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Re-posted from http://www.advisory.com/

October 02, 2014


New details have emerged about the first patient diagnosed with Ebola in the United States—as well as questions about how a Dallas hospital missed initial signs that the man was infected with the deadly virus and discharged him.

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New details about the patient and his journey to the U.S.

On Tuesday evening, CDC officials confirmed the first case of Ebola diagnosed in the United States after an infected Liberian man flew on a passenger plane from Liberia to Dallas, Texas, where he is now being treated at Texas Health Presbyterian Hospital.

Thomas Eric Duncan, a Liberian national, flew from Liberia on Sept. 19 and arrived in the United States on Sept. 20 to visit relatives. He flew from Monrovia to Brussels to Washington Dulles to Dallas-Fort Worth. He was not symptomatic on the flight, meaning it is highly unlikely that he infected anyone during his trip.

The man first became ill on Sept. 24. According to the New York Times, Duncan is believed to have become infected when he helped his landlord's daughter get to the hospital on Sept. 15. The woman—stricken with Ebola—was turned away from the hospital and Duncan helped bring her home.

How the hospital missed the signs of Ebola

Duncan first went to Texas Health Presbyterian Hospital on Sept. 25. However, health workers did not suspect Ebola, so he was discharged.

According to hospital officials, one of the nurses asked the man about his travel history and he volunteered that he had been in Liberia days before. However, a miscommunication between members of Duncan's care team led workers to lower his risk status and his discharge from the hospital.

At a press conference on Wednesday, Mark Lester—a vice president of Texas Health Resources, the hospital's parent system—said, "Regretfully, that information was not fully communicated throughout the full team... As a result, the full import of that information wasn't factored into the clinical decision-making."

Moreover, Lester noted that the patient was neither vomiting nor experiencing diarrhea at that point. The patient's "overall clinical presentation" didn't indicate Ebola, Lester says.

However, CDC experts say the man was experiencing enough symptoms to be contagious. When the patient's health worsened on Sept. 28, he returned to the hospital via ambulance. He has since been isolated in the hospital's ICU and staff say his condition is "serious but stable."

More than 80 people had at least indirect contact with Duncan and are being monitored, according to Texas health officials. Workers are closely monitoring at least 18 people who came into close contact with the patient while he was contagious, including several children. The children—who attend four schools in the Dallas Independent School District—have not presented any Ebola symptoms , so it is unlikely they could have infected any other students or staff.

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Expert: 'People make mistakes'

"Unfortunately those things happen… People make mistakes," says Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.  

Fauci says the "CDC has been trying very hard to get the message out with a variety of announcements that if you're in a health facility… and someone comes in with symptoms that are compatible with Ebola... do a simple travel history, just ask them the question. Have you done any foreign travel lately? Unfortunately, that did not work in this case. It's a lesson learned. And hopefully, that won't happen again."

The hospital had been prepared for a possible Ebola case. It held a meeting the week before to review guidelines for diagnosis and isolating patients with the deadly virus.

According to NPR's "Shots," the case highlights the difficulty that U.S. hospitals could face identifying the early symptoms of Ebola, which can resemble that of many other illnesses.

Experts say the key to quick diagnosis of Ebola patients is taking travel histories.

At some U.S. hospitals, staff now are asking for travel histories from all patients, regardless of symptoms. "If they have a positive travel history and any symptoms that could be close, that immediately activates isolation before any further workup occurs," says Ross Wilson, the CMO of the New York City Health and Hospitals Corporation.

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Wilson says his hospital has been doing surprise practice drills where people walk in and pretend to have symptoms of Ebola. "This has been a very helpful way for us to assess, but also to learn from," Wilson says, adding that simulations can identify "where things aren't working as well as we thought they might be."

Despite the initial miscommunication that led to Duncan's release, hospital and state officials have reassured the public that they are well equipped to handle an Ebola patient. "This is a very sophisticated city, a very sophisticated hospital, and the dynamics are significantly different from what they are in West Africa," says Texas Department of State Health Services Commissioner David Lakey (Neporent, "Good Morning America," ABC News, 10/1; Greenfieldboyce, "Shots," NPR, 10/1; Berman, Washington Post, 10/1; Altman, TIME, 10/1; Fox, NBC News, 10/1; Johnson, Modern Healthcare, 10/1 [subscription required]; New York Times, 10/1; CBS News, 10/2).

- See more at: http://www.advisory.com/_apps/dailybriefingprint?i={0BBB826F-DBB1-448E-BFA4-03DC367E80E6}#sthash.qOJYgNdc.dpuf

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