'Breach in protocol' caused second U.S. Ebola infection

DALLAS — A health care worker who cared for the Ebola patient who died last week tested positive for the deadly virus, sending health officials scrambling Sunday to find the "breach in protocol" that resulted in her infection.

The woman was among caregivers for Thomas Eric Duncan, who died Wednesday at Texas Health Presbyterian Hospital. A state test finding that she had Ebola was confirmed Sunday by the Centers for Disease Control and Prevention, making it the first known case transmitted in the U.S.

CDC chief Thomas Frieden said his agency will investigate how a worker in full protective gear contracted the virus.

"At some point there was a breach in protocol," Frieden said. "That breach in protocol resulted in this infection."

The White House said President Obama discussed the news with Health and Human Services Secretary Sylvia Burwell, directing that the CDC "investigation into the apparent breach in infection-control protocols at the Dallas hospital move as expeditiously as possible."

Dallas Police officers stood sentry outside the two-story beige-brick apartment building Sunday in the leafy East Dallas neighborhood where the patient lived. Across the street, a scrum of news media lined up along the curb. A few neighbors wandered over to survey the scene.

Lynda Edwards, who lives down the street, said she became alarmed when helicopters began hovering overhead around 7 a.m. and news crews began arriving.

"It's scary," she said, adding that televised news conferences from the CDC haven't eased her fears.

"It doesn't sound like we have a plan," Edwards said. "The public needs to know what the plan is."

The phone call from the CDC of the Ebola confirmation reached Dallas Mayor Mike Rawlings around midnight Saturday, triggering a new round of decontamination and new steps to reassure residents.

"I was disappointed but not surprised," Rawlings told USA TODAY. "The odds were we would have another one."

For the next seven hours, members of the Dallas Fire-Rescue Department descended on the apartment building where the infected medical worker lived and decontaminated everything outside and in the common areas of the building, including the laundry room, entrance way, elevator and hallways, he said. They did not enter the worker's apartment.

As workers in hazmat suits scrubbed nearby, Rawlings personally walked through the neighborhood, talking to residents. As a precaution, the workers were ordered to do a second cleaning of all common areas.

"We knew the patient was being taken care of at the hospital," Rawlings said. "We focused on the safety of the city."

City and county officials, who are heading the response effort, will be increasing the number of people monitored by CDC staffers in Dallas, Rawlings said. At least 19 hospital staffers who dealt with Duncan during his two hospital visits were monitoring themselves for signs of Ebola. Now that group will be closely monitored by the CDC team, which includes taking their temperature twice a day, daily visits by CDC staff and restrictions on their movement, he said.

"This shows the system's working," Rawlings said. "That's what's making me feel most comfortable."

Rawlings said the patient's dog, still inside the apartment, will soon be sent to a new location to await a reunion with its owner. There were no plans to euthanize the dog as Spanish officials did in a case last week, he said.

The Ebola epidemic has killed more than 4,000 people in West Africa, the vast majority of them in Liberia, Guinea and Sierra Leone. In the U.S., tougher scrutiny for Ebola began Saturday at New York's Kennedy Airport, where federal Homeland Security officials began screening travelers from those nations, taking their temperature and observing them for other Ebola symptoms.

The program will be added at four more U.S. airports in coming days. Rep. Michael McCaul, R-Texas, said more action might be needed.

"There's a lot of talk about banning flights," McCaul said on CBS' Face the Nation. "I think we need to ... look at the idea of potentially temporarily suspending the 13,000 visas that would be coming out of this region."

Sen. John McCain, R-Ariz., speaking on CNN's State of the Union, said the U.S. needs "some kind of czar" to take charge of the Ebola response. "Americans have to be reassured," he said.

The Dallas caregiver reported having a fever Friday night and was hospitalized, isolated and referred for testing within 90 minutes, Clay Jenkins, Dallas County's chief executive and its Homeland Security director, said at a news conference.

"While this is obviously bad news, it is not news that should bring about panic," Jenkins said. "We knew it was a possibility that a second person would contract the virus. We had a contingency plan in place."

The woman, who requested anonymity, was listed in stable condition, Jenkins said.

Frieden cited four steps being taken by the CDC: ensuring the woman is cared for safely, identifying her contacts, treating all health care workers who cared for Duncan as having potentially been exposed, and reviewing procedures used to protect health care workers who treat Ebola patients.

Frieden called the positive test "very concerning" but stressed that the protocols for the care of Ebola patients are safe if done properly. He said that removing the protective gear incorrectly, for example, raises risk.

The news hit the region's health care community hard, said Steve Love, president and chief executive of the Dallas-Fort Worth Hospital Council. The area's 85 hospitals have been training constantly for an Ebola case and holding conference calls to discuss such things as what to do if a child with Ebola shows up at an emergency room, he said.

"We were hoping and praying there would not be any additional Ebola cases," Love said. "But it is not surprising that this happened."

Dan Varga, chief clinical officer for the hospital group that includes Texas Health Presbyterian, confirmed that the woman had worn full protective gear when working with Duncan. He said the woman was not one of the 48 health care workers who were being most closely watched and that the number of workers being monitored could be expanded.

Duncan initially sought treatment Sept. 25 and was sent home with antibiotics, despite informing health workers he had recently been to West Africa. He returned three days later in an ambulance and was diagnosed with the deadly infection.

Duncan was the first person diagnosed with Ebola in the U.S.

Ebola is spread through direct contact with bodily fluids of a sick person or exposure to contaminated objects such as needles. People are not contagious before symptoms such as fever develop. The health care worker who tested positive, along with the others who dealt with Duncan, was self-monitoring — watching for symptoms consistent with early signs of Ebola, Varga said. The monitoring guidelines include taking a temperature twice a day.

"That health care worker is a heroic person," Jenkins said. "Let's remember as we do our work that this is a real person who is going through a great ordeal, and so is that person's family."

Last week, the hospital defended the quality of care it provided Duncan, saying treatment was not affected by the man's nationality or lack of health insurance.

"Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care,'' said Wendell Watson, the hospital's director of public relations, in a statement.

Bacon reported from McLean, Va. Contributing: William M. Welch in Los Angeles