flight restrictions from Ebola countries. And it’s not close.
By Aaron Blake
Nearly two-thirds of Americans say they are concerned about an Ebola outbreak in the United States, and about the same amount say they want flight restrictions from the countries in West Africa where the disease has quickly spread.
A new poll from the Washington Post and ABC News shows 67 percent of people say they would support restricting entry to the United States from countries struggling with Ebola. Another 91 percent would like to see stricter screening procedures at U.S. airports in response to the disease’s spread.
Thus far, some countries in Europe have restricted flights from these countries in West Africa, and an increasing number of U.S. lawmakers are calling for similar bans. The White House has yet to increase restrictions, with federal officials saying such a move could actually increase the spread of the disease by hampering the movement of aid workers and supplies.
Concern about Ebola, at this point, is real but not pervasive. About two-thirds (65 percent) say they are concerned about an Ebola outbreak in the United States. But while people are broadly concerned about an outbreak, they are not necessarily worried about that potential outbreak directly affecting them. Just 43 percent of people are worried about themselves or someone in their family becoming infected – including 20 percent who are “very worried.”
That finding echoes a Pew poll from last week which showed just 11 percent were “very worried” about themselves or their families becoming infected. Since that survey, Dallas Ebola patient Thomas Eric Duncan died, and news that a nurse who provided care for him became infected broke on the final day of the Post-ABC poll.
By comparison, slightly more Americans said they were worried about the H1N1 virus – a.k.a. the swine flu – in October 2009 (52 percent). Concern about Ebola is about on-par with concern about Avian influenza – a.k.a. the bird flu – in 2006 (41 percent) and slightly higher than concern about Sudden Acute Respiratory Syndrome (SARS) in 2003 (as high as 38 percent).
The support for increasing restrictions puts the White House in a tough spot. Given the moves by other countries and the American public’s stance, there is increasing pressure to act. And given the very real — but still somewhat muted — concerns about the disease, that’s significant, especially if the disease continues to expand.
The Department of Homeland Security announced Tuesday that all travelers from Ebola outbreak countries in West Africa will be funneled through one of five U.S. airports with enhanced screening starting Wednesday.
Customs and Border Protection within the department began enhanced screening — checking the traveler’s temperature and asking about possible exposure to Ebola — at New York’s John F. Kennedy International Airport on Oct. 11.
Enhanced screening for travelers from Liberia, Sierra Leone and Guinea was expanded Oct. 16 to Washington Dulles, Chicago O’Hare, New Jersey’s Newark and Hartsfield-Jackson Atlanta international airports.
Those airports were supposed to screen 94% of the average 150 people per day arriving from the three countries. Lawmakers from other states asked for enhanced screening at their airports, too.
Some lawmakers have called for more restrictions, such as suspending visas or denying entry at ports for citizens from the three countries.
Jeh Johnson, secretary of Homeland Security, announced that travelers from West Africa must arrive at one of the five airports starting Wednesday.
“We are working closely with the airlines to implement these restrictions with minimal travel disruption,” Johnson said. “If not already handled by the airlines, the few impacted travelers should contact the airlines for rebooking as needed.”
The enhanced screening will apply to anyone who traveled recently to, from or through the three outbreak countries, according to the department’s announcement to be published Thursday in the Federal Register. Customs and Border Protection will work with airlines to identify potential travelers before they board, but airlines will be obligated to comply with the rule for carrying to the USA any passengers who recently traveled through the region, according to the filing.
The restrictions should affect only about nine travelers per day who would have arrived at other airports. Katie Cody, a spokeswoman for American Airlines, which serves Europe from hubs such as Philadelphia and Charlotte, said the airline has no concerns about the change.
“We have been tracking that, and we don’t have any concerns because the numbers are so small,” Cody said.
British Airways, which serves a variety of U.S. destinations other than the five targeted airports, said it would comply with the measures.
“Customers affected will be offered a refund or will be rerouted if there is availability,” spokeswoman Michele Kropf said.
Republican lawmakers offered muted praise but pressed for stricter travel restrictions.
“In addition to requiring all travelers from at-risk countries to fly through airports with enhanced screening measures in place, I continue to call on the administration to suspend all visas from Liberia, Sierra Leone and Guinea,” said Rep. Michael McCaul, R-Texas, the head of the House Homeland Security Committee.
The head of the House Judiciary Committee, Rep. Bob Goodlatte, R-Va., said a “real solution” is to deny entry to anyone from the three countries under a provision of the 1952 Immigration and Nationality Act.
“President Obama has a real solution at his disposal under current law and can use it at any time to temporarily ban foreign nationals from entering the United States from Ebola-ravaged countries,” Goodlatte said. “The vast majority of Americans strongly support such a travel moratorium, and I urge the president to take every step possible to protect the American people from danger.”
Rep. John Conyers of Michigan, the top Democrat on the House Judiciary Committee, said steering travelers through the five airports is a sensible precaution.
“As agreed upon by experts in both the public health and transportation communities, issuing a blanket travel ban would not only be counterproductive, but it would also irresponsibly impede getting much-needed supplies and relief to the countries that need it most,” Conyers said.
Roger Dow, CEO of the U.S. Travel Association, a trade group for all aspects of travel, praised the move to calm travel concerns while avoiding a travel ban.
“The Obama administration continues to heed the counsel of an overwhelming consensus of health and security experts and resist calls for any sort of travel ban on the grounds that it will be counterproductive to efforts to contain Ebola,” Dow said.
A Liberian national, Thomas Eric Duncan, who became the first person diagnosed with the disease in the USA after arriving in Dallas on Sept. 20, had a temperature of 97.3 degrees but didn’t tell airport officials in Monrovia, Liberia, that he had cared for a pregnant woman suffering from Ebola. He died Oct. 8, and two nurses who treated him have become infected.
Sen. Charles Schumer, D-N.Y., said the enhanced screening adds a layer of protection against Ebola entering the country.
“The Department of Homeland Security’s policy to funnel all passengers arriving from Ebola hot spots to one of these five equipped airports is a good and effective step towards tightening the net and further protecting our citizens,” Schumer said.
Obama and Johnson have said they will continue to monitor travel restrictions for possible changes.
“We are continually evaluating whether additional restrictions or added screening and precautionary measures are necessary to protect the American people and will act accordingly,” Johnson said.
Gabbard Calls On CDC To Increase Incubation Period To Prevent Ebola Spread
By Chad Blair
Rep. Tulsi Gabbard (D-HI) has called on the Center for Disease Control to implement stricter incubation guidelines for people who have been in contact with patients “confirmed or suspected” to have the Ebola virus.
According to a press release from her office, Gabbard is calling on the CDC to increase the quarantine and restriction period from the 21-day standard to 42 days, “based on the latest scientific studies and the World Health Organization report that the incubation period for the deadly Ebola virus can extend as long as 42 days.”
On Friday, Gabbard called for the “immediate suspension” of visas for citizens of Ebola-stricken West African nations as well as flights from those countries into the United States.
“Recent mistakes have revealed that the U.S. public health system is clearly not fully prepared to combat Ebola and prevent its spread in the United States,” she said in a statement.
Democrats like Gabbard are among a growing number who are “beginning to sound more like Republicans when they talk about Ebola. And Republicans are moving into overdrive with their criticism of the government’s handling of the deadly virus,” according to The Washington Post.
“The sharpened rhetoric, strategists say, suggests Democrats fear President Obama’s response to Ebola in the United States could become a political liability in the midterm election and Republicans see an opportunity to tie increasing concerns about the disease to the public’s broader worries about Obama’s leadership.”
The Washington Post notes, however, that Gabbard is “a liberal Democrat who is not in any danger of losing reelection.” It also reports that a Washington Post-ABC News poll showed that “67 percent of Americans would support restricting entry to the United States from countries fighting dealing with an Ebola crisis.”
How is the end of an Ebola outbreak decided and declared?
Information note – October 2014
Who decides the date?
The WHO Ebola outbreak response team is responsible for establishing the date of the end of the outbreak in collaboration with the affected country’s subcommittee for surveillance, epidemiology and laboratory.
How is the date determined?
An Ebola virus disease outbreak in a country can be declared over once 42 days have passed and no new cases have been detected. The 42 days represents twice the maximum incubation period for Ebola (21 days). This 42-day period starts from the last day that any person in the country had contact with a confirmed or probable Ebola case.
This includes health care workers who have been exposed to patients with Ebola virus disease, even if the health worker was wearing personal protective equipment and followed infection control procedures since such a person could be exposed accidentally without realizing it. In the setting of an Ebola treatment centre, the date of the last infectious contact is defined as the day when the last patient in the treatment centre tested negative for Ebola virus disease, using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test.
If no new case has been detected at the end of this 42-day period, the risk of a further case is very low, and the outbreak is declared over.
Why 42 days?
The maximum incubation period for Ebola virus disease is 21 days. The 42-day period set by WHO (twice the maximum incubation period) provides a margin of security to cover any possible missed cases, uncertainty in reporting dates or hidden chains of transmission. (*)
During the 42-day period, the surveillance system should be fully functional, so that all contacts of the last patient are followed to detect possible chains of transmission.
What is the procedure to make the declaration?
The WHO Ebola outbreak response team in collaboration with the affected country’s subcommittee for surveillance, epidemiology and laboratory determines the date of the end of the epidemic. The government of the affected country, in collaboration with WHO and international partners, makes an official declaration of the end of the epidemic.
The Obama administration has reversed course on putting travel restrictions on those coming from three West African nations tainted with Ebola and is putting in place demands that they enter only through five U.S. airports prepared to screen for the virus.
Homeland Security Secretary Jeh Johnson said in a statement that the new rules will take effect Wednesday, bowing to demands from both parties that the U.S. do a better job so secure the border from Ebola.
“Today, as part of the Department of Homeland Security’s ongoing response to prevent the spread of Ebola to the United States, we are announcing travel restrictions in the form of additional screening and protective measures at our ports of entry for travelers from the three West African Ebola-affected countries,” said Johnson.
He said the rules require that anyone coming from Liberia, Sierra Leone or Guinea enter the U.S. only through the five airports where special Ebola screenings have been set up: New York’s John F. Kennedy, Newark Liberty, Washington Dulles, Atlanta’s Hartsfield-Jackson and Chicago’s O’Hare.
“All passengers arriving in the United States whose travel originates in Liberia, Sierra Leone or Guinea will be required to fly into one of the five airports that have the enhanced screening and additional resources in place. We are working closely with the airlines to implement these restrictions with minimal travel disruption. If not already handled by the airlines, the few impacted travelers should contact the airlines for rebooking, as needed,” said the statement.
He said that passengers flying into those airports on flights originating in Liberia, Sierra Leone and Guinea “are subject to secondary screening and added protocols, including having their temperature taken, before they can be admitted into the United States. These airports account for about 94 percent of travelers flying to the United States from these countries.”
There are no direct, non-stop commercial flights from Liberia, Sierra Leone or Guinea to the U.S.
NIH unit treating Dallas nurse for Ebola is one of 4 special isolation facilities in U.S.
By Lena H. Sun
It has a specially designed air-flow system to prevent contaminated air from leaving the patient room. It requires anyone who enters to be buzzed in. Personnel who work there receive special training in infection control to prevent the spread of bioterror agents, natural or man-made. It also has a tiny gym.
Welcome to the Special Clinical Studies Unit at the National Institutes of Health in Bethesda, Md. It is a 4,000-square-foot unit inside the NIH Clinical Center, the nation’s only hospital dedicated to research, which provides free state-of-the-art care to very sick patients from all over the world.
Now it’s home to its first confirmed Ebola patient, Nina Pham.
Pham is the first patient with a confirmed infectious disease to be cared for in the special seven-bed unit, center director John Gallin said in an interview Friday. Opened in 2010 for patients who need advanced isolation and extended stays, the unit was initially designed to take care of personnel working at the U.S. Army Medical Research Institute of Infectious Diseases in case they were exposed to infectious agents. In more recent years, it has been used to house healthy volunteers participating in live vaccine trials. The volunteers need to be monitored in a place where they can be safely quarantined, Gallin said. To accommodate those healthy volunteers, the unit has a dining room and a “tiny fitness area,” he said.
Pham, the first nurse diagnosed with Ebola after caring for a patient in Dallas, is in fair and stable condition, officials said Friday morning.
What does an Ebola isolation ward look like?
“We are giving her the best possible care on a symptomatic and systemic basis,” Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, said during a news conference.
Pham, 26, was transferred to the facility, one of four in the country with a special biocontainment unit, late Thursday. She was diagnosed with Ebola on Sunday, becoming the first person to contract the disease on U.S. soil. Pham had been part of the team that treated Thomas Eric Duncan, a Liberian man who flew to Dallas last month before being diagnosed with Ebola. Duncan died last week, four days before it was announced that Pham had contracted the disease.
“There is no specific therapy that has been proven to be effective against Ebola, and that’s why excellent medical care is critical,” Fauci said. He said Pham was “very, very tired” from her trip.
Patients infected with the Ebola virus require a large number of staffers to provide care around-the-clock. At NIH, that comes out to about 27 people a week — doctors, nurses, support staff — for one patient, Gallin said. With about 50 to 60 such personnel specially trained for infectious disease and critical care, NIH can only care for two Ebola patients at a time, he said.
The four facilities that provide such care were designed in the aftermath of the Sept. 11, 2001, terrorist attacks to protect against bioterrorism. Two of them, Emory University Hospital in Atlanta and the Nebraska Medical Center, are each treating one Ebola patient. The other facility is St. Patrick Hospital in Missoula, Mont.
They require staff to undergo more rigorous training in infection control, and staff must follow strict protocol for putting on and taking off personal protective equipment in a separate anteroom. Officials say meticulous attention to detail in following protocols is what sets them apart from other facilities.
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Emory has treated three Ebola patients, all of whom have recovered. The University of Nebraska treated one patient who recovered and is now caring for a freelance NBC cameraman. St. Patrick has not yet treated an Ebola patient. The hospital has received so many inquiries that it has set up a special hotline where they are transcribed and forwarded to the appropriate departments.
Bruce Ribner gives a tour of the Emory University Hospital isolation unit which has been used for treatment of patients infected with the Ebola virus. (Emory University via YouTube)
Unlike the Dallas hospital where Pham and another nurse were infected, which officials said most likely occurred because of a breach of protocol involving personal protective equipment, no health workers taking care of the Ebola patients at the special facilities have become infected.
“There is a step-by-step, checklisted procedure to putting on your personal protective equipment for when you go in to the patient’s room to perform your duties and when you come out,” said Mark Rupp, medical director of Nebraska Medical Center’s infection control department, which includes the special unit. “That’s the big difference with what goes on in our unit and what goes on in a regular intensive-care unit.”
The facilities have one person whose only job is to make sure health-care workers put on and take off their protective equipment correctly. At NIH, this person is dubbed “the Watson,” Gallin said, for the sidekick to Sherlock Holmes.
The Watson “has the authority to stop everything at any moment if someone looks like they’re breaking protocol,” Gallin said. The Watson has a checklist, like a pilot’s preflight checklist, and everything has to be done in that order. If not, the Watson can “scream at them and tell them to stop,” Gallin said, which apparently happened at least once Thursday night when doctors and staff were admitting Pham.
The protective gear that health-care workers take off is autoclaved (sanitized via pressurized steam) and then incinerated. Equipment that is not disposable is disinfected according to the manufacturer’s directions. The units also have negative air pressure to prevent germs from spreading beyond patient rooms. For Ebola patients, contaminated air is not such a concern because the disease is not transmitted through the air, but through contact with bodily fluids.
The seven-bed, 4,000-square-foot biocontainment unit at the National Institutes of Health Clinical Center in Bethesda, Md., is a state-of-the-art facility built to keep the world’s scariest pathogens from escaping. The four U.S. facilities are all different — NIH’s even has a gym — but they contain many of the same things. This layout is based on the unit at Emory University in Atlanta.
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RED ALERT: TOP GENERAL WARNS EBOLA WILL NOT STAY IN WEST AFRICA!!!!
Dallas Mayor: ‘It May Get Worse Before it Gets Better’
“There are two things that I harken back to this. The only way that we are going to beat this is person by person, moment by moment, detail by detail. We have those protocols in place, the city and county, working closely with the CDC and the hospital. The second is we want to minimize rumors and maximize facts. We want to deal with facts, not fear. And I continue to believe that while Dallas is anxious about this and with this news this morning, the anxiety level goes up a level, we are not fearful and I’m pleased and proud of the citizens that I talk to day in and day out knowing that there is hope if we take care and do what is right in these details. It may get worse before it gets better. But it will get better.”
The comments were given at a news conference in Dallas this morning announcing that another hospital worker in Dallas has been diagnosed with Ebola.
Nurses’ Union: Ebola Patient Left In Open Area Of ER For Hours
A Liberian Ebola patient was left in an open area of a Dallas emergency room for hours, and nurses treating him worked without proper protective gear and faced constantly changing protocols, according to a statement released by the nation’s largest nurses’ union.
Among those nurses was Nina Pham, 26, who has been hospitalized since Friday after catching Ebola while caring for Thomas Eric Duncan, the first person diagnosed with the virus in the U.S. He died last week.
Public-health authorities announced Wednesday that a second Texas Health Presbyterian Hospital health care worker had tested positive for Ebola, raising more questions about whether American hospitals and their staffs are adequately prepared to contain the virus.
The CDC has said some breach of protocol probably sickened Pham, but National Nurses United contends the protocols were either non-existent or changed constantly after Duncan arrived in the emergency room by ambulance on Sept. 28.
Medical records provided to The Associated Press by Duncan’s family show that Pham helped care for him throughout his hospital stay, including the day he arrived in intensive care with diarrhea, abdominal pain, nausea and vomiting, and the day before he died.
When Pham’s mother learned she was caring for Duncan, she tried to reassure her that she would be safe.
Pham told her: “Mom, no. Don’t worry about me,” family friend Christina Tran told The Associated Press.
Duncan’s medical records make numerous mentions of protective gear worn by hospital staff, and Pham herself notes wearing the gear in visits to Duncan’s room. But there is no indication in the records of her first encounter with Duncan, on Sept. 29, that Pham donned any protective gear.
Deborah Burger of National Nurses United, who convened a conference call with reporters to relay what she said were concerns of nurses at the hospital, said they were forced to use medical tape to secure openings in their flimsy garments and worried that their necks and heads were exposed as they cared for Duncan.
RoseAnn DeMoro, executive director of Nurses United, said the statement came from “several” and “a few” nurses, but she refused repeated inquiries to state how many. She said the organization had vetted the claims, and that the nurses cited were in a position to know what had occurred at the hospital. She did not specify whether they were among the nurses caring for Duncan.
The nurses allege that his lab samples were allowed to travel through the hospital’s pneumatic tubes, possibly risking contaminating of the specimen-delivery system. They also said that hazardous waste was allowed to pile up to the ceiling.
Wendell Watson, a Presbyterian spokesman, did not respond to specific claims by the nurses but said the hospital has not received similar complaints.
“Patient and employee safety is our greatest priority, and we take compliance very seriously,” he said in a statement. He said the hospital would “review and respond to any concerns raised by our nurses and all employees.”
The nurses’ statement said they had to “interact with Mr. Duncan with whatever protective equipment was available,” even as he produced “a lot of contagious fluids.” Duncan’s medical records underscore that concern. They also say nurses treating Duncan were also caring for other patients in the hospital and that, in the face of constantly shifting guidelines, they were allowed to follow whichever ones they chose.
When Ebola was suspected but unconfirmed, a doctor wrote that use of disposable shoe covers should also be considered. At that point, by all protocols, shoe covers should have been mandatory to prevent anyone from tracking contagious body fluids around the hospital.
A few days later, however, entries in the hospital charts suggest that protection was improving.
“RN entered room in Tyvek suits, triple gloves, triple boots, and respirator cap in place,” a nurse wrote.
The Presbyterian nurses are not represented by Nurses United or any other union. DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to reporters or they would be fired.
The AP has attempted since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have so far been unwilling to speak.
David R. Wright, deputy regional administrator for the U.S. Centers for Medicare & Medicaid Services, which monitors patient safety and has the authority to withhold federal funding, said his agency is going to want to get all of the information the nurses provided.
“We can’t talk about whether we’re going to investigate or not, but we’d be interested in hearing that information,” he said.
CDC officials did not immediately respond to requests for comment.
Duncan first sought care at the hospital’s ER late on Sept. 25 and was sent home the next morning. He was rushed by ambulance back to the hospital on Sept. 28. Unlike his first visit, mention of his recent arrival from Liberia immediately roused suspicion of an Ebola risk, records show.
The CDC said 76 staff members at the hospital could have been exposed to Duncan after his second ER visit. Another 48 people who may have had contact with him before he was isolated are being monitored. Pham remained hospitalized Tuesday in good condition and said in a statement that she was doing well.
The Rev. Jim Khoi, pastor at Our Lady of Fatima Church in Fort Worth, which Pham’s family attends, said the 2010 Texas Christian University nursing school graduate appeared to be in good spirits when she spoke to her mother via video chat.
Pham’s mother, Ngoc Pham, is “calm,” Khoi said. “She trusts in God. And she asks for prayers.”
CDC: Ebola Patient Traveled By Air With “Low-Grade” Fever
The CDC has announced that the second healthcare worker diagnosed with Ebola — now identified as Amber Joy Vinson of Dallas — traveled by air Oct. 13, with a low-grade fever, a day before she showed up at the hospital reporting symptoms.
The CDC is now reaching out to all passengers who flew on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth. The flight landed at 8:16 p.m. CT.
All 132 passengers on the flight are being asked to call 1 800-CDC INFO (1 800 232-4636). Public health professionals will begin interviewing passengers about the flight Wednesday afternoon.
“Although she (Vinson) did not report any symptoms and she did not meet the fever threshold of 100.4, she did report at that time she took her temperature and found it to be 99.5,” said CDC Director Tom Frieden. Her temperature coupled with the fact that she had been exposed to the virus should have prevented her from getting on the plane, he said. “I don’t think that changes the level of risk of people around her. She did not vomit, she was not bleeding, so the level of risk of people around her would be extremely low.”
Vinson first reported a fever to the hospital on Tuesday (Oct. 14) and was isolated within 90 minutes, according to officials. She did not exhibit symptoms while on the Monday flight, according to crew members. However, the CDC says passenger notification is needed as an “extra level of safety” due to the proximity in time between the flight and the first reported symptoms.
“Those who have exposures to Ebola, she should not have traveled on a commercial airline,” said Dr. Frieden. “The CDC guidance in this setting outlines the need for controlled movement. That can include a charter plane; that can include a car; but it does not include public transport. We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.”
Frieden specifically noted that the remaining 75 healthcare workers who treated Thomas Duncan at Texas Health Presbyterian Hospital will not be allowed to fly. The CDC will work with local and state officials to accomplish this.
Frontier Airlines is working closely with the CDC to identify and notify all passengers on the flight. The airline also says the plane has been thoroughly cleaned and was removed from service following CDC notification early Wednesday morning.
However, according to Flighttracker, the plane was used for five additional flights on Tuesday before it was removed from service. Those flights include a return flight to Cleveland, Cleveland to Fort Lauderdale–Hollywood International Airport (FLL), FLL to Cleveland, Cleveland to Hartsfield–Jackson Atlanta International Airport (ATL), and ATL to Cleveland.
While in Ohio, Vinson visited relatives, who are employees at Kent State University. The university is now asking Vinson’s three relatives stay off campus and self-monitor per CDC protocol for the next 21 days out of an “abundance of caution.”
“It’s important to note that the patient was not on the Kent State campus,” said Kent State President Beverly Warren. “She stayed with her family at their home in Summit County and did not step foot on our campus. We want to assure our university community that we are taking this information seriously, taking steps to communicate what we know,” said Dr. Angela DeJulius, director of University Health Services at Kent State.
Vinson is a Kent State graduate. She received degrees from there in 2006 and 2008.
Cleveland’s Public Health Director, Toinette Parrilla, said Vinson was visiting in preparation for her wedding. While there, she visited her mother and her fiance.
The latest Ebola diagnosis was announced by the Texas Department of State Health Services early Wednesday morning.
Vinson is the second worker at Presbyterian Hospital to be diagnosed after providing health care to Duncan, the first person to be diagnosed with Ebola in the United States. He died last week.
Medical records provided to The Associated Press by Thomas Eric Duncan’s family show Amber Joy Vinson was actively engaged in caring for Duncan in the days before his death. The records show she inserted catheters, drew blood, and dealt with Duncan’s body fluids.
Dallas Mayor Mike Rawlings addressed the media on Wednesday, saying the patient lives alone and has no pets.
“It may get worse before it gets better,” Rawlings said, “but it will get better.”
Crews worked to decontaminate the common areas of Vinson’s Dallas apartment building Tuesday morning. The apartment unit will be decontaminated by contractors starting early Wednesday afternoon.
The CDC announced that Vinson will be transported to Emory Hospital in Atlanta for further treatment. Two previous American Ebola patients, Dr. Kent Brantly and Nancy Writebol, were treated at Emory and were the first Ebola patients to be treated in the United States. They were released in August.
Nina Pham was diagnosed with the virus over the weekend and remains isolated in good condition. Pham’s dog — a Cavalier King Charles Spaniel named Bentley — has been taken into custody and is being cared for at an undisclosed location.
Frontier Airlines released the following statement:
“At approximately 1:00 a.m. MT on October 15, Frontier was notified by the CDC that a customer traveling on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth on Oct. 13 has since tested positive for the Ebola virus. The flight landed in Dallas/Fort Worth at 8:16 p.m. local and remained overnight at the airport having completed its flying for the day at which point the aircraft received a thorough cleaning per our normal procedures which is consistent with CDC guidelines prior to returning to service the next day. It was also cleaned again in Cleveland last night. Previously the customer had traveled from Dallas Fort Worth to Cleveland on Frontier flight 1142 on October 10.
Customer exhibited no symptoms or sign of illness while on flight 1143, according to the crew. Frontier responded immediately upon notification from the CDC by removing the aircraft from service and is working closely with CDC to identify and contact customers who may traveled on flight 1143.
Customers who may have traveled on either flight should contact CDC at 1 800 CDC-INFO.
The safety and security of our customers and employees is our primary concern. Frontier will continue to work closely with CDC and other governmental agencies to ensure proper protocols and procedures are being followed.”
Frontier jet made 5 flights before taken out of service in Ebola scare
The Frontier Airlines jet that carried a Dallas healthcare worker diagnosed with Ebola made five additional flights after her trip before it was taken out of service, according to a flight-monitoring website.
Denver-based Frontier said in a statement that it grounded the plane immediately after the carrier was notified late Tuesday night by the Centers for Disease Control and Prevention about the Ebola patient.
Ebola patient flew day before symptoms surfaced
Amber Joy Vinson of Dallas, traveled by air on Oct. 13, the day before she first reported symptoms.
Flight 1143, on which the woman flew from Cleveland to Dallas/Fort Worth, was the last trip of the day Monday for the Airbus A320. But Tuesday morning the plane was flown back to Cleveland and then to Fort Lauderdale, Fla., back to Cleveland and then to Atlanta and finally back to Cleveland again, according to Daniel Baker, chief executive of the flight-monitoring site Flightaware.com.
He said his data did not include any passenger manifests, so he could not tell how many total passengers flew on the plane Tuesday.
The airline said it is working with the CDC to contact all 132 passengers on the Monday flight that carried the Ebola patient.
Frontier could not be reached to confirm the FlightAware data, and it was unclear if passengers on the additional flights were being contacted.
The passenger “exhibited no symptoms or sign of illness while on Flight 1143, according to the crew,” Frontier said.
The plane went through a routine but “thorough” cleaning Monday night, Frontier said. Airline industry experts said routine overnight cleaning includes wiping down tray tables, vacuuming carpet and disinfecting restrooms.
The healthcare worker also had flown to Cleveland from Dallas three days earlier on Frontier Flight 1142, the airline reported.
In response to the news that another Ebola patient flew on a commercial flight, the union that represents 60,000 flight attendants on 19 airlines is asking the CDC to monitor and care for the four flight attendants who were on flight from Cleveland to Dallas/Fort Worth.
cComments
whats it going to take to close the border to people from africa? 10 dead? 100 dead? 1000 dead? we know obumma doesnt give a flying fluke about the american citizens, but isn’t there someone in the government with an ounce of brains? or is this part of obumma’s scheme to declare martial law?…
The Assn. of Flight Attendants “will continue to press that crew members are regularly monitored and provided with any additional resources that may be required,” the group said.
The Ebola scare prompted the union last week to call for better measures to protect flight attendants from exposure to the deadly virus.
The group’s international president, Sara Nelson, suggested that flight attendants are being asked to do too much in the fight against Ebola.
“We are not, however, professional healthcare providers and our members have neither the extensive training nor the specialized personal protective equipment required for handling an Ebola patient,” she said in a statement.
Earlier this month, United Airlines was rushing to contact passengers who flew on two flights that carried a Liberian man infected with Ebola from Brussels to Washington, D.C., and then to Dallas.
The Ebola-stricken healthcare worker who flew on Frontier had been treating the Liberian man, Thomas Eric Duncan, who has since died.
Airline-industry stock prices have taken a beating in recent weeks, with some analysts blaming the Ebola scare.
On Wednesday, stocks of Delta Air Lines and American Airlines fell more than 6% in early trading before partially recovering. With less than 90 minutes remaining in the regular trading session, the two stocks were each down about 2% from Tuesday’s closes. Frontier is privately held.
There are only 19 level 4 bio-containment beds in the whole of the United States…and four in the UK
Liz Bennett
The UK is well set for an Ebola outbreak (sarcasm alert) We have TWO isolation units, but one is getting ‘redeveloped’ so it’s not available right now. Called High Security Infectious Diseases Units there are two in the country, each capable of taking two patients. One is at The Royal Free Hospital in Hampstead North London, the other, the one getting a bit of a make-over, is at The Royal Victoria Infirmary in Newcastle, up in the north-east of England.
Four level 4 bio-containment beds between 69,000,000 people
In the US there are 4 units geared up to handle Ebola. The National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, has 3 beds. Nebraska Medical Center, Omaha, has 10 beds. Emory Hospital, Atlanta has 3 beds and St Patricks Hospital, Missoula has 3 beds (source)
19 level four biocontainment beds for 317,000,000 people
I think we just found out why the government(s) are under-playing the situation. They simply do not have the facilities to cope with even a small outbreak. They are, in fact in exactly the same position as the dirt-poor hospitals in West Africa…there are not enough facilities to stop the spread of the disease if it gets out. The quality of care is better, but the availability of containment most likely isn’t.
I am sure ‘regular’ isolation units will be pressed into use but they are not designed to handle level 4 biohazards, they are nowhere near as secure medically speaking, as biocontainment units.
A couple of days ago I explained how exponential spread works. You can read that article here if you like. As a quick recap. Once a disease is at the point where every carrier infects 2 more people,(exponential spread) it will continue until it:
A) runs out of hosts
B) is stopped by medical science or
C) mutates into something less harmful.
What follows will show you how woefully inadequately our governments have prepared for something as lethal as Ebola.
In the flu pandemic of 1918-1920 28% of Americans were infected with the disease…try to remember I am talking numbers here not HOW disease spreads or any medical similarities between diseases, 625,000 Americans lost their lives out of some 29,400,000 infections. The population of the United States at that time was 105,000,000 people. (source)
Fast forward to today. If that flu pandemic had hit the United States in 2014, when the population stands at 317,000,000 people 88,760,000 people would have been infected and 2,130,240 of them would have died.
Now, let’s try this with Ebola. I have picked Liberia just because it is in the news due to the Thomas Duncan case.
Liberia has a population of 4,290,000 people, as of the latest figures there have been 3692 cases of Ebola, this represents 0.0086% of the population.Of those infections, 1998 people have died that’s a fatality rate of 54%. (source)
If that same infection and death rate were applied to the United States Ebola would infect 269,000 people and of those 156,281 would die.
Now, if as doctors and scientists fear the basic reproduction rate rises to 2 in Liberia the numbers change very quickly. Using the mean average incubation time of 9 days it would take around 13 weeks for the entire population of Liberia to become infected. (10 doublings starting with 3692 = just under the population of Liberia. This multiplied by 9 days gives us 90 days which divided by 7 gives 12.85 weeks.) Of the 4,290,000 people infected 2,316,000 would lose their lives.
This is just Liberia, not the other affected countries in West Africa.
Translated to an equivalent outbreak in the United States, where the basic reproduction rate is also 2, the numbers are horrifying. Starting with patient zero it would take around 245 days, 35 weeks for every person in the United States to become infected. Of those 17,118,000 people would die. (27.17 doublings x 9 days = 245 days =35 weeks)
Please remember the figures for Liberia are pulled from the CDC website, the percentages are correct.
United States was based on exactly the same parameters as for Liberia…a like for like comparison.
The CDC could be spending their time educating people, advising people to stock up, get ready for the possibility of staying in their homes. Self imposed isolation, or if need be state imposed isolation, that may last for an extended time period may become a reality. They’re not doing it though are they? They are sprouting figures and applying them to West Africa, and they can’t even get that right. They are saying that there could be 1.4 deaths in West Africa in a worst case scenario. When actually applying the figures they supplied with some simple mathematics we can see that 1.4 million deaths is a gross understatement.
Even a basic reproduction rate of 1.7, the latest figure for Liberia it will only take around 30 weeks to get to the same point as the above scenario, over 2,000,000 dead.
Don’t get me wrong, I am not saying that the UK government is any better, if anything they are worse, they don’t even try to do the maths. Most of them went to Eton (a very expensive school that churns out politicians) so it’s unlikely they would be capable of it even if they wanted to. You only have to look at our national finances to see they are no good at sums. They send out press briefings that there will be an emergency COBRA meeting, do you have any clue what that stands for? Let me enlighten you, Cabinet Office Briefing Room A. COBRA is not an emergency planning group, it’s an effing office.
Although I am loathed to say it, it’s time that our governments started worrying about the facilities at home rather than worrying about the facilities abroad. Stopping the disease in Africa does not mean we are out of the woods. There are so many unreported cases, people turned away from medica facilities in West Africa that nobody has the slightest idea how many cases of Ebola are actually out there. The porous borders of the region mean that people move around without the controls that are usually exercised in the west. There has to be a travel ban on non-US citizens entering the United States from these areas, the same applies from the UK.
Border control has to be improved in both countries if we have any hope of halting the spread of this terrible disease. The west is going to be the destination for anyone from Ebola hit areas that can afford to make their way from Africa. Many West Africans have contacts in the west who will help them get out, and shelter them when they arrive. As harsh as it seems this has to be stopped, it’s time for governments to put their own citizens first. Repatriation of your own is one thing, risking millions of lives at home because you won’t man up and prevent foreigners entering is quite another.
Guinea, Liberia and Sierra Leone have been struggling since March to stop what has become the largest Ebola outbreak ever recorded. The disease is causing widespread fear and disruption in West Africa, and shows no signs of being brought under control.
CHRONOLOGY OF COVERAGE
OCT. 15, 2014
Spain’s ad hoc, improvisational response to citizens infected by Ebola virus and brought back to the country underscores holes in West’s readiness to confront wider outbreak; cases of Ebola in Spain have raised urgent questions about risks of disease spreading even in developed countries, particularly among health care workers. MORE
OCT. 15, 2014
Doctors Without Borders criticizes lack of reliable evacuation systems from West Africa, saying that more would volunteer to fight Ebola in region if it were not so difficult to leave in case of emergency; cites fact that it took 50 hours to evacuate French nurse to Paris after she tested positive for virus. MORE
OCT. 15, 2014
Bellevue Hospital is designated as center for treatment of the Ebola virus should it emerge in New York City; announcement comes amid widespread concerns that disease may not be so easily contained by every hospital that has an isolation unit. MORE
OCT. 15, 2014
World Health Organization warns new cases of Ebola virus could reach 10,000 a week in West Africa by December, nearly 10 times the current rate; reports none of the three most heavily affected countries, Liberia, Sierra Leone and Guinea, are adequately prepared for epidemic; comments come in report before the United Nations Security Council, which voices fear that epidemic could renew the risk of political instability in a region barely recovering from civil war.MORE
OCT. 15, 2014
Dr Thomas R Frieden, Centers for Disease Control and Prevention director, acknowledges for first time that quicker and more concerted action on agency’s part might have kept Dallas nurse from contracting Ebola virus; says agency plans a more robust response to any future Ebola cases in American hospitals. MORE
OCT. 15, 2014
Frank Bruni Op-Ed column contends other, more common ailments deserve more concern and attention in United States than Ebola; points out influenza kills between 3,000 and 50,000 Americans per year, and skin cancer kills 10,000 per year; lists other common, and much-researched, illnesses that Americans should vaccinate and protect themselves against. MORE
OCT. 15, 2014
Jere Longman On Soccer column examines plight of SIerra Leone’s national soccer team, caught amid self-destructive feud between nation’s soccer federation and sports ministry; observes that team was already exhausted from playing road-only games due to Ebola outbreak. MORE
OCT. 14, 2014
Transmission of Ebola virus to Dallas nurse Nina Pham forces Centers for Disease Control and Prevention to reconsider its approach to containing the disease; state and federal officials are re-examining whether equipment and procedures are adequate or too loosely followed, and whether more decontamination steps are necessary when health workers leave isolation units. MORE
OCT. 14, 2014
Experience of Emory University Hospital in Atlanta in caring for three Ebola patients calls into question oft repeated assurances from federal health officials that most American hospitals can safely treat disease; transmission of virus to Dallas nurse Nina Pham has also raised questions about general level of preparedness in hospitals around the country; medical experts have begun to suggest it may be better to transfer patients to designated centers with expertise in treating Ebola. MORE
OCT. 14, 2014
Public health concerns about Ebola virus have spread to both political parties, which are engaged in finger-pointing debate that could jar midterm elections; Republicans blame the Obama administration for failing to protect the United States, and Democrats are saying it is GOP budget cutting that has put Americans at risk. MORE
OCT. 14, 2014
Experts rule out notion that Ebola virus has become a super-pathogen and raise doubts that it will evolve into one; say virus is not fundamentally different from those in previous outbreaks dating back to 1976, and it is highly unlikely that natural selection will give it ability to spread more easily, particularly by becoming airborne. MORE
OCT. 14, 2014
Friends of Dallas nurse Nina Pham describe the 26-year-old, part of the team that treated Thomas Eric Duncan, as conscientious and caring, and from a very private family. MORE
OCT. 14, 2014
Editorial warns effort to combat the Ebola virus in Western Africa is lagging dangerously behind; contends the international community must dramatically step up aid if epidemic is to be controlled; holds obligation is particularly strong for the United Sates as it faces first case of patient who contracted the virus domestically. MORE
OCT. 14, 2014
Sierra Leone’s national soccer team is enduring a series of demeaning and discouraging indignities since outbreak of Ebola in West Africa; team is barred from playing in its own stricken country and it must play every match on the road as it struggles to qualify for the 2015 Africa Cup of Nations, continent’s biennial championship. MORE
OCT. 14, 2014
World Bank president Dr Jim Yong Kim, frustrated with slow global response to Ebola outbreak, has made fighting epidemic his mission, driving bank to act on Ebola with uncharacteristic speed; bank has committed $400 million to fighting disease. MORE
OCT. 13, 2014
The topic everyone on Wall Street is discussing urgently but quietly isn’t the volatile stock market. It is Ebola. MORE
OCT. 13, 2014
News that a nurse at Texas Health Presbyterian Hospital has contracted Ebola virus transforms part of Dallas into scene of concern and contamination; residents in victim’s neighborhood are filled with anxiety, while hazardous-materials crews scramble to clean her apartment building. MORE
OCT. 13, 2014
Nurse at Texas Presbyterian Hospital in Dallas becomes first person to contract Ebola within United States; development prompts local, state and federal officials to scramble to determine how she became infected, despite wearing protective gear, and to monitor others potentially at risk; news further stokes fears among health care workers across country. MORE
OCT. 13, 2014
Centers for Disease Control and Prevention say agency will take new steps to help hospital workers protect themselves, providing more training and urging hospitals to practice dealing with potential Ebola patients. MORE
OCT. 13, 2014
Op-Ed article by Prof Siddhartha Mukherjee contends Ebola case of Thomas Eric Duncan in Dallas shows that medical community must rethink concept of quarantine, in light of the absence of any established anti-viral treatment; calls for development of pilot program for rapid-testing quarantine. MORE
OCT. 12, 2014
Liberian Army has suddenly become linchpin in fight against Ebola virus rampaging the country; for decades, Liberians viewed the armed forces with fear due to atrocities committed during civil war. MORE
OCT. 11, 2014
Doctors Without Borders, first to respond to Ebola crisis in West Africa, remains primary international medical aid group battling disease there; strained and overworked charity has erected six treatment centers in West Africa, with plans for more, and has treated the majority of patients, just as they have in previous Ebola outbreaks and some other epidemics in the developing world. MORE
OCT. 10, 2014
Health workers at International Medical Corps treatment center in Liberia face dilemma of how to care for newborn whose mother may have died of Ebola; many health workers have contracted Ebola while attending to births and being exposed to blood and other body fluids, provoking fears of providing maternity care; doctors speculate that Ebola can be transmitted from mother to baby (Series: The Ebola Ward). MORE
OCT. 10, 2014
Britain says it will introduce measures at airports and rail terminals to screen passengers from affected countries as concerns over Ebola grow in Europe. MORE
OCT. 10, 2014
Presidents of Guinea, Liberia and Sierra Leone, nations most affected by the Ebola outbreak, implore world leaders to increase their support to fight the disease; speak at meeting of the World Bank and the International Monetary Fund in Washington. MORE
OCT. 10, 2014
Nebraska Biocontainment Patient Care Unit in Omaha, with arrival of two Ebola patients in last six weeks, is at forefront of the nation’s response to the disease; unit’s 10 beds sat empty for years. MORE
OCT. 10, 2014
Dallas officials say Sgt Michael Monnig, local shefiff’s deputy examined for possible infection with Ebola virus, has tested negative and is sent home from hospital; many in city remain uneasy. MORE
OCT. 9, 2014
Thomas Eric Duncan dies of Ebola in Dallas, renewing questions about whether delay in receiving treatment could have played a role in his death and what role it played in the possibility of his spreading the disease to others; it remains unclear why, and how, Texas Health Presbyterian Hospital did not initially view the Liberian man as a potential Ebola case; nearly 50 people who came into contact with Duncan when he was experiencing active symptoms are being monitored. MORE
OCT. 9, 2014
Federal health officials will require temperature checks for the first time at five major American airports for people arriving from three West African countries hardest hit by Ebola epidemic; however, health experts say measures are more likely to calm worried public than to prevent people with Ebola from entering country; move comes after death of Thomas Eric Duncan, Liberian man who was the first person diagnosed with Ebola in the United States. MORE
OCT. 9, 2014
Bellevue Hospital Center in Manhattan shows off its isolation rooms and its leave-no-skin-cell-uncovered precautions in an attempt to reassure New Yorkers that should the Ebola virus arrive in the city, its premier public hospital could handle it. MORE
OCT. 9, 2014
European leaders are scrambling to upgrade their response to Ebola crisis after Pres Obama’s announcement that he will send 3,000 troops to West Africa to build hospitals and otherwise help in fight against the disease. MORE
OCT. 9, 2014
Spanish health officials explain how auxiliary nurse Maria Teresa Romero Ramos became the first Ebola case in Western Europe, saying that it was likely she became infected when she touched her face with the gloves she had worn while tending to a Spanish missionary with Ebola at a Madrid hospital. MORE
OCT. 9, 2014
Dog named Excalibur who belonged to Ebola-infected nurse Maria Teresa Romero Ramos is destroyed by Spanish health officials, even as protesters and animal rights activists surround Madrid home of the nurse and her husband; online petition calling for dog’s life to be spared drew hundreds of thousands of signatures. MORE
OCT. 9, 2014
Editorial notes new screening procedures directed at travelers entering United States from Guinea, Liberia or Sierra Leone, center of the Ebola epidemic in West Africa; holds screenings, while burdensome and possibly of little practical value, may ease public anxieties about keeping virus out of country and assure people that risks are being minimized. MORE
OCT. 8, 2014
Schedule for a single day at newly opened Ebola treatment center in Suakoko, Liberia, run by International Medical Corps charity, offers portrait of efforts to halt spread of virus; center is both ordinary and otherwordly, where health workers tend to those infected and those quarantined while awaiting test results (Series: The Ebola Ward).MORE
OCT. 8, 2014
Spain’s government comes under heavy criticism for its handling of Western Europe’s first Ebola case, as health care workers argue that they have not been given proper training or equipment to handle the disease; government quarantines three more people and monitors dozens who had come into contact with infected nurse. MORE
OCT. 8, 2014
Centers for Disease Control and Prevention scrambles to address concerns from health workers nationwide as anxiety mounts over Ebola virus; agency has scheduled two nationwide conference calls, but has so far not changed its recommendations on protective gear.MORE
OCT. 8, 2014
Doctors report first positive signs in recovery of Thomas Eric Duncan, Liberian man battling Ebola virus in Dallas hospital; Duncan’s temperature and blood pressure have normalized, though he remains on a ventilator and is still receiving kidney dialysis. MORE
OCT. 8, 2014
Centers for Disease Control and Prevention officials promise additional measures to screen airline passengers arriving in United States for Ebola virus; remain opposed to draconian travel restrictions such as outright bans, saying that they would cause more problems than they would solve. MORE
OCT. 7, 2014
Nurse in Spain becomes first health worker to be infected with Ebola virus outside West Africa, raising serious concerns about how prepared Western nations are to safely treat people with the deadly illness; nurse contracted the illness while treating a Spanish missionary who was infected in Sierra Leone and flown to Madrid, where he died; infection exposes weak spots in Spain’s highly praised health care defense systems. MORE
OCT. 7, 2014
Adel Faqih, Saudi Arabia’s acting health minister, says this year’s hajj has been free of Ebola and other contagious diseases like Middle East Respiratory Syndrome because of measures taken to protect more than two million Muslim pilgrims. MORE
OCT. 7, 2014
Pres Obama says screening for Ebola virus at airports both in the United States and West Africa will increase, but does not offer specifics; Dallas residents remain on edge as they await to learn if those who came into contact with Ebola patient Thomas Eric Duncan became infected. MORE
Story 1: Stop The Ebola Illegal Alien Invasion/Pandemic — Secure The U.S./Mexican Border — Videos
USA Invaded by Central America….
RED ALERT: TOP GENERAL WARNS EBOLA WILL NOT STAY IN WEST AFRICA!!!!
Why Do Viruses Kill
MicroKillers: Super Flu
The Influenza Pandemic of 1918
We Heard the Bells: The Influenza of 1918 (full documentary)
In 1918-1919, the worst flu in recorded history killed an estimated 50 million people worldwide. The U.S. death toll was 675,000 – five times the number of U.S. soldiers killed in World War I. Where did the 1918 flu come from? Why was it so lethal? What did we learn?
After Armageddon (when deadly virus strikes)
SOMETHING ‘NEVER SEEN BEFORE’ IS COMING TO AMERICA (GLOBAL PANDEMIC)
Video: Ebola patient escapes quarantine, spreads panic in Monrovia (Liberia)
Judge Jeanine Pirro – Hidden Danger? – Could Illegal Immigrant Kids Bring Diseases To U.S.?
Obama Triggers a Massive Surge of Illegal Immigrant Children(90,000!)
Reporters Confront U.S. Border Patrol Over Illegal Immigration Stand-Down
Pestilence : Illegal Aliens bringing serious diseases across the U.S. Border (Aug 01, 2014)
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immigrants bring in serious, contagious diseases
PJTV – Illegal Immigrants Being Illegally Dumped in Arizona…Illegally
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.
Oliver Cromwell
What Happens When You Are Infected With The Ebola Virus? Common Cold,Bleeding Out The Ears And Eyes
Ebola Outrage as Outbreak Officially Begins In U.S.
Dallas Dog Raises Questions About Animals And Ebola
Ebola: The Undocumented Pandemic
#Ebola outbreak: Texas nurse tests positive & Suspected Case in Boston
CDC investigating Ebola protocol, as second U.S. patient confirmed
SouthCom Issues Stark Ebola Warning: “Katie Bar the Door”
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.’
US Army: Ebola like FLU needs Winter Weather to go AIRBORNE
CDC Warns On AIRBORNE EBOLA
Max Alert! EBOLA Bodily Fluids Readily Airborne Weaponizable
Second CONFIRMED Case Of Ebola In The U.S. Texas hospital worker tests positive for Ebola
Pestilence : Health Care worker at Dallas Texas Hospital tests positive for Ebola (Oct 12, 2014)
Ebola Health care worker tests positive at Texas hospital
Pestilence : Press Conference of Second Confirmed Diagnosed Case in Texas (Oct 12, 2014)
Ebola – The Truth About the Outbreak (Documentary)
What Pisses Me Off About Ebola
Science Today: Virus Mutation | California Academy of Sciences
Antigenic Shift
Influenza: Get the (Antigenic) Drift
Flu Shift and Drift
Virus Basics
Introduction to Viruses and Viral Replication
Antigenic Shift – the Spread of a New, Mutated Virus
Ebola: The world’s most dangerous Virus (full documentary)
Texas nurse fighting Ebola receives blood transfusion from survivor Dr Kent Brantly – who also matched blood types with two others struck by the deadly virus in the U.S.
Nina Pham, 26, has received blood transfusion from Dr Kent Brantly
Survivor Brantly also donated to Dr Nick Sacra and NBC’s Ashoka Mukpo
Antibodies in his blood could help the patients fight the disease
Pham caught the Ebola virus while treating Thomas Eric Duncan in Dallas
Second person who some identified as Miss Pham’s boyfriend is being monitored for symptoms
Miss Pham raised in Vietnamese family in Fort Worth and graduated from Texas Christian University in 2010 with Bachelor of Science in Nursing
HazChem teams spent the weekend fumigating her Dallas apartment
Authorities have blamed a ‘breach of protocol’ – but nursing leaders have criticized the CDC for making her a scapegoat
About 70 staff members at Texas hospital were involved in the care of first Ebola patient Thomas Eric Duncan after he was hospitalized
By NICK FAGGE IN DALLAS, TEXAS FOR MAILONLINE and MIA DE GRAAF FOR MAILONLINE
The Texan nurse diagnosed with Ebola has received a blood transfusion from survivor Dr Kent Brantly.
It is the third time Dr Brantly has donated blood to an Ebola victim after medics discovered he had the same blood type as previous patient Dr Nick Sacra and NBC cameraman Ashoka Mukpo, who is still being treated.
Incredibly, nurse Nina Pham, 26, has also matched with Dr Brantly and on Monday received a transfusion of his blood in a move that doctors believe could save her life.
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.
Cured: Dr Nick Sacra was cleared of Ebola after receiving a blood transfusion from Dr Kent Brantly
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
+10
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.’
Hazard: Protect Environmental workers move disposal barrels to a staging area outside the Dallas apartment of Miss Pham
Clean up: A man in full hazmat clothing walks in front of Pham’s home after disinfecting the front porch
Compassion: Tom Ha, who taught Miss Pham bible class said: ‘I expect, with the big heart she has, she went beyond what she was supposed to do to help anyone in need’
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”
- Friend of Miss Pham
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.
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.”
A Texas Health Presbyterian Hospital health care worker in Dallas who had “extensive contact” with the first Ebola patient to die in the United States has contracted the disease.
The Centers for Disease Control and Prevention in Atlanta confirmed the news Sunday afternoon after an official test.
The infected person detected a fever Friday night and drove herself to the Presbyterian emergency room, where she was placed in isolation 90 minutes later. A blood sample sent to the state health lab in Austin confirmed Saturday night that she had Ebola — the first person to contract the disease in the United States.
The director for the Centers for Disease Control and Prevention said Sunday that the infection in the health care worker, who was not on the organization’s watch list for people who had contact with Ebola patient Thomas Eric Duncan, resulted from a “breach in protocol.”
“We have spoken with the health care worker,” who cannot “identify the specific breach” that allowed the infection to spread, said CDC director Dr. Tom Frieden. The CDC has sent additional staff members to Dallas to “assist with the response,” he said.
Frieden said exposure can result from a “single inadvertent slip.” He cautioned: “Unfortunately it is possible in the coming days we will see additional cases of Ebola” in health care workers.
Texas health commissioner David Lakey said the health care worker had “extensive contact” with Duncan. The nurse, who missed two days of work before going to the emergency room, is believed to have had contact with one person while symptomatic. Ebola, which is spread through direct contact with bodily fluids of a sick person, can only be transmitted from infected people showing symptoms.
“We have been preparing for an event like this,” Lakey said.
Presbyterian chief clinical officer Daniel Varga said the exposure occurred during Duncan’s second visit to the hospital. Duncan, the first person to die of Ebola in the United States, went to the Presbyterian emergency room Sept. 25 and was sent home with antibiotics only to return to the hospital on Sept. 28. He was diagnosed with Ebola and died Oct. 8.
It is not clear how the health care provider contracted Ebola. According to Duncan’s patient records released by the family to The Associated Press, this is what happened at Presbyterian:
— On Sept. 28, an ambulance with Duncan arrived at the hospital’s emergency bay shortly after 10 a.m.
— Doctors performed tests on Duncan, who told them he had recently arrived from Africa, and determined he had sinusitis.
— Now in isolation, Duncan was projectile vomiting, having explosive diarrhea and his temperature was 103.1 degrees.
— On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper.
— On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.
Varga at Presbyterian said the worker was wearing protective gear, including a gown, glove, mask and shield, when she came into contact with Duncan. “This individual was following full CDC precautions,” Varga said
Officials haven’t released the name of the health care worker or her job description. Dallas County Judge Clay Jenkins said he has spoken to the health care worker’s parents, who have asked for privacy.
“Let’s remember that this is a real person who is going through a great ordeal. So is that person’s family,” Jenkins said.
The second Ebola patient lives in the 5700 block of Marquita Avenue in East Dallas, where the person’s apartment was going to be decontaminated Sunday. While the CDC didn’t consider the person to be at “high risk” of contracting Ebola, the health care worker had been monitoring for signs of the disease, including checking for fever twice daily.
The person’s car was decontaminated and the common area of an apartment complex was going to be cleaned by a hazardous-material team Sunday.
A crew of 15 people from the Cleaning Guys was going to decontaminate the person’s apartment Sunday afternoon, said company owner Erick McCallum. “Our main objective is for this to go away and to be eradicated,” he said.
Staff writers Melissa Repko, Sherry Jacobson, Claire Cardona, Eva-Marie Ayala and Matthew Haag contributed to this report.
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Update at 2:59 p.m.
Brad Smith, Vice President of CG Environmental-Cleaning Guys, a hazardous material company, was hired to clean the apartment unit of the ill health care worker.
He said the hazmat crew will begin cleaning in the next hour or two. They are not sure how long it will take. The crew will include up to 15 people.
He said he’s not concerned about the safety of the crew. He heard the health care worker contracted Ebola after “there was something that went wrong in her PPE” or “personal protective equipment.”
“I’m not sure how it happened,” he said. “But we will not let that happen to our guys.”Smith said the company was hoping not to get any more calls about an Ebola case.
“I was speechless. I don’t know what my thoughts were,” he said. “I just knew we had to react and gear up and do it again.”
Smith said the crew plans to clean the exterior today and clean the interior tomorrow. It will be similar to the cleanup of the apartment where Thomas Eric Duncan stayed.
“We won’t do anything different,” he said. “We think the last time we went out we were successful in cleaning it up. We will continue to so the same thing.”
Update at 12:21 p.m.
At the end of Marquita, morning services were underway at Skillman Church of Christ. The congregation first became aware of the deadly disease when medical missionary Dr. Kent Brantly, who many congregants know, contracted the illness.
Then many became close to the son of Thomas Eric Duncan, who died of the disease. Now pastor Joel Sanchez was telling the church that a healthcare worker just a few blocks away has Ebola.
“As much as we are connected to the world, it’s easy to see something on the television and think of it as happening over yonder, over there,” he said. “But when it hits close to home, it becomes real.”
The congregation prayed for the healthcare worker who Sanchez said put another in front of herself because he had a need. They prayed for the family of Duncan. But then Sanchez asked his congregation not to forget the thousands suffering in West Africa, an area with limited medical resources where nearly 4,000 people have died from Ebola.
“We can’t forget those people whose only course of action is to pray that they don’t get it,” Sanchez said.
Dallas County Judge Clay Jenkins, Mayor Mike Rawlings and Dr. Daniel Varga held a news conference Sundaymorning to inform the public that a health care worker at Texas Health Presbyterian Hospital in Dallas test positive for the Ebola virus after coming in close contact with Ebola patient Thomas Eric Duncan.
Health care worker at Presbyterian Hospital in Dallas tests positive for Ebola
Louis DeLuca/Staff Photographer
Police guard the residence at 5700 block of Marquita, where reportedly a person diagnosed with Ebola lived, photographed in Dallas on Sunday, October 12, 2014. (Louis DeLuca/The Dallas Morning News)
A Texas Health Presbyterian Hospital health care worker in Dallas who had “extensive contact” with the first Ebola patient to die in the United States has contracted the disease
The infected person detected a fever Friday night and drove herself to the Presbyterian emergency room, where she was placed in isolation 90 minutes later. A blood sample sent to the state health lab in Austin confirmedSaturday night that she had Ebola — the first person to contract the disease in the United States.
The director for the Centers for Disease Control and Prevention said Sunday that the infection in the health care worker, who was not on the organization’s watch list for people who had contact with Ebola patient Thomas Eric Duncan, resulted from a “breach in protocol.”
“We have spoken with the health care worker,” who cannot “identify the specific breach” that allowed the infection to spread, said CDC director Dr. Tom Frieden. The CDC has sent additional staff members to Dallas to “assist with the response,” he said.
Frieden said exposure can result from a “single inadvertent slip.” He cautioned: “Unfortunately it is possible in the coming days we will see additional cases of Ebola” in health care workers.
Texas health commissioner David Lakey said the health care worker had “extensive contact” with Duncan. The nurse, who missed two days of work before going to the emergency room, is believed to have had contact with one person while symptomatic. Ebola, which is spread through direct contact with bodily fluids of a sick person, can only be transmitted from infected people showing symptoms.
“We have been preparing for an event like this,” Lakey said.
Presbyterian chief clinical officer Daniel Varga said the exposure occurred during Duncan’s second visit to the hospital. Duncan, the first person to die of Ebola in the United States, went to the Presbyterian emergency room Sept. 26 and was sent home with antibiotics only to return to the hospital on Sept. 28. He was diagnosed with Ebola and died Oct. 8
Officials haven’t released the name of the health care worker or her job description. Dallas County Judge Clay Jenkins said he has spoken to the health care worker’s parents, who have asked for privacy.
“Let’s remember that this is a real person who is going through a great ordeal. So is that person’s family,” Jenkins said.
The second Ebola patient lives in the 5700 block of Marquita Avenue in East Dallas, where the person’s apartment was decontaminated Sunday. While the CDC didn’t consider the person to be at “high risk” of contracting Ebola, the health care worker had been monitoring for signs of the disease, including checking for fever twice daily.
The person’s car was decontaminated and the common area of an apartment complex was cleaned by a hazardous-material team Sunday. A pet also lived in the person’s apartment.
Dallas police have cordoned off the East Dallas apartment, where a frenzy of news media and helicopters circling above have drawn neighbors outside. Police officers and a CDC representative talked to residents Sundaymorning and distributing papers about Ebola symptoms. Dallas Mayor Mike Rawlings also visited with residents.
“It just breaks my heart. … She was just an innocent woman who took care of someone who was sick,” said neighbor Colleen Watson said. “She did her job, and probably with full empathy and kindness, and for this to happen to her is so much sadder than any other case.”
Dina Smith was holding her 3-year-old daughter, still in disbelief that the first contracted case was just a block away. She said Mayor Mike Rawlings and staff members from the mayor’s office visited Sunday morning and talked to residents.
“I’m not particularly concerned because from everything I heard, she was a nurse and took every precaution,” Smith said. “But you hear the helicopters overhead and see the news, and it makes you pay more attention.”
Lindsey Carpenter, 33, said her roommate had searched on the Internet to find out why news helicopters were flying over their neighborhood. He barged into her room at 9:30 a.m. when he found an answer: “There’s an Ebola patient in the neighborhood.”
Carpenter, who works in a hospital in Lewisville, said she hopes Presbyterian investigates how the nurse contracted Ebola — especially because she was exposed to Duncan during his second visit to the hospital.
“They were prepared with hazmat suits and everything,” she said. “I wonder how she got it. It’s really puzzling. There’s probably more to the story that we don’t know.”
Texas Health says “the Emergency Department at Texas Health Dallas is diverting ambulance traffic with the exception of patients showing symptoms of Ebola Virus Disease. The ED is open and seeing patients arriving by any other means.”
Staff writers Melissa Repko, Sherry Jacobson, Claire Cardona, Eva-Marie Ayala and Matthew Haag contributed to this report.
Update at 12:21 p.m.
At the end of Marquita, morning services were underway at Skillman Church of Christ. The congregation first became aware of the deadly disease when medical missionary Dr. Kent Brantly, who many congregants know, contracted the illness.
Then many became close to the son of Thomas Eric Duncan, who died of the disease. Now pastor Joel Sanchez was telling the church that a healthcare worker just a few blocks away has Ebola.
“As much as we are connected to the world, it’s easy to see something on the television and think of it as happening over yonder, over there,” he said. “But when it hits close to home, it becomes real.”
The congregation prayed for the healthcare worker who Sanchez said put another in front of herself because he had a need. They prayed for the family of Duncan. But then Sanchez asked his congregation not to forget the thousands suffering in West Africa, an area with limited medical resources where nearly 4,000 people have died from Ebola.
“We can’t forget those people whose only course of action is to pray that they don’t get it,” Sanchez said.
WATCH: Dallas mayor, hospital doctors give details on Ebola patient No. 2
Dallas County Judge Clay Jenkins, Mayor Mike Rawlings and Dr. Daniel Varga held a news conference Sundaymorning to inform the public that a health care worker at Texas Health Presbyterian Hospital in Dallas test positive for the Ebola virus after coming in close contact with Ebola patient Thomas Eric Duncan.
The cafeteria, where employees and patients at Texas Health Presbyterian Hospital normally take a meal break, is looking more like a ghost town since the outbreak of Ebola. A cafeteria worker said their business had taken a major hit in the wake of Nina Pham’s becoming symptomatic after treating Thomas Eric Duncan while he was ill at this hospital.
Breitbart Texas visited Texas Health Presbyterian Hospital on Monday to check out the mood of workers in the hospital. While visiting the various café’s throughout the hospital, there was a severe shortage of customers. A worker in “Café Presby” said their business is down by 25 percent over the past two weeks.
“I am concerned for our workers,” the employee said. “I hope we don’t have to lay anyone off or cut their hours because of this.”
A nurse who spoke with Breitbart Texas said they are very concerned for Nina Pham. “We aren’t as concerned for ourselves as we are for her. Exposure is one of the risks that comes with our job. We take all the precautions we can but there is always a risk of exposure.”
Another nurse who works for a different hospital but was visiting Texas Health Presbyterian said Nina Pham is a friend of one of her friends. “We are all praying for Nina,” she said. “She is a very sweet and caring nurse. We know she is strong and will recover from this.”
Breitbart Texas spoke with a doctor in the hospital about employee morale. “We are doing fine,” the doctor said. “The real enemy here is the media.” He expressed concern about some outlets sensationalized coverage of the Texas Ebola cases.
While exiting the hospital’s parking lot, the parking toll attendant wore protective gloves while handling the cash handed to her by people leaving the hospital.\
The World Health Organization called the Ebola outbreak “the most severe, acute health emergency seen in modern times” on Monday but also said that economic disruptions can be curbed if people are adequately informed to prevent irrational moves to dodge infection.
WHO Director-General Margaret Chan, citing World Bank figures, said 90 percent of economic costs of any outbreak “come from irrational and disorganized efforts of the public to avoid infection.”
Staffers of the global health organization “are very well aware that fear of infection has spread around the world much faster than the virus,” Chan said in a statement read out to a regional health conference in the Philippine capital, Manila.
“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.
The Ebola epidemic has killed more than 4,000 people, mostly in the West African countries of Liberia, Sierra Leone and Guinea, according to WHO figures published last week.
Chan did not specify those steps but praised the Philippines for holding an anti-Ebola summit last week which was joined by government health officials and private sector representatives, warning that the Southeast Asian country was vulnerable due to the large number of Filipinos working abroad.
While bracing for Ebola, health officials should continue to focus on major health threats, including non-communicable diseases, she said.
Philippine Health Secretary Enrique Ona said authorities will ask more than 1,700 Filipinos working in Liberia, Sierra Leone and Guinea to observe themselves for at least 21 days for Ebola symptoms in those countries first if they plan to return home.
Once home, they should observe themselves for another 21 days and then report the result of their self-screening to health authorities to be doubly sure they have not been infected, he said, adding that hospitals which would deal with any Ebola patients have already been identified in the Philippines.
Last month, U.N. Secretary-General Ban Ki-moon urged leaders in the most affected countries to establish special centers that aim to isolate infected people from non-infected relatives in an effort to stem the spread of Ebola.
Ban has also appealed for airlines and shipping companies not to suspend services to countries affected by Ebola. Doing so, he said, hinders delivery of humanitarian and medical assistance.
As Thomas Eric Duncan’s family mourns the USA’s first Ebola death in Dallas, one question reverberates over a series of apparent missteps in the case: Who is in charge of the response to Ebola?
The answer seems to be — there really isn’t one person or agency. There is not a single national response.
The Atlanta-based Centers for Disease Control and Prevention has emerged as the standard-bearer — and sometimes the scapegoat — on Ebola.
Public health is the purview of the states, and as the nation anticipates more Ebola cases, some experts say the way the United States handles public health is not up to the challenge.
“One of the things we have to understand is the federal, state and local public health relationships,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Public health is inherently a state issue. The state really is in charge of public health at the state and local level. It’s a constitutional issue. The CDC can’t just walk in on these cases. They have to be invited in.”
USA TODAY
Texas health care worker tests positive for Ebola
The CDC deployed a team of 10 — three senior epidemiologists, a communication officer, a public health adviser and five epidemic intelligence officers, or “disease detectives” — to Dallas on the night of Sept. 30, hours after the agency announced that Duncan, a Liberian national who traveled to Dallas, had the Ebola virus. The next afternoon, Dallas County Judge Clay Jenkins, head of the Dallas County Office of Homeland Security and Emergency Management; CDC director Tom Frieden; and David Lakey, commissioner of the Texas Department of State Health Services, agreed during a conference call to set up an Emergency Operations Center in Dallas County with Jenkins in charge.
The EOC was staffed by officials from Dallas County, the city of Dallas, the CDC, the county and state health departments and the Dallas County Sheriff’s Department, among others.
This was the team that made decisions on matters such as isolating people who had been in direct contact with Duncan, including his fiancée, Louise Troh, her teenage son and two other male relatives. Because they were not sick, they couldn’t technically be quarantined, Jenkins said Friday. Instead, Lakey issued a “control order” to keep them at home, where they could be monitored for signs of Ebola. Jenkins and Texas Gov. Rick Perry agreed to the order.
Texas officials were criticized for keeping the family inside the apartment where Duncan first showed signs of the disease, potentially exposing them to the virus. The family worried about Duncan’s soiled sheets and other waste in the apartment. The response team located a private home where the family could move and got permits to clean the apartment and truck 140 55-gallon barrels of waste to an incinerator 400 miles away.
Jenkins says he has a working model for how to respond to Ebola cases. Others aren’t so confident.
“In Texas, they really were slow to the plate,” said Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine. “Texas is going to be the example of what not to do.”
Duncan, who arrived in Dallas on Sept. 20, somehow slipped through a Liberian airport screening process that allowed him into the country. He became ill several days later and went to the emergency room at Texas Health Presbyterian hospital Sept. 25; he was prescribed antibiotics, told to take Tylenol and sent home early on the morning of Sept. 26..
According to medical records provided to the Associated Press by Duncan’s family, his temperature spiked at 103 degrees during that visit. Duncan told a nurse that he had recently been in Africa, and he showed symptoms that can indicate Ebola: fever, sharp headache and abdominal pain. He was given a battery of tests and sent to his sister’s apartment with antibiotics. He returned by ambulance Sept. 28, was admitted to the hospital and placed in isolation. On Sept. 30, the CDC confirmed that he had Ebola.
In a statement Friday, the hospital said it had made procedural changes and continues to “review and evaluate” decisions surrounding Duncan’s case.
Murphy says some of the issues in Texas stem from a “system problem” in the way public health care is managed in the USA. The Centers for Disease Control provides only guidance for infection prevention and management. “What they do in Texas, what they do in Illinois, it’s up to the state,” he says.
“The question is, who’s in charge?” Murphy says. “The states can follow all the guidelines and take the advice, which they usually do, but they don’t have to. It’s not a legal requirement. So there really is no one entity that’s controlling things.”
Though the CDC is tasked with readying the nation for an Ebola outbreak, then leading the national response, the Department of Homeland Security is responsible for protecting the borders, according to Thomas Skinner, a spokesman for the CDC, which is under the auspices of the Department of Health and Human Services.
The CDC collaborates with health departments and laboratories around the USA to make sure they are able to test for Ebola and respond rapidly if there is a case in their state, CDC spokeswoman Kirsten Nordlund said.
The agency is working to educate U.S. health care workers on how to isolate patients and protect themselves from infection; it developed a Web-based document that identifies rapidly emerging CDC guidelines for Ebola applicable to public health preparedness national standards for state and local planning.
The agency developed an introductory training course for licensed clinicians who intend to work in Ebola treatment units in Africa, and at any given time, it has 300-500 people working at CDC headquarters to support its Ebola response, Nordlund said.
Homeland Security “is focused on protecting the air traveling public and is taking steps to ensure that passengers with communicable diseases like Ebola are screened, isolated and quickly and safely referred to medical personnel,” deputy secretary Alejandro Mayorkas said Thursday.
That includes issuing “do not board” orders to airlines if the CDC and State Department determine a passenger is a risk to the traveling public; providing information and guidance about Ebola to the airlines; posting notices at airports to raise awareness about Ebola; and providing a health notice called a care sheet to travelers entering the USA that have traveled from or through affected countries.
In addition, Health and Human Services has the authority to suspend the entry of persons into the USA based on outbreaks of disease in other countries and when necessary to protect public health.
Screening started Saturday at New York’s John F. Kennedy airport. Medical workers will take the temperature of airline passengers originating from Guinea, Liberia and Sierra Leone, and Customs and Border Protection staffers will ask questions about their health and possible exposure to Ebola. Those suspected of possible Ebola exposure will be referred to a CDC public health officer for additional screening.
The testing will expand in the next few days to four more airports: Washington Dulles, Newark, Chicago’s O’Hare and Atlanta’s Hartsfield-Jackson airports.
Osterholm and Murphy say the nation’s public health system leaves room for a broad array of Ebola responses from state to state.
“We have to have more clarity,” Osterholm says. “We have to have a level of excellence. If that means putting the CDC in charge of these departments of public health, that means we have to find a way to do that. We can have agreements (between the states and the CDC). … We can’t leave it up to the whims of the state to do it right or not do it right.”
He acknowledges that no one has called for such a change.
“Not yet,” he says. “But we need it, though. Texas was an example of how not to do it.”
Contributing: Rick Jervis in Dallas, Gregory Korte
W.H.O. contradicts CDC, admits Ebola can spread via coughing, sneezing and by touching contaminated surfaces
The World Health Organization has issued a bulletin which confirms what Natural News has been asserting for weeks: that Ebola can spread via indirect contact with contaminated surfaces and aerosolized droplets produced from coughing or sneezing.
“…wet and bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits violently, could transmit the virus — over a short distance — to another nearby person,” says a W.H.O. bulletin released this week. [1] “This could happen when virus-laden heavy droplets are directly propelled, by coughing or sneezing…”
That same bulletin also says, “The Ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects.”
In other words, the WHO just confirmed what the CDC says is impossible — that Ebola can be acquired by touching a contaminated surface.
CDC remains in total denial, spreading dangerous disinformation about Ebola transmission vectors
This information published by the WHO directly contradicts the ridiculous claims of the CDC which continues to insist Ebola cannot spread through “indirect” means.
According to the CDC, Ebola can only spread via “direct contact,” but the CDC is basing this assumption on the behavior of the Ebola outbreak from 1976 — nearly four decades ago.
The CDC, in fact, continues to push five deadly assumptions about Ebola, endangering the lives of Americans in the process by failing to communicate accurate safety information to health professionals and the public.
Because of the CDC’s lackadaisical attitude about Ebola transmission, the Dallas Ebola outbreak may have been made far worse by people walking in and out of the Ebola-contaminated Duncan apartment while wearing no protective gear whatsoever.
Because the CDC sets the standards for dealing with infectious disease in the United States, when the CDC claims Ebola can only spread via “direct contact,” that causes emergency responders, Red Cross volunteers and even family members to conclude, “Then we don’t even need to wear latex gloves as long as we’re not touching the patient!”
Not “airborne” but can spread through the air
Both the CDC and the WHO continue to aggressively insist that Ebola is not an “airborne” disease. “Ebola virus disease is not an airborne infection,” says the WHO bulletin. But that same bulletin describes the ability of Ebola to spread through the air via aerosolized droplets.
The medical definition of “airborne,” it turns out, is a specific, narrow definition that defies the common understanding of the term. To most people, “airborne” means it can spread through the air, and Ebola most certainly can spread through the air when it is attached to aerosolized particles of spit, saliva, mucus, blood or other body fluids.
The CDC has now admitted there is a slight possibility of Ebola mutating to become “airborne” but says that chance is very small. [2] However, all honest virologists agree that the longer Ebola remains in circulation in West Africa, replicating among human hosts, the more chances it has to mutate into an airborne strain.
But the virus doesn’t need to mutate to continue to spread. It has already proven quite capable of spreading via indirect contact in a way that all the governments of the world have been utterly unable to stop. Despite the best efforts of the CDC and WHO, Ebola continues to replicate out of control across West African nations. Even in the United States, the Dallas “patient zero” incident has reportedly caused 100 people to be monitored for possible Ebola infections.
This is why government claims that “we have this under control” are just as much hogwash as the claim that Ebola can only spread via “direct contact.”
But that seems to be the default response of government to all legitimate threats: first, deny reality and misinform the public. Keep people in the dark and maybe the whole thing can be swept under the rug… at least until the mid-term elections.
When the experts describe the Ebola disaster, they do so with numbers. The statistics include not just the obvious ones, such as caseloads, deaths and the rate of infection, but also the ones that describe the speed of the global response.
Right now, the math still favors the virus.
Global health officials are looking closely at the “reproduction number,” which estimates how many people, on average, will catch the virus from each person stricken with Ebola. The epidemic will begin to decline when that number falls below one. A recent analysis estimated the number at 1.5 to 2.
The number of Ebola cases in West Africa has been doubling about every three weeks. There is little evidence so far that the epidemic is losing momentum.
“The speed at which things are moving on the ground, it’s hard for people to get their minds around. People don’t understand the concept of exponential growth,” said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention. “Exponential growth in the context of three weeks means: ‘If I know that X needs to be done, and I work my butt off and get it done in three weeks, it’s now half as good as it needs to be.’ ”
Frieden warned Thursday that without immediate, concerted, bold action, the Ebola virus could become a global calamity on the scale of HIV. He spoke at a gathering of global health officials and government leaders at the World Bank headquarters in Washington. The president of Guinea was at the table, and the presidents of Liberia and Sierra Leone joined by video link. Amid much bureaucratic talk and table-thumping was an emerging theme: The virus is still outpacing the efforts to contain it.
“The situation is worse than it was 12 days ago. It’s entrenched in the capitals. Seventy percent of the people [who become infected] are definitely dying from this disease, and it is accelerating in almost all settings,” Bruce Aylward, assistant director general of the World Health Organization, told the group.
Aylward had come from West Africa only hours earlier. He offered three numbers: 70, 70 and 60. To bring the epidemic under control, officials should ensure that at least 70 percent of Ebola-victim burials are conducted safely, and that at least 70 percent of infected people are in treatment, within 60 days, he said.
More numbers came from Ernest Bai Koroma, president of Sierra Leone: The country desperately needs 750 doctors, 3,000 nurses, 1,500 hygienists, counselors and nutritionists.
The numbers in this crisis are notoriously squishy, however. Epidemiological data is sketchy at best. No one really knows exactly how big the epidemic is, in part because there are areas in Liberia, Sierra Leone and Guinea where disease detectives cannot venture because of safety concerns.
The current assumption is that for every four known Ebola cases, about six more go unreported.
The latest World Health Organization statistics, published Wednesday, show 8,033 cases of suspected or confirmed Ebola in the West Africa outbreak, with 3,865 deaths. That figure does not include Thomas Eric Duncan, a Liberian man who died Wednesday in Dallas.
How quickly Ebola spreads compared to other diseases VIEW GRAPHIC
“This has been a particularly difficult outbreak because of the difficulty getting a lot of data quickly out of the countries,” said Martin Meltzer, a CDC researcher who models epidemics. “My crystal ball is painted a deep black. It’s like tracking a hurricane.”
Meltzer helped produce a report in late September that said that at current rates of infection, as many as 1.4 million people would become infected by January. That number, officials stressed, was a straight extrapolation of the explosive spread of Ebola at a time when the world had managed to mount only a feeble response. The more vigorous response underway is designed to bend that curve.
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The U.S. military is building 17 treatment centers that can hold 100 people each, but the top military commander in Africa said Tuesday that they won’t be ready until mid-November. Liberia and Sierra Leone have a particularly keen need for more hospital beds. The two countries currently have 924 beds between them, but they need 4,078, according to the WHO.
“The virus is moving on virus time; we’re moving on bureaucracy or program time,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The virus is actually picking up the pace. Even as we add resources, we get farther behind.”
Aylward, the WHO official, pointed to some bright spots in the response in recent weeks. Liberia has gone from just six burial teams to 54. Officials are working with religious leaders to enable safe burials while respecting cultural traditions. “There’s a way to observe most of the ritual while keeping safe,” Aylward said in an interview.
But he said that overall, the countries in West Africa still lack a coordinated response.
“What is needed in every country is a list, an Excel spreadsheet. It’s not complicated. Here is every district, every county, here is burials and who is going to lead them, here is case finding and contact tracing, here is behavioral change,” Aylward said. In effect, the countries need better numbers.
The latest data from the WHO show hints of progress in bringing Ebola under control in certain rural areas stricken by the disease earlier this year. Seven provinces in Guinea that previously reported Ebola cases saw no new infections in the most recent three-week period covered in Wednesday’s WHO update. Two districts in Sierra Leone and one in Liberia showed a decline in infections.
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But experts caution against reading too much into small fluctuations that may simply reflect an increase or decrease in surveillance or a reappraisal of older data. This cautious attitude toward lower numbers particularly applies to a reported drop in new cases in Liberia in the past three weeks, which the WHO said is “unlikely to be genuine” and more likely reflects “a deterioration in the ability of overwhelmed responders to record accurate epidemiological data.”
Gerardo Chowell, a mathematical epidemiologist at Arizona State University, used data compiled through the end of August to estimate the reproduction number of 1.5 to 2 for this Ebola epidemic. Chowell said that even modest gains in lowering that number could give health officials and the military a better chance of controlling the epidemic.
“Maybe we can bring it from two to 1.2 or 1.3, which would indicate that the number of new cases will be dramatically reduced, and that will give you time,” he said.
Another key number: how many days elapse between the time symptoms occur (which is when a person becomes contagious) and when health officials diagnose the disease in that person. Driving that number down is critical to containing the virus.
The incubation period for Ebola is usually about a week to 10 days, although it can last as long as 21 days. That creates obvious challenges for health workers who have to do contact tracing — they have to repeatedly knock on doors and take the temperatures of people who weeks earlier were potentially exposed to the virus. But it also gives those same workers a decent interval of time to track down people who may be infected before they start shedding the virus and potentially spreading the disease.
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There are several scenarios for how this plays out. One is that the conventional methods of containing Ebola — isolating patients and doing contact tracing of people who might be exposed — lower the rate of new infections until finally the epidemic burns itself out. That has been the case in all previous outbreaks of Ebola, although no outbreak has ever been nearly as extensive as this one.
A second scenario is more dire: The conventional methods come too late, the epidemic keeps spreading, and the virus is beaten back only when vaccines can be developed and scaled up to the point where they can be widely distributed.
As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.
“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”
The UK is well set for an Ebola outbreak (sarcasm alert) We have TWO isolation units, but one is getting ‘redeveloped’ so it’s not available right now. Called High Security Infectious Diseases Units there are two in the country, each capable of taking two patients. One is at The Royal Free Hospital in Hampstead North London, the other, the one getting a bit of a make-over, is at The Royal Victoria Infirmary in Newcastle, up in the north-east of England.
Four level 4 bio-containment beds between 69,000,000 people
In the US there are 4 units geared up to handle Ebola. The National Institutes of Health (NIH) Clinical Center, Bethesda, Maryland, has 3 beds. Nebraska Medical Center, Omaha, has 10 beds. Emory Hospital, Atlanta has 3 beds and St Patricks Hospital, Missoula has 3 beds (source)
19 level four biocontainment beds for 317,000,000 people
I think we just found out why the government(s) are under-playing the situation. They simply do not have the facilities to cope with even a small outbreak. They are, in fact in exactly the same position as the dirt-poor hospitals in West Africa…there are not enough facilities to stop the spread of the disease if it gets out. The quality of care is better, but the availability of containment most likely isn’t.
I am sure ‘regular’ isolation units will be pressed into use but they are not designed to handle level 4 biohazards, they are nowhere near as secure medically speaking, as biocontainment units.
A couple of days ago I explained how exponential spread works. You can read that article here if you like. As a quick recap. Once a disease is at the point where every carrier infects 2 more people,(exponential spread) it will continue until it:
A) runs out of hosts
B) is stopped by medical science or
C) mutates into something less harmful.
What follows will show you how woefully inadequately our governments have prepared for something as lethal as Ebola.
In the flu pandemic of 1918-1920 28% of Americans were infected with the disease…try to remember I am talking numbers here not HOW disease spreads or any medical similarities between diseases, 625,000 Americans lost their lives out of some 29,400,000 infections. The population of the United States at that time was 105,000,000 people. (source)
Fast forward to today. If that flu pandemic had hit the United States in 2014, when the population stands at 317,000,000 people 88,760,000 people would have been infected and 2,130,240 of them would have died.
Now, let’s try this with Ebola. I have picked Liberia just because it is in the news due to the Thomas Duncan case.
Liberia has a population of 4,290,000 people, as of the latest figures there have been 3692 cases of Ebola, this represents 0.0086% of the population.Of those infections, 1998 people have died that’s a fatality rate of 54%. (source)
If that same infection and death rate were applied to the United States Ebola would infect 269,000 people and of those 156,281 would die.
Now, if as doctors and scientists fear the basic reproduction rate rises to 2 in Liberia the numbers change very quickly. Using the mean average incubation time of 9 days it would take around 13 weeks for the entire population of Liberia to become infected. (10 doublings starting with 3692 = just under the population of Liberia. This multiplied by 9 days gives us 90 days which divided by 7 gives 12.85 weeks.) Of the 4,290,000 people infected 2,316,000 would lose their lives.
This is just Liberia, not the other affected countries in West Africa.
Translated to an equivalent outbreak in the United States, where the basic reproduction rate is also 2, the numbers are horrifying. Starting with patient zero it would take around 245 days, 35 weeks for every person in the United States to become infected. Of those 17,118,000 people would die. (27.17 doublings x 9 days = 245 days =35 weeks)
Please remember the figures for Liberia are pulled from the CDC website, the percentages are correct. The scenario for the United States was based on exactly the same parameters as for Liberia…a like for like comparison.
The CDC could be spending their time educating people, advising people to stock up, get ready for the possibility of staying in their homes. Self imposed isolation, or if need be state imposed isolation, that may last for an extended time period may become a reality. They’re not doing it though are they? They are sprouting figures and applying them to West Africa, and they can’t even get that right. They are saying that there could be 1.4 deaths in West Africa in a worst case scenario. When actually applying the figures they supplied with some simple mathematics we can see that 1.4 million deaths is a gross understatement.
Even a basic reproduction rate of 1.7, the latest figure for Liberia it will only take around 30 weeks to get to the same point as the above scenario, over 2,000,000 dead.
Don’t get me wrong, I am not saying that the UK government is any better, if anything they are worse, they don’t even try to do the maths. Most of them went to Eton (a very expensive school that churns out politicians) so it’s unlikely they would be capable of it even if they wanted to. You only have to look at our national finances to see they are no good at sums. They send out press briefings that there will be an emergency COBRA meeting, do you have any clue what that stands for? Let me enlighten you, Cabinet Office Briefing Room A. COBRA is not an emergency planning group, it’s an effing office.
Although I am loathed to say it, it’s time that our governments started worrying about the facilities at home rather than worrying about the facilities abroad. Stopping the disease in Africa does not mean we are out of the woods. There are so many unreported cases, people turned away from medica facilities in West Africa that nobody has the slightest idea how many cases of Ebola are actually out there. The porous borders of the region mean that people move around without the controls that are usually exercised in the west. There has to be a travel ban on non-US citizens entering the United States from these areas, the same applies from the UK.
Border control has to be improved in both countries if we have any hope of halting the spread of this terrible disease. The west is going to be the destination for anyone from Ebola hit areas that can afford to make their way from Africa. Many West Africans have contacts in the west who will help them get out, and shelter them when they arrive. As harsh as it seems this has to be stopped, it’s time for governments to put their own citizens first. Repatriation of your own is one thing, risking millions of lives at home because you won’t man up and prevent foreigners entering is quite another.
In February 2002, consultations between the National Institute of Allergy and Infectious Diseases (NIAID) and its Blue Ribbon Panel on Bioterrorism produced several recommendations for NIAID to better protect people from the threat of bioterrorism. Fulfilling some of those recommendations required more laboratory space for working with dangerous pathogens than was previously available in the United States. In September 2003 and September 2005, NIAID announced the recipients of grants partially funding the construction of two National Biocontainment Laboratories (NBLs) and thirteen Regional Biocontainment Laboratories (RBLs), increasing Biosafety Level-4 (BSL-4) and BSL-3 lab space nationwide.
The NBLs and RBLs are operated by the grant recipients, research institutions across the country. These labs support biodefense and emerging infectious diseases research as resources that provide lab space for basic research of dangerous pathogens and development of new vaccines and treatments. The NBLs are required to have BSL-4, BSL-3, and BSL-2 labs, animal facilities, insectary facilities, clinical facilities, and research support space. The RBLs are required to have BSL-3 and BSL-2 labs, animal facilities, and research support space. While fulfilling the need of researchers occupying the facility, the NBLs and RBLs can be used by other biodefense researchers within the region, particularly those within the Regional Centers of Excellence in Biodefense and Emerging Infectious Diseases. In addition, these labs are available to provide assistance to national, state, and local public health efforts during a biological attack.
The Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases (RCEs) are consortia of universities and research institutions that pursue research with the intentions of producing therapeutics, vaccines, and diagnostics for pathogens that could be used in a bioterrorist attack or could become more widespread. Activities within the RCEs include developing and conducting research programs, training new scientists in research activities, and developing and maintaining facilities and services supportive of activities of the RCEs and other regional biodefense investigators. The RCEs also develop effective treatments and treatment strategies from basic research findings and provide first-line responders with facilities and support during a biological attack.
The National Institute of Allergy and Infectious Diseases (NIAID) created the RCE program in response to a recommendation from meetings between the NIAID and its Blue Ribbon Panel on Bioterrorism in February 2002. By June 2005, NIAID had established a total of ten RCEs in ten geographical regions across the country. Each RCE is composed of the investigators from the lead institution that submitted the application and collaborating investigators at universities and research institutions within the consortium. The consortia have access to resources such as facilities and services within the RCE and the National Biocontainment Laboratories and the Regional Biocontainment Laboratories.
Regional Centers of Excellence for Biodefense and Emerging Infectious Diseases
This map displays major Biosafety Level 4 (BSL-4) facilities around the world according to data collected by FAS in 2010 and 2011. These high-containment facilities are used to conduct beneficial research on dangerous and emerging pathogens.
Required for work with dangerous and exotic agents which pose a high individual risk of life-threatening disease. The facility is either in a separate building or in a controlled area within a building, which is completely isolated from all other areas of the building. Walls, floors, and ceilings of the facility are constructed to form a sealed internal shell which facilitates fumigation and is animal and insect proof. A dedicated non-recirculating ventilation system is provided. The supply and exhaust components of the system are balanced to assure directional airflow from the area of least hazard to the area(s) of greatest potential hazard. Within work areas of the facility, all activities are confined to Class III biological safety cabinets, or Class II biological safety cabinets used with one-piece positive pressure personnel suits ventilated by a life support system. The Biosafety Level 4 laboratory has special engineering and design features to prevent microorganisms from being disseminated into the environment. Personnel enter and leave the facility only through the clothing change and shower rooms, and shower each time they leave the facility. Personal clothing is removed in the outer clothing change room and kept there. A specially designed suit area may be provided in the facility to provide personnel protection equivalent to that provided by Class III cabinets. The exhaust air from the suit area is filtered by two sets of HEPA filters installed in series. Supplies and materials needed in the facility are brought in by way of double-doored autoclave, fumigation chamber, or airlock, which is appropriately decontaminated between each use. Viruses assigned to Biosafety Level 4 include Crimean-Congo hemorrhagic fever, Ebola, Junin, Lassa fever, Machupo, Marburg, and tick-borne encephalitis virus complex (including Absettarov, Hanzalova, Hypr, Kumlinge, Kyasanur Forest disease, Omsk hemorrhagic fever, and Russian Spring-Summer encephalitis).
BSL-3, Biosafety Level 3
Applicable to clinical, diagnostic, teaching, and research or production facilities involving indigenous or exotic strains of agents which may cause serious or potentially lethal disease as a result of exposure by inhalation. All procedures involving the manipulation of infectious material are conducted within biological safety cabinets or other physical containment devices, or by personnel wearing appropriate personal protective clothing and equipment. The laboratory has special engineering and design features. A ducted exhaust air ventilation system is provided. This system creates directional airflow that draws air from “clean” areas toward “contaminated” areas. The High Efficiency Particulate Air (HEPA)-filtered exhaust air from Class II or Class III biological safety cabinets is discharged directly to outside or through the building exhaust system. The typical HEPA filter removes 99.97% of all particles that are 0.3 micron or larger in size, which means that all microbial agents will be trapped in the filter. Biosafety Level 3 practices, containment equipment, and facilities are recommended for manipulations of cultures or work involving production volumes or concentrations of cultures associated with most biological warfare agents.
BSL-2, Biosafety Level 2
Suitable for work involving agents of moderate potential hazard to personnel and the environment. Agents which may produce disease of varying degrees of severity from exposure by injection, ingestion, absorption, and inhalation, but which are contained by good laboratory techniques are included in this level. Biosafety Level 2 practices, containment equipment, and facilities are recommended for activities using clinical materials and diagnostic quantities of infectious cultures associated with most biological warfare agents.
BSL-1, Biosafety Level 1
Suitable for work involving well-characterized agents of no known or of minimal potential hazard to laboratory personnel and the environment. The laboratory is not necessarily separated from the general traffic patterns in the building. Work is generally conducted on open bench tops using standard microbiological practices. Special containment equipment is not required or generally used. This is the type of laboratory found in municipal water- ing laboratories, in high schools, and in some community colleges.
Biosafety Level Information
For more information about BSL facilities in the United States and worldwide, please see the links below.
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.
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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.
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“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.”
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!
A 1976 photograph of two nurses standing in front of Mayinga N., a person with Ebola virus disease; she died only a few days later due to severe internal hemorrhaging.
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.[1]
The virus may be acquired upon contact with blood or bodily fluids of an infected human or other animal.[1] Spreading through the air has not been documented in the natural environment.[2]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.[1]
Outbreak control require community engagement, case management, surveillance and contact tracing, a good laboratory service, and safe burials.[1] 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.[1]
No specific treatment for the disease is yet available.[1] 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.[1] This supportive care improves outcomes.[1] The disease has a high risk of death, killing between 50% and 90% of those infected with the virus.[1][3] 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.[1] From 1976 (when it was first identified) through 2013, the World Health Organization reported a total of 1,716 cases.[1][4] The largest outbreak to date is the ongoing 2014 West African Ebola outbreak, which is affecting Guinea, Sierra Leone, Liberia, and Nigeria.[5][6] As of 28 September 2014, 7,157 suspected cases resulting in the deaths of 3,330 have been reported.[7] Efforts are under way to develop a vaccine; however, none yet exists.[1]
Signs and symptoms of Ebola usually begin suddenly with an influenza-like stage characterized by fatigue, fever, headaches, joint, muscle, and abdominal pain.[9][10] Vomiting, diarrhea, and loss of appetite are also common.[10]Less common symptoms include the following: sore throat, chest pain, hiccups, shortness of breath, and trouble swallowing.[10] 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.[10][11] Skin manifestations may include a maculopapular rash (in about 50% of cases).[12] 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.[9]
Heavy bleeding is rare and is usually confined to the gastrointestinal tract.[12][15] In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death.[9] All people infected show some signs of circulatory system involvement, including impaired blood clotting.[12] 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.[14]
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.[16] 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.
Transmission
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.[17] 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.[18] 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.[17] The symptoms limit a person’s ability to spread the disease as they are often too sick to travel.[19] 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.[20][21] Semen may be infectious in survivors for up to 7 weeks.[1] It is not entirely clear how an outbreak is initially started.[22] 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.[23] Medical workers who do not wear appropriate protective clothing may contract the disease.[24]Hospital-acquired transmission has occurred in African countries due to the reuse of needles and lack of universal precautions.[25][26] Some healthcare centers caring for people with the disease do not have running water.[27]
Airborne transmission has not been documented during EVD outbreaks.[2] They are, however, infectious as breathable 0.8– to 1.2-μm laboratory-generated droplets.[28] 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.[29]
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.[30]
Reservoir
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.[31]
Bats are considered the most likely natural reservoir of the EBOV. Plants, arthropods, and birds were also considered.[1][32] 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.[33] Of 24 plant species and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected.[34] 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.[35] 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.[36][37] 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.[38]
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.[33][39] 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.[33]
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.[40] Fruit bats are also eaten by people in parts of West Africa where they are smoked, grilled or made into a spicy soup.[37][41]
Like all mononegaviruses, ebolavirions contain linear nonsegmented, single-strand, non-infectious RNAgenomes 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.[42] 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.[43] The genomes of the five different ebolaviruses (BDBV, EBOV, RESTV, SUDV, and TAFV) differ in sequence and the number and location of gene overlaps.
Structure
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.[43] 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.[44]
Replication
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.[45]
Pathophysiology
Pathogenesis schematic
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.[46]
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.[47]
Diagnosis
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.[48]
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.[49] 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.[44]
Phylogenetic tree comparing the Ebolavirus and Marburgvirus. Numbers indicate percent confidence of branches.
Classification
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.[50]
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.[51] However, paleoviruses (genomic fossils) of filoviruses (Filoviridae) found in mammals indicate that the family itself is at least tens of millions of years old.[52]Fossilized viruses that are closely related to ebolaviruses have been found in the genome of the Chinese hamster.[53]
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.[22] If a person with Ebola dies, direct contact with the body of the deceased patient should be avoided.[22]
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.[60] These include avoiding contact with infected people and regular hand washing using soap and water.[61] Traditional burial rituals, especially those requiring washing or embalming of bodies, should be discouraged or modified.[62][63] Social anthropologists may help find alternatives to traditional rules for burials.[64] Airline crews are instructed to isolate anyone who has symptoms resembling Ebola virus.[65]
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.[66][67]
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
Quarantine, also known as enforced isolation, is usually effective in decreasing spread.[68][69] Governments often quarantine areas where the disease is occurring or individuals who may be infected.[70] In the United States, the law allows quarantine of those infected with Ebola.[71] During the 2014 outbreak, Liberia closed schools.[72]
Contact tracing
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.[73][74]
Treatment
Standard support
A hospital isolation ward in Gulu, Uganda, during the October 2000 outbreak
Intensive care is often used in the developed world.[77] This may include maintaining blood volume and electrolytes (salts) balance as well as treating any bacterial infections that may develop.[77] Dialysis may be needed for kidney failure while extracorporeal membrane oxygenation may be used for lung dysfunction.[77]
Prognosis
The disease has a high mortality rate: often between 25 percent and 90 percent.[1][3] As of September 2014, information from WHO across all occurrences to date puts the overall fatality rate at 50%.[1] 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.[78] 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.[1]
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.[1] From 1976 (when it was first identified) through 2013, the World Health Organization reported 1,716 confirmed cases.[1][4] The largest outbreak to date is the ongoing 2014 West Africa Ebola virus outbreak, which is affecting Guinea, Sierra Leone, Liberia and Nigeria.[5][6] As of 13 August, 2,127 cases have been identified, with 1,145 deaths.[5]
1976
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).[79] 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.[80] Subsequently a number of other cases were reported, almost all centered on the Yambuku mission hospital or having close contact with another case.[80] 318 cases and 280 deaths (a 88% fatality rate) occurred in the DRC.[81] 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.[82]
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.[83] 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.[84]
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.[83][85][86] The 2007 outbreak eventually affected 264 individuals and resulted in the deaths of 187.[1]
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.[87] The WHO reported 149 cases of this new strain and 37 of those led to deaths.[1]
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.[1]
On 17 August 2012, the Ministry of Health of the Democratic Republic of the Congo reported an outbreak of the Ebola-Bundibugyo variant[88] in the eastern region.[89][90] 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.[1][91]
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.[92] Researchers traced the outbreak to a two-year old child who died on 28 December 2013.[93][94] 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.[92]
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.”[95] 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.[96] By late August 2014, the disease had spread to Nigeria, and one case was reported in Senegal.[97][98][99][100] On 30 September 2014, the first confirmed case of Ebola was diagnosed in the United States at Texas Health Presbyterian Hospital in Dallas, Texas.[101]
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.”[102]
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.[103] The WHO reports that more than 216 healthcare workers are among the dead, partly due to the lack of equipment and long hours.[104][105]
History
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).[106] Virus isolated from both outbreaks was named “Ebola virus” by Belgian researchers[107] after the Ebola River, located near the Zaire outbreak.[108] 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.[106]
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.[109] An electron microscopist from USAMRIID discoveredfiloviruses similar in appearance to Ebola in the tissue samples sent from Hazelton Research Products’ Reston Quarantine Unit.[110]
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.[109]
Blood samples were taken from 178 animal handlers during the incident.[111] Of those, six animal handlers eventually seroconverted, including one who had cut himself with a bloody scalpel.[46][112] When the handlers did not become ill, the CDC concluded that the virus had a very low pathogenicity to humans.[112]
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.[109]
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.[117]
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.[119]
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.[120]
Ebola has a high mortality among primates.[121] Frequent outbreaks of Ebola may have resulted in the deaths of 5,000 gorillas.[122] 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.[120] Transmission among chimpanzees through meat consumption constitutes a significant risk factor, while contact between individuals, such as touching dead bodies and grooming, is not.[123]
Domesticated animals
Reston ebolavirus (REBOV) can be transmitted to pigs.[124] 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,[70] where the virus had infected pigs.[125] Despite its status as a Level‑4organism and its apparent pathogenicity in monkeys, REBOV has not caused disease in exposed human laboratory workers.[126] 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.[124] 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.[82]
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.[127]
Research
A number of experimental treatments are being studied.[128] 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”.[129] 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.[130]
Medications
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.[131] 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.[132][133]
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.[138] ZMapp has proved effective in a trial involving Rhesus macaque monkeys.[139]
Antivirals
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.[9][140] On 4 October 2014, it was reported that a French nun who contracted Ebola while volunteering in Liberia was cured with Favipiravir treatment.[141]BCX4430 is a broad-spectrum antiviral drug developed by BioCryst Pharmaceuticals and currently being researched as a potential treatment for Ebola by USAMRIID.[142] The drug has been approved to progress to Phase 1 trials, expected late in 2014.[143]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.[144] It has subsequently been used to treat the first patient diagnosed with Ebola in the USA, after he had recently returned from Liberia.[145] 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.[146] 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.[147]
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.[152]
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.[153] 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.[154]
Blood products
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.[155] At the end of September, WHO issued an interim guideline for this therapy.[156] The blood serum from those who have survived an infection is currently being studied to see if it is an effective treatment.[157] During a meeting arranged by WHO this research was deemed to be a top priority.[157] 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.[76]
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Obama’s Cadillac Tax Crashes and Burns Killing Obamacare and Injuring MIT Professor Gruber — Rest In Peace — Obamacare Is Shovel Ready — Videos
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The Pronk Pops Show Podcasts
Pronk Pops Show 371: November 14, 2014
Pronk Pops Show 370: November 13, 2014
Pronk Pops Show 369: November 12, 2014
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Pronk Pops Show 366: November 7, 2014
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Pronk Pops Show 361: October 31, 2014
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Pronk Pops Show 356: October 24, 2014
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Pronk Pops Show 349: October 15, 2014
Pronk Pops Show 348: October 14, 2014
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Pronk Pops Show 315: August 18, 2014
Pronk Pops Show 314: August 15, 2014
Pronk Pops Show 313: August 14, 2014
Pronk Pops Show 312: August 13, 2014
Pronk Pops Show 311: August 11, 2014
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Story 1: Obama’s Cadillac Tax Crashes and Burns Killing Obamacare and Injuring MIT Professor Gruber — Rest In Peace — Obamacare Is Shovel Ready — Videos
ObamaCare a Trojan Horse for Single-Payer
Obama lies about “cadillac” plan taxation
36 Times Obama Said You Could Keep Your Health Care Plan | SuperCuts #18
ACA Architect Confession: Created Lies For Obama
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
What is the “cadillac tax?”
Obamacare’s Cadillac Tax Pushing People To Plans With High Deductible- Union You Got What You Wanted
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
The Five: Large Employers Cite ObamaCare “Cadillac” Tax In Reducing Benefits
SMOKING GUN! Gruber Admits Obama Was in Room During Planning of Cadillac Lie
GRUBER: “Lack of transparency is a huge political advantage.”
GRUBER; Deceive Americans Critical to Pass Obamacare-Calls us ‘Stupid Americans'; Part 1 of 3
Gruber Remarks Puts Obama Administration on Scramble; Part 2 of 3
Jonathan Gruber: States Which Do Not Set Up an Exchange Do Not Get Tax Subsidies
BookTV: Jonathan Gruber, “Health Care Reform: What It Is, Why It’s Necessary, How It Works”
Jonathan Gruber admits Obamacare is inherently unaffordable
Obamacare – Concerns “Cadillac Tax” Forcing Employers To Cut Back Health Plans
Krauthammer rips Jonathan Gruber: “We’re hearing the true voice of liberal arrogance”
Megyn Slams ObamaCare Architect Who Declined to Appear on ‘Kelly File’
Democrats Loved Jonathan Gruber Before They Forgot Who He Was
Sen. Harry Reid, 2009: Gruber Is One Of The ‘Most Respected Economists’ Out There
Sen. Harry Reid (D-NV) in a December 2009 floor speech on Capitol Hill lauded Jonathan Gruber as one of the most “respected economists in the world” as Reid cited facts defending the Senate’s Obamacare bill.
Nancy Pelosi In 2009: Americans Should Read Jonathan Gruber’s ObamaCare Analysis
Nancy Pelosi In 2009: Americans Should Read Jonathan Gruber’s ObamaCare Analysis (November 5, 2009)
AHEC 2013 Conference
As part of the 24th Annual Health Economics Conference hosted by PennLDI, Mark Pauly and Jonathan Gruber were featured in the Plenary Panel discussing the role of economics in shaping (and possibly reshaping) the ACA. See below for the conference agenda with links to working papers. See the full AHEC agenda: http://ldi.upenn.edu/ahec2013/agenda
Jonathan Gruber at Noblis – January 18, 2012
The Noblis Technology Tuesday speaker series covers a broad spectrum of political, technical and innovative ideas. Noblis is a nonprofit science, technology, and strategy organization that brings the best of scientific thought, management, and engineering expertise with a reputation for independence and objectivity. The opinions expressed in this video are those of the speaker and do not necessarily reflect the views or opinions of Noblis.
Jonathan Gruber spoke to a Noblis audience on January 18, 2012 Few experts know more about America’s dire need of health care reform than Gruber. And of that short list, he is the only one prepared to enter the pages of a comic book to make the case. To be clear: Gruber is not an expert; he is “the” expert. An award-winning MIT economist and the director of the Health Care Program at the National Bureau of Economic Research, he was a key architect of the ambitious health care reform effort in Massachusetts and is a member of the Health Connector Board now implementing it; in 2006 he was named by “Modern Healthcare” as the nineteenth most powerful person in health care in the United States. In 2008 he was a consultant to the Clinton, Edwards, and Obama presidential campaigns. The national legislation passed by Congress in 2009 derives directly from Gruber’s insights learned during the Massachusetts health care debate.
Honors Colloquium 2012 – Jonathan Gruber
Dr. Jonathan Gruber is a Professor of Economics at the Massachusetts Institute of Technology, where he has taught since 1992. He is also the Director of the Health Care Program at the National Bureau of Economic Research, where he is a Research Associate. He is an Associate Editor of both the Journal of Public Economics and the Journal of Health Economics. In 2009 he was elected to the Executive Committee of the American Economic Association. He is also a member of the Institute of Medicine, the American Academy of Arts and Sciences, and the National Academy of Social Insurance.
Dr. Gruber received his B.S. in Economics from MIT, and his Ph.D. in Economics from Harvard University. Dr. Gruber’s research focuses on the areas of public finance and health economics. He has published more than 140 research articles, has edited six research volumes, and is the author of Public Finance and Public Policy, a leading undergraduate text, and Health Care Reform, a graphic novel. In 2006 he received the American Society of Health Economists Inaugural Medal for the best health economist in the nation aged 40 and under. During the 1997-1998 academic year, Dr. Gruber was on leave as Deputy Assistant Secretary for Economic Policy at the Treasury Department. From 2003-2006 he was a key architect of Massachusetts’ ambitious health reform effort, and in 2006 became an inaugural member of the Health Connector Board, the main implementing body for that effort. In that year, he was named the 19th most powerful person in health care in the United States by Modern Healthcare Magazine.
BookTV: Jonathan Gruber, “Health Care Reform: What It Is, Why It’s Necessary, How It Works
Jonathan Gruber, economics professor at the Massachusetts Institute of Technology and director of the health care program at the National Bureau of Economic Research, presents his thoughts on health care. Mr. Gruber a leading architect of Massachusetts’ health care reform also consulted with Congress and President Obama on the creation of the Affordable Care Act, signed into law by the President in 2010.
Obamacare architect Jonathan Gruber suddenly recast as bit player after uproar
Nancy Pelosi, fellow Democrats scramble to distance themselves from MIT professor, economist
For years, Massachusetts Institute of Technology professor Jonathan Gruber was deemed an architect of Obamacare and his economic modeling was cited regularly by the health care law’s defenders on Capitol Hill and in legal briefs defending the Affordable Care Act in federal courts.
But after tapes surfaced of the economist saying “stupid” voters needed to be bamboozled and the books cooked to get the legislation passed in 2010, Democrats are scrambling to reduce Mr. Gruber to a bit player — and raising questions about whether he needs to be expunged from their defense strategy as they face yet another Supreme Court review.
House Minority Leader Nancy Pelosi, who as speaker in 2009 posted an Obamacare “myth buster” citing Mr. Gruber, vehemently distanced herself from him Thursday.
SEE ALSO: EDITORIAL: Jonathan Gruber’s payday
“I don’t who he is. He didn’t help write our bill,” she said, but added that Mr. Gruber’s comments were a year old and he had recanted them.
In the comments that have just come to light, Mr. Gruber said the health care bill was written in a “tortured” way to ensure the Congressional Budget Office didn’t score the individual mandate as a tax, even though the U.S. Supreme Court ultimately upheld the mandate as constitutional under Congress’ taxing power.
“Lack of transparency is a huge political advantage,” Mr. Gruber said at the time. “And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical to get the thing to pass.”
Mr. Gruber said this week that he regretted the remarks. But House Speaker John A. Boehner, Ohio Republican, said Thursday that American voters are “anything but stupid” and oppose the health care system’s overhaul for valid reasons.
Mitch McConnell, the Kentucky Republican selected as the next Senate majority leader, said Mr. Gruber made a classic “Washington gaffe — when a politician mistakenly tells you what he really thinks.”
However, Mr. Gruber’s explanation in 2012 of how Obamacare’s subsidies should be paid put the Justice Department in a tough spot.
In legal briefs submitted last year to a federal district court in Virginia, Obama administration attorneys cited Mr. Gruber in a case defending their ability to pay subsidies to enrollees regardless of whether they are part of state-run or federally run health care exchanges.
“According to the calculations of one health care economist, without the minimum coverage provision and subsidized insurance coverage, premiums for single individuals would be double the amount anticipated under the ACA,” the Justice Department wrote in a legal brief last November, citing Mr. Gruber’s work in a footnote.
The Supreme Court decided this month to take up the case, King v. Burwell, after the challengers lost to the administration in the 4th U.S. Circuit Court of Appeals.
Neither the Justice Department nor the White House responded to questions about Mr. Gruber — who declined to comment for this story — and his role in their legal strategy.
But Sam Kazman, general counsel for the Competitive Enterprise Institute, which is funding the administration’s opponents in the King case, said Mr. Gruber’s 2012 remarks about subsidies bolster their own arguments.
Mr. Gruber at the time said subsidies would flow only to states that set up their own exchanges.
“What’s important to remember politically about this is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits — but your citizens still pay the taxes that support
this bill,” the economist told an audience.
That would mean consumers
in most states wouldn’t be eligible for subsidies, which would puncture a big hole in Obamacare. The Obama administration has argued that even though the law says subsidies go to state exchanges, they also should include states that have opted for the federal exchange.
Mr. Kazman said the Gruber comments create a major problem for Mr. Obama
.
“He’s not toxic to us,” Mr. Kazman said in an interview Thursday. “We may give him an award for public service
.”
In a parallel case before the D.C. Circuit, the administration tried to downplay Mr. Gruber in its latest court filings. On Nov. 3, the Justice Department said in a footnote that “post-enactment statements by a non-legislator are entitled to no weight.”
“In any event
, Professor Gruber has since clarified that the remarks on which plaintiffs rely were mistaken,” the attorneys told the D.C. Circuit, which has suspended its proceedings until the Supreme Court weighs in.
In the King case, Obama administration attorneys
who cited Mr. Gruber in briefs at the lower court dropped him from their arguments to the Supreme Court, said Michael A. Carvin, an attorney for the health care law’s opponents.
He wasn’t about to let the justices forget.
“Tellingly,” Mr. Carvin said in a reply brief, “the government also ignores that Jonathan Gruber — the ACA architect whose work it cited in every brief below but is nowhere mentioned now — articulated the incentive purpose of [subsidies] as early as 2012.”
Mr. Gruber has made hundreds of thousands of dollars off Obamacare, serving as a consultant to the Department of Health and Human Services and to states that used health care
grant money to pay him for his services.
Timothy Jost, a law professor at Washington and Lee University
who closely tracks the health care law, said the controversy has been overblown.
“This whole thing just puzzles me,” he said. “He wasn’t a legislator. He didn’t write the bill. He didn’t vote on the bill.”
http://www.washingtontimes.com/news/2014/nov/13/jonathan-gruber-obamacare-architect-recast-as-bit-/
Transcending Obamacare: An Introduction To Patient-Centered, Consumer-Driven Health Reform
Avik Roy
Today, the Manhattan Institute is publishing my 20,000-word, 68-page health reform proposal entitled “Transcending Obamacare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Solvency.” It represents a novel approach to health reform: neither accepting Obamacare as is, nor requiring the law’s repeal to move forward. And yet its ambition is to permanently solve our health care entitlement problem, while also expanding coverage for the uninsured.
As most Apothecary readers know, I’ve long been critical of Obamacare, the so-called Affordable Care Act. The law expands Medicaid, the worst health insurance program in the developed world. It significantly drives up the underlying cost of health insurance for those who shop for coverage on their own. And regardless of what John Roberts has to say about it, Obamacare’s individual mandate—forcing most Americans to buy government-certified health coverage—is an injury to the Constitution.
But I’ve also long supported the principle of universal coverage. Universal coverage, done right, is a core part of a conservative worldview that values equality of opportunity for the sick and the poor. If 10 of the 11 freest economies in the world can establish universal coverage, it’s not impossible for the United States to do so in a way that is consonant with economic freedom.
Switzerland and Singapore: Market-based health reform models
The most market-oriented health care systems in the developed world—those ofSwitzerland and Singapore—have much to teach us about how to achieve universal coverage in a way that spends far less than what the U.S. does. In 2012, U.S. government entities spent $4,160 per capita on health care. That’s more than twice as much as Switzerland, and nearly five times as much as Singapore.
And that brings us right back to Obamacare. The vast majority of the law is misguided and misconceived. But a handful of its provisions can provide the basis of constructive health care reform: in particular, its use of Swiss-style means-tested tax credits to subsidize private health insurance premiums. Most importantly, those tax credits are applied to insurance plans that people shop for on their own, substantially expanding the market for individually purchased health coverage.
The Swiss system is far from perfect, as I have discussed on many occasions. But the basic idea in Switzerland is to offer premium subsidies to the people who really need them. In Switzerland, one-fifth of the population gets subsidized health coverage. In the U.S., around four-fifths do. That’s the difference between a safety net and an entitlement leviathan.
Conservative health reform after Obamacare
One of the fundamental flaws in the conservative approach to health care policy is that few—if any—Republican leaders have articulated a vision of what a market-oriented health care system would look like. Hence, Republican proposals on health reform have often been tactical and political—in opposition to whatever Democrats were pitching—instead of strategic and serious.
Those days must come to an end. The problems with our health care system are too great. Health care is too expensive for the government, and too expensive for average Americans.
In 2012, as the Romney campaign came to a close, Rich Lowry, the editor ofNational Review, asked me to write an article with my thoughts about the best path forward for conservative health care reform. I outlined a four-step plan to take the entire gamish of government health care programs and reform them into something consumer-driven and fiscally sustainable: (1) deregulate Obamacare’s insurance exchanges, including repeal of the individual mandate, while preserving guaranteed issue for individuals with pre-existing conditions; (2) migrate future retirees onto the reformed exchanges; (3) repeal Obamacare’s employer mandate; (4) migrate Medicaid acute-care and dual-eligible enrollees onto the exchanges.
“After these four relatively simple steps,” I wrote, “we would be left with a health-care system that would look a lot like Switzerland’s. Rises in premium subsidies could be held to a sustainable growth rate to ensure their long-term fiscal stability. And Americans might finally have the opportunity to purchase insurance for themselves, gain control of their own health-care dollars, and enjoy a wide range of low-cost, high-quality coverage options.”
A few months later, former Congressional Budget Office director Douglas Holtz-Eakin and I wrote a similar piece for Reuters, which elicited a broad range of responses from both the left and the right.
It became clear that I had to do more than write op-eds, that I had to develop this idea in detail, with credible fiscal and economic modeling.
Modeling market-based health reform
So, over the last 18 months, I’ve done just that. Stephen Parente, a health economist at the University of Minnesota, and his team modeled the fiscal and coverage impact of the bulk of my proposed set of reforms. (I then modeled the remainder, using analyses from the Congressional Budget Office, the Centers for Medicare and Medicaid Services, and the like.)
The Manhattan Institute for Policy Research, where I am a Senior Fellow, raised money to fund Parente’s work on this project. Steve and his team and I went back and forth for months, refining and tweaking the proposal until it met five non-negotiable goals. The end result had to:
Based on our modeling, the plan, over a thirty-year period, reduces federal spending by $10.5 trillion and federal revenue by $2.5 trillion, for a net deficit reduction of $8 trillion. We project that it will expand coverage by more than 12 million individuals over its first decade, despite the fact that it repeals the individual mandate. It reduces the cost of private-sector insurance policies by 17 percent for single policies and 4 percent for family policies.
But the most dramatic improvement, we estimate, is in the Medicaid population. A group that today receives substandard care and substandard access to care will see a dramatic increase in provider access and health outcomes, based on Parente-developed indices that measure these things.
Breaking free of the repeal-or-reform debate
Importantly, while this plan is compatible with “repealing and replacing” Obamacare, it does not require the repeal of Obamacare. To achieve the former, you would repeal Obamacare and replace it with a universal system of state-based health insurance exchanges. To achieve the latter, you’d reform the pre-existing ACA exchanges, and gradually migrate future retirees and Medicaid enrollees onto the reformed exchanges.
In this way, perhaps the plan can attract interest from both the right and the center.
We’ll soon find out.
http://www.forbes.com/sites/theapothecary/2014/08/13/transcending-obamacare-an-introduction-to-patient-centered-consumer-driven-health-reform/
Jonathan Gruber Embraced Misleading the Public About Obamacare Even While It Was Still Being Debated
Peter Suderman
In the week since video surfaced of Obamacare architect Jonathan Gruber saying that “lack of transparency” and “the stupidity of the American voter” were critical to passing the health law, two more videos of Gruber making statements with similar themes or tones have received attention.
Both clips reveal a gleefully dismissive attitude toward public concerns about the law, and offer a telling reminder of the attitude that played a crucial role in shaping and selling the law to the public.
In the first video, recorded in March of 2010, just a few days before the law would pass the House, Gruber argues that the public does not really care about the uninsured. What it cares about is cost control. Therefore, he says, the law had to be sold on the basis of its cost control.
Yet as Gruber admits in the video, the bill was not primarily focused on cost control—the bill “is 90% health insurance coverage and 10% about cost control.” Indeed, the problem with cost control, he says, is that “we don’t know how” to do it.
The primary quote. Via CNN:
Elsewhere in the same speech, Gruber says:
Remember, this is what Gruber was saying as the law was still being debated. It didn’tpass in the House, the critical step before hitting President Obama’s desk, until more than a week later. And what Gruber was saying, even before the bill was law, was that supporters had intentionally emphasized parts of the bill that were relatively minor, and that were not certain to even produce their intended effects.
This is not lying, exactly; the bill did in fact include some attempts at cost control, although as Gruber said, it was unclear at the time if or how well they would work. And Gruber may well have been right that the public was more concerned with cost control than expanding coverage. But, especially in combination with the other video released this week, it indicates that Gruber believed that the law’s advocates were not being completely straight with the public, that supporters of Obamacare were telling the public what they believed the public wanted to hear instead of giving them the full story, and that they were doing so on the understanding that telling the full story would make the bill impossible to pass.
What it shows, in other words, is Gruber openly embracing a strategy of messaging manipulation and misleading emphasis even while the bill was still being debated. If the public understood the bill clearly, he believed, they would reject it. It was more important to pass the bill.
Another video, posted today by The Daily Signal, shows Gruber taking a similarly dismissive attitude toward public concerns about the bill. At a meeting with the Vermont House Health Care Committee, Gruber is presented with a question about whether systems like those described in a report by Gruber and Harvard health economist William Hsiao, might result in “ballooning costs, increased taxes and bureaucratic outrages” as well “shabby facilities, disgruntled providers” and destructive price controls.
Gruber’s response begin with: “Was this written by my adolescent children by any chance?” The Signal quotes two-term Vermont state senator and Reagan-adviser John McClaughry as saying that the question had been submitted “by a former senior policy adviser in the White House who knew something about health care systems.”
Gruber’s response is intended as a joke, and it reveals little about the health care law (the reforms in question are specific to Vermont). But it says plenty about Gruber, and the flippant, arrogant way he treats concerns and criticism.
This is the person whom the White House relied on to help craft the bill; he was paid handsomely to model its effects (a fact he did not disclose, even when asked), and he was in the room when important decisions were made about how it would work. He claims to have helped write specific portions of the law himself. Gruber was not the sole architect of the law, but he was one of its biggest single influences on both its design and on how the media, which quoted him repeatedly, reported and understood the law.
The White House and its allies are desperately trying to distance themselves from Gruber right now by downplaying his role in the law’s creation. But the record of his involvement is clear enough: At The Washington Post, Ezra Klein has variously described Gruber as “one of the key architects behind the structure of the Affordable Care Act” and “the most aggressive academic economist supporting the reform effort.” The New York Times in 2012 described his role as helping to design the overall structure as well as being “dispatched” by the White House to Congress to write the legislative text. Gruber’s work was cited repeatedly by the White House, Democratic leadership, and the media.
So when he describes the thinking about how the law was crafted and sold to the public, it’s worth taking note. This is the posture of one of the law’s authors and chief backers. It’s part of the spirit in which the law was created and passed. Gruber’s ideas were embedded in the law’s structure and language, and so was his attitude.
http://reason.com/blog/2014/11/14/jonathan-gruber-embraced-misleading-the
White House says Gruber’s wrong, attacks GOP
By LUCY MCCALMONT
The White House is denouncing comments from key Obamacare architect Jonathan Gruber that a lack of transparency and the stupidity of voters helped in the passage of the health care law and is instead pointing a finger at Republicans.
“The fact of the matter is, the process associated with the writing and passing and implementing of the Affordable Care Act has been extraordinarily transparent,” White House press secretary Josh Earnest said during a news briefing in Myanmar, according to a transcript provided by the White House.
Story Continued Below
“I disagree vigorously with that assessment,” Earnest responded when asked about Gruber’s claim that Obamacare wouldn’t have passed if the administration was more transparent and voters more intelligent.
He added, “It is Republicans who have been less than forthright and transparent about what their proposed changes to the Affordable Care Act would do in terms of the choices are available to middle class families.”
Earnest said the president “is proud of the transparent process that was undertaken to pass that bill into law.”
The response from the White House comes as a third video of Gruber criticizing the intelligence of American voters has surfaced.
“We just tax the insurance companies, they pass on higher prices that offsets the tax break we get, it ends up being the same thing. It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter,” Gruber said in remarks from 2012 that aired Wednesday evening on “On the Record with Greta Van Susteren.”
Gruber has been causing headaches for the White House as conservatives have had a field day that began with comments the MIT professor made in 2013.
“Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter, or whatever, but basically that was really, really critical for the thing to pass,” Gruber said at the time, according to one of the videos that has recently come to light.
In another video clip of a separate event, while talking about tax credits in the Affordable Care Act, he said, “American voters are too stupid to understand the difference.”
Gruber apologized for the comments during an appearance earlier this week on MSNBC’s “Ronan Farrow Daily”:
(Also on POLITICO: Ted Cruz out on a limb on Obamacare repeal)
“I was speaking off the cuff, and I was basically speaking inappropriately, and I regret having made those comments.”
Meanwhile, House Minority Leader Nancy Pelosi dismissed Gruber’s role in Obamacare on Thursday, telling the press, “I don’t know who he is. He didn’t help write our bill.”
Many outlets were quick to point out that Pelosi cited Gruber in a “Health Insurance Reform Mythbuster” on her official website in 2009.
House Speaker John Boehner released a statement Thursday, slamming Gruber for his comments.
“If there was ever any doubt that ObamaCare was rammed through Congress with a heavy dose of arrogance, duplicity, and contempt for the will of the American people, recent comments by one of the law’s chief architects, Jonathan Gruber, put that to rest,” the top Republican said.
The statement continues, “The American people are anything but ‘stupid.’ They’re the ones bearing the consequences of the president’s health care law and, unsurprisingly, they continue to oppose it.”
http://www.politico.com/story/2014/11/jonathan-gruber-obamacare-voters-white-house-response-112856.html
Cadillac insurance plan
Informally, a Cadillac plan is any unusually expensive health insurance plan, usually arising in discussions of medical-cost control measures in the United States.[1][2][3][4] The term derives from the Cadillac automobile, which has represented American luxury since its introduction in 1902,[1] and as a health care metaphor dates to the 1970s.[1] The term gained popularity in the early 1990s during the debate over the Clinton health care plan of 1993,[1] and was also widespread during debate over possible excise taxes on “Cadillac” plans during the health care reforms proposed during the Obama administration.[1] (Bills proposed by Clinton and Obama did not use the term “Cadillac”.)
The Patient Protection and Affordable Care Act (as amended by the Health Care and Education Reconciliation Act of 2010) imposes an annual 40% excise tax on plans with premiums exceeding $10,200 for individuals or $27,500 for a family (not including vision and dental benefits) starting in 2018.[4]
Criticisms of these plans generally center on the small or nonexistent co-pays, deductibles, or caps that encourage the overuse of medical care, driving the cost up for the uninsured or those on other plans, which some say necessitates aCadillac tax.[citation needed]
A study published in Health Affairs in December 2009 found that high-cost health plans do not provide unusually rich benefits to enrollees. The researchers found that only 3.7% of the variation in the cost of family coverage in employer-sponsored health plans is attributable to differences in the actuarial value of benefits. Only 6.1% of the variation is attributable to the combination of benefit design and plan type (e.g., PPO, HMO, etc.). The employer’s industry and regional variations in health care costs explain part of the variation, but most is unexplained. The researchers conclude “…that analysts should not equate high-cost plans with Cadillac plans, but that in fact other factors—industry and cost of medical inputs—are as important in predicting whether a plan is a high-cost plan. Without appropriate adjustments, a simple cap may exacerbate rather than ameliorate current inequities.”[5]
See also
References
External links
http://en.wikipedia.org/wiki/Cadillac_insurance_plan
ObamaCare Tax: Full List of ObamaCare Taxes
How ObamaCare Taxes Affect You: New Taxes, Hikes, Breaks, Credits, and Other Changes
Here’s a full list of ObamaCare Taxes. The 21 new ObamaCare tax hikes and breaks impact us all, but which ObamaCare taxes will you actually pay? Find out how the tax related provisions in the Affordable Care Act (ObamaCare) will affect you, your family, your business, and your tax returns for 2013 and beyond.
The Bottom Line on the ObamaCare Tax Plan
The new tax related provisions in theAffordable Care Act(ObamaCare) include tax hikes, limits to deductions, tax credits, tax breaks, and other changes. While a few of the changes directly affect the average American, tax increases primarily affect high earners (those making over $200,000 as an individual or $250,000 as a family), large businesses (those making over $250,000), and the health care industry, while tax credits primarily affect low-to-middle income Americans and small businesses.
Here are some quick facts to help you understand how ObamaCare affects taxes:
• For the majority of the 85% of Americans with health insurance the percentage of income paid in taxes won’t change much, if at all. However, some of the changes may directly or indirectly affect specific groups.
• The majority of the 15% of Americans without health insurance will primarily be affected by the Individual Mandate (the requirement to buy health insurance), the Employer Mandate (the requirement for large employers to insure full-time employees), and Tax Credits (tax credits reduce premium costs for individuals, families, and small businesses).
• Many Americans will be affected by changes to new limits on medical tax deduction thresholds MSAs, FSAs, and HSAs.
• Small businesses will not be required to provide health insurance, but will gettax credits to reduce premium costs if they choose to offer group plans.
• Even if you won’t see higher taxes under the Affordable Care Act, it doesn’t mean there aren’t costs associated with the law. You’ll still need to buy health insurance, unless you qualify for Medicaid or an exemption, and that will cost you money.
• As a rule of thumb those who make less pay less and those who make more pay more, both in regard to health insurance costs and taxes under theAffordable Care Act.
• The Congressional Budget Office has shown that the revenue generated from the new taxes, along with cuts to spending, will help to pay for the Affordable Care Act’s many provisions, fund tax credits and lower the deficit by 2023.Learn More.
Why Does ObamaCare Create New Taxes?
ObamaCare includes many new benefits, rights, and protections including the requirement for health insurers to cover people with pre-existing conditions. It also expands access to affordable health insurance to almost 50 million low-to-middle income men, women, and children across the country by offering reduced premiums via tax credits and expanding Medicaid and CHIP. Expanding the quality, affordability and availability of health insurance (along with other aspects of the law) come at a high cost. Assuming all tax provisions remain in place, the revenue generated from these new taxes help to cover the costs of the program and reduces the deficit. Learn more about the new benefits, rights, protections offered by the Affordable Care Act.
A Quick Overview of Key Taxes in the Affordable Care Act
Before we get to the full list of taxes here is a quick overview of the key tax related provisions that may affect those without insurance, those who plan to go without insurance, and those who are struggling to afford insurance now.
Individual Mandate (new tax): Americans who can afford to must obtain minimum essential health coverage for 2014, get an exemption or pay a per month fee.
Employer Mandate (new tax): Come 2015 large employers must insure full time employees or pay a per employee fee. Over half of Americans get their insurance through work and the largest group of uninsured is currently the working poor.
Advanced Premium Tax Credits (tax break): Low-to-middle income Americans are eligible for tax credits which reduce the upfront cost of premiums on health insurance purchased through their State’s “Health Insurance Marketplace”.
Small Business Tax Credits (tax break): Small businesses may be eligible for tax credits of up to 50% of their cost of employee premiums through theSmall Business Health Options Program.
Taking all the tax provisions in the ACA into account ObamaCare technically provides the greatest middle class tax cut to healthcare in history.
Full List of All Taxes in ObamaCare / All Taxes in the Affordable Care Act
The following list of new ObamaCare taxes collectively raise over $800 billion by 2022. Here is a complete list of new fees and taxes contained withinObamaCare:
ObamaCare Taxes That Most Likely Won’t Directly Affect the Average American
• 2.3% Tax on Medical Device Manufacturers 2014
• 10% Tax on Indoor Tanning Services 2014
• Blue Cross/Blue Shield Tax Hike
• Excise Tax on Charitable Hospitals which fail to comply with the requirements of ObamaCare
• Tax on Brand Name Drugs
• Tax on Health Insurers
• $500,000 Annual Executive Compensation Limit for Health Insurance Executives
• Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D
• Employer Mandate on business with over 50 full-time equivalent employees to provide health insurance to full-time employees. $2000 per employee $3000 if employee uses tax credits to buy insurance on the exchange (marketplace). (pushed back to 2015)
• Medicare Tax on Investment Income 3.8% over $200k/$250k
• Medicare Part A Tax increase of .9% over $200k/$250k
• Employer Reporting of Insurance on W-2 (not a tax)
• Corporate 1099-MISC Information Reporting (repealed)
• Codification of the “economic substance doctrine” (not a tax)
ObamaCare Taxes That (may) Directly Affect the Average American
• 40% Excise Tax “Cadillac” on high-end Premium Health Insurance Plans 2018
• An annual $63 fee levied by ObamaCare on all plans (decreased each year until 2017 when pre-existing conditions are eliminated) to help pay for insurance companies covering the costs of high-risk pools.
• Medicine Cabinet Tax
Over the counter medicines no longer qualified as medical expenses for flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs), and Archer Medical Saving accounts (MSAs).
• Additional Tax on HSA/MSA Distributions
Health savings account or an Archer medical savings account, penalties for spending money on non-qualified medical expenses. 10% to 20% in the case of a HSA and from 15% to 20% in the case of a MSA.
• Flexible Spending Account Cap 2013
Contributions to FSAs are reduced to $2,500 from $5,000.
• Medical Deduction Threshold tax increase 2013
Threshold to deduct medical expenses as an itemized deduction increases to 10% from 7.5%.
• Individual Mandate (the tax for not purchasing insurance if you can afford it) 2014
Starting in 2014, anyone not buying “qualifying” health insurance must pay an income tax surtax at a rate of 1% or $95 in 2014 to 2.5% in 2016 on profitable income above the tax threshold. The total penalty amount cannot exceed the national average of the annual premiums of a “bronze level” health insurance plan on ObamaCare exchanges.
• Premium Tax Credits for Small Businesses 2014 (not a tax)
• Advanced Premium Tax Credits for Individuals and Families 2014 (not a tax)
• Medical Loss Ratio (MRL): Premium rebates (not a tax)
The link below provides a full list of ObamaCare Taxes by the IRS.
For a full list of taxes provisions from the IRS
Or see the latest publication by the joint tax committee on the Affordable Care Act.
Who Does ObamaCare Tax?
Let’s take a look at how ObamaCare’s taxes affect certain income groups.
ObamaCare Taxes for High Earners and Large Businesses
Most of the new taxes are on high-earners (individuals making over $200,000 and families making over $250,000), large businesses (over 50 full-time equivalent employees making over $250,000), and industries that profit from healthcare. Essentially those who will see gains under ObamaCare are required to put money back in the program via taxes.
FACT: Tax increases generally affect single filers with an adjusted gross income (AGI) above $200,000 and married couples filing jointly above $250,000. Some of the tax increases don’t kick in until single AGI hits $400,000 and married filing jointly AGI hits $450,000.
ObamaCare Taxes for the Average American With Health insurance
For most of the 85% of Americans with health insurance, making less than $250,000, most of the new taxes won’t mean much of anything although certain taxes below will affect specific individuals and families.
ObamaCare Taxes for the Average American Without Health insurance
The 15% of Americans without health insurance will be required to obtain health insurance (Individual Mandate) or will face a “tax penalty”.
The good news is that many uninsured will be exempt from the Individual mandate due to income, offered cost assistance through the marketplaceincluding Tax Credits (also available to small businesses), qualify for Medicaid, or will get insurance through work (the Employer Mandaterequires large employers to insure full-time employees by 2015). Adults who are under 26 will be able to stay on their parents plan as well, this will help to limit the number of young people who will pay the fee. Both the employer and individual mandates are part of our “shared responsibility” to expand the quality and affordability of health insurance in the United States as a trade for our new benefits, rights and protections.
ObamaCare Taxes for Small Businesses
Small businesses with less than 25 full-time equivalent employees will have access to tax credits to reduce premium costs of group plans.
ObamaCare Taxes for Specific Groups With Health Insurance
Here are a few changes that my affect specific groups of Americans with health insurance:
• Other tax provisions such as changes medical deduction thresholds, HSAs, MSAs, and FSAs may impact some Americans by limiting tax deductions.
• The Medical Loss Ratio (MLR or 80/20 rule) will mean that some Americans may get rebates if health insurance companies spend on non-healthcare related expenses.
• Tax provisions like the 10% tanning bed tax, taxes on drug companies, taxes on medical devices and taxes on health insurance companies selling insurance on and off the exchange may affect the amount of money we pay for some health care related goods and services, but will not have a significant impact on our daily lives.
• The employer mandate has caused some companies to cut down full-time workers to part-time to avoid providing benefits, however major employers like Disney and Walmart have actually increased their full-time workforce in response to the looming 2015 deadline.
• Overall the benefits tend to outweigh the costs for the average American as even those who pay a little more, get a lot more in return due to the increased quality of their health insurance.
Will I pay More Taxes and High Premiums Because of ObamaCare?
As mentioned above premium rates and the taxes you will have to pay are primarily based on income. Aside from income premium prices are based on which plan you choose, family size, age, smoking status and geography. Subsidies reduce the overall rate of your premiums (however smoking is calculated after subsidies). Come 2018 there will be a 40% excise tax on high end health insurance plans.
Aside from the tax provisions that require Americans to obtain insurance and subsidize it’s costs, ObamaCare also includes a few tax related provisions that work as consumer protections including requirements for better reporting and the Medical Loss Ratio.
ObamaCare Tax Rebates
Some consumers in both individual and group markets will see tax rebates due to ObamaCare’s Medical Loss Ratio (MLR). Health insurance companies will have to provide rebates to consumers if they spend less than 80 to 85% of premium dollars on medical care.
Medical Loss Ratio (MLR)
The Medical Loss Ratio (MLR) means that Insurance companies are now required to spend at least 80% of premium dollars (85% in large group markets) on medical care and quality improvement activities. Insurance companies that are not meeting this standard will be required to provide rebates to their consumers. The MLR isn’t a tax, but it does have implications in regards to filing taxes and rebates can be given in the form of reduced premiums. See our page on ObamaCare Health Insurance Regulations for more details.
ObamaCare Income Tax Penalty For Not Having Insurance “Individual Mandate”
Starting in 2014, most people will have to have insurance or pay a “penalty deducted from your taxable income”. For individuals, penalty starts at $95 a year, or up to 1% of income, whichever is greater, and rise to $695, or 2.5% of income, by 2016.
For families the tax will be $2,085 or 2.5% percent of household income, whichever is greater. The requirement can be waived for several reasons, including financial hardship or religious beliefs. If the tax would exceed 8% of your income you are exempt, also some religious groups are exempt. That tax cannot exceed the cost of a “bronze plan” bought on the exchange.
Many individuals who are exempt from the mandate to buy insurance will still be eligible for free or low-cost insurance through the health insurance marketplace.
While some states, including Alabama, Wyoming and Montana, have passed laws to block the requirement to carry health insurance, those provisions do not override federal law. Get more information on the ObamaCare Individual Mandate.
The Individual Mandate is officially called the “individual shared responsibility provision”.
What Are ObamaCare Tax Credits?: Advanced Premium Tax Credits
Premium tax credits are a form of cost assistance that reduce premium costs for coverage purchased on your State’s “health insurance marketplace” for individuals, families, and small businesses.
Advanced Premium Tax Credits for Individuals and Families
Individuals and families will have access to Advanced premium tax credits on the marketplace. Tax Credits are deducted from your premium cost by your health insurance provider and are adjusted on your Modified Adjusted Gross Income (MAGI). You can choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.
Aside from premium tax credits individuals and families can also get lower cost sharing on out-of-pocket expenses like coinsurance, copays, deductibles and out-of-pocket maximums through the marketplace.
Eligibility for Tax Credits
In general, you may be eligible for the credit if you meet all of the following:
If you are eligible for the credit, you can choose to:
How Will Advanced Premium Tax Credits Affect My Health Insurance Costs?
Under the Affordable Care Act health insurance that costs less than 8% of your MAGI is considered affordable. Although the law doesn’t guarantee lower costs, premium tax credits help to ensure that more Americans will have access to affordable insurance.
s a rule of thumb most Americans will pay between 1.5% and 9.5% on their Modified Adjusted Gross Income (MAGI) when using tax credits to buy a basic Silver Plan on the marketplace.
If the lowest-priced coverage available to you would cost more than 8% of your household income are exempt from the individual mandate.
The amount you pay is on a sliding scale based on your income. Use the chart below to get an idea of what you and your family may pay for insurance purchased through the Health Insurance Marketplace. Make sure to check outObamaCare Subsidies for more detailed information on Premium Tax Credits.
The 2013 Federal Poverty Level Guidelines below are used to Determine if your percentage of the poverty level for both taxes and cost-assistance.
Household Size
100%
133%
150%
200%
300%
400%
1
$11,170
$14,856
$16,755
$22,340
$33,510
$44,680
2
15,130
20,123
22,695
30,260
45,390
60,520
3
19,090
25,390
28,635
38,180
57,270
76,360
4
23,050
30,657
34,575
46,100
69,150
92,200
5
27,010
35,923
40,515
54,020
81,030
108,040
6
30,970
41,190
46,455
61,940
92,910
123,880
7
34,930
46,457
52,395
69,860
104,790
139,720
8
38,890
51,724
58,335
77,780
116,670
155,560
For each additional person, add
$3,960
$5,267
$5,940
$7,920
$11,880
$15,840
This following table is an example of how premium tax credits work. Please note that the numbers below are purely for example and don’t reflect your personal rates.
For “Silver Plan”
ObamaCare Employer / Employee Taxes
ObamaCare’s taxes mean large employers will have to provide health insurance to their employees and will see a raised Medicare part A tax, small businesses may be eligible for tax breaks.
Medicare part A Tax Hike for Employers and Employees
The Medicare part A tax is paid by both employees and employers who earn over a certain amount. ObamaCare’s Medicare tax hike is a .9% increase (from 2.9% to 3.8%) on the current total Medicare part A tax. This tax is split between the employer and employee meaning that they will both see a .45% raise. Small businesses making under $250,000 are exempt from the tax. Employees making less than $200,000 as an individual or ($250,000) as a family are also exempt. Employers must withhold and report an additional 0.9 percent total on employee wages or compensation that exceed $200,000.
Tax Penalty for Not Providing Full-time Workers with Health Insurance the “Employer Mandate”
Employers with over 50 full-time equivalent employees must either insure their full-time employees or pay a penalty or “employer shared responsibility fee”. The penalty is $2000 per employee. If however, at least one full-time employee receives a premium tax credit because coverage is either unaffordable or does not cover 60 percent of total costs, the employer must pay the lesser of $3,000 for each of those employees receiving a credit or $750 for each of their full-time employees total.
Employers with under 25 full time employees, whose average income doesn’t exceed $50,000, can apply for tax credits of up to 50% for insuring their employees.
Tax Credits for Small Businesses
Small businesses with under 25 full-time equivalent employees with average annual wages of less than $50,000 can apply for tax breaks of up to 50% of their share of employee premium costs via ObamaCare’s Small Business Health Options Program (accessible through your State’s Health Insurance Marketplace). The credit can be as much as 50% of employer premiums (35% for not-for-profits in 2014). The credit is only available if the employer is paying at least 50% of the total premiums.
Small Business Health Options Program
Employers with 50 or fewer employees, you can purchase affordable insurance through the Small Business Health Options Program (SHOP) even if they don’t qualify for tax credits.
Reporting
Along with the new law there are new requirements for reporting.
Other ObamaCare Taxes on Big Business
Aside from having to adhere to the “employer mandate” ObamaCare also imposes taxes and fees that are unique to big business. ObamaCare taxes some medical device manufactures, drug companies and health insurance companies. Beginning in 2013, medical device manufacturers and importers must pay a 2.3% tax on the sale of a taxable medical device. This raises $29 billion over a 10 years. However, many states are asking to delay the medical device excise tax to protect jobs in states that produce the devices. An annual fee for health insurers is expected to raise more than $100 billion over 10 years, while a fee for brand name drugs will bring in another $34 billion.
Medical Device Excise Tax
There is a 2.3% medical excise tax on medical device manufacturers and importers on the sale of taxable medical devices. Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device. The tax applies to sales of taxable medical devices after Dec. 31, 2012. You can learn more from the official IRS page on the Medical Device Tax.
What Increases Do the ObamaCare Taxes Include for The $200k/$250k Earners?
ObamaCare Medicare Part A Payroll Tax
Starting in 2013, individuals with earnings above $200,000 and married couples making more than $250,000 will see an increase in the Medicare part A payroll tax. It’s an increase of 2.35%, up from the current 1.45% ( a .9% Medicare part A payroll tax hike), on adjusted income over the threshold.
ObamaCare Unearned Income Tax
This group will also pay a 3.8% unearned income (capital gains) tax on interest, dividends, annuities, royalties, rents, and gains on the sale of investments over the threshold.
Taxable income under the $200,000 for individuals and $250,000 threshold for families is subject to the same benefits and tax cuts as those who make under the threshold.
ObamaCare Home Sales Tax / ObamaCare Real Estate Tax Increase
ObamaCare increases taxes on unearned income by 3.8% and this can add additional taxes to the sales of some homes, but many limitations apply which means it won’t affect most sellers. The 3.8% capital gains tax typically doesn’t apply to your primary residence. It also doesn’t usually apply to homes you have owned for over 5 years or on profits of less than $250,000 for individuals and $500,000 for couples due to a capital gains tax exclusion rule for sales of a primary home.
In short the ObamaCare home sales tax isn’t something that most of us will pay, it is a tax is aimed at those selling non-primary residences in short term periods for profit and not at the average American buying and selling their primary residence.
ObamaCare Medical Expense Deductions
ObamaCare increases the medical expense deduction threshold. Unreimbursed medical expense deductions will now be available only for those medical expenses in excess of 10% of AGI, which has been raised from 7.5%. There is a temporary exemption for individuals ages 65 and older and their spouses from 2013 through 2016.
ObamaCare “Cadillac” Tax
Starting in 2018, the new health care law imposes a 40% excise tax on the portion of most employer-sponsored health coverage (this excludes dental and vision) that exceed $10,200 a year and $27,500 for families. The tax has been dubbed a “Cadillac” tax because it hits only high-end “gold”, “platinum” and high-end health care plans not purchased on the exchange. The tax raises over $150 billion over the next 10 years.
New ObamaCare Taxes Summary
Going through the new ObamaCare taxes line by line is, in itself, taxing. The bottom line is that a majority of Americans will find themselves paying less for better healthcare, while higher-earners will pay tax rates closer to what they did in the Clinton years. ObamaCare pays for most of itself via the above taxes, reforms to Medicare, and health care as a whole, as well as cutting out billions in wasteful spending.
ObamaCare Taxes Moving Forward into 2014
We hope this helps you to understand the new ObamaCare taxes and how they work. Many of the ObamaCare’s taxes won’t be fully implemented until 2022, but most will be in effect by 2014. ObamaCare helps all Americans get access to quality affordable healthcare, and new benefits, rights and protections. Make sure to look out for ObamaCare tax breaks, credits, subsidies and breaks on up front costs moving forward into 2014. As we learn more we will update our full ObamaCare tax list.
ObamaCare Taxes: New Health Care Taxes
http://obamacarefacts.com/obamacare-taxes/
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