How a Dallas hospital failed to diagnose the Ebola patient
hospital in Dallas that diagnosed America's first-ever known Ebola case also failed to recognize the patient's Ebola potential when he first sought care, missing an opportunity to isolate him when he was already contagious.
The patient, Thomas Eric Duncan, had been visiting the US from Liberia. He left Monrovia on September 19 and traveled through Brussels, arriving in Dallas on September 20. He had no symptoms when he was departing Liberia or entering the US, which means he wouldn't have been infectious at the time.
Four days later he started to feel ill, which means he would have been infectious. Two days after that, he sought care at Texas Health Presbyterian Hospital. His was diagnosed with a "low grade, common viral infection" and sent home with an antibiotic.
The patient's sister said that Duncan told a nurse that he had come from Liberia. 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. "As a result, the full import of that information wasn't factored into the clinical decision-making." Ebola was not suspected.
CDC guidance not followed
If this is correct, the hospital did not follow CDC guidance. In advance of Ebola reaching America, the CDC put out guidance for health workers, including this recommendation: "Treat all symptomatic travelers returning from affected West African countries as potential cases and obtain additional history."
A thorough medical history can help health professionals diagnose between 70 and 90 percent of illnesses.
By September 28, Duncan — who is in his mid-40s, according to the New York Times, 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. At that point, he was running a high fever and vomiting. This time, hospital staff suspected Ebola and placed Duncan in an isolation unit. On September 30, the CDC confirmed that he has Ebola.
Duncan remains in intensive care and isolation at the hospital, where he is in serious condition.
http://www.vox.com/2014/10/1/6881735/eb ... eak-dallas
