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Sunday, October 5, 2014

INITIAL CONTACT LETTER (WORKING DRAFT) TO CDC / NIAID / FAA / USAID: October 5, 2014

COMMENTS WELCOME PRIOR TO SENDING TO AGENCIES BELOW (NUMBERS ARE CORRECT ON ACTUAL DOCUMENT)

TO:  Centers for Disease Control (CDC)
        National Institutes of Health (NIH)
        National Institute of Allergy and Infectious Diseases (NIAID)

FROM:  Flash News Network (FNN)
              Scott Anthony, Editor

DATE:  October 5, 2014



Recently, you have received a letter from one of our high-level colleagues, Jason K., founder of “Saving the Truth Movement” which represents several thousand concerned citizens of the United States.  Jason is a contributing Editor for Flash News Network, and in addition, his publication and his readers are also part of our network (FNN).  As such, we are also submitting in writing questions our readers have, many of which mirror those of his readers and subscribers.  We are adding additional concerns and questions that we have, as the Ebola outbreak is a seemingly very complex, and confusing situation.

Please note, that while some of our questions may be very similar, there are also some differences;  therefore, we are asking that you give this letter a thorough review, and to provide us with written answers to the questions being presented.

To quote Jason K., we will start this particular letter with the same preamble:

“     The following is a letter of great concern. Ebola is presenting itself as an increasing threat to the United States Of America. We as American People, bring these concerns and questions to you, with the expectations of receiving a full, factual reply, in a timely manner. As the American people, we have the right to know the answers, to the following:

  1.   It has been noticed, "Aerosolized Transmission" is being left out of all interviews, reports, and/or all public discussions. With the exception of one Physician who brought up the topic of “Aerosolized Transmission” during an interview on CNN.  As you are aware, Aerosolized Transmission is a form of Direct Contact.  We are now calling in to question the lack of concern displayed by the CDC regarding this form of transmission.  In fact, “aerosolized transmission” is being all but dismissed by Dr. Tom Frieden, Director for the CDC.  We find the dismissing of this form of transmission troubling, particularly because the CDC has now published “Interim Guidelines for Healthcare Settings” as well as for First Responders, both of which acknowledge that aerosolized transmission is a potential method for Ebola to spread.  Specifically, the CDC is recommending that surgical masks and face shields be utilized during any activity that may result in droplets being expelled by the patient (for example, during intubation, cardiopulmonary resuscitation, etc).  IF Ebola poses little risk of aerosolized transmission and is only able to be transmitted via direct contact with a person who is positive for Ebola AND symptomatic, then why include droplet precautions as a transmission risk?  We believe the CDC is correct in publishing the use of droplet precautions, however, when speaking publicly, particularly during news briefings, the CDC is downplaying the potential for aerosolized transmission. Therefore, we now need to ask the question;  WHY is the CDC downplaying this route of transmission?  Obviously, there is a strong enough indicator that transmission is possible via aerosolized droplets, and yet, the CDC repeatedly keeps going on record stating that “DIRECT CONTACT” with a symptomatic patient is the ONLY method which will cause illness with Ebola.  Why is the CDC sending out mixed messages?

  1. The CDC and NIAID is repeatedly stating that Ebola is not now, nor has ever been an “airborne pathogen.”  While this may be correct, there is no mention of "Aerosolized Droplet Direct Contact” for which Scientists, PhD’s, Virologists and others have written about recently including Jason K. The scientific and  medical journals are quite clear on the matter.  While Aerosolized Droplet Transmission is not being discussed specifically, we are instead witnessing “wordplay games” with “Airborne vs. Aerosolized” on the mainstream broadcast media.  Again  Aerosolized Droplets are a form of direct contact through coughing, sneezing, and/or being too close to a person whom may be sick (generally accepted is 2 meters or less).  In general, this is for all intents considered "Direct Contact" wherein it is possible to transmit the Ebola Virus.  Why is this information not being explained in greater detail to the American People?  Specifically, to ensure proper education and awareness of exactly how Ebola can be transmitted and more importantly, how American citizens can protect themselves from this known danger?

  1. On the topic of “aerosolized” transmission, the CDC on October 1, 2014, published “Interim Guidance for EMS / 9-1-1 Public Safety Answering Points” in which there are specific guidelines for EMS providers to utilize PPE during resuscitative measures, as well as suctioning of airways, etc.  Contained within the EMS guidelines, the CDC now recommends the use of NIOSH Fit Tested N95 Respirators during EMS activities for suspected Ebola patients.  While we have several concerns regarding how EMS personnel will ultimately be able to protect themselves during routine calls for “febrile patients with abdominal pain, muscle pain, etc” the main concern / question we have at this time is the inclusion of the N95 Respirators.  To be clear, the CDC itself defines a N95 Respirator as a device to be utilized that “Protects from exposure to airborne particles and barrier to splashes, droplets, and sprays. In a healthcare setting, protects from exposure to biohazards including viruses and bacteria.”  Given that the N95 Respirator is being recommended over a regular surgical mask or face shield, the question now becomes “Why is the CDC recommending a particulate respirator (N95) as PPE during routine EMS activities for a virus that is considered by the CDC / WHO / NIAID as a non-airborne pathogen?  IF Ebola is not airborne, and if Ebola is NOT transmitted via non-contact (i.e. respiratory tract) methods, then why would the CDC recommend a costly and more restrictive barrier product such as the N95 respirator?  Obviously, we all want EMS / Healthcare Facility personnel to remain as safe as possible, however, the fact that the CDC is making this recommendation is sending out a mixed-message;  either the Ebola virus is an airborne pathogen, or it isn’t.  The other possible explanation for the N95 recommendation is that the CDC is just not certain whether or not Ebola is able to be transmitted via the airways or not.  TO BE CLEAR, it is perfectly acceptable for the CDC to state “we just don’t know if it is airborne transmittable or not.”  However, failing to state this, the CDC implies by the N95 recommendation that Ebola IS able to be transmitted via the air, but is simply not stating this clearly.  Clarification is greatly needed in the EMS / First Responder community, as well as the general public.  If airborne transmission of Ebola is absolutely not possible, then why recommend the “Fit Tested N95 Respirator?”

  1. CDC also issued several updates to its website including recommendations for Healthcare Settings, Airlines and EMS responders.  In those updates, the CDC has conflicting terminology, particularly regarding what “body fluids” consists of.  In the more recent updates, “sweat” is mentioned more than once.  It is this specific modality that is now an area of concern.  Perspiration, as we all know, is a common bodily function.  Knowing this, it becomes particularly troublesome to know that it is possible for Ebola to be present in perspiration, and more troubling to know that a person who is either symptomatic or asymptomatic may be able to transmit the Ebola filovirus via perspiration;  a persons “sweat” can easily lay atop of any item they come into contact with.  This is potentially a very troubling issue for airline travelers and flight crews who are aboard aircraft that are traveling from known infected areas such as West Africa to America and other locations.  Further, the CDC sites studies that show that Ebola, as been able to remain viable for several hours on fomites and other non-host objects.  In the case of a person traveling on an aircraft (or other modes of transportation such as trains, ships, etc) it becomes clear that a threat exists for other persons who may subsequently share the same seat or area as a potentially infected person with Ebola without proper decontamination procedures taking place post-flight / sailing, etc.  In reviewing recommendations from the World Health Organization, proper decontamination of aircraft takes at least one hour for seats as an example.  Other items such as arm-rests can take up to 30 minutes.  Ultra-violet lighting is not an effective decontamination method in aircraft as planes in general, are shielded from Ultraviolet light spectra.  Therefore, it is of great concern that potentially infected persons can be traveling out of known “hot zones” (i.e. Sierra Leone, Liberia, Guinea, etc) without failing the initial screenings (i.e. febrile illness observed) and subsequent full decontamination of the aircraft would not take place post-flight given the unknown risk that is present.  As we have recently witnessed, the CDC can no longer assume that infected persons will fail the initial screening, nor can it be assumed that those who are infected will not take counter-measures to circumvent the initial screenings to lower their temperatures, etc., so that they may travel freely out of known epidemic regions.  This in fact, places other travelers at great risk, including the flight crews and ground crews.  During the recent #CDCchat on Twitter, I specifically asked what secondary measure or alternative screenings were being put into place to ensure that potentially infected travelers were not granted boarding privileges onto US-bound aircraft, to which I have not received a response.  Therefore, I am committing this question again to writing as to what the CDC and other US Agencies are doing to ensure that potentially infected persons are not able to board US-bound flights from known epidemic regions.  Additionally, how is the CDC and FAA ensuring passenger safety in terms of decontamination of aircraft given the extensive process proper decontamination entails?  It is known that most aircraft are only thoroughly cleaned once per 24 hours unless there is an actual known pathogen exposure.  If an airline is not made aware of an exposure until several days after an Ebola patient is identified, then there are potentially hundreds of innocent persons exposed to contaminated body fluids (as defined by the CDC) on any given aircraft once an infected person is on board the aircraft.  What are the specific measures that the FAA and CDC will look at to prevent further exposure risks moving forward?


After reviewing the multiple hearings and press briefings given by the CDC, NIAID, DOD and other agencies, one thing is clear;  there are no clear answers and the plans to protect innocent Americans from the threat of Ebola from imported cases is not solidified at this time.  The initial comments and testimony provided essentially stated that there would be little to no risk to the American Homeland.  As we have just witnessed, the risk to the Homeland exists.  While it is appreciated that this outbreak is unprecedented and that there always a certain level of “unknown” variables, it is distressing that the lead agencies are providing very mixed-messages and using terminology that is causing more confusion among the general public.  In addition, the use of terms during press briefings such as “boots on the ground,” “kinetics” etc., are terms used during military press briefings and are better suited in that type of forum.  There is an element of distrust and the overall tone being transmitted by the lead health agencies seems to be more of a “game” to those employing mitigation strategies rather than addressing real-world concerns from the average citizen.

In closing, it would appreciated if the CDC, NIAID, USAID and other health agencies involved in seeking to quell any potential Ebola threats to America start utilizing clear and concise terms, start to employ honesty and empathy during press briefings and website updates as well as to simply admit to areas of uncertainty.  There is much confusion as to which agencies actually have the lead in the Ebola outbreak situation, confusion as to why USAID is playing such a key role, as well as why the United States is permitting infected individuals to import Ebola from known epidemic centers.  We appreciate your response to the above listed concerns, and look forward to an honest and open dialogue as we move forward in the weeks ahead.

For Flash News Network,

Scott Anthony

Editor

References:

1. http://www.who.int/ihr/ports_airports/aviation_guide_p2_en.pdf
2. http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource3healthcare.html#e
3. http://www.cdc.gov/media/releases/2014/t1005-ebola-confirmed-case.html
4. http://www.cdc.gov/quarantine/air/managing-sick-travelers/ebola-guidance-airlines.html
5. http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html
6. Guidance on Air Medical Transport for Patients with Ebola Virus Disease(http://www.cdc.gov/vhf/ebola/hcp/guidance-air-medical-transport-patients.html)