Thread: Is the U.S. Prepared for an Ebola Outbreak?

Is the U.S. Prepared for an Ebola Outbreak?


By KAREN YOURISH and LARRY BUCHANAN OCT. 10, 2014

The handling of the first person found to have Ebola in the United States has raised questions over whether the country is prepared for an outbreak. Nearly a dozen federal, state and local government agencies, as well as several private entities, were involved in responding to the case in Dallas. Related Article


Sept. 19
Foreign Airport Check-in

At the airport in Monrovia, Liberia, Thomas Eric Duncan is checked by health workers. His temperature is normal, and he answers “no” on a questionnaire about whether he has been exposed to anyone with Ebola in the past 21 days. Four days before his flight, Mr. Duncan helped a sick woman to the hospital and then back home, where she died a few hours later.

federal The United States Centers for Disease Control and Prevention trained the workers who screened Mr. Duncan.

The screening process is not foolproof. Because it can take as long as 21 days for someone infected with Ebola to develop symptoms, a lack of fever does not necessarily indicate a lack of infection. Also, travelers may not realize they had been exposed to someone with Ebola, or they may not reveal it.


Sept. 20
Going Through U.S. Customs

Mr. Duncan flies from Monrovia to Brussels, then to Washington and finally to Dallas. He clears customs in Washington, where he may have been given a flier on the warning signs of Ebola. American officials believe Mr. Duncan did not have a fever when he arrived in the United States.

federal Customs and Border Protection agents are supposed to contact the C.D.C. if they think someone may be infected.

On the day Mr. Duncan died, federal officials announced that passengers from the three countries most affected by the Ebola outbreak will be tested for fever by Customs and Border Protection staff members on arrival in the United States. Those who have a fever will be evaluated by a C.D.C. official. It will be up to local health departments to decide whether to place them in quarantine.
Health experts say the new measures are more likely to calm the public than to prevent Ebola from entering the country. They caution that a temperature check on arrival would almost certainly not have detected the virus in Mr. Duncan.


Sept. 25
First Hospital Visit

Louise Troh, Mr. Duncan’s fiancée, whom he had gone to Dallas to visit, drives him to Texas Health Presbyterian Hospital. According to the hospital, he has a temperature of 100.1 degrees, abdominal pain, a sharp headache and decreased urination. He tells a nurse that he was recently in West Africa but that he has not been around anyone ill.

federal C.D.C. guidelines specify that doctors and nurses should be on alert for Ebola in anyone who has been in West Africa. The diagnostic team at Texas Health Presbyterian Hospital sent Mr. Duncan home.

In allowing him to leave, the hospital delayed Mr. Duncan’s treatment and provided more opportunities for the infection to spread to others.

The hospital has offered multiple explanations for why Mr. Duncan was released. Officials initially said that Mr. Duncan’s condition did not warrant admission. On Oct. 2, the hospital released a statement blaming a flaw in its electronic records system for the decision to send Mr. Duncan home. The next day, the hospital said that there was no flaw in the system and that Mr. Duncan’s “travel history was documented and available to the full care team.” On Oct. 10, the Associated Press reported that Mr. Duncan's medical records showed that his temperature spiked to 103 degrees during his initial visit.



Sept. 28
Second Hospital Visit

Mr. Duncan’s symptoms worsen, and Ms. Troh’s daughter calls 911. She warns the arriving emergency medical technicians that they need to be careful because Mr. Duncan is from “a viral country.”

Dallas Fire-Rescue medical workers took Mr. Duncan to the hospital in an ambulance. The hospital admitted Mr. Duncan and placed him in isolation.



Sept. 29-30
Testing and Contact Tracing

Based on Mr. Duncan’s symptoms and travel history, the C.D.C. recommends testing his blood for Ebola. Tests by the C.D.C. and a state lab come back positive for the virus.

The C.D.C. sent a team to help state and local officials track down people who came into contact with Mr. Duncan.
The Texas Department of State Health Services reported the results to the hospital and began tracking down direct contacts.
Dallas County Health and Human Services began tracking down contacts. It also advised five public school students who had contact with Mr. Duncan to stay home from school.
private sector



Oct. 1
Isolating the Closest Contacts

The four people living in the apartment where Mr. Duncan was staying — Ms. Troh and three others — are ordered to remain there and not receive visitors until a 21-day monitoring period is over.

federal
state The Texas Department of State Health Services issued the orders.
local The Dallas County Sheriff’s Department helped deliver the orders. Dallas County Health and Human Services checked the temperatures of the four people twice a day.
private sector



Oct. 2
Sanitizing the Apartment

A company is hired to sanitize the apartment, but the workers cannot start because permits to transport the contaminated material are not in place.

Dallas County hired the cleaning company.

Ms. Troh and the three others in the apartment were living in extremely unsanitary and potentially dangerous conditions for days after Mr. Duncan tested positive for Ebola, and for more than a week after he first visited the hospital with symptoms.



Oct. 3
Moving to a Temporary Home

Ms. Troh and the others living with her move to a temporary home, where they remain under quarantine.

County Judge Clay Jenkins of Dallas, Mayor Michael S. Rawlings and other city officials sought the temporary housing.
private sector The use of the home was donated by an unnamed member of a Dallas church.

For several days before the donor came forward, local officials tried to place Ms. Troh and the three others in hotels, apartment buildings and elsewhere, but they were unable to find anyone to take them in.



Oct. 3
Sanitizing the Apartment

The cleaning company begins decontaminating the apartment. An emergency permit is issued for another company to transport Ebola-contaminated items from the apartment and the hospital.

federal The United States Department of Transportation granted the special permit to a company called Stericycle to transport the waste.
state The Texas Department of State Health Services hired Stericycle to transport waste from the apartment.
local private sector The hospital hired Stericycle to transport contaminated items from the hospital.



Oct. 4
Trying an Experimental Drug

The hospital administers doses of an experimental drug called brincidofovir.

federal The Food and Drug Administration approved the drug to be used on Mr. Duncan on an emergency basis. Mr. Duncan was the first Ebola patient to receive this drug.

The drug is being developed by the biotechnology company Chimerix.



Oct. 8
Handling the Body

Thirteen days after his first visit to the hospital, Mr. Duncan dies.

The C.D.C. has guidelines on the safe handling of the remains of Ebola patients.
state The Texas Department of State Health Services recommended to Mr. Duncan’s family that he be cremated, per C.D.C. guidelines. The family agreed.




More on NYTimes.com

• 
  How Hospital Workers Are Supposed to Treat Ebola Safely
  
  
• 
  Ebola Facts: When Did Ebola Arrive and Spread at a Dallas Hospital?
  
  
• 
  Retracing the Steps of the Dallas Ebola Patient
  
  

Sources: James G. Hodge Jr., professor of public health law and ethics, Arizona State University; Leila Barraza, assistant professor, University of Arizona; United States Centers for Disease Control and Prevention; Dallas County Health and Human Services; Texas Department of State Health Services; City of Dallas; Food and Drug Administration; United States Department of Transportation; United States Government Accountability Office; Dallas County Judge; Dallas Independent School District; Texas Health Resources

http://www.nytimes.com/interactive/2...-outbreak.html