About 70 hospital staffers cared for Dallas Ebola patient

The numbers of those exposed keeps growing and growing.

DALLAS (AP) -- They drew his blood, put tubes down his throat and wiped up his diarrhea. They analyzed his urine and wiped saliva from his lips, even after he had lost consciousness.

About 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Thomas Eric Duncan after he was hospitalized, including a nurse now being treated for the same Ebola virus that killed the Liberian man who was visiting Dallas, according to medical records his family provided to The Associated Press.

The size of the medical team reflects the hospital's intense effort to save Duncan's life, but it also suggests that many other people could have been exposed to the virus during Duncan's time in an isolation unit.

On Monday, the director of the Centers for Disease Control and Prevention said the infection of the nurse means the agency must broaden the pool of people getting close monitoring. Authorities have said they do not know how the nurse was infected, but they suspect some kind of breach in the hospital's protocol.

The medical records given to the AP offer clues, both to what happened and who was involved, but the hospital says the CDC does not have them.

"This is not something we can afford to experiment with. We need to get this right," said Ruth McDermott-Levy, who directs the Center for Global and Public Health in Villanova University's College of Nursing.

Until now, the CDC has been actively monitoring 48 people who might have had contact with Duncan after he fell ill with an infection but before he was put in isolation. The number included 10 people known to have contact and 38 who may have had contact, including people he was staying with and health care professionals who attended to him during an emergency room visit from which he was sent home. None is sick.

The CDC has not yet established a firm number of health care workers who had contact with Duncan.

"If this one individual was infected - and we don't know how - within the isolation unit, then it is possible that other individuals could have been infected as well," said Dr. Tom Frieden, director of the CDC. "We do not today have a number of such exposed people or potentially exposed health care workers. It's a relatively large number, we think in the end."

Caregivers who began treating Duncan after he tested positive for Ebola were following a "self-monitoring regimen" in which they were instructed to take their temperatures regularly and report any symptoms. But they were not considered at high risk.

Typically, the nurses, doctors and technicians caring for a contagious patient in isolation would be treating other people as well and going home to their families after decontaminating themselves. The hospital has refused to answer questions about their specific duties.

The 1,400-plus pages of medical records show that nurses, doctors and other hospital employees wore face shields, double gowns, protective footwear and even hazmat suits to avoid touching any of Duncan's bodily fluids. Ebola spreads through direct contact with those fluids, usually blood, feces and vomit. The virus has also been detected in urine, semen and breast milk, and it may be in saliva and tears.

CDC officials said there were chinks in that protection at Texas Presbyterian, but they have not identified them and are investigating.

A CDC spokesman did not dispute that the agency did not have the medical records, and said he would double check. It's unclear why those reports are not in the hands of federal health investigators.

"Patient had large, extremely watery diarrhea," a nurse wrote in a report filed the day Duncan tested positive.

Another nurse noted that Duncan's urine was "darker in color with noted blood streaks."

It was unclear from the records released to the AP how many of the approximately 70 individuals involved in Duncan's care had direct contact with his body or fluids.

Dr. Aileen Marty, a World Health Organization doctor who recently returned to Florida International University after a month fighting Ebola in Nigeria, said no amount of protection is going to help if hospital workers do not put on and take off their protective layers carefully.

"The first thing in caring for someone with Ebola is to do everything in your power to never become a victim," she said.

And tracking all contacts, even within the medical setting, is complicated.

Generally, the first step in locating care providers for isolated infected patients is a personnel log on the door, "that should have everyone going in and out, signing in and out," said Dr. Lisa Esolen, Geisinger Health System's Medical Director of Health Services and Infection Prevention and Control. Medical records indicate the Dallas hospital had a log.

On the day before Duncan died, records indicate that at least nine caregivers entered and exited the room.

A spokesman for Texas Health Resources, the hospital's parent company, said the CDC probably has a log from the room door that would list everyone who got close to Duncan.

Dr. Christopher Ohl, who heads Wake Forest Baptist Medical Center's infectious-disease department and has worked with the CDC in the past, said the expanding monitoring "is an abundance of caution that's probably beyond what needs to be done" because medical caregivers will notice if they're getting a fever, and they're not contagious until that point.

"You start to know when you get those body aches and headaches, most people know that," he said. "It's not like you're surprised by it. Most people can figure out what to do when that happens."

ource

But, but, "an ebola outbreak couldn't happen in the first world, it only happens in places like the third world because their healthcare is crap" is a sentiment we've been hearing on ATS from members sick of ebola threads, so it must be true?

a reply to: boncho

I'm sick of them as well. Wish it wasn't necessary and/or we didn't feel the need to start yet another thread about this monster of a virus.

Just how many people came in contact with these 70 + the other 48 ?

a reply to: boncho

The media's saying it too so it must be true. Plenty of threads but it's a hot topic at this point. Kind of proved many of the naysayers wrong in this instance

originally posted by: Yeahkeepwatchingme
a reply to: boncho

The media's saying it too so it must be true. Plenty of threads but it's a hot topic at this point. Kind of proved many of the naysayers wrong in this instance

At least it's a real topic. Id rather the influx of Ebola threads vs. election year political threads. I don't need to hear about the last time politicians took a poop, and what was inside it.

Hate to say it, but they should have had a select team of caregivers for Duncan and nobody else should have been allowed in the area except if absolutely necessary. There really was no need to have 70 people caring and being exposed to one patient regardless of it being Ebola.

I know that may sound heartless, but there needs to be tighter protocols and procedures in place for situations like this. I seriously doubt that there was much more 70 people could do that 25 people couldn't. Minimizing unnecessary exposure should be almost as important as caring for the patient. Just my .02.

What we're being told and what is actually happening is confusing! People who lived with and visited Duncan while he was sick didn't catch it. Emergency room personal who had no protective gear on his first visit didn't get it. Ambulance grew that took him to the hospital didn't get it, yet a nurse if full protective gear got it.

There seems to be a lot more to the transmission than the medical field knows. Can the people who were exposed become carriers of the virus without developing it? Could a secondary infection, like a mild head cold, render one more susceptible?

What we're hearing, and what we're seeing seem to be two different things.

Yeah, now "70 staffers who cared for the patient have been exposed", whereas a couple of days ago, the media was griping about the "substandard health care provided by the hospital".

SEVENTY people attended to him, over just a few days, and they've been trying to call that "substandard"?

The guy was visiting the USA for his kid's graduation, I doubt he had any medical insurance at all. The hospital would have been well within their rights to have turned him away had he not had insurance, under the American laughingly called "best in the world" healthcare system.

a reply to: babybunnies

Actually it is 100% illegal to deny care to a patient regardless if they have insurance or not. Granted they didn't have to do all they did, but they had to give him care by law.

originally posted by: SpaDe_
Hate to say it, but they should have had a select team of caregivers for Duncan and nobody else should have been allowed in the area except if absolutely necessary. There really was no need to have 70 people caring and being exposed to one patient regardless of it being Ebola.

I know that may sound heartless, but there needs to be tighter protocols and procedures in place for situations like this. I seriously doubt that there was much more 70 people could do that 25 people couldn't. Minimizing unnecessary exposure should be almost as important as caring for the patient. Just my .02.

good point,

a reply to: MrLimpet

Dr. Jane Orient, Executive Director of the Association of American Physicians and Surgeons, reported…
EBOLA – “it’s very, very contagious, it only takes between 5 and 10 virus particles to infect a person. You don’t have to have cuts…there are receptors for the viruses in [people’s] normal skin.”

70 staffers, huh?

I'd imagine they contaminated the entire facility just walking around (let alone brushing up against things). The more we hear about this ... the worse it gets. At least one of those folks were contaminated. "They" blamed it on her violating a protocol. How about the protocol where Class IV pathogens are contained in Class IV facilities. What about that protocol?

Did Frieden set the United States up for failure when he suggested a violation of those protocols? That part where he suggested any hospital in the US could care for a patient infected with a Class IV pathogen? Uh-uh!! Class II facilities cannot contain a Class IV pathogen ... inside a patient or not. That's what those "facility ratings" are all about. Sheesh!!!!

How many of YOU would feel comfortable even entering this facility? Has anyone seen any reports of the decontamination protocols for this facility being conducted? You know that facility needs to be hosed down ... top to bottom ... with a chlorine solution ... by protocol, to continue its mission? Why in the Hell hasn't the Joint Commission stepped in here and shut that facility off to the public???

This, on the original ebola thread I mentioned this should be done

www.bloomberg.com...

U.S. and local health officials want to set up dedicated hospitals in each state for Ebola patients, part of a new emphasis on safety for health-care workers after a nurse caring for an infected patient in Dallas tested positive for the virus.

a reply to: MrLimpet

Thank you for this article. Truly tragic and slightly horrifying. On a more personal note: I've been posting all week on the incomprehensible incompetency of Dr Frieden and the CDC. I have since been openly targeted by two members who told me "there's too many posts about Ebola". All I can say to that is, "You ain't seen nothing yet." And, despite their bizarre personal attacks for reasons that elude me, I'm not going anywhere. I have a lot to say about the idiotic strategy employed by the CDC in regard to the Ebola outbreak in the US, and I've only just begun...

a reply to: boncho

Remember "ebola" was brought into the US, that is why we have now cases linked to the infected person, thankfully the ebola now in the US is just two isolate cases so far, we should expect more, but if they can stay isolated the better.

Now as for the OP, I am glad that is been some sort of procedure involving the care workers that attended the infected man.

It most be scary to be a health care worker in Dallas this days.

a reply to: bludragin

I've seen your posts. Yes, people are getting burned out from information overload and the repeated attempts to express how deep the hole is getting. You've got my nod ... keep at it.

There are checks and balances built into much of the bureaucracy in any organization. It's time for people to start calling on the Joint Commission to pull any hospital's certification ... immediately after an Ebola patient has stepped onto the property. We can't risk even one community to this catastrophe. "They" should have never created an opportunity for this to get off the continent of Africa.

Can you imagine the consequences of this finding an animal reservoir (in America) to set up in? Can you imagine a homeless dude dying out in a park and a crow pecking his eyes out and flying off to God knows where? Or some stray dog (or a raccoon) eating out his liver?

The more I see, the more I worry. The more I hear the CDC say there's no reason to panic, while not seeing actual Class IV pathogen controls being established/maintained, the more I want to scream the alarm to anyone who's within earshot. Sustained incompetence/negligence cannot just be bumbling ... there's got to be an agenda. We're way too smart for this.

a reply to: Snarl

Sustained incompetence/negligence cannot just be bumbling ... there's got to be an agenda. We're way too smart for this.

The agenda is written into the system that drives it, and the cogs that turn the wheels. The cogs being the inept controllers in control simply because they wiggled themselves into the positions politically even though they weren't meant for the job.

Think about it, the CDC, WHO, the DOE, the like usually have appointed heads, or people of many hats, simply riding the position for what they can get out of it professionally and personally, career and comfort first.

In the case of the CDC that's not true at the moment as Friedman has a long history with the organization, but there was still claims he spent more time eating cocktail weenies than he did contemplating the impact Ebola was going to have when it first emerged. The CDC refused to even get involved until they got everything their way, and the African governments conceded a number of things, mostly control on the outbreak.

Not, "We will do anything we can just let us know", but "Well, until you let me do this and that, oh and I want a shiny pen and a plaque, and one of those things with my name on it saying how important I am to this crisis...."

So what is the agenda? Its the one that every bureaucrat is simply looking for a way to make themselves really famous in their field or their political positions, so they can accelerate up the ladder and collect as much benefit as possible. Inept people in positions of power or purpose, only there because it was opportune and it is paying their expenses. That is how I see a future outbreak spread, by inept oompa loompas more focused on their weekend at the cottage than the matter at hand.

This isn't a widespread conspiracy so much as it is government inefficiency and positions with no accountability. Not saying its the case entirely here, or that it is bound to happen in this instance. But examples are evident throughout many industries and its always happening. It just takes the right mix of asshat and existential crises to create a billion dollar/billion life boondoggle.

Not good.

WHO says there could be up to 10,000 new cases of Ebola per week in 2 months - @AP

a reply to: boncho

I starred your post ... but I'm not conceding my CT is wrong.

Thanks for always being there (rational), brother.

originally posted by: babybunnies
Yeah, now "70 staffers who cared for the patient have been exposed", whereas a couple of days ago, the media was griping about the "substandard health care provided by the hospital".

SEVENTY people attended to him, over just a few days, and they've been trying to call that "substandard"?

The guy was visiting the USA for his kid's graduation, I doubt he had any medical insurance at all. The hospital would have been well within their rights to have turned him away had he not had insurance, under the American laughingly called "best in the world" healthcare system.

According to one news article I'd read just before his passing, there was a claim in the article that was made that he was originally turned away because he had no health insurance. I looked through my history but I can't find it so it must be more than 2 days old. Sorry.