US hospital's missteps in Ebola case worry public

Dallas hospital staff sent infected man home, resulting in potential spread of virus in city

Dallas - Health officials' handling of the first Ebola patient diagnosed in the United States continued to raise questions, after the hospital that mistakenly sent him home when he first visited its emergency room acknowledged both nurses and doctors had access to the fact that he had arrived from Liberia.

For reasons that remain unclear, nurses and doctors released the patient under the erroneous belief that he had a low-grade fever from a viral infection, allowing him to put others at risk of contracting Ebola. Those exposed include several schoolchildren, and the exposure has the potential to spread a disease throughout Dallas that has killed 3,000 people in Africa.

Last Thursday, Texas Health Presbyterian Hospital in Dallas released a statement essentially blaming a flaw in its electronic health records system for its decision to send the patient - Mr Thomas E. Duncan, a Liberian national visiting his girlfriend and relatives in the US - home the first time he visited its emergency room. The hospital said there were separate "workflows" for doctors and nurses in the records, so the doctors did not receive the information that he had come from Africa.

But last Friday evening, the hospital effectively retracted that portion of its statement, saying "there was no flaw" in its records system.

It said "the patient's travel history was documented and available to the full care team in the electronic health records, including within the physician's workflow".

The hospital had said previously that the patient's condition during his first visit did not warrant admission and that he was not exhibiting symptoms specific to Ebola.

The hospital's admission came on a day when health officials narrowed down to 10 the number of people considered most at risk of contracting Ebola after coming into contact with Mr Duncan.

They also moved the four people who had shared an apartment with him from their potentially contaminated quarters, as local and federal officials tried to assure the public that the disease was contained despite initial missteps.

The four - a girlfriend of Mr Duncan and three of her relatives - had been under orders not to leave their home. The cleanup of the apartment began last Friday afternoon - more than a week after Mr Duncan first went to the hospital.

In Washington last Friday, while military officials announced that the army would more than double the number of soldiers it is sending to West Africa to nearly 4,000, up from a planned 3,000-strong force to help contain the Ebola virus there, senior White House officials tried to play down the series of missteps in the handling of the case in Dallas. They insisted the public health system was working effectively and would prevent an epidemic of the deadly virus from taking root in the US.

Around the country, anxiety spread as two hospitals in the Washington area each reported a possible case of Ebola, and a television journalist working in Liberia prepared to return to the US after being told he had the virus.

Besides the 10 people considered most at risk in Dallas, another 40 are being monitored in the city but are considered at relatively low risk. No one has developed any symptoms. The first signs often appear within eight to 10 days, but can take as long as 21 days.

White House officials acknowledged the public's growing nervousness, but said Americans had little to worry about.

"There's a lot of fear," said Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "It's the unknown. It's the cataclysmic nature of it - namely it's acute, it kills in a high percentage."

Federal officials have rejected the idea of expanding the screening of passengers arriving from West Africa and said they would not support calls for a ban on travel to the US from countries being ravaged by the disease.

"We believe those types of steps actually impede the response," Ms Lisa Monaco, the homeland security adviser, said of proposals to restrict air travel.

New York TImes, AFP