A second person in the US – the first to become infected inside the country – has tested positive for the Ebola virus, the Centers for Disease Control and Prevention confirm. She is a health care worker who was caring for a patient with Ebola at the Texas Presbyterian Hospital in Dallas.
“The health care worker, who provided care for the Dallas index patient, was isolated soon after symptoms started and remains so now,” says a Centers for Disease Control and Prevention (CDC) statement.
The “index” patient she was caring for was Thomas Eric Duncan – the first person to die of Ebola in the US. According to NBC News, Mr. Duncan may have contracted the virus in Liberia while taking a dying neighbor to the hospital in a taxi.
In a press briefing, CDC director Dr. Tom Frieden says, “at some point there was a breach in protocol and that breach in protocol resulted in this infection.”
However, he adds that although the CDC have spoken to the health care worker, “that individual has not been able to identify a specific breach.”
The health care worker had been self-monitoring for fever and symptoms while caring for Mr. Duncan. After reporting having a low-grade fever that developed in the night, she was referred for testing on Friday, October 10th.
Following protocol, she was isolated and CDC officials interviewed her to find out who she had been in contact with. The federal agency says so far, one close contact has been identified and is being monitored. Meanwhile, decisions about treatment of the second Ebola patient will be made by the hospital and the patient.
Understandably, the news is a great shock for the patient, her family and colleagues and the community of Dallas, say the CDC, adding that they and the Texas Department of State Health Services “remain confident that wider spread in the community can be prevented with proper public health measures.”
Such measures include continuing to trace contacts and monitoring those known to have been in contact with the index patient, isolating them immediately if they develop symptoms.
The CDC say it is necessary to monitor all health care workers who came into contact with Mr. Duncan as well as the new patient. Mr. Duncan was isolated in the hospital from September 28th until the day he died on October 8th. Anyone who came into contact with him over that period “will now be considered patient contacts for follow-up monitoring,” says the CDC statement.
Ebola spreads through direct contact with body fluids of an infected person or the remains of someone who has died of the infection. You can also become infected if you touch contaminated objects such as needles.
The infection has a typical incubation period of 8-10 days, but sometimes this can be as short as 2 days or as long as 21 days. A sick person is contagious once they develop fever. The CDC recommend monitoring for the full 21 days.
“The care of Ebola can be done safely, but it is hard to do it safely,” says Dr. Frieden. “It requires meticulous and scrupulous attention to infection control, and even a single inadvertent innocent slip can result in contamination.”
The CDC have sent staff to Texas to help with the response and are recommending that the hospital keep the number of workers who care for anyone suspected of having Ebola to an absolute minimum. They also recommend procedures required to support such patients be “limited solely to essential procedures.”
Dr. Frieden says they are also re-examining procedures around personal protective equipment, “understanding that there is a balance and putting more on isn’t always safer; it may make it harder to provide effective care.”
In answering a question about how the second patient may have become infected, he suggests there is “a need to enhance the training and protocol to make sure the protocols are followed.”
“The protocols work,” he adds. “We have decades of experience caring for patients with Ebola,” and he emphasizes the need to examine every possible way that a single lapse or breach, however inadvertent, may arise.
The CDC have also ramped up Ebola screening at five US airports: New York’s JFK, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta. Between them, these five international airports receive nearly 95% of West African travelers.
As of October 10th, the World Health Organization (WHO) report there are a total of 8,399 confirmed, probable and suspected cases of Ebola virus disease in seven affected countries and 4,033 deaths since the start of the epidemic in West Africa. The seven countries are Guinea, Liberia, Nigeria, Senegal, Sierra Leone, Spain and the US. These countries fall into two categories:
- Those with widespread and intense transmission – Guinea, Liberia and Sierra Leone
- Those with an initial case or cases, or with localized transmission – Nigeria, Senegal, Spain and the US.
There is also a separate, unrelated outbreak of Ebola in the Democratic Republic of Congo.