[Update]
(CNN) — The Texas hospital treating the first person diagnosed with Ebola on American soil says a “flaw” in its electronic health records prevented doctors from seeing the patient’s travel history. Patient Thomas Eric Duncan told the nurse he’d been in Africa, but that information was entered into a document that isn’t automatically visible to physicians, Texas Health Presbyterian Hospital Dallas said in a statement Thursday. After discovering this, the hospital says it has changed the system so doctors and nurses will see travel history documentation. “We feel that this change will improve the early identification of patients who may be at risk for communicable diseases, including Ebola,” the hospital said.
(CNN) — Days before he became the first person diagnosed with Ebola on American soil, Thomas Eric Duncan answered “no” to questions about whether he had cared for a patient with the deadly virus.
Before leaving Liberia, Duncan also answered no to a question about whether he had touched the body of someone who died in an area affected by the disease, said Binyah Kesselly, board chairman of the Liberia Airport Authority.
Witnesses say Duncan had been helping Ebola patients in Liberia. Liberian community leader Tugbeh Chieh Tugbeh said Duncan was caring for an Ebola-infected patient at a residence in Paynesville City, just outside Monrovia.
Earlier Thursday, Kesselly told CNN that the authority “will seek to prosecute” if Duncan lied on his health screening questionnaire before leaving West Africa.
Liberian President Ellen Johnson Sirleaf told Canadian public broadcaster CBC on Thursday that she would consult with lawyers to decide what to do with Duncan when he returns home.
“The fact that he knew (he was exposed to the virus) and he left the country is unpardonable, quite frankly,” Johnson Sirleaf told CBC. “I just hope that nobody else gets infected.”
“With the U.S. doing so much to help us fight Ebola, and again one of our compatriots didn’t take due care, and so, he’s gone there and … put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him, to tell you the truth.”
Duncan’s family said he hadn’t mentioned any exposure to Ebola in Liberia.
His girlfriend says he told her he hadn’t been in contact with anyone with Ebola. Wilfred Smallwood, Duncan’s half-brother, said Thursday that he doesn’t believe Duncan knew he had Ebola when he left Liberia for the United States. But he said it isn’t out of the ordinary to come to the assistance of suffering people.
Asked about whether Duncan had contact with Ebola patients, he said, “(it’s) what we do in Liberia — our tradition is to help somebody who needs help.”
Screened several times before leaving Liberia
The health questionnaire typically contains questions about the passenger’s recent contact with Ebola patients. Passengers also are asked whether they’ve experienced any symptoms consistent with Ebola, such as vomiting, diarrhea or joint pain, in the past couple of days.
Duncan was screened three times before he boarded his flight in Liberia to Brussels, Kesselly said.
“The first screening was at the gate, before you get to the parking lot. The second time is before you enter the terminal building and the third is before you board the flight. At every point your temperature is scanned.”
His temperature at those checkpoints was a consistent 97.3 degrees Fahrenheit, Centers for Disease Control and Prevention chief Thomas Frieden told reporters Thursday. “Basically, he didn’t have a fever,” Frieden said, noting that the Ebola patient’s temperature was taken by a trained CDC health care worker with a thermometer approved by the Food and Drug Administration.
Kesselly said airport authority would seek to prosecute Duncan “if it is determined that he made a false declaration during the health screening questionnaire.”
“We cannot make the (Ebola) risk zero until the outbreak is controlled in West Africa,” said Frieden. He went on to say that isolating West African countries completely through travel restrictions would make it more difficult to assist in controlling the outbreak, and would eventually put the United States at greater risk.
Family quarantined
Duncan is in serious condition at Texas Health Presbyterian Hospital. So far, no one who had contact with Duncan has shown any indication of having contracted Ebola, Dallas County Judge Clay Jenkins told reporters Thursday.
Smallwood said that when Duncan first visited Texas Health Presbyterian Hospital, neither Duncan nor the hospital knew then that he had Ebola.
This was Duncan’s first time in the United States, Smallwood said. The Liberian national was visiting his son and his son’s mother in Dallas, Smallwood said.
The partner of Duncan has been quarantined in her Dallas apartment where Duncan became sick with the virus, the woman told CNN’s Anderson Cooper. The woman, who asked to be identified only by her first name, Louise, is quarantined with one of her children who is younger than 13 and two nephews in their 20s. The four of them were in the apartment when Duncan became ill, Cooper said.
Louise and her family are in isolation with sheets and towels used by the Ebola-stricken Duncan, Cooper said. Louise did use bleach to clean her apartment, “but it’s not clear to me how systematic the cleaning was,” he said.
Authorities are working to find “more suitable living arrangements” for the family, Jenkins said.
Up to 100 people being contacted
Health officials are reaching out to as many as 100 people who may have had contact with Duncan, a spokeswoman with the Texas Department of State Health Services said Thursday. These are people who are still being questioned because they may have crossed paths with the patient either at the hospital, at his apartment complex or in the community.
“Out of an abundance of caution, we’re starting with this very wide net, including people who have had even brief encounters with the patient or the patient’s home,” spokeswoman Carrie Williams said. “The number will drop as we focus in on those whose contact may represent a potential risk of infection.”
The number of direct contacts who have been identified and are being monitored right now is “more than 12,” a federal official told CNN on Thursday. “By the end of the day, we should have a pretty good idea of how many contacts there are,” the official said.
Being “monitored” means a public health worker visits twice a day to take the contact’s temperature and ask them if they are experiencing any symptoms.
None of the people being monitored has so far shown symptoms. Most are not being quarantined, though Dallas County health officials have ordered four close relatives of the patient to stay home and not have any visitors until at least October 19.
“The family was having some challenges following the directions to stay home, so we’re taking every precaution,” Texas Department of Health spokeswoman Carrie Williams said about why the state had issued a legal order.
Two things are still spreading in Dallas: fear and frustration.
Some parents are scared to take their kids to the schools that his girlfriend’s children attended. Attendance at those schools Thursday was down to about 86% on Thursday, said Mike Miles, superintendent of the Dallas Independent School District.
Custodians are stepping up cleanup work at the schools, he said. “We don’t think there’s any virus at any of those buildings, but we’ll take that off the table, so we’re doing extra cleaning and disinfecting,” Miles said.
Others are upset at the hospital where Duncan first sought care, which sent him home and raised the possibility he could infect others for at least two additional days.
U.S. President Barack Obama contacted Dallas Mayor Mike Rawlings on Thursday to make sure Dallas was getting the federal resources it needs “to treat the patient safely, and control this case so that it does not spread widely,” the White House said.
‘They dropped the ball’
On September 24, four days after he arrived in Dallas from Liberia, Duncan started feeling symptoms. That day is significant because that’s when he started being contagious. Late the following night, he went to Texas Health Presbyterian Hospital Dallas with a low-grade fever and abdominal pain, the hospital said.
Duncan told a nurse he had been in Africa.
But “regretfully, that information was not fully communicated throughout the full team,” said Dr. Mark Lester, executive vice president of Texas Health Resources.
Duncan was sent home with painkillers and antibiotics, only to return in worse condition on September 28. That’s when he was isolated.
“It was a mistake. They dropped the ball,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said of the miscommunication at the hospital. “You don’t want to pile on them, but hopefully this will never happen again. … The CDC has been vigorously emphasizing the need for a travel history.”
Gupta said this mishap doesn’t make sense.
“A nurse did ask the question, and he did respond that he was in Liberia, and that wasn’t transmitted to people who were in charge of his care,” he said. “There’s no excuse for this.”
And one of Duncan’s friends said he was the one who contacted the Centers for Disease Control and Prevention with concerns that the hospital wasn’t moving quickly enough after Duncan’s second hospital visit. But the hospital said the patient’s condition “did not warrant admission” last week.
‘It gets bad — fast’
Because the early symptoms of Ebola can include abdominal pain, fever and vomiting — ailments that also come with other illnesses — there are concerns about how to distinguish between Ebola and, say, the flu.
But the answer is fairly simple.
“Ebola tends to progress much more quickly,” said Sanjay Gupta, CNN chief medical correspondent. “It gets bad — fast.”
And once it gets bad, Ebola can bring on a host of ghastly symptoms, including diarrhea and unexplained bruising and bleeding.
But Ebola is much harder to contract than the flu. The virus can be spread only through the bodily fluids of people who have active symptoms of the illness.
