Ebola Update 10/15/14

October 15th, 2014

A second healthcare worker at Texas Health Presbyterian Hospital Dallas has tested positive for the Ebola virus, the Centers for Disease Control and Prevention (CDC) and the Texas health department announced today.

The patient, identified only as a woman at this point, is one of 76 healthcare workers at the hospital who have been monitored for Ebola symptoms because they may have been exposed to Liberian national Thomas Eric Duncan after he was admitted on September 28. The woman reported a low-grade fever yesterday and was immediately isolated. Preliminary testing that detected the Ebola virus was performed overnight by the Texas Department of State Health Services. The CDC said it would perform its own confirmatory test.The second healthcare worker traveled by air on Frontier Airlines on October 13 from Cleveland to Dallas, the day before she reported having a low-grade fever. Crew members on Frontier Airlines flight 1143 said the woman did not exhibit any signs or symptoms of illness, according to the CDC. The agency is asking all 132 passengers of this flight to call it at 1-800-232-4636 so they can be interviewed about the flight. “Individuals determined to be at any potential risk will be actively monitored,” the agency said.  Frontier Airlines said it has removed the aircraft that made flight 1143 from service. It noted that the healthcare worker had flown from Dallas to Cleveland on October 10.

 From CDC

  • Second healthcare worker is now infected from exposure to index patient
  • Situation changes every day
  • We will always share what we know, and always share more rather than less
  • This second case is very concerning –our thoughts are with the healthcare worker and her family
  • We are planning for possibility of additional cases in coming days
  • Taking a series of steps to stop spread of Ebola-will require many partners to do their part
  • Second patient is ill but clinically stable – after she reported symptoms, she was rapidly isolated, tested and results returned back at 1 a.m. today from Texas state lab. We expect that to be confirmed shortly at CDC lab. She will be transferred to Emory University.
  • These two healthcare workers had extensive contact with index patient during his highly infectious period –substantial amounts of vomiting and diarrhea
  • Continue to identify other healthcare workers who had high level of contact with index patient. We know there are approximately 50 other healthcare workers who entered the index patient’s room during time of his hospitalization. 

How was nurse able to get on an aircraft without being monitored or quarantined?

  • The second healthcare worker traveled to Ohio before it was known that the first healthcare worker was ill; at that point that second healthcare worker and the rest of healthcare team were undergoing self-monitoring. The second healthcare worker reported no symptoms or no fever; but she should have not traveled on a commercial airline. We will from this moment forward make sure no other individual will undertake travel in anyway other than controlled movement. 

National Nurses United criticized protocols in place at hospital? Your response?

  • We are working closely with the hospital – we have staff there around the clock. There are intensive efforts to train, retrain and supervise staff. The single most important way to get consistency is to have a site manager. We have ensured that 24/7 there will be a site manager to monitor infection control and PPE at all times. Two nurses from Emory are also doing peer to peer training. We understand what the nurse’s concerns are. 

Misc

  • First patient is still in Dallas Hospital and in an improved condition today; we will assess each hour each day whether that is the best place for her. Second patient is being transferred to Emory.
  • We work with state and local health authorities to determine controlled movement. 

Was any skin left exposed by the PPE worn by the healthcare workers? Did hospital not tell workers that they could not travel before today?

  • Some forms of PPE used did allow some exposure by parts of the skin. There are ways to do it, sometimes with exposure to skin, sometimes without. The important thing is that protocols are followed.
  • All healthcare workers caring for index patient were under self-monitoring; they were not being actively monitored because no one had shown any symptoms.
  • Risk to other airline passengers is extremely low since the healthcare worker was not symptomatic at the time of flight.

Any risk to contracting Ebola on public transportation? 

  • If you are a member of traveling public, should you be worried that you will become infected by sitting next to someone on a bus? The answer is no.
  • If you are sick, should you get on a bus or other public transit? The answer is no.
  • We are contacting everyone on that flight out of an abundance of caution. 

How will it be possible to stop people who treated the index patient from getting on public transportation?

  • In terms of controlled movement, we have worked the details out with state and local public health authorities
  • At this time, we require anyone who may have been exposed to travel by controlled movement only – no public transportation
  • The healthcare worker who traveled to Ohio on Monday should not have traveled by plane or public transport by virtue of the fact that she was in an exposed group. And although she did not report any symptoms and didn’t meet the fever threshold, she did report that she did take her temperature and found it to be 99.5. Level of risk to people around her is extremely low, but because of that extra margin of safety, we will be contacting them all. 

You said a site manager is an important element of containing this virus. Why was one not installed immediately with the index patient?

  • We will certainly make sure that happens with every new case.

I anticipate guidance from ISDH on lab testing and PPE procedures in the near future and will share when available.

Questions call Deb McMahan, MD