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Second health worker infected with Ebola flew the day before reporting symptoms Ebola-stricken health care worker flew on passenger plane a day before being diagnosed
(about 1 hour later)
A second Texas Health Presbyterian Hospital worker who tested positive for Ebola flew on a commercial flight from Cleveland to Dallas on Monday, the day before she reported symptoms of the virus, the Centers for Disease Control and Prevention said. The second health-care worker diagnosed with Ebola flew on a passenger jet with more than 130 other passengers on Monday, a day before she reported symptoms of the virus and was tested, according to authorities.
The health worker, who has not been named, cared for an Ebola-stricken Liberian man at the hospital, then tested positive for the disease in a preliminary test, Texas health officials announced Wednesday morning. Public health officials criticized the woman for flying, saying that even though she had no symptoms at the time, she should not have traveled that way.
She flew on Frontier Airlines Flight 1143 at around 6 p.m. on Oct. 13. There were 132 passengers on board, according to the airline and health officials. The CDC said it is working to reach out those passengers and is also asking them to call a hotline. “She should not have flown on a commercial airline,” Thomas Frieden, director of the Centers for Disease Control and Prevention, said during a news conference Wednesday.
The agency and the airline also said that the health-care worker did not exhibit any symptoms while on the flight. A person infected with Ebola is only contagious once the person becomes symptomatic. This worker flew on a Frontier Airlines flight from Cleveland to Dallas-Fort Worth on Monday night. She did not exhibit any symptoms during the flight, the CDC and the airline said Wednesday.
Dallas County Judge Clay Jenkins said at an early-morning news conference that the female worker was isolated within 90 minutes of taking an elevated temperature reading. He also warned that additional cases could be on the horizon. The health-care worker was not identified by public health officials, but family members told Reuters and the Dallas Morning News that her name is Amber Vinson, a nurse at Texas Health Presbyterian Hospital. She was part of a team that had cared for Thomas Eric Duncan, a Liberian man who flew to Texas and was diagnosed with Ebola last month, during his hospitalization in Dallas. Duncan died last week. Nina Pham, a nurse who also cared for Duncan, was diagnosed with Ebola on Sunday.
“We are preparing contingencies for more, and that is a very real possibility,” Jenkins said, hours before the airline announcement. Public health officials announced early Wednesday morning that the second health care worker had been infected as well. She reported a fever Tuesday and was isolated and tested for the illness. This second health care worker had flown from Dallas to Cleveland on Friday, Oct. 10, before returning Monday, about a day before she reported her fever.
The health department said the preliminary Ebola test was conducted late Tuesday at the state public health laboratory in Austin and results were received at about midnight. Confirmatory testing on a separate specimen will be conducted by the Centers for Disease Control and Prevention in Atlanta. The flight the second health-care worker took back to Dallas arrived at 8:16 p.m. on Monday and remained overnight, because it was done with flights for the day. After that, the plane “received a thorough cleaning per our normal procedures” before resuming service on Tuesday, Frontier said in a statement. It was also cleaned on Tuesday night in Cleveland, the airline said.
“Today’s development … while concerning and unfortunate, is continued evidence that our monitoring system is working,” said Daniel Varga, chief clinical officer for Texas Health Resources, the hospital system to which the Dallas hospital belongs. People with Ebola are not contagious until they are symptomatic, and the health care worker was not exhibiting any symptoms until Tuesday, authorities say. Ebola can be spread through direct contact with bodily fluids, and it is considered difficult to contract.
The second infection of a health worker at the facility has called into question the procedures in place to protect workers. Varga said he does not believe that there is a “systematic” or institutional problem at the hospital, but he acknowledged some missteps. Still, the CDC is asking all 132 passengers on Flight 1143 to call 1-800-232-4636. Beginning on Wednesday afternoon, public health officials will begin interviewing passengers and working to monitor anyone deemed to be at risk. But it is not known how many crew members were on the flight as well as how many people were involved in the cleaning of the plane in Dallas and Cleveland.
The second Ebola-stricken worker, who was not named, helped care for Thomas Eric Duncan, who became the first Ebola patient diagnosed in the United States. Duncan died at the same hospital after coming down with the deadly virus following a flight from Liberia. “The safety and security of our customers and employees is our primary concern,” Frontier said in a statement Wednesday. “Frontier will continue to work closely with CDC and other governmental agencies to ensure proper protocols and procedures are being followed.”
Nina Pham, the first health-care worker who came down with the disease after treating Duncan, was said to be doing better. One of the two health-care workers being treated at Dallas will be transferred to Emory University Hospital in Atlanta on Wednesday, according to the CDC.
“A lot is being said about what may or may not have occurred to cause our colleagues to contract this disease, but it’s clear there was an exposure somewhere, sometime in their treatment of Mr. Duncan,” Varga said. “We’re a hospital that may have done some things differently with the benefit of what we know today.” Dallas County Judge Clay Jenkins said at an early-morning news conference that the female worker was isolated within 90 minutes of having a higher temperature. He had also warned that additional cases of Ebola were considered likely.
“No one wants to get this right more than our hospital,” he added. “We are preparing contingencies for more, and that is a very real possibility,” Jenkins said.
Varga added that the hospital can manage up to three patients in its intensive care unit isolation ward, in addition to its emergency room isolation beds. President Obama postponed a trip to New Jersey and Connecticut Wednesday to convene a White House meeting about Ebola. The White House said he will meet with the cabinet agencies coordinating the government’s response to the virus.
[Read: Dallas hospital learned its Ebola protocols on the fly.] It is still unclear how Pham and the second health care worker were infected. The CDC said Tuesday it had not determined how Pham was infected, so it was not immediately known how many people were at risk. A team of about 76 people — including this second health care worker — had possible exposure to Duncan during his care, according to the CDC. They are being monitored for symptoms.
“Health officials have interviewed the latest patient to quickly identify any contacts or potential exposures, and those people will be monitored,” the Texas Department of State Health Services statement said. “The type of monitoring depends on the nature of their interactions and the potential they were exposed to the virus.”
Early Wednesday, Dallas officials began the process of decontaminating the second health-care worker’s apartment, distributing information fliers throughout the neighborhood and issuing reverse 911 information calls to residents.
Dallas Police Department Maj. Max Geron handed out fliers to media that he said had been given to hundreds of residents of the Village Bend apartment complex in northeast Dallas, just a few miles from Texas Health Presbyterian Hospital.
The sheet, bearing logos of City of Dallas, Dallas County, Dallas Independent School District and the CDC, advises that a “health care worker who lives in your area has tested positive for Ebola…. While this may be concerning, there is no ongoing danger to your health….”
Decon in progress in apt building of 2nd health care worker with Ebola. @dallasfireres_q @dallaspiosana #DallasEbola pic.twitter.com/QGACzhqXvA — Maj. Max Geron (@MaxDPD) October 15, 2014Decon in progress in apt building of 2nd health care worker with Ebola. @dallasfireres_q @dallaspiosana #DallasEbola pic.twitter.com/QGACzhqXvA — Maj. Max Geron (@MaxDPD) October 15, 2014
Decon in progress in apt building of 2nd health care worker with Ebola. @dallasfireres_q @dallaspiosana #DallasEbola pic.twitter.com/QGACzhqXvADecon in progress in apt building of 2nd health care worker with Ebola. @dallasfireres_q @dallaspiosana #DallasEbola pic.twitter.com/QGACzhqXvA
— Maj. Max Geron (@MaxDPD) October 15, 2014— Maj. Max Geron (@MaxDPD) October 15, 2014
Flyer distributed to residents in cmplx of 2nd hlth care wrkr w/Ebola. @dallaspiosana @DallasFireRes_q #DallasEbola pic.twitter.com/dC1RY6MoLE — Maj. Max Geron (@MaxDPD) October 15, 2014 National Nurses United, a labor organization, issued a statement it said came from nurses at the hospital who reported feeling “unsupported, unprepared, lied to and deserted to handle their own situation.”
Flyer distributed to residents in cmplx of 2nd hlth care wrkr w/Ebola. @dallaspiosana @DallasFireRes_q #DallasEbola pic.twitter.com/dC1RY6MoLE — Maj. Max Geron (@MaxDPD) October 15, 2014 Among other things, the statement said that the guidelines for handling Duncan were constantly shifting, and that for the first two days of Duncan’s isolation, the protective equipment given to nurses did not cover their necks.
Dallas officials had said earlier that 77 workers were potentially exposed to Duncan in the hospital before he died Oct. 8, and they are being monitored daily for any signs of fever or other symptoms. Pham, the nurse who was diagnosed Sunday, is now in good condition. She had direct contact with one person while she was symptomatic — the only time a person with Ebola is infectious — and that person has no symptoms and is being monitored, officials said. “A lot is being said about what may or may not have occurred to cause our colleagues to contract this disease, but it’s clear there was an exposure somewhere, sometime in their treatment of Mr. Duncan,” Daniel Varga, chief clinical officer for Texas Health Resources, the hospital system that oversees Texas Health Presbyterian, said Wednesday.  “We’re a hospital that may have done some things differently with the benefit of what we know today.”
It was not immediately known how many people the second worker had come in contact with; those contacts will now have to be traced and checked. Thomas Frieden, director of the CDC, had said Tuesday he was hearing concerns from hospitals across the United States.
Jenkins, the Dallas County judge, said the procedure of allowing the remaining 75 health workers to self-monitor their temperatures and look for signs of other symptoms such as diarrhea is working. “I’ve been hearing loud and clear from health care workers around the country that they’re worried, that they don’t feel prepared to take care of a patient with Ebola,” he said during a news conference.
“This is not going to be a situation where we’re going to put protective orders on 75 health workers,” Jenkins said. “The system right now is working.” Frieden expressed regret that his agency had not done more to help the hospital in Dallas with infection control. He said that from now on, the CDC will dispatch an “Ebola response team” to any hospital with a confirmed Ebola case.
The 48 other contacts of the index patient who were not health-care workers are still being monitored, and so far none are symptomatic. Most are in the final stages of the 21-day monitoring period and are unlikely to contract the virus at this point, the CDC said on Tuesday. “I wish we had put a team like this on the ground the day the first patient was diagnosed,” he said. “That might have prevented this infection.”
The handling of the Ebola cases in Texas has become the nation’s first real encounter with the disease and its infectiousness — and it is becoming a case study in how not to deal with such a dangerous virus, which is spread through contact with bodily fluids of those infected. The CDC sent an additional team of 16 people to Texas to help manage infection control and monitor hospital workers, following an initial group of 10 that had been sent on Sept. 30, the day Duncan was diagnosed.
Indeed, CDC Director Thomas Frieden said the agency regretted its initial response to the first Ebola diagnosis in Texas, acknowledging that more could have been done to combat infection at the hospital treating Duncan. He said authorities still don’t know how exactly Pham was infected — whether it involved a flaw in her personal protection gear or in the way the gear was used. The infections of two health care workers in Dallas, combined with the numerous times the hospital has changed its story regarding the way Duncan was initially cared for, have created a sense of unease about how prepared U.S. hospitals are for additional Ebola cases.
Nurses at the hospital, who spoke anonymously through National Nurses United, citing fear of retribution, said protocols at the hospital were “constantly changing” and that nurses received minimal training in infection-control procedures. [This post has been updated. First published: 11:28 a.m. Last update: 1:04 p.m.]
In the initial hours and days of treating Duncan in isolation, nurses said they wore non-impermeable gowns, with no protection for their necks.
And they accused the hospital of sending contaminated lab specimens from Duncan through the same hospital tube system used for all patients, rather than specially sealing or hand delivering them. The result was that the entire lab tube system was potentially contaminated, they added.
The nurses at Texas Health Presbyterian Hospital are not members of National Nurses United or any union in Texas.
On Tuesday, Frieden announced that steps were taken to shore up infection and safety control procedures at the hospital, including the addition of a 24-hour site manager to monitor the process of taking off and putting on personal protective equipment.
The CDC this week also sent a second team of 16 public health experts, including some who specialize in infection control, to Dallas, in addition to the team of 10 that were deployed on Sept. 30.
“What I think we believe that what we could have done better was the oversight of the implementation of the protocols,” Health and Human Services Secretary Sylvia Burwell told CNN on Wednesday morning.
“I do have confidence in the CDC and Dr. Frieden,” she added.
Now that there appear to be two cases of Ebola transmission among health-care workers, the agency and its director are likely to face further questions about whether something systemic went wrong.
Amy Ellis Nutt in Dallas contributed to this report.
[This post has been updated.]
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