This Article is From Oct 04, 2014

Health Officials in Dallas Pinpoint 10 People Most at Risk for Ebola

Health Officials in Dallas Pinpoint 10 People Most at Risk for Ebola

Medical staff outside the Ebola ward at Makeni Regional Hospital in Makeni, Sierra Leone, Sept. 27, 2014.

Dallas: Health officials Friday narrowed down to 10 the number of people considered most at risk of contracting Ebola after coming into contact with an infected Liberian man. They also moved the four people who had shared an apartment with the man from their potentially contaminated quarters, as local and federal officials tried to assure the public that the disease was contained despite initial missteps here.

The four people, a girlfriend of Thomas E. Duncan, the Liberian who is the first person in the United States to develop symptoms of Ebola, and three of her relatives had been under orders not to leave their home, and Texas officials apologized to them for not moving faster to have the apartment cleaned of potentially infectious materials.

The cleanup began Friday afternoon - more than a week after Duncan first went to the hospital but was sent home because information about his travels from Liberia was not properly relayed - as television-news helicopters swirled in the skies above and workers in yellow protective suits scoured the apartment, whose entryway and balcony were covered with a black tarp.

"I want to see them treated as I would want my own family treated," said county Judge Clay Jenkins, the top elected official of Dallas County, who visited the family inside the apartment Thursday night. The four were in quarantine Friday at a private residence.

On Thursday, a glitch had stopped the cleanup.

Kasey Bonner, coordinator for the Cleaning Guys, the company hired to do the job, said its workers were not allowed to enter the apartment because the company did not have permission to transport hazardous material by road.

"There was no protocol put in place for handling Ebola on Texas highways," Bonner said, adding that the problem was later resolved.

The confusion was indicative of the various local, state and federal protocols and levels of preparedness that have raised questions about the ability of the nation's health care infrastructure to handle a potential epidemic.

In Washington on Friday, while military officials announced that the Army would more than double the number of soldiers it is sending to West Africa to help contain the Ebola virus there, senior White House officials tried to play down the series of missteps in the handling of the Ebola case in Dallas. They insisted that the public health system in the United States was working effectively and would prevent an epidemic of the deadly virus from taking root in this country.

As administrators at a Texas hospital acknowledged that Duncan had been sent away with a fever even after a nurse was told he had been in Liberia, White House aides defended the administration's response to the disease, saying that the federal Centers for Disease Control and Prevention had been working closely for months with state health officials, doctors and hospitals.

Around the country, anxiety spread quickly Friday as two hospitals in the Washington area each reported a possible case of Ebola (one later tested negative), and a television journalist working in Liberia prepared to return to the United States after being told he had the virus. Besides the 10 people considered most at risk in Dallas, another 40 people are being monitored daily in the city but are considered at relatively low risk, officials said. No one has developed any symptoms of the disease. The first signs of the illness often appear within eight to 10 days, but can take as long as 21 days.

White House officials acknowledged the public's growing nervousness, but said Americans had little to worry about.

"There's a lot of fear," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "It's the unknown. It's the cataclysmic nature of it - namely it's acute, it kills in a high percentage."

But he said he was convinced that "the system that's in place, with our health care infrastructure, would make it extraordinarily unlikely that we would have an outbreak."

In a briefing with reporters Friday, Rear Adm. John Kirby, the Pentagon press secretary, said the total U.S. military presence in West Africa could rise to as high as 4,000, an increase from the 3,000 that President Barack Obama announced several weeks ago.

Kirby also announced that the Army would more than double the number of soldiers it was sending to West Africa, to 3,200.

But the White House did not announce any new initiatives inside the United States to address concerns about the sometimes chaotic response in Dallas. In the past several months, officials said the CDC had expanded facilities capable of testing for Ebola and had mailed detailed information six times to health professionals about how to treat and contain  it. On Thursday, the federal government sent another set of guidelines on Ebola, they said.

But federal officials flatly rejected the idea of expanding the screening of passengers arriving in the United States from West Africa and said they would not support a growing chorus of calls for a ban on travel to the United States from countries being ravaged by the disease. They said such moves would be ineffective and, at worst, could prevent medical workers and other assistance from reaching Africa.

"We believe those types of steps actually impede the response," Lisa Monaco, the president's homeland security adviser, said of proposals to restrict air travel. "They impede and slow down the ability of the United States and other international partners to actually get expertise and capabilities and equipment into the affected areas."


Rep. Tim Murphy, R-Pa., chairman of a health oversight committee in the House, said he was "deeply concerned" about the travel decision and announced that his committee would hold a hearing in about two weeks to examine the federal government's response to the Ebola outbreak.

Administration officials have spent the past several weeks repeatedly offering assurances that the U.S. health system was well equipped to seamlessly handle the Ebola virus if it arrived on the country's shores. Obama has said several times that he has confidence in medical experts at the CDC.

But images from Monrovia, Liberia and Dallas in the past few days have raised new questions about the adequacy of the U.S. effort on both continents.

In Liberia, the help Obama promised several weeks ago has been slow to arrive, and logistical glitches have prevented the U.S. military from being able to quickly set up the hospitals and treatment centers needed to halt the virus ravaging that country. Gen. David M. Rodriguez, commander of the Africa Command, told reporters in Washington that the military was working quickly, but it could take "several weeks" to get the hospitals built and the medical personnel trained.

In Dallas, the misstep at Texas Health Presbyterian Hospital, where Duncan is being treated in serious condition, was followed by the acknowledgment Thursday that the apartment where he had stayed with a friend, Louise Troh, as well as three of her relatives, had not been sanitized, with the sheets and towels that he had used while sick and vomiting still there.

The hospital released a statement late Thursday essentially blaming a flaw in its electronic health records system for its decision to send Duncan home the first time he visited its emergency room, saying there were separate "work flows" for physicians and nurses in the records so that doctors did not receive the information that he had come from Africa. They promised to change the system and said it was also being "modified" to specifically refer to the Ebola-endemic regions in Africa.

But some health policy experts said it was hardly the only lapse that needed to be examined.

Dr. Ashish Jha, a professor at Harvard University's School of Public Health, said there appeared to be "literally multiple failures" that led to Duncan's release Sept. 25, only to be hospitalized three days later when his symptoms worsened. Among them, he said, are that the nurse who learned Duncan had just come from Liberia failed to tell a doctor directly.

"In a well-functioning emergency department, doctors and nurses talk to each other," Jha said. "Also, why didn't the physician think to ask the question separately? Anyone who comes in with a febrile illness, a travel history, that's a fundamental part of understanding what might be going on."

Jha said that by blaming its electronic records system, the hospital seemed to be "grasping at straws."

He added, "For me, the most disappointing thing isn't that the system didn't work, but in the aftermath, instead of helping every other hospital in the country understand where their system failed and learn from it, they have thrown out a whole lot of distractions."

The criticism from the health experts contrasted sharply with the tone coming from federal officials, who said the most important thing they could do was to communicate with the public about the need to be careful and the need to remain calm.

Sylvia Mathews Burwell, secretary of health and human services, said she recognized the anxiety and concern that many people had about even a single case of Ebola in the United States. But she said the country had "the public health providers to contain the spread of this disease."

Monaco said she was confident that the mistakes made at the hospital would not be repeated at other health facilities. She also noted that since March, when the first Ebola cases were reported in Africa, thousands of people from the affected region had flown to the United States, and there has been only one known case of Ebola.

"The United States is prepared to deal with this crisis, both at home and in the region," Monaco told reporters in an afternoon briefing at the White House. "Every Ebola outbreak over the past 40 years has been stopped. We know how to do this, and we will do it again." 
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