DALLAS, Texas, October 1, 2014 (AMG) – The first case of Ebola Virus Disease was diagnosed in Dallas, Texas on September 30, making the United States the only country outside of West Africa with a confirmed case of the disease.
The patient, identified as Thomas Eric Duncan, arrived in Dallas on September 20 from Liberia and is now in isolation at the Texas Health Presbyterian Hospital. It is unclear how the patient became infected with the virus, but it is known that like all air passengers travelling to and from Liberia, he was screened for Ebola prior to his departure on September 19.
How was this missed?: The forty-two year old Liberian national began to feel ill on September 24 and sought medical care on September 26, but was only admitted to hospital and placed under isolation in intensive care some two days later.
City of Dallas spokeswoman, Sana Syed, said the ambulance that transported Duncan on September 28 was used for the next two days before he was diagnosed with Ebola. Syed emphasized that the ambulance was decontaminated according to national standards by paramedics after transporting Duncan – a procedure that is always followed. As a result, patients who were transported in the ambulance after Duncan were not at risk of contracting the virus. The paramedics who attended to him, however, have since been isolated but have not shown any symptoms of Ebola thus far.
While passengers travelling by air are screened numerous times for Ebola before leaving Liberia, Guinea and Sierra Leone, there is no guarantee that an infected person will be identified since symptoms can take between 2 to 21 days to occur after a person is infected with the virus.
Screening is done by checking passengers’ temperatures at the airport, but CNN’s Senior Medical Correspondent, Elizabeth Cohen, reported that there are unclear stipulations on the screening process upon arrival in the United States from West Africa.
CDC spokesman, Jason McDonald, said that guidelines for assessing patients with possible Ebola symptoms include inquiries into travel histories to West Africa, as well as contact with people who have been exposed to the virus.
Worryingly, Dr. Mark Lester, Executive Vice President of Texas Health Resources, said that although Duncan told a nurse on his first visit to the hospital on September 26 that he had recently travelled from Liberia, this information was not ‘fully communicated’ to the medical team.
Contacts traced: The Centres for Disease Control and Prevention (CDC) said that passengers who travelled on the same aircraft as the infected patient are not at risk of having the virus since the patient had no symptoms during the time he was travelling, and therefore was not contagious.
CDC Director Dr. Thomas Frieden, while stressing that Ebola could not be spread from an asymptomatic patient, said that he is confident that the virus will not spread widely in the United States. He however cautioned that America needs to be on its guard as long as the outbreak continues in West Africa.
According to CDC reports, Duncan came in contact with 12 to 18 people while in the United States, including five children who attend four different schools in Texas. Family members and other persons who came into contact with Duncan will be closely monitored for twenty-one days for signs of Ebola symptoms.
Ebola’s burden: Ebola Virus Disease became a medical concern this year when an outbreak occurred in Guinea in March. Since then, approximately 6,574 persons have been infected with the virus and more than 3,000 have died. While there have been outbreaks of the disease since 1976, the current outbreak is the largest both in the number of human cases, and the number of countries simultaneously affected.
In West Africa, the countries with the largest outbreaks have been Liberia, Sierra Leone and Guinea. Nigeria and Senegal have also reported cases of Ebola, and in the Democratic Republic of the Congo, a separate outbreak has occurred.
According to the World Health Organization (WHO), early symptoms of the virus include fever fatigue, muscle pain, headache and sore throat. Symptoms that follow are vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding.
Human transmission of the virus occurs through contact with bodily fluids, specifically blood, semen, urine, saliva, breast milk, sweat and tears. Coming into contact with objects that have infected bodily fluids on them can also result in infection with the virus.
There is no treatment for the virus itself, but supportive care, rehydration and treatment of symptoms increase the chance of survival.
The Caribbean response: At September 18, the Caribbean Public Health Agency (CARPHA) considered the Ebola threat to the Caribbean to be low, but admitted that its risk assessment could change as the situation evolved. Trinidad & Tobago’s Prime Minister, Kamla Persad-Bissessar has called for a regional coordinative approach to addressing the Ebola threat, while Barbados is said to have made considerable headway with establishing an isolation centre and training its border officials on Ebola Virus Disease.
Up to press time, AMG was unable to receive comments from CARPHA concerning yesterday’s developments in the United States.