Md. officials emphasize Ebola screening after lapse in Texas
By By Scott Dance
The Baltimore Sun|
Oct 02, 2014 at 6:38 PM
Maryland public health officials are putting caregivers — from Baltimore's major teaching hospitals to strip-mall urgent care centers to ambulances — on heightened alert for signs of Ebola as details emerge about missteps in Dallas, where a man with the deadly virus was initially sent home from a hospital.
Health care providers have for months been preparing for Ebola's potential arrival in the U.S., and on Tuesday confirmed a Liberian man visiting family in Dallas had the virus. Despite warnings to screen patients for factors that might raise suspicions of Ebola, the man exposed as many as 100 people to the illness before seeking care a second time.
State Health Secretary Joshua Sharfstein said Thursday the case underscores the need for vigilance: "It certainly helps get the message to the health care community that it's very important to follow through with the protocols," which include screening for early symptoms such as headache and fever and for recent travel to West Africa.
While Sharfstein urged health providers to be on guard for those risk factors, health officials also are seeking to calm any panic over the possibility of an Ebola outbreak spreading in the U.S. Doctors say the risk of that happening is minimal because of the nation's superior medical facilities and infection control practices.
But that risk can grow, as demonstrated in the Texas case, when health providers don't follow Centers for Disease Control and Prevention guidelines that call for screening and putting any suspicious patients under quarantine.
"Unfortunately, that did not happen in this case," said Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases. "We just need to put that behind us and look ahead and make sure that in the future that doesn't happen again."
Two days after he was sent home from a Dallas hospital, the man who is the first person to be diagnosed with Ebola in the United States was seen vomiting on the ground outside an apartment complex as he was bundled into an ambulance. Liberia identified him as Thomas Eric Duncan, a resident of its capital, Monrovia.
Liberian authorities on Thursday 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 when he had actually helped a neighbor with the disease days earlier.
Liberia President Ellen Johnson Sirleaf told Canadian Broadcasting Corp. 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," she said.
Duncan initially sought treatment at Texas Health Presbyterian Hospital late Sept. 25. He was sent home with antibiotics even though he told a nurse he had recently returned from West Africa. By Sunday, he needed an ambulance to return to the same hospital, where he was admitted. He remains in serious condition.
"His whole family was screaming. He got outside and he was throwing up all over the place," apartment resident Mesud Osmanovic, 21, said Wednesday, describing the chaotic scene before Duncan was admitted to Texas Health Presbyterian.
Four of Duncan's relatives have been quarantined to the apartment where he was staying with them. Police and armed security guards were keeping people away from the apartment Thursday, while maintenance workers using high-pressure water were scrubbing the parking lot with bleach.
Health officials also are monitoring up to 100 other people for Ebola symptoms. It is believed he came into direct contact with 12 to 18 people, who then came in contact with scores of others.
Ebola is transmitted through contact with any bodily fluids of a person who is showing symptoms, which include vomiting and diarrhea. It can take as long as three weeks for a person with the virus to become contagious.
Maryland health officials have for months acknowledged the potential for Ebola to be diagnosed here, as the disease has spread rapidly in West Africa. Out of more than 7,000 Ebola cases there, more than 3,300 people have died of the hemorrhagic fever the virus causes.
"It's certainly possible, and that's what we want to be prepared for," Dr. David Blythe, state epidemiologist for the Maryland Department of Health and Mental Hygiene, said Thursday.
Patients with suspicious symptoms and travel histories have raised concerns of Ebola in at least two Baltimore-area hospitals, but the Texas case is the only one to be confirmed in the U.S. No scares in Maryland have raised alarm to the level of requiring a blood test for Ebola, Blythe said.
Since August, the state has been one of 13 capable of testing for Ebola, with the support and authorization of the CDC. If a case of Ebola were suspected here, state health officials would test the patient's blood for the presence of the RNA of the Ebola virus, and would also send samples of the patient's blood to the CDC in Atlanta, said Robert Myers, director of the state public health lab.
In Maryland, the testing would occur at the state's public health lab at State Center in Baltimore. A new lab is set to open later this year near Johns Hopkins Hospital, officials said.
To prevent a repeat of oversights by Texas health care workers, Maryland officials are widely distributing warnings signs and protocols for screening and care to doctors, nurses and first responders across the state.
"We have been trying to get communications out to a variety of different health care settings, including nonhospital health care settings and physicians overall to … make sure everyone's aware and everyone knows what to be on the lookout for and what to do," Blythe said.
Caregivers are routinely instructed to inspect and interview patients for signs of dangerous pathogens causing outbreaks elsewhere, such as Middle East Respiratory Syndrome and enterovirus D68, as well as Ebola.
"Our providers are very familiar with this kind paradigm where we interview patients and screen them for risk factors so we can rapidly identify [illnesses] and take appropriate precautions," said Dr. Lisa Maragakis, director of epidemiology at Johns Hopkins Hospital.
So far, the messages have worked, said Dr. Anthony Harris, a professor of epidemiology and public health at the University of Maryland School of Medicine.
"We've had to test out these protocols in that we have had patients returning from countries where Ebola has been present, and the protocols have worked tremendously effectively," Harris said. "The public should be reassured we are fully prepared."
Duncan, in his mid-40s, occasionally visited his family in Dallas over the years, said Osmanovic, the family's neighbor. Most of the neighborhood is from Liberia, Somalia or Sudan. Osmanovic is from Bosnia.
Of the original 18 people thought to have been in contact, many were "close family members," said Dr. Christopher Perkins, Dallas County Health and Human Services medical director. Five of them were children, none of whom were showing symptoms. The four different schools they attended would be staffed with additional health professionals and classes would remain in session, said Mike Miles, Dallas Independent School District superintendent.
Texas officials said health workers who took care of the patient had so far tested negative for the virus and there were no other suspected cases in the state.
A Liberian official said Duncan traveled through Brussels to the United States. United Airlines said in a statement that the man took one of its flights from Brussels to Washington Dulles International Airport, where he changed planes to travel to Dallas-Fort Worth. Other travelers are not thought to be at risk of exposure to Ebola because it is believed Duncan was not contagious until after arriving in Dallas.
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Some airlines have suspended or cut back flights since the summer, and only one European carrier now offers direct services to Guinea, Sierra Leone and Liberia. However, those still operating have taken measures to protect passengers and crew, along with airports in the region and beyond.
The International Air Transport Association said Thursday that the Ebola crisis has taken on a "new dimension" with the case in the United States, but it repeated that flying remained safe. The World Health Organization has not placed any restrictions on travel and has encouraged airlines to keep flying to the worst-hit regions.
"Travelers should be reassured. WHO has clearly said that the risk of Ebola transmission on board an aircraft is very low," IATA Director General Tony Tyler said on Thursday.
Tribune Newspapers and Reuters contributed to this article.