Case in Dallas
The First Ebola Case Imported into the U.S.
Although some questioned the wisdom of treating Americans stricken with Ebola in West Africa in the U.S., the discussion changed dramatically when the first case imported from West Africa was diagnosed in Dallas, Texas.
On September 25, 2014, Thomas Eric Duncan, a Liberian who had recently traveled to the U.S., sought care for fever, headache and abdominal pain at Texas Presbyterian Hospital in Dallas. Although he told the ER that he had just arrived form Liberia, he was diagnosed with a sinus infection and returned to his fiancée’s apartment. On September 28, he was transported to the hospital because of persistent fever and progressive symptoms, and was hospitalized. On September 30, he became the first patient to have laboratory-confirmed Ebola virus infection diagnosed in the United States. He died on October 8th.
Along with contact tracing, the apartment where Mr. Duncan had stayed needed to be decontaminated. News cameras flew overhead while people were moved out of the apartment, and emergency personnel decontaminated the area. None of the four people who stayed in the apartment with Mr. Duncan contracted Ebola.
Within seven days after Mr. Duncan’s death, Ebola symptoms developed in two nurses directly involved in his care, and those nurses were confirmed to have Ebola. Both nurses subsequently recovered, thanks in part to early diagnoses and advanced treatments.
Next Steps in Dallas: Contact Tracing and Infection Control
On September 30, two days after the diagnosis of Ebola was confirmed in the “index” patient from Liberia, CDC and Texas health officials began contact tracing, identifying 48 possible or confirmed contacts, including family members. A total of 147 healthcare workers who were involved in Mr. Duncan’s care or the care of the two nurses were closely monitored for 21 days after their last exposure to an Ebola patient. Out of an abundance of caution, passengers who were on a plane from Cleveland to Dallas with one of the nurses before her diagnosis were also monitored.
Ebola did not develop in any other community or healthcare–related contacts of the three Ebola patients.
Barbara Knust of the CDC discusses the response to the Dallas nurses becoming infected, as well as some of the surrounding stigma.
Post Dallas: Revised Guidelines and New Procedures
In preparation for the possibility of Ebola entering the U.S., CDC had issued recommendations on evaluating, isolating, and treating patients with Ebola. Before the Dallas case, CDC had allowed for some flexibility with regards to safety protocols, including the use of Personal Protective Equipment (PPE). On October 20, 2014, CDC announced that it was “tightening previous infection control guidance for healthcare workers caring for Ebola to ensure there is no ambiguity.” Preparedness initiatives for healthcare facilities and healthcare workers were also launched.
In addition, CDC established Rapid Response Teams composed of CDC experts in infection control, clinical care, contact tracing, communications, and environment waste management. The teams were designed to support state and local health departments, and were ready to deploy to any hospital in the U.S. that had a patient under investigation.
Lastly, CDC and the Department of Homeland Security’s Customs and Border Protection began enhanced entry risk assessment and management at five U.S. airports, and each state and territory developed a plan to monitor persons who had possible exposures to Ebola.
Carmen Villar, the Chief of Staff at the CDC, reflects on the Ebola case identified in Dallas, Texas.