http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?emc=edit_th_20141013&nl=todaysheadlines&nlid=56381892
By MANNY FERNANDEZOCT. 12, 2014
DALLAS — A nurse here became the first person to contract Ebola within the United States, prompting local, state and federal officials who had settled into a choreographed response to scramble on Sunday to solve the mystery of how she became infected, despite wearing protective gear, and to monitor additional people possibly at risk.
The news further stoked fears of health care workers across the country, many of whom have grown increasingly anxious about having to handle Ebola cases. The confirmation on Sunday of the second Ebola case in Dallas — four days after the death on Wednesday of the first patient, Thomas Eric Duncan, 42, a Liberian who arrived in this country in September — opened a new and more frightening chapter in the unfolding public health drama.
While the new Ebola patient was not publicly identified, officials said that she was a nurse who had helped treat Mr. Duncan at a hospital here and that she may have violated safety protocols. It was the first confirmed instance of Ebola being transmitted in this country. Officials expanded the pool of people they had been monitoring, because the nurse had not been among the 48 health care workers, relatives of Mr. Duncan and others whom they were evaluating daily.
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The federal Centers for Disease Control and Prevention recommended that health officials look more closely at the protective gear that nurses, doctors and hospital assistants use when treating Ebola patients. It also, for the first time, was considering the idea that patients with the virus should be transferred to hospitals with special containment units and experience in treating the disease.
The Dallas hospital at the center of the two Ebola cases, Texas Health Presbyterian Hospital, was facing renewed scrutiny over whether it had properly trained its workers. It sent Mr. Duncan home on Sept. 25 under the belief he had a sinus infection, only to have him return Sept. 28 when his conditions worsened.
The C.D.C. said it would conduct a nationwide training conference call on Tuesday for thousands of health care workers to ensure they would be fully prepared to treat a patient with Ebola.
“The care of Ebola patients can be done safely, but it’s hard to do it safely,” Dr. Thomas R. Frieden, director of the C.D.C., told reporters Sunday. “Even a single, inadvertent innocent slip can result in contamination.”
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The stricken nurse reported a low-grade fever overnight Friday, officials said. It appeared that she drove herself to the emergency room of Presbyterian Hospital, where she worked, and was admitted and put in isolation 90 minutes later, the officials said.
She had extensive contact with Mr. Duncan on multiple occasions after his second visit and admission to the hospital on Sept. 28, Dr. Frieden said.
The nurse had been monitoring herself for symptoms of Ebola, under a regimen prescribed by the C.D.C. Health officials will now investigate who had been in contact with Mr. Duncan after he was admitted to the hospital and while he was in isolation, Dr. Frieden said.
Before her trip to the emergency room, officials said, the nurse had not been at work for two days. A preliminary blood test was done at the state public health lab in Austin, and the positive result was received late Saturday evening, officials said. Late Sunday afternoon, the C.D.C. confirmed that she had Ebola after completing its own tests.
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The director of the federal Centers for Disease Control and Prevention said that a Dallas hospital where a nurse became infected with Ebola did not follow worker safety guidelines in the course of treating Thomas Eric Duncan, the Liberian man who died last week.
The woman was in stable condition on Sunday. Dr. Daniel Varga, chief clinical officer of Texas Health Resources, which oversees Texas Health Presbyterian Hospital, told reporters on Sunday that the worker had worn protective gear when coming in contact with Mr. Duncan, although he did not detail the type of contact.
“This individual was following full C.D.C. precautions,” Dr. Varga said, adding, “Gown, glove, mask and shield.” Asked how concerned he was that the worker tested positive despite the precautions, he replied, “We’re very concerned.”
Despite Dr. Varga’s reassurances about C.D.C. precautions having been followed, Dr. Frieden said it appeared that the woman had breached safety protocol at the hospital, possibly when removing the protective gear. Speaking on the CBS program “Face the Nation” and later at a news conference, he said that questioning of the worker had not identified precisely how a breach occurred, and that the cause of her infection was not known. Dr. Frieden said that everyone who had treated Mr. Duncan was now considered to be potentially exposed and that other cases of Ebola were possible.
“We’re deeply concerned about this new development,” he said on the talk show.
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The C.D.C. has said that for health workers in the United States, gloves, gowns, masks and face shields or goggles would be protection enough. But many health workers across the country, seeing images of people in Africa completely encased in full-body hazardous-material suits, have requested similar protection.
“A lot of us are starting to get worried,” said Debra Buccellato, an emergency room nurse in Santa Rosa, Calif. “I’m a single mom, so if I got sick there’d be a huge void.”
Ms. Buccellato, 38, said supervisors at her hospital had distributed information about C.D.C. guidelines, but added, “I have not seen any active training or practice drills, and I haven’t seen any new or upgraded personal protective equipment.”
She said that she had emailed her manager to ask for more training, but that she was not sure that hazardous-material suits were the best option for her 90-bed facility, Sutter Santa Rosa Hospital.
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“I don’t know how realistic it is to go to that level when you have X amount of patients to take care of and time issues,” Ms. Buccellato said. For now, she said, she plans to start wearing a face mask for her entire shift.
On Sunday, National Nurses United, the country’s largest union and professional association of nurses, continued to sound the alarm and call for hazardous-material suits at all hospitals.
“I’m angry about this,” said RoseAnn DeMoro, the executive director. “We want the first line of defense to be the most prepared. Our hospitals are resisting us. The C.D.C. doesn’t say that we need hazmat suits. If this doesn’t change dramatically, we will picket every hospital in this country if we have to.”
President Obama on Sunday directed the C.D.C. to expedite its investigation into how the health care worker contracted the deadly virus, according to aWhite House statement.
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In an indication that the White House was taking steps in advance of any possible spread of the disease, Mr. Obama also directed federal officials to make sure that hospitals and health workers across the nation “are prepared to follow protocols should they encounter an Ebola patient,” the statement said. Mr. Obama was briefed by Lisa Monaco, the president’s assistant for homeland security, and then spoke by telephone with Sylvia Mathews Burwell, the secretary of health and human services.
While other patients with Ebola have been treated in the United States in recent weeks, the nurse is only the second person — after Mr. Duncan — whose condition was diagnosed in the United States. All of the other patients — including medical personnel, relief workers and journalists — received a diagnosis while working in West Africa near Ebola victims, and were brought to this country for treatment.
Four hospitals in the United States — Emory University Hospital in Atlanta; Nebraska Medical Center in Omaha; the National Institutes of Health in Bethesda, Md.; and St. Patrick Hospital in Missoula, Mont. — have high-containment units for isolating patients with dangerous infectious diseases, and medical teams at those facilities have conducted extensive training and drills for dealing with pathogens like Ebola.
But in Dallas on Sunday, officials were trying to persuade residents to remain calm, and reminded them that their risk of exposure was low.
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“You cannot contract Ebola other than from the bodily fluids of a symptomatic Ebola victim,” said County Judge Clay Jenkins, Dallas County’s chief executive, who himself has had close contact with those who lived with Mr. Duncan. “You cannot contract Ebola by walking by people on the street or by being around contacts who are not symptomatic. There’s nothing about this case that changes that basic premise of science.”
City officials moved swiftly to clean and decontaminate many of the places where the nurse had been or had even briefly touched, including her apartment in a complex on Marquita Avenue, the complex’s common areas and the car she took to the hospital. Police officers were prohibiting access to her apartment. Officials believe the woman’s pet dog was inside the apartment, but was doing fine.
“We have a plan in place to take care of the pet, and we do not believe that pet has any signs, and we’ll move accordingly later today,” Mayor Mike Rawlings of Dallas said.
Remaining calm was easier said than done for many of the woman’s neighbors. Early Sunday, city officials knocked on the doors of nearby homes and called residences in the four blocks surrounding the complex to inform people that someone who lived in the neighborhood had tested positive for Ebola.
“It’s a little creepy,” said Kara Lutley, 25, who lives across the street from the nurse’s apartment building. “It’s been in Dallas, but it hasn’t been this close.”
At the hospital, the car the woman arrived in was decontaminated and secured so no one could go near it, officials said. “We decontaminated hand railings, everything in the parking lot, so everybody can feel comfortable that the exterior was taken care of,” Mr. Rawlings said.
The hospital also took the unusual step on Sunday of prohibiting ambulances from bringing new patients into its emergency room. Officials said that the hospital was open, but that they had decided to put the emergency room on so-called diversion status because of staff limitations. “While we are on diversion we are also using this time to further expand the margin of safety by triple-checking our full compliance with updated C.D.C. guidelines,” hospital officials said in a statement. “We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection.”
Reporting was contributed by Jack Healy from Dallas; Sabrina Tavernise, Mark Landler and Emmarie Huetteman from Washington; and Denise Grady and Pam Belluck from New York.
