Andrew Jones
ASHEVILLE, N.C. — At round 2 a.m., 7-year-old twin brothers arrived at Mission Hospital in Asheville. Both had a fever, a cough, a rash, pink eye, and chilly signs.
The boys sat in a single ready room after which one other. Two hours and 20 minutes handed earlier than the 2 have been remoted, in accordance with Centers for Medicare & Medicaid Services records obtained by KFF Health News. Then two extra hours ticked by.
As the solar rose, an emergency room physician known as the state epidemiologist and described the signs. The public well being official instructed him to maintain the youngsters within the hospital and quarantine them. Shortly after that decision, the sufferers have been identified.
It was measles.
Hospital employees gave the daddy directions on quarantine the household and despatched them residence.
The virus uncovered not less than 26 different folks within the hospital that January day, federal investigators decided. Health inspectors for CMS investigated the measles infections and different failures in care and concluded that the twins’ signs ought to have triggered an isolation process for which Mission Hospital staffers had educated seven months earlier. CMS designated Mission in “Immediate Jeopardy” for the exposures and different unrelated points, one of the vital extreme sanctions a hospital can face, threatening to tug federal funding until it remedied the issues.
A spokesperson for Mission stated its employees was educated to handle airborne illness and is following federal guidelines.
As U.S. hospitals face an growing threat of encountering measles, and strain to right away spot it, well being care employees face an uncommon barrier: Many don’t know what it appears like.
“There’s a word, ‘morbilliform’ — it means measles-like, and there are lots of viruses that can cause a rash that looks like a measles rash in children,” stated Theresa Flynn, a pediatrician in Raleigh and the president of the North Carolina Pediatric Society. In 30 years in well being care, she’s by no means seen a measles case, she stated.
North Carolina has reported greater than 20 instances since mid-December, and greater than 3,000 folks nationwide have been contaminated because the starting of 2025.
Children in areas with low immunization charges have been especially susceptible to outbreaks, triggering public well being campaigns to advertise the measles vaccine. CMS Administrator Mehmet Oz inspired vaccination in a CNN interview on Feb. 8.
With two doses of the measles, mumps, and rubella vaccine, an individual has a 3% probability of getting the virus after publicity. If uncovered, an unvaccinated individual has a 90% probability of being contaminated, in accordance with the CDC. It can take every week or two earlier than somebody contaminated with measles exhibits signs.
But for the previous yr, the Trump administration has sown doubt about vaccine effectiveness. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist earlier than taking workplace, and underneath his management the Centers for Disease Control and Prevention has decreased the variety of photographs advisable to kids.
After measles erupted in West Texas final yr, Kennedy publicly recommended unconventional and unproven treatments for the virus, together with steroids, antibiotics, and cod liver oil.
Infectious illness consultants and medical doctors stated federal insurance policies have left well being care employees to lean on their very own expertise or steerage from their state public well being programs to combat a illness that many are making ready to see for the primary time and that originally might behave just like the frequent chilly.
“As measles becomes more common, all of us are leveling up in our ability to recognize and immediately respond to suspected measles,” Flynn stated.
Three C’s
Officially, the U.S. has maintained “measles elimination status” since 2000, that means the U.S. has prevented vital unfold of the virus. After outbreaks in Texas, Arizona, Utah, and now South Carolina, the nation is on observe to lose that designation earlier than the yr is out. Its own adopted regulations tie elimination standing to an absence of a steady viral unfold persisting for 12 months.
One county in South Carolina, an hour’s drive from Asheville, has had more than 900 cases within the present outbreak — greater than Texas reported in all of 2025.
Symptoms of measles, a virus that attacks the lungs and airways, can embrace fever, cough, a blotchy rash, and pink, watery eyes. Researchers contemplate measles among the many most contagious ailments, and the virus might stay lively for as much as two hours after an contaminated individual leaves a room.
It could be deadly, with 1 to 3 deaths per 1,000 cases in children.
In 2025, two kids in Texas and one grownup in New Mexico died of measles.
Along with monitoring information, the CDC provides detailed summaries on its web site for diagnosing measles. State public well being businesses and a few counties have developed dashboards tracing the illness because it surfaces in such locations as hospitals, colleges, grocery shops, and airports. Large hospital programs developed employees coaching protocols final yr and shared them with space clinics.
Look for the three C’s, that guidance said: cough, coryza (chilly signs), and conjunctivitis (pink eye). According to CMS inspection information, HCA Healthcare, which owns Mission Hospital, educated Mission employees on the three C’s early final yr. On high of failing to isolate the dual sufferers instantly, Mission employees didn’t have a delegated space for sufferers with respiratory signs, federal inspectors discovered.
The CDC advises well being employees to right away place sufferers with measles or suspicious signs in a particular isolation room, the place airflow is managed inward. The Mission sufferers have been separated from different sufferers solely by plastic partitions, in accordance with the CMS information.
Mission spokesperson Nancy Lindell stated the hospital was outfitted and staffed to handle airborne sicknesses like measles.
“Our hospital has been working with state and federal health officials on proactive preparedness, and we are following guidance provided by the CDC,” Lindell stated.
(Dogwood Health Trust, a personal basis established as a part of HCA’s buy of Mission Health, helps fund KFF Health News protection.)
Most U.S. clinics and hospitals have by no means skilled measles instances, stated Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases and a nurse practitioner. She known as CMS’ Immediate Jeopardy penalty for Mission “extreme,” given the virus could be so tough to determine.
“In the middle of winter right now, measles looks like every other viral respiratory infection that kids come in with,” Stinchfield stated.
The CDC has been much less communicative prior to now yr with clinics about their response to outbreaks, stated well being employees and infectious illness consultants. This disconnect started quickly after Trump took workplace, in accordance with a KFF Health News investigation discovering that well being officers in West Texas have been unable to speak with CDC scientists as measles surged final February and March.
“We certainly do not feel the support or guidance from the CDC right now,” stated Brigette Fogleman, a pediatrician at Asheville Children’s Medical Center, the place employees members have give you their very own technique of staving off the virus: screening sufferers over the cellphone and of their automobiles earlier than a go to.
In response to questions on how the CDC is supporting well being care organizations through the measles resurgence, spokesperson Andrew Nixon stated that “state and local health departments have the lead in investigating measles cases and outbreaks” and that the CDC gives assist “as requested.” He pointed to quite a few guides and simulation instruments the company has developed because the virus has unfold.
Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University, acknowledged that diagnosing measles is a serious problem, emphasizing that coordination amongst public well being businesses is vital in overcoming that problem.
Stinchfield attributed the unfold of measles to CDC leaders’ lack of communication to clinics and to the general public — no adverts on buses, no social media campaigns, no sense of urgency. “When you are at the highest level of measles cases in 30 years, we should be seeing lots more from our federal government,” Stinchfield stated. “And I think it’s harming kids and causing an inordinate amount of work and expense that really doesn’t belong in health care right now.”
State Prepares for More Measles Cases
In North Carolina’s Buncombe County, residence to Asheville and Mission Hospital, well being officers had counted seven measles instances by mid-February and anticipated many extra, in accordance with state epidemiologist Zack Moore. It’s unclear what number of of these are related to the Mission publicity.
“We are preparing for a future in which we follow a trajectory like South Carolina,” Moore said, “where we see sort of a gradual accumulation of cases, and then all of a sudden it reaches kind of a tipping point, and we see a more explosive growth in the outbreak and spread across the state.”
Fogleman, who is also a pediatrician, and Buncombe health department director Jennifer Mullendore spoke during a recent Facebook livestream hosted by the county, urging households to get their kids vaccinated, debunking vaccine misinformation, and updating dad and mom on native case numbers.
Days earlier than, a neighborhood non-public faculty had quarantined about 100 college students after an publicity. Only 41% of students there have been immunized, in accordance with state information.
At Fogleman’s clinic, dad and mom are requested to attend of their automobiles with their kids, and staffers come out to display screen them there. Some dad and mom resist vaccination and notice lately weakened federal suggestions round measles vaccines for children under 4, she stated.
Kennedy handpicked the committee members who made these suggestions, with a number of members having unfold medical misinformation prior to now.
One dad or mum lately instructed a nurse, “It’s only measles. It doesn’t kill anybody,” Fogleman stated.
That’s not true, her staff should clarify.
As the clinic holds households within the parking zone, making an attempt to determine whether or not signs level to the damaging virus, it’s tough to get the message throughout, Fogleman stated, particularly when the nation’s high illness company hasn’t carried out a widespread info marketing campaign concerning the dangers from measles — or the vaccine’s skill to virtually totally forestall it.
“We can’t change the past,” Fogleman stated. “All we can do is try to educate and move forward.”
