Wednesday, October 15, 2014

CDC now eyes passengers on domestic flight after second Dallas health care worker tests for Ebola the next day with minimal symptoms; what about isolation, quarantine reach?

In a startling new development, a second health care worker in Dallas from Texas Presbyterian Hospital has tested positive for Ebola after showing fever.  The patient was on a Frontier Airlines Flight from Cleveland to Dallas the day before, Monday, October 13, 2014, Columbus Day. 
The Centers for Disease Control has asked all passengers who were on that flight to be interviewed, in an announcement here

 Apparently the CDC will work with the airline to contact the passengers. 
The statement does NOT say that the other passengers will be isolated.  CDC characterizes this as “Passenger Notification underway”.
However, given the way health departments in Texas and New Jersey have handled other contact tracing situation, it’s not sure that the passengers would be allowed freedom of movement as long as they don’t show symptoms.  The only passengers at any risk at all would be those seated immediately next to the passenger, and this would be an issue only if another passenger came into some kind of contact with the patient or fluids.  The patient did not show symptoms during the flight.
It’s easy to imagine other situations where CDC could want to contact a lot of people.  If someone went to a sold-out concert, where seats are reserved, and then became symptomatic the next day (or even during the event), the CDC could want to interview everyone in the hall, or at least in the proximity of the patient. 
If a situation like this happened with Amtrak, it would be even more ambiguous.  Amtrak (at least on regular regional trains, I’m not sure about Acela) sells reserved coach seats, but doesn’t make seat assignments.  Trains in the NE corridor are crowded, but the probability of coming into contact with any person in a situation like this is extremely low. 
Right now, screening of passengers from three West African countries (including indirectly) happens at five US airports (or will start soon), but the implication of this story is that even domestic passengers can be at a theoretical risk.
CNN has a story here which contains links to others stories where nurses at Texas Presbyterian are pointing out to horrible gaffes during the first exposures of Duncan at the hospital during the first two visits.  It is becoming more apparent that regular hospitals are not was well prepared to handle Ebola as the specific level 4 containment hospitals.  A strategy would be to build containment facilities in many cities, including Dallas.  This hospital (in the NE part of Dallas, off 175)  is very large in area, and would be a logical place to build one.
I am concerned about the possibility  of severe disruption myself by being caught in a CDC “dragnet” (or local health department one) when there is no real risk.  If there is a particular fact (like sitting next to someone who vomited) that is another matter.  Until it is clearer what the “rules of conduct” when in “minor isolation” are going to be, I won’t make any plane reservations at all, not even domestically. 


CNN reports that CDC refers to people under monitoring as allowed "controlled movements", which allows driving in a car, but not flying (or probably going to a packed concert).  CNN says that the second health care worker had been told she should not fly, but did so anyway.  

Further Update:

CNN is broadcasting allegations by nurses of misconduct at the hospital.  The nurses would not be identified because they fear "retaliation".  This is really getting ugly.  

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