Dallas Nurse Tests Positive for Ebola

     DALLAS (CN) – A Dallas nurse tested positive for Ebola late Saturday night after caring for the late Thomas Eric Duncan, in what the country’s top public health official calls a troubling “breach in protocol.”
     Blood samples from a nurse at Texas Health Presbyterian Hospital Dallas tested positive for Ebola Saturday evening, the Texas Department of State Health Services said.
     The nurse cared for Thomas Duncan, of Liberia, who died of Ebola Oct. 8 at the hospital.
     The nurse, whose name was not released, had a fever on Friday evening and was quickly isolated.
     “We have known that further cases of Ebola are a possibility among those who were in contact with Mr. Duncan before he passed away last week,” the hospital said in a statement Sunday.
     “The system of monitoring, quarantine and isolation was established to protect those who cared for Mr. Duncan as well as the community at large by identifying any potential Ebola cases as early as possible and getting those individuals into treatment immediately.”
     Officials at the Centers for Disease Control in Atlanta said diagnosis “is understandably disturbing news for the patient,” but that it “remains confident” a wider spread can be stopped “with proper public health measures including ongoing contact tracing, health monitoring among those known to have been in contact with the index patient and immediate isolations if symptoms develop.”
     CDC director Dr. Tom Frieden said he was “deeply troubled” by the first case of Ebola transmission reported in the United States.
     “Clearly, there was a breach in protocol,” Frieden said on CBS’ “Face the Nation” Sunday morning.
     “We know from many years of experience that it’s possible to care for patients with Ebola safely without risk to workers but we also know that it’s hard and that even a single breach can result in contamination.”
     While severe and often fatal, Ebola is difficult to transmit. It requires direct contact with blood, bodily fluids or contaminated needles. It is not spread through casual contact or through the air.
     The virus is not contagious before the appearance of symptoms, which include sudden fever, fatigue and headaches. The incubation period, between exposure and symptoms, can be from two to 21 days.
     The CDC is “intensively working” with Presbyterian Hospital to figure out how the transmission happened, Frieden said.
     Dr. Dan Vargas, chief clinical officer and senior executive vice president of Presbyterian-parent Texas Health Resources, said Sunday that he is “still confident” the precautions in place will protect health care workers.
     “We don’t have a full analysis of all of the care … to try to understand specific elements of who came into contact with Mr. Duncan, under what circumstances,” he said at a news conference with county and city leaders Sunday morning.
     “The health care worker has done self-monitoring and has not worked the past two days.”
     Texas Health Resources and Presbyterian are monitoring 18 employees for possible Ebola exposure, Vargas said.
     Under CDC guidelines, the employees take their temperatures twice daily.
     “From the time self-monitoring indicated the need for contact to the time the patient entered full isolation in the emergency department was less than 90 minutes,” Vargas said.
     An unidentified “close contact” of the patient has been placed into isolation.
     Presbyterian will not be “closed off” due to this second case of Ebola, Vargas said. However, the emergency room at the hospital has been placed on “diversion” status until further notice, due to limitations in staffing. Incoming ambulances are being rerouted to other Dallas hospitals.
     “We continue to fully care for all of our patients and we are also using this time to further expand the margin of safety by triple checking out full compliance with the updated CDC guidelines,” Vargas said. “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 a significant risk for infection. All of these steps are being taken so the public and our employees can have complete confidence in our facilities and the care we provide.” Hospital officials said earlier that up to 50 employees were involved in Duncan’s care in a 24-bed intensive care unit.
     Eighteen of those employees are being monitored twice daily by CDC epidemiologists, Dallas County Judge Clay Jenkins said.
     This is in addition to the continued monitoring of 48 non-health-worker contacts identified by the CDC. Monitoring will continue for 21 days after their exposure – the maximum incubation period for the disease.
     “There are currently 19 epidemiologists and disease detectives on the ground,” Jenkins said.
     Dallas Mayor Mike Rawlings said the positive test was reported to officials at midnight Saturday and that they moved quickly so citizens could “wake up feeling safe” and informed.
     “The Dallas Fire-Rescue haz-mat team has cleaned up the common areas and decontaminated any of the open areas of an apartment complex in the 3700 block of Marquita,” he said “They sprayed a cleanup agent and right now police are standing by to make sure no one enters that apartment complex. Furthermore, we have knocked on every door in that block and talked to every single person that came to the door, explained what happened and what we have done so they will not be afraid of the haz-mat unit.”
     Police were returning to the block to answer questions late Sunday. Rawlings urged citizens to call 311 with questions or concerns.
     “Haz-mat has moved to Presbyterian, where the patient’s car was decontaminated and secured away from people,” Rawlings said. “We decontaminated hand railings, everything in the parking lots, so everyone can feel comfortable. … The exterior was taken care of. We have a plan in place to send haz-mat units into the apartment to clean up the unit later today.”
     Rawlings added: “We thought we would get this phone call,” so officials have been planning for such a scenario for a week and have a response team in place.

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