Dallas
FOR YEARS, THOMAS ERIC DUNCAN languished, alone, thousands of miles from his family, the woman he loved, and the son he hadn’t seen grow up.
Duncan had been one of hundreds of thousands of civilians who fled Liberia’s deadly civil war in the 1990s, forced out of his own home and into a squalid refugee camp across the border in Ivory Coast. He had tried to start over, living with his brother in a tent. The two young men befriended the woman who lived in the tent next door, Louise Troh; Duncan fell in love. Amid the poverty of years in the camp, Troh and Duncan had a son, Karsiah, in 1995.
Everyone in the camp longed for a visa to the United States, a veritable golden ticket that held the promise of a new life on American shores, far away from the violence and poverty of the home they no longer knew. Troh and Karsiah won the lottery in the late 1990s; Duncan, who had never married his partner, was left behind. He spent another decade and a half in the camp, where he learned French, Ivory Coast’s official language.
Finally, in 2013, Duncan, still yearning for a ticket to America, felt it was safe enough to return home to Liberia. He moved into an apartment and got a job as a driver for a FedEx contractor. Louise had moved to the Dallas area, where Karsiah had grown up as a promising student, a high school quarterback who won admission to a college in San Antonio.
Then, Duncan’s luck seemed to change. One day the phone rang at the home of Wilfred Smallwood, the brother who had shared Duncan’s tent in the refugee camp and who now lived in Phoenix: “I got my visa! I got my visa!” Duncan shouted, ecstatic.1 His life seemed to be moving again; he and Troh would be married when he arrived, his son thrilled with anticipation at the prospect of seeing his father once again. Troh helped him book his plane ticket, from Monrovia through Brussels, then to Washington and on to Dallas.
In the days before his plane left, a young woman named Marthalene Williams needed his help. Williams, the daughter of Duncan’s landlord, was pregnant. She was also sick. Duncan, the landlord, and the landlord’s son piled into a taxi with the young woman, bound for Monrovia’s main hospital, and the nation’s largest Ebola ward. Duncan later said he believed she was miscarrying; he didn’t know she had the virus that was raging through his country.2
But the hospital had no room. Like so many others who were suffering, Williams was turned away. They got back into the taxi, and Duncan carried her into her own apartment. Williams, her brother, and her father would all be dead within a few days.
On September 19, Duncan arrived at Monrovia’s airport. Asked whether he had been in contact with anyone who had Ebola, Duncan said no. Whether his omission of the young pregnant woman was a lie or whether he truly did not know she was sick remains unclear. Either way, Duncan showed no signs of any disease; he boarded the airplane. By the next day, after layovers in two of the world’s busiest airports, he arrived in Dallas on United Airlines flight 822.3
Troh was ecstatic. She drove Duncan home to their apartment in Vickery Meadows, a melting pot of a neighborhood in Dallas, a magnet for new arrivals from South and Central America, from sub-Saharan Africa, a mini United Nations deep in the heart of Texas.
Five days after he arrived, Duncan began to feel aches in his joints and shooting pains in his abdomen. He developed a fever. That night, at 10:00 p.m., Duncan drove the few miles to Texas Health Presbyterian Hospital. A nurse took his temperature—103 degrees, well above normal—and asked whether he had traveled recently.
Texas Presbyterian was one of the dozens of hospitals across the country that had made initial plans in the unlikely case an Ebola patient walked through its doors. Just a week before Duncan had arrived, the hospital had run drills to prepare for a patient who needed to be isolated.4 The Centers for Disease Control and Prevention (CDC) had issued an advisory to American hospitals on August 1, urging those facilities to be alert for anyone complaining of fever, stomach pain, joint aches, vomiting, or diarrhea. The CDC issued a follow-up alert on September 4.
Duncan told the nurse he had just arrived from Africa, though he did not specify that he had been in West Africa. But the staff seemed to miss the message; a doctor prescribed Duncan antibiotics and sent him home to recover.
Over the next three days, Duncan’s condition worsened. By September 28, he could no longer get out of bed, so weakened by the constant tremors and emissions that taxed his body. That day, he returned to the hospital’s emergency room in an ambulance.
By now, the nurses suspected they might be dealing with something never before seen in an American hospital. Sidia Rose, the nurse who first interviewed Duncan in the emergency room, wearing some protective gear, asked her patient again about his time in Africa, and whether he had come into contact with anyone who might have been sick. Duncan once again said no. The doctors treating him huddled: Duncan might have malaria, they guessed, or gastroenteritis, or a particularly nasty flu. Or, one speculated, he might have Ebola. Duncan lay in the emergency room for at least three hours before his doctors put him in isolation.
At the home of Sonya Marie Hughes, one of Dallas County’s nine epidemiologists, the phone rang. It was a special line, a twenty-four-hour emergency hotline that hospitals are supposed to call when they suspect an outbreak of some dangerous disease. Hughes called her boss, Wendy Chung. Chung, in turn, called the CDC in Atlanta: Ebola, she warned, might have arrived in America.5
When Chung arrived at the hospital, she was shaken by Duncan’s blood work. The patient’s platelets were low, something that might be caused by an infectious disease like Ebola. He was not throwing up yet, and there was no diarrhea. CDC operators in Atlanta weren’t worried yet, because Duncan had not attended a funeral before leaving Liberia.
Still, Chung needed to test Duncan’s blood for the presence of Ebola—and fast. Only one agency in the state, the Texas Department of Health in Austin, was capable of running a test for such a rare disease. But the department’s experts in Austin were not even sure how they were supposed to transfer the samples from Dallas, about three hours north by car. Finally, after conferring with an increasingly nervous CDC, they agreed to have it couriered south for testing.
In the hours that followed, Duncan’s condition deteriorated, and Chung’s fears grew. Overnight, the patient began exhibiting more violent symptoms. Isolation, no matter how delayed, had been the right decision.
On Monday, September 29, the CDC announced that a patient in Dallas was being tested for the Ebola virus. Results were due the following afternoon.
Texas Presbyterian’s staff was quickly overwhelmed with the incredible amount of work it took to care for just one patient in isolation. Among the nurses asked to aid Duncan, fear was becoming palpable. But they knew their calling, and they stuck to their work. All were given the opportunity to decline to treat Duncan. None shied away. The precautions they took got progressively more restrictive: first, nurses wore only masks, then face shields, positive-pressure respirators, another layer of gloves. The hospital had no full-body biohazard suits equipped with respirators.
On Tuesday, Duncan finally confided in one of the nurses treating him. He told her about Marthalene Williams, the young woman who had died after he helped her to and from the hospital in Monrovia. Chung blanched when the nurse relayed the story. At least seventy-six hospital workers had been exposed to Duncan while he showed symptoms of the disease—including Chung herself. How many dozens more, including the five school-age children who lived in Troh’s apartment and the three-person EMT squad who had brought him to the hospital, had been exposed?
After calling the CDC, now convinced that Duncan had Ebola, Chung donned as much personal protective equipment as she could find and walked into the unit where Duncan lay. She began interviewing him herself: Where did you go? Whom did you speak with, touch, come into contact with? Dallas’s top epidemiologist knew she was racing the clock to trace Duncan’s contacts, to prevent an outbreak on American soil.
At the same time, she knew she would have to monitor herself for signs of the disease for the next three weeks.
Hours later, the blood work returned, and the CDC confirmed Chung’s worst fears. The man in the isolation ward had Ebola. A rapid response team, headed by the legendary epidemiologist Pierre Rollin, dispatched immediately from Atlanta. That night, an increasingly anxious state saw its governor, Rick Perry, holding a press conference at the hospital, trying to reassure his constituents that every possible precaution was being taken.
On Wednesday morning, Gary Weinstein, the doctor in charge of Duncan’s care in the hospital’s Medical Intensive Care Unit, reviewed his treatment options, slim though they were. A blood transfusion using blood from someone who had recovered and built up antibodies was not among those options. Neither Kent Brantly nor Nancy Writebol, the only two Americans with antibodies, matched Duncan’s blood type. ZMapp, the drug that may have saved both of them, was not a choice either because the supply of the hard-to-create drug had run out. The CDC recommended against another drug, TKM-Ebola, which would probably have made Duncan even worse.
The only option, he concluded, was brincidofovir, an experimental drug that had never been tested in humans.6 Manufactured by Chimerix, a North Carolina–based firm, the drug would stop the virus from replicating—if it worked at all. Even before they gave the drug to Duncan, hospital administrators would have to jump through a series of hoops, filing reams of paper required to grant what is called an Emergency Investigational New Drug Application with the Food and Drug Administration. (When news of the possible intervention leaked, Chimerix’s stock rose sharply.)
Outside the hospital, in Vickery Meadows and around the neighborhood, Chung’s team and experts from the CDC began tracking down everyone who might have had contact with Duncan. Initially, they believed that number might be small, no more than two dozen people. Eventually, they found more than one hundred people Duncan had been around—all of whom would need to be monitored for the next three weeks.
Though the CDC was in town, it quickly became apparent to local officials that the agency was not about to take over the entire response. Even if the CDC was equipped to take on such a mammoth task, they lacked the authority to do so. That hit home during a conference call, when Texas health commissioner David Lakey suggested establishing an incident command structure that would put one person in charge. Clay Jenkins, the Dallas County judge—the chief executive of local government—loved the sound of that idea.
“Well, who’s going to be in charge?” Jenkins asked on the call.
Tom Frieden, the CDC’s director, spoke softly: “You would be in charge,” he told Jenkins.7
“Everyone thinks the CDC comes and takes charge,” Lauren Trimble, Jenkins’s top aide, later told a journalist. “That was our assumption. Well, they don’t. They’ll help, sure. But we still have to do it.”8
Once the enormity of his task had set in, Jenkins began re-creating a response the county had executed a few years earlier, when a flu sickened hundreds around Dallas. The county set up an emergency operations center on the third floor of their building downtown. Their first job would be to take care of Troh’s apartment.
The apartment itself posed the greatest immediate threat of spreading the disease. It was where Duncan had spent days sweating, possibly bleeding, possibly excreting other bodily fluids. They would need to sanitize the entire space, though those who had shared it with Duncan while he became more and more contagious would have to be quarantined. Troh’s family, unable to leave the house, had to rely on donations from a local food bank.
Health officials dropped off fliers to residents at the Ivy Apartments warning about the dangers of Ebola and offering pointers on how to protect themselves. Many of the residents, though, did not speak English as a primary language, making it difficult to comprehend the fliers they had been given.
The county also needed to tamp down a growing sense of panic that was clearly infecting their populace. One of the young boys in the household had gone to school at Tasby Middle School on Wednesday; school officials had to send him home. The children in Troh’s apartment attended four different schools; attendance at those schools plummeted from a daily average of 96 percent to 86 percent as nervous parents kept their children at home. Students told reporters waiting outside those schools that other children, the children of African immigrants, were being bullied.9
The panic was spreading, too, to other parts of the country—and with a month to go before American voters cast ballots in midterm elections, the public’s reasonable fears were being inflamed for partisan gain. Perry established a state task force to combat infectious diseases and called on the Obama administration to create enhanced screening facilities for travelers coming back from West Africa, accompanied by fully staffed quarantine stations. Senator Jerry Moran of Kansas, who headed the Republican Party’s Senate campaign arm, and Representative Frank Wolf of Virginia demanded that the White House appoint a single adviser in charge of the response to the outbreak. (They suggested three senior statesmen, Mike Leavitt, Robert Gates, and Colin Powell—all Republicans.) Senator Ted Cruz, the ambitious young Texas Republican, asked the Federal Aviation Administration what steps could be taken to prevent passengers potentially infected with the virus from coming to the United States.
Republican candidates running for Senate seats in North Carolina and Michigan began calling for a ban on travel between the United States and West Africa. Influential members of Congress in charge of committees that oversee commercial aviation agreed: “We believe a temporary travel ban for such individuals who live in or have traveled from certain West African countries is reasonable and timely,” Pennsylvania Republican Representative Bill Shuster and South Dakota Republican Senator John Thune said in a letter to the administration. Representative Dennis Ross, a Florida Republican, introduced legislation to restrict commercial flights and travel visas for anyone from Liberia, Guinea, and Sierra Leone. House Speaker John Boehner said banning flights sounded like a good idea. (It did not seem to matter to any of those leaders that there were no direct flights from Monrovia or Conakry or Freetown to the United States; all passengers would have to connect through Lagos, or Brussels, or Paris, or London, and none of those countries had implemented travel bans.)
To humanitarian officials in charge of the response such as Anthony Fauci and Rajiv Shah, travel bans were exactly the opposite of what needed to happen. The flights were a lifeline, one that funneled medical responders into the places they were most desperately needed. Banning flights out of West Africa effectively meant banning doctors and nurses from flying into West Africa. They told President Obama that banning flights outright was a policy prescription that yielded no real results. During his first term, Obama had lifted a twenty-two-year-old ban on travel to the United States by those infected with HIV. At the time, he said, the policy was “rooted in fear rather than fact.”
But to political strategists, a call to ban flights played precisely to the fears most American voters harbored. Soon Republicans calling for a ban were joined by some Democrats—including Senator Kay Hagan, locked in a tight race for reelection in North Carolina (one she would ultimately lose). Polls showed 41 percent of Americans had “not much” or no confidence in their federal government’s ability to respond to the outbreak, including a majority of Republicans.
Only one Democrat, Arkansas Senator Mark Pryor, attacked Ebola from the other direction. He accused his opponent, Republican Tom Cotton, of voting to take funding away from disease fighters at the CDC. In November, Pryor lost by seventeen points.
Outside the political realm, others began acting more irrationally. Navarro College, a small two-year community school sixty miles outside of Dallas, sent a letter to several applicants from Nigeria on October 2, informing them that their acceptances had been rescinded because they lived in a country with confirmed Ebola cases. A teacher at a Catholic school in Louisville, Kentucky, quit her job rather than take a twenty-one-day paid leave after returning from a medical mission in Africa. Geographic logic had no place at Saint Margaret Mary Catholic School. The teacher, Susan Sherman, had served her mission in Kenya, on the other side of the continent from the infected countries.
Dallas County officials had contributed to the chaos, too: CNN had aired an interview with Louise Troh, in the days after Duncan was admitted to the hospital, in which she claimed that her family was being quarantined inside an apartment still crawling with Ebola-laden bodily fluids. Health officials realized they had not even figured out what kinds of permits they would need to transport debris from the apartment to an incinerator. Troh’s family waited for days before health officials finally took away the sheets and towels on which Duncan had slept.10 By Friday, Hazmat crews cleared out the apartment, stuffing everything but the walls into protective bags, and then into barrels. They had to chainsaw through the television and the PlayStation as Troh’s family stood nearby, still in the clothes they had put on that morning.
Hours later, Jenkins had found a home for the family, thanks to Dallas mayor Mike Rawlings. Rawlings’s son had vacated a house he was renovating a few miles away; to transport the family safely, and without scrutiny from the news media flying helicopters overhead, Jenkins made a call to the White House. Soon, those helicopters got an order to vacate the area; a dignitary, they were told, might be flying into nearby Love Field, so they needed to clear the airspace.11
The family spirited down a back stairwell, escorted by Jenkins into an idling SUV. It drove them the half hour to the new house, a small four-bedroom affair where the family could complete its quarantine out of sight of the media—and, importantly, in a safe, clean environment.12
In the hospital, Duncan continued to fight, and he tried to stay upbeat, though his body was failing him. On Tuesday, he asked doctors to play an action movie. On Wednesday, he told his nurses he was hungry—a positive sign that he might be staging a comeback. They fed him a packet of saltines and a can of Sprite, though he managed to take just a few sips.
The outward signs betrayed the extent of the damage the virus was causing. There was blood in Duncan’s urine, and doctors began to grow worried about his lung function. By October 4, his condition was downgraded from serious to critical. His organs began failing, just as the supply of the experimental drug, brincidofovir, arrived.13
Two days later, on Monday, October 6, Duncan’s mother, sister, and nephew arrived at the hospital, after driving all night from North Carolina. Doctors only allowed them to see the rapidly deteriorating Duncan through a closed-circuit television monitor. Finding her son glassy-eyed and virtually comatose, his mother Nowai Korkoyah dissolved into inconsolable sobs: “My son is dead!” she wailed.14
Nurses cared for Duncan around the clock. He was heavily sedated, tears running down his face. By Wednesday morning, his pulse had dropped to the mid-forties. The brincidofovir kept dripping through his intravenous, but doctors realized that their last hopes were diminishing rapidly. Duncan’s blood pressure suddenly dropped, a terrible indication of what was to come. One of the nurses, John Mulligan, wiped the tears away from Duncan’s eyes. It would all be okay, Mulligan told Duncan.
Fifteen minutes later, at 7:51 a.m. on October 8, 2014, Thomas Eric Duncan’s heart stopped.
Jenkins and Troh’s pastor made their way to the home across town a few hours later. They sat away from Troh, to avoid becoming exposed themselves, and told her the man she loved was gone. Troh lost it. Her son, Karsiah, had not been able to see his father before he died. The closest he came was signing papers allowing Texas Presbyterian to cremate the body.
Dallas County officials were not yet out of the woods. Still within the incubation period were 177 people who had come into contact with Duncan—friends, neighbors, children, and medical personnel. They checked their temperatures religiously, monitored by everyone from the county health department to the CDC in Atlanta. Every cough, every ache that would otherwise pass unnoticed became cause for concern.
It was a young nurse, one of those who had treated Duncan, who began to feel unwell first.
Nina Pham had a reputation for getting things right, for double- and triple-checking patient charts to avoid mistakes. The twenty-six-year-old daughter of Vietnamese refugees had earned her degree in nursing from Texas Christian University; friends there credited her with inspiring them, and even teaching them, to be better nurses. Just two months before Duncan had arrived, she had received her certificate in critical care nursing.
But on October 10, Pham developed a low-grade fever. She called one of Dallas County’s epidemiologists to warn her; when Pham’s temperature hit 100.5, she drove herself to her own hospital, where she was put in isolation just ninety minutes later. Jenkins and the epidemiologists were stunned at the news: Pham had not been on the list of those who might have been exposed.15
Doctors raced to treat her aggressively, assuming the worst. Three days later, the day after the CDC confirmed that Pham had become the first person to contract Ebola inside the United States, she received a blood transfusion from Kent Brantly; unlike Duncan, Pham’s blood type matched Brantly’s, and within hours Ebola-fighting antibodies were coursing through her veins.
On the same day, one of Pham’s colleagues, Amber Joy Vinson, boarded a Frontier Airlines flight from Cleveland to Dallas. A Kent State graduate from the small town of Tallmadge, Ohio, Vinson, age twenty-nine, had returned to her childhood home to plan her wedding; she visited a bridal store to try on dresses while she was there.
During her time at home, Vinson had begun feeling unwell. Her temperature also began rising, to 99.5 degrees. The day after she arrived home, Vinson’s fever went up again; it took about twenty-four hours for blood tests to reveal that she, too, had Ebola.
The fact that Vinson had traveled twice, from Dallas to Cleveland and back, alarmed CDC doctors, and spooked the media. Federal authorities raced to track down about 150 people with whom Vinson had come into contact in Ohio, including 87 people on the two Frontier airplanes she flew. (The airline took one plane out of service and replaced seat covers and carpet near where Vinson had sat.) A Transportation Security Administration agent in Cleveland, who had patted Vinson down on her return trip, was placed on a three-week paid leave. So were the six members of the Frontier flight crew, four flight attendants and two pilots, who flew from Cleveland to Dallas.
At the same time, another lab worker who handled the Liberian man’s blood had departed on a cruise a few days before; when she started feeling unwell, the lab worker quarantined herself in her cabin until the cruise ship neared Galveston, Texas. Federal officials had already asked the governments of Belize and Mexico to allow the lab worker to disembark; both countries said no. Governor Rick Perry refused to allow the ship to dock with a potentially Ebola-infected person aboard, so the Coast Guard dispatched a helicopter to pick her up. She never developed symptoms.
There is an old and cynical saying in the news media: If it bleeds, it leads. Vinson and Pham quickly proved that blood need not be spilled to provoke a frenzy, much of it centered on rumors that proved inaccurate. Reports that Vinson had traveled against doctors’ orders turned out to be false; she had been given approval to fly home by a CDC physician.
Still, the media publicly fretted about the prospect of so many who had come into contact with Duncan traveling freely across the country. Both Ohio and Texas implemented new rules restricting travel for anyone who might have been exposed.
In truth, the physical characteristics of Ebola make it susceptible to oxygen, making transmission unlikely, though not impossible. But calm and rational analysis of medical facts are tough to fit into a breaking news headline on television.
A debate was brewing, both on public airwaves and on the conference calls between senior medical officials, over how Pham and Vinson had been infected. No one knew for sure; neither nurse could remember coming into direct contact with Duncan’s bodily fluids. The CDC’s Frieden had seemed to suggest, the day after Pham fell ill, that the nurses had not properly protected themselves. He apologized a day later for seeming to blame the nurses for getting sick, though Frieden and Anthony Fauci continued to believe they had not followed protocols.
Duncan’s infection, and the subsequent infections of Vinson and Pham, deeply shook the White House and those who believed that the U.S. hospital system was better prepared to catch any potential Ebola cases. “We all had the impression that any hospital would not only be able to recognize that somebody was infected with Ebola, but take appropriate precautions,” said Amy Pope, the president’s deputy homeland security adviser. “We had gone into it with the assumption that U.S. providers would be able to recognize the signs of Ebola.”
Texas Presbyterian had missed those signs.
“Basically, the facts showed we were wrong on two counts: One, the hospital did not do the travel history [on Duncan], so they basically missed it the first time he was at the hospital. So they didn’t recognize from the outset, so that made clear to us that we needed to put some other triggers in place,” Pope said. “The second piece was, what kind of infection control did they exercise?”
The patients, Pham and Vinson, were lucky that their symptoms were caught early. Duncan had been sent home to fight the virus alone for three days. Now, hypersensitive to the possibility of Ebola’s spread, doctors intervened the moment both women showed any signs of infection. And where the CDC had been caught off guard by Duncan, they were more ready to treat new patients—just not at Texas Presbyterian.
Only a handful of facilities around the nation are capable of treating a patient under biosecurity level-4 conditions: the Nebraska Medical Center, Emory University in Atlanta, the National Institutes of Health (NIH) in Bethesda, Maryland, just outside of Washington, and the U.S. Army Medical Research Institute for Infectious Diseases (USAMRIID) at Fort Detrick. The Nebraska facility was already treating one patient, Ashoka Mukpo, a freelance cameraman who had contracted Ebola while on assignment in Liberia. The NIH offered to take Pham; she arrived in the Special Clinical Studies Unit, on NIH’s Washington-area campus, on October 17, about a week after her first symptoms. Vinson would be sent to Emory, where she arrived on October 15, just a day after being diagnosed.
Instead of simply isolating patients, all four hospitals were practicing what they called “supportive care,” an intensive treatment regimen aimed at keeping the body strong enough, long enough, to develop its own antibodies. Doctors worked hard to maintain vital signs like breathing and blood pressure, to ward off the hemorrhaging and organ shutdown that progressed during advanced stages of infection. Treating a patient with so much attention required an around-the-clock staff effort; in Bethesda, about twenty-seven people per week treated Pham.16 In Atlanta, Vinson too received blood transfusions from both Brantly and Writebol.
Pham was most worried about her dog, a Cavalier King Charles spaniel named Bentley. A week earlier, a dog belonging to a Spanish missionary who was fighting for his life after returning from West Africa had been euthanized; health officials there were worried that the Ebola virus might lurk in the dog’s blood and infect someone new. Pham did not want her dog to suffer the same fate. Jenkins, the Dallas County judge, was also determined to save the dog, for public relations purposes if nothing else.
Fortunately for Bentley, the U.S. Army Medical Research Institute for Infectious Diseases had an answer. The diagnostic tests that the Army scientists had prepared before American troops were deployed to Liberia would also indicate the presence of Ebola in dog blood. USAMRIID had run those tests in case the 101st Airborne had taken Army working dogs with them on deployment. (Ultimately, the military decided against taking their dogs.) Army doctors and veterinarians kept Bentley in quarantine for three weeks, testing his blood from time to time to see if he had picked up Ebola. The virus never showed itself in the dog.
Both Pham and Vinson, overseen by teams of dedicated doctors, recovered remarkably quickly. In just a week after arriving in Bethesda, five straight blood tests showed the Ebola virus had left Pham’s bloodstream. Nine days after she arrived at Emory, Vinson, too, was declared virus-free.
Pham walked out of the NIH facility under her own power on October 24, two weeks after first falling ill. At a press conference surrounded by the doctors who treated her, Pham—showing no outward signs of the aftereffects of the virus—read a brief statement. Fauci, among those who had treated her, made a point to put his arm around her, to demonstrate there was no risk in touching a survivor. “She has no virus in her,” Fauci said at the press conference. She was reunited with Bentley when she returned home to Dallas.
Four days later, Vinson, too, walked out of Emory looking healthy, if shaken. She wiped away tears as she thanked God, her family, and the medical team that nursed her back to health.
In Washington, with an election around the corner, Republicans began ratcheting up pressure on the White House. Privately, even Democrats were worried that President Obama’s response was missing the mark. What the White House sought to convey was a president executing a calm and steady response, driven by science and not irrational fear and panic. What the public saw, more often, was an aloof executive detached from the rising panic his constituents felt.
Obama tried to make clear that he took the threats seriously. The day Pham arrived in Bethesda, Obama canceled out-of-town fundraisers for Democratic candidates in Rhode Island and New York. He also signed an order that gave the Pentagon the authority to call up National Guard troops, if needed, to fight the outbreak.
Publicly, the White House still projected outward confidence. Most strikingly, Obama hosted Pham in the Oval Office. A woman who had been diagnosed with the most dangerous virus in the world just two weeks prior was photographed hugging the president of the United States of America. The photograph led all three nightly news broadcasts. He called Vinson, too, when she was released.
Back in Dallas, what could have turned into the first full-scale outbreak of the Ebola virus in American history, perhaps miraculously, did not. Days went by, with Jenkins, Rawlings, and their staffs on high alert. The first potential contacts, those who had been near Duncan as he deteriorated, began to emerge from quarantine with no symptoms. After three weeks, all 177 contacts were clear.17
But while scientists were beginning to understand the Ebola virus more intimately than ever, Pham and Vinson presented a new mystery: Was it the fast treatment they received that helped them recover so quickly? Was it the antibodies they received through blood transfusions from Brantly and Writebol? Was it the focus on keeping vital signs at healthy levels, to give their bodies the time to develop their own antibodies?
The experiences of Pham and Vinson, and of Brantly and Writebol before them, had taught scientists one valuable lesson: Providing support, no matter how ill a patient, was worth the effort.
“The general dogma in our industry in July was that if patients got so ill that they required dialysis or ventilator support, there was no purpose in doing those interventions because they would invariably die,” Bruce Ribner, medical director of Emory University Hospital’s Serious Communicable Diseases Unit, said at a press conference. “I think we have shown our colleagues in the U.S. and elsewhere that that is certainly not the case, and therefore, I think we have changed the algorithm for how aggressive we are going to be willing to be in caring for patients with Ebola virus disease.”18
What Ribner meant was: If the worst happens, we know how to treat the Ebola virus. It was an important message for the world, both in the United States and for nongovernmental organizations still trying to decide how to be helpful in West Africa.
But at the same press conference, Ribner betrayed just how much the medical community had left to learn about the virus that had now breached American shores. Asked why Pham and Vinson had recovered so quickly, Ribner admitted: “The honest answer is that we’re not exactly sure.”
That uncertainty bedeviled the White House. The government’s confidence in its ability to prevent an outbreak on American soil had been deeply shaken, and now they wondered whether the military—already setting up Ebola treatment centers at breakneck speed on the other side of the Atlantic—might have to build similar facilities back home.
“Because our confidence was so undermined by what happened in that Dallas hospital, the fact that two health care workers became infected in the hospital, created a situation of, we really don’t have that much insight into the way our hospitals do business,” Pope said. “There was a question of, could there be other Dallas cases?”