Health officials on Monday were scrambling to identify and monitor a large number of health care workers at a Dallas hospital who could be at risk of contracting Ebola after they cared for Thomas Eric Duncan in the hospital’s isolation ward.
It’s unclear how many caregivers could be at risk; some reports indicated as many as 70 were involved in Duncan’s treatment. Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, said he wouldn’t be surprised if more workers develop the disease in the coming weeks.
A 26-year-old nurse at the hospital, who was identified Monday by her family as Nina Pham, tested positive for the virus Saturday even though she had worn protective clothing in her multiple contacts with Duncan.
The Rev. Jim Khoi, the priest at the church Pham’s family attends, said Pham’s mother had told him that Pham had been given blood from an Ebola survivor as part of her treatment. Doctors in Nebraska also have used blood from a survivor to treat a freelance cameraman who contracted Ebola while on assignment in Liberia.
Word of Pham’s treatment came as more details emerged on the size of the medical team that treated Duncan as he slipped toward death. The employees drew Duncan’s blood, put tubes down his throat and wiped up his diarrhea. They analyzed his urine and wiped saliva from his lips, even after he had lost consciousness.
Pham’s infection made it necessary, Frieden said, to identify all those employees and actively monitor them for Ebola -- something officials initially thought was unnecessary because they had all been wearing protective gear when treating Duncan. The onset of either Ebola symptoms or a high fever would require they be isolated, assessed and tested for the virus.
“The thinking here is straightforward,” Frieden said. “If this one individual was infected and we don’t know how within the isolation unit, then it is possible that other individuals could have been infected as well. So we consider them to potentially be at risk and we’re doing an in-depth review and investigation.”
The incident, which Frieden described as a “breach of protocol,” has prompted the CDC to intensify caregiver training, education and outreach at the hospital to ensure that staff can safely treat patients with the deadly virus going forward.
All U.S. hospitals should be prepared to screen and treat possible Ebola patients, Frieden said – a point that was brought home hours later when the University of Kansas Hospital in Kansas City, Kan., said that it was testing a patient there for the Ebola virus.
Lee Norman, the hospital’s chief medical officer, said the patient, who had worked as a medical officer aboard a commercial vessel off Africa’s west coast, was considered at low to moderate risk but had gone to the hospital early Monday morning with a high fever and other symptoms and was isolated in an infectious disease unit for tests.
Hospital staff treating him wore protective equipment and will not treat other patients until the person’s diagnosis is complete.
“We think an abundance of caution is just being prudent,” Norman said.
In his earlier comments, Frieden made the same point. “We have to rethink the way we address Ebola infection control because even a single infection is unacceptable,” he said.
CDC personnel are looking at whether Pham may have become infected during removal of her protective equipment or during several medical procedures Duncan underwent in the days before he died on Oct. 8, Frieden said.
Additional CDC personnel and state authorities have been dispatched to the hospital to help coordinate the investigation, to identify and contact additional health care workers, and to train hospital staff in infection control.
“We’re not going to wait for the final results of that investigation,” Frieden said. “Each time we identify a process or training or equipment or protocol that can be improved there, we are improving it right there on the site.”
Pham graduated from Texas Christian University in Fort Worth in 2010 and moved to Dallas, where she went to work at Presbyterian. A family friend, Tom Ha, who knows Pham’s family through the Roman Catholic church they both attend, told the Fort Worth Star-Telegram on Monday that the church had held a prayer service for her on Sunday. The news of her infection was stunning, he said.
“She is in stable condition right now. It’s not critical condition,” he said. “But the news is very, very scary. . . . How could it happen, especially at a hospital where they knew the man had Ebola?”
Frieden said representatives of the CDC are now watching as hospital workers put on and remove protective equipment to make sure it’s done correctly. They’re also considering the use of different equipment that may be easier to use and remove in order to cut the risk of self-contamination, he said.
The CDC is also considering having hospital staff sprayed with a disinfectant that kills Ebola after they leave the isolation ward. “That was already in our guidelines for gloves, but we’re looking at that more broadly,” Frieden said.
Pham’s apartment has been cleaned and disinfected, but officials are searching for a place to put her dog, which also will need to be monitored for the virus, said Texas Health Commissioner Dr. David Lakey.
It’s unclear whether dogs can harbor or spread Ebola, but out of caution, officials in Spain recently put down the dog of a Spanish woman who contracted the virus.
Potential Ebola patients in Dallas include 10 people who had contact with Duncan before his being hospitalized on Sept. 28, and 38 others who may have had contact with Duncan before Sept. 28. So far, none of these individuals has shown signs of infection, but all are being actively monitored.
By attributing the new infection to a breach of safety protocol, some felt Frieden was blaming Pham for becoming infected.
But Frieden said he wasn’t criticizing the infected caregiver when he discussed a “protocol breach.” He said he was using common public health terms that were simply misinterpreted.
“Some interpreted that as finding fault with the hospital or health care worker and I’m sorry if that was the impression given. It was certainly was not my intention,” Frieden said.
While he focused on efforts in Dallas, Frieden said all U.S. hospitals should be prepared to screen and treat possible Ebola patients.
That admonition was echoed by the National Nurses United, which represents registered nurses. The union called for all U.S. hospitals to implement an emergency plan for Ebola and other disease outbreaks. That plan would include full training for staff, increased supplies of hazardous materials suits and other protective equipment, properly equipped isolation rooms and procedures to dispose of hazardous medical waste.
The diagnosis of the first Ebola case transmitted in the United States also set off calls for action in Washington.
President Barack Obama was briefed Monday afternoon on the situation in Dallas, the White House said. He called for the CDC to expedite its investigation and share the findings with hospitals and health care workers throughout the nation. He also spoke with United Nations Secretary-General Ban Ki-moon about the need for more international assistance to help fight the outbreak in West Africa.
In a letter to Senate appropriators, Sen. Bob Casey, D-Pa., called on lawmakers to beef up funding for the federal government’s Hospital Preparedness Program, which provides money to states and local communities to pay for additional training for health emergencies. Casey said funding for the program has dropped by 50 percent since 2003.
“We have to ensure that hospitals and medical facilities have the resources they need to protect public health,” Casey said in a statement. “The drastic cuts that have hit the Hospital Preparedness Program should be reversed.”
Democratic Sens. Amy Klobuchar and Al Franken of Minnesota joined Minnesota Gov. Mark Dayton in asking Frieden to include Minneapolis-St. Paul International Airport in the locations where passengers entering the United States from West Africa would undergo basic health screenings upon arrival.
Screenings began Saturday at John F. Kennedy International Airport in New York and are expected to begin Thursday at four additional airports: Washington Dulles, Newark Liberty in New Jersey, Chicago O’Hare and Hartsfield-Jackson in Atlanta.
On the initial day of screening at JFK, 91 passengers had their temperatures checked, Frieden said. None, however, had a fever and none of five people who were selected for additional assessment by the CDC was found to have exposure to Ebola, Frieden said.
The Department of Transportation has said that 94 percent of passengers flying to the United States from the most seriously affected countries – Guinea, Liberia and Sierra Leone – fly through the five airports where screening is now scheduled to take place. But the Dallas developments had the Minnesota officials worried nonetheless.
“The Ebola experience in Dallas, Texas, has taught us that even one case of Ebola in our state or country can have devastating consequences,” the three wrote in a letter to Frieden.
The new Dallas case also set off a flurry of concern internationally, with health specialists calling it a reminder that Ebola can strike far beyond the three West African countries where an epidemic is out of control.
“In my long career in public health, I have never before seen a health event strike such fear and terror, well beyond the affected countries,” World Health Organization Director-General Margaret Chan said in a speech delivered on her behalf in Manila, Philippines.
Ebola has taken a heavy toll on health care workers in Guinea, Liberia and Sierra Leone, where more than 400 have been infected, of whom 232 have died. In Sierra Leone, the disease has proven fatal to 97 of the 123 health care workers who contracted it from patients.
A Spanish nursing assistant who contracted the disease while treating two missionaries who subsequently died was reported in critical condition Monday, the seventh day since she was diagnosed. Doctors said they were hopeful that she would survive because the amount of virus detected in her system had declined, but they cautioned that the disease’s progress was difficult to predict.