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In Dallas Ebola Case, Officials Are Monitoring Children Exposed to Patient Scrutiny in Texas to Detect Whether Ebola Spread
(about 3 hours later)
DALLAS — Health officials in Dallas are monitoring at least five schoolchildren in North Texas who came into contact with a man found to have Ebola virus, after he became sick and infectious. DALLAS — The man who has become the first Ebola patient to develop symptoms in the United States told officials at Texas Health Presbyterian Hospital on Sept. 26 that he had just arrived from West Africa but was not admitted that day because that information was not passed along at the hospital, officials acknowledged Wednesday.
The authorities also said that an early opportunity to put the patient in isolation, limiting the risk of contagion, may have been missed because of a failure to pass along critical information about his travel history. The man, Thomas E. Duncan, was sent home under the mistaken belief that he had only a mild fever, a hospital administrator said; the information that he had traveled from Liberia, one of the nations at the heart of the Ebola epidemic, was overlooked. Mr. Duncan came back to Texas Health Presbyterian Hospital on Sept. 28 and was admitted for treatment, but in those two days in between, his contacts with a number of people — including five schoolchildren and the medics who helped transport him to the hospital — potentially exposed them to Ebola, forcing officials to monitor and isolate them in their homes and to begin a thorough cleaning of the schools the students attended. Mr. Duncan is now in serious but stable condition.
The patient was identified by Liberian health officials and The Associated Press as Thomas Eric Duncan, a Liberian national. Mr. Duncan came to the United States on Sept. 20 aboard a commercial airliner and officials said that he had shown no symptoms of the disease while on the flight and that he had posed no threat to other passengers. Mr. Duncan’s case began with him playing the part of good Samaritan on another continent. Mr. Duncan — a Liberian national in his mid-40s who had come to America to visit relatives in Dallas — had direct contact with a woman stricken by Ebola in Monrovia, the Liberian capital, on Sept. 15, days before he left Liberia for the United States, the woman’s parents and Mr. Duncan’s neighbors said.
Mr. Duncan worked at a shipping company in Monrovia, Liberia, but had just quit his job, giving his resignation in early September, his boss said. He had gotten a visa to the United States and had decided to go, his neighbors said. He lived alone, but has family in the United States, they said. The family of the woman, Marthalene Williams, 19, took her by taxi to a hospital with Mr. Duncan’s help after failing to get an ambulance. Ms. Williams was turned away for lack of space in the hospital’s Ebola treatment ward, the family said, and they took her back home in the evening, hours before she died: Mr. Duncan helped carry her because she was no longer able to walk. In the taxi, Ms. Williams, who was seven months pregnant, had been convulsing.
Mr. Duncan may have become infected after his landlord’s daughter fell gravely ill. On Sept 15, Mr. Duncan helped his landlord and his landlord’s son carry the stricken woman to the hospital, his neighbors and the woman’s parents said. She died the next day. Mr. Duncan flew on Sept. 19 from Monrovia to Brussels, where, according to United Airlines, he took Flight 951 to Washington Dulles Airport and continued to Dallas/Fort Worth on Flight 822, arriving Sept. 20. Here in Dallas, the case was being handled with extraordinary caution and raised widespread concern. There was no indication of panic among residents in the largely Hispanic and African neighborhood where Mr. Duncan was staying in the Fair Oaks section of the city. But misinformation about how the disease spreads was everywhere, even as local, state and federal health officials continued to make clear that Ebola is not an airborne illness and is not spread through casual contact but through direct contact with the bodily fluids of a sick person.
Soon, the landlord’s son also became ill, and he died on Wednesday in an ambulance on the way to the hospital. Two other residents in the neighborhood who may have had contact with the woman have also died. Their bodies were collected on Wednesday as well. “We’re confident that it’s isolated and it’s being contained, but everyone is working tirelessly to double- and triple- and quadruple-check their work, to make sure that we’ve done an absolutely thorough job of identifying anyone who might be at any risk,” said the top elected official of Dallas County, County Judge Clay Jenkins.
Health officials in Dallas said Wednesday that they believed Mr. Duncan came in contact with at least 12 to 18 people when he was experiencing symptoms. So far, none has been confirmed infected. Some members of the Liberian community in the Dallas area said that given the spread of the disease in their home country, they were skeptical of the health information being released publicly, adding that public gatherings were being canceled out of fear of possible contagion.
The five children, who possibly had contact with Mr. Duncan at a home over the weekend, attended four different schools, which authorities said would remain open. As a precaution, they said all the schools — including one high school, one middle school, and two elementary schools — would undergo a thorough cleaning. At an African cafe down the street from the apartment complex where Mr. Duncan had been staying with relatives and a middle school attended by one or two of the students being monitored, a group of Ethiopian men and women sat talking at a table outside. No one knew Mr. Duncan or his family, and one woman was unfamiliar with Ebola and its effects.
“This case is serious,” Gov. Rick Perry of Texas said at a news conference. “This is all hands on deck.” “I touch you like this,” a man told her, tapping her on the knee, “and you get Ebola.”
Health officials on Wednesday continued to track down other people who might have been exposed to Mr. Duncan after he began showing symptoms, on Sept. 24, and will monitor them every day for 21 days — the full incubation period of the disease. Most people develop symptoms within eight to 10 days. As a patient becomes sicker and the virus replicates in the body, the likelihood of the disease spreading grows. Officials said Wednesday that they believed Mr. Duncan came into contact with 12 to 18 people when he was experiencing active symptoms and when the disease was contagious, and the daily monitoring of those people had not yet shown them to be infected.
Even as public officials sought to reassure the public that the situation was under control, there were questions about how the patient was treated when he first went to a hospital on Sept. 26. When Mr. Duncan first arrived at the hospital on Sept. 26, six days after he had arrived in America, he told a nurse that he had come from West Africa. Public health officials have been urging doctors and nurses to be on the alert for Ebola in anyone who has been in Guinea, Liberia or Sierra Leone. But information about Mr. Duncan’s travel was not “fully communicated” to the full medical team, said Dr. Mark Lester, executive vice president of Texas Health Resources, the parent organization that oversees Texas Health Presbyterian Hospital.
Dr. Mark Lester, executive vice president of the Texas Health Resources System, said the hospital staff had been instructed to ask patients about their travel history, following the advice of federal authorities. As a result, that information was not used in the clinical diagnosis and Mr. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection, Dr. Lester said.
That checklist, he said, was utilized by a nurse and the patient volunteered that he had just come from Liberia. “Regretfully that information was not fully communicated” to the full medical team, Dr. Lester said. The five students who came into contact with Mr. Duncan attend four Dallas area public schools. They have been advised to stay home from school. The students — at a high school, a middle school and two elementary schools — are under observation by county health officials. “The students don’t have symptoms, so the odds of passing on the virus is very low,” said Mike Miles, the Dallas district’s superintendent.
As a result, that information was not used in the clinical diagnosis and Mr. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection. He was rushed to the hospital in an ambulance two days later, his condition having significantly deteriorated. He remains in isolation at Texas Health Presbyterian Hospital of Dallas in serious condition. The schools will remain open, but will undergo an extensive cleaning. Additionally, at least three Dallas Fire and Rescue emergency medical technicians were being monitored and were in isolation at home, although they, as well as the other adults under observation, were free to leave their homes because they were not being quarantined. The medics helped transport Mr. Duncan to the hospital on Sept. 28. Even the emergency vehicle that was used — Ambulance No. 37 — is in isolation and not in service, officials said.
In the time between Mr. Duncan’s trips to the hospital, health officials said he came into contact with more people while he was symptomatic and infectious. The contacts possibly included the five children who saw him over the weekend before going to school on Monday. “This case is serious,” Gov. Rick Perry of Texas said at a news conference at the hospital on Wednesday. “This is all hands on deck.”
Other people who came into contact with him include relatives and the medical technicians who took him by ambulance to the hospital. At least three Dallas Fire and Rescue emergency medical technicians were being monitored and were in isolation at home, according to officials. Some of the children and adults under observation are from Liberia, but it was unclear how many. There are an estimated 10,000 Liberians living in four counties in North Texas, including Dallas and Tarrant counties. One active group, the Liberian Community Association of Dallas-Fort Worth, was founded more than 30 years ago.
Even the emergency vehicle that was used — Ambulance No. 37 — is in isolation and not in service. In Kannapolis, N.C., a man who only gave his name as Joe said he was Thomas Duncan’s brother and that Mr. Duncan’s mother was inside a house there. “His mom is in there crying for her son,” he said. “I’m worried about my brother. And I’m over here trying to figure out what to do.”
The five children who had contact with Mr. Duncan are being kept home from school, according to David Daigle, a spokesman for the federal Centers for Disease Control and Prevention team that is working with local health officials to trace the contacts. Adults without symptoms do not have to stay home or be quarantined, but will be visited once a day for 21 days by health teams to have their temperatures taken and be checked for signs of illness. The first round of visits to contacts took place on Wednesday afternoon, Mr. Daigle said. In Monrovia, Mr. Duncan had lived in a neighborhood called 72nd SKD Boulevard, for two years, living by himself in a small room that he rented from the parents of the ill young woman he helped carry, Emmanuel and Amie Williams. Mr. Duncan had told them and his neighbors that his son lived in the United States, played baseball, and was trying to get him to come to America.
Mr. Duncan, who was visiting relatives in the United States, was not ill during the flight to America, health officials said at a news conference Tuesday. Indeed, he was screened before he boarded the flight and had no fever. For the past year, Mr. Duncan had worked as a driver at Safeway Cargo, the Liberian customs clearance agent for FedEx, said Henry Brunson, the company’s manager. Mr. Duncan quit abruptly on Sept. 4, giving no reason. But Mr. Brunson said he knew that Mr. Duncan had family members in the United States.
Because Ebola is not contagious until symptoms develop, there is “zero chance” that the patient infected anyone else on the flight, Dr. Thomas R. Frieden, the director of the federal disease centers, said. Ebola is spread only by direct contact with body fluids from someone who is ill. “His sister came from the United States and he asked for a day off so that he could go meet her at the Mamba Point Hotel,” Mr. Brunson said, mentioning a hotel popular among foreigners. “He quit a few weeks after that.”
Since the outbreak in West Africa, there have been more than 100 reports to the disease centers from local health departments concerned that a patient might have been exposed to the virus, according to officials. Roughly 14 of those cases led to blood tests to determine if the virus was present. The man in Dallas is the first one whose test came back positive. The way Mr. Duncan appears to have been infected with Ebola is typical in Monrovia, where the epidemic is spreading rapidly and most people are dying at home because of a lack of ambulances and Ebola treatment centers. At home, they spread the virus to family and friends who are taking care of them.
The Dallas-Fort Worth region is among the state’s most ethnically and racially diverse. There are an estimated 10,000 Liberians living in the four-county area known as North Texas that includes Dallas County. One active community group, the Liberian Community Association of Dallas-Fort Worth, was founded more than 30 years ago. It appeared that Mr. Duncan had been staying with relatives who lived near the hospital in the Fair Oaks section of Dallas. The family of Ms. Williams said they had no choice but to take her back home after being turned away from John F. Kennedy Memorial Hospital, first at its maternity ward and then at its Ebola center. While she was sick at home, she appeared to have also infected a neighbor, Sarah Smith, whose corpse was picked up Wednesday.
“The C.D.C. is on the ground, and we are going individual by individual that he had contact with, making sure they are in the appropriate isolation,” said Mayor Michael S. Rawlings of Dallas. “There is very little risk at this point for folks that just live in the general area.” Neighbors said that an ailing Ms. Williams used to visit Ms. Smith, who lived in a pink house next door. After Ms. Smith fell ill, a friend of hers living nearby started coming over to take care of her. That friend, Marie Wread, did chores for Ms. Smith, including washing her clothes.
Still, many in the community were skeptical of the assurances of public health officials, especially as they hear ever more dire reports from relatives and friends back in Africa. On Wednesday, a visibly ill Ms. Wread was taken by ambulance to a hospital; her daughter, Mercy, 9, joined her in the ambulance, though she was not showing symptoms herself. Other neighbors, fearful of the growing contagion, had insisted angrily that Mercy be taken away.
Ms. Williams appears to have been the first patient in her area of the Monrovia neighborhood. On Sept. 15, Mr. Duncan rode in the taxi in the front passenger seat while Ms. Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Later, after being turned away at the hospital, Mr. Duncan helped carry Ms. Williams back to the family home that evening.
“He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back,” said Arren Seyou, 31, who witnessed the scene and occupies the room next to Mr. Duncan’s.
Sonny Boy, 21, also started getting sick about a week ago, his family said. In a sign of how furiously the disease can spread, an ambulance had come to their house on Wednesday to pick up Sonny Boy. Another ambulance picked up a woman and her daughter from the same area, and a team of body collectors came to retrieve the body of yet another woman — all four appeared to have been infected in a chain reaction started by Marthalene Williams.
A few minutes after the ambulance left, Ms. Williams’ and Sonny Boy’s parents got a call. It was about Sonny Boy. He had died on the way to the hospital.