First case: Thomas Eric Duncan Ebola virus cases in the United States

1 first case: thomas eric duncan

1.1 thomas eric duncan in liberia
1.2 duncan s illness in dallas
1.3 contact tracing
1.4 reactions

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.