CDC Says It Should Have Responded Faster to Dallas Ebola Case

Texas Health Presbyterian Hospital in Dallas, Texas.
Texas Health Presbyterian Hospital in Dallas, Texas. –EPA

DALLAS — The director of the federal Centers for Disease Control and Prevention said on Tuesday that the agency planned a more robust response to any future Ebola cases in U.S. hospitals, saying for the first time that quicker and more concerted action on its part might have kept a Dallas nurse from becoming infected by the virus.

The acknowledgment came on a day when a nurses’ union released a scathing statement that it said was composed by nurses at the Dallas hospital where the nurse, Nina Pham, 26, contracted Ebola. The statement told of “confusion and frequently changing policies and protocols,’’ inadequate protection against contamination and spotty training.

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“Were the protocols breached?’’ asked Deborah Burger, a co-president of the union, National Nurses United, reading the statement. “The nurses say there were no protocols.’’

Officials at the hospital, Texas Health Presbyterian Hospital, defended their efforts to “provide a safe working environment,’’ but said they would review any concerns raised by nurses.

CDC officials, responding earlier to the broader criticisms about their handling of the Ebola cases in Dallas, pledged to dispatch within hours a newly created response team to any hospital that had a confirmed case of Ebola, and they increased the amount of expertise, oversight and training at the hospital where the nurse treating Thomas Eric Duncan, 42, who had Ebola, became infected.

They have sent some of the world’s leading experts on Ebola to Dallas, as well as two nurses from Emory University Hospital in Atlanta who cared for Ebola patients safely and who will train hospital staff members on infection control and the use of protective gear.

“I wish we had put a team like this on the ground the day the patient, the first patient, was diagnosed,’’ Dr. Thomas R. Frieden, director of the CDC, said at a news conference Tuesday. “That might have prevented this infection. But we will do that from today onward with any case, anywhere in the U.S.’’

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He added, “We could have sent a more robust hospital infection-control team and been more hands-on with the hospital from Day One.’’

Officials said they were now monitoring daily 76 health care workers at Texas Health Presbyterian Hospital in Dallas who treated or cleaned up after Duncan or might have handled blood specimens from the time he was admitted to the hospital on Sept. 28 to his death last Wednesday. “There were 76 people who had some level of contact and therefore are being actively monitored,’’ Frieden said.

An additional 48 people were already being watched because they had possible contact with Duncan before he was hospitalized. One contact of Pham was also being monitored. The total under observation is now 125.

Duncan, a Liberian who arrived in the U.S. last month, was initially sent home from the hospital although he had a fever and reported coming from Africa. His case was diagnosed on Sept. 30, two days after he was admitted and put in isolation at the hospital. At some point while he was in isolation, the critical-care nurse, Pham, contracted Ebola after having extensive interactions with him. The hospital said she was in “good condition,’’ and for the first time on Tuesday, Pham made a public statement, as the hospital where she works and that is now treating her said the costs of her care would be covered and would not be a financial burden on her or her family.

“I’m doing well and want to thank everyone for their kind wishes and prayers,’’ she said.

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At the same time, Frieden said that the 48 people whom officials started monitoring two weeks ago had passed a critical period and were now unlikely to contract the disease. They were more than 14 days into the 21-day maximum incubation period. One of them is Duncan’s fiancée, Louise Troh, 54, who has been under state-ordered quarantine with her 13-year-old son and two other young men. “Right now, we’re OK,’’ she said in a phone interview from the house where she and the others have been staying, in an undisclosed location. “I’m healthy. Everybody’s fine. God is in control.’’

The Rev. George Mason, Troh’s pastor at Wilshire Baptist Church, drove late Tuesday afternoon to pick up an application for a new apartment for Troh. He said she would be starting over with almost nothing — the apartment where she had been living and Duncan had been staying was shut by officials and decontaminated, and much of what was inside, including carpet and bedding, was incinerated.

“She lost everything,’’ Mason said. “It’s like she had a fire.’’

Officials with the nurses’ union that issued the statement Tuesday night said it had been prepared by Presbyterian nurses who had knowledge of the care provided to Duncan and to Pham. They refused to identify the nurses or their departments, saying the Presbyterian nurses feared retaliation, and they refused to say whether any of the nurses who prepared the statement had been involved in treating Duncan.

The statement asserted that when Duncan arrived by ambulance with Ebola symptoms at the hospital’s emergency room on Sept. 28, he “was left for several hours, not in isolation, in an area where other patients were present.’’ At some point, it said, a nurse supervisor demanded that he be moved to an isolation unit “but faced resistance from other hospital authorities.’’

The nurses who first interacted with Duncan wore generic gowns, three pairs of gloves with no taping around the wrists, and surgical masks with the option of a shield, the statement said. “The gowns they were given still exposed their necks, the part closest to their face and mouth,’’ the nurses said. “They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical booties nor were they advised the number of pairs of gloves to wear.’’

The statement said hospital officials allowed nurses who interacted with Duncan at a time when he was vomiting and had diarrhea to continue their normal duties, “taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan that was later recommended by the C.D.C.’’

Told of the statement, a spokeswoman for the CDC said the agency would not be looking at the situation from a regulatory perspective. “That oversight comes from the health department at the state level,’’ the spokeswoman said.

Frieden said the agency’s Ebola response teams would be deployed anywhere in the country starting on Tuesday. “We will put a team on the ground within hours, with some of the world’s leading experts in how to take care of and protect health care workers from Ebola infection,’’ he said, adding it would include specialists in other fields.

It was unclear what, if any, monitoring the CDC performed of the precautions hospital workers took as they went in and out of Duncan’s room. Officials said Pham had worn a gown, mask and other protective gear when she came into contact with Duncan, but they said she appeared to have breached safety protocol, possibly when removing the protections. The Texas health commissioner, David L. Lakey, said she was working with investigators to try to pinpoint when she may have been exposed.

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