Dallas:
A nurse here became the first person to contract Ebola
within the United States, prompting local, state and federal officials
who had settled into a choreographed response to scramble Sunday to
solve the mystery of how she became infected despite wearing protective
gear and to monitor additional people possibly at risk.
The news
further stoked fears of health care workers across the country, many of
whom have grown increasingly anxious about having to handle Ebola cases.
The confirmation Sunday of the second Ebola case in Dallas - four days
after the death Wednesday of the first patient, Thomas Eric Duncan, 42, a
Liberian who arrived in this country in September - opened a new and
more frightening chapter in the unfolding public health drama.
While
the new Ebola patient was not publicly identified, officials said that
she was a nurse who had helped treat Duncan at a hospital here and that
she may have violated safety protocols. It was the first confirmed
instance of Ebola being transmitted in this country. Officials expanded
the pool of people they had been monitoring, because the nurse had not
been among the 48 health care workers, relatives of Duncan and others
whom they were evaluating daily.
The U.S. Centers for Disease
Control and Prevention recommended that health officials look more
closely at the protective gear that nurses, doctors and hospital
assistants use when treating Ebola patients. It also, for the first
time, was considering the idea that patients with the virus should be
transferred to hospitals with special containment units and experience
in treating the disease. The Dallas hospital at the center of the two
Ebola cases - Texas Health Presbyterian Hospital, which sent Duncan home
on Sept. 25 under the mistaken belief he had a sinus infection, only to
have him return Sept. 28 when his conditions worsened - was facing
renewed scrutiny over whether it had properly trained its workers.
The
CDC said it would conduct a nationwide training conference call Tuesday
for thousands of health care workers to ensure they would be fully
prepared to treat a patient with Ebola.
"The care of Ebola
patients can be done safely, but it's hard to do it safely," Dr. Thomas
R. Frieden, director of the CDC, told reporters Sunday. "Even a single,
inadvertent innocent slip can result in contamination."
The
stricken nurse reported a low-grade fever overnight Friday, officials
said. It appeared that she drove herself to the emergency room of
Presbyterian Hospital, where she worked, and was admitted and put in
isolation 90 minutes later, the officials said.
She had extensive
contact with Duncan on multiple occasions after his second visit and
admission to the hospital on Sept. 28, Frieden said.
The nurse
had been monitoring herself for symptoms of Ebola, under a regimen
prescribed by the CDC. Health officials will now investigate who had
been in contact with Duncan after he was admitted to the hospital on
Sept. 28 and while he was in isolation, Frieden said.
Before her
trip to the emergency room, officials said, the nurse had not been at
work for two days. A preliminary blood test was done at the state public
health lab in Austin and the positive result was received late Saturday
evening, officials said. Late Sunday afternoon, the CDC confirmed that
she had Ebola after completing its own tests.
The woman was in
stable condition on Sunday. Dr. Daniel Varga, chief clinical officer of
Texas Health Resources, which oversees Texas Health Presbyterian
Hospital, told reporters on Sunday that the worker had worn protective
gear when coming in contact with Duncan, although he did not detail the
type of contact.
"This individual was following full CDC
precautions," Varga said, adding, "Gown, glove, mask and shield." Asked
how concerned he was that the worker tested positive despite the
precautions, he replied, "We're very concerned."
Despite Varga's
reassurances about CDC precautions having been followed, Frieden said it
appeared the woman had breached safety protocol at the hospital,
possibly when removing the protective gear. Speaking on the CBS program
"Face the Nation" and later at a news conference, he said that
questioning of the worker had not identified precisely how a breach
occurred and that the cause of her infection was not known. Frieden said
everyone who treated Duncan was now considered to be potentially
exposed and that other cases of Ebola were possible.
"We're deeply concerned about this new development," he said on the talk show.
The
CDC has said that for health workers in the United States gloves,
gowns, masks and face shields or goggles would be protection enough. But
many health workers across the country, seeing images of people in
Africa completely encased in full-body hazardous-material suits, have
requested similar protection.
"A lot of us are starting to get
worried," said Debra Buccellato, an emergency room nurse in Santa Rosa,
California. "I'm a single mom, so if I got sick there'd be a huge void."
Buccellato,
38, said supervisors at her hospital had distributed information about
CDC guidelines, but added, "I have not seen any active training or
practice drills, and I haven't seen any new or upgraded personal
protective equipment."
She said she had emailed her manager to
ask for more training, but said she was not sure that hazardous material
suits were the best option for her 90-bed facility, Sutter Santa Rosa
Hospital.
"I don't know how realistic it is to go to that level
when you have X amount of patients to take care of and time issues,"
Buccellato said. For now, she said she plans to start wearing a face
mask for her entire shift.
On Sunday, National Nurses United, the
country's largest union and professional association of nurses,
continued to sound the alarm and call for hazardous material suits at
all hospitals.
"I'm angry about this," said RoseAnn DeMoro, the
executive director. "We want the first line of defense to be the most
prepared. Our hospitals are resisting us. The CDC doesn't say that we
need hazmat suits. If this doesn't change dramatically, we will picket
every hospital in this country if we have to."
Dr. Ken Anderson,
the chief operating officer of the American Hospital Association's
research arm, said his organization was recommending that hospitals
follow CDC guidelines and was not providing suggestions of its own.
"We
rely on the policies and procedures that are found at every hospital,"
he said. "Their own best internal education is what's going to make that
most effective."
President Barack Obama on Sunday directed the
CDC to expedite its investigation into how the health care worker
contracted the deadly virus, according to a White House statement.
In
an indication that the White House was taking steps in advance of any
possible spread of the disease, Obama also directed federal officials to
make sure that hospitals and health workers across the nation "are
prepared to follow protocols should they encounter an Ebola patient,"
the statement said. Obama was briefed by Lisa Monaco, the president's
assistant for homeland security, and then spoke by telephone with Sylvia
Mathews Burwell, the secretary of health and human services.
While
there have been other patients with Ebola treated in the United States
in recent weeks, the nurse is only the second person - after Duncan -
whose condition was diagnosed in the United States. All of the other
patients - including medical personnel, relief workers and journalists -
received a diagnosis while working in West Africa near Ebola victims
and were brought to this country for treatment.
Four hospitals in
the United States - Emory University Hospital in Atlanta, Nebraska
Medical Center in Omaha, the National Institutes of Health in Bethesda,
Maryland, and St. Patrick Hospital in Missoula, Montana - have
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.
But
in Dallas on Sunday, officials were trying to persuade residents to
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," said County Judge Clay Jenkins, Dallas
County's chief executive, who himself has had close contact with those
who lived with Duncan. "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."
City officials moved swiftly to clean and decontaminate
many of the places where the nurse had been or had even briefly
touched, including her apartment in a complex on Marquita Avenue, the
complex's common areas and the car she took to the hospital. Police
officers were prohibiting access to her apartment. Officials believe the
woman's pet dog was inside the apartment but was doing fine.
"We
have a plan in place to take care of the pet, and we do not believe
that pet has any signs, and we'll move accordingly later today," Mayor
Mike Rawlings of Dallas said.
Remaining calm was easier said than
done for many of the woman's neighbors. Early Sunday, city officials
knocked on the doors of nearby homes and called residences in the four
blocks surrounding the complex to inform people that someone who lived
in the neighborhood had tested positive for Ebola.
"It's a little
creepy," said Kara Lutley, 25, who lives across the street from the
nurse's apartment building. "It's been in Dallas, but it hasn't been
this close."
At the hospital, the car the woman arrived in was decontaminated and secured so no one could go near it, officials said.
"We
decontaminated hand-railings, everything in the parking lot, so
everybody can feel comfortable that the exterior was taken care of,"
Rawlings said.
The hospital also took the unusual step Sunday of
prohibiting ambulances from bringing new patients into its emergency
room. Officials said the hospital was open, but said they had decided to
put the emergency room on so-called diversion status because of staff
limitations.
"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 CDC 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."
© 2014, The New York Times News Service