Liz Szabo

USA TODAY

A man infected with Ebola was allowed to leave a Dallas hospital last week because the results of a screening weren't shared with his health care team, which concluded he had a common virus and discharged him, hospital officials said Wednesday.

While health experts agree that the USA is not at risk for a large Ebola epidemic like the one affecting West Africa, some doctors are concerned that the infected patient was sent home from the hospital without treatment the first time he sought care.

The Ebola patient, now in intensive care at Texas Health Presbyterian Hospital in Dallas, arrived in the USA on Sept. 20 without symptoms and sought care Sept. 26. He was sent home, only to return to the hospital two days later and be admitted.

United Airlines said in a statement Wednesday that it had been told by the Centers for Disease Control and Prevention that the Ebola victim flew part of his itinerary on the airline. The carrier said it believes the patient flew from Brussels to Washington's Dulles International Airport on Flight 951 and from Washington to Dallas/Fort Worth on Flight 822.

The Associated Press has identified the patient as Thomas Eric Duncan, noting that he was identified by his sister, Mai Wureh.

As the disease progresses, patients can develop heavy vomiting and diarrhea, and more advanced cases can cause people to vomit blood and suffer severe abdominal pain.

At a news conference Wednesday, hospital officials said a triage nurse performed the recommended screening — asking about his symptoms and his travel history — but her report wasn't communicated to the rest of his health care team.

Duncan is now in serious but stable condition, according to hospital officials.

Mark Lester, executive vice president at Texas Health Resources, said the patient "volunteered that he had been to Africa in response to the nurse operating the checklist and asking that question."

That information "wasn't present" as the man's health care team made its decision about whether to admit or release him, Lester said.

Hospital officials said there was no risk to other patients in the emergency room. Ebola can be spread only through contact with bodily fluids, such as blood and vomit. The man had fever and abdominal pain but wasn't vomiting, said Edward Goodman, the hospital epidemiologist.

Health officials are monitoring a "handful" of people with whom the Ebola patient had contact before he was hospitalized, said Thomas Frieden, director of the Centers for Disease Control and Prevention, on Tuesday.

Those people include five school-aged children in Texas. The children are being monitored at home, Texas Gov. Rick Perry said Wednesday at the press conference.

"Let me assure you, these children have been identified and are being monitored," Perry said.

For weeks, Frieden has told the public that American hospitals are ready for Ebola patients and that emergency room staffers are being urged to check not only a patient's symptoms but also to ask about recent travel. The American College of Emergency Physicians is sending out an alert to all of its members Wednesday to remind them of this protocol.

Patients with recent travel to West Africa and any of the symptoms of Ebola are supposed to be tested for the virus. However, early symptoms of Ebola, such as fever, can be difficult to differentiate from ordinary viruses.

"One of the things that will be really important for the CDC is to try to understand if it highlights specific weaknesses or gaps in the system," said infectious disease specialist Jesse Goodman, professor of medicine at Georgetown University Medical Center and the former chief scientist at the Food and Drug Administration.

"It is critical for hospitals and health care workers everywhere to be sure they are alert, obtain travel histories, and if there is any question at all it could be Ebola, contact CDC, and while sorting things out, act to isolate a sick patient returning from an epidemic area," Goodman said.

Emergency department doctors see dozens of sick patients a day, and many have fevers or viruses at this time of year, said Rade Vukmir, spokesman for the American College of Emergency Physicians.

Vukmir noted that Ebola is not the only catastrophic illness for which hospital staffs have been asked to screen patients. In the past decade, hospitals also have developed protocols for screening patients for everything from hantavirus to MERS, the Middle Eastern respiratory syndrome, and monkeypox, he says.

"The symptoms, especially early on, are very non-specific," said Robert Murphy, professor of medicine and biomedical engineering at Northwestern University.

"It will happen again if triage staff doesn't get a good travel history and suspect that Ebola is possible," Murphy said. "It is very unfortunate that the patient was seen, exposed numerous people, then sent home to expose more, then finally admitted. This is how Ebola spreads."

Still, given the news out of Dallas, Vukmir said it's safe to assume that hospitals now have reminded their staffs about the importance of screening patients for Ebola. That reduces the chance that another Ebola patient will be missed.

"I guarantee you there has been discussion today" in emergency rooms nationwide about the importance of those checks, he said. "They will be doing it today."

Infectious disease experts note huge differences between the USA and the countries hit hardest in the Ebola outbreak — Liberia, Guinea and Sierra Leone — that have been traumatized by war and poverty

Their health care systems were weak before the outbreak and now have collapsed. Many hospitals lack such basics as running water and soap, and there may be only one doctor for tens of thousands of people.

People in those countries use burial practices that involve washing the bodies of dead relatives, which can spread the virus throughout families.

Doctors got a very late start in fighting Ebola. The first case appeared in December, but health officials didn't realize that they were dealing with Ebola until March. By then, nearly 50 people had been diagnosed. The international community didn't mobilize until recent weeks.

Ebola has infected 7,178 people and has killed 3,338 in Guinea, Sierra Leone, Liberia, Senegal and Nigeria, the World Health Organization says. The outbreaks in Nigeria and Senegal are likely over. In other countries, however, the number of cases has been doubling every three weeks, and the CDC estimates that the disease could affect up to 1.4 million people by January if it's not quickly controlled.

The longer the virus spreads out of control, the greater the likelihood that more cases will appear in the USA, Goodman said.

While Frieden has said that any hospital with the ability to isolate patients can treat Ebola patients, Goodman said, "It is important not to be overconfident and to continuously, now and in the future, re-examine ... how the virus is behaving."

Contributing: Karen Weintraub, Charisse Jones, USA TODAY; The Associated Press



Timeline

The current outbreak of Ebola in West Africa is the largest since the virus was first discovered in 1976. Until Sept. 30, no cases of this disease, which has a 50% fatality rate, had been diagnosed in humans in the United States.

• Sept. 19. Thomas Eric Duncan leaves Monrovia, Liberia, for a trip to the United States. He has been exposed to Ebola but is not exhibiting symptoms, so he is not contagious. It is unclear whether he knew he had been exposed.

• Sept. 20. After changing planes in Brussels, Belgium, and at Washington Dulles International Airport, Duncan arrives in Dallas to visit his sister.

• Sept. 24. Duncan's family members tell U.S. authorities this is the day he first felt sick. That is when he likely became contagious.

• Sept. 26. Duncan seeks treatment at Texas Health Presbyterian Hospital Dallas and is sent back to his sister's apartment with antibiotics.

• Sept. 28. Duncan is transported to the same hospital by ambulance. He is critically ill and put in isolation in the hospital's intensive care unit.

• Sept. 30. The federal Centers for Disease Control and Prevention confirms that Duncan has been stricken with the Ebola virus, the first patient to be diagnosed in the USA.

• Oct. 1. Duncan's condition is upgraded from critical to serious, and health officials say they are closely monitoring a second patient who had contact with Duncan. Others who have been in contact with Duncan, including paramedics and children, are being observed for symptoms.