No sign of others with Ebola in Texas, officials say

Posted at 9:23 AM, Oct 02, 2014

DALLAS — [Breaking news update at 3:25 p.m. ET Thursday]

A contractor will arrive “as soon as possible” to deal with “hygiene issues” at the Dallas apartment where a family is quarantined after a man who had been staying there was diagnosed with Ebola, Dallas County Judge Clay Jenkins told reporters Thursday. So far, no one who had contact with the patient, Thomas Eric Duncan, has shown any indication of having contracted Ebola, Jenkins said.

Custodians are stepping up cleanup work at Dallas schools attended by the five students who may have been in contact with a man diagnosed with Ebola. “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,” said Mike Miles, superintendent of the Dallas Independent School District. Attendance at those schools Thursday was down to about 86%, Miles said.

Officials are dividing into two teams to narrow a list of people who may have had contact with a man who was diagnosed with Ebola in Texas, CDC spokesman David Daigle told reporters Thursday. “We’re making great progress on that,” Daigle said. “I think you’ve heard already that there’s a list of about 100 what we call potential or possible contacts. And that will be culled down to a list that we will begin contact tracing on.”

[Original story, posted at 3 p.m. ET Thursday]

Did U.S. Ebola patient lie on airport questionnaire?

(CNN) — If it’s determined that U.S. Ebola patient Thomas Eric Duncan lied on his health screening questionnaire before leaving West Africa, the Liberia Airport Authority “will seek to prosecute,” board chairman Binyah Kesselly told CNN on Thursday.

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 helping Ebola patients during his stay in Liberia, witnesses say. Liberian community leader Tugbeh Chieh Tugbeh said Duncan was caring for an Ebola-infected patient at a residence in Paynesville City, just outside of Monrovia.

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.

Duncan is in serious condition at Texas Health Presbyterian Hospital.

Wilfred Smallwood, who says he’s a half-brother of Duncan, said Thursday that he doesn’t believe Duncan knew he had Ebola when he left Liberia for the United States. “(It’s) what we do in Liberia — our tradition is to help somebody who needs help,” he said when asked about Duncan’s contact with Ebola patients.

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. Smallwood left Liberia nine years ago to move to the United States, where many relatives live. Duncan, a resident of Liberia, 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.

Dr. David Lakey, commissioner of the Texas Department of State Health Services, said the home’s conditions “need to be improved.” There has been “hesitancy” on the part of companies in Texas that would be able to clean the woman’s apartment, he said, but the department has identified an “entity” that is on its way to help.

There is a law enforcement officer stationed at the apartment to ensure the four people inside do not come into contact with anyone else, Lakey said. Food is being delivered to the family.

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.

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.

‘I just got scared’

Among the people Duncan encountered were his girlfriend’s five children, Liberian community leader Stanley Gaye said.

Dallas Independent School District Superintendent Mike Miles said the patient came in contact with five students who attended four different schools in the area.

Sam Tasby Middle School is one of those schools.

“I just got scared because I thought that that kid came to that school and probably got contact with him,” said Nellie Catalan, whose child attends the middle school.

“I know it doesn’t get (spread) by the air, but you never know.”

More than 3,500 students attend the four schools, which are getting cleaned and sanitized over the next few days.

But student Denise Trujillo said she’s still worried.

“I don’t feel like going to school tomorrow,” she said.

While the five students who were near Duncan are staying home and being monitored, their schools will remain open.

The investigation is ongoing, but health officials don’t believe there is a workplace or community organization that Duncan visited where anyone was exposed, Frieden said Thursday.

‘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.

‘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.

Searching for others

Duncan’s contacts will be monitored for 21 days — the longest amount of time it takes for Ebola symptoms to show up.

If any of Duncan’s contacts show symptoms, they will be isolated.

So far, so good.

The paramedics who transported Duncan to the hospital haven’t shown symptoms, said Rawlings, the Dallas mayor.

Neither have his girlfriend’s children.

“They are doing well. … They are doing fine,” said Gaye, the Liberian community leader. “All she asks for are our prayers.”

But if one of those contacts ends up having Ebola, the tedious processes of tracking and monitoring a web of contacts would have to start all over again.