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Ebola crisis: Could the virus spread in the US? Ebola crisis: Could the virus spread in the US?
(14 days later)
A Liberian man who was the first person to be diagnosed with the deadly Ebola virus in the US has died in hospital in Dallas. Two nurses who cared for him are also infected. How did the virus get to the US and could it now spread? Two Dallas nurses have recovered after being infected while treating the first person to be diagnosed with the deadly Ebola virus in the US. How did the virus get to the US and could it further spread?
The outbreak gripping West Africa is the world's worst, infecting nearly 9,000 people and killing more than 4,400. The outbreak gripping West Africa is the world's worst, infecting nearly 10,000 people and killing nearly 5,000.
Thomas Eric Duncan travelled to the US from one of the worst affected countries, Liberia, and died a little after two weeks later. Liberian national Thomas Eric Duncan travelled to the US from one of the worst affected countries, Liberia, and died a little after two weeks later.
How did he arrive undetected and what are the risks to Americans? Seven Americans have now been treated for the virus on US soil. But what are the ongoing risks?
Who are the first US patients? Who were the first US patients?
Duncan, a Liberian national, tested positive in Dallas, Texas, on 30 September, 10 days after he arrived in the US to visit his former girlfriend and their 19-year-old son. Duncan tested positive in Dallas, Texas, on 30 September, 10 days after he arrived in the US to visit his former girlfriend and their 19-year-old son.
He worked as a driver for a courier service and lived in the Paynesville 72nd Community suburb of Monrovia.He worked as a driver for a courier service and lived in the Paynesville 72nd Community suburb of Monrovia.
Despite aggressive treatment in hospital, including an experimental drug, he succumbed to the virus on 8 October.Despite aggressive treatment in hospital, including an experimental drug, he succumbed to the virus on 8 October.
Nurses Nina Pham, 26, and Amber Vinson, 29, became infected while caring for Duncan. Nurses Nina Pham, 26, and Amber Vinson, 29, became infected while caring for Duncan. Both later recovered and were released from hospital.
Top US health official Tom Frieden originally said there had been a breach of protocol by health workers that led to the nurse becoming infected. Top US health official Tom Frieden originally said there had been a breach of protocol by health workers that led to the nurses becoming infected.
However, nurses working at the hospital have said they were given little guidance and inadequate protective clothing to deal with the infection.However, nurses working at the hospital have said they were given little guidance and inadequate protective clothing to deal with the infection.
Are these the first people in the US to have Ebola? Were these the first people in the US to have Ebola?
No, a small number of American aid workers who contracted the virus while abroad have recovered after flying back to the US for treatment. But Duncan and the health worker were the first diagnosed within the US. No, a small number of American aid workers who contracted the virus while abroad have recovered after flying back to the US for treatment. But Duncan and the health workers were the first diagnosed within the US.
Three of the aid workers were colleagues at the same hospital in Liberia. Kent Brantly and Nancy Writebol were flown back to Atlanta for treatment, while Rick Sacra, a family doctor from Massachusetts, recovered in Nebraska.Three of the aid workers were colleagues at the same hospital in Liberia. Kent Brantly and Nancy Writebol were flown back to Atlanta for treatment, while Rick Sacra, a family doctor from Massachusetts, recovered in Nebraska.
Another American to contract Ebola, NBC cameraman Ashoka Mukpo, was transported from Liberia and is being treated at the Nebraska Medical Center in Omaha. Another American to contract Ebola, NBC cameraman Ashoka Mukpo, was transported from Liberia, treated at a Nebraska facility and later released.
A fourth American who has not been named has also recovered after being flown to Atlanta. Subsequently, Craig Spencer - a doctor treating Ebola patients in Guinea - also tested positive for the virus upon his return to New York City. He is currently receiving treatment in an isolation unit.
Do we know how Duncan was infected?Do we know how Duncan was infected?
It is believed he came into contact with Marthalene Williams, a young Ebola-infected woman in Liberia on 15 September, according to a report by the New York Times.It is believed he came into contact with Marthalene Williams, a young Ebola-infected woman in Liberia on 15 September, according to a report by the New York Times.
Duncan is said to have helped take her to hospital, but she was later turned away due to lack of space in the Ebola treatment ward. He helped to carry her home, where she died hours later.Duncan is said to have helped take her to hospital, but she was later turned away due to lack of space in the Ebola treatment ward. He helped to carry her home, where she died hours later.
Williams's brother, Sonny Boy, also later displayed symptoms of Ebola and died en route to a local hospital.Williams's brother, Sonny Boy, also later displayed symptoms of Ebola and died en route to a local hospital.
How did an infected person come into the US undetected?How did an infected person come into the US undetected?
Duncan was screened for Ebola symptoms at Roberts International Airport, located near the Liberian capital of Monrovia. He displayed no signs of the virus and was allowed to board an SN Brussels Airlines flight to Brussels, Belgium, then on to Washington Dulles and finally Dallas-Fort Worth.Duncan was screened for Ebola symptoms at Roberts International Airport, located near the Liberian capital of Monrovia. He displayed no signs of the virus and was allowed to board an SN Brussels Airlines flight to Brussels, Belgium, then on to Washington Dulles and finally Dallas-Fort Worth.
Binyah Kesselly, chairman of the board of the Liberia Airport Authority, said it would be "nearly impossible" to identify a person infected with the Ebola virus if the person were not showing symptoms.Binyah Kesselly, chairman of the board of the Liberia Airport Authority, said it would be "nearly impossible" to identify a person infected with the Ebola virus if the person were not showing symptoms.
Isolating affected countries is a move opposed by the US Centers for Disease Control and Prevention because, they say, it could make the epidemic worse by disrupting the flow of aid. Isolating affected countries is a move opposed by the US Centers for Disease Control and Prevention (CDC) because, they say, it could make the epidemic worse by disrupting the flow of aid.
Are the passengers on Duncan's flight in danger? In late October, Australia announced it will suspend entry visas for people from Ebola-affected countries in West Africa.
The Centers for Disease Control and Prevention (CDC) do not plan to monitor passengers on Duncan's flights. The move was swiftly criticised by Amnesty International as counterproductive and discriminatory.
According to CDC Director Thomas Frieden, Mr Duncan was not considered infectious at that time and posed "zero risk of transmission" to those on the aircraft. The same day, US President Barack Obama told reporters it was imperative to allow health workers to travel to and from West African nations to further their efforts to contain the outbreak.
How dangerous is Ebola anyway?How dangerous is Ebola anyway?
Ebola basics: What you need to knowEbola basics: What you need to know
Could it now spread in the US? Is the US ready?
Dr Tom Frieden, head of the CDC, has warned that other cases could follow. The CDC recently announced new federal guidelines that US medics returning from treating Ebola patients in West Africa will be actively monitored but not placed in quarantine.
He said that 48 people who may have had contact with Duncan before he was diagnosed and isolated were being monitored for symptoms. The move came after a nurse was put in isolation in a tent in New Jersey, a decision later condemned by UN Secretary-General Ban Ki-moon.
Another 77 health workers, including the two infected nurses, have been potentially exposed to Duncan while he was in hospital. The guidelines have also been criticised by New Jersey Governor Chris Christie, who oversees one of three US states with a 21-day quarantine for all health workers who have had contact with Ebola patients.
A man who was possibly at risk from Ms Pham is being monitored. And the 132 passengers who shared an aeroplane with Ms Vinson from Cleveland to Dallas are being sought, although the risk is low. Meanwhile, the US Army Chief of Staff has imposed a 21-day monitoring period for all soldiers returning from the region.
Health officials have expressed confidence they can contain the virus because basic sanitation levels are so different between the US and Africa. The CDC has also introduced a raft of new measures since Duncan's diagnosis, including:
The hour after America knew Mr Obama has praised healthcare workers' ongoing response to the medical crisis, saying they are doing "God's work" and their efforts must be supported.
Should Duncan have been diagnosed earlier?
Duncan sought medical attention at Texas Health Presbyterian Hospital on 25 September, where hospital officials said he displayed a low grade fever and abdominal pain. Basic blood tests were performed, but he was not screened for the Ebola virus.
A nurse asked Duncan if he had travelled from Africa, and he said he had, but that detail was not fully communicated to the medical staff, an oversight the hospital now says was "regretful".
Duncan was given antibiotics and a pain reliever and sent home, where his condition worsened, says his sister.
On 28 September, a friend of Duncan's contacted the CDC for advice, and was instructed to call the Texas Department of Health, who sent an ambulance.
Are US hospitals ready?
Dr Frieden, director of the US Centers for Disease Control and Prevention, admitted the CDC was slow to react to the first case in Texas but he announced a raft of new measures directed at the hospital in Dallas treating Ms Pham and also nationwide.
Health workers across the US were "very distressed" that a nurse could have been infected, he said as he set out a new action plan:
This plan was reaffirmed by President Obama on Wednesday, who cancelled two days of engagements to stay in Washington to monitor what he promises will be a more "aggressive" response.
Ebola patients treated outside West Africa*Ebola patients treated outside West Africa*