Trying to contain the Ebola outbreak in Spain

The Spanish health authorities said Thursday that three more people had been quarantined overnight in a Madrid hospital as Spain seeks to contain the risk of Ebola spreading from an auxiliary nurse who is Western Europe’s first case.

The auxiliary nurse, María Teresa Romero Ramos, tested positive for the disease on Monday, six days from when she first reported feeling ill after tending to a Spanish missionary who died at Carlos III Hospital, which Spain has designated to handle Ebola cases. Ms. Romero is one of six people quarantined at the hospital, but she is the only one who has tested positive. Altogether, about 80 people are being monitored to see if they develop symptoms of Ebola.

Spain’s efforts to contain the disease coincide with an investigation into what went wrong as well as mounting criticism from medical staff members involved in treating Ebola patients about the safety rules under which they have been working. The criticism is also putting pressure on the government of Prime Minister Mariano Rajoy, who has turned down calls to dismiss his health minister, Ana Mato, over the handling of the Ebola case.

Juan Manuel Parra Ramírez, a doctor who saw Ms. Romero when she was first hospitalized on Monday in Alcorcón, on the outskirts of Madrid, sent an open letter to Madrid‘s health authorities criticizing the conditions in which he tended to her. The sleeves of the protective suit he was given were too short, he said, while he learned only through the news media that Ms. Romero had tested positive, according to his letter, which was published Thursday by Spanish newspapers.

On Wednesday, the authorities offered the first official explanation of how Ms. Romero was probably infected. A doctor who has been treating her said that, based on her own account, she touched her face with a glove after removing her protective suit following a visit to the room of Manuel García Viejo, the Spanish missionary who died on Sept. 25. Criticism has centered on why the medical team that treated Ebola included

people with relatively low qualifications like Ms. Romero, who volunteered, and why such staff members were then handed risky duties that involved direct access to the patient, including the removal of infected material from his room. Unlike registered nurses, auxiliaries typically receive no advanced training and are assigned tasks like washing patients or bringing them food.

Some hospital staff members have said the safety protocol was not only inadequate but was also explained only in a single, short training session.

Another element of concern is why the procedures allowed Ms. Romero to go on vacation the day after the missionary died, putting her out of direct communication with her team and the hospital. By contrast, Doctors Without Borders, which has been leading efforts to treat Ebola cases in Africa, requires staff members to remain under direct monitoring during the period after their tour of duty.

Rubén Moreno, health spokesman for the governing Popular Party, told Spanish national television on Thursday that there was nothing wrong with Spain’s safety protocol, but that “you need to make adjustments” in any such procedures. “It’s obvious that the patient herself has recognized she didn’t respect fully the protocol,” Mr. Moreno said. “The protocol is one thing and compliance another.”

Accounts differ over why Ms. Romero was not immediately hospitalized when she reported feeling feverish to a medical center on Sept. 30. Francisco José Rodríguez, the official responsible for health issues within the regional government of Madrid, said at a news conference on Wednesday that Ms. Romero had failed to inform the doctor who initially assessed her fever that she had handled an Ebola patient. Mr. Rodríguez also suggested that she might have understated the gravity of her fever when she called the health services to report feeling ill.

“I am not ruling out the fact that she may have been lying to us,” he said.

But six days later, on Monday, when Ms. Romero called the health services to report that her condition had worsened, she was taken by a normal ambulance to a hospital in Alcorcón, which has no infrastructure intended to deal specifically with a disease like Ebola. She was transferred to Carlos III Hospital shortly after midnight, several hours after she had tested positive for Ebola. Officials said they would disinfect Ms. Romero’s home on Thursday, a day

after her dog, Excalibur, was put down as a precautionary measure, amid protests from animal rights activists who tried to block access to the home. Excalibur’s fate also incited widespread outrage on social media.

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