Ebola in the US – Background

Ebola SEM

I’ve been having a number of friends contact me wanting to know both my thoughts about the emerging Ebola epidemic as well as asking questions about it. It finally reached a point where I realized it would be easier to write about it openly and maybe give people my views on this situation, which are strictly that, MY views. It doesn’t mean they are correct and don’t represent those of any organizations with which I’m affiliated. I’ll give a brief overview of the history of the first case in the US and then will likely post separate items as different questions get asked or other notable stories and/or ideas come to mind.

This interest began when a Liberian man was diagnosed with Ebola at Texas Health Presbyterian Hospital in Dallas. I think that was when the public finally understood just how serious a problem has been emerging in West Africa. People have come to realize that air travel no longer makes the Atlantic Ocean that big anymore. The concept of a global village became very real in a number of people’s minds as a result.

Ebola Distribution Map

Ebola Distribution Map

The timeline is pretty interesting and shows some of the gaps in our system:

9/15 The patient tried to bring a friend to a hospital in Liberia for care who had Ebola. They took a cab and he carried her when she was too weak to walk. Obviously that would qualify as very close contact. They tried multiple hospitals but were turned away. They eventually returned home where she eventually died.

9/19 The patient flies from Monrovia, Liberia to Brussels, Belgium. From there he continues the next leg of his trip to Dulles airport in Washington, DC.

9/20 He continues from Washington to Dallas, TX.

9/24 (Wednesday) He becomes symptomatic. This is a crucial piece of information because Ebola does not spread when a person is symptom free. That means that nobody aboard the flights or might have passed him in the various airports has anything to worry about. (At this point, Ebola is only spread through direct contact. This is technically referred to as contact transmission and if you pay attention in hospitals you will see signs that say “Contact Precautions” or “Contact Isolation” in some rooms. It should be noted that this doesn’t indicate an Ebola patient is in the room, there are other conditions that are only spread through direct contact. A common one in hospitals is MRSA).

9/26 (Friday) He has become sick enough to seek medical care at Texas Health Presbyterian Hospital. Somehow there was a breakdown in communication and the vital information that he had just come from Liberia didn’t make it to the right people. This was a major failure in communications given that there had been guidance to hospitals on identifying potential Ebola victims. I would assume that the hospital is conducting a root cause analysis to determine where there gaps were that allowed this breakdown and that there will be some remediation steps taken to prevent those kinds of errors from being made again. It would even be better if they are transparent with their findings so other hospitals can learn from the problem and analyze their systems for any similar gaps.

9/28 (Sunday) Dallas Fire and Rescue brings the patient back to the hospital via ambulance. I once worked in an ambulance with a patient with active tuberculosis that had not been diagnosed and remember the trepidation I had after I found that out. I can’t even imagine what is going through the minds of this crew.

9/30 (Tuesday) The patient tests positive for Ebola. The CDC holds a press conference that afternoon. I’m pretty certain that a number of people in public health and health care roles uttered a collective “Oh S***.”

At this point public health kicks it into full gear and starts its investigation, a core component of which is called contact tracing. This is trying to identify everyone that might have had contact with the patient. The disease has an incubation period of 2-21 days, which is the time it can take from being exposed to developing symptoms. It should be noted here again that until someone is symptomatic, they will not spread the disease to others. Currently there about 100 contacts identified.

That’s the basic story. Watch for subsequent posts for additional thoughts and analysis.

Leave a Reply