Cases diagnosed in U.S. Ebola virus cases in the United States

1 cases diagnosed in u.s.

1.1 first case: thomas eric duncan

1.1.1 thomas eric duncan in liberia
1.1.2 duncan s illness in dallas
1.1.3 contact tracing
1.1.4 reactions


1.2 second case: nina pham

1.2.1 controversies , lawsuit


1.3 third case: amber vinson

1.3.1 monitoring of other health care workers


1.4 fourth case: craig spencer

cases diagnosed in u.s.

first case: thomas eric duncan

thomas eric duncan in liberia

thomas eric duncan monrovia, liberia, date country hit hardest ebola virus epidemic. duncan worked personal driver general manager of safeway cargo, fedex contractor in liberia. according manager henry brunson, duncan had abruptly quit job on september 4, 2014, giving no reason.

on september 15, 2014, family of marthalene williams, later died of ebola virus disease, not call ambulance transfer pregnant williams hospital. duncan, tenant, helped transfer williams taxi ebola treatment ward in monrovia. duncan rode in taxi treatment ward williams, father , brother.

on september 19, duncan went monrovia airport, where, according liberian officials, duncan lied history of contact disease on airport questionnaire before boarding brussels airlines flight brussels. in brussels, duncan boarded united airlines flight 951 washington dulles airport. dulles, boarded united airlines flight 822 dallas/fort worth. arrived in dallas @ 7:01 p.m. cdt on september 20, 2014, , stayed partner , 5 children, lived in fair oaks neighborhood of dallas. vickery meadow, region of dallas duncan resided, has large african immigrant population , dallas s densest neighborhood.

duncan s illness in dallas

texas presbyterian hospital, duncan treated

duncan began experiencing symptoms on september 24, 2014, , arrived @ texas health presbyterian hospital emergency room @ 10:37 p.m. on september 25. @ 11:36 p.m., triage nurse asked duncan symptoms, , duncan reported feeling abdominal pain, dizziness, nausea , headache (new onset). nurse recorded fever of 100.1 °f (37.8 °c), did not inquire travel history not triage protocol @ time. @ 12:05 a.m., duncan admitted treatment area room on-duty physician accessed electronic health record (ehr). physician noted nasal congestion, runny nose, , abdominal tenderness. duncan given paracetamol (acetaminophen) @ 1:24 a.m. ct scan results came noting no acute disease abdominal , pelvic areas , unremarkable head. lab results returned showing low white blood cells, low platelets, increased creatinine, , elevated levels of liver enzyme ast. temperature noted @ 103.0 °f (39.4 °c) @ 3:02 a.m. , 101.2 °f (38.4 °c) @ 3:32 a.m. duncan diagnosed sinusitis , abdominal pain , sent home @ 3:37 a.m. prescription antibiotics, not effective treating viral diseases.

duncan s condition worsened, , transported on september 28 same texas health presbyterian hospital emergency room ambulance. duncan arrived in emergency room @ 10:07 a.m., experiencing diarrhea, abdominal pain, , fever. within fifteen minutes, doctor noted duncan had come liberia , needed tested ebola. doctor described following strict c.d.c. protocol including wearing mask, gown, , gloves. @ 12:58 p.m., doctor called cdc directly. 9:40 p.m., duncan experiencing explosive diarrhea , projectile vomiting. @ 8:28 a.m. next morning, doctor noted duncan appeared deteriorating. 11:32 a.m., duncan suffering fatigue severe enough prevent him using bedside toilet. later day, duncan transferred intensive care unit (icu) after other patients had been evacuated. next day, september 30, duncan diagnosed ebola virus disease after positive test result.

duncan s diagnosis publicly confirmed during cdc news conference same day. evening, duncan reported feeling better , requested watch movie. following morning, duncan breathing rapidly , complaining of pain on . afternoon, however, able eat, , doctor noted feeling better. next day, october 3, duncan again reported feeling abdominal pain. evening, hospital contacted chimerix, biotechnology company developing brincidofovir combat disease. next day, duncan s organs failing, , intubated him breathe. in afternoon, hospital began administering brincidofovir. nurses nina pham , amber joy vinson continued care duncan around clock. on october 7, hospital reported duncan s condition improving. however, duncan died @ 7:51 a.m. on october 8, becoming first person die in united states of ebola virus disease , index patient later infections of nurses pham , vinson.

contact tracing

on october 5, cdc announced had lost track of homeless man had been in same ambulance duncan. announced efforts underway find man , place him in comfortable , compassionate monitoring environment. later day, cdc announced man had been found , being monitored.

up 100 people may have had contact had direct contact duncan after showed symptoms. health officials later monitored 50 low- , 10 high-risk contacts, high-risk contacts being duncan s close family members , 3 ambulance workers took him hospital. came contact duncan being monitored daily watch symptoms of virus, until october 20, when health officials removed 43 out of 48 initial contacts of thomas duncan isolation. on november 7, 2014, dallas officially declared ebola free after 177 monitored people cleared 21 day threshold without becoming ill.

reactions

on october 2, liberian authorities said prosecute duncan if returned because before flying had filled out form in had falsely stated had not come contact ebola case. liberian president ellen johnson sirleaf told canadian broadcasting corporation angry duncan had done, given how united states doing tackle crisis: 1 of our compatriots didn t take due care, , so, s gone there , in way put americans in state of fear, , put them @ risk, , feel saddened , angry him.…the fact knew (he might carrier) , left country unpardonable, quite frankly. before death, duncan brazenly claimed did not know @ time of boarding flight had been exposed ebola; said believed woman helped having miscarriage, contradicts corroborated accounts family members helped transport woman ebola ward.

duncan s family said care duncan received @ best incompetent , @ worst racially motivated . family members threatened legal action against hospital duncan received treatment. in response, texas health presbyterian hospital issued statement, our care team provided mr. duncan same high level of attention , care given patient, regardless of nationality or ability pay care. have long history of treating multicultural community in area. hospital spent estimated $500,000 on duncan s treatment. had no health insurance.

officials @ texas presbyterian hospital have said hospital has become ghost town patients have canceled scheduled surgeries , seeking emergency care have avoided emergency room.

the reaction care , treatment of thomas duncan, , subsequent transmission 2 of nurses on care team, have caused several hospitals question extent obligated treat ebola patients. discussions on curtailing treatment underway @ geisinger health system, operates hospitals in pennsylvania, , intermountain healthcare, runs facilities in utah, according spokesmen. concern surrounds reality understaffed , poorly equipped hospitals performing invasive procedures, renal dialysis , intubation, both of duncan received @ texas presbyterian, put staff @ risk contracting virus. emory university hospital in atlanta used renal dialysis in treating patients @ biocontainment unit, no health care workers became infected. in october 2014 vickery meadow residents stated people discriminating against them because of incident.

second case: nina pham

president obama hugs nina pham @ white house after treatment @ national institutes of health in bethesda, maryland.

on night of october 10, nina pham, 26-year-old nurse had treated duncan @ texas health presbyterian hospital, reported low-grade fever , placed in isolation. on october 11, tested positive ebola virus, becoming first person contract virus in u.s. on october 12, cdc confirmed positive test results. hospital officials said pham had worn recommended protective gear when treating duncan on second visit hospital , had extensive contact him on multiple occasions . pham in stable condition of october 12.

on october 16, pham transferred national institutes of health clinical center in bethesda, maryland. on october 24, nih declared pham free of ebola virus. day pham traveled white house met president obama.

controversies , lawsuit

tom frieden, director of centers disease control , prevention, blamed breach in protocol infection. hospital s chief clinical officer, dr. dan varga, said staff had followed cdc recommendations. bonnie costello of national nurses united said, don t scapegoat , blame when have disease outbreak. have system failure. have correct. frieden later spoke clarify had not found fault hospital or healthcare worker . national nurses united criticized hospital lack of ebola protocols , guidelines changing . briana aguirre, nurse had cared nina pham, criticized hospital in appearance on nbc s today show. aguirre said , others had not received proper training or personal protective equipment, , hospital had not provided consistent protocols handling potential ebola patients second week of crisis. report indicated healthcare workers did not wear hazmat suits until duncan s test results confirmed infection due ebola, 2 days after admission hospital. frieden later said cdc have been more aggressive in management , control of virus @ hospital.

on march 2, 2015 new york times reported pham filed suit against texas health resources, hospital s parent company, accusing of negligence, fraud , invasion of privacy . pham described still suffering numerous physical , psychological problems, listing lack of proper training reason illness.

third case: amber vinson

an aeromedical biological containment system (abcs), same model used transport both nina pham , amber vinson isolation units

on october 14, second nurse @ same hospital, identified 29-year-old amber vinson, reported fever. amber joy vinson among nurses had provided treatment duncan. vinson isolated within 90 minutes of reporting fever. next day, vinson had tested positive ebola virus. on october 13, vinson had flown frontier airlines flight 1143 cleveland dallas, after spending weekend in tallmadge , akron, ohio. vinson had elevated temperature of 99.5 °f (37.5 °c) before boarding 138-passenger jet, according public health officials. vinson had flown cleveland dallas on frontier airlines flight 1142 on october 10. flight crew members flight 1142 put on paid leave 21 days.

during press conference, cdc director tom frieden stated should not have traveled since 1 of health care workers known have had exposure duncan. passengers of both flights asked contact cdc precautionary measure.

it later discovered cdc had, in fact, given vinson permission board commercial flight cleveland. before trip dallas, spoke dallas county health department , called cdc several times report 99.5 °f (37.5 °c) temperature before boarding flight. cdc employee took call checked cdc chart, noted vinson s temperature not true fever – temperature of 100.4 °f (38.0 °c) or higher – cdc deemed high risk , , let board commercial flight. on october 19, vinson s family released statement detailing government-approved travel clearances , announcing had hired washington, dc, attorney, billy martin. precaution, sixteen people in ohio had had contact vinson voluntarily quarantined.

on october 15, vinson transferred emory university hospital in atlanta. 7 days later, vinson declared ebola free emory university hospital.

monitoring of other health care workers

as of october 15, 2014, there 76 texas presbyterian hospital health care workers being monitored because had had level of contact thomas duncan. on october 16, after learning vinson had traveled on plane before ebola diagnosis, texas department of state health services advised health care workers exposed duncan avoid travel , public places until 21 days after last known exposure.

fourth case: craig spencer

on october 23, craig spencer, physician treated ebola patients in west africa, tested positive ebola @ bellevue hospital center after having 100.3 °f (37.9 °c) fever. officials said hospitalized fever, nausea, pain, , fatigue. had flown new york city guinea within previous ten days, , contacted city s department of health , doctors without borders after showing symptoms. spencer traveled guinea treat ebola victims on september 16 , returned on october 16. spencer had been self-monitoring symptoms of disease, , began feel sluggish on october 21, did not show symptoms 2 days. case first diagnosed in new york. city trying find people may have been in contact spencer between october 21–23.

on october 22, day before had symptoms, spencer rode new york city subway, walked on high line park, went bowling alley , restaurant in brooklyn, took uber cab home in manhattan, , took 3-mile (4.8 km) jog in harlem near lived. 3 other people spencer in previous few days quarantined well. spencer s apartment , bowling alley went cleaned hazmat company bio recovery corporation. health officials stated unlikely spencer have transmitted disease through subway poles, hand railings, or via bowling balls.

new york hospitals, health-workers, , officials had conducted weeks of drills , training in preparation craig spencer. upon arrival @ hospital, put in specially designed isolation center treatment. not many details treatment given, except participated in decisions relating medical care. on october 25, new york post reported anonymous source had said nurses @ bellevue had been calling in sick avoid having care spencer. hospital spokesperson denied there sick out. on november 1, condition upgraded stable , , on november 7 hospital announced free of ebola. spencer released hospital on november 11. cheered , applauded medical staff members, , hugged mayor of new york, bill de blasio walked out of hospital. mayor declared: new york city ebola free .

as result of spencer s ebola case, u.s. senator charles schumer (d-ny), has proposed ebola fund in omnibus bill considered in fiscal year 2015. schumer said funds needed compensate new york city, other cities treating ebola patients, in same way federal government covers communities suffer after natural disaster. schumer said craig spencer s care @ bellevue hospital involved around 100 health care workers. in addition, city s health department has established 24-hour-a-day operation involving 500 staffers keep track of approximately 300 persons west africa hot spots arrive in new york every day.