With the news that a man in Dallas has Ebola and is being treated at a Dallas hospital while as many as 100 people in the U.S. are now at risk of Ebola exposure because they came into contact with him, for many Americans their worst fears of the deadly Ebola virus have come true.
It officially has touched down in the U.S.— and not under the control of the Centers for Disease Control and Prevention, like previous patients.
Officials said a handful of people currently are in isolation — the man’s family members and the medical technicians who rushed him to the hospital Sunday. Dozens of others — mainly those who had contact with people who had direct contact — are being monitored for fever or other symptoms, but are free to go on with their lives.
“None are symptomatic,” Erikka Neroes, a spokeswoman for the Dallas County Health and Human Services Department, told The New York Times.
“It’s a constant process of interviews and locating as many contacts as are out there,” she said. “We expect daily that there could be more people added.”
She said others might fall off the list as time passes and they show no symptoms.
“It’s constantly evolving,” she added.
But even as health officials in Texas and at the CDC — which has dispatched a team to Texas — try to assure Americans that they have the capability to stop the disease from spreading across the U.S. like a real-life version of the Hollywood movie Contagion, there are many indications that the efficacy of any system to control the virus is only as good as the people running it.
The most glaring example of that is what happened when the man, who has been identified by the Times and other media outlets as Thomas Eric Duncan arrived late last Thursday night at Texas Health Presbyterian Hospital because he didn’t feel well. Apparently, a nurse at the hospital asked about travel as part of normal procedure. When he told her he had recently returned from West Africa, that triggered no alarms in her head. He was sent home with antibiotics.
“Regretfully, that information was not fully communicated throughout the full teams. As a result, the full import of that information wasn’t factored into the full decision-making,” Texas hospital official Mark Lester said.
The Times reports that neighbors saw him vomiting on the ground outside the apartment complex two days later as he was being hustled into an ambulance.
“His whole family was screaming. He got outside and he was throwing up all over the place,” resident Mesud Osmanovic, 21, said Wednesday, according to the Times.
Duncan’s nephew, Josephus Weeks, told the Today show that he actually called the CDC himself because he did not feel hospital officials in Dallas were acting with enough urgency.
“I called CDC to get some actions taken because I was concerned for his life and he was not getting the appropriate care,” Weeks said on television. “And I feared that other people might get infected if he was not taken care of.”
Dr. Anthony S. Fauci, the head of the National Institutes of Health, acknowledged that things could have been handled better and told CNN he was confident the measures being taken would prevent any outbreak of the disease.
“It is regrettable that there wasn’t the connecting of the dots,” Fauci said. “Because of the attention that has been paid to the situation in Dallas, people will be very much aware of paying attention to the travel history.”
Duncan apparently helped to bring a pregnant woman with Ebola, 19-year-old Marthalene Williams, the daughter of his landlord in Liberia, to a hospital in Monrovia. When she was turned away for lack of space, Duncan helped bring her back to her family’s home and carried her into the house. She died the next day, while the landlord’s son and three neighbors who came in contact with the woman died soon afterward.
When he left for the U.S. four days later, he was checked at the airport in Monrovia for signs of the disease. When he was determined to have no fever, he was allowed to board his flight.
Dr. Nicole Cohen, an infectious disease specialist with the agency’s Division of Migration and Quarantine, told the Times that the CDC in August sent medical workers to West Africa to train local government officials and airport workers in Ebola screening. They were told to ask travelers if they have been exposed to Ebola in the last 21 days, have had a fever, and have had any symptoms including severe headache, muscle ache, abdominal pain, unusual bruising or bleeding, vomiting and diarrhea. In addition, the screener is expected to use a hand-held non-contact temperature monitor, a few inches from the travelers’ forehead, to check for fever, according to the Times.
But the system has to rely on travelers to self-report their possible exposure — which they know could get them banned from the flight.
“Our expectation is that people who are sick or people who are exposed should be getting the message they shouldn’t be traveling,” Cohen said.
Representatives from several airlines told the Times they have not taken any specific steps to deal with Ebola and they said they were not responsible for screening passengers.
Duncan flew from Liberia to Brussels on Brussels Airways, then to Dulles International Airport near Washington on Sept. 20 on United 951, and then on to Dallas-Fort Worth on Flight 822, the airline confirmed.
Texas officials said health workers who took care of the patient had so far tested negative for the virus and there were no other suspected cases in the state. Texas Gov. Rick Perry told a news conference he was confident the virus would be contained, as did other officials.
Ebola spreads through contact with bodily fluids such as blood or saliva, which health experts say limits its potential to infect others, unlike airborne diseases. Still, the long window of time before patients exhibit signs of infection, such as fever, vomiting and diarrhea, means an infected person can travel without detection.
While past outbreaks killed as many as 90 percent of victims, the current epidemic’s fatality rate has averaged about 50 percent in West Africa.
The patient arrived in Texas on Sept. 20, and first sought treatment six days later, according to the U.S. Centers for Disease Control and Prevention. The Liberian government said that the man showed no signs of fever or other symptoms of Ebola when he left the country on Sept. 19.
There was widespread panic among parents and schoolchildren in the Dallas-Fort Worth area after they learned that five school-age children had had contact with Duncan.
“My mom, she recommended that I not touch a lot of kids at school,” Royale Hollis, 15, a freshman at Emmett J. Conrad High School, which at least one of the children attended, told the Times. “I haven’t been shaking hands, just bumping elbows. People just keep their distance. Girls don’t give boys hugs. We’re all cool with each other but we just don’t want to catch anything.”
That high school is just around the corner from the apartment complex where Duncan was staying. The children are believed to have had contact with Duncan over the weekend, when he was sick and contagious, and then to have attended school the following Monday, according to the Times, which said they are now being monitored at home by health workers.
The children among them “did not have any symptoms and so the odds of them passing on any sort of virus is very low,” said Mike Miles, Dallas Independent School District superintendent.
Miles said the four different schools they attended would be staffed with additional health professionals and classes would remain in session.
Health officials said the chances that they passed the virus to other people at the school are extremely low because even when people are infected with Ebola, they are not contagious until they develop symptoms. And even then, according to the Times, the virus can be transmitted only through bodily fluids and close physical contact.
But that didn’t stop many parents from keeping their kids at home.