Shaken
by America’s second case of Ebola, health officials in Dallas and across the
nation are escalating efforts to control the disease — and public concern.
Experts
had warned that another case was possible. But the infection disclosed Sunday
was not where most had been looking. It wasn’t among 48 individuals being
watched because of their contact with Thomas Eric Duncan, the Liberian who died
of Ebola last week in Dallas.
Instead,
it was a nurse at Texas Health Presbyterian Hospital Dallas who became the first
person infected with Ebola on American soil. While protected by a gown, mask,
shield and gloves, she had extensive contact on multiple occasions with Duncan,
officials said.
Hospital
and federal officials said they did not know how she caught the virus, only
that it was through an accidental breach of protective procedures. She was
among more than 50 people who the hospital said cared for Duncan during 10 days
he spent in isolation.
“It
is deeply concerning that the infection occurred,” said Dr. Tom Frieden, head
of the Centers for Disease Control and Prevention. Ebola treatment “protocols
work … but we know that even a single lapse or breach can result” in spreading
the virus.
The
woman, in stable condition Sunday in isolation at Presbyterian, was not
identified by name. By the afternoon, a Dallas apartment rented by a critical
care nurse at Presbyterian had been decontaminated, causing a stir among
neighbors near that complex in the M Streets off Lower Greenville Avenue.
Local
leaders were urging calm in a city uneasy at being at the center of an Ebola
scare, and questions were being raised anew about the training of health care
professionals and whether more needs to be done to contain the disease.
Since
coming down with symptoms, the latest patient had been in close contact with
only one person. That individual has been placed in isolation at Presbyterian
but has shown no symptoms, health officials said.
None
of the other people who have been closely monitored because of their contacts
with Duncan have shown signs of the illness.
Sunday,
Dallas County Judge Clay Jenkins and Dallas Mayor Mike Rawlings made a point of
repeating what has been said at nearly every Ebola-related news briefing: that
there is no risk of contracting the disease without contact with fluids from
someone who is showing symptoms.
“There
is nothing about this case that changes that basic premise of science,” Jenkins
said. “While this is obviously bad news, this is not news that should bring
about panic.”
Still,
Frieden said he wouldn’t be surprised if there’s another case because everyone
who treated Duncan may have been exposed.
“Unfortunately,
it is possible in the coming days that we will see additional cases of Ebola,”
he said.
As
a result of the new infection, local and national health officials announced a
series of moves intended to limit further spread of the illness:
Another
team of federal disease detectives has already started work in Dallas to figure
out what went wrong and identify any other contacts who will need to be monitored.
Staffers
at Presbyterian will get more training on how to protect themselves from Ebola.
President
Barack Obama ordered additional steps to ensure the readiness of hospitals
nationwide.
Any
American hospital treating an Ebola patient will be advised to keep the number
of health care workers involved to the minimum and to eliminate any optional
procedures.
Presbyterian
was urged to designate a clinical manager whose only responsibility will be to
monitor Ebola infection controls.
Because
of staffing issues, Presbyterian temporarily diverted ambulances away from its
emergency room. That order was lifted briefly late Sunday before being
reinstated. No explanation for the late changes in status was given.
Frieden,
the CDC chief, would not rule out designating a few specialty hospitals to
treat Ebola patients. Americans who contracted Ebola overseas have been sent to
hospitals in Nebraska and Atlanta. But all hospitals need to be prepared if new
cases show up, Frieden said.
“We
can’t let any hospital let its guard down,” he said.
Rep.
Bennie G. Thompson, D-Miss., the senior Democrat on the House Homeland Security
Committee, said the CDC should consider recommending transfer of Ebola patients
“to one of our nation’s biocontainment units upon diagnosis if there are beds
available.”
Duncan’s treatment
Duncan
had become infected in Liberia but didn’t get sick until several days after he
arrived in Dallas. Ebola can be transmitted only through contact with bodily
fluids from someone who is clearly ill with the virus.
Frieden
said that Duncan had received more extensive treatments in his final days than
any other Ebola patients in the U.S. Those treatments included kidney dialysis
and being placed on a ventilator to aid his breathing. Both of those procedures
involve extensive contact with bodily fluids — and, thus, greater risk for
contact.
The
nurse who became infected had developed a low-grade fever Friday evening. She
called Presbyterian and was told to come in. She was immediately placed in
isolation. A blood test came back positive for Ebola at 9:30 p.m. Saturday,
according to hospital officials.
Before
the nurse’s infection, health care workers who cared for Duncan during his
hospitalization were considered at low risk because they wore protective gear.
They were told only to check themselves for symptoms. Now, anyone at the
hospital who had contact with Duncan will be added to the list of those being
monitored.
But
that list was still being assembled Sunday, said Dr. Daniel Varga, chief
clinical officer for Texas Heath Resources.
“We
are going through that right now to try to understand specific elements of who
came in contact with Mr. Duncan, around what circumstances on what days,” he
said at a Sunday morning news conference.
He
said the nurse was in protective gear when she came into contact with Duncan,
but he did not specify her duties.
Hazmat team
Even
before the news conference at Presbyterian, a Dallas County hazardous materials
team had decontaminated the public areas of the nurse’s apartment complex in
the M Streets off Lower Greenville Avenue and the parking lot at Presbyterian
where she’d parked, along with her car.
Officials
sent a “reverse 911 call” to every telephone line within four blocks of the
apartment, and police officers and others knocked on every door in the
neighborhood to explain the situation and leave information about Ebola.
“We
had this plan in place last week,” Rawlings said. “So when we got this phone
call, which we thought we might get, we put an action team in place and they
have been working all this [prior] evening so that as people are waking up they
know that they are safe.”
Arrangements
were in the works to take care of the Presbyterian staffer’s dog, which was in the
apartment.
By
Sunday afternoon, a decontamination team was working in the apartment.
The
speed of the response was in marked contrast to what happened after Duncan was
diagnosed with Ebola. It took officials days to figure out how to clean the
apartment where he’d been staying and to dispose of contaminated materials.
Rawlings
and Dallas County Health Director Zachary Thompson were among several people
walking the nurse’s neighborhood, answering questions and distributing
information.
“You
have to be honest with people,” the mayor said. “If you are honest with them on
the bad stuff, they will believe you about the good stuff.”
The
new case sets a new 21-day clock for watching for additional cases. People
infected with Ebola can develop symptoms as long as 21 days after their first
exposure.
Only
Presbyterian staffers were exposed to Duncan after he was hospitalized on Sept.
28. The last day a Presbyterian staffer could have been exposed was when Duncan
died last Wednesday.
Health
officials at every level once again warned that despite the precautions being
taken, new Ebola cases could develop, particularly among those already being
monitored.
“One
thing I’ve learned in disaster response is you have to have a little humility,”
said Dr. David Lakey, commissioner of the Texas Department of State Health
Services.
Staff writers Tom
Benning and Melissa Repko in Dallas and Todd J. Gillman in Washington
contributed to this report.
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