Ebola - The New Pandemic - Coming to someplace near you soon?!

[Peter Lemkin]

Ebola virus outbreak in the United States

From Wikipedia, the free encyclopedia


For a background of the ongoing outbreak, see Ebola virus epidemic in West Africa.

On September 30, 2014, the CDC announced that Thomas Eric Duncan, a 42-year-old Liberian national, had been diagnosed with Ebola virus disease in Dallas, Texas.[SUP][6][/SUP][SUP][7][/SUP] Duncan, who had been visiting family in Dallas, was treated at Texas Health Presbyterian Hospital Dallas.[SUP][8][/SUP][SUP][9][/SUP] By October 4, Duncan's condition had deteriorated from "serious but stable" to "critical."[SUP][10][/SUP] On October 8, Duncan died of Ebola virus disease.[SUP][11][/SUP][TABLE="class: infobox, width: 22"]
Cases in the United States[TR]
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[TH="colspan: 2, align: center"]Map showing location of Ebola patients diagnosed in the U.S. (in red). Does not include people evacuated to the U.S. after contracting Ebola in Africa. Updated:October 13, 2014[/TH]
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[TH]Deaths[/TH]
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[TH]Cases first diagnosed in U.S.[/TH]
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[TH]Cases evacuated to U.S. from other countries[/TH]
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[TH]Suspected cases in medical isolation[SUP][note 1][/SUP][/TH]
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[TH]Quarantined people[/TH]
[TD]4[SUP][3][/SUP][/TD]
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[TH]Under observation[/TH]
[TD]10 (via primary contact)[SUP][note 2][/SUP]
100 (via secondary contact)[SUP][note 3][/SUP][SUP][5][/SUP][/TD]
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A second case of Ebola was diagnosed on October 11 in a nurse, Nina Pham, who had provided care to Duncan at the hospital.[SUP][12][/SUP] A third case was diagnosed on October 14 in another nurse, Amber Vinson, who had also treated Duncan.[SUP][13][/SUP]

Contents

[hide]

• 1 Background
  • 1.1 First case
    
  • 1.2 Secondary infections of health workers
    • 1.2.1 Nina Pham
      
    • 1.2.2 Amber Vinson
      
    
    
  • 1.3 Monitoring of other health care workers
    
  
  
• 2 Reaction
  • 2.1 Containment efforts
    
  
  
• 3 Medical evacuations to the U.S.
  
• 4 Biocontainment units
  
• 5 See also
  
• 6 Notes
  
• 7 References
  
• 8 External links
  

Background[edit]

First case[edit]

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[TD]Articles related to the[/TD]
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[TH][URL="https://en.wikipedia.org/wiki/Ebola_virus_epidemic_in_West_Africa"]Ebola virus epidemic in
West Africa[/URL][/TH]
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[TH]Background articles[/TH]
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• Ebola virus disease Timeline
  

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[TH]Overview[/TH]
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• Ebola virus epidemic in West Africa
  
• Responses
  

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[TH]Affected nations[/TH]
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• Guinea
  
• Liberia
  
• Sierra Leone
  
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[TH]Unrelated[/TH]
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[TD]Democratic Republic of the Congo outbreak[/TD]
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Thomas Eric Duncan was from Monrovia, Liberia, a country among those hardest hit by the Ebola virus epidemic. Duncan worked as a personal driver for the general manager of Safeway Cargo, a FedEx contractor in Liberia.[SUP][14][/SUP] According to the manager, Henry Brunson, Duncan abruptly quit his job on September 4, 2014, giving no reason.[SUP][15][/SUP] Duncan was traveling on a visa when he made his first trip to the U.S. to reunite with his estranged son and the teen's mother, Louise Troh, who had been his girlfriend in Liberia.[SUP][16][/SUP][SUP][17][/SUP]
On September 15, 2014, the family of Ebola virus disease patient Marthalene Williams were unable to summon an ambulance to transfer Williams to the hospital. Their tenant, Duncan, helped to transfer Williams by taxi to an Ebola treatment ward in Monrovia, Liberia. Duncan rode in the taxi to the treatment ward with Williams, her father, and her brother. The family was turned away due to lack of space and Duncan helped carry Williams from the taxi back into her home, where she died shortly afterward.[SUP][18][/SUP]
On September 19, Duncan went to the airport in Monrovia, where according to Liberian officials Duncan lied about his history of contact with the disease on an airport questionnaire before boarding a Brussels Airlines flight to Brussels. In Brussels, Duncan boarded United Airlines Flight 951 to Washington Dulles Airport.[SUP][19][/SUP] From Washington, he boarded United Airlines Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT[SUP][20][/SUP] on September 20, 2014,[SUP][8][/SUP][SUP][21][/SUP] and stayed with his partner and her five children, who live in the Fair Oaks neighborhood of Dallas.[SUP][22][/SUP][SUP][23][/SUP]
Duncan began experiencing symptoms on September 24, 2014, and went to the Texas Health Presbyterian Hospital emergency room late in the evening of September 25, 2014. During this visit, the hospital reported his symptoms were a 100.1 °F (37.8 °C) fever, abdominal pain for two days, a headache, and decreased urination; and that he had no vomiting, diarrhea, or nausea at the time. The ER nurse had asked about his travel history and recorded he had come from Liberia. It was initially reported that this information was not relayed to the doctor by the hospital's electronic medical record (EMR) system,[SUP][24][/SUP] but the hospital later retracted that statement. Hospital officials also said that Duncan had been asked if he had been around anyone who had been sick, and said Duncan told them he had not.[SUP][25][/SUP] He was diagnosed with a "low-grade, common viral disease" and was sent home with a prescription for antibiotics.[SUP][26][/SUP] Medical records later retrieved by the Associated Press revealed Duncan had a fever as high as 103 °F (39 °C) during the initial visit and that he rated his pain as 8 on a scale of 1 to 10.[SUP][27][/SUP] Duncan began vomiting on September 28, 2014, and was transported the same day to the same Texas Health Presbyterian Hospital emergency room by ambulance.[SUP][28][/SUP][SUP][29][/SUP] His Ebola diagnosis was confirmed during a CDC news conference on September 30, 2014.[SUP][30][/SUP][SUP][31][/SUP]
On October 1, 2014, Texas Governor Rick Perry announced at a news conference that Duncan had contact with up to 18 people in Dallas, including several school children,[SUP][32][/SUP][SUP][33][/SUP] who are being monitored at home.[SUP][34][/SUP] Up to 100 people may have had contact with people who had contact with Duncan after he showed symptoms. Health officials later monitored 50 low-risk contacts, and 10 high-risk contacts. The 10 high-risk contacts are Duncan's close family members and three ambulance workers who took him to the hospital.[SUP][35][/SUP] Everyone who came into contact with Duncan is currently being monitored daily to watch for symptoms of the virus.[SUP][36][/SUP] The same day, a second person who had close contact with Duncan was put under close observation.[SUP][37][/SUP] On October 3, Howard University Hospital announced they had placed a patient in isolation after he displayed Ebola-like symptoms and had recently traveled to Nigeria,[SUP][38][/SUP] but that patient was later "ruled out" of having Ebola.[SUP][39][/SUP] On October 4, 2014, two people earlier suspected of having Ebola were declared not infected.[SUP][2][/SUP]
Duncan was treated at Texas Health Presbyterian Hospital in Dallas.[SUP][8][/SUP] As of October 4, Duncan's condition had deteriorated from "serious but stable" to "critical".[SUP][40][/SUP] Duncan was not given the experimental drugZMapp, which was used to treat previous cases of Ebola in aid workers and medical staff, as stocks of the drug were depleted at the time of his infection.[SUP][41][/SUP] American Ebola survivor Kent Brantly offered to donate his blood to Duncan; however, their blood types were incompatible.[SUP][42][/SUP]
On October 4, Duncan began receiving the experimental drug brincidofovir, which only received an FDA emergency investigational new drug authorization for Ebola treatment on October 6. Duncan was still in critical condition as of October 6, while still receiving brincidofovir.[SUP][43][/SUP][SUP][44][/SUP] The next day, the CDC announced it had lost track of a homeless man who had been in the same ambulance Duncan had taken. They announced efforts were under way to locate the man and place him in a comfortable and compassionate monitoring environment.[SUP][45][/SUP] Later that day, the CDC announced that the man had been found and is being monitored.[SUP][4][/SUP] On October 7, it was reported that Duncan's condition was improving.[SUP][46][/SUP] However, Duncan died at 7:51 a.m. Central Time (DST) on October 8, 2014, and became the first patient to die within the United States of Ebola virus disease.[SUP][47][/SUP][SUP][11][/SUP]
Josephus Weeks, the nephew of Duncan, accused Texas Health Presbyterian of "ignorance, incompetence and indecency" in the care of his uncle. Jesse Jackson also accused the hospital of discrimination.[SUP][48][/SUP]The hospital stated Duncan received the "highest level of attention and care, regardless of nationality or ability to pay."[SUP][49][/SUP]

Secondary infections of health workers[edit]

Nina Pham[edit]

On the night of October 10, a 26-year-old nurse, Nina Pham, who had treated Duncan at Texas Health Presbyterian Hospital, reported a low-grade fever and was placed in isolation. On October 11, Pham tested positive for Ebola virus, becoming the first person to contract the virus in the U.S.[SUP][12][/SUP][SUP][50][/SUP][SUP][51][/SUP] On October 12, the CDC confirmed the positive test results.[SUP][12][/SUP] Hospital officials said Pham wore the recommended protective gear when treating Duncan on his second visit to this Dallas hospital, and she had "extensive contact" with him on "multiple occasions". Pham was in stable condition as of October 12.[SUP][12][/SUP][SUP][50][/SUP][SUP][52][/SUP] Although no evidence exists of dogs transmitting Ebola virus to humans, Pham's dog is being quarantined out of caution.[SUP][53][/SUP]
Tom Frieden, director of the Centers for Disease Control and Prevention, initially blamed a breach in protocol for the infection.[SUP][54][/SUP] The hospital's chief clinical officer, Dr. Dan Varga, said all staff had followed CDC recommendations. Bonnie Costello of National Nurses United said, "You don't scapegoat and blame when you have a disease outbreak. We have a system failure. That is what we have to correct."[SUP][55][/SUP]Frieden later spoke to "clarify" that he had not found "fault with the hospital or the healthcare worker." [SUP][56][/SUP] National Nurses United criticized Texas Health Presbyterian for its lack of Ebola protocols and guidelines that were "constantly changing."[SUP][57][/SUP] Nurses at the hospital who were assigned to care for Duncan claimed they did not receive the proper training or personal protective equipment.[SUP][58][/SUP] A report indicated that healthcare workers did not wear hazmat suits until Duncan's test results confirmed his infection due to Ebola, two days after his admission to the hospital. Frieden later admitted that the CDC could have been more aggressive in the management and control of the virus at the hospital.[SUP][59][/SUP]
Pham's infection represents the first case contracted on U.S. soil, leading Frieden to launch an investigation as to how she became infected.[SUP][60][/SUP][SUP][61][/SUP] On October 13, Dr. Frieden urged the public to brace for more bad news, however, suggesting that there could be additional cases in coming days, particularly among the health care workers who cared for the previous patient, Duncan.[SUP][60][/SUP]

Amber Vinson[edit]

On October 14, a second nurse at Texas Health Presbyterian Hospital, identified as 29-year-old Amber Vinson,[SUP][62][/SUP] reported a fever. Vinson was among the nurses who provided treatment for Duncan and was isolated within 90 minutes of reporting the fever. By the next day, Vinson had tested positive for Ebola virus.[SUP][63][/SUP] On October 13, Vinson had flown Frontier Airlines Flight 1143 from Cleveland to Dallas, after spending the weekend in Akron, Ohio. She had a fever of 99.5 °F (37.5 °C) before boarding the 128-passenger jet, according to public health officials. Vinson had flown to Cleveland from Dallas on Frontier Airlines Flight 1142 on October 10.[SUP][64][/SUP] During a press conference, CDC Director Tom Frieden stated she should not have traveled, since she was one of the health care workers known to have exposure to Duncan.[SUP][65][/SUP] Passengers of both flights were asked to contact the CDC as a precautionary measure.[SUP][66][/SUP][SUP][67][/SUP][SUP][68][/SUP]
It was later discovered that the CDC gave Vinson permission to board a commercial flight to Cleveland.[SUP][69][/SUP] Before her trip back to Dallas, she called the CDC several times to report her 99.5 °F fever before boarding her flight. A CDC employee who took her call checked a CDC chart, noted that Vinson's fever wasn't 100.4 °F (38.0 °C) or higher which the CDC deemed as "high risk", and gave her permission to board the commercial flight.[SUP][70][/SUP]
On October 15, the U.S. Department of Health and Human Services announced Vinson will be transferred to Emory University Hospital in Atlanta.[SUP][71][/SUP]

Monitoring of other health care workers[edit]

There are currently 76 Texas Presbyterian Hospital health care workers being monitored because they had some level of contact with Thomas Duncan. [SUP][72][/SUP]

Reaction[edit]

"First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low."

US President Barack Obama, Remarks by the President on the Ebola Outbreak, September 16, 2014.[SUP][73][/SUP]

On October 2, Liberian authorities said they could prosecute Duncan if he returned because he had filled out a form before flying falsely stating he had not come into contact with an Ebola case.[SUP][74][/SUP] Liberian President Ellen Johnson Sirleaf told the Canadian Broadcasting Corporation she was angry with Duncan for what he had done, especially given how much the United States was doing to help tackle the crisis: "One of our compatriots didn't take due care, and so, he's gone there and in a way put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him.…The fact that he knew (he might be a carrier) and he left the country is unpardonable, quite frankly."[SUP][75][/SUP]
The United States federal government told American citizens not to worry about an epidemic of Ebola in the United States, stating that the risk of such an epidemic was very low.[SUP][76][/SUP] On Twitter on September 30, over 50,000 tweets in response to the Ebola case were posted in one hour.[SUP][77][/SUP]

Containment efforts[edit]

On October 12, Dr. Aileen Marty, a doctor with the WHO who had spent 31 days in Nigeria, criticized the complete lack of screening for Ebola on her recent return to the United States through Miami International Airport.[SUP][78][/SUP] After the death of the Liberian national Duncan, who had been exposed to Ebola but lied on a questionnaire regarding his exposure, President Obama announced that the government would develop expanded screening of airline passengers for Ebola, but there would be no travel ban.[SUP][79][/SUP]
The process of screening airplane passengers for fever, as well as the issuance of Ebola questionnaires, is to be implemented at five U.S. airports, which take more than 94% of the passengers from Guinea, Liberia, and Sierra Leone, the three countries that are hit heavily with Ebola. These airports are John F. Kennedy International Airport (Queens, New York); Newark Liberty International Airport (Newark, New Jersey); O'Hare International Airport (Chicago, Illinois); Washington Dulles International Airport (Dulles, Virginia); and HartsfieldJackson Atlanta International Airport (Atlanta, Georgia).[SUP][80][/SUP][SUP][81][/SUP] Although no plans have been announced for other airports, screening in the U.S. represents a second layer of protection since passengers are already being screened upon exiting these three countries. However, the risk can never be totally eliminated.[SUP][82][/SUP]

Medical evacuations to the U.S.[edit]

Map, showing countries and U.S. states affected with Ebola in color.
Nebraska and Georgia are in blue, indicating medically evacuated cases with no deaths.
Texas is in lighter red, indicating local transmission with no deaths, and orange, indicating an initial case that lead to an Ebola death.

As of October 6, 2014, five Americans have been evacuated to the U.S. for treatment after contracting Ebola in West Africa.[SUP][83][/SUP] Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan's Purse, and co-worker Nancy Writebol were infected while working inMonrovia.[SUP][84][/SUP][SUP][85][/SUP][SUP][86][/SUP] Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital.[SUP][87][/SUP]On August 21, Brantly and Writebol recovered and were discharged.[SUP][88][/SUP]
On September 4, a Massachusetts physician, Rick Sacra, was airlifted from Liberia to be treated in Omaha, Nebraska at the Nebraska Medical Center. Working for Serving In Mission (SIM), he is the third U.S. missionary to contract EVD.[SUP][89][/SUP] He thinks he probably contracted Ebola while performing a caesarean section on a patient who had not been diagnosed with the disease. While in hospital, Sacra received a blood transfusion from Kent Brantly, who had recently recovered from the disease. On September 25, Sacra was declared Ebola-free and released from the hospital.[SUP][90][/SUP]
On September 9, the fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. The identity of the patient, a doctor working for the WHO in Sierra Leone, was not released.[SUP][91][/SUP] He was scheduled to receive a blood or serum transfusion from a British man who had recently recovered from the disease.[SUP][92][/SUP] In addition, on September 21, a CDC employee was flown back to the United States after low risk exposure with a healthcare worker. Currently he shows no symptoms and is being monitored. The CDC announced he poses no risks to his family or the United States.[SUP][93][/SUP] On September 28, a fourth American doctor was admitted to National Institutes of Health hospital.[SUP][94][/SUP]
On October 2, NBC News photojournalist Ashoka Mukpo, covering the outbreak in Liberia, tested positive for Ebola after showing symptoms.[SUP][95][/SUP]Four other members of the NBC team, including Dr. Nancy Snyderman, were being closely monitored for symptoms.[SUP][96][/SUP] Mukpo was evacuated on October 6 to the University of Nebraska Medical Center for treatment in their isolation unit.[SUP][83][/SUP]
Another doctor was evacuated from Sierra Leone after suffering a needle prick injury while treating Ebola patients and developing a fever. He was treated at the National Institutes of Health Clinical Center where he was found not to have Ebola and was released.[SUP][97][/SUP]

Biocontainment units[edit]

There are four specialized biocontainment units in the United States: the University of Nebraska Medical Center in Omaha, Nebraska, where Mukpo and Sacra were treated; the U.S. Army Medical Research Institute of Infectious Diseases (Fort Detrick, Maryland); St. Patrick Hospital and Health Sciences Center (Missoula, Montana);[SUP][98][/SUP] and Emory University Hospital (Atlanta, Georgia), where Brantley, Writebol and the unnamed patient had gone after contracting Ebola.[SUP][95][/SUP]