Update, Oct. 15, 2014, 9:15 a.m.: Texas Health Presbyterian officials confirmed Wednesday morning that a second healthcare worker who treated Thomas Eric Duncan, the first confirmed U.S. Ebola case, has contracted the disease. Speaking in at a press conference Wednesday morning with Dallas officials, Dr. Daniel Varga, Presbyterian's chief clinical officer and senior vice president, stated, "A lot is being said about what may or may not have occurred to cause some of our colleagues to contract this disease, but it's clear there was an exposure somewhere sometime in their treatment of Mr. Duncan."
On Tuesday, CDC director Thomas Friedan conceded that more should have been done to respond to the first Ebola diagnosis in the United States, saying, "We did send some expertise in infection control, but I think we could, in retrospect, with 20/20 hindsight, have sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed."
Hospital and CDC officials say they still don't know exactly how Presbyterian workers were infected.
--- Original story:
Ever since Thomas Eric Duncan arrived in Dallas from Liberia and was confirmed as the first case of Ebola on U.S. soil at the end of September, there's been a strange evolution going on both about Duncan's case and about how prepared the United States was for its first Ebola case.
The basic story has stayed about the same: Duncan helped take a pregnant woman to a hospital in Monrovia, Liberia. He abruptly quit his job and hopped a plane to Dallas to be reunited with a woman he planned to marry and to meet his son, according to the New York Times. Duncan then got sick, went to Texas Health Presbyterian and was initially tuned away. On his second visit, he was diagnosed with Ebola. Despite eventually receiving an experimental drug, Duncan died last Wednesday.
That's the short version. However, it's the details that have been hazy, and the way things happened has shifted and changed as the full story continues to trickle out.
5. Duncan only exposed a few people to the virus. Well, that was the official word initially, anyway. When it first came out that Duncan had gone on September 25 to Texas Health Presbyterian in Dallas presenting with symptoms of the disease and was prescribed antibiotics and turned away, officials assured a panicky public that Duncan had only encountered a few people during the days he was both infectious and not quarantined.
At the start, officials said that only the people Duncan was staying with and a few others needed to be quarantined, about 10 people total. That number soon mushroomed to about 50 and then to more than 100. Ultimately the state has been monitoring 48 people, including the family Duncan stayed with and a homeless man who was transported in the same ambulance used to take Duncan to the hospital. It's worth noting that Duncan's family was quarantined by law in the apartment he'd stayed in and that the apartment wasn't properly sanitized -- including the removal of the linens Duncan used while ill -- until almost a week after he was diagnosed. Also, officials actually lost track of the homeless man they were monitoring for the disease while monitoring him. Confidence inspiring, right?
Ironically enough that estimate didn't include the Sheriff's deputy that walked into the apartment Duncan stayed at (the deputy showed some potential symptoms but tested negative for the disease) or the nurse who cared for Duncan wearing the protective gear prescribed by the Centers for Disease Control (she presented with symptoms this weekend and tested positive for Ebola). There's a big difference between a few people being exposed to the disease and more than 100.
4. What happened the first time Duncan went to the Texas Health Presbyterian emergency room? There are still a number of questions about what actually occurred, and who knew what and when. Initially, Duncan went to the hospital complaining of stomach problems and a fever, and told the medical staff he'd just come in from Liberia a few days before. Yet that crucial bit of information -- the bit about Duncan having just arrived from a country that is both infested with the disease and ill-equipped to handle it -- was never relayed to the doctors.
Then the story went that the information was recorded on Duncan's medical chart via a computer program, but the computer program malfunctioned. That version of events lasted for a day before hospital officials came back saying it wasn't a computer program glitch and that the information simply wasn't passed from the nurse to the doctor.
And that's where they left it. There's still no clear explanation for how this information wasn't passed along or who or what exactly was responsible for the mistake.
And then it came out after Duncan died that he hadn't simply showed up at the hospital with a little fever of 100 degrees. Officials had claimed that his symptoms were "not severe at the time he first visited the hospital emergency department" but that simply wasn't true, according to the Times. Nope, not only did Duncan have severe stomach pain, he also had a 103 degree fever, a temperature that critics say should have immediately had him admitted to the hospital. Obviously that didn't happen.
3. Ebola isn't a real threat to the United States, because we're way better equipped to handle an outbreak. That has been the official stance, the soothing truism that has been oft-repeated since Duncan was diagnosed with Ebola. See, West Africa has been grappling with this devastating disease all this time, with poor results, because many of the countries have been ripped apart by civil war and crippling poverty, so they don't have infrastructure, they don't have the funds for medical supplies and cleanliness and all that, as National Geographic noted. Even if there was an outbreak in the United States, we're set because we have that Holy Grail of government-running: a plan.
Well, kind of. It turns out that isn't entirely the case in the United States. There are basic plans in place for how cities and states would deal with an Ebola outbreak, but these plans are incredibly generic and based on how cities and states would react to measles, floods, hurricanes and dirty bombs. There are no specific plans for how an actual Ebola outbreak would be handled, according to Reuters. While there are some federal plans on how to deal with a flu pandemic or something along that line, the CDC simply provides guidelines for how cities and states should deal with a disease like Ebola (it's worth mentioning that CDC officials are now reviewing those guidelines in the wake of the Dallas nurse catching the virus, according to the Wall Street Journal.) And once this all filters down to the hospital level, there hasn't been much in the way of training medical staff to recognize or handle an Ebola patient.
2. We definitely have a handle on Ebola. Except, it seems like there's less understanding of the virus on an official level than expected. While experts say that you're more likely to catch a cold than this disease, it has still proven to be impressively transmissible. A nurse in Madrid was caring for a priest brought back from Liberia with Ebola. She reportedly wore all the proper gear -- the face mask, the gloves, the shield, the impermeable gown -- but it seems she touched her face while getting out of the gear and subsequently caught the disease. And in a move that alarmed a lot people and simultaneously showed how much of the disease is still a mystery, Spanish authorities got a court order to euthanize the woman's dog because one journal article reported it was possible that mixed breed dogs could transmit the disease, according to the Associated Press. Despite protests, the dog was killed, even though it's unclear if the dog was really even a risk for transmitting the disease.
1. It's not that infectious.And speaking of things that have been a little unclear, let's talk about how Ebola isn't that infectious. Initially that was the word on Ebola -- it is only contracted through blood, urine, semen, vomit, spit or any of the other wonderful secretions or excretions the body is capable of literally throwing at you.
Experts note that the disease is highly lethal (killing about 90 percent of those who contract it) but not as infectious as the common cold or chickenpox. And while this truth sounds comforting, Ebola has still proved it can be transmitted, even when not based in the decimated public health systems of West Africa. A Dallas nurse who provided care for Duncan started feeling feverish on Friday night and tested positive for Ebola on Saturday, according to the Department of State Health Services. Again, the woman reportedly wore protective gear as advised by the CDC, but still somehow contracted Ebola. So far, the explanation has been that there was "a violation of protocol" that caused the nurse to be exposed to the disease (though Dr. Thomas Friedan, director of the CDC, has been roundly criticized for implying it was the nurse's fault she got Ebola.) And maybe there was, but this news certainly doesn't make the disease look any less threatening.