Judge Clay Jenkins, who is overseeing the county’s emergency response, was told there was no list. Simply put, nurse Nina Pham and her colleagues, who handled fluids, inserted IVs, and cleaned Thomas Eric Duncan in his dying days, were supposed to take their own temperatures and let someone know if they felt ill.

DALLAS — The top administrator in Dallas County rushed to Texas Health Presbyterian Hospital last 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 determine who else might be at risk.


That was not nearly enough for Jenkins, and that night, he began making changes. Hospital officials told potentially exposed 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 board 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 bodily fluids were allowed to treat other patients, take mass transit, and board 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 US Representative Michael Burgess, a Texas Republican and doctor who did his residency in Dallas.

Area health officials have said repeatedly during the response that their guidance and directions can change.


Thursday, Jenkins unveiled stricter restrictions, requiring hospital staff who had been potentially exposed to avoid the public for 21 days and check their temperature twice a day, once in person with a 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.

Officials said 125 friends, family, doctors, nurses, technicians, ambulance drivers, and others may have been exposed in the days before Duncan died Oct. 8. Since then, the two nurses have tested positive and at least 18 other people in Texas and Ohio have been identified as secondary contacts who merit watching.

But for a time after Pham was diagnosed with Ebola, different hospital workers had different levels of monitoring, based in part on their exposure risk. Some self-reported their temperatures. Some continued to care for patients. Saturday, hospital spokesman Wendell Watson referred all questions on the facility’s monitoring practices to county officials.