ASHEVILLE, N.C. \u2014 At around 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 cold symptoms.<\/p>\n
The boys sat in one waiting room and then another. Two hours and 20 minutes passed before the two were isolated, according to Centers for Medicare & Medicaid Services records<\/a> obtained by KFF Health News. Then two more hours ticked by.<\/p>\n As the sun rose, an emergency room doctor called the state epidemiologist and described the symptoms. The public health official told him to keep the kids in the hospital and quarantine them. Shortly after that call, the patients were diagnosed.<\/p>\n It was measles.<\/p>\n Hospital staff gave the father instructions on how to quarantine the family and sent them home.<\/p>\n The virus exposed at least 26 other people in the hospital that January day, federal investigators determined. Health inspectors for CMS investigated the measles infections and other failures in care and concluded that the twins\u2019 symptoms should have triggered an isolation procedure for which Mission Hospital staffers had trained seven months earlier. CMS designated Mission in \u201cImmediate Jeopardy<\/a>\u201d for the exposures and other unrelated issues, one of the most severe sanctions a hospital can face, threatening to pull federal funding unless it remedied the problems.<\/p>\n A spokesperson for Mission said its staff was trained to manage airborne sickness and is following federal rules.<\/p>\n As U.S. hospitals face an increasing risk of encountering measles, and pressure to immediately spot it, health care workers face an unusual barrier: Many don\u2019t know what it looks like.<\/p>\n \u201cThere\u2019s a word, \u2018morbilliform\u2019 \u2014 it means measles-like, and there are lots of viruses that can cause a rash that looks like a measles rash in children,\u201d said Theresa Flynn, a pediatrician in Raleigh and the president of the North Carolina Pediatric Society. In 30 years in health care, she\u2019s never seen a measles case, she said.<\/p>\n \t\t North Carolina has reported more than 20 cases since mid-December, and more than 3,000 people nationwide have been infected since the beginning of 2025.<\/p>\n Children in areas with low immunization rates have been especially susceptible<\/a> to outbreaks, triggering public health campaigns to promote the measles vaccine. CMS Administrator Mehmet Oz encouraged vaccination in a CNN interview on Feb. 8<\/a>.<\/p>\n With two doses of the measles<\/a>, mumps, and rubella vaccine, a person has a 3% chance of getting the virus after exposure. If exposed, an unvaccinated person has a 90% chance of being infected, according to the CDC. It can take a week or two before someone infected with measles shows symptoms.<\/p>\n But for the past year, the Trump administration has sown doubt about vaccine effectiveness<\/a>. Health and Human Services Secretary Robert F. Kennedy Jr. was a longtime anti-vaccine activist before taking office, and under his leadership the Centers for Disease Control and Prevention has reduced the number of shots recommended to children.<\/p>\n After measles erupted in West Texas last year, Kennedy publicly recommended unconventional and unproven treatments<\/a> for the virus, including steroids, antibiotics, and cod liver oil.<\/p>\n Infectious disease experts and doctors said federal policies have left health care workers to lean on their own experience or guidance from their state public health systems to fight a disease that many are preparing to see for the first time and that initially may behave like the common cold.<\/p>\n \u201cAs measles becomes more common, all of us are leveling up in our ability to recognize and immediately respond to suspected measles,\u201d Flynn said.<\/p>\n Three C\u2019s<\/p>\n Officially, the U.S. has maintained \u201cmeasles elimination status\u201d since 2000, meaning the U.S. has avoided significant spread of the virus. After outbreaks in Texas, Arizona, Utah, and now South Carolina, the nation is on track to lose that designation before the year is out. Its own adopted regulations<\/a> tie elimination status to a lack of a continuous viral spread persisting for 12 months.<\/p>\n One county in South Carolina<\/a>, an hour\u2019s drive from Asheville, has had more than 900 cases<\/a> in the current outbreak \u2014 more than Texas reported in all of 2025.<\/p>\n Symptoms of measles, a virus that attacks the lungs and airways<\/a>, can include fever, cough, a blotchy rash, and red, watery eyes. Researchers consider measles among the most contagious diseases, and the virus may remain active for up to two hours after an infected person leaves a room.<\/p>\n It can be lethal, with 1 to 3 deaths per 1,000 cases in children<\/a>.<\/p>\n In 2025, two children in Texas and one adult in New Mexico died of measles.<\/p>\n Along with tracking data, the CDC provides detailed summaries<\/a> on its website for diagnosing measles. State public health agencies and some counties have developed dashboards tracing the disease as it surfaces in such places as hospitals, schools, grocery stores, and airports. Large hospital systems developed staff training protocols last year and shared them with area clinics.<\/p>\n Look for the three C\u2019s, that guidance said<\/a>: cough, coryza (cold symptoms), and conjunctivitis (pink eye). According to CMS inspection records, HCA Healthcare, which owns Mission Hospital, trained Mission staff on the three C\u2019s early last year. On top of failing to isolate the twin patients right away, Mission staff didn\u2019t have a designated area for patients with respiratory symptoms, federal inspectors found.<\/p>\n The CDC advises health workers to immediately place patients with measles or suspicious symptoms in a special isolation room, where airflow is controlled inward. The Mission patients were separated from other patients only by plastic partitions, according to the CMS records.<\/p>\n Mission spokesperson Nancy Lindell said the hospital was equipped and staffed to manage airborne illnesses like measles.<\/p>\n \u201cOur hospital has been working with state and federal health officials on proactive preparedness, and we are following guidance provided by the CDC,\u201d Lindell said.<\/p>\n (Dogwood Health Trust, a private foundation established as part of HCA\u2019s purchase of Mission Health, helps fund KFF Health News coverage.)<\/p>\n Most U.S. clinics and hospitals have never experienced measles cases, said Patsy Stinchfield, a former president of the National Foundation for Infectious Diseases and a nurse practitioner. She called CMS\u2019 Immediate Jeopardy penalty for Mission \u201cextreme,\u201d given the virus can be so difficult to identify.<\/p>\n \u201cIn the middle of winter right now, measles looks like every other viral respiratory infection that kids come in with,\u201d Stinchfield said.<\/p>\n The CDC has been less communicative in the past year with clinics about their response to outbreaks, said health workers and infectious disease experts. This disconnect began soon after Trump took office, according to a KFF Health News investigation<\/a> finding that health officials in West Texas were unable to talk with CDC scientists as measles surged last February and March.<\/p>\n \u201cWe certainly do not feel the support or guidance from the CDC right now,\u201d said Brigette Fogleman, a pediatrician at Asheville Children\u2019s Medical Center, where staff members have come up with their own method of staving off the virus: screening patients over the phone and in their cars before a visit.<\/p>\n In response to questions about how the CDC is supporting health care organizations during the measles resurgence, spokesperson Andrew Nixon said that \u201cstate and local health departments have the lead in investigating measles cases and outbreaks\u201d and that the CDC provides support \u201cas requested.\u201d He pointed to numerous guides and simulation tools the agency has developed as the virus has spread.<\/p>\n Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University, acknowledged that diagnosing measles is a major challenge, emphasizing that coordination among public health agencies is critical in overcoming that challenge.<\/p>\n Stinchfield attributed the spread of measles to CDC leaders\u2019 lack of communication to clinics and to the public \u2014 no ads on buses, no social media campaigns, no sense of urgency. \u201cWhen you are at the highest level of measles cases in 30 years, we should be seeing lots more from our federal government,\u201d Stinchfield said. \u201cAnd I think it\u2019s harming kids and causing an inordinate amount of work and expense that really doesn\u2019t belong in health care right now.\u201d<\/p>\n State Prepares for More Measles Cases<\/p>\n In North Carolina\u2019s Buncombe County, home to Asheville and Mission Hospital, health officials had counted seven measles cases by mid-February and anticipated many more, according to state epidemiologist Zack Moore. It\u2019s unclear how many of those are connected to the Mission exposure.<\/p>\n \u201cWe are preparing for a future in which we follow a trajectory like South Carolina,\u201d Moore said, \u201cwhere 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.\u201d<\/p>\n Fogleman, who is also a pediatrician, and Buncombe health department director Jennifer Mullendore spoke during a recent Facebook livestream<\/a> hosted by the county, urging families to get their children vaccinated, debunking vaccine misinformation, and updating parents on local case numbers.<\/p>\n Days before, a local private school had quarantined about 100 students after an exposure. Only 41% of students there<\/a> were immunized, according to state data.<\/p>\n At Fogleman\u2019s clinic, parents are asked to wait in their vehicles with their children, and staffers come out to screen them there. Some parents resist vaccination and note recently weakened federal recommendations around measles vaccines for children under 4<\/a>, she said.<\/p>\n Kennedy handpicked the committee members who made those recommendations, with several members having spread medical misinformation in the past.<\/p>\n One parent recently told a nurse, \u201cIt\u2019s only measles. It doesn\u2019t kill anybody,\u201d Fogleman said.<\/p>\n That\u2019s not true, her team must explain.<\/p>\n As the clinic holds families in the parking lot, trying to figure out whether symptoms point to the dangerous virus, it\u2019s difficult to get the message across, Fogleman said, especially when the nation\u2019s top disease agency hasn\u2019t conducted a widespread information campaign about the risks from measles \u2014 or the vaccine\u2019s ability to almost entirely prevent it.<\/p>\n \u201cWe can\u2019t change the past,\u201d Fogleman said. \u201cAll we can do is try to educate and move forward.\u201d<\/p>\n \n\t\t\t\t\t\t\t\t\t\t\tAndrew Jones: \t\t\t\tRelated Topics\t\t\t<\/p>\n \t\t\t\t \t\t\t\t\t\t\t
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