US - Texas: Mr. Duncan - Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

[hawkeye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Amazingly confident that they can stop "this thing in it's tracks". Even if they successfully stop this round, there will be another - as long as travel remains opened between countries with infections.

 

[mixin]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

"Only a handful of contacts"
he was staying with his relatives
he's critically ill

 

[sharon sanders]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Notes. Please read from bottom up:

FluTrackers.com @FluTrackers · 3m 3 minutes ago
Conference over.

FluTrackers.com @FluTrackers · 3m 3 minutes ago
Frieden: Patient was staying with family members and not in hotel. Says zero risk of transmission during his air flights into #US. #ebola

FluTrackers.com @FluTrackers · 6m 6 minutes ago
Frieden: Describing contact tracing procedure. Mentioned successful Senegal and Lagos #ebola tracing.

FluTrackers.com @FluTrackers · 10m 10 minutes ago
Frieden: People can call CDC for information or log onto website for #ebola info: http://www.cdc.gov/vhf/ebola/

FluTrackers.com @FluTrackers · 11m 11 minutes ago
Frieden: Patient came to US to visit family. Beginning contact tracing today. #ebola

FluTrackers.com @FluTrackers · 13m 13 minutes ago
Frieden: Have no doubt will stop this (#ebola) in its tracks.

FluTrackers.com @FluTrackers · 14m 14 minutes ago
Frieden: "Handful" describes the number of people with direct contact with this patient. #ebola

FluTrackers.com @FluTrackers · 16m 16 minutes ago
Goodman: Patient is in intensive care. #ebola

FluTrackers.com @FluTrackers · 18m 18 minutes ago
Frieden: Any hospital in #US that has isolation unit can isolate for #ebola.

FluTrackers.com @FluTrackers · 20m 20 minutes ago
Frieden: It appears this patient was not involved in #ebola treatment in #Liberia. Not sick until 4 days after flights into #US.

FluTrackers.com @FluTrackers · 23m 23 minutes ago
Frieden: Says #ebola only spreads by direct contact. CDC team of epidemiologists on way to Dallas, Texas for contact tracing etc.

FluTrackers.com @FluTrackers · 24m 24 minutes ago
Goodman: #Ebola is not an "airborne" transmitted disease. Hospital has a plan to deal with #ebola.

FluTrackers.com @FluTrackers · 26m 26 minutes ago
Lakey:Texas lab has a team to test for #ebola in Austin.Got result at 1:22 pm today.Closely monitoring situation.No more cases at this time.

FluTrackers.com @FluTrackers · 29m 29 minutes ago
Frieden: Says #ebola will not spread widely in the #US. There might be close contacts of this person who might test positive.

FluTrackers.com @FluTrackers · 29m 29 minutes ago
Frieden: Treating patient and doing contract tracing. Says only symptomatic persons can transmit #ebola

FluTrackers.com @FluTrackers · 31m 31 minutes ago
Frieden: Giving recap of #ebola stats. Traveler from #Liberia has tested + for ebola in Dallas, Texas.

 

[sharon sanders]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

hat tip Crof for link

First Imported Case of Ebola Diagnosed in the United States

CDC confirmed on September 30, 2014, through laboratory tests, the first case of Ebola to be diagnosed in the United States in a person who had traveled to Dallas, Texas from West Africa. The patient did not have symptoms when leaving West Africa, but developed symptoms approximately five days after arriving in the United States.

The person sought medical care at Texas Health Presbyterian Hospital of Dallas after developing symptoms consistent with Ebola. Based on the person’s travel history and symptoms, CDC recommended testing for Ebola. The medical facility isolated the patient and sent specimens for testing at CDC and at a Texas lab participating in CDC’s Laboratory Response Network. CDC and the Texas Health Department reported the laboratory test results to the medical center to inform the patient. Local public health officials have begun identifying close contacts of the person for further daily monitoring for 21 days after exposure.

The ill person did not exhibit symptoms of Ebola during the flights from West Africa and CDC does not recommend that people on the same commercial airline flights undergo monitoring, as Ebola is only contagious if the person is experiencing active symptoms. The person reported developing symptoms several days after the return flight.

CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond. CDC and public health officials in Texas are taking precautions to identify people who have had close personal contact with the ill person and health care professionals have been reminded to use meticulous infection control at all times.

We know how to stop Ebola’s further spread: thorough case finding, isolation of ill people, contacting people exposed to the ill person, and further isolation of contacts if they develop symptoms. The U.S. public health and medical systems have had prior experience with sporadic cases of diseases such as Ebola. In the past decade, the United States had 5 imported cases of Viral Hemorrhagic Fever (VHF) diseases similar to Ebola (1 Marburg, 4 Lassa). None resulted in any transmission in the United States.

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html

 

[Sharky]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Here's the timeline from Frieden's statement at the press conference:

19 Sep -- Left Liberia, no symptoms
20 Sep -- Arrived US, no symptoms
24 Sep -- Began to develop symptoms
26 Sep -- Initially sought care
28 Sep -- Admitted to hospital and placed in isolation
30 Sep -- CDC & Texas lab received blood samples; PCR tested positive for Ebola Zaire

 

[hawkeye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Here's the timeline from Frieden's statement at the press conference:

19 Sep -- Left Liberia, no symptoms
20 Sep -- Arrived US, no symptoms
24 Sep -- Began to develop symptoms
26 Sep -- Initially sought care
28 Sep -- Admitted to hospital and placed in isolation
30 Sep -- CDC & Texas lab received blood samples; PCR tested positive for Ebola Zaire

Thank you.
I'd like to call out that the 24th -- this is when the individual essentially 'noticed' something was wrong. I think to be absolutely certain (at least as much as possible) - the contact tracing should go all the way back to the 19th.

Doesn't Ebola need at least 9 days in the blood stream before it can truly be detected (positively).

 

[Sharky]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Thank you.
I'd like to call out that the 24th -- this is when the individual essentially 'noticed' something was wrong. I think to be absolutely certain (at least as much as possible) - the contact tracing should go all the way back to the 19th.

Agree. In fact, it would be helpful to understand the nature of his exposure in Liberia, as well.

One thing I haven't heard much talk about yet is regarding both sets of HCWs he approached -- on the 26th, and again on the 28th. There is certainly risk of exposure both for the HCWs themselves, and possibly secondary contacts in those healthcare facilities.

With 4 full days of being symptomatic outside of quarantine, the list of primary and secondary contacts could be significant -- if they can even be found at this stage. Tracing back to the 19th just compounds the problem.

Doesn't Ebola need at least 9 days in the blood stream before it can truly be detected (positively).

The exact duration between exposure and detectability would depend on the initial level of exposure and other factors. Some people apparently develop symptoms (and are therefore shedding virus) in as little as 3 days.

 

[JimO]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

There are two exposure events with respect to HCWs. He sought care on the 26th, which means he had to be pretty sick by then, and then he went back on the 28th in a condition that was probably highly contagious. So, there are contacts to trace from both hospital visits and any contacts he had between the visits. There has to be more than a "handful" of contacts to trace unless the same people were working in the ER on both the 26th and 28th.

What will be telling is how the secondary cases are reported and monitored.

 

[Laidback Al]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

According to my internet search there is no direct commercial flight from Monrovia to Dallas. There were at least two intermediate stops.

 

[AnnaLisa]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Chicago is one hub. Then Chicago to Dallas....or Mexico another hub that gets you to Dallas.

 

[Graupel]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

All of the discussion about transmission assumes no viral shedding before febrile illness, but there is almost certainly wide individual variation.

 

[alforddm]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

You can also fly from Boston to Dallas as my hubby did it recently. Of course of you make several connections you can go anywhere.

 

[Ray]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Why not reduce airline travel from affected countries? Study below.

Vespignani et al. model (updated 9/22) simulates international spread of outbreak and provide estimate for probability of Ebola virus disease case importation in countries across the world.

http://currents.plos.org/outbreaks/...ed-with-the-2014-west-african-ebola-outbreak/

"We have explored the scenario assuming an 80% airline traffic flow reduction to and from the West African region that provided evidence of a general time-delay of the distribution characterizing the probability of case importation of about three to four weeks. This is a quite well known result backed by theoretical arguments, numerical and data evidence 15,16,17,18,19. Although this delay may be useful, it would not help much unless interventions on the ground could be put into place in the interval that were effective in stopping the growth of the EVD outbreak 20. In addition,travel restrictions may hamper the deployment of personnel and support in the region, ultimately creating a counter productive effect in the containment effort.

 

[MHSC]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

At the risk of being lynched I would take with a pinch of salt the testomy of the patient that he was asymptomatic on flight.

Think about this. If someone had known they had been in contact with an Ebola case in West Africa and they had the opportunity to get out to relatives in US, there may be a temptation to run, either presymptomatic or at start of feeling ill. They may put their own health above others safety.

Now you are ill ,surrounded by CDC officials asking when symptoms started......are you going to own up that you ran because you were sick....risk becoming a hate figure.....risk your family knowing the reason you came to visit was because you had been in contact with someone who had Ebola. The temptation would be there to lie. I am not saying this patient is, but there is a motive if they did. It is well documented in Liberia and Sierra Leone that patients often walked into routine hospitals and lied about their symptoms, hoping to get treatment there instead of going to Ebola holding centres. Many HCW got infected this way, as they didn't suspect Ebola based on the symptoms the patient was relaying, and only after admission did they begin to suspect the patient hadn' t been telling the whole truth.


One way to check is see when flight was booked, was it a long planned journey to see relatives, flights booked over 3 weeks ago etc. However if it was recent or last minute booking, then I would er on side of contact and trace passengers that used toilet, and in seats close by. By just taking word of patient they may leave a possible contamination train to speed away.

Anyway who am I to tell CDC how to do their job.

One thing for sure.....THEY CANT GET THIS WRONG.

Fp

Agreed, as I was speculating, what citizenship is he? If he originated in another country and was passing through Liberia then we know it was accidental. If not then there are questions.

It is my understanding that most often symptoms appear 4 days after exposure and about day 7-8 things take a turn for the worse. Following this timeline, an accidental exposure fits, a planned trip to obtain care does not unless he is one of the few that has a long incubation period.

19 - exposure
23 - Day 1 of disease? First symptoms (4 days since exposure)
26 - sought care & sent home
28 - admitted to ER
29 - Day 7, symptoms intensify
30 - CDC says critical

 

[Graupel]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

It was assumed EBV couldn't possibly leave rural areas. Wrong.
It was assumed someone with EBV wouldn't be able to fly. Wrong.
It was assumed EBV couldn't move to big cities. Wrong.
It was assumed no-one could possibly fly trans-continently. Wrong.
It was assumed hi-alert status would catch any cases in the US quickly. Wrong.

All of that said, the control in Senegal and Nigeria highlight what's possible if there are only a few cases.

 

[hawkeye]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

It was assumed EBV couldn't possibly leave rural areas. Wrong.
It was assumed someone with EBV wouldn't be able to fly. Wrong.
It was assumed EBV couldn't move to big cities. Wrong.
It was assumed no-one could possibly fly trans-continently. Wrong.
It was assumed hi-alert status would catch any cases in the US quickly. Wrong.

All of that said, the control in Senegal and Nigeria highlight what's possible if there are only a few cases.

I agree with your post but hate what it potentially means.

 

[Pathfinder]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Government Confirms First Case of Ebola in US

DALLAS ? Sep 30, 2014, 7:18 PM ET

By DAVID WARREN and LAURAN NEERGAARD Associated Press
...
"The bottom line here is that I have no doubt we will control this importation, or this case of Ebola, so that it does not spread widely in this country," Frieden told a news conference.

"It is certainly possible that someone who had contact with this individual, a family member or other individual, could develop Ebola in the coming weeks," he added. "But there is no doubt in my mind that we will stop it here."
...
Frieden said he believed the case also marked the first time this strain of Ebola has been diagnosed outside of West Africa.
...
After arriving in the U.S. on Sept. 20, the patient began to develop symptoms on Sept. 24 and initially sought care two days later, Frieden said. The patient was admitted to the hospital on Sept. 28, when Texas Health Presbyterian put him under strict isolation. Blood tests by Texas health officials and the CDC separately confirmed an Ebola diagnosis on Tuesday.

Frieden would not reveal the patient's nationality.

Asked how many people the patient may have had close contact with in that time period, Frieden said, "I think a handful is the right characterization."
...
http://abcnews.go.com/US/wireStory/officials-confirm-ebola-case-diagnosed-us-25874421

 

[Graupel]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Asked how many people the patient may have had close contact with in that time period, Frieden said, "I think a handful is the right characterization."

How many people came through the ER over the course of 10+ days? All of whom may be slightly at risk, and all of whom will be demanding testing immediately. Ugh. It's going to get seriously ugly for the testing labs.

 

[MHSC]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Graphic on the usual course of the illness

http://www.africanman.co.za/wp-content/uploads/2014/08/EbolaSymptoms3.png

 

[Pathfinder]

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Re: US - Texas: Patient tests positive for Ebola in Dallas - travel history to Liberia

Dallas Mayor: EMS Crew And Ambulance Used In Ebola Case Isolated

September 30, 2014 7:13 PM

DALLAS, TX (CBSDFW.COM) - Dallas Mayor Mike Rawlings confirmed an EMS crew and ambulance that was used to transport a patient now confirmed to have the Ebola virus in Dallas has been isolated. ?We have quarantined both them and the unit itself to make sure that nothing was there that can be spread and we?re going about our protocol about how to do that,? said the mayor. ?We?ve created an emergency center at Dallas City Hall that are going through those procedures right now. So we?re taking all precautions to make sure everybody?s safe. ?

The Mayor expressed his concerns for all involved as well. ?First and foremost we have got to have our thoughts and prayers for this man who is very sick; who hopefully will get well? but we?re going to make sure everybody else is safe at the same time.

Dallas Fire and Rescue Officials say the ambulance has been ?decontaminated.?
...
http://abcnews.go.com/US/wireStory/officials-confirm-ebola-case-diagnosed-us-25874421