Delay in Dallas Ebola Cleanup as Workers Balk at Task

Kevin Sack and Marc Santoraoct, New York Times, October 2, 2014

More than a week after a Liberian man fell ill with Ebola and four days after he was placed in isolation at a hospital in Dallas, the apartment where he was staying with four other people had not been cleaned and the sheets and dirty towels he used while sick remained in the home, health officials acknowledged on Thursday afternoon.

Even as the authorities were reaching out to at least 80 people who may have had contact–either directly or indirectly–with the patient, Thomas E. Duncan, while he was contagious, they were scrambling to find medical workers to safely clean the apartment.

Thomas Duncan

Thomas Duncan

The four family members who are living there are among a handful who have been directed by the authorities to remain in isolation, following what officials said was a failure to comply with an order to stay home. Texas health officials hand-delivered orders to residents of the apartment requiring them not to leave their home and not to allow any visitors inside until their roughly three-week incubation periods have passed.

The orders–known as communicable disease control orders–are permitted under the state’s health code. Violations could result in either criminal prosecution or civil court proceedings.

But even as the orders were being issued, there were concerns about the conditions in the home where they were being ordered to stay.

The woman who was hosting Mr. Duncan told CNN that she had been with him the first time he sought treatment at the hospital and that she had twice told workers there he had been in Liberia. Still they sent him back with only some antibiotics to the apartment, where the woman was staying with one of her children and two nephews.

Over the next two days, Mr. Duncan began sweating profusely and had diarrhea. His sweaty sheets were still on the bed on Thursday morning, the woman said. She put the towels he used in a bag but said she did not know what to do with them.

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The Texas health commissioner, Dr. David Lakey, told reporters during an afternoon news conference that health workers should have moved more swiftly to clean the apartment but that they had had trouble finding an outside medical team to do the work. They encountered “a little bit of hesitancy,” he said.

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A spokeswoman for the Dallas County health and human services department, Erikka Neroes, said the initial list of 12 to 18 people thought to have direct contact with Mr. Duncan had been expanded to people who had either direct or secondary contact.

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The five children who came in contact with Mr. Duncan were being kept home from school, and local officials tried to reassure parents at the four different schools they attended that the facilities were thoroughly cleaned and that children are safe. There were reports that some parents were keeping their children home.

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Mr. Duncan remained in isolation at Texas Health Presbyterian Hospital on Thursday, in stable but serious condition. Mr. Duncan probably became infected in Monrovia, the Liberian capital, on Sept 15, when he helped carry his landlord’s convulsing pregnant daughter to a clinic to be treated for Ebola.

The woman, 19-year-old Marthalene Williams, was turned away from the overcrowded clinic because it did not have room for her and died the next day. The landlord’s son and three neighbors who came in contact with the woman also died soon afterward.

Mr. Duncan went to the airport in Monrovia on Sept. 19 to board a flight to Brussels and then on to the United States. From Brussels, Mr. Duncan flew to Dulles International Airport, near Washington, on Sept. 20 on United Flight 951, and then on to Dallas-Fort Worth on Flight 822, the airline confirmed.

Four days later, on Sept. 24, Mr. Duncan told doctors, he started to get sick. On Sept. 25, he went the emergency room with a fever and nausea.

He was sent home under the mistaken belief that he had only a mild fever, a hospital administrator said; the information that he had traveled from Liberia, one of the nations at the heart of the Ebola epidemic, was overlooked.

He returned to the hospital on Sept. 28, this time sped there in an ambulance and gravely ill.

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