Wednesday, October 01, 2014

CDC seems to become aggressive with contact tracing after first US Ebola case in Dallas


CNN has a new story on Ebola in Dallas today, with the story URL title “no reason to panic”, as with this linkNevertheless, the CDC is aggressive with contact tracing in Dallas.  The main blunder was that emergency physicians at Texas Presbyterian Hospital did not ask the patient when he showed up at the hospital on Friday Sept. 26 about foreign travel.  Some accounts say that the patient did mention fear of Ebola then, but it wasn’t taken seriously. That would given the opportunity to isolate him immediately. Instead, the hospital sent him home and did not learn about travel to Liberia until the patient returned to the hospital on Sunday Sept. 28.  Today, on CNN medical correspondent Sanjay Gupta (himself a neurosurgeon in Atlanta) said on CNN this morning “Someone fell down on the job” at Texas Presbyterian. A subsequent CNN headline read "They didn't ask, he didn't tell." Later info indicates that a nurse did ask, the patient told, but the nurse didn't pass the info to others on Sept. 26.  
  
The ambulance workers have all tested negative for Ebola, but they are all being “watched”.  It isn’t clear if that means “quarantine” (Vox, below, says it does).  Probably the person had minimal contact with others between Sept. 26 and Sept. 28 if he was unwell. But the challenge would be to find anyone who as in close contact with the person in those two days and could have touched a surface contaminated with bodily fluids from the patient.
  
Right now, CDC is continuing to reassure the public that the virus is not spread through the air, but there have been speculations about future mutations.  Yet, over decades, these haven’t happened.
    
USA Today and station WFAA in Dallas reports that a second patient is being monitored, here

VoxDotCom has a new and thorough story including a description of how CDC will do the contact tracing here.  Suppose that someone later diagnosed with Ebola goes to a disco and engages in “dirty dancing”.   The household contact would be unlikely to have transmitted the virus, short of actually touching blood or other fluids.  If these person is feeling OK when he goes dancing, he shouldn’t be capable of transmitting it. But health officials could feel they have to come after every single potential contact. 
  
The virus is intermediate in transmissibility between STD’s (HIV, Hepatitis B), being more easily transmitted than those (by surface contact with fluids), and influenza, being less transmissible than anything that actually spreads through the air.

  

On CNN, one female reporter just said that one will not test positive for Ebola until showing symptoms, and this could mean that the ambulance workers and other close contacts are still not in the clear.   The Dallas Morning News has a detailed timeline on this whole incident, including the ambulance workers, here.  There is a story about the DISD students who might have very incidental exposure here

CNN reports that there is no evidence that Ebola has ever been spread by insects.  It infects onlu mammals, apparently mostly primates, and perhaps bats.

Latest Texas Gov, Rick Perry says that some school students had incidental contact with the patient and are being monitored at home.  (1 PM, CNN).

Update: Oct. 2:  There is a furor over the way the quarantine of four family members is being handled, but the details are changing quickly.  
  
First picture; Park in downtown Dallas, Nov. 2011 (my visit); second, CDC in Atlanta, wikipedia link here

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