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Texas Ebola patient, Thomas Eric Duncan, may have had contact with up to 100 people Texas Ebola patient, Thomas Eric Duncan, may have had contact with up to 100 people
(about 9 hours later)
Texas health officials said Thursday that there are “about 100” people who may have had contact with Thomas Eric Duncan, the man being treated in a Dallas-area hospital for Ebola. Public health officials in Texas said Thursday that as many as 100 people may have had contact with the Liberian man diagnosed with Ebola. Four of those people, at least two of whom are family members, have been ordered to remain at home in an attempt to prevent the spread of the disease.
“We are working from a list of about 100 potential or possible contacts and will soon have an official contact tracing number that will be lower,” Texas Department of State Health Services spokeswoman Carrie Williams said in a statement. Still, authorities continued to stress that only Thomas Eric Duncan, who became the first person diagnosed with Ebola in the United States, had exhibited any Ebola symptoms.
“Out of an abundance of caution, we’re starting with this very wide net, including people who have had even brief encounters with the patient or the patient’s home. The number will drop as we focus in on those whose contact may represent a potential risk of infection.” “The only person who’s had symptoms is Mr. Duncan, who’s in the hospital,” Dallas County Judge Clay Jenkins said during a news conference Thursday, where county officials provided an update on their response. Jenkins is the top elected official in Dallas County.
Dallas County Health and Human Services Director Zachary Thompson said none of those people have shown symptoms of the illness thus far. Only the immediate family members of the victim are being regularly monitored for Ebola symptoms; they’ve been ordered to stay at home and avoid contact with others. “And no one who has been around Mr. Duncan in the time he has been symptomatic has shown any indication of having contracted Ebola,” Jenkins said.
On Wednesday, health officials said 12-18 people, including five children who attend four different Dallas-area schools, may have had contact with Duncan. The Centers for Disease Control and Prevention said the list of 100 people being assessed includes “potential, possible contacts.” Many, but not all, of these people had been interviewed by Thursday, Thomas Frieden, director of the CDC, said in a conference call with reporters.
“Now the number has increased in terms of number of contacts,” Thompson said in a phone interview on Thursday. It is unclear how many people had direct contact with Duncan. Authorities say the number of people who require monitoring will be much lower once that has been determined.
The man, who was identified by family members on Wednesday, is the first person to be diagnosed with the Ebola virus in the United States. Some students have not returned to the schools attended by five students who are believed to have had contact with Duncan, the school district reported. Those five students are staying at home, and attendance is down at the campuses, even as nurses have begun regularly visiting classrooms and counselors have been made available.
He traveled from Liberia to the United States changing planes at the Brussels airport and at the Dulles International Airport in the Washington, D.C. area, before arriving in Dallas on Sept. 20. But it was not until four days later, on Sept. 24, that he began experiencing abdominal pain and a fever. A law enforcement officer was stationed at the apartment complex Duncan was visiting to make sure the quarantined individuals do not go out. The quarantine order, which was delivered by local health officials Wednesday night, says that the family cannot have visitors without approval, has to provide blood samples and must agree to any testing.
The next night, Sept. 25, Duncan sought care at Texas Health Presbyterian Hospital, but was sent home with antibiotics, his sister Mai Wureh told the Associated Press. A hospital official acknowledged on Wednesday that nurses and doctors should have isolated Duncan based on his symptoms and his recent travel to Liberia, where the Ebola outbreak is widespread. While authorities were reluctant to go into detail about why these four people without any symptoms were quarantined, they said it had to do with making sure they remained at home and accessible for monitoring.
“Regretfully, that information was not fully communicated throughout the full team,” said Mark C. Lester, executive vice president of the health-care system that includes Texas Health Presbyterian Hospital. “As a result, the full import of that information wasn’t factored into the clinical decision-making.” “They were noncompliant with the request to stay home,” Jenkins said. “I don’t want to go too far beyond that.”
Days later on Sept. 28, an ambulance was called to a residence in The Ivy Apartments community in Dallas. Duncan, by then, was seriously ill, and according to Reuters, was seen vomiting multiple times outside the complex. There are also issues of hygiene at the apartment, including properly disposing of Duncan’s belongings and the sheets on which he slept. The home had not been cleaned by Thursday afternoon because there has “been a little bit of hesitancy” in finding someone willing to do it, said David Lakey, commissioner of the Texas Department of State Health Services.
The Centers for Disease Control and Prevention and Texas state health officials confirmed in separate tests that Duncan had Ebola. He was isolated at the Texas hospital. The sheets and Duncan’s belongings have been placed in a sealed plastic bag, and they will be disposed of by a contractor who has previously worked with hospitals on medical cleanups and agreed to clean the home, Jenkins said.
Health officials are working rapidly to track down anyone who may have come into contact with Duncan, particularly after he began showing symptoms and was contagious. Three other people who came into contact with Duncan are the Dallas Fire-Rescue Department crew members who took him to the hospital. They are going to remain at home and will be checked for symptoms over the same three-week period.
A friend of the family said there was a cookout “for a lot of people” on Sept. 20 that Duncan attended. “That’s what we do when someone comes. We had a welcoming for him,” the friend said, who asked not to be identified. People who have come into direct contact with an Ebola patient who has symptoms must be watched for three weeks, beginning on the last day they had that contact. This process, which is called contact tracing, involves observing them for symptoms such as a high fever. If a contact exhibits a high fever, that person will be isolated.
Aaron Yah, 40, who saw Duncan on Sept. 20, the day he arrived in Dallas, said he seemed fine. But when Yah saw him on Sunday at the Ivy Apartments, “he was lying down in bed,” Yah said. “He told me he was sick. He said he was weak and had diarrhea.” Liberian authorities said Thursday they plan to prosecute Duncan for lying on an airport questionnaire when he said he had not cared for an Ebola patient or touched anyone who had died from the disease, according to the Associated Press. Neighbors in the Liberian capital said they thought he became infected after he helped to transport a sick, pregnant neighbor, the AP said.
From the list of 100 potential contacts, health workers will determine who had direct contact with the Ebola patient’s fluids, said CDC spokesman Tom Skinner. That list may be established by the end of the day, he added. Before Duncan left Liberia, his temperature was taken at the airport in Monrovia by a person trained by the Centers for Disease Control and Prevention. A thermometer approved by the U.S. Food and Drug Administration showed he did not have a fever.
People confirmed as contacts have their temperatures taken and are asked about their health twice daily for 21 days. The screening at the airport in Monrovia, Liberia’s capital, has been in place for months, Deborah R. Malac, the U.S. ambassador to Liberia, said in a telephone interview Thursday.
There is no risk to passengers on any of the three flights Duncan took before arriving in Dallas because at that time he was not contagious. “They have confidence that everything that was supposed to have been done was done,” Malac said.
Ebola can only be transmitted through direct contact with the bodily fluids of a sick person. Screening protocols have been added since the beginning of the Ebola outbreak, which has killed more than 3,300 people in West Africa, according to the World Health Organization.
Elahe Izadi contributed to this report. Duncan began showing symptoms about four or five days after arriving in Texas, Frieden said. He visited Texas Health Presbyterian Hospital Dallas shortly thereafter for medical treatment because he had a fever and some abdominal pain.
He told a nurse that he had traveled from Liberia, but that information was not relayed to other health-care workers, and he was released from the hospital.
“This is a very sophisticated hospital,” Lakey said during the conference call. “They’ve done a lot of education related to preparedness for Ebola. . . . Unfortunately, connections weren’t made related to travel history and symptoms.”
As a result, Duncan left the hospital during the period when health officials say he was symptomatic, which is the only time Ebola is contagious. A little more than two days later, he returned to the same hospital in an ambulance and was placed in isolation after being recognized as a potential Ebola patient.
If another case of Ebola does occur in the Dallas area, emergency rooms in the county are prepared to handle it, said Zachary Thompson, director of Dallas County Health and Human Services.
“The plain truth is, we can’t make the risk zero until the outbreak is controlled in West Africa,” Frieden said. “What we can do is minimize that risk, as is being done now in Dallas.”
Duncan flew on two commercial planes that landed at two of the busiest airports in the United States on Sept. 20. He traveled on a United Airlines flight from Brussels to Dulles International Airport and transferred to another United flight to Dallas-Fort Worth International Airport. But authorities said this posed no danger to his fellow travelers or anyone who later boarded those planes, because he was not symptomatic at the time and therefore not contagious.
As they have done since Duncan’s illness was diagnosed Tuesday, public health officials assured the public that they could contain the virus.
“The bottom line here is that we remain confident that we can contain any spread of Ebola in the United States,” Frieden said. “There could be additional cases who are already exposed. If that occurs, systems are in place.”
mark.berman@washpost.com
Amy Ellis Nutt in Dallas and Kevin Sieff contributed to this report.
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