Panic and Quarantine
EVEN BEFORE RON KLAIN arrived at the White House, the spread of the Ebola outbreak in the minds of the American people had made that fateful jump, from a far-off foreign problem to a perceived threat at home. Few concepts are scarier than the notion of a virus, something so small it is invisible except under an electron microscope, capable of killing in the most gruesome of ways, especially if, as Michael Osterholm had written in the New York Times in September, that virus goes airborne.1
The White House, led by the cerebral and logical president, insisted on staying out of the way of the scientists who had both the knowledge and capacity to be able to stop the virus. But while those scientists had the expertise necessary to marshal the greatest Army against a pathogen in the history of the world, they lacked the diplomatic touch, the art of spin necessary to communicate with an already frightened and nervous public.
On October 16, Tom Frieden of the Centers for Disease Control and Prevention (CDC) arrived at the Capitol complex in Washington, to give members of Congress an update on American efforts to fight Ebola. By then, the CDC had 139 staffers on the ground in West Africa, and more than 1,000 agency staffers had provided logistics, communications and analytics support, both in Atlanta and overseas. Three thousand U.S. troops were on their way to Liberia, and hundreds of doctors affiliated with global nongovernmental organizations (NGOs) were pouring back in. Still, Frieden said, the outbreak represented “the biggest and most complex Ebola challenge the world has ever faced.”
Looking over his lectern, Pennsylvania congressman Tim Murphy, a Ph.D. psychologist whose public health experience included appearing on a Pittsburgh television station to offer medical advice and who had called the hearing, delivered his own verdict: “The math,” Murphy said, “still favors the virus.”
Klain and others understood that they were battling public psychology, as well as a virus. Humans are conditioned, they knew, to fear the new threat much more than the old, more common threat, regardless of any logic. When we hear about a shark attack off the Florida coast, or a terrorist threat against a major landmark, we are much more likely to fear that new threat than we are to fear threats that, statistically speaking, are much more likely to kill us. Humans fear the shark bite and the terrorist’s bomb more than they do being hit by a car, even though a car is thousands of times more likely to kill someone than a shark or a terrorist—or, for an American living across a vast ocean from the epicenter of an outbreak, than the Ebola virus.
It is another trick of evolution, a mechanism that allows our brain to keep on living despite the threat of being hit by a car—or, thousands of years ago, being eaten by a bear or a tiger as we slept in a cave—without being consumed by fear, while at the same time adapting to and factoring in new threats.
In his office on the grounds of the National Institutes of Health (NIH) just outside Washington’s borders, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, understood the sentiment. It was similar to one he had experienced with the rise of HIV and AIDS, a virus doctors struggled to understand and the public began to fear. Fauci, who has treated more AIDS patients than almost any other medical professional alive, remembered the panic of the 1980s, as the epidemic reached its peak, when people worried they might get AIDS from going out to a restaurant in Greenwich Village, where a gay waiter might be the server. Someone had asked Fauci: Can I get AIDS from eating spaghetti? Fauci had seen a similar panic after envelopes containing deadly anthrax were sent to some news outlets and members of Congress, just weeks after the September 11, 2001, terrorist attacks.
In the midst of the AIDS epidemic, after the anthrax attacks and now again during the Ebola outbreak, Fauci made the media rounds, trying to convey that the respective threats of contracting a deadly disease—from a gay waiter in a restaurant, from handling one’s mail, or from a traveler returning from West Africa—were entirely out of touch with the actual risk. Once again, Fauci was called upon to appear on the Sunday morning news shows, on cable news, and on major radio programs, where he was asked about the threat of contracting Ebola. His strategy, honed over decades of dealing with a panicky public, was to repeat himself, again and again.
“You have to respect the fear of people,” Fauci told an interviewer at the Washington Ideas Forum in October 2014, at the height of the U.S. panic. “You can’t denigrate it and say, ‘Why are you afraid?’ You’ve got to explain to [the public], and you’ve got to do it over and over.”
The fear of contracting Ebola was, Fauci and Klain knew, entirely illogical. But logic and rationality are among the first victims in a dangerous situation, and both men understood they would have to factor in the public terror as they crafted their own response. Irrational fear was not even confined to those who didn’t do this sort of stuff for a living. USAID director Rajiv Shah recalled having returned from a trip to West Africa in mid-October, landing early in the morning and racing to his office to take a quick shower. Shah headed to the White House for a National Security Council meeting, to share what he had seen on the ground. When he told his fellow emergency responders—including some of the same medical experts who knew the real risks—that he had just returned from the epicenter of the outbreak, several of those at the table physically recoiled.
Shah, Fauci, and, when he came on board, Klain found themselves on the same side of the next significant policy fight the administration faced. After successfully fighting off proposals to ban flights between infected West African countries and the United States, they now faced calls to quarantine anyone who had traveled to Liberia, Guinea, or Sierra Leone.
To those at National Security Council meetings, quarantines were just travel bans by other means: quarantining travelers meant quarantining returning volunteers, the very doctors, nurses, logisticians, and Samaritans who were most needed to fight the disease. And that was before the 3,000 American troops would rotate home—how would the military quarantine so many of its own for three full weeks?
The debate had only just begun when one of those volunteers, a young doctor with an office at Columbia University in New York, woke up with a headache.
Senior government officials would later be struck by the image of Craig Spencer, a young hip emergency room physician who never lost his liberal idealism, sitting next to Kent Brantly, a deeply faithful man who worked for an organization run by the evangelist Franklin Graham, in the White House. The two men were from entirely different worlds, but both had traveled to West Africa to fight for some of the most impoverished people on the planet. More than a few in the Obama administration saw the common ground Spencer and Brantly found as refreshing evidence that, in a deeply polarized political environment, Americans on both sides of the ideological spectrum were good and selfless.
In the middle of October, Spencer, age thirty-three, had returned from a tour of duty volunteering for Médicens Sans Frontières (MSF) in Guinea. He was exactly the kind of volunteer MSF needed, having worked in some of the most battle-scarred regions of Africa, in Rwanda and Burundi. But the deployment to Guinea affected Spencer more than his previous stints overseas, he wrote later.
“The suffering I’d seen, combined with exhaustion, made me feel depressed for the first time in my life,” he wrote in the New England Journal of Medicine.2 He slept for hours on end and withdrew from his friends. Even back home, he felt the same angst about shaking hands or making physical contact that infused daily life in Guinea. He worried most about infecting his fiancée; the twice-a-day ritual of taking his own temperature caused minor panic attacks.
Ten days after he returned to the United States Spencer woke up with the certainty that something was wrong. Despite another night of deep sleep, Spencer felt exhausted, and he had a fever. His breathing was too rapid to be normal. The thermometer showed his temperature was creeping up. Spencer quickly called New York City’s public health department to report himself. In a way, he felt relieved: “Although my worst fear had been realized, having the disease briefly seemed easier than constantly fearing it,” he wrote. Within hours, Spencer was admitted to an isolation unit at New York’s Bellevue Hospital, with a temperature of 100.3.
That afternoon, October 23, was Klain’s second day on the job. He was sitting in the office of Sylvia Matthews Burwell, the secretary of Health and Human Services, when both of their phones vibrated. It was the CDC, activating a warning system established to alert top officials when someone showed up at a hospital to be tested for Ebola. Both Klain and Burwell scrolled through the CDC’s alert, which included a fact profile of the patient: physician, recently returned from Guinea, and more specifically from an area in Guinea with a significant outbreak, showing symptoms twelve days after his last possible exposure to the virus. Check, check, check. And Spencer’s temperature was rising every hour. Double check.
Klain raced out of Burwell’s office, making his way back to the White House to mount his first response, little more than twenty-four hours after taking the job. Klain called New York governor Andrew Cuomo, and Tony Shorris, New York City’s deputy mayor, to share what he knew and hear their plans. He and Shorris were having maybe their third conversation ever; they had been introduced a few days before, through a mutual friend. Now the two of them would have to come up with a plan to prevent Ebola from spreading through America’s largest city.
Fortune once again smiled: If any agency in America knows what it takes to fight an outbreak, it is the New York City Department of Health, which has decades of experience tracing contacts and performing medical surveillance—though maybe not in something as deadly or as scary as Ebola. Over the years, the agency had battled everything from cholera to AIDS to the spread of bedbugs.3 Contact tracing, the key first step to bring an outbreak under control, was old hat for New York’s frontline medical workers.
Interviewers spoke with Spencer almost immediately to build a timeline of his activities after returning home, so they could identify and track anyone with whom he might have come into contact. Spencer detailed his calendar: he had ridden the subway, of course (he was, after all, a New Yorker). He had gone bowling, eaten a meatball sandwich, ridden in an Uber. He was worried beyond words about his fiancée.
Spencer represented a crucial test of the administration’s efforts to maintain an impression of competence. On one hand, treating Spencer effectively and watching him recover could give the administration the feel-good story it needed to show that the federal government was capable of handling whatever might come its way. On the other hand, if anyone else got sick, the downside risks were tremendous. The stakes were so high it forced a sort of clarity in the moment.
“That was the beginning and the end of our communications strategy,” Klain recalled later.
As far as I was concerned, the only thing that mattered was that no one else in New York get Ebola. If we could show in those hard first ten days that Craig Spencer could leave the hospital healthy, and that no nurse, or no person who rode the subway, or no person who got in an Uber, or no person who bowled, or no person who ate a meatball sandwich, or no person who lived in an apartment building with a nurse or a doctor got Ebola, that was the only communications strategy that mattered.… The thing that was going to be most effective in allaying public fears was to be able to say to people: Well, look, you saw it with your own eyes. Nobody got sick.
The media was obsessively reporting the story, wondering aloud whether Ebola could be transmitted in the subway, in the meatball sandwich shop, in an Uber. Several outlets reported Spencer’s condition just hours after he was admitted to the hospital, even identifying him by name. It galled Klain that Spencer hadn’t even had the chance to call his own mother to tell her before news outlets reported his illness. It galled him more that outlets reported that Spencer had a temperature of 104.1 degrees—a dangerously high level that would seem to indicate he had been sick, and contagious, for days. Somewhere along the way, two digits had been transposed: Spencer’s actual temperature by that afternoon had risen to 101.4, still high, but nowhere near as dangerous as early reports suggested.
After hanging up with Shorris, Klain met Obama, chief of staff Denis McDonough. and Lisa Monaco, Obama’s chief homeland security adviser, in the White House’s Diplomatic Room. Obama, conscious that a new case of Ebola, after the nurses in Dallas, would create new calls for quarantines and flight restrictions, cracked a wry joke: “Well,” he said, “this isn’t going to help.”
The only way Klain knew the White House could assuage a nervous public would be to ensure that no one else got sick. There were not many appealing ways to satisfy media outlets intent on running ever more shock-inducing headlines on their front pages and in their broadcasts. But there was that third audience Klain needed to satisfy, an audience whose buy-in the government needed in order to create a truly national safety net to detect the first signs of any Ebola outbreak, and one that had its own financial future to consider. These were the hospital administrators, those professionals who ran the major public health institutions in big cities around the country.
The administrators had seen what happened to Texas Presbyterian Hospital in Dallas, when Duncan fell ill. Patients avoided that facility in droves, a situation that grew even worse when nurses Pham and Vinson contracted the disease. Revenue collapsed. Klain needed other hospitals to agree to serve as Ebola treatment centers in the United States, a process that would require them to spend lots of money to build isolation units, train staff, and ultimately gain certification, but one that could also cost them if patients started to wonder whether the virus lurked somewhere in their doctor’s office. Just as Klain needed to prove to the public that no one else in New York would get sick, he needed to prove to other hospitals around the nation that they would be well taken care of if and when a patient with Ebola arrived on their doorstep. And that meant showing support for Bellevue now that Spencer was sick.
The difference between the American medical system and that of the other Western nation most likely to have to deal with Ebola cases, the United Kingdom, illustrated the difficulties the White House faced. In the United Kingdom, the centralized health system meant that the government could designate one hospital to treat any patients who came down with the disease. It was not the hospital’s choice, it was the government’s choice. In the United States, the federal government had no such authority, either over state hospitals or privately run hospitals. It was up to Klain and his team to convince hospitals that it was in their interest to accept any patients who might show up presenting scary symptoms.
If something went wrong at Bellevue, Klain knew that the task of convincing other hospitals to treat Ebola patients would be all the more difficult. On the other hand, if everything went smoothly, Klain thought he could portray the doctors and nurses at Bellevue as heroes, piquing the interest of other hospitals that might want their own doctors and nurses to be seen in a similar light.
Making sure everything went well meant working proactively as much as possible. As Duncan lay in intensive care in Dallas, his blood samples making their way to Austin for testing, the CDC had waited crucial hours before deploying a team to help Texas Presbyterian. The CDC would not make the same mistake again: even before Spencer’s blood samples came back showing he was positive for the Ebola virus, CDC advisers walked through Bellevue’s front door.
Those advisers set about creating a support network around the hospital, training nurses and doctors alike in donning and doffing personal protective equipment and other protective measures. The last thing anyone needed was another sick nurse. The CDC team began running down a checklist of questions they needed to answer quickly: Treating anyone with a contagious disease, especially one like Ebola, generates a lot of waste; where would that waste go? How would it be treated? How would the hospital deal with public anxieties about their nurses and doctors? Landlords who owned apartments where some nurses lived hinted that those nurses could be evicted because of the risk they posed. Every one of those questions had come up in Dallas; in New York, the CDC wanted answers before questions turned to problems.
At the same time, Klain, McDonough, Monaco, and their teams kept adjourning to separate meeting spaces across the White House’s sprawling campus to hammer out the administration’s policies on returning health-care workers. How would a returning volunteer like Spencer be monitored, quarantined if necessary? Hundreds of American doctors, nurses, technicians, and others who had volunteered in West Africa would be returning home in the coming months, and debates raged over how strictly those who came home would be monitored. They kept Obama apprised of the internal debate throughout the weekend.
If Spencer’s proactive decision to call public health officials at the first sign of trouble demonstrated the best inclinations of a hyper-aware volunteer cognizant of the danger he or she might pose to others, the way another young returning volunteer was about to be treated demonstrated the worst instincts of politicians eager to show their own leadership, however misguided. And it would illustrate to the White House, once again, the urgency of creating a policy that struck the delicate balance between protecting Americans and protecting individuals, between preventing an outbreak at home and providing the resources necessary to fight the disease in West Africa.
Kaci Hickox had already had a long day, or days, when she arrived at Newark’s Liberty International Airport on Friday, October 24, the day after Spencer checked himself into the hospital. The flight from Freetown required a stopover in Europe, and after a month in the hot zone, the stress of a long trip weighed on her. She had volunteered at an MSF clinic in Sierra Leone, a clinic where staff did not bother to count the number of victims who had died; it was easier to count the smaller number who survived. On Hickox’s first day in the clinic, she had asked one of her patients whether any of her family members had gotten sick; the woman told her that seventeen family members had died within the past two months. On her last night, Hickox gently fed Tylenol and antiseizure medication to a ten-year-old girl whose body shook with violent tremors. Hours before she boarded a plane home, Hickox watched the girl die.4
So Hickox may have had other things on her mind when she told the immigration agent at the airport that she was returning from West Africa. The young man steered her toward a secondary screening room, a windowless facility in the bowels of Newark’s airport. There, over the next four hours, she was questioned by a parade of officials. She got the sense that some were accusing her of an unspoken wrongdoing. Others exhibited at least a modicum of friendliness, introducing themselves and offering weak smiles. Someone brought Hickox a granola bar and a glass of water when she asked. The nurse noticed that one of her interrogators, a man from the CDC, was scribbling notes in the margins of the official-looking form he was filling out; the CDC’s form did not include enough space for all the information the man had to collect.
After four hours, as she grew increasingly frustrated with her detention in the claustrophobic space, a U.S. Customs agent used a forehead scanner to take her temperature, then smirked when the readout showed Hickox had a 101 degree fever. Hickox knew a forehead scanner would be thrown off by her flushed cheeks. The agent seemed as if he didn’t particularly care.
But she had little choice other than to follow the agent to an ambulance, which drove her to University Hospital in Newark. She thought the fuss the agents were making was beyond overkill. Eight police squad cars escorted Hickox the few miles between the airport and a tent, set up outside the hospital as a kind of makeshift isolation unit. The two senior doctors who attended to Hickox were confused—they were told their new patient had a fever. An oral thermometer, far more accurate than the forehead scanner, pegged Hickox’s temperature at exactly 98.6 degrees.
“There’s no way you have a fever,” one of the doctors told her. “Your face is just flushed.”
Hickox was the first person to be subject to new orders issued the day before by New York governor Andrew Cuomo, a Democrat, and New Jersey governor Chris Christie, a Republican. Under those orders, any travelers returning through John F. Kennedy Airport or Newark’s Liberty from West Africa who had contact with an Ebola victim would have to be quarantined for the full twenty-one-day incubation period. If passengers lived in New York or New Jersey, they could be quarantined at home, subject to twice daily check-ins with state medical personnel.
For Hickox, who lived in Maine, that meant an extended time in the tent, which had only a portable toilet and no shower. When she asked to be allowed to take a shower, after two days traveling from the other side of the world and seven hours in an unpleasant airport quarantine room, hospital staff gave her a bucket and a sponge. Instead of a clean change of clothes, Hickox was given thin paper scrubs. Even her cell phone barely got reception. Her situation did not change when her blood work came back the next day: she had tested negative for Ebola.
Christie, a bombastic figure known more for yelling at anyone and everyone who opposes him than for any actual policy achievements during his two terms as governor, maintained that quarantine was the right approach, even as he repeated a number of incorrect statements. At a press conference on Saturday, Hickox’s first full day of quarantine, while campaigning for the Republican governor of Florida, Christie said the nurse was “obviously ill.” (Not known for backing down or admitting fault in the face of facts, Christie repeated his misinformation over the following years, including in a nationally televised debate just days before ending his quixotic presidential campaign in 2016.)
The next day, a second test of her blood came back, this one also negative.5
Hickox had the presence of mind to mount a public relations campaign, with help from a few well-placed friends. “I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine,” she wrote in an op-ed for the Dallas Morning News,6 placed through a friend who worked at the paper.
On Sunday, Hickox’s cell phone worked well enough to call in to CNN, where she castigated Christie’s diagnosis from afar. “First of all, I don’t think he’s a doctor,” Hickox said of the governor. “Secondly, he’s never laid eyes on me. And thirdly, I’ve been asymptomatic since I’ve been here.”7
After hanging up with CNN, Hickox told hospital staff she wanted to see her lawyer. She had not shown any symptoms since arriving back in the United States, though it still took hours of wrangling and negotiations before she was allowed to speak with an attorney. By Monday, eighty hours after arriving at Newark, she was freed, allowed to return home to Maine. Some of the hospital staff, who agreed with Hickox about the danger of blanket quarantine policies, made a show of shaking her hand without wearing protective gloves.
Still, Christie and Cuomo had put even more pressure on the White House. On Sunday, Obama met with his Ebola team and senior administration officials—twenty-six people in all, including Vice President Joe Biden, the secretaries of Health and Human Services, Defense, and Homeland Security, Attorney General Eric Holder, and others. They had to walk the thin line between acknowledging the obvious threat and allowing scientists to do the work that would actually stop the disease’s spread.
“The President underscored that the steps we take must be guided by the best medical science, as informed by our most knowledgeable public health experts,” the White House said in a statement that day.
He also emphasized that these measures must recognize that healthcare workers are an indispensable element of our effort to lead the international community to contain and ultimately end this outbreak at its source, and should be crafted so as not to unnecessarily discourage those workers from serving. He directed his team to formulate policies based on these principles in order to offer the highest level of protection to the American people.
In plainer English: the White House did not want to take the steps Cuomo and Christie wanted to pursue. They would have to find a way to convince Americans that returning health-care workers would not start their own Ebola outbreak once they got home—without locking them in a tent outside a hospital in Newark.
Christie’s office tried to spin Hickox’s departure as a political victory. She would return home by private transport, Christie’s office said, not by train or plane. Another Republican governor facing a tough reelection fight in November, Maine’s Paul LePage, said his state would work with Hickox to quarantine her at home; Hickox had no interest in such an arrangement. After just a few days, a state court refused to grant LePage an order forcing the nurse to stay home. She took pride in going for a bike ride with her partner the next day. She never came down with the Ebola virus.
Still, underscoring just how much the American public feared the Ebola virus, polling showed that a vast majority of voters sided with Christie over Hickox. Eighty percent of Americans told CBS News pollsters they wanted anyone returning from West Africa to be quarantined. In New Jersey, just 37 percent of voters said they believed the federal government was handling the outbreak well,8 and two-thirds said they approved of Christie’s decision to quarantine the young nurse.9
Just two days after Spencer was admitted to the hospital, Samantha Power and her team boarded an Air Force jet, a modified 737, at Andrews Air Force Base just outside the Capitol Beltway. Power hoped to raise global awareness by showing up in West Africa. And her presence would be notable: she would be the first member of President Obama’s Cabinet to set foot in the hot zone. She brought along reporters from NBC News, the Reuters United Nations bureau chief, and Evan Osnos, a staff writer at the New Yorker, to shed some light on what she saw as an undercovered crisis.
“It was an opportunity to demystify Ebola,” Max Gleischman, Power’s spokesman, recalled in an interview later.
Still, Spencer’s illness scared the team, and as Christie and Cuomo implemented new quarantine requirements in New Jersey and New York, the team members questioned whether they should go. They were supposed to return home to New York, where Power had to go to work at the United Nations. What would it look like if America’s ambassador to Turtle Bay were stuck in a quarantine tent the way Kaci Hickox had been? Ultimately, Susan Rice, Power’s predecessor and now the president’s national security adviser, signed off on the trip.
Power stopped first in Conakry, Guinea, then in Monrovia, Liberia, and Freetown, Sierra Leone. As she whisked between government ministries and American embassies, Power and her team were subjected to the same rigorous cleaning processes as an everyday West African: bleach baths for their shoes, guards armed with forehead thermometers, constant hand-washing. At one point, Gleischman asked Power to slow down, so the NBC cameras could capture her undergoing the screening process.
In Liberia, Power saw firsthand just how vast the scope of the outbreak had become. There were signs everywhere, advertising the emergency number residents should call if they found a dead body, or if they suspected a friend or family member was ill. Inside the giant emergency operations center in Monrovia, detailed maps of the city covered the walls. Blue pushpins represented the locations of those who might be infected. Red pushpins represented bodies that needed to be picked up. Gleischman was struck by the sea of blue and the islands of red, scenes of death and disease in a tightly crowded city of a million residents.
After a quick trip back to Monrovia’s airport, then across the country in an Osprey, Power visited a mobile testing lab run by the U.S. Navy in rural Bong County, near the heart of the initial outbreak. They visited an Ebola treatment unit—though they stayed far away from any potentially infected patients, cognizant that Cuomo and Christie still had quarantine orders ready to be imposed.
A day later, in Freetown, the magnitude of the outbreak appeared most evident—the city was a ghost town. At a soccer stadium the British military had taken over to build their own operations center, Power watched new medical trainees, about to be deployed into the field, dress in full personal protective equipment and jog around a track under the tropical sun, preparing for the intensity of treating patients in a hot zone.
Power made a final stop in West Africa, in Ghana, where she met with Anthony Banbury, the American who had been placed in charge of the United Nations Mission for Ebola Emergency Response, or UNMEER, at the new group’s makeshift headquarters in an industrial park near Accra’s main airport.
Banbury had been in charge of field support for UN missions across the world before taking over as head of the Ebola response. And despite his thirty years’ experience at the UN, he made clear to Power and her team that he was frustrated. Amid piles of gear stacked to the ceiling, like some kind of Costco for public health, Banbury told Power he had been frustrated by the logistical hurdles he faced, and the pace with which help was arriving.
“The U.N. just isn’t equipped to do these things quickly,” Gleischman said later, summing up the consensus view among the U.S. delegation. “It’s just not fast, and this was a time where speed was literally a matter of life or death.”
Frustration with UNMEER’s slow start soon trickled down to American and other international responders on the ground. Within weeks, high staff turnover at the UN agency convinced many that the new mission was doomed to irrelevance.
Power’s last stop came in Brussels, where her U.S. Air Force plane parked at the far end of the tarmac for half an hour while medical personnel were summoned to check the Americans for signs of infection. Once cleared, Power hosted about twenty European ambassadors at the American embassy to the European Union. She was there to shake the cup, to ask for international assistance, and to deliver a message. Get engaged in the fight in West Africa now, she told the assembled ambassadors, before you have to deal with Ebola in Europe.
Arriving back home at John F. Kennedy International Airport, the delegation went through the same security screening that every other traveler from West Africa endured. Their temperatures were taken, they told interviewers who they had met and where they had gone, and they wrote down their contact information and that of their personal doctors. Michelle Nichols, the Reuters bureau chief, snapped a photo of Ambassador Power having her temperature checked in the security line. For the next twenty-one days, Power—or, on occasion, her assistant—called the New York Public Health Department to report her temperature.
The fear spreading across the United States was born in part from a gross miscalculation of the actual threat that everyday Americans faced. But even those who were cognizant of the threat, the volunteers and scientists who lived day to day in the hot zone, felt the stress of the risk they were taking.
Their environment, where every surface could be crawling with the world’s deadliest virus, where skin-to-skin contact was prohibited, infused every waking moment and made peaceful sleep difficult to come by. The more intimately familiar they were with the virus, the more it could embed itself deep in their imaginations. Some feared touching armrests on the airplanes that ferried them home; for others, it took weeks to be able to shake a friend’s hand, or even to hug a loved one, without an instinctual fear. The virus’s incubation period meant twice-daily appointments with a thermometer for three weeks after returning home, another reminder of the danger they faced, even an ocean away from the hot zone.
Joe Woodring, the CDC investigator who deployed to Liberia’s northern Nimba County in October, hoped his mind wouldn’t play tricks on him as he returned to his Washington-area home. He landed on a Monday, and while he appeared perfectly healthy, his young daughter did not—she had a head cold. Just minutes after he hugged his family, Woodring’s daughter let out an explosive sneeze, all over her dad. Woodring’s eyes went wide as he looked at his wife—this is not good timing, he thought.
Three days later, on his second day back at his office at the National Center for Health Statistics, Woodring felt the uncomfortable beginnings of a fever. He had been the first scientist from his office to travel to West Africa, which made him something of a guinea pig for colleagues who might follow in his footsteps. And he felt it: Though he wasn’t showing any symptoms, and he had had no contact with anyone who might have been symptomatic in recent days, some of those colleagues, even those with medical degrees, were avoiding him. They made clear, subtly and overtly, that they were thrilled to welcome him back—after his three weeks of self-monitoring were over.
Now, Woodring started to worry. He was almost certain his temperature was rising thanks to whatever harmless bug his daughter had passed on. But now he felt a headache, too. It could be nothing, he thought. Or it could be the first sign of an infection. Woodring couldn’t find his boss around the office, so he sent a quick e-mail detailing his symptoms. I think I should go home, Woodring wrote. Seconds later, a response from his boss: Please go.
On the way home, Woodring called his wife. In a tone as cool and measured as he could muster, and one that certainly didn’t match the worst-case scenario playing out in his head, Woodring explained what was going on. It’s nothing, he assured her. It’s just that head cold. But just to be safe, they agreed his wife would take their children to her mother’s house nearby, just for the night.
Woodring took his temperature once again that night. It had edged slightly higher, north of 99 degrees, but it hadn’t spiked dramatically. He called the Maryland Department of Health’s special line, set aside for those who had reason to worry; once again, he explained his situation, and his symptoms, and asked their advice—at what point should he start to assume the worst? After a few minutes of consultations, they agreed that if his temperature hit 101.5 degrees, and if he developed any other symptoms—another headache, severe joint pain, diarrhea—he would need to go to a treatment facility capable of handling an Ebola patient, in his case nearby Walter Reed Medical Center. As the late afternoon turned to evening, Woodring worried, less about himself and more about what his case could mean for others.
“Oh my god, this is going to look so bad on CDC,” he said to himself.
But as the sun rose the next morning, Woodring’s temperature had subsided, down to a normal 98 degrees. He had not taken any Tylenol, which can mask a fever; this gave him more confidence that the readings his thermometer displayed were real. He was in the clear; his relieved wife and daughters came home that night.
He had learned a valuable lesson. When he came back from his second deployment, a month later, Woodring warned his family beforehand. If anyone is sick, even with a tiny head cold, dad was going to stay somewhere else for a while.