On Wednesday, it was announced that a second Texas Health Presbyterian Hospital healthcare worker who had provided care for U.S. Ebola patient zero has tested positive for the often deadly disease. That first patient on the continent — Thomas Eric Duncan, who had recently arrived in the U.S. from Liberia, at the epicenter of West Africa’s wildfire Ebola outbreak — died at the hospital earlier this week. Both of the infected clinical staff had cared for Mr. Duncan, wearing what they had been told was effective hazardous materials (hazmat) protective gear.
The health care worker who reported a fever Tuesday has been identified in the media as a nurse, Amber Joy Vinson, 29, who was immediately isolated at the hospital, but had unfortunately traveled by air on an Oct. 13 evening domestic flight, the day before she reported symptoms and after developing an initial low fever. Persons who may have been in close contact with the patient prior to her isolation at the hospital, in family encounters, and on the flight are being contacted and will be monitored if it’s deemed advisable on a case-by-case basis. The type of monitoring depends on the nature of their interactions and the potential they were exposed to the virus. The Centers for Disease Control and Prevention (CDC) is working carefully with the airline to identify and notify all passengers who flew on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth Oct. 13, and individuals who are determined to be at potential risk will be monitored.
A preliminary Ebola test on samples from Ms. Vinson was run late Tuesday at the state public health laboratory in Austin, and results were received at about midnight. Confirmatory testing on a separate specimen will be conducted by the Centers for Disease Control and Prevention in Atlanta.
CDC is asking all 132 passengers on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth on October 13 (the flight route was Cleveland to Dallas Fort Worth and landed at 8:16 p.m. CT) to call 1 800-CDC INFO (1 800 232-4636). After 1 p.m. ET, public health professionals will begin interviewing passengers about the flight, answering their questions, and arranging follow up. Individuals who are determined to be at any potential risk will be actively monitored.
In a statement, Frontier Airlines says “at approximately 1:00 a.m. MT on October 15, Frontier was notified by the CDC that a customer traveling on Frontier Airlines flight 1143 Cleveland to Dallas/Fort Worth on Oct. 13 has since tested positive for the Ebola virus. The flight landed in Dallas/Fort Worth at 8:16 p.m. local and remained overnight at the airport having completed its flying for the day at which point the aircraft received a thorough cleaning per our normal procedures which is consistent with CDC guidelines prior to returning to service the next day. It was also cleaned again in Cleveland last night. Previously the customer had traveled from Dallas Fort Worth to Cleveland on Frontier flight 1142 on October 10.
“[The] customer exhibited no symptoms or sign of illness while on flight 1143, according to the crew. Frontier responded immediately upon notification from the CDC by removing the aircraft from service and is working closely with CDC to identify and contact customers who may traveled on flight 1143.
“Customers who may have traveled on either flight should contact CDC at 1 800 CDC-INFO.”
A severe and often fatal illness, Ebola is spread through direct contact with blood, secretions, or other bodily fluids of a sick person or exposure to contaminated objects, such as needles. Authorities say it cannot be spread simply by being near someone who is infected.
The severity of the disease varies, but more than 50% of patients with Ebola have died during past outbreaks. There is no licensed cure or vaccine for Ebola, although testing of several is being fast-tracked; however, some people can recover with intensive treatment in a hospital setting.
According to the CDC, Ebola symptoms include sudden fever, sometimes with a headache and joint and muscle aches. Other symptoms may include nausea, weakness, diarrhea, vomiting, stomach pain, and lack of appetite. Some patients may also experience rash, red eyes, hiccups, cough, sore throat, chest pain, problems breathing, problems swallowing, or bleeding inside and outside the body. Symptoms usually appear 8 to 10 days after exposure, but may appear anywhere from 2 to 21 days after exposure.
Persons experiencing such symptoms, and who’ve has known or suspected direct contact with a person or animal with Ebola are advised to seek medical care immediately, informing the doctor about any recent travel, and making sure to notify the doctor’s office or emergency room about your symptoms before going so that arrangements can be made, if needed, to prevent others from becoming sick.
People should in general practice careful hygiene and obviously avoid contact with the blood and body fluids of people who are ill with Ebola.
Texas is one of 12 U.S. states authorized to conduct Ebola testing, and the first step in Ebola testing at the Austin lab is a virus inactivation step, which renders the specimen non-infectious.
Suspected Ebola samples will be packaged and shipped in accordance with the U.S. Department of Transportations (DOTs) Hazardous Materials Regulations (HMR; 49 CFR Parts 171-180) as Category A Infectious Substances. Specific information regarding sample submission and acceptance to the laboratory will be provided by the laboratory receiving the sample.
On Wednesday, the CDC hosted a press telebriefing to update the investigation of Ebola in the United States and West Africa, moderated by Tom Skinner ad attended by Department of Health & Human Services (HHS) Secretary Sylvia Mathews Burwell and Centers for Disease Control and Prevention Director Tom Frieden
Ms. Burwell said the CDC hosted a conference call Tuesday afternoon with more than 5,600 clinicians to discuss health care system preparedness and how Emory University hospital and Nebraska medical center are preparing for Ebola and the lessons learned. She also affirmed that HHS will provide a go team for rapid on sight response to hospitals treating Ebola patients.
Dr. Freidan noted that Ebola virus spreads person to person and can create another generational spread in about 8 to 10 days, that the second Dallas health care patient will be transferred to Emory in Atlanta, and says the CDC is working very closely to the hospital in Dallas to promote a safe environment for the care of everyone at that hospital for the patients and for the health care workers.
Dr. Friedan said they have continued with their intensive investigation and interventions to understand what may have happened and to increase safety, noting that the two infected health care workers had both worked on Sept. 28th, 29th, and 30th, and and both had extensive contact with the patient when he had “extensive production of body fluids” because of vomiting and diarrhea.
Investigators are continuing to intensively assess exposures of all other health care workers at that facility to identify how many others may have had that level of intensive contact, and that there were 48 contacts to Mr. Duncan before he was isolated, none of whom have developed symptoms so far.
Answering a question form David Lewkewict of FOX News about how Ms. Vinson had been able to get on an aircraft and not be monitored or quarantined if she had been in contact with the index patient, Dr. Frieden said she travelled to Ohio before it was known that the first healthcare worker was ill, and at the time was undergoing self-monitoring. However, he said because at that point she was in a group of individuals known to have exposure to Ebola, he says she should not have been allowed to travel by plane or any public transport. And “although she did not report any symptoms, and she did not meet the fever threshold of 100.4, she did report at that time that she took her temperature and found it to be 99.5. So by both of those criteria, she should not have been on that plane. I don’t think that changes the level of risk of people around here. She did not vomit, she was not bleeding. The level of risk of people around her would be extremely low. Because of that extra margin of safety, we will be contacting them all.”
He said CDC guidance in this setting outlines the need for what is called controlled movement, which can include a charter plane or a car, but it does not include commercial air travel or other forms of public transport.
The Director affirmed that from this moment forward, the CDC will ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.
Dr. Friedan also noted the CDC are working closely with the hospital, and that there are intensive efforts under way to train, retrain, and supervise staff. The single most important way to get consistency is a site manager 24/7 who will monitor how personal protective equipment is put on, taken off, and what’s done when people are in it.
Secretary Burwell noted that HHS has two nurses from Emory onsite in Dallas who are experts in the treatment and they’re doing peer to peer training to help that issue with regard to the nurses.
Addressing a question from Reuters’ Julie Steenhuysen about media reports that first tier caregivers of Mr. Duncan’s necks had been exposed, Dr. Friedan said there was a lot of variability in the use of personal protective equipment around the time the patient was diagnosed, and that the CDC are now working with the hospital to provide maximum possible support to health care workers and allow them to do their jobs by minimizing their risk of contamination.
Answering Kelly Gilblom of Bloomberg News abou why only one of the two current patients has been transferred from Emory, Dr. Friedan explained that the first patient was reportedly in improved condition Wednesday, and the CDC will continue assess each hour, each day, whether that is the best place for her or somewhere else might be. In terms of controlled movement, in conjunction with state and local public health authorities.
Texas Department of State Health Services
Centers for Disease Control and Prevention
U.S. Department Of Health And Human Services