Ebola monitoring inconsistent as virus spread

This Friday, Oct. 17, 2014, in Dallas, photographs shows an excerpt from a Texas Department of State Health Services document that healthcare workers with possible exposure to Ebola are being asked to sign. The document is signed by David L. Lakey, M.D., Commissioner, TDSHS. (AP Photo/Tony Gutierrez)

DALLAS (AP) — The top administrator in Dallas County rushed to Texas Health Presbyterian Hospital this week responding to urgent news: One of its nurses had caught Ebola from a patient. He quickly asked for the hospital’s watch list to find out who else might be at risk.

Judge Clay Jenkins, who is overseeing the county’s emergency response, was told there was no such list. Simply put, nurse Nina Pham and her co-workers, who were handing fluids, inserting IVs and cleaning Thomas Eric Duncan in his dying days, were supposed to take their own temperatures and let someone know if they felt sick.

That wasn’t nearly enough for Jenkins, and that evening, he began to make changes. Hospital officials told potentially exposed hospital workers to stop seeing patients other than Pham.

But the next day, the Centers for Disease Control and Prevention allowed another nurse who cared for Duncan, Amber Vinson, to get on a plane in Ohio and fly to Dallas with a mild fever. She was later diagnosed with Ebola, and CDC Director Dr. Tom Frieden has conceded that she “should not have traveled on a commercial airline.”

The inconsistent response by health officials in monitoring and limiting the movement of health workers has been one of the critical blunders in the Ebola outbreak. Friends and family who had contact with Duncan before he was hospitalized were confined to homes under armed guard, but nurses who handled his contagious bodily fluids were allowed to treat other patients, take mass transit and get on airplanes.

“I don’t think the directions provided to people at first were as clear as they needed to be, and there have been changes in the instructions given to people over time,” said Rep. Michael Burgess, R-Texas, a doctor who did his residency in Dallas.

Local health authorities have said repeatedly throughout the response that their guidance and direction can change.

“Please keep in mind the contact list is fluid, meaning people may fall off the list or new people may be added to the list depending on new information that could arise at any time on any given day,” said Dallas County health department spokeswoman Erikka Neroes on Friday when asked how many people are even being monitored.

On Thursday, Jenkins announced stricter restrictions that require hospital staffers who had been potentially exposed to stay away from the public for 21 days and check their temperature twice a day, once in person with a public health worker. It was the first written order anyone being monitored has been asked to sign.

“They can walk their dog, but they can’t go to church; they can’t go to schools; they can’t go to shopping centers,” said Mayor Mike Rawlings.

Public health epidemiologists were notifying the health care workers of the directions Friday, said Texas Department of State Health Services spokeswoman Carrie Williams.

But even those medical agreements allow some wiggle room. For example, they say public transit isn’t outright banned but “should be discussed with the public health authority.”

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