Ebola virus cases in the United States


Four laboratory-confirmed cases of Ebola virus disease occurred in the United States in 2014. Eleven cases were reported, including these four cases and seven cases medically evacuated from other countries. The first was reported in September 2014. Nine of the people contracted the disease outside the US and traveled into the country, either as regular airline passengers or as medical evacuees; of those nine, two died. Two people contracted Ebola in the United States. Both were nurses who treated an Ebola patient; both recovered.
On September 30, 2014, the Centers for Disease Control and Prevention announced that Thomas Eric Duncan, a 45-year-old Liberian national visiting the United States from Liberia, had been diagnosed with Ebola in Dallas, Texas.
Duncan, who had been visiting family in Dallas, was treated at Texas Health Presbyterian Hospital Dallas. By October 4, his condition had deteriorated from "serious but stable" to "critical". On October 8, he died of Ebola.
The other three cases diagnosed in the United States as of 2014 were:
  • October 11, 2014, a nurse, Nina Pham, who had provided care to Duncan at the hospital.
  • October 14, 2014, Amber Joy Vinson, another nurse who treated Duncan.
  • October 23, 2014, physician Craig Spencer, diagnosed in New York City; he had just returned from working with Doctors Without Borders in Guinea, a country in West Africa. He was treated at Bellevue Hospital in New York City.
Hundreds of people were tested or monitored for potential Ebola virus infection, but the two nurses were the only confirmed cases of locally transmitted Ebola. Public health experts and the Obama administration opposed instituting a travel ban on Ebola endemic areas, stating that it would be ineffective and would paradoxically worsen the situation.
No one who contracted Ebola while in the United States died from it. No new cases were diagnosed in the United States after Spencer was released from Bellevue Hospital on November 11, 2014.

Cases diagnosed in the U.S.

First case: Thomas Eric Duncan

Thomas Eric Duncan in Liberia

was from Monrovia, Liberia, to date the country hit hardest by the Ebola virus epidemic. He worked as a personal driver for the general manager of Safeway Cargo, a FedEx contractor in Liberia. According to manager Henry Brunson, Duncan had abruptly quit his job on September 4, 2014, giving no reason.

On September 15, 2014, the family of Marthalene Williams, who later died of Ebola virus disease, could not call an ambulance to transfer the pregnant Williams to a hospital. Duncan, their tenant, helped to transfer Williams by taxi to an Ebola treatment ward in Monrovia. Duncan rode in the taxi to the treatment ward with Williams, her father and her brother.
On September 19, Duncan went to Monrovia Airport, where, according to Liberian officials, he lied about his history of contact with the disease on an airport questionnaire before boarding a Brussels Airlines flight to Brussels. In Brussels, he boarded United Airlines Flight 951 to Washington Dulles Airport. From Dulles, he boarded United Airlines Flight 822 to Dallas/Fort Worth. He arrived in Dallas at 7:01 p.m. CDT on September 20, 2014, and stayed with his partner and her five children, who lived in the Fair Oaks apartment complex in the Vickery Meadow neighborhood of Dallas. Vickery Meadow, the neighborhood in Dallas where Duncan lived, has a large African immigrant population and is Dallas's densest neighborhood.

Duncan's illness in Dallas

Duncan began experiencing symptoms on September 24, 2014, and arrived at the Texas Health Presbyterian Hospital emergency room at on September 25. At, a triage nurse asked him about his symptoms, and he reported feeling "abdominal pain, dizziness, nausea and headache ". The nurse recorded a fever of, but did not inquire as to his travel history as this was not triage protocol at the time. At, Duncan was admitted into a treatment area room where the on-duty physician accessed the electronic health record. The physician noted nasal congestion, a runny nose, and abdominal tenderness. Duncan was given paracetamol at CT scan results came back noting "no acute disease" for the abdominal and pelvic areas and "unremarkable" for the head. Lab results returned showing slightly low white blood cells, low platelets, increased creatinine, and elevated levels of the liver enzyme AST. His temperature was noted at at and at Duncan was diagnosed with sinusitis and abdominal pain and sent home at with a prescription for antibiotics, which are not effective for treating viral diseases.

Duncan's condition worsened, and he was transported on September 28 to the same Texas Health Presbyterian Hospital emergency room by ambulance. He arrived in the emergency room at, experiencing diarrhea, abdominal pain, and fever. Within fifteen minutes, a doctor noted that Duncan had recently come from Liberia and needed to be tested for Ebola. The doctor described following "strict protocol" including wearing a mask, gown, and gloves. At, the doctor called the CDC directly. By, Duncan was experiencing explosive diarrhea and projectile vomiting. At the next morning, the doctor noted that he "appeared to be deteriorating". By, he was severely fatigued, enough to prevent him from using the bedside toilet. Later that day, he was transferred to an intensive care unit after all other patients had been evacuated. The next day, September 30, he was diagnosed with Ebola virus disease after a positive test result.
Duncan's diagnosis was publicly confirmed during a CDC news conference the same day.
That evening, Duncan reported feeling better and requested to watch a movie. The following morning, he was breathing rapidly and complaining of "pain all over". By the afternoon, however, he was able to eat, and the doctor noted that he was feeling better. The next day, October 3, he again reported feeling abdominal pain. That evening, the hospital contacted Chimerix, a biotechnology company developing Brincidofovir to combat the disease. The next day, Duncan's organs were failing, and he was intubated to help him breathe. In the afternoon, the hospital began administering Brincidofovir. Nurses Nina Pham and Amber Joy Vinson continued to care for Duncan around the clock. On October 7, the hospital reported that Duncan's condition was improving. However, he died at on October 8, becoming the first person to die in the United States of Ebola virus disease and the index patient for the later infections of nurses Pham and Vinson.

Contact tracing

On October 5, the CDC announced it had lost track of a homeless man who had been in the same ambulance as Duncan. They announced efforts were underway to find the man and place him in a comfortable and compassionate monitoring environment. Later that day, the CDC announced that the man had been found and was being monitored.
Up to 100 people may have had contact with those who had direct contact with Duncan after he showed symptoms. Health officials later monitored 50 low- and 10 high-risk contacts, the high-risk contacts being Duncan's close family members and three ambulance workers who took him to the hospital. Everyone who came into contact with Duncan was being monitored daily to watch for symptoms of the virus, until October 20, when health officials removed 43 out of the 48 initial contacts of Thomas Duncan from isolation. On November 7, 2014, Dallas was officially declared "Ebola free" after 177 monitored people cleared the 21 day threshold without becoming ill.

Reactions

On October 2, Liberian authorities said they could prosecute Duncan if he returned because before flying he had filled out a form in which he had falsely stated he had not come into contact with an Ebola case. Liberian President Ellen Johnson Sirleaf told the Canadian Broadcasting Corporation she was angry with Duncan for what he had done, especially given how much the United States was doing to help tackle the crisis: "One of our compatriots didn't take due care, and so, he's gone there and in a way put some Americans in a state of fear, and put them at some risk, and so I feel very saddened by that and very angry with him. ... The fact that he knew and he left the country is unpardonable, quite frankly."
Before his death, Duncan brazenly claimed that he did not know at the time of boarding the flight that he had been exposed to Ebola; he said he believed the woman he helped was having a miscarriage, which contradicts corroborated accounts from family members who also helped transport the woman to an Ebola ward.
Duncan's family said the care Duncan received was at best "incompetent" and at worst "racially motivated". Family members threatened legal action against the hospital where Duncan received treatment. In response, Texas Health Presbyterian Hospital issued a statement, "Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care. We have a long history of treating a multicultural community in this area."
The hospital spent an estimated $500,000 to treat the uninsured Duncan.
Officials at Texas Presbyterian Hospital reported that patients' cancellation of elective surgeries and potential emergency patients' preference for other hospitals' emergency rooms had left their hospital looking like a "ghost town".
The reaction to the care and treatment of Thomas Duncan, and the subsequent transmission to two of the nurses on his care team, caused several hospitals to question the extent to which they are obligated to treat Ebola patients. Their concern surrounds the reality that understaffed and poorly equipped hospitals performing invasive procedures, like renal dialysis and intubation, both of which Duncan received at Texas Presbyterian, could put staff at too much risk for contracting the virus. Emory University Hospital in Atlanta also used renal dialysis in treating patients at their biocontainment unit, but no health care workers became infected. In October 2014 Vickery Meadow residents stated that people were discriminating against them because of the incident.