• 2014 Ebola Outbreak

  • The Case for a USPHS Surgeon General From the Ranks - Former SG Richard Carmona

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    Published on 01-31-2015 12:42 PM
    1. Categories:
    2. General Interest



    Jason Humbert, 40, of Washington is serving as a nurse with the U.S. Public Health Service Commissioned Corps and helping to treat Ebola in Monrovia, Liberia.

    Life has changed in Monrovia, Liberia. People living in the West African capital used to embrace friends and family, but now keep their distance. Schools have closed, and remain so. Awareness campaigns keep popping up throughout the city, including a sign in December that read, “Don’t give Ebola this Christmas. No touching, no hugging, stay safe.”

    Any danger of contracting the Ebola virus is about 5,000 miles away from here, but Jason Humbert, who grew up in Washington, is reminded daily of the disease. He is completing a six-week assignment at a hospital in Monrovia, where he provides medical care to local and international health care workers who contracted Ebola. As a nurse and officer with the U.S. Public Health Service Commissioned Corps, he has helped eight people fully recover from a disease that often turns deadly.

    “This is not only good news for the patients, but a positive sign for other brave health care workers on the front lines to know there are resources for them if they become ill with Ebola,” Humbert said in an email. Since the Monrovia Medical Unit opened in November, officers have treated 33 health care workers, 15 whom tested positive for Ebola. According to the Centers for Disease Control and Prevention, Liberia was hit the hardest by Ebola with more than 3,600 deaths, followed by more than 3,150 deaths in Sierra Leone and 1,880 deaths in Guinea.

    Humbert, 40, graduated from Washington High School in 1992 and now lives in Ashburn, Va., with his wife, Tina, and their three young children. He holds degrees in nursing, homeland security and public health preparedness, and he previously worked for the Army Nurse Corps and National Institute of Health. His late mother, Patricia Humbert, was a nurse at Washington Hospital for 40 years. He said the residents in Liberia have shown “exceptional resiliency” in response to the first outbreak of Ebola in West Africa and also the largest outbreak of Ebola anywhere. Many swapped their daily greetings for “elbow bumps,” he said, and schools are expected to reopen in February.

    “The social distancing aspect of helping to prevent the spread of Ebola was a dramatic change in cultural practices for Liberians, who are used to greeting each other with handshakes and hugs,” he said. “Liberia has adapted quite well to these new practices, which has helped with containing the spread of Ebola.” He said the number of health care worker infections fell in Liberia and Sierra Leone, but rose in Guinea in December.

    “The numbers of cases suggest a decline in the epidemic, which is good news. The message now seems to be to not get complacent, to keep vigilant about the social distancing and practices that have helped curb the spread of the virus.” Humbert works alongside a team of doctors, infection control officers, pharmacists, lab workers and behavioral health specialists. They work 12-hour shifts and sleep in tents with bunk-cots at night.

    Officers follow strict regimens to keep themselves safe, such as disinfecting their rubber boots daily, washing their hands with chlorine and wearing full suits in the hot and humid climate. They also don two pairs of gloves, goggles and an apron. Removing the safety gear is a step-by-step procedure that is monitored by other officers.

    Health care workers have a higher risk of infection because they come into close contact with the patients and highly infectious bodily fluids, Humbert said.
    “Additionally, in their communities, health care workers are usually the first point of contact when someone is sick,” he said. “Health care workers have the potential to be exposed to the virus when they are away from the treatment centers and not in personal protective equipment.” In addition to his current assignment, Humbert has investigated the market of fraudulent products that claim to treat, cure or prevent Ebola.

    USPHS, part of the federal Department of Health and Human Services, is a uniformed service with more than 6,800 public health professions “serving the most underserved and vulnerable populations domestically and abroad,” according to a news release. Officers have responded to public health emergencies including the September 11 terrorist attacks, the 2010 earthquake in Haiti, Hurricane Sandy and the 2012 shooting at Sandy Hook Elementary School in Newtown, Conn.

    Article by Emily Petsko, Observer-Reporter.com
    Published on 12-23-2014 02:29 PM
    1. Categories:
    2. General Interest

    By Dr. Karen DeSalvo Acting Assistant Secretary for Health U.S. Department of Health and Human Services
    (Article Reprinted from Huffpost Healthy Living)

    They sacrificed Thanksgiving with their families. They left behind aging parents, nervous spouses, and growing children. They were not able to celebrate their kids' birthdays in person, cheer them on at football and soccer games, or see them perform in their schools' holiday concerts. They postponed a honeymoon, missed a family trip to see the Rockettes, and canceled a vacation to Central America. They missed out on hot showers, hugs from their loved ones, and a good night's sleep in a comfortable bed.

    As Chief Medical Officer, Captain Paul Reed wrote, they said goodbye to "the many little exceptional moments like cooking dinner while the kids are doing homework on the counter, picking out pumpkins for Halloween, or curling up on an early morning."

    On Saturday, they came home.




    They are officers serving in the U.S. Public Health Service Commissioned Corps. They went to Liberia to offer help, healing, and hope in a country deeply impacted by Ebola - continuing the legacy of our Corps and our country. When our neighbors need us most, we open our hearts and extend our hand - regardless of whether they live in places near or far.

    The mission - which continues, with the dedicated officers of a second team that takes their place and arrived in Liberia recently - is to care for health care workers, so they, in turn, can care for the people in the region who have Ebola.

    The officers who returned this Saturday have helped pave the way both for our own officers and for the rest of the world as they come to West Africa to be a part of this historic, humanitarian mission.

    Like the many other men and women from the U.S. Government who are deployed to West Africa, including from the Centers for Disease Control, the Department of Defense, and the U.S. Agency for International Development, the Commissioned Corps presence is not only saving lives. The work these public servants do is opening minds. It's sending a message to aid workers from West Africa and around the globe that we are there to serve you so you can continue to serve others. It's an important part of moving beyond the fear and embracing the facts.

    I want to share some words that Lt. Jason Kopera wrote to his commanding officers: "...overhearing a conversation with a Ghanaian army soldier while waiting at the heliport in Bong gave me a new perspective. Basically, he said everyone was watching and waiting to see what the U.S. would do, and that once we arrived it gave everyone a sense of renewed hope and allowed them to breathe a little easier knowing that everything was going to be okay. How often do you get the chance to have that type of global impact?"

    I had the chance to welcome home Lt. Kopera and dozens of his fellow officers as they arrived back on U.S. soil this past Saturday. I am so grateful for their service and sacrifice. For giving up holidays, helping with kids' homework, and happy moments with loved ones so they could serve others, half a world away.

    Follow Dr. Karen DeSalvo on Twitter: www.twitter.com/KBDeSalvo
    by Published on 12-21-2014 09:50 AM
    1. Categories:
    2. General Interest

    Job well done TEAM 1 and thank you for being the first to blaze a trail for all officers in the next rotations through MMU-1.

    As so well stated by Acting Assistant Secretary for Health, Dr. Karen DeSalvo, "
    I am so grateful for the service and sacrifice of all of our Commissioned Corps officers. By healing health care workers at the Monrovia Medical Unit, they are able to bring additional safety and security to the people of Liberia."













    Published on 12-18-2014 01:11 PM
    1. Categories:
    2. General Interest

    This article was written by Former SG Richard Carmona and is reprinted from The Daily Caller

    On Dec 15 the U.S. Senate took action largely along party lines to confirm Dr. Vivek Murthy as the next U.S. Surgeon General. This nomination has languished for a year due to insufficient Senate support for Dr. Murthy. But, as the lame duck session entered its 11th hour, Senator Reid again invoked the nuclear option to clear the way for Dr. Murthy’s confirmation.

    Dr. Murthy barely received enough votes to be confirmed – culling together the support of just 51 Senators primarily along party lines. This is indeed unfortunate since the doctor of the nation needs bipartisan support to be successful. For disease and the public’s health knows no party affiliation. Dr. Murthy is a gifted young physician very early in his career. He has some early significant accomplishments behind him but no formal public health training and little management or senior leadership experience. His nomination became controversial due to his inexperience and his political advocacy and perceived bias and on several issues. That being said it is important to recognize that the problem is in the politicization of the Surgeon General nomination process and Dr. Murthy’s nomination and confirmation simply reflect that dysfunction.

    The Surgeon General is the leader of the U.S. Public Health Service Commissioned Corps, one of the seven uniformed services of the United States. The position carries with it the rank of Vice Admiral. This is a three star rank equivalent to the Surgeons General of the Army, Navy and Air Force. The difference is that the Army, Navy and Air Force Surgeons General earn their rank and title after decades of selfless service, as did the U.S. Surgeon General before politicians began to circumvent the uniformed service merit system for their own benefit.

    This blatant act of political self-interest does not benefit the public but does undermine the credibility of the office of the Surgeon General and serves to demoralize and demean the career uniformed service of our men and women who are now marginalized and prevented form meritoriously being considered for Surgeon General as they once were.

    Partisan politicians acting in self-interest is nothing new. However, we should recognize that by politically conferring the rank of vice admiral and the title of Surgeon General on any person who has not earned that right you are actually disadvantaging that person from the start. In the beltway where the Surgeon General resides and works his peers are real admirals, generals and senior health professionals who have earned their respective positions.

    Politicians have many opportunities such as ambassadorships and appointed partisan positions to reward political support and advocacy. The office of the Surgeon General should never be a pawn for political patronage. The public expects and deserves the most qualified public health professional who merits consideration.
    Ironically, if not but for a late political strategic blunder by a Republican senator, Dr. Murthy’s name may never have been advanced for confirmation.

    Putting the plague of politics aside we now must turn to the more important issue of protecting the health, safety and security of the nation. Dr. Murthy is fortunate in that he will be surrounded by members of the USPHCC. True professionals who, after many years of public health leadership and management experience, can provide him with historical perspective and public health guidance moving forward. Dr. Murthy would be wise to follow their lead.
    Published on 12-15-2014 09:35 PM
    1. Categories:
    2. General Interest

    Murthy, 37, is a British-born Indian-American who was educated at Harvard and Yale and has both medical and business degrees. He completed his residency in 2006 at Boston's Brigham and Women's Hospital, where he is an attending physician. He will be the first Indian-American to serve in the role. Murthy's nomination comes from his political advocacy during the election campaign for President Obama, although his past statements on gun control slowed his nomination. In 2008, he co-founded Doctors for Obama, a group of doctors and medical students who supported the Obama campaign. The group transitioned to Doctors for America after President Obama won. Normally, Dr. Murthy would enter the Corps as a LCDR but with this nomination and confirmation, he is an Acting Vice Admiral.

    Murthy is the latest in a string of executive nominations that were only able to pass the Senate after Majority Leader Harry Reid, D-Nev., pushed through a rules change last year to lower the threshold from 60 to 51 votes to advance certain presidential nominations. Republicans have not said whether they will keep the rules change in place in the next Congress. Murthy replaces Acting Surgeon General Boris Lushniak, who has been serving since former Surgeon General and Acting VADM Regina Benjamin resigned in July 2013. RADM Lushniak has resumed his role as Deputy Surgeon General.

    RADM Lushniak was simply the best Acting Surgeon General the career Corps could have hoped for; moving up the rank and experience ladder since joining the Corps in 1988, he led the Corps like no other ASG. His experience in CDC's EIS Program, at NIOSH and FDA made him an ideal Surgeon General with the breadth of experience necessary for the job. RADM Lushniak is highly experienced in the field, having completed service with the Indian Health Service in Winslow, Arizona and most importantly, serving with NIOSH in the field where he conducted epidemiological investigations of workplace hazards. RADM Lushniak is well established as a first responder and member of the Command cadre, having served on special assignments and disaster response activities in Bangladesh, St. Croix, Russia, and Kosovo, as part of the CDC/NIOSH team at Ground Zero (World Trade Center) and the CDC team investigating the anthrax attacks in Washington, DC. He served as the Chief Medical Officer of the Office of Counterterrorism at the FDA, and in 2005 was appointed FDA Assistant Commissioner, Counterterrorism Policy and Director of the Office of Counterterrorism and Emerging Threats within the Office of the Commissioner.

    RADM Lushniak was born in Chicago to post-World War II immigrants from Ukraine. He is an inspiration to many inside and outside the ranks of the Corps and will likely go down in Corps history as one of finest examples of the unfairness of the current nomination system that minimizes the career officers of the Corps as only able to attain Acting or Deputy roles in the service of our nation, despite being far, far, more qualified for the Surgeon General position than any civilian nominee.
    Published on 11-24-2014 11:04 AM

    MONROVIA, Liberia — A cluster of American uniformed officers gathered in the sticky heat this week to say a prayer for a dead Liberian nurse, the first loss to Ebola at the only U.S. government-operated clinic in West Africa.

    The 34-year-old nurse's death Wednesday hit the American staff hard at the clinic charged with caring for health care workers sickened by Ebola.
    "She was one of us. She was a health care provider just like all of us," said Russ Bowman, 53, of Albuquerque, a lead physician here. "This is what this unit is for — to provide care to folks ... providing care for the people of Liberia. We're here to back them up. And we weren't able to save her. And that's a tragedy."


    USA TODAY
    Reporter's Notebook: Inside Liberia's Ebola fight

    The nurse — whose name was not made available — was unconscious and already failing when she arrived by ambulance the night before. "It's a shame she wasn't here a lot earlier," said Jennifer Malia, 41, of Laytonsville, Md., a lab medical technician. "I believe we really could have helped and maybe had a different outcome."

    Her arrival at such a late stage of the disease raises concerns that the new clinic, which opened Nov. 7, is not being adequately publicized by Liberian health officials. Four Liberian health workers with Ebola are being treated there. All are improving. "I'd like to be able to answer that, definitively, yes (word has spread)," says Paul Reed, the chief medical officer. "But I don't know that."

    Chief Medical Officer Paul Reed.(Photo: Gregory H. Stemn for USA TODAY)

    When President Obama announced in September he was sending U.S. troops to Liberia, it was with the caveat that none would directly treat patients infected with Ebola, which has killed 3,000 in this country.


    USA TODAY
    U.S. diplomat doubts Liberia Ebola cases will end soon

    But with health workers among the most threatened by the disease, the responsibility for a clinic devoted to treating doctors and nurses who become ill fell upon the U.S. Public Health Service, a little-known branch of the Department of Health and Human Services. "It's a very noble mission, an honorable mission," says Reed, who left behind a wife and four children to deploy.

    The Public Health Service is one of the nation's seven uniformed services with members who carry military ranks and wear uniforms similar to those of the U.S. Coast Guard. They often are sent to domestic and international health disasters.

    This is the first time Public Health Service members have operated an Ebola clinic. All 69 workers here are volunteers. "I told my oldest before I left 'This is what God wants us to do. We're here to help people. That's what Mommy does,' " says Malia, a married mother of three. Malia and her colleagues live on pre-packed military Meals Ready-to-Eat. The clinic sits near Liberia's international airport and looks much like a military field hospital with air-conditioned, barrack-like structures assembled neatly into a green zone and a hot zone for Ebola patients.


    USA TODAY
    Liberian president hopes to defeat Ebola by Christmas

    Clinicians follow painstaking procedures for donning and taking off protective gear, thoroughly dousing themselves with a chlorine mix to kill the virus as they shed the suits.
    With the hoods and masks on in the red zone, they are nearly unrecognizable. So many carry a small photo on their suit allowing patients to see what they look like.

    Bowman says he has developed a healthy respect for Ebola. Clinicians are methodical about how they move around patients. One staff member always watches for any safety breach. "It's kind of like a rattlesnake," Bowman says of the disease. "You don't poke it. You know what it can do. You prepare for it. You avoid things that can put you in harm's way."


    USA TODAY
    Hand washing is key to protecting U.S. troops from Ebola

    The Liberian nurse was in the last stages of the disease, her body teaming with the virus. The U.S. Public Health officers washed her repeatedly with water tinged with chlorine and kept fluids flowing into her veins, hoping that by morning she might improve. But the nurse was too far gone, Bowman says. "She was unresponsive when she came in and clearly very ill. ... We did what we could for her," Bowman says. "It's a very tenacious illness."

    Lt. Shane Deckert and CDR David Lau work inside the Monrovia Medical Unit.(Photo: Gregory H. Stemn for USA TODAY)
    Published on 10-31-2014 04:01 PM
    1. Categories:
    2. General Interest


    CAPT Calvin Edwards has deployed to Liberia to oversee a U.S. Public Health Service team combating Ebola.

    CHAMBERSBURG, Pa. — A Chambersburg man has deployed to Liberia to oversee a U.S. Public Health Service team combating Ebola.
    Calvin Edwards, 51, received recognition from President Barack Obama in a Wednesday afternoon speech about American health care workers fighting the outbreak. Obama’s remarks apparently referred to The Washington Post’s interview with Edwards as he prepared over the weekend to board a C-17 aircraft headed to Monrovia, the capital of Liberia.

    “We read about how on his 29th wedding anniversary, carrying a pillow from home and a copy of the New Testament he takes on deployments, he left for training to oversee a team in Liberia … but before he did, he made sure to buy his wife a dozen roses,” Obama said, as quoted in a transcript of the speech.

    The Washington Post quoted Edwards as saying he is respectful of Ebola, but not afraid of it.

    “It doesn’t hop from person to person. It requires contact with bodily fluid,” he told The Post.

    On a typical day, Edwards does food-safety inspections for the U.S. Food and Drug Administration in Harrisburg, Pa. However, he also is a member of the Public Health Service Commissioned Corps, one of the seven uniformed services. The Public Health Service is composed of health professionals overseen by the U.S. surgeon general. The nation does not currently have a surgeon general in place because the Senate has stalled on confirming the nominee submitted by Obama last year.

    A U.S. Department of Health and Human Services spokeswoman confirmed Thursday that Edwards is the officer in charge of the Monrovia Medical Unit. Sixty-five officers comprise the team that is caring for health care workers who become ill from Ebola. “The Commissioned Corps are trained and ready to respond to public health crises and humanitarian missions. The dedicated officers have the skills to make a significant impact in one of the international community’s most devastating public health emergencies,” Acting Surgeon General Rear Adm. Boris Lushniak said in a statement.

    Ebola in West Africa has sickened more than 13,000 people and killed nearly 5,000 of them.

    The Post reported Edwards, an amateur beekeeper, left for training in Alabama on Oct. 19. He has four children. “As he boarded the plane to Monrovia, Capt. Edwards reminded his team of their oath to defend our country, and they responded with a rousing rendition of ‘The Star-Spangled Banner.’ And they’re all there right now, making us proud,” Obama said in his speech.

    Reprinted from Herald Mail Media
    Published on 10-28-2014 08:11 PM

    HARBEL, Liberia—”Where have you done this before?” USAID Administrator Raj Shah asked on October 15, as he stepped through the taupe colored tent flap into the new 25-bed critical care hospital being built to treat all health care and aid workers who fall ill to Ebola. “Nowhere, sir. No one has,” replied an army engineer.

    Historically, mobile medical units like this one provide versatile trauma care for military operations. In this case, the Department of Defense (DoD) and the U.S. Public Health Service (USPHS) customized the Monrovia Medical Unit to treat highly contagious Ebola patients.

    Once complete, the hospital will be operated and staffed by a team of 65 specialized officers from the USPHS Commissioned Corps – an elite uniformed service with more than 6,800 full-time, highly qualified public health professionals, serving the most underserved and vulnerable populations domestically and abroad.

    The Commissioned Corps will deploy clinicians, administrators, and support staff to Liberia to treat health care workers with Ebola, and to continue efforts by USAID, DoD and international partners to build capacity for additional care in Liberia.

    Link to Photos
    1. Categories:
    2. General Interest

    Do We Need a Surgeon General?
    Federal Times - By Richard H. Carmona, M.D., M.P.H., FACS

    As I finished writing this opinion piece, the title seemed to evolve into a rhetorical question. The Ebola crisis has metastasized to the United States and the media and numerous government and private spokespersons are attempting to educate and calm the American public while not inflaming or confusing the situation.

    A single credible, trusted, nonpartisan recurring voice is what is needed to educate and reassure America and the world who is watching us.
    Recently, Surgeon General Jesse Steinfeld, the 11th surgeon general of the United States (serving from 1969 to 1973), passed away. His obituary heralded his many significant accomplishments as surgeon general and commander of the United States Public Health Service Commissioned Corps, one of the seven uniformed services of the United States. What was particularly striking and concerning and voiced in his obituaries and commentary about his life, were references to Surgeon General Steinfeld having to fight and battle various individuals, groups and entities in order to promulgate health policy that would benefit the public he served.

    This prompted me to review the obituaries and commentary about other surgeons general who passed away in the last decade. These would include Surgeons General Julius Richmond, #12; Bill Stewart, #10; and C. Everett “Chick” Koop, #13.

    These surgeons general were extraordinary public servants who served selflessly in increasingly embattled positions. Like Surgeon General Steinfeld, their obituaries and press commentary were often punctuated with adjectives such as, “fighting,” “combative,” “battling entrenched political interests,” “adversarial maneuvering” and “stressful attempts to take out or eliminate the surgeon general”. These descriptors often sounded as if the surgeons general were officers in a combat unit battling hostile adversaries as they attempted to survive in an increasingly partisan battlefield. The sad truth is they were, we still are and in some cases the surgeons general succumbed to the lethal wounds of political warfare where resuscitation is rarely possible.

    Surgeons general of the Army, Navy, Air Force and U.S. Public Health Service were always career uniformed officers who merited consideration for promotion and advancement by their seniority, accomplishments, demonstrated leadership, education and training. The White House would receive recommendations from the respective uniformed service chiefs and the President would then recommend names to the Senate for confirmation as a surgeon general with the rank of Vice Admiral or Lt. General, depending on the service.

    This tried and true process, over a century old, still exists in the uniformed services except for the U.S. Public Health Service. Since the late 1960s and early 1970s, various political administrations have gone outside of the USPHS to identify and nominate candidates who were believed to be more politically aligned with the political party in power at the time. By doing so, they demean the service of career USPHS officers who are qualified but passed over in attempts to align science with desired political platforms.

    Interestingly, these attempts at prospectively attempting to identify politically aligned surgeons general nominees have usually failed and caused frustration for leaders in both political parties over the years; all surgeons general come to understand that you are the doctor of the nation and not the surgeon general of the Republican or Democratic parties.

    In addition, those outside nominees, if confirmed, are immediately promoted to vice admiral even though some have no military or uniformed service experience. This process is offensive to all career officers who selflessly sacrifice throughout a long uniformed service career to merit consideration for promotion as an admiral and surgeon general. This politically motivated action also diminishes the credibility of the Office of the Surgeon General.

    It is also apparent that not every physician is capable of being surgeon general. An example would be the current nominee for surgeon general who is very early in his professional career, with great potential but without significant progressive leadership experience or specific public health education or in depth experience with complex policy, global and public health issues. However, he was the co-founder of Doctors for America, a partisan organization supporting President Barack Obama.

    In a recently published book, Surgeon General’s Warning, author Mike Stobbe painfully discusses the gradual political demise of the United States surgeon general and suggests that therefore, it may be time to end the position. As much as I appreciated Stobbe’s scholarly work, my review of it leads me to a very different conclusion. We should actually act to strengthen the Office of the Surgeon General by protecting it from political manipulation. In our hyper-partisan political world characterized by gridlock and great political poetic license in the interpretation of science to support ones preconceived political bias, who will have the responsibility to speak scientific truth to power? Who will provide the scientifically based “informed consent” to the American public and at times, the world?

    Eliminating or allowing further diminishment of the Office of the Surgeon General to occur is not in the best interest of the American public although it may benefit politicians.

    In July 2007, I joined Surgeons General Koop and Satcher testified before a congressional committee investigating the attempts to politicize the Office of the Surgeon General. Three surgeons general serving four separate presidents, from the very liberal to the ultraconservative administrations, all testified on the issues challenging them during their tenures. The surgeon general testimonies were remarkably similar and a clear bipartisan indictment of the attempts to manipulate science and diminish the Office of the Surgeon General. Not surprising but extremely disappointing, Congress took no action on this unprecedented testimony that they themselves had requested.

    It is clear that our nation needs and deserves a strong, qualified and nonpartisan surgeon general who resides in a protected and well-funded Office of the Surgeon General. The public we have the privilege to serve deserves no less.

    Richard H. Carmona, M.D., M.P.H., FACS, served as the 17th Surgeon General of the United States.
    by Published on 10-09-2014 10:57 AM

    A White House Office of the Press Secretary-issued FACT SHEET entitled "The U.S. Government's Response to Ebola at Home and Abroad" identifies the U.S. Public Health Service Commissioned Corps as operating and staffing a hospital for infected health workers. The USPHS is preparing a cadre of 65+ officers, composed of Safety / Preventive Medicine, Pharmacy, Nurse, Physician, and support staff for 60 day mission rotations to operate a treatment facility for health care workers who have contracted Ebola Virus Disease (EVD). The 25-bed hospital will be established in Liberia, West Africa. The USPHS officers will be selected from multiple Tier deployment teams.

    To illustrate the challenges faced by health care workers, symptoms may present post 2 - 21 days after exposure to body fluids, which include fever, unexplained bruising, headache, vomiting, stomach pain, muscle pain, unexplained bleeding, and diarrhea. This means constant vigilance among health care workers and our officers to be both self-aware and observe others for symptoms. Further complicating ebola symptomology, West Africa is a physical and mental challenge due to heat stress and vectorborne / foodborne / waterborne transmitted diseases that can cause physical symptoms similar to EVD. Officers will need to be in optimal fitness and heat acclimatized as much as possible.

    At symptom onset, transmission of the virus can occur from contact with blood, saliva, urine, tears/conjunctive tissue, sweat, vomitus and feces. After symptom onset, death occurs (on average) after 10 days without intervention. If the patient survives into convalescence, secretions of blood, urine, tears/conjunctive tissue, semen, vaginal, milk and fecal matter may transmit the virus over 84 days post symptom onset. Medevac from Liberia takes approximately 3 days, and return from Africa approximately 5 - 7 days, after which officers will need to monitor themselves for symptom onset.

    The U.S. Public Health Service is the only uniformed service taking a role in direct patient care. The Department of Defense will provide specimen testing and health care worker training, logistics and infrastructure.