Hospital Failed to Isolate Ebola Patient at First

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Editor’s note: This story was updated on Oct. 2, 2014, with additional information throughout.

Oct. 1, 2014 — A man being treated in a Dallas hospital for Ebola reportedly lied on a form that asked if he’d recently had contact with anyone infected before leaving Liberia.

The Liberian government says it plans to prosecute the man, identified in news reports as Thomas Eric Duncan, according to the Associated Press.

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Meanwhile, the Texas State Health Department says as many as 100 “potential or possible” contacts may have had even brief encounters with the man or the apartment where he was staying with family members when he was infectious.

Officials say they expect that number to drop as they focus solely on those who might be at risk of infection.

Earlier in the week, hospital officials admitted they had missed an opportunity to isolate the man when he was having the first symptoms of Ebola.

The man initially came to Texas Heath Presbyterian Hospital in Dallas after 10 p.m. on Thursday, Sept. 25.

At that point, he had a low fever and abdominal pain, says Edward Goodman, MD, an infectious disease specialist at the hospital.

He was given antibiotics and allowed to go home, even though he’d told a nurse who was using the hospital’s Ebola checklist that he’d recently traveled to Texas from West Africa.

“Regretfully, that information was not fully communicated through the whole team. So the import of that information was not fully appreciated,” says Mark Lester, MD. He’s an executive vice president for Texas Health Resources, the company that owns the hospital.

The man returned to a relative’s home for 2 days before being taken by ambulance back to Texas Health’s emergency department on Sunday, Sept. 28.

Witnesses saw Duncan vomiting on the ground outside of the apartment building before the ambulance picked him up on Sunday, according to media reports.

He also vomited in the ambulance on the way to the hospital, according to a spokeswoman for the city of Dallas. The ambulance he rode in was cleaned, but was still in use for 2 days after it transported him. It has since been quarantined, the spokeswoman says.

Three paramedics who transported him are under observation for 21 days. So far, tests show they didn’t catch the virus.

Also on Thursday, public health officials took legal action to order four of Duncan’s close family members to stay home and not have any visitors until Oct. 19, by which time Ebola symptoms will have appeared in them if they’re infected.

State laws, including Texas’s, give public health departments the ability to “implement control measures” if they believe someone might spread a disease to others.

Usually, that’s a verbal order that allows doctors to detain a potentially infectious person immediately for a short time until a written order for a longer isolation period can be issued, says Jeffrey S. Duchin, MD. He’s chair of the public health committee for the Infectious Disease Society of America.

“It takes minutes,” Duchin says. “All health care facilities should know how to communicate directly with their local public health authorities 24-7. This is something we’ve been working on the U.S. for many years,” he says.

Before returning to the hospital, the man had contact with five school-aged children at a relative’s home. The kids are being watched at their homes. So far, none of them are ill.  As a precaution, their schools are adding more health care workers to check for symptoms of illness in their classmates and beefing up their custodial staff to disinfect the classrooms and common areas, says Mike Miles, superintendent of the Dallas Independent School District.

More Details

The New York Times reports that the man may have become infected with the virus in Monrovia, after he helped carry his landlord’s daughter to a local hospital. She died of Ebola the next day.

In a press conference on Thursday, Tom Frieden, MD, director of the CDC, said that Duncan’s temperature was taken at the airport in Monrovia. His temperature was normal at 97.3.

Doctors say the Dallas hospital cleared an entire ward to treat the man, who they described as being in serious but stable condition.

Hospital officials say they’re still trying to figure out how many health workers or other patients might have been exposed to the man when he first came to the hospital.

But because his initial symptoms were mild, they think the risk to others was low.

“Since his arrival on Friday, he was not vomiting or having diarrhea, so there were no exposures. So we really feel like no health care workers were exposed on Friday,” Goodman says.

“There was no further exposure from Sunday morning on. People were wearing appropriate protective equipment,” he says.

When notified of a potential Ebola case, public health authorities can start appropriate testing, start tracking those who may have come in contact with the patient, and begin providing technical support to hospitals.

But the delay in making the man’s diagnosis pushed back those activities — which are critical to containing the spread of the disease — for at least 2 days.

‘All Hands on Deck’

Years ago, Russian scientists determined that just one particle of Ebola virus was enough to infect an animal, says Elke Mühlberger, PhD, microbiologist and Ebola expert at the Boston University School of Medicine.

But Muhlberger cautions that the animals were being directly injected with the virus for experimental purposes, and that’s much different than the way humans contract the disease. It’s not known how many viral particles it might take to infect a person.

She says Ebola is far less infectious than viruses that are airborne, like measles and influenza. She says it is “very, very, very unlikely” that Ebola could mutate to become transmitted by air. “We’ve never seen that happen before,” she says.

In a Dallas press conference earlier in the week, Governor Rick Perry reassured the city that appropriate measures were in place to stop the spread of the infection.

“This is all hands on deck. We understand that,” Perry said.

“We’re working very closely with both the city and county health officials on this very serious case,” he said.

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