The first known case of Ebola contracted or transmitted in the U.S. was confirmed Sunday in a Dallas healthcare worker, prompting authorities including President Barack Obama to call for an investigation — and better preparation at the nation’s hospitals.
The worker, who was in stable condition Sunday, was wearing full protective gear when she was caring for Ebola victim Thomas Eric Duncan, who died last week at Texas Health Presbyterian Hospital Dallas.
Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said Sunday in Atlanta that he “is deeply concerned” to learn that “a breach in protocol” at a the hospital resulted in the health worker becoming infected.
“This individual was following full CDC precautions,” said Dr. Daniel Varga, chief clinical officer of Texas Health Resources, which oversees Texas Health Presbyterian. “Gown, glove, mask and shield.” Asked how concerned he was that even after those precautions, the worker tested positive, he replied, “We’re very concerned.”
Frieden said Sunday that the worker had extensive contact multiple times with Duncan during his care.
She was not among the 48 people who were identified as Duncan’s contacts during the initial investigation. Of those, 10, including relatives, are considered high-risk. Four relatives are being checked twice a day and are being guarded to ensure they remain isolated.
The remaining 38 are considered low-risk contacts and are being monitored for fever. The 21-day incubation period for most of the 48 will end on Sunday.
The worker made contact with Duncan after he was admitted to the hospital Sept. 28, when he was brought in by ambulance with serious symptoms and was isolated. He had been released from the emergency room after his first visit, on Sept. 25.
“At some point, there was a breach in protocol,” Frieden said. “And that breach in protocol resulted in this infection.”
Duncan, 42, of Liberia, died Wednesday morning at the hospital.
Frieden said the worker had a low level of the virus, adding that it appears she had contact with only one person while she might have been infectious.
He said the agency will conduct “a complete investigation on how this may have occurred” and outlined steps the agency plans to prevent a recurrence.
President Barack Obama asked federal authorities take more steps to ensure hospitals and healthcare providers are ready to follow proper procedures in dealing with an Ebola patient, The Associated Press reported.
The White House also said Obama has asked the CDC to move as quickly as possible in investigating the apparent breach of procedures.
Fort Worth crew cleans up again
A Fort Worth hazardous materials crew arrived Sunday afternoon to begin decontaminating the apartment in the 5700 block of Marquita Avenue, near Greenville Avenue in Dallas, where the worker lives. Brad Smith of Fort Worth-based CG Environmental – Cleaning Guys said a crew of eight scrubbed the exterior of the apartment with a chemical solution. Smith said he sent a worker inside to feed and water the woman’s dog.
But at 7 p.m. Sunday, Smith said “the state of Texas” took him off the project and brought in another cleaning crew.
He said he doesn’t know why they decided to go with another cleaning company. “We are disappointed,” he said. “We put it all out on the line and would have liked to finish the project.”
Smith said some of his other customers have asked them to not come back after the 21-day-waiting period from Sunday.
His company also decontaminated the Dallas apartment where Duncan stayed before he was hospitalized and cleaned parts of the hospital where he was treated.
Dallas County officials hurried early Sunday to reassure residents that they were not in danger.
“While this was obviously bad news, it is not news that should bring about panic,” Dallas County Judge Clay Jenkins said Sunday morning at a somber news conference at the hospital.
The worker was isolated after reporting a low-grade fever Friday night, the health department statement said. She was “self-monitoring,” according to hospital guidelines, and was put in isolation within 90 minutes of reporting symptoms, officials said.
Varga did not identify the worker.
The emergency department at Presbyterian is on diversion, meaning ambulances are not bringing patients to the emergency department, the hospital said in a statement.
“We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection,” the statement says.
Ebola, which has killed more than 4,000 people in West Africa, is not airborne — it is spread through direct contact with body fluids of a sick person or exposure to contaminated objects such as needles. People are not contagious before symptoms such as fever develop.
Frieden said that among healthcare workers, Ebola “requires meticulous and scrupulous attention to infection control, and even a single inadvertent innocent slip can result in contamination.”
The CDC’s key recommendations include making sure the number of workers caring for a suspected Ebola patient be kept to a minimum; limiting care to essential procedures; and looking into use of personal protective equipment, “understanding there is a balance and putting more on isn’t always safer — it may make it harder to provide effective care,” Frieden said.
He said the CDC is also recommending that one full-time employee be made responsible solely for “the oversight, supervision and monitoring of effective infection control while an Ebola patient is cared for.”
The CDC has sent more personnel to Texas to help, Frieden said.
He said that during the investigation, the CDC will look especially closely at kidney dialysis and respiratory intubation.
“Both of those procedures may spread contaminated materials and are considered high-risk procedures,” he said. “They were undertaken on the index patient [Duncan] as a desperate measure to try to save his life.”
Frieden said taking off equipment is particularly risky, because it can be difficult to remove gloves or masks without touching contaminated material and then getting it on clothes, face or skin. The Dallas worker told officials she does not know how protocol may have been breached.
Besides the risks of the 48 contacts identified, more cases of Ebola are possible in the days to come, Frieden said, because other workers may have made the same breach of protocol.
Reporter Monica Nagy contributed to this report, which includes material from The Associated Press.
HOW EBOLA SPREADS
According to the World Health Organization:
• The Ebola virus is transmitted among humans through direct physical contact with infected body fluids, the most infectious being blood, feces and vomit. It has also been detected in breast milk, urine and semen.
• Saliva and tears may also carry some risk. But in studies of saliva, the virus was found most often in patients at a severe stage of illness.
• The whole live virus has never been isolated from sweat.
• The virus can also be transmitted by contact with previously contaminated surfaces and objects.