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A Project of The Annenberg Public Policy Center

What We Were Told About Ebola

Sen. John McCain claimed on a Sunday talk show that “we were told there would never be a case of Ebola in the United States.” Not exactly. U.S. health officials, early in the outbreak, said it was highly unlikely, but we could not find any instances of them saying it would never happen.

At a July 28 press briefing concerning the Ebola outbreak in West Africa, Centers for Disease Control and Prevention official Stephan Monroe said the virus “poses little risk to the U.S. general population.” But, he added, “it’s possible that someone could become infected with the Ebola virus in Africa and then get on a plane to the U.S.” Monroe called this scenario a “very remote possibility,” but he didn’t say it could never happen, as the senator claimed.

Even earlier, in an April 2 Bloomberg News story about the outbreak, Monroe said a suspected Ebola case in Canada that turned out to be a false alarm “reminded us that any of these diseases are only a plane ride away.”

That is exactly what happened in Texas, where Thomas Duncan died Oct. 8 after contracting the disease in Liberia and flying home to the United States.

The Arizona Republican made his remarks on CNN Oct. 12 after “State of the Union” host Candy Crowley asked McCain about the breaking news that “one of the health care workers who had contact with Ebola patient Thomas Eric Duncan has tested positive for the virus.” McCain criticized federal officials for giving information about Ebola “that’s not correct.”

Crowley, Oct. 12: Let me talk to you first about this breaking news we have this morning, and that is, look, I’m not a doctor, you’re not a doctor, we can only listen to doctors. But do you get the sense that the federal government is on top of this? Is there anything more you think the federal government can do?

McCain: Well, first of all, from spending time here in Arizona, my constituents are not comforted. There has to be more reassurance given to them. I would say that we don’t know exactly who’s in charge. There has to be some kind of czar.

I think that we have to look at people coming into the United States, not only at our airports here but the places where they leave from. As you know, there are not direct flights from Africa. And Americans have to be reassured here. I don’t think we are comforted by the fact that we were told there would never be a case of Ebola in the United States and obviously that’s not correct. I was impressed by your panel, but frankly I’d like to know who’s in charge, among other things.

The U.S. agency chiefly responsible for preventing the spread of infectious diseases is the Centers for Disease Control and Prevention, which acted early to contain the spread of the virus at its source. The World Health Organization said the Ebola outbreak started in Guinea in March. The CDC, on March 31, sent a five-member team to Guinea to assist on Ebola cases, according to the April 2 Bloomberg News article. At the time, the WHO reported that there were 112 confirmed Ebola cases, including 70 deaths, in Guinea. (As of Oct. 13, the CDC website had reported more than 4,600 confirmed cases in multiple countries, including 2,431 deaths.)

In the Bloomberg article in April, Monroe — who is deputy director for the agency’s National Center for Emerging and Zoonotic Infectious Diseases — spoke of the possibility of travelers bringing the disease to North America.

Bloomberg News, April 2: Last week, when Canadian officials feared that a severely ill patient who had recently been to Liberia may have been infected with deadly Ebola, the U.S. took notice. It was a “false alarm,” Monroe said, “that reminded us that any of these diseases are only a plane ride away.”

On July 28, Monroe spoke again about the possibility of infected travelers arriving in the U.S. This time it was during a CDC press briefing that was held after two U.S. workers became infected with the virus at a hospital in Liberia. Monroe called it a “very remote possibility.”

Monroe, July 28: I want to underscore that Ebola poses little risk to the U.S. general population. … While it’s possible that someone could become infected with the Ebola virus in Africa and then get on a plane to the United States, it’s very unlikely that they would be able to spread the disease to fellow passengers. The Ebola virus spreads through direct contact with the blood, secretions, or other body fluids of ill people, and indirect contact – for example with needles and other things that may be contaminated with these fluids. Most people who become infected with Ebola are those who live with and care for people who have already caught the disease and are showing symptoms.

Nevertheless, because people do travel between West Africa and the U.S., CDC needs to be prepared for the very remote possibility that one of those travelers could get Ebola and return to the U.S. while sick. We are actively working to educate American healthcare workers about how to isolate patients and how they can protect themselves from infection. Today, we are sending out a Health Alert Notice to remind U.S. healthcare workers of the importance of taking steps to prevent the spread of this virus.

Less than two weeks after Monroe called it a “very remote possibility,” CDC Director Tom Frieden wrote on the CDC Director Blog that “there is a risk for Ebola to be introduced to the United States,” but that “widespread transmission in the United State is highly unlikely.”

Frieden, Aug. 8: There is a risk for Ebola to be introduced to the United States via an infected traveler from Africa. If that were to happen, widespread transmission in the United States is highly unlikely due to our systematic use of strict and standard infection control precautions in health care settings, although a cluster of cases is possible if patients are not quickly isolated. Community spread is unlikely due to differences in cultural practices, such as in West Africa where community and family members handle their dead.

So, the possibility of an Ebola case in the U.S. went from being a “very remote possibility” to being a “risk” that could lead to a “cluster of cases.” But in both cases, the possibility existed. That also has been the position of President Obama and the White House, and for the same reasons.

The fact that Ebola cannot be spread through the air — like influenza — has helped to contain past outbreaks to a particular region, President Obama said at an Aug. 1 press conference. There have been 16 Ebola outbreaks since 2000, mostly in African countries, according to the CDC.

Obama, Aug. 1: Keep in mind that Ebola is not something that is easily transmitted. That’s why, generally, outbreaks dissipate. But the key is identifying, quarantining, isolating those who contract it and making sure that practices are in place that avoid transmission. And it can be done, but it’s got to be done in an organized, systematic way, and that means that we’re going to have to help these countries accomplish that.

On Sept. 16, the White House issued a fact sheet saying an outbreak in the U.S. “is highly unlikely,” but “unintentional” cases were possible. This was two weeks before the CDC confirmed the first case of Ebola in the U.S. in Texas.

White House, Sept. 16: Despite the tragic epidemic in West Africa, U.S. health professionals agree it is highly unlikely that we would experience an Ebola outbreak here in the United States, given our robust health care infrastructure and rapid response capabilities. Nevertheless, we have taken extra measures to prevent the unintentional importation of cases into the United States, and if a patient does make it here, our national health system has the capacity and expertise to quickly detect and contain this disease.

It would have been correct for McCain to say we were told that an Ebola case in the United States is highly unlikely, as conservative commentator Rush Limbaugh has said. But we can find no evidence that “we were told there would never be a case of Ebola in the United States.” We asked McCain’s office for evidence, but we did not get a response and neither did our colleagues at Politifact. If we do, we will update this item.

— Eugene Kiely