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CDC Cites 'Breach' In Ebola Protocol As Second Texas Case Emerges

Police stand guard outside the apartment of a hospital worker who has tested positive for Ebola in Dallas Sunday. In the background is a yellow barrel used to dispose of hazardous materials.
Roger Steinman
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A health care worker in Texas who cared for Ebola patient Thomas Eric Duncan has been confirmed to have the virus, according to the Centers for Disease Control. The head of the CDC says the infection stems from a breach in protocol that officials are working to identify.

The worker helped treat Duncan during his second stay at Texas Health Presbyterian Hospital, officials say. Duncan died of the disease Wednesday.

The case is the first instance of an Ebola infection being transmitted inside the U.S. The new patient, a woman, is not being identified; CNN reports that she's a nurse, citing an official familiar with the case.

The worker reported a low fever Friday night and went to the hospital; a blood sample was sent for testing at the state public health laboratory in Austin. The preliminary result was released late Saturday.

Update at 4 p.m. ET: Case Of Ebola Is Confirmed

The CDC has announced that its follow-up tests on the patient's blood confirm that she has Ebola.

Update at 11:15 a.m. ET: Woman Was Not Among 48 Contacts From Duncan Case

"Our hearts really do go out" to the patient in Dallas and her family, says Dr. David Lakey, commissioner of the Texas Department of State Health Services.

He added that the health care worker "did what was appropriate, in coming in for a blood test" after noticing symptoms.

A worker at Texas Health Presbyterian Hospital in Dallas, where Ebola patient Thomas Eric Duncan died on Wednesday, has tested positive for the virus.
LM Otero / AP
The Florida Channel
A worker at Texas Health Presbyterian Hospital in Dallas, where Ebola patient Thomas Eric Duncan died on Wednesday, has tested positive for the virus.

Lakey said the woman is not among the 48 people who were identified as having had potential contact with Thomas Eric Duncan before he was put in an isolation unit. That group, which includes some health workers, is still being monitored, Lakey said, adding that none have shown signs of being infected.

Speaking by phone at a the Centers for Disease Control and Prevention news conference, Lakey said that officials in Dallas are working to ensure they understand how the virus was transmitted in the new case, to improve health workers' procedures.

Responding to questions, Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, said the worker hasn't identified a specific moment that might have led to the breach.

Both health officials also said they're confident the virus will be contained, saying they would break the chain of transmission.

"I firmly believe that we're going to stop this here," Lakey said, referring to the Dallas hospital.

Update at 11:08 a.m. ET: 'A Breach In Protocol'

"We're deeply concerned" by the emergence of a second Ebola case in Dallas, says Dr. Tom Frieden, speaking at a CDC news conference in Atlanta. He said the agency is carrying out a second test Sunday to confirm or disprove the patient's initial positive test result for Ebola.

"At some point there was a breach in protocol," Frieden said of the new case, which then resulted in the infection.

Frieden said that so far, the level of Ebola in the patient's system is low.

He said that after extensive interviews with the patient, experts have determined that only one person may have had contact with her when she may have been infectious. Frieden said they are evaluating other potential exposures.

Frieden went on to outline several steps health agencies are undertaking, with a focus on protocols that will prevent the spread of Ebola. They include a review of the protective gear, he said, noting that putting on more materials isn't always a guarantee that the level of risk will fall.

The CDC chief said that removing gear is a particularly critical process in preventing an Ebola infection.

In another high-profile Ebola case that's ongoing, Teresa Romero, the nurse who contracted Ebola in Spain after treating an infected patient, has said she may have touched her face as she was removing her protective gear.

Update at 8:55 a.m. ET: Patient Treated Duncan On Second Visit

Asked whether the worker treated Duncan on his first or second visit to the hospital last month, Dr. Dan Varga, the chief clinical officer of Texas Health Resources, the hospital's parent company, says it was on the second visit.

He spoke at a Sunday morning news conference about the new Ebola case.

Varga said that all of the health care workers are following CDC precautions. He added that the worker had been wearing protective gear when treating Duncan, including a "gown, gloves, mask and shield."

The new patient had been working up until two days ago, Varga said.

Varga added that officials are confident in the measures they've taken to protect health care workers. As an added precaution, Texas Health Presbyterian will not provide emergency services; instead, ambulances will be sent to other hospitals.

Update at 8:45 a.m. ET: Patient Is In Stable Condition

The worker had been self-monitoring after caring for Duncan, Varga says, a process that included taking one's own temperature twice a day. The worker was admitted to an isolation unit at the hospital immediately after arriving.

"The entire process, from the patient's self-monitoring to the admission into isolation, took less than 90 minutes," Varga said. He added that the patient's condition is currently listed as stable.

"A close contact has also been proactively placed in isolation," he said.

At the news conference, Dallas Mayor Mike Rawlings said the patient's house has been decontaminated and access to it is being controlled by police. He added that neighbors have been contacted in a door-to-door campaign, as well as by phone.

Officials of the Texas department of health urged people not to panic, stressing that Ebola can only be spread through direct contact with bodily fluids or objects contaminated by an infected person.

On the question of how contagious Ebola is, NPR's Michaeleen Doucleff recently noted, "Even in the current epidemic in West Africa, where the virus has been out of control, each person who has gotten sick has spread Ebola to only about two others, on average."

No details about the patient were released, with officials citing the worker's wish for privacy.

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The Centers for Disease Control in Atlanta will perform further tests to confirm the diagnosis.

"We knew a second case could be a reality, and we've been preparing for this possibility," said Dr. David Lakey, commissioner of the Texas Department of State Health Services, in the statement. "We are broadening our team in Dallas and working with extreme diligence to prevent further spread."

Officials are identifying the patient's contacts and will monitor them based on the nature of their interactions with the patient. Ebola is spread through direct contact with bodily fluids, and is not contagious before patients show symptoms such as fever.

The worker helped care for Duncan, the 42-year-old who contracted Ebola in Liberia and flew to Texas on Sept. 20. He first developed symptoms on Sept. 24. Duncan died at Texas Health Presbyterian Hospital on Wednesday.

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Bill Chappell is a writer and editor on the News Desk in the heart of NPR's newsroom in Washington, D.C.