Tracking US patient zero through unquarantined odyssey

The man who has become the first Ebola patient to develop symptoms in the United States told officials at Texas Health Presbyterian Hospital on Sept. 26 that he had just arrived from West Africa but was not admitted that day because that information was not passed along at the hospital, officials acknowledged Wednesday.
The man, Thomas E. Duncan, was sent home under the mistaken belief that he had only a mild fever, a hospital administrator said; the information that he had traveled from Liberia, one of the nations at the heart of the Ebola epidemic, was overlooked. Mr. Duncan came back to Texas Health Presbyterian Hospital on Sept. 28 and was admitted for treatment, but in those two days in between, his contacts with a number of people — including five schoolchildren and the medics who helped transport him to the hospital — potentially exposed them to Ebola, forcing officials to monitor and isolate them in their homes and to begin a thorough cleaning of the schools the students attended. Mr. Duncan is now in serious but stable condition.
Mr. Duncan’s case began with him playing the part of good Samaritan on another continent. Mr. Duncan — a Liberian national in his mid-40s who had come to America to visit relatives in Dallas — had direct contact with a woman stricken by Ebola in Monrovia, the Liberian capital, on Sept. 15, days before he left Liberia for the United States, the woman’s parents and Mr. Duncan’s neighbors said.
The family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help after failing to get an ambulance. Ms. Williams was turned away for lack of space in the hospital’s Ebola treatment ward, the family said, and they took her back home in the evening, hours before she died, Mr. Duncan helped carry her because she was no longer able to walk. In the taxi, Ms. Williams, who was seven months pregnant, had been convulsing.
Mr. Duncan flew on Sept. 19 from Monrovia to Brussels, where, according to United Airlines, he took Flight 951 to Washington Dulles Airport and continued to Dallas/Fort Worth on Flight 822, arriving Sept. 20. Here in Dallas, the case was being handled with extraordinary caution and raised widespread concern. There was no indication of panic among residents in the largely Hispanic and African neighborhood where Mr. Duncan was staying in the Fair Oaks section of the city. But misinformation about how the disease spreads was everywhere, even as local, state and federal health officials continued to make clear that Ebola is not an airborne illness and is not spread through casual contact but through direct contact with the bodily fluids of a sick person.
“We’re confident that it’s isolated and it’s being contained, but everyone is working tirelessly to double- and triple- and quadruple-check their work, to make sure that we’ve done an absolutely thorough job of identifying anyone who might be at any risk,” said the top elected official of Dallas County, County Judge Clay Jenkins.
Some members of the Liberian community in the Dallas area said that given the spread of the disease in their home country, they were skeptical of the health information being released publicly, adding that public gatherings were being canceled out of fear of possible contagion.
At an African cafe down the street from the apartment complex where Mr. Duncan had been staying with relatives and a middle school attended by one or two of the students being monitored, a group of Ethiopian men and women sat talking at a table outside. No one knew Mr. Duncan or his family, and one woman was unfamiliar with Ebola and its effects.
“I touch you like this,” a man told her, tapping her on the knee, “and you get Ebola.”
Officials said Wednesday that they believed Mr. Duncan came into contact with 12 to 18 people when he was experiencing active symptoms and when the disease was contagious, and the daily monitoring of those people had not yet shown them to be infected.
When Mr. Duncan first arrived at the hospital on Sept. 26, six days after he had arrived in America, he told a nurse that he had come from West Africa. Public health officials have been urging doctors and nurses to be on the alert for Ebola in anyone who has been in Guinea, Liberia or Sierra Leone. But information about Mr. Duncan’s travel was not “fully communicated” to the full medical team, said Dr. Mark Lester, executive vice president of Texas Health Resources, the parent organization that oversees Texas Health Presbyterian Hospital.
As a result, that information was not used in the clinical diagnosis and Mr. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection, Dr. Lester said.
The five students who came into contact with Mr. Duncan attend four Dallas area public schools. They have been advised to stay home from school. The students — at a high school, a middle school and two elementary schools — are under observation by county health officials. “The students don’t have symptoms, so the odds of passing on the virus is very low,” said Mike Miles, the Dallas district’s superintendent.
The schools will remain open, but will undergo an extensive cleaning. Additionally, at least three Dallas Fire and Rescue emergency medical technicians were being monitored and were in isolation at home, although they, as well as the other adults under observation, were free to leave their homes because they were not being quarantined. The medics helped transport Mr. Duncan to the hospital on Sept. 28. Even the emergency vehicle that was used — Ambulance No. 37 — is in isolation and not in service, officials said.
“This case is serious,” Gov. Rick Perry of Texas said at a news conference at the hospital on Wednesday. “This is all hands on deck.”
Some of the children and adults under observation are from Liberia, but it was unclear how many. There are an estimated 10,000 Liberians living in four counties in North Texas, including Dallas and Tarrant counties. One active group, the Liberian Community Association of Dallas-Fort Worth, was founded more than 30 years ago.
In Kannapolis, N.C., a man who only gave his name as Joe said he was Thomas Duncan’s brother and that Mr. Duncan’s mother was inside a house there. “His mom is in there crying for her son,” he said. “I’m worried about my brother. And I’m over here trying to figure out what to do.”
In Monrovia, Mr. Duncan had lived in a neighborhood called 72nd SKD Boulevard, for two years, living by himself in a small room that he rented from the parents of the ill young woman he helped carry, Emmanuel and Amie Williams. Mr. Duncan had told them and his neighbors that his son lived in the United States, played baseball, and was trying to get him to come to America.
For the past year, Mr. Duncan had worked as a driver at Safeway Cargo, the Liberian customs clearance agent for FedEx, said Henry Brunson, the company’s manager. Mr. Duncan quit abruptly on Sept. 4, giving no reason. But Mr. Brunson said he knew that Mr. Duncan had family members in the United States.
“His sister came from the United States and he asked for a day off so that he could go meet her at the Mamba Point Hotel,” Mr. Brunson said, mentioning a hotel popular among foreigners. “He quit a few weeks after that.”
The way Mr. Duncan appears to have been infected with Ebola is typical in Monrovia, where the epidemic is spreading rapidly and most people are dying at home because of a lack of ambulances and Ebola treatment centers. At home, they spread the virus to family and friends who are taking care of them.
The family of Ms. Williams said they had no choice but to take her back home after being turned away from John F. Kennedy Memorial Hospital, first at its maternity ward and then at its Ebola center. While she was sick at home, she appeared to have also infected a neighbor, Sarah Smith, whose corpse was picked up Wednesday.
Neighbors said that an ailing Ms. Williams used to visit Ms. Smith, who lived in a pink house next door. After Ms. Smith fell ill, a friend of hers living nearby started coming over to take care of her. That friend, Marie Wread, did chores for Ms. Smith, including washing her clothes.
On Wednesday, a visibly ill Ms. Wread was taken by ambulance to a hospital; her daughter, Mercy, 9, joined her in the ambulance, though she was not showing symptoms herself. Other neighbors, fearful of the growing contagion, had insisted angrily that Mercy be taken away.
Ms. Williams appears to have been the first patient in her area of the Monrovia neighborhood. On Sept. 15, Mr. Duncan rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Later, after being turned away at the hospital, Mr. Duncan helped carry Ms. Williams back to the family home that evening.
“He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back,” said Arren Seyou, 31, who witnessed the scene and occupies the room next to Mr. Duncan’s. Sonny Boy, 21, also started getting sick about a week ago, his family said. In a
sign of how furiously the disease can spread, an ambulance had come to their house on Wednesday to pick up Sonny Boy. Another ambulance picked up a woman and her daughter from the same area, and a team of body collectors came to retrieve the body of yet another woman — all four appeared to have been infected in a chain reaction started by Marthalene Williams.
A few minutes after the ambulance left, Ms. Williams’ and Sonny Boy’s parents got a call. It was about Sonny Boy. He had died on the way to the hospital

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