Hospital 'dropped the ball' with Ebola patient's travel history, NIH official says醫院“丟球”埃博拉患者的旅行史,美國國立衛生研究院相關負責人表示

By Catherine E. Shoichet, Ashley Fantz and Holly Yan, CNN
October 2, 2014 -- Updated 0057 GMT (0857 HKT)
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STORY HIGHLIGHTS
  • NEW: U.S. official to CNN: The situation is a "screw-up"
  • Dallas mayor: The patient came into contact with up to 20 people
  • Hospital says symptoms 'did not warrant admission' last week
  • NIH official on hospital: "They dropped the ball"
 

(CNN) -- The first person to be diagnosed with Ebola on American soil went to the emergency room last week, but was released from the hospital even though he told staff he had traveled from Liberia.

"A travel history was taken, but it wasn't communicated to the people who were making the decision. ... It was a mistake. They dropped the ball," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"You don't want to pile on them, but hopefully this will never happen again. ... The CDC has been vigorously emphasizing the need for a travel history," Fauci told CNN's "The Lead with Jake Tapper."

 
Dallas residents respond to Ebola threat

Hospital officials have acknowledged that the patient's travel history wasn't "fully communicated" to doctors, but also said in a statement Wednesday that based on his symptoms, there was no reason to admit him when he first came to the emergency room last Thursday night.

 
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"At that time, the patient presented with low-grade fever and abdominal pain. His condition did not warrant admission. He also was not exhibiting symptoms specific to Ebola," Texas Health Presbyterian Hospital Dallas said.

The patient, identified by his half-brother as Thomas Eric Duncan, told hospital staff that he was from Liberia, a friend who knows him well said.

A nurse asked the patient about his recent travels while he was in the emergency room, and the patient said he had been in Africa, said Dr. Mark Lester, executive vice president of Texas Health Resources. But that information was not "fully communicated" to the medical team, Lester said.

The man underwent basic blood tests, but not an Ebola screening, and was sent home with antibiotics, said Dr. Edward Goodman with Texas Health Presbyterian Hospital.

Three days later, the man returned to the facility, where it was determined that he probably had Ebola. He was then isolated.

"The hospital followed all suggested CDC protocols at that time. Texas Health Presbyterian Hospital Dallas' staff is thoroughly trained in infection control procedures and protocols," the hospital said Wednesday.

The Centers for Disease Control and Prevention, which has helped lead the international response to Ebola, advises that all medical facilities should ask patients with symptoms consistent with Ebola for their travel history.

Duncan's travel history "was not acted upon in an appropriate way," said Dr. Sanjay Gupta, CNN's Chief Medical Correspondent.

"A nurse did ask the question and he did respond that he was in Liberia and that wasn't transmitted to people who were in charge of his care," Gupta said. "There's no excuse for this."

A U.S. official told CNN senior medical correspondent Elizabeth Cohen that the situation was clearly "a screw-up." A patient who shows up to a hospital with a fever and a history of travel to Liberia should be treated as an infection risk, the official said.

Asked repeatedly by Gupta whether the patient should have been tested for Ebola during his first visit to the hospital, CDC Director Dr. Thomas Frieden said officials were still looking at details about how the case was handled.

"We know that in busy emergency departments all over the country, people may not ask travel histories. I don't know if that was done here," Frieden said. "But we need to make sure that it is done going forward."

Friend: I called the CDC with concerns

Duncan is a 42-year-old Liberian national, according to his friend. This is Duncan's first trip to the United States, where he was visiting family and friends.

The close associate, who does not want to be identified because of the sensitivity of the case, contacted the CDC with concerns that the hospital wasn't moving quickly enough after Duncan's second hospital visit.

 
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Photos: Ebola outbreak in West AfricaPhotos: Ebola outbreak in West Africa

The associate said Duncan is "all right" now, but is in pain and hasn't eaten in a week.

The patient is now under intensive care and isolated, Frieden said.

He is in serious condition, the hospital told CNN. Neither the hospital nor government officials have identified Duncan by name.

Obama administration recirculates guidelines

It's unknown whether others were infected after Duncan's first visit to the hospital. People who have Ebola are contagious -- but only through contact with infected bodily fluids -- when they display active symptoms of the virus, such as a high fever, severe headache, diarrhea and vomiting, among others. It's not like a cold or the flu, which can be spread before symptoms show up, and it doesn't spread through the air.

Liberia is one of the hotspots in a large outbreak of Ebola in West Africa, with 3,458 cases and 1,830 deaths as of September 23, according to the World Health Organization. Other countries affected include Guinea, Nigeria and Sierra Leone. In total, more than 3,000 people have died in those countries from Ebola, and more than 6,500 have contracted the disease.

This summer, two American missionaries who were working in Liberia contracted the virus and were brought back to the United States, where they were treated with the experimental drug ZMapp. Another American doctor working with the same charity was also infected in Liberia and brought home for treatment. They all have since recovered from the virus and were released from care.

The CDC has ramped up a national effort to stem the spread of Ebola, and in September President Barack Obama spoke at CDC headquarters in Atlanta. He called the virus a global health and security threat, and pledged U.S. assistance to the affected countries to try to stem the tide of the disease.

After the Dallas diagnosis, the Obama administration is recirculating its guidance about how to respond to the virus, White House spokesman Josh Earnest told reporters.

"In light of this incident," Earnest said, "the administration has taken the step of recirculating our guidance to law enforcement agencies that are responsible for securing the border, to those agencies that represent individuals who staff the airline industry and to medical professionals all across the country, to make sure people are aware there is an important protocol that should be implemented if an individual presents with symptoms that are consistent with Ebola."

Finding the people the man came in contact with

The patient came into contact with up to 20 individuals, Dallas Mayor Mike Rawlings told CNN.

A CDC team is in Dallas helping to find anyone he may have come in contact with, Frieden said.

Once those people are identified, they will be monitored for 21 days -- taking their temperatures twice a day -- in cooperation with local and state health officials, Frieden said.

Some school-age children have been in contact with the Ebola patient, but the students haven't exhibited symptoms of the deadly virus, authorities said.

Five students at four different schools came into contact with the man, Dallas Superintendent Mike Miles said.

The children are being monitored at home, and the schools they attended remain open, he said.

Paramedics who transported the patient to the hospital have been isolated, Rawlings' chief of staff said. They have not shown symptoms of the disease so far, Frieden said.

The ambulance used to carry the patient was still in use for two days after the transport, city of Dallas spokeswoman Sana Syed said.

But she emphasized that the paramedics decontaminated the ambulance, as they do after every transport, according to national standards.

Learn how Ebola spreads

Ebola: 9 things to know about the killer disease

Air travel testing

The Ebola patient told authorities he flew part of his trip on United Airlines, a spokesperson for the airline said, citing information from the CDC. The airline believes the patient flew from Brussels to Washington Dulles and then from Dulles to Dallas-Fort Worth on September 20, the spokesperson said.

"The director of the CDC has stated there is 'zero risk of transmission' on any flight on which the patient flew because he was not symptomatic until several days after his trip and could not have been contagious on the dates he traveled," the spokesperson said.

Every person who travels by air is screened before departure and at arrival in Liberia, Guinea and Sierra Leone, but because the man says he began feeling ill days after landing in the United States, a screening test in West Africa would likely have not turned up that he had Ebola.

However, it's unclear what kind of screening someone flying from West Africa might receive when they land in the United States, Cohen said. The CNN correspondent and her crew recently reported in and flew from West Africa, where she said they were screened numerous times for Ebola by having their temperatures taken at the airport.

Should we worry?

But when they arrived back in the United States, and asked travel officials about whether their temperatures would be taken or whether they'd be screened for Ebola, they were given unclear explanations about how the process worked and ultimately were not tested.

Regardless, the CDC maintains that passengers on planes with the Texas patient were likely not at risk because the man was not displaying active symptoms.

醫院“丟球”埃博拉患者的旅行史,美國國立衛生研究院相關負責人表示
由凱瑟琳·E. Shoichet,阿什利Fantz和冬青燕,美國有線電視新聞網
2014年10月2日 - 更新0057 GMT(0857 HKT)

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新聞提要
新:美國官員向CNN記者:這種情況是一種“螺旋式”
達拉斯市長:患者進入了多達20人的接觸
醫院說的症狀“並不能保證錄取”上週
美國國立衛生研究院的官方醫院:“他們放棄了球”
(CNN) -第一個人被診斷為埃博拉病毒在美國本土去了急診室,上週,但出院,即使他對工作人員說,他從利比里亞旅行。
“一個旅遊史拍攝,但它並沒有傳達給誰是做決定的人......這是一個錯誤,他們放棄了球,”安東尼·福奇博士,國家過敏研究所所長說:傳染病。
“你不想堆在他們身上,但希望這不會再發生。......疾病預防控制中心一直在大力強調需要有旅遊史,”福西告訴CNN的“傑克攻絲帶頭作用。”
達拉斯居民埃博拉病毒的威脅作出反應
醫院官員承認,病人的旅行史並沒有“充分的溝通”,以醫,但也表示在週三的聲明中說根據他的症狀,沒有理由承​​認他,當他第一次來到急診室上週四晚。
致命的病毒襲擊美國年前 追踪埃博拉患者的旅行
“當時,病人出現低燒和腹痛。他的病情並不保證錄取,他也沒有表現出特有的症狀埃博拉,”得克薩斯州衛生長老會醫院達拉斯說。
患者,確定了他的同父異母兄弟為托馬斯埃里克-鄧肯,告訴醫院工作人員說,他是從利比里亞,誰知道他還有一位朋友說。
一名護士問病人他最近的旅行,而他是在急診室,病人說他一直在非洲,稱得克薩斯州衛生資源的執行副總裁馬克博士萊斯特。但這些信息並沒有“充分溝通”的醫療團隊,萊斯特說。
該男子接受了基本的驗血,但不是埃博拉病毒篩查,並被送回家用抗生素,說得克薩斯健康長老會醫院醫生愛德華·古德曼。
三天後,這名男子回到了工廠,在那裡它被確定,他可能有埃博拉病毒。然後,他被隔離。
“醫院遵循所有建議的疾病預防控制中心的協議,在那個時候德州衛生長老會醫院達拉斯小牛隊的工作人員在感染控制程序和協議全面訓練,”醫院說,星期三。
疾病控制中心和預防,這有助於導致埃博拉國際響應,建議所有醫療機構應詢問患者與埃博拉病毒是一致的症狀為他們的旅行史。
鄧肯的旅行史“以適當的方式並沒有採取行動,”桑傑·古普塔博士,CNN首席醫療記者說。
“一個護士都問這個問題,他沒有作出回應,他在利比里亞,而不是傳遞到人誰負責照顧他的,”古普塔說。“沒有藉口了。”
一名美國官員告訴CNN資深醫療記者伊麗莎白·科恩,這種情況顯然是“螺旋上升”。一個病人誰顯示了與發燒的一家醫院,並前往利比里亞的歷史應被視為感染的風險,該負責人表示。
當被問及多次被古普塔病人是否應該被他第一次到醫院在測試的埃博拉病毒,疾病預防控制中心主任醫師托馬斯·弗里登說,官員們仍然希望在有關案件是如何處理的細節。
“我們知道,在繁忙的急診室在全國各地,人們可能不會問旅行史,我不知道這是否是在這裡完成的,”弗里登說。“但我們需要確保它完成前進。”
朋友:我打電話給疾病預防控制中心與擔憂
鄧肯是一個42歲的利比里亞國家,據他的朋友。這是鄧肯的第一次到美國,在那裡他拜訪家人和朋友。
的親密夥伴,誰不希望因為案件的敏感性被識別,接觸疾病預防控制中心與擔憂,該醫院沒有鄧肯的第二醫院就診後,移動速度不夠快。
埃博拉患者錯誤地發布 佩里:埃博拉病毒的患者有過接觸的孩子
組圖:埃博拉疫情在西非 組圖:埃博拉疫情在西非
聯營說鄧肯是“沒事”,現在,卻是在痛苦中,並在一個星期沒吃過。
該患者目前正在重症監護室和隔離,弗里登說。
他是在病情嚴重,醫院告訴CNN。無論是醫院也不是政府官員已經確定了鄧肯的名字。
奧巴馬政府再循環準則
它是未知的人是否感染了鄧肯的第一次到醫院後。誰擁有埃博拉病毒的人是會傳染的 - 但只是通過與被感染的體液接觸 - 當他們顯示病毒活躍的症狀,如高燒,嚴重頭痛,腹瀉和嘔吐等。它不象感冒或流感,它可以傳播之前的症狀出現,並且它不通過空氣傳播。
利比里亞是西非大爆發埃博拉的熱點之一,3458箱子和1,830人死亡的9月23日,根據世界衛生組織。受影響的其他國家包括幾內亞,尼日利亞和塞拉利昂。總體而言,超過3000人死於這些國家的埃博拉病毒,超過6500而感染疾病。
今年夏天,兩名美國傳教士誰在利比里亞工作感染病毒和被帶回美國,在那裡他們與治療實驗性藥物ZMapp。另一位美國醫生用同樣的慈善工作也被感染了在利比里亞和治療帶回家。它們都具有自恢復從病毒和照顧被釋放。
CDC已經憋足了國家的努力來阻止埃博拉病毒的蔓延,並於9月美國總統奧巴馬在疾病預防控制中心總部設在亞特蘭大的講話。他稱該病毒的全球健康和安全構成威脅,並表示美國援助受災國家,試圖阻止這種疾病的潮流。
達拉斯診斷後,奧巴馬政府正循環的關於如何對病毒作出反應的指導,白宮發言人喬希認真告訴記者。
“鑑於這一事件,”語重心長地說,“政府已經採取循環我們的指導,執法機構,負責確保邊界的步驟,那些代表個人誰的工作人員,航空業機構和醫療人員全部在全國范圍內,以確保人們都知道有,如果一個人介紹,症狀與埃博拉一致認為應該實施的一個重要的協議。“
找人的男子走了進來接觸
病人走進多達20個人的接觸,達拉斯市市長邁克·羅林斯告訴CNN。
CDC的球隊是達拉斯幫助找到合適的人,他可能已經走在了接觸,弗里登說。
每天服用它們的溫度的兩倍 - - 一旦這些人被確定,他們將21天監測與當地和國家的衛生官員合作,弗里登說。
一些學齡兒童一直在與埃博拉患者接觸,但學生並沒有表現出這種致命病毒的症狀,當局說。
五名學生在四個不同的學校來與人接觸,達拉斯總監邁克·邁爾斯說。
孩子們正在家中監視,他們就讀的學校照常開放,他說。
醫護人員誰運送病人到醫院被隔離,工作人員羅林斯負責人說。他們還沒有表現出該疾病的症狀,到目前為止,弗里登說。
用於攜帶病人的救護車仍在使用的交通工具兩天後,達拉斯市的發言人薩納賽義德說。
但她強調,醫護人員消毒救護車,因為他們每一個運輸後做的,按照國家標準。
了解埃博拉病毒是如何傳播
埃博拉:9的事情了解的致命疾病
航空旅行測試
埃博拉患者告訴當局,他飛到了他在美國聯合航空公司之旅的一部分,發言人航空公司說,援引來自疾病預防控制中心的信息。該航空公司認為,患者從布魯塞爾飛往華盛頓杜勒斯國際機場,然後從杜勒斯到達拉斯 - 沃斯堡9月20日,該發言人說。
“疾病預防控制中心的負責人曾表示有在其上的病人立馬因為他不對症,直到他的行程後數天,已經不能傳染,他前往的日期,任何飛行”傳播的零風險'“的代言人說。
每個人誰搭乘空中篩選出發前和抵達利比里亞,幾內亞和塞拉利昂,但由於該名男子說,他開始登陸美國後,感覺身體不適天后,在西非的篩選試驗很可能還沒有止跌回升他有埃博拉病毒。
不過,目前還不清楚篩選有人從西非飛行時,他們在美國的土地可能會收到什麼樣的,科恩說。CNN的記者和她的​​工作人員最近報導和來自西非,她說,他們有他們的考慮下在機場被篩選過無數次埃博拉飛去。
我們是否應該擔心呢?
但是,當他們回到了美國,並詢問他們是否氣溫將採取旅遊官員或者他們是否會進行篩選,埃博拉病毒,他們得到關於如何處理工作,最終都沒有測試不清的解釋。
無論如何,疾病預防控制中心認為,在飛機上與德州患者的乘客很可能沒有風險,因為該男子沒有顯示活躍的症狀。

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