A Texas health care worker who was part of the team that treated
America’s first Ebola case has tested positive for the virus, a state health
official said today.
A Texas health worker who provided care for the first person
diagnosed with Ebola in the United States has tested positive for the deadly
virus in a preliminary examination, a state health official said on Sunday.
The health care worker at the Texas Health Presbyterian Hospital
reported a low-grade fever Friday night and was isolated and referred for
testing, the Texas Department of State Health Services said in a statement.
“We knew a second case could be a reality, and we’ve been
preparing for this possibility,” said Dr. David Lakey, commissioner of the
health service.
The first person in the United States diagnosed with Ebola,
Liberia citizen Thomas Eric Duncan, died in an isolation ward of the Dallas
hospital on Oct. 8, 11 days after being admitted.
The U.S. government has since ordered five airports to start
screening passengers from West Africa for fever.
No word on how the worker contracted the virus, although it’s
remarkable that with all the precautions, all the protective gear, the worker
was still exposed.
Health officials have interviewed the patient and are identifying
any contacts or potential exposures. People who had contact with the health
care worker after symptoms emerged will be monitored based on the nature of their
interactions and the potential they were exposed to the virus.
Health care workers see a lot of patients every day so you would
hope that part of the monitoring that went on following the death of Thomas
Duncan was limiting the number of hospital patients seen by the people who
treated him.
Dare we point out that this wasn’t supposed to happen? That we
were told that all the protective clothing, isolation wards, and hi-tech care
would make the spread of the disease unlikely?
It may be unlikely, but it’s happened.
Rick
Moran is PJ Media's Chicago editor and Blog editor at The American Thinker. He
is also host of the"RINO Hour of Power" on Blog
Talk Radio. His own blog is Right
Wing Nut House.
U.S. lacks a single standard for Ebola response
By Larry Copeland in USA Today
newspaper
Corrections and clarifications: A
previous version of this timeline gave a different date for Thomas Eric
Duncan's first visit to Texas Health Presbyterian Hospital. The hospital
revised the date.
ATLANTA — As Thomas Eric Duncan's
family mourns the USA's first Ebola death in Dallas, one question reverberates
over a series of apparent missteps in the case: Who is in charge of the
response to Ebola?
The answer seems to be — there
really isn't one person or agency. There is not a single national response.
The Atlanta-based Centers for
Disease Control and Prevention has emerged as the standard-bearer — and sometimes
the scapegoat — on Ebola.
Public health is the purview of the
states, and as the nation anticipates more Ebola cases, some experts say the
way the United States handles public health is not up to the challenge.
"One of the things we have to
understand is the federal, state and local public health relationships,"
says Michael Osterholm, director of the Center for Infectious Disease Research
and Policy at the University of Minnesota. "Public health is inherently a
state issue. The state really is in charge of public health at the state and
local level. It's a constitutional issue. The CDC can't just walk in on these
cases. They have to be invited in."
The CDC deployed a team of 10 —
three senior epidemiologists, a communication officer, a public health adviser
and five epidemic intelligence officers, or "disease detectives" — to
Dallas on the night of Sept. 30, hours after the agency announced that Duncan,
a Liberian national who traveled to Dallas, had the Ebola virus. The next
afternoon, Dallas County Judge Clay Jenkins, head of the Dallas County Office
of Homeland Security and Emergency Management; CDC director Tom Frieden; and
David Lakey, commissioner of the Texas Department of State Health Services,
agreed during a conference call to set up an Emergency Operations Center in
Dallas County with Jenkins in charge.
The EOC was staffed by officials
from Dallas County, the city of Dallas, the CDC, the county and state health
departments and the Dallas County Sheriff's Department, among others.
This was the team that made
decisions on matters such as isolating people who had been in direct contact
with Duncan, including his fiancée, Louise Troh, her teenage son and two other
male relatives. Because they were not sick, they couldn't technically be
quarantined, Jenkins said Friday. Instead, Lakey issued a "control
order" to keep them at home, where they could be monitored for signs of
Ebola. Jenkins and Texas Gov. Rick Perry agreed to the order.
Texas officials were criticized for
keeping the family inside the apartment where Duncan first showed signs of the
disease, potentially exposing them to the virus. The family worried about
Duncan's soiled sheets and other waste in the apartment. The response team
located a private home where the family could move and got permits to clean the
apartment and truck 140 55-gallon barrels of waste to an incinerator 400 miles
away.
Jenkins says he has a working model
for how to respond to Ebola cases. Others aren't so confident.
"In Texas, they really were
slow to the plate," said Robert Murphy, director of the Center for Global
Health at Northwestern University Feinberg School of Medicine. "Texas is
going to be the example of what not to do."
Duncan, who arrived in Dallas on
Sept. 20, somehow slipped through a Liberian airport screening process that
allowed him into the country. He became ill several days later and went to the
emergency room at Texas Health Presbyterian hospital Sept. 25; he was
prescribed antibiotics, told to take Tylenol and sent home early on the morning
of Sept. 26..
According to medical records
provided to the Associated Press by Duncan's family, his temperature spiked at
103 degrees during that visit. Duncan told a nurse that he had recently been in
Africa, and he showed symptoms that can indicate Ebola: fever, sharp headache
and abdominal pain. He was given a battery of tests and sent to his sister's
apartment with antibiotics. He returned by ambulance Sept. 28, was admitted to
the hospital and placed in isolation. On Sept. 30, the CDC confirmed that he
had Ebola.
In a statement Friday, the hospital
said it had made procedural changes and continues to "review and
evaluate" decisions surrounding Duncan's case.
Murphy says some of the issues in
Texas stem from a "system problem" in the way public health care is
managed in the USA. The Centers for Disease Control provides only guidance for
infection prevention and management. "What they do in Texas, what they do
in Illinois, it's up to the state," he says.
"The question is, who's in
charge?" Murphy says. "The states can follow all the guidelines and
take the advice, which they usually do, but they don't have to. It's not a
legal requirement. So there really is no one entity that's controlling
things."
Though the CDC is tasked with
readying the nation for an Ebola outbreak, then leading the national response,
the Department of Homeland Security is responsible for protecting the borders,
according to Thomas Skinner, a spokesman for the CDC, which is under the
auspices of the Department of Health and Human Services.
The CDC collaborates with health
departments and laboratories around the USA to make sure they are able to test
for Ebola and respond rapidly if there is a case in their state, CDC
spokeswoman Kirsten Nordlund said.
The agency is working to educate
U.S. health care workers on how to isolate patients and protect themselves from
infection; it developed a Web-based document that identifies rapidly emerging
CDC guidelines for Ebola applicable to public health preparedness national
standards for state and local planning.
The agency developed an introductory
training course for licensed clinicians who intend to work in Ebola treatment
units in Africa, and at any given time, it has 300-500 people working at CDC
headquarters to support its Ebola response, Nordlund said.
Homeland Security "is focused
on protecting the air traveling public and is taking steps to ensure that
passengers with communicable diseases like Ebola are screened, isolated and
quickly and safely referred to medical personnel," deputy secretary
Alejandro Mayorkas said Thursday.
That includes issuing "do not
board" orders to airlines if the CDC and State Department determine a
passenger is a risk to the traveling public; providing information and guidance
about Ebola to the airlines; posting notices at airports to raise awareness
about Ebola; and providing a health notice called a care sheet to travelers
entering the USA that have traveled from or through affected countries.
In addition, Health and Human
Services has the authority to suspend the entry of persons into the USA based
on outbreaks of disease in other countries and when necessary to protect public
health.
Screening started Saturday at New
York's John F. Kennedy airport. Medical workers will take the temperature of
airline passengers originating from Guinea, Liberia and Sierra Leone, and
Customs and Border Protection staffers will ask questions about their health
and possible exposure to Ebola. Those suspected of possible Ebola exposure will
be referred to a CDC public health officer for additional screening.
The testing will expand in the next
few days to four more airports: Washington Dulles, Newark, Chicago's O'Hare and
Atlanta's Hartsfield-Jackson airports.
Osterholm and Murphy say the
nation's public health system leaves room for a broad array of Ebola responses
from state to state.
"We have to have more
clarity," Osterholm says. "We have to have a level of excellence. If
that means putting the CDC in charge of these departments of public health,
that means we have to find a way to do that. We can have agreements (between
the states and the CDC). ... We can't leave it up to the whims of the state to
do it right or not do it right."
He acknowledges that no one has
called for such a change.
"Not yet," he says.
"But we need it, though. Texas was an example of how not to do it."
Contributing: Rick Jervis in Dallas,
Gregory Korte
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