A World Health Organization (WHO) health worker gives a demonstration on how to put on a protective suit.
News reports and confirmation from CDC tell us there's a case of Ebola in the US.
Health experts were observing up to 18 people, including children, who had contact with the first person to be diagnosed with the deadly Ebola virus in the United States, officials said on Wednesday.
Confirmation that a man who flew to Texas from Liberia later fell ill with the hemorrhagic fever prompted U.S. health officials to take steps to contain the virus, which has killed at least 3,338 people in Liberia, Sierra Leone and Guinea, the World Health Organization said.
Well, to be clear, there have been cases before because we brought U.S. citizens home with it, knowing that's what they had.
Earlier this year, folks in various cities had possible/suspected cases, but not one of them panned out. They could have been actual cases, they just weren't.
However, in this case, a man came to a Dallas hospital's emergency room and it turns out he's got the real deal.
What can we learn from these first reports? More on this below the fold.
According to Reuters, a man from Liberia showed up in the ER Friday, was treated and sent home on antibiotics, but returned Sunday. Hey, that fella was just as much from Liberia on Friday as Sunday, and therefore was a high-risk patient. In fact, the ER, or at least someone in the ER, knew that but didn't properly act on it. Julia Belluz makes the key points:
The patient, Thomas Eric Duncan [more on that below] had been visiting the US from Liberia. He left Monrovia on September 19 and traveled through Brussels, arriving in the US on September 20. He had no symptoms when he was departing Liberia or entering the US, which means he wouldn't have been infectious at the time.
Four days later, he started to feel ill. Two days after that, he sought care at Texas Health Presbyterian Hospital. His was diagnosed with a "low grade viral infection" and sent home with an antibiotic.
The patient's sister said that [the patient] told a nurse that he had just been to Liberia, where the New York Times reports he had recently quit his job at a Monrovia shipping company. That nurse failed to communicate this vital information to the rest of the team, and Ebola was not suspected.
I'm a little uncomfortable blaming the nurse, as the doctor ought to be taking their own travel history when they see the patient, who is a Liberian national (according to
NBC Nightly News). But nurse, or doc, a systems failure did not allow proper information to flow. That needs to be addressed not just at this Dallas hospital but at every hospital in the US, since patients can literally come from anywhere.
This NYC advisory tells us what to look for:
FEVER (≥ 101.5°F) and compatible symptoms* for EVD in patient who has traveled to an Ebola affected area** in the 21 days before illness onset.
* Severe headache, myalgias, vomiting, diarrhea, abdominal pain or unexplained hemorrhage
** CDC Website to check current affected areas: www.cdc.gov/ebola
The time to disseminate this information (and to drill it) is before the patient arrives not after. This was a blown opportunity.
The next piece to consider is whether it's ethical or smart to give out the name of the Liberian national. As veteran health reporter Maryn McKenna notes:
also, since i am not yet clear whether the patient approved the release of his name, i’ll be Block/Reporting anyone who uses it in my TL.
.@DemFromCT if had it just from family; & family minority/immigrant; & disease panic-inducing? wld ask editors to discuss consequences 1st.
.@DemFromCT am not interested in causing a family to be stigmatized/attacked/etc bc of alarm, mis-info among public
And in real life?
A friend in Dallas tells me now that they have named the patient & the school that kids in family go, others are pulling kids out now. Sigh
As i started to write this piece, I eliminated the name of the patient but by the time I finished, it was all over the news.
I have an uneasy feeling that releasing the name was not the right thing to do.
[Addendum: reports appear to indicate the name came from family, but I still think it was a major decision by editors to publish, and warrants more discussion than I am seeing elsewhere.]
Oh, and as for the medical aspects of containing Ebola? That doesn't worry me at all. Contacts will be traced, and observed for the requisite 3 weeks, and the event will be over, at least this time. But the odds are it will happen again, and we'll go through the same thing all over again.
Let's have perspective. Thousands of people die from flu every year, yet only half the public gets their advised flu shots. Why is that? How is media helping with that? Work on something that can make a difference, and affects nearly everyone before scaring us half to death about Ebola.
Of course, if it makes us more sympathetic to West Africa, I can live with it.
In any case, for those who want to read more, here are some excellent and trusted resources:
• Joanne Kenen and Susan Levine: Ebola's here: Don't panic
• Maryn McKenna: Keys to Controlling Ebola in the US: Travel Records and Infection Control
• Julia Belluz: How Dallas failed to diagnose the Ebola patient
• Helen Branswell: The cost of not controlling Ebola in Africa? Cases elsewhere, experts warn