Nearly a week after the first U.S. case of Ebola was confirmed, a Dallas patient’s condition has been downgraded from serious to critical.
The patient, Thomas Eric Duncan, was breathing with the help of a ventilator, his nephew Josephus Weeks told NBC News on Saturday morning. Stephen O’Brien, a spokesman for Texas Health Presbyterian Hospital Dallas, declined to confirm that information.
Duncan’s fiancee, Louise Troh, told The Associated Press she didn’t speak with him Saturday and learned his condition worsened after a reporter told her.
“I pray in Jesus’ name that it will be all right,” Troh told the AP in a telephone interview.
U.S. public health officials said Saturday that it would take more than a month before they could declare the risk of Ebola exposure eliminated.
Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, said in a briefing Saturday that although the incubation period for Ebola is 21 days, officials usually wait twice as long before declaring that the risk has passed.
The U.S. Ebola event will not end until 42 days from the last day of exposure, which as of now would be when Duncan, who is from Liberia, was taken to Texas Health Presbyterian Hospital and placed in isolation Sept. 28.
If new cases are discovered, Frieden said, the countdown would start again. Meanwhile the director of the Texas Department of State Health Services said plans were being made for how to handle other cases that may arise.
Officials have screened 114 people who may have been exposed to Duncan after he arrived in Dallas on Sept. 20 and were monitoring about 50 of them as of Saturday.
“We are just working around the clock,” said Zachary Thompson, the Dallas County Health and Human Services director.
The 50 includes nine people considered at high risk of exposure, including healthcare workers and relatives of Duncan, Frieden said.
He said it was important to follow up with Duncan’s potential contacts during the “peak period” of about a week after exposure. As of Friday, officials had reached all but one of the 50, including all nine considered high risk, Frieden said.
Decontaminating Dallas apartment
The four people Duncan was staying with in an apartment in Dallas have been confined to a house. They include Troh, her 13-year-old son; and two young men — one a relative, one a friend.
The Fort-Worth-based cleaning company hired to decontaminate the apartment was awaiting the go-ahead to start the final phase of cleanup.
“It’s going to be a complete clean-out of the apartment,” Brad Smith, vice president of The Cleaning Guys, said Saturday afternoon.
The first phase took 11 hours Friday. Workers packaged soiled linens, personal belongings and beds for transportation. The bedding, linens and clothing were placed in garbage bags, sealed, placed in plastic drums partially filled with bleach and then sealed again.
Smith said Dallas County officials could call him any minute Saturday night to remove curtains and the final items of the apartment.
“We are only cleaning the inside of the apartment,” Smith said, adding that the Homeland Security Department and CDC officials take it from there.
Halting flights not the answer, officials say
Frieden said calls from some members of the public to stop commercial airline flights from West Africa and “seal ourselves off from the world” would not prevent cases like that of Duncan, who apparently did not have symptoms until days after he arrived.
In fact, Frieden said, it could backfire: When Senegal recently halted flights to Liberia, he said, the move delayed the arrival of healthcare workers from the African Union.
He said exit screening of passengers at airports in West African countries has stopped 77 people from boarding departing flights, including 17 in September, though there was no follow-up monitoring to determine whether those people were later diagnosed with Ebola.
While the CDC is evaluating how West African arrivals are screened in the U.S., Frieden said, “nothing that we would have done in Liberia or the U.S. would have changed the course of the current situation.”
One thing that can be learned from Duncan’s case, he said, is that healthcare workers need to document a patient’s travel history.
“Hospitals across the nation have to learn from this experience. The travel history is very important to take right now,” said Dr. David Lakey, commissioner of the Texas Department of State Health Services.
Lakey then made a plea to healthcare workers listening to the briefing: “If you have a patient with fever or symptoms possibly related to Ebola, you have to ask that travel history.”
Clearing up events
Officials at Texas Presbyterian Hospital conceded late Friday that doctors handling Duncan’s case initially turned him away from the hospital despite having been informed that he had recently arrived in to Texas from Africa.
Earlier in the week, hospital officials said emergency room doctors who first treated Duncan were not aware that had traveled from Africa, even though a nurse who questioned him had documented that fact.
They said the miscommunication was due to a flaw in the electronic medical record system.
“We would like to clarify a point made in the statement released earlier in the week. As a standard part of the nursing process, the patient’s travel history was documented and available to the full care team in the electronic health record, including within the physician’s workflow,” the new hospital statement said.
“There was no flaw in the EHR in the way the physician and nursing portions interacted related to this event.”
Duncan arrived in Dallas from Liberia on Sept. 20. He first visited the hospital’s emergency room on Sept. 25 with a temperature of 100.1 degrees, abdominal pain, a headache and trouble urinating, according to a statement released by the hospital late Thursday.
A nurse asked Duncan whether he had traveled during the past four weeks, and he said he had been in Africa, according to the hospital statement.
The nurse recorded that information in Duncan’s electronic medical record. But the hospital initially said doctors who treated him used a separate record that did not include the travel history. The earlier statement, now revised, said doctors and nurses use separate “workflows.”
The man was sent home with a prescription for antibiotics, relatives said, but he got worse.
Second hospital trip
On Sept. 28, Duncan returned to the hospital by ambulance, was placed in isolation and two days later tested positive for Ebola.
Hospital officials initially said they released Duncan’s medical information “in the interest of transparency, and because we want other U.S. hospitals and providers to learn from our experience.”
They also said they had changed the electronic medical record format in response to Duncan’s case, “relocated the travel history documentation to a portion of the [medical record] that is part of both workflows. It also has been modified to specifically reference Ebola-endemic regions in Africa,” the statement said.
“We have made this change to increase the visibility and documentation of the travel question in order to alert all providers. We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola,” it said.
A CDC team sent to Dallas has been tracking Duncan’s contacts in both the community and the hospital.
Staff writer Monica S. Nagy contributed to this report, which includes material from the Los Angeles Times.