The first patient ever diagnosed with Ebola in the United States died today in an isolation unit in Texas — raising questions about the quality of care he received and the initial missteps leading up to his diagnosis.
The patient, a Liberian named Thomas Eric Duncan, was visiting his girlfriend, their son, and other family in the United States. He left Monrovia on September 19 and arrived in Dallas on September 20. He had no symptoms when he departed Liberia or entered the US.
Four days later Duncan started to feel ill, and soon after, sought care at Texas Health Presbyterian Hospital. Ebola was not initially suspected. Instead, Duncan was diagnosed with a "low grade, common viral infection" and sent home with an antibiotic.
On this first hospital visit, Duncan's sister said a nurse was informed that Duncan had come from Liberia. This should have raised flags about his disease. But this vital information "was not fully communicated throughout the full team," said Mark C. Lester, executive vice president of the health-care system that includes Texas Health Presbyterian.
In other words, hospital staff missed an opportunity to diagnose Duncan, get him into care, and also stop Duncan from spreading the virus while he was contagious.
By September 28, Duncan — who is 42 and recently quit his job in Monrovia as a driver for a shipping company — had fallen gravely ill. He was sent to Texas Presbyterian in an ambulance.
This time, hospital staff suspected Ebola. Here's a timetable in calendar form:
For just over a week, Duncan remained in intensive care and isolation at the hospital, where his condition had worsened from serious to critical. This weekend, he had been "fighting for his life," according to the CDC director Tom Frieden, on dialysis and a respirator. He had also received the experimental antiviral drug brincidofovir, which the Food and Drug Administration approved for emergency use.
On October 8 at 7:51 a.m., more than a week after he was diagnosed, he died.
His girlfriend Louise Troh reacted in a statement: "I trust a thorough examination will take place regarding all aspects of his care. I am now dealing with the sorrow and anger that his son was not able to see him before he died."
Duncan's body will be wrapped in multiple, leak-proof bags, disinfected, and cremated per CDC protocol.
Public health authorities are tracking possible related cases
The misstep in failing to diagnose Duncan at an early stage might have affected his outcome, but it has also affected the lives of everyone with whom he came into contact.
Officials are following up with 38 people who had some kind of exposure to Duncan or his family. They are also tracking ten people who had close contact with Duncan. These include health workers and emergency responders who cared for Duncan, and Duncan's family members. So far no one has fallen ill.
According to The New York Times, Duncan had probably contracted the virus in Liberia from his landlord's daughter who was sick with Ebola — Duncan had helped bring her to the hospital (and she later died). It's not yet clear whether Duncan knew he had been exposed when he boarded the plane in Monrovia, though the CDC confirmed that his temperature had been checked at the time and he was not running a fever.
The CDC still says it can contain any US outbreak
"It is certainly possible that someone who had contact with [Duncan]... could develop Ebola in the coming weeks," said the CDC's Frieden. Still, he added: "I have no doubt we will stop this in its tracks in the US. I also have no doubt as long as this continues in Africa, we need to be on guard."
That said, the failure to screen and diagnose Duncan initially — and recent news of a nurse contracting Ebola in Spain after treating an infected patient there — seems to have raised public concern about Ebola. The CDC reported that they now receive about 800 calls or e-mails about Ebola each day — compared with just 50 prior to Duncan's case.
The CDC also said it has tested about 15 other individuals in the US for Ebola this year and all have tested negative so far, except for Duncan.
As a precautionary measure, the Department of Homeland Security announced that they would begin screening flight passengers coming in from West Africa for signs of infection, starting with five American airports.
There have been other Americans who have come down with Ebola in Africa and returned to the US for treatment. Most recently, Nebraska Medical Center took in Ashoka Mukpo, a freelance NBC cameraman who got Ebola in Liberia. All have survived so far.
Further reading: What we know about Ebola in the US