New concern worldwide as nurse in Spain gets Ebola
By CONNIE CASS and LAURAN NEERGAARD
WASHINGTON — Raising fresh concern around the world, a nurse in Spain on Monday became the first person known to catch Ebola outside the outbreak zone in West Africa. In the U.S., President Barack Obama said the government was considering ordering more careful screening of airline passengers arriving from the region.
In dealing with potential Ebola cases, Obama said, "we don't have a lot of margin for error."
Already hospitalized in the U.S., a critically ill Liberian man, Thomas Duncan, began receiving an experimental drug in Dallas. But there were encouraging signs for an American video journalist who returned from Liberia for treatment. Ashoka Mukpo, 33, was able to walk off the plane before being loaded on a stretcher and taken to an ambulance, and his father said his symptoms of fever and nausea appeared mild.
"It was really wonderful to see his face," said Dr. Mitchell Levy, who talked to his son over a video chat system at Nebraska Medical Center.
In Spain, the stricken nurse had been part of a team that treated two missionaries flown home to Spain after becoming infected with Ebola in West Africa. The nurse's only symptom was a fever, but the infection was confirmed by two tests, Spanish health officials said. She was being treated in isolation, while authorities drew up a list of people she had had contact with.
Medical workers in Texas were among Americans waiting to find out whether they had been infected by Duncan, the African traveler.
In Washington, the White House continued to rule out any blanket ban on travel from West Africa.
People leaving the outbreak zone are checked for fevers before they're allowed to board airplanes, but the disease's incubation period is 21 days and symptoms could arise later.
Airline crews and border agents already watch for obviously sick passengers, and in a high-level meeting at the White House, officials discussed potential options for screening passengers when they arrive in the U.S. as well.
Obama said the U.S. will be "working on protocols to do additional passenger screening both at the source and here in the United States." He did not outline any details or offer a timeline for when new measures might begin.
Additional screening would not have caught Duncan because he wasn't exhibiting any Ebola symptoms when he arrived in the U.S.
The Obama administration maintains that the best way to protect Americans is to end the outbreak in Africa. To that end, the U.S. military was working Monday on the first of 17 promised medical centers in Liberia and training up to 4,000 soldiers this week to help with the Ebola crisis.
The U.S. is equipped to stop any further cases that reach this country, said White House spokesman Josh Earnest.
"The tragedy of this situation is that Ebola is rapidly spreading among populations in West African who don't have that kind of medical infrastructure," Earnest said.
About 350 U.S. troops are already in Liberia, the Pentagon said, to begin building a 25-bed field hospital for medical workers infected with Ebola. A torrential rain delayed the start of the job on Monday.
The virus has taken an especially devastating toll on health care workers, sickening or killing more than 370 in the hardest-hit countries of Liberia, Guinea and Sierra Leone — places that already were short on doctors and nurses before Ebola.
Texas Gov. Rick Perry urged the U.S. government to begin screening air passengers arriving from Ebola-affected nations, including taking their temperatures.
Perry stopped short, however, of joining some conservatives who have backed bans on travel from those countries.
Federal health officials say a travel ban could make the desperate situation worse in the afflicted countries, and White House spokesman Earnest said it was not currently under consideration.
Southwest Airlines CEO Gary Kelly said he saw no need for additional screening at airports and noted that airlines already carefully clean planes.
Airlines have dealt with previous epidemics, such as the 2003 outbreak in Asia of SARS, or severe acute respiratory syndrome.
"Now it's Ebola," Kelly said. "We are always on the alert for any kind of infectious disease."
The U.S. didn't ban flights or impose extra screening on passengers during the SARS outbreak or the 2009 swine flu pandemic. Both of those were airborne diseases that spread more easily than the Ebola virus, which is spread by contact with bodily fluids.
The CDC did meet many direct flights arriving from SARS-affected countries, to distribute health notices advising travelers that they might have been exposed, how they could monitor their health and when to call a doctor.
Canadian health authorities attempted various methods of screening arriving passengers for SARS, including sometimes checking for fever. Authorities later reported that five SARS patients entered Canada in three months, but none had symptoms while traveling through airports.
General airport fever checks aren't very effective, especially as flu season begins, said Lawrence Gostin, a prominent health law professor at Georgetown University. But checking and questioning only passengers from the outbreak zone "might reassure the public. I don't think there would be a big downside."
The SARS death rate was about 10 percent, higher for older patients. Its new relative MERS, now spreading in the Middle East, appears to be more deadly, about 40 percent. About half of people infected with Ebola have died in this outbreak.
Associated Press writers Jorge Sainz in Spain, David Koenig in Dallas, Josh Funk in Omaha, Matthew Perrone, Lolita Baldor and Joan Lowy in Washington, and Krista Larson and Sarah DiLorenzo in Liberia contributed to this report.
Doctors from East Georgia Regional Medical Center and Georgia Southern University as well as emergency response officials from Bulloch County, Statesboro and state agencies met Monday at the hospital to show a united front in dealing with the possibility of an Ebola outbreak.
The case of a man being treated in a Texas hospital after returning from Liberia remained the only known instance of the viral disease developing in someone already in the United States. So officials such as hospital CEO Bob Bigley referred to the threat as "very low" in southeast Georgia.
"Even though, from the hospital's perspective, we feel the area's at very low risk, we know we're not the end-all on this subject, and we appreciate having everybody here in developing our response plan," Bigley said, welcoming the roughly 35 participants.
Trevor Thomas, the epidemiologist for Georgia's Southeast Health District, said the 16-county district contains no known population groups from either Liberia or Sierra Leone, countries in West Africa that have active outbreaks.
"So from that perspective, there's not much risk there," Thomas agreed. "Additionally, Guinea, Sierra Leone and Liberia are not very high on the vacation spots for South Georgians."
Georgia Southern University, however, does have international students, as well as some visiting professors, from West Africa.
Dr. Brian DeLoach, the director of the GSU Student Health Center, said the university has about 80 students from the region but that the largest percentage, at least half, come from Nigeria, and others from Burkina Faso.
The university has no students from Guinea, Liberia, Sierra Leone or Senegal, he said. Those countries, plus Nigeria, are on the Centers for Disease Control and Prevention's list of countries that have had Ebola cases this year. However, Nigeria and Guinea have seen fewer cases after a quick response, Southeast Health District Emergency Preparedness Coordinator Roger Naylor explained after the meeting.
All of the West African students at Georgia Southern, DeLoach had noted, have now been at the university more than 21 days and so are past the maximum incubation period for the Ebola virus, meaning none could carry it.
"We don't anticipate any of them traveling home over the break," DeLoach said. "That's not typically what they do. There may be a very small number who are coming for spring who are not here already. We're going to be having some discussions about what that means for us."
GSU Provost and Vice President for Academic Affairs Dr. Jean Bartels said international students communicate regularly with a campus group and would be unlikely to leave the country or return without the university knowing about it.
However, the university has no control over international students being visited by friends or family from their home countries, and has to rely on people to self-report private travel, DeLoach said.
"We're glad those individuals chose us to come here to study," he said after the meeting. "We just want to keep them safe and healthy, and we want to keep the rest of our campus safe and healthy as well and do that in the appropriate way."
In fact, university officials have a meeting on Ebola-related concerns planned for today.
DeLoach also had a question for the hospital.
Under Georgia Southern's protocol, he said, if someone reports to the Health Center with symptoms and other risk factors, he or the other staff physician would wear protective gear while obtaining a more thorough patient history.
If all the signs pointed to Ebola, the Health Center would call the Emergency Medical Service to transport the patient to the hospital.
"So this is important to have this discussion," DeLoach said. "Is everybody OK with that? Would the hospital accept the patient? Would EMS be willing to transport the patient in that situation?"
Dr. Allen Scott, the medical director of EGRMC's emergency department, said the hospital would probably serve as a staging area for testing, then do a referral to another hospital for the specialized care. Emergency room Clinical Director Amy Shuman said the hospital plans to have the protective equipment in place in its triage room for personnel who would handle the patients. Bulloch County EMS Director Doug Vickers said the agency will also have the masks, gloves and other equipment and would like a "heads-up to slow down and do it right."
To not ‘drop the ball'
The 2014 Ebola outbreak has been larger than all previous years' combined, with more than 3,400 deaths from more than 7,400 suspected cases. The disease is spread through direct contact with the bodily fluids, including sweat, of a person who is showing symptoms.
Using a special isolation unit, Emory University Hospital in Atlanta has treated three patients who came down with Ebola while in Africa, including a doctor who had been there to treat patients. But the only known case of someone developing symptoms after open travel to the United States remains that of Thomas Eric Duncan, who arrived in Dallas from Liberia. Duncan told a nurse at Texas Health Presbyterian Hospital he had been to West Africa, but was sent home after his initial visit to the emergency room, the Associated Press reported.
One purpose of Monday's meeting was to make sure that Statesboro's hospital and emergency responders are not "the next to drop the ball," by forgetting to ask a question or communicate what they learn, Bigley said.
Bulloch County Public Safety Director Ted Wynn helped lead the meeting. Afterward, he said the group appeared prepared and informed.
"I obviously feel good about the fact that we are at low risk here in Bulloch County, but I also feel good about the fact that we're keeping our eye on this and making sure that we stay informed," Wynn said.
Al Hackle may be reached at (912) 489-9454.