Second Dallas Hospital Worker Has Ebola

By Brenda Goodman, MA
WebMD Health News

Reviewed by Arefa Cassoobhoy, MD, MPH

Oct. 15, 2014 -- The second health care worker in Dallas to get Ebola boarded a commercial flight on Monday, despite CDC guidance that people who've been exposed to the virus limit their travel.

The nurse, 29-year-old Amber Joy Vinson according to the Dallas Morning News, was running a fever of 99.4 before she boarded Frontier Airlines flight 1143, which flew from Cleveland to Dallas on Oct. 13.

Her temperature was too low to meet the "Ebola threshold" of 100.4, but because it was even slightly elevated and because she was part of a group known to have been exposed to someone who was infected, "she should not have traveled on a commercial airline," said CDC director Tom Frieden, MD, in a conference call on Wednesday.

"The CDC guidance in this setting outlines the need for what is called controlled movement. That can include a charter plane, that can include a car, but it does not include public transport," Frieden said.

It was unclear whether Vinson was aware of that guidance, which was posted on the CDC's web site in late August.

The Texas Board of Nursing says Vinson received her license as a registered nurse in August 2012.

Frieden said preparations were underway to move her to Emory University Hospital in Atlanta. He said she was ill, but "clinically stable."

Emory said she would be treated in the same isolation unit in which three patients already have been treated for Ebola. One remains in the unit, while two others were released after recovering.

Her family is expected to make a statement later in the day. Three people who had close contact with her were being watched, the CDC said.

"We will from this moment forward ensure that no other individual who's being monitored for exposure undergoes travel in any way other than controlled movement," Frieden said. He didn't discuss the steps public health authorities might be taking to restrict the travel of other exposed health care workers.

Frieden stressed that despite the slip, the risk to other passengers on the plane was likely to be low, because the nurse had no other symptoms the day of her flight.

Still, to add an "extra margin of safety," the agency is reaching out to 132 people who were passengers on Vinson's flight.

According to the crew, Vinson was not showing any symptoms during the flight. But because of the short time between when the plane landed at night and when she began showing symptoms the next morning, the CDC wants to talk to others on the flight. They're asking passengers to call 800-CDC-INFO (800-232-4636).

Anyone who is found to be at risk will be watched for symptoms, the agency says in a news release.

The Ohio Department of Health said in a statement it was contacting Vinson's family members, who she was visiting, and identifying those who had contact with her. People who traveled on Vinson's flight to Cleveland, Frontier Airlines flight 1142 on Oct. 10, should also contact the CDC, the department said. The CDC was sending a liaison to Ohio to help.

More on Vinson

Vinson had been involved in the care of Thomas Eric Duncan, a Liberian citizen who flew to the U.S. late last month after being exposed to the virus.

Like Nina Pham, the first nurse at Texas Health Presbyterian Hospital to get Ebola, she cared for Duncan during the three days -- the 28th, 29th, and 30th -- in September when he was most infectious.

"Both had extensive contact with the patient when the patient had extensive production of body fluids because of vomiting and diarrhea," Frieden said.

Frieden said the CDC's investigators have determined that a variety of forms of personal protective equipment were worn by hospital workers during that time, including some that allowed for exposed skin.

Vinson and Pham were two of 76 health care workers who are employed by the hospital but not working because they had some kind of contact with Duncan. Those workers have been told to keep a close eye out for early symptoms like fever, headache, and muscle pains.

"We're setting up a place where people can move away from their families if they want to. They can also stay at home if they want," said Dallas County Judge Clay Jenkins in a news conference on Wednesday.

"This is not going to be a situation where we're going to put protective orders on 75 health care workers," he said.

Nurses' Group Speaks Out

Meanwhile, National Nurses United, a union and professional nurses' organization claiming 185,000 members, called for President Barack Obama to require uniform standards in all U.S. hospitals to ensure the safety of health care workers, patients, and the public from Ebola and other diseases.

The group is sending a letter to the president, said RoseAnn DeMoro, the group's executive director, in a conference call Wednesday.

The group said nurses at Texas Health Presbyterian Hospital reported that when Duncan arrived at the hospital on Sept. 28 – after being sent home 2 days earlier – "no one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn, and there was no training." Duncan was left for several hours in an area where other patients were around.

The nurses are asking for a full readiness plan for Ebola and other outbreaks. That would include training nurses and other health care providers, supplying proper protective gear, and providing properly equipped isolation rooms and proper procedures for getting rid of medical waste and linens. Many nurses on the call told stories of subpar training and supplies. One said her staff received 10 minutes of training on caring for Ebola patients. Another said her supervisor told her safety goggles were not in the budget.

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Hospital officials said they were unsure exactly what the point of exposure was for Vinson. "It's clear there was an exposure somewhere, sometime in their treatment of Mr. Duncan," said Daniel Varga, MD. He's chief clinical officer for Texas Health Resources, the company that runs the hospital.

Earlier in the day prior to the CDC briefing, Varga rejected the notion that the hospital had somehow faltered in its infection control practices.

"I don't think we have a systematic institutional problem," he said.

"I think our ability to get these folks into isolation and manage them has been very effective. We're looking at every possible angle around this."

"No one wants to get this right more than our hospital," he said.

Frieden said the CDC was reviewing how it handles Ebola cases and plans to send a team of infection control experts to hospitals treating people with Ebola.

Dallas reacted swiftly to news of the second case, said Mayor Mike Rawlings.

Cleaning of the woman's apartment and car are underway.

Neighbors at her apartment complex on Village Bend Drive in Dallas were sent reverse 911 calls at 6:15 a.m. on Tuesday to inform them of the news.

Workers have also passed out Ebola information pamphlets throughout the complex where she lived.

"The only way we are going to beat this is person by person, moment by moment, detail by detail," Rawlings said. "It may get worse before it gets better, but it will get better," he said.

In Atlanta, The person currently being treated at Emory's isolation unit has not been identified, although their arrival came after the WHO said one of its doctors was being evacuated from Sierra Leone after getting Ebola. The person, in a statement released by Emory on Wednesday, said, "I want to share the news that I am recovering from this disease, and that I anticipate being discharged very soon, free from the Ebola virus."

The person said their condition worsened after arriving at Emory, and "I became critically ill," but "I am well on the way to a full recovery."

Kathleen Doheny contributed to this report.

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SOURCES: Clay Jenkins, judge, Dallas County, Texas. Daniel Varga, MD, chief clinical officer, Texas Health Resources, Dallas. Mike Rawlings, mayor, Dallas. News conference, City of Dallas, Oct. 15, 2014.

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