Delayed diagnosis, then workplace infections
This summary of Texas Health Presbyterian Hospital Dallas’ experience with the first Ebola patient in the United States is compiled from statements and data provided by the hospital and the Centers for Disease Control and Prevention (CDC):
Liberia native Thomas Duncan arrived at the Texas Health Presbyterian Hospital Dallas emergency department at 10:37 p.m. on Sept. 25. Fifty-nine minutes later, a triage nurse asked Duncan about his symptoms, and he reported "abdominal pain, dizziness, nausea and headache (new onset)." The nurse recorded a fever of 100.1 degrees F. The nurse did not ask about his travel history because the Ebola screening protocol did not yet require that inquiry.
Duncan was admitted at 12:05 a.m. to a treatment room where a physician accessed the electronic health record (EHR) and visited Duncan, but he did not yet examine the patient. At 12:33 a.m., an emergency department nurse continued Duncan’s assessment and asked about his travel history. She noted "came from Africa 9/20/14." The EHR prompted the nurse to verbally relay the travel information to the physician, but she did not. The physician began examining Duncan and accessed the EHR, which included the travel information (contrary to original reports, which said the EHR did not convey that information). The record also showed that Duncan rated his pain as 8 on a scale of 1 to 10.
The EHR indicates that the attending physician asked Duncan and his companion about Duncan’s personal history and health information. The patient identified himself as a "local resident" and said he had not been in contact with any sick people and claimed he had not experienced diarrhea, vomiting, or nausea.
Documenting nasal congestion, a runny nose, and abdominal tenderness, the physician provided an extra strength pain reliever at 1:24 a.m. A computed tomography scan revealed nothing of concern, but lab results showed a slightly low white blood count, low platelets, increased creatinine, and a mild elevation in the liver enzyme AST. His temperature was noted at 103.0 degrees F at 3:02 a.m. and 101.2 degrees F at 3:32 a.m. The physician diagnosed sinusitis and abdominal pain and sent Duncan home at 3:37 a.m. with a prescription for antibiotics.
Duncan’s condition worsened, and he returned by ambulance on Sept. 28 at 10:07 a.m. with diarrhea, abdominal pain, and fever. Fifteen minutes later, a doctor noted that Duncan recently had come from Liberia and ordered a test for Ebola. At 12:58 p.m., the doctor called the Centers for Disease Control and Prevention (CDC) directly. By 9:40 p.m., Duncan was experiencing explosive diarrhea and projectile vomiting.
On Oct. 10, 26-year-old nurse Nina Pham, who had treated Duncan at the hospital, reported a low-grade fever and was placed in isolation. On Oct. 11, she tested positive for the Ebola virus, becoming the first person to contract the virus in the United States.
On Oct. 14, 29-year-old Amber Vinson, a nurse who also had treated Duncan, reported a fever and was isolated within 90 minutes of reporting the fever. She tested positive for Ebola the next day. Both nurses recovered.