Keys to Controlling Ebola in the US: Travel Records and Infection Control

Daliborlev (CC), FLickr

Daliborlev (CC), Flickr

If you’re at all interested in infectious diseases, you’ve probably heard by now that a person traveled to the United States while infected with Ebola, was diagnosed and is now in a hospital in Texas. (I was on a flight without Wi-Fi yesterday from before the press conference was announced to after it concluded. Turning my phone on after arrival was… interesting.)

The Centers for Disease Control and Prevention held a press conference yesterday afternoon (transcript is here), and WIRED’s Greg Miller covered it.

The quick details:

  • The infected person flew from Liberia to the US on Sept. 19-20 to visit family members who live in Texas.*
  • He began to develop symptoms on Sept. 24 (important because victims are infectious only after symptoms develop).
  • He went to an ER in Dallas on Sept. 26 and was given antibiotics and sent home.
  • Two days later, Sept. 28, he was taken by ambulance to Texas Presbyterian Hospital in Dallas and was admitted on suspicion of Ebola and put in isolation.
  • The test results confirming the diagnosis came down yesterday, the same day as the announcement.


(*A quick Google will demonstrate that the patient and his family have been named by the Associated Press, with the New York Times using the name and attributing it to AP. Given the unnecessary panic around Ebola at this point, I have conflicting thoughts about whether and how the name should be used, so am passing on using it for now.)

There’s been so much coverage of this in the past 24 hours, and the story is so fast-moving, that it’s not useful to point out specific news sources. But I want to recommend two good posts that explore the background to this while trying to knock down the panic, and then raise two questions of my own.

First, epidemiologist Tara C. Smith, PhD, in The Guardian, on the US having already anticipated this might happen:

Ebola is already here in the United States. It’s existed in labs for decades, among researchers and experimental primates and other animals with no spread out into the open. And based on models of travel patterns published earlier this month, we already knew that an imported case of Ebola might make its way here. Hospitals across the country have been busy preparing, and there have been a few suspected cases that ended up testing negative, so we’ve already had test runs in Ohio, New York, California and other areas.

Second, Judy Stone, MD, at Scientific American, on putting the risk of Ebola — even in the US — in perspective:

Basic isolation is something we do everyday in hospitals. Here, for example, is a photo of me garbed to enter an isolation room for a patient with CRE (carbapenem-resistant Enterobacter). Not Ebola, but an increasingly common, often fatal bacteria most commonly acquired in hospitals, and associated with a 40-50% death rate. I wish more people would get excited about CRE or other highly resistant bacteria (superbugs). Nosocomial (hospital-acquired) infections are far more likely to kill you in the US than Ebola is.

Now, my two issues, addressing identifying the patient last week, and caring for him now:

According to several reports (such as this one from Julia Belluz), when the patient went to the ER the first time, he told health care workers that he had been in Liberia recently. That information was not considered important and not communicated to the rest of the ER team, and he was sent home.

This was a major misstep. Given our very interconnected world, and the increasing importation of what are called “tropical” diseases, taking a travel history and paying attention to the results ought to be a routine part of any ER workup. In fact, the CDC had already specifically recommended this because of the possibility that Ebola might be imported.

Because the patient’s travel history was not attended to, he was sent home, and 12-18 others (including a few school-age children) will now be monitored for possible spread of the disease in the outside world. The second point I want to raise, though, is the possibility of spread within healthcare — not so much at the Texas hospital, because all eyes will be on it now, but in whatever hospital might receive the next Ebola patient to arrive.

As a specialty, infection prevention — that’s the science of keeping disease organisms from spreading in hospitals, nursing homes and other health acre institutions — gets a lot of lip service, but very little money or prioritization. Check, for instance, Eli Perencevich’s calculations of federal antibiotic-resistance prevention funding; the Infectious Diseases Society of America’s anatomization of government policies regarding reimbursement for infection-prevention consults; or my exploration for Scientific American of how much infection control depends on minimum-wage workers.

If — as seems probable — other Ebola-infected persons arrive in the US, it would be good to know that the control of their infection will depend on a corps of physicians and other healthcare workers who are not only highly trained, but also highly compensated and valued by health care systems that have emphasized the importance of their tasks to the rest of the systems’ personnel. I’m not sure we can say that now.


Leave a Reply

Your email address will not be published. Required fields are marked *