Sunday, October 12, 2014

Dallas Ebola Press Conference & Hospital Statement



# 9181


A clearly subdued Dallas County Judge (highest ranking county official in the state of Texas) Clay Jenkins, in a press conference this morning at Texas Health Presbyterian Hospital, provided additional details on the first nosocomial transmission of Ebola in the United States.

What we know (some details are being withheld to protect the family, and observe HIPAA regulations), is that a healthcare provider at Texas Presbyterian Hospital – who was involved in Eric Duncan’s care after he was admitted on the 28th -  was in isolation last night with a mild fever. 


This particular HCW was considered a `low risk’ contact of Mr. Duncan. This patient’s initial tests came back positive around midnight last night.

According to Dr. Varga, head of clinical care at Texas Presbyterian, this HCW was following all CDC recommended infection control procedures (Gloves, gown, facemask & eye shield), but a review is underway to understand what happened. 

Here is a statement from Dr. Dan Varga, released at the same time as the press conference was begun:


Statement from Dr. Dan Varga, Oct. 12, 7:30 a.m. CDT


Ebola Virus 

Statement from Dr. Dan Varga, Chief Clinical Officer, Senior Executive Vice President

Late Saturday, a preliminary blood test on a care-giver at Texas Health Presbyterian Hospital Dallas showed positive for Ebola. The healthcare worker had been under the self-monitoring regimen prescribed by the CDC, based on involvement in caring for patient Thomas Eric Duncan during his inpatient care that started on September 28.

Individuals being monitored are required to take their temperature twice daily. As a result of that procedure, the care-giver notified the hospital of imminent arrival and was immediately admitted to the hospital in isolation. The entire process, from the patient’s self-monitoring to the admission into isolation, took less than 90 minutes. The patient’s condition is stable. A close contact has also been proactively placed in isolation. The care-giver and the family have requested total privacy, so we can’t discuss any further details of the situation.

We have known that further cases of Ebola are a possibility among those who were in contact with Mr. Duncan before he passed away last week. The system of monitoring, quarantine and isolation was established to protect those who cared for Mr. Duncan as well as the community at large by identifying any potential ebola cases as early as possible and getting those individuals into treatment immediately.

Finally, we have put the ED on “diversion” until further notice because of limitations in staffed capacity — meaning ambulances are not currently bringing patients to our emergency department. While we are on diversion we are also using this time to further expand the margin of safety by triple-checking our full compliance with updated CDC guidelines. We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection.

All of these steps are being taken so the public and our own employees can have complete confidence in the safety and integrity of our facilities and the care we provide.



Meanwhile, the city of Dallas has sealed off this new patient’s apartment, decontaminated the common areas in the apartment complex, sealed and decontaminated the patient’s car, and has canvassed the neighborhood – knocking on doors – checking on everyone and providing information to nearby residents.


A close contact of this patient is also in isolation as precaution – but is not currently symptomatic.  There is also reportedly a pet in the apartment, and efforts will be made later today to check on, and provide for, this animal.


We will probably  be hearing later today from the CDC, the State of Texas, and Dallas County Department of Health.


While obviously a setback, this was not unexpected.  


Despite all of the reassurances over the level of precautions being taken, there is no way to reduce the risk of treating an Ebola patient to zero.  As Zach Thomas, head of Dallas County Health Department – in a TV interview (WFAA) right after the press conference – warned `Don’t be shocked if we see another case’.

Stay tuned.


Don said...

Isn't it possible that air transmission could have been responsible in this case? A sneeze or cough when the nurse was leaning over the patient, for example? Or is the face guard and mask sufficient to rule that out?

Michael Coston said...


It is too soon to speculate what happened in this case.

Technically, a sneeze or a cough with nurse leaning over the patient isn't airborne transmission - it is via `propelled droplets' - something the CDC has acknowledged as a possibility.

See Ian Mackay's blog

Facemask & Eye shield `ought' to protect against such exposures, but they must be carefully donned, and there is always a risk of contamination during removal.

Don said...

This seems like an important question to be certain of the answer. If it is possible for some droplets to evade a properly donned and removed CDC-approved facemask and eye shield, then this has serious implications for all HCWs who care for Ebola patients. One hopes that the CDC has done exhaustive studies to prove that the PPE is infallible if used correctly but one also wonders if that is true.

Michael Coston said...


AFAIK, no specific transmission studies have been done testing various levels of PPEs against the Ebola virus.

As you might imagine, given its lethality, there are huge ethical and logistical barriers to doing that kind of research on humans.

The recommendations from the CDC & WHO are based mostly on nearly 40 years of observations in the field as to what worked, and what didn't.

Will they be changed over time?

Possibly , as more is learned about the mechanics of transmission in modern hospital settings.

Infallibility is a very high standard for any protective gear. One I doubt is achievable in any real-world Healthcare setting.

Don said...

It isn't necessary to do the testing with infectious material. You can do it with powder that fluoresces under a black light, for example.

Here is one set of procedures for putting on and taking off PPE.

From what I just saw on CNN, the official CDC procedures and equipment are not anywhere near as stringent. My suspicion is that the Dallas hospital is using the less stringent procedures and equipment.

In the CNN story, Sanjay Gupta did a demo of putting the official CDC equipment on and off. He slathered some chocolate sauce on his hands and the front of his gown before taking everything off. He got chocolate on his arm and on his neck. Maybe he was being deliberately a bit careless but it was easy to see that it would be very difficult to avoid contamination.

And a survey was just release in which 76% of nurses in America say that they have had insufficient training on handling an infectious patient.

This is shameful!