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.
