A second health care worker who treated the United States' first Ebola patient has been infected. The incident has exposed a series of gaps in US preparedness for confronting the deadly virus.
President Barack Obama and top US health authorities said last month that the United States was ready for the "unlikely event" that the hemorrhagic virus ravaging West Africa could make its way into the United States, and that any emergence would be quickly contained.
But when a Liberian man with a fever, body pains and recent history of travel to the country the worst hit by current epidemic first walked into a Dallas hospital on September 25, he was sent back home after about four hours.
That decision put other emergency room patients, the man's family and hospital staff at risk of exposure to Ebola.
When he was rushed via ambulance back to that same hospital on September 28, vomiting and experiencing diarrhea which made him highly contagious, dozens of health care staff may have been infected by not adequately protecting themselves.
Thomas Eric Duncan was not diagnosed with Ebola until September 30, and he died on October 8.
The CDC has identified 118 people who either had definite or possible contact with Duncan, more than half of whom are health care workers.
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The first case of infection in the US was announced Sunday, in a nurse named Nina Pham, followed by another female health care worker on Wednesday.
"What happened there, regardless of the reason, is not acceptable," said Anthony Fauci, head of the National Institute for Allergy and Infectious Diseases.
The Centers for Disease Control and Prevention chief Thomas Frieden described the situation as "very concerning."
"The investigation is identifying additional health care workers who will be very closely monitored and we are planning for the possibility of additional cases in the coming days," he said.
National Nurses United said that their discussions with staff at the Texas Health Presbyterian Hospital Dallas revealed the facility was woefully unprepared to deal with an Ebola patient Duncan arrived.
"Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present," the union said of his arrival at Texas Health Presbyterian Hospital Dallas on September 28.
"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."
The union said blood specimens were not specially sealed or hand delivered to labs as required, and that nurses who treated him were not properly covered.
Ebola is transmitted through close contact with the bodily fluids of an infected person, and healthcare workers are at particular risk because the patients often vomit profusely and have severe diarrhea.
"Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks," it added.
"The suits they were given still exposed their necks, the part closest to their face and mouth."
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The nurses' union has sent a letter to President Barack Obama asking for better training and improved protective equipment so that nurses are not placed in harm's way.
Frieden said Wednesday that staff at the Dallas hospital showed "a lot of variability in the use of personal protective equipment," including wearing three to four layers of coverings.
He said he understood the "fear and the anxiety" that the staff must have felt, but pointed out that putting on more layers actually increased the risk of contamination by making them harder to safely take off.
Frieden also admitted Tuesday he made a mistake by not sending a specialized CDC team to Dallas right away to train staff and oversee the response.
"What we are dealing with is a disease that's unfamiliar in the US. It's hard. I've thought often about it. I wish we had put a team like this on the ground" right after Duncan was diagnosed, he told reporters.
"That might have prevented this infection."
Frieden vowed to immediately dispatch an expert team anywhere needed, should future cases arise.
A new wrinkle in the CDC's handling of the response emerged Wednesday when Frieden said the second health care worker who was infected had traveled on a domestic flight from Ohio to Texas the day before she was diagnosed.
She should not have been allowed to do so even though her colleague's diagnosis had not yet been made.
"She was in a group of individuals known to have exposure to Ebola. She should not have traveled on a commercial airline," Frieden said.
Asked by reporters during the White House briefing if Obama continued to have confidence in Frieden, spokesman Josh Earnest said "yes."