DALLAS — The sister of the first Ebola patient diagnosed in the United States said her brother told relatives that he had notified officials the first time he went to the hospital that he was visiting from Liberia.
Mai Wureh said her brother — Thomas Eric Duncan — went to a Dallas emergency room on Thursday and they sent him home with antibiotics. Duncan told his sister that hospital officials asked for his Social Security number, and he said that he didn't have one because he was visiting from Liberia.
At a news conference Wednesday, Dr. Mark Lester confirmed that a nurse asked Duncan on his first visit whether he had been in an area affected by the Ebola outbreak that has killed thousands in West Africa.
"A checklist was in place for Ebola in this hospital for several weeks. That checklist was utilized by the nurse, who did ask [the] question [if the patient had been to Africa,]" Lester said. "[...] Regretfully, that information [was not shared] with the full team."
As the medical team assessed Duncan on his first visit, they thought it was a low-grade viral infection. Dr. Edward Goodman, a Texas Health Presbyterian infectious disease specialist, said when Duncan went to the emergency room Thursday he was not vomiting or having diarrhea, but he did have a fever and some abdominal pain.
"All the information wasn't present as they made their clinical decision," Lester said.
Duncan was recognized as a possible case of Ebola when he returned to the hospital Sunday, and has been under strict isolation since.
Dallas Independent School District Superintendent Mike Miles also revealed that five children from four of the district's campuses were possibly exposed to the virus.
Miles identified the schools as:
- Conrad High School
- Tasby Middle School
- Hotchkiss Elementary School
- Dan D. Rogers Elementary School
Tasby Middle School shares a campus with Jack Lowe Sr. Elementary School, but DISD officials say there are no students at Lowe Elementary who were directly exposed to Duncan.
The superintendent said students at the schools "possibly had contact with the patient" and attended classes at the schools earlier this week. Miles said none of the students have exhibited any symptoms of Ebola at this time.
"So, the odds of them passing on any sort of virus is very low," Miles said.
The students are now at home and are being monitored by Dallas County Health and Human Services.
Miles said the schools have been staffed with additional health employees as a precaution and to answer questions, and more sanitation staff to be sure the schools are cleaned and disinfected.
Duncan was staying at a northeast Dallas apartment complex, according to a Dallas police spokesman.
Lt. Joel Lavender confirmed Duncan was transported on September 28 from the Ivy Apartments, located east of Greenville Avenue and north of Tasby Middle School, to Texas Health Presbyterian Hospital Dallas.
Residents and the manager at the complex said no one from either the Centers for Disease Control and Prevention or the health department have contacted them.
Officials say about 12 to 18 people total were in direct contact with Duncan since he arrived in Dallas. Of those, the children will be monitored for fever and other symptoms in person by Dallas County Health and Human Services staff and asked to stay home from school for 21 days. The adults will be asked to self-monitor.
Those who were in contact with Duncan are not under quarantine.
Sana Syed, a spokeswoman with the city of Dallas, confirmed Duncan was vomiting when he arrived at the hospital Sunday. The three paramedics who transported the patient are temporarily off duty and among those under observation. All three paramedics tested negative for the virus.
Dallas County Judge Clay Jenkins said the "virus is isolated" and "contained" and encouraged the public not to fear using Texas Health Presbyterian while the patient is being treated.
"There is no danger to you if you use Presbyterian Hospital for your medical needs," Jenkins said.
Due to close contact with the diagnosed patient, a second person is under the close monitoring of health officials as a possible second patient, said the director of Dallas County's health department Wednesday morning in an interview with WFAA.
Zachary Thompson, the director of Dallas County Health and Human Services, says all those who've been in close contact with the diagnosed patient are being monitored as a precaution.
Tuesday, the CDC confirmed a patient at Texas Health Presbyterian Hospital Dallas was the first person to be diagnosed with the Ebola virus in the United States. While reported to be in critical condition Tuesday, the patient's condition was downgraded to serious but stable the following morning.
The patient left Liberia on September 19 and arrived in Dallas to visit relatives the following day, said CDC director Tom Frieden. Dallas Mayor Mike Rawlings said there is "zero chance" Duncan could've infected others when he wasn't showing symptoms, and he was checked for symptoms before boarding his flight to the U.S.
"The executives at D/FW have looked at the flights and determined what happened at that time and [say] there was zero chance a person was infected [when the patient arrived in Dallas,]" Rawlings said.
United Airlines issued a statement Wednesday reiterating that the CDC has told them there was "zero risk of transmission" on the flights the patient was on, but that the airlines believes the patient was on Flight 951 from Brussels to Washington Dulles, then Flight 822 from Dulles to D/FW Airport.
Late on Thursday, September 25, he sought treatment at the hospital after becoming ill but was sent home with a prescription for antibiotics. Two days later, he was admitted with more critical symptoms, after requiring an ambulance ride to the hospital.
The ambulance has since been decontaminated per CDC guidelines and will soon be put back into service.
"I have no doubt that we'll stop this in its tracks in the U.S.," Frieden said. "But I also have no doubt that — as long as the outbreak continues in Africa — we need to be on our guard."
More than a half a dozen employees with the CDC arrived in Dallas after news of the confirmed diagnosis broke. The CDC and Dallas County are working together in what they call a "contact investigation." Anyone who has had contact with the patient, including emergency room staff, will be under the observation of health officials for 21 days. If any of those under monitoring show symptoms, they'll be placed in isolation.
Stanley Gaye, president of the Liberian Community Association of Dallas-Fort Worth, said the 10,000-strong Liberian population in North Texas is skeptical of the CDC's assurances because Ebola has ravaged their country.
"We've been telling people to try to stay away from social gatherings," Gaye said at a community meeting Tuesday evening. Large get-togethers are a prominent part of Liberian culture.
Local officials said the county's response to the health alert has been ideal so far.
"We're going to be transparent," said Dallas County Judge Clay Jenkins. "There are no perfect responses [to a public health emergency] but the CDC is describing this as a 'textbook response.'"
He said county health officials are acting as "boots on the ground" for the CDC and operating on their directions. Mayor Rawlings said 911 and 311 operators are being trained to answer questions about Ebola and paramedics have been retrained on how to handle Ebola patients after they had been trained in the past.
The Dallas County Medical Society along with the county health department has sent out a notice to all county medical providers with new guidelines for identifying and treating potential Ebola patients.
The health advisory urges providers to collect a travel history in all patients presenting with fever, place a surgical mask on anyone who reports travel to a country affected the Ebola outbreak, and to immediately escort the patient to a private room for medical evaluation. Prompt isolation of patients who meet the standards is recommended.
The recommendations apply to all medical providers, including family practice physicians.
"All doctors out in the community need to be aware that others could be arriving with fever and signs and symptoms, and the important thing is to ask about travel," said Dr. John Carlo, chair of the emergency response committee at the Dallas County Health Department.
Health care facilities are also being told to place posters at entrance areas to all acute care areas that ask patients to immediately inform staff if they are ill and recently travelled internationally.
Ebola symptoms can include fever, muscle pain, vomiting and bleeding, and can appear as long as 21 days after exposure to the virus. The disease is not contagious until symptoms begin, and it takes close contact with bodily fluids to spread.
Accompanied by Gov., Rick Perry, state health director David L. Lakey spoke Wednesday afternoon from Texas Health Presbyterian Hospital.
"This is a very sophisticated city, a very sophisticated hospital ... and the chances of it being spread are very, very scarce," he said.
Lakey said the state was preparing for the virus as early as August. He also said health officials have been in close contact with the patient's family.
"Messages have been conveyed to them about how we need to approach the situation," he said.
WFAA's Janet St. James, Josh Davis, Jenny Doren and Rebecca Lopez and the Associated Press contributed to this report
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