The medical community in Dallas no doubt will spend a long time dissecting what went wrong in the handling of Thomas Eric Duncan’s case when he went to Texas Health Presbyterian of Dallas on Sept. 25 complaining of illness, a day after his Ebola symptoms started surfacing.
A few extra questions and closer attention to communication among the hospital’s staff could have made the difference between life and death.
Duncan died Wednesday, and this tragedy should weigh heavily on the minds of everyone in the medical community.
Ebola is a truly scary disease because of its high fatality rate. But Ebola doesn’t have to be fatal as long as doctors are able to respond quickly as soon as the patient starts to show symptoms.
They didn’t have that opportunity in Duncan’s case because of the botched handling of crucial information: the fact that he had arrived in Dallas on Sept. 20 from Liberia, the most heavily affected country in the current Ebola epidemic. More than half of all Ebola infections — now totaling 7,470 — from the West African epidemic have occurred in Liberia, according to the U.S. Centers for Disease Control and Prevention. Liberia accounts for nearly two-thirds of the 3,431 deaths so far.
In Liberia, possibly because the medical system is so badly overwhelmed, Ebola has an extraordinarily high fatality rate of 54 percent of those infected. But in neighboring Sierra Leone, the fatality rate is less than 25 percent, according to CDC statistics. Doctors’ ability to stabilize and tend to patients makes all the difference.
Because information about Duncan’s recent arrival from Liberia wasn’t adequately considered by doctors, they didn’t know of the emergency at their doorstep. Duncan was sent home on Sept. 26. During the next couple of days, his condition worsened.
He was highly contagious at that point, which meant that everyone who came in contact with him was at risk of infection. The chain of danger to the public only grew worse because of the hospital’s failure to place him in isolation. Duncan stayed in an apartment with children who then went to four Dallas ISD schools, prompting alarmed parents to pull their children from classes. Ambulance personnel were placed at risk. The entire city went on high alert.
Aside from the contagion factor, Duncan’s own life hung in the balance because of the deadly wrong communication chain at Presbyterian. Had doctors recognized the seriousness of the Liberia connection, they almost certainly would have reacted sooner to keep him in the hospital and place him in quarantine.
That’s the point when they could have — and should have — begun intensive efforts to stabilize him. That includes keeping his fever under control, keeping him hydrated and ensuring that his electrolytes were in balance, and keeping close tabs on his oxygen levels and blood pressure. Those measures would have given Duncan’s body its best chance at fighting back, aided by drugs to control infections when Ebola attacked vital organs.
Critics no doubt will point to the experimental drugs administered to two other patients, including Dr. Kent Brantly of Fort Worth, after they contracted Ebola while working in West Africa. They lived. Dallas County Commissioner John Wiley Price has suggested that Duncan was denied immediate treatment because of his race and income.
That’s an unproductive diversion. This boils down to human error: At least one person possessed information crucial to a patient’s survival. That person relied on computer communications to pass information up the ladder and failed to pass it along orally to decision makers at Presbyterian.
Duncan’s doctors appeared not to have taken time for a simple discussion of the basic information they needed before sending him home on Sept. 26.
It’s possible that Dallas and the country avoided catastrophe after recovering from the initial, egregious mistakes. But the tragedy of Duncan’s death was avoidable. Thousands of people have survived Ebola, and Duncan should have been among them.
Tod Robberson is a Dallas Morning News editorial writer. Reach him by email at trobberson@dallasnews.com.
