US case of Ebola spreads to Dallas healthcare worker

A hospital worker here who helped treat the Liberian man who died last week of the Ebola virus has tested positive for the disease, even though the worker was wearing a gown, gloves, mask and other protective gear when coming into contact with the victim, officials said Sunday. http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?hp&action=click&pgtype=Homepage&version=LedeSumLargeMedia&module=a-lede-package-region&region=top-news&WT.nav=top-news&assetType=nyt_now
The hospital employee, a woman whom officials did not identify, worked at Texas Health Presbyterian Hospital in Dallas, where the first person diagnosed with Ebola in the United States, Thomas Eric Duncan, 42, died last Wednesday. The health care worker reported a low-grade fever Friday night, went to the hospital at some point after that and was immediately admitted and put in isolation, officials said.
The case, following the failure to recognize the Liberian man as a potential Ebola patient when he first sought treatment at the hospital, raises further questions about whether hospitals in the United States are prepared to deal with the disease.
Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said during a news conference on Sunday that his agency was considering the idea that Ebola patients should be transferred to hospitals with special containment units and experience in treating the disease.
But he emphasized that all hospitals should be able to recognize potential Ebola cases, and diagnose and isolate patients, because travelers with possible exposures could turn up almost anywhere.
The health care worker in Dallas had extensive contact with Mr. Duncan on multiple occasions after his second visit and admission to the hospital on Sept. 28, Dr. Frieden said. Mr. Duncan, who left Liberia on Sept. 19, first went to the emergency room on Sept. 25. He was released but returned days later after his condition worsened. Dr. Daniel Varga, chief clinical officer of Texas Health Resources, which
oversees Texas Health Presbyterian Hospital, said that the worker was wearing protective gear when she came into contact with Mr. Duncan, although Dr. Varga did not detail the type of contact or the type of job the person has at the hospital.
“This individual was following full C.D.C. precautions,” Dr. Varga said, adding, “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.”
Despite Dr. Varga’s reassurances about C.D.C. precautions having been followed, Dr. Frieden said that the latest report indicated a clear breach of safety protocol at the hospital. He said that questioning of the worker had not identified a breach and that the cause of her infection was not known.
“Unfortunately it is possible in the coming days that we will see additional cases of Ebola,” he said. Everyone who treated Mr. Duncan was now considered to be potentially exposed.
The second Ebola case, which the C.D.C. had not yet confirmed with its own tests of the hospital worker’s blood, immediately broadened the scope of the response by local officials, renewed fears of the spread of the disease in a city already on edge and raised questions about whether officials have failed to monitor a large enough pool of people potentially at risk.
Health officials said the woman was not one of the 48 individuals initially monitored for possible direct or indirect contact with Mr. Duncan before he was admitted to the hospital, including health care workers and Mr. Duncan’s relatives. None of those 48 individuals, health officials said, had shown any signs of the virus. The woman had been “self-monitoring” to check for symptoms of Ebola.
Health officials would now investigate who had been in contact with Mr. Duncan after he was admitted and while in isolation, Dr. Frieden said.
The C.D.C. said that the agency would address the question of how hospital workers could protect themselves with new urgency, more training and strengthened recommendations.
“Every U.S. health care facility needs to have the capability to intially handle a case,” Abbigail Tumpey, a spokeswoman for the C.D.C., said. “Even if the patient is going to be transferred to another facility, they need to be able to handle the first moments of interacting with a patient.”
Ms. Tumpey said the C.D.C. would issue more specific instructions and explanations for how health care workers should properly put on and take off protective equipment. Among other things, the agency will urge nurses and doctors to enlist a co-worker or “buddy” to watch them don and doff protective clothing in a safe way.
Proper handling of the equipment is crucial, Dr. Frieden said, because if the gear is contaminated, workers can infect themselves by touching it with bare hands.
Two other areas being examined, he said, were kidney dialysis and respiratory intubation of Ebola patients. Both procedures are considered high risk and may spread contaminated material.
Clay Jenkins, Dallas County’s chief executive, said all of the health care professionals who had been self-monitoring would now be checked twice daily by epidemiologists. It was unclear how many people had been self-monitoring in the Dallas area, but the number included 18 employees being tracked by Texas Health Presbyterian and Texas Health Resources. In addition, a close contact of the person who tested positive has been placed into isolation at the hospital.
Dallas officials stressed that residents should remain calm and reminded them that their risk of exposure was low. “You cannot contract Ebola other than from the bodily fluids of a symptomatic Ebola victim,” Mr. Jenkins said. “You cannot contract Ebola by walking by people on the street or by being around contacts who are not symptomatic. There’s nothing about this case that changes that basic premise of science. So it’s important, that while this is obviously bad news, it is not news that should bring about panic.”
In addition to being present in body fluids, the virus is also present on a patient’s skin after symptoms develop, said Dr. Bruce Ribner, the infectious disease specialist who heads the team that has cared for three Ebola patients at Emory University Hospital in Atlanta. Speaking at a medical conference last week, Dr. Ribner said that his team had tested the patients, and that finding the virus on the skin underlined how contagious the disease is once symptoms set in.
The first two patients treated at Emory, Dr. Kent Brantly and Nancy Writebol, recovered and were released. The third, who has not been identified, is still being treated. Two patients have been treated at the Nebraska Medical Center in Omaha; one patient, Dr. Rick Sacra, recovered and was released, and the other, Ashoka Mukpo, 33, an American freelance journalist, is still being treated.
Four hospitals in the United States — Emory in Atlanta, Nebraska Medical Center in Omaha, the National Institutes of Health in Bethesda, Md., and St. Patrick Hospital in Missoula, Mont. — have special high-containment units for isolating patients with dangerous infectious diseases, and medical teams at those facilities have conducted extensive training and drills for dealing with pathogens like Ebola.
In response to the latest report of the second victim in Dallas, officials moved swiftly to clean and decontaminate many of the places where the health care worker had been, including her apartment in a beige-brick complex where she lives on Marquita Avenue, the complex’s common areas and the car she drove to to the hospital.
By 8 a.m. Sunday, police were prohibiting access to the complex in a quiet residential neighborhood two miles north of downtown Dallas, and to the worker’s apartment. A biohazard barrel left over from the decontamination sat on the front lawn.
Some neighbors said city workers had knocked on their door or placed fliers on their doorstep. Others, like Lara Lutley, 25, who lives across the street, heard about the news on television. “It’s a little creepy,” she said. “It’s been in Dallas but it hasn’t been this close.”
At the hospital, “we decontaminated handrailings, everything in the parking lot, so everybody can feel comfortable that the exterior was taken care of,” Mayor Mike Rawlings of Dallas said.
The hospital took the unusual step Sunday of prohibiting ambulances from bringing new patients into its emergency room. Officials stressed the hospital was open for business, but said they decided to put the emergency room on so-called diversion status because of limitations in staff capacity.
“While we are on diversion we are also using this time to further expand the margin of safety by triple-checking our full compliance with updated C.D.C. guidelines,” hospital officials 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.”

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