Since the first imported case of Ebola in the U.S. was confirmed at Texas Health Presbyterian Hospital in Dallas Sept. 30, much has developed, including the first and second known transmissions of Ebola virus disease in the nation.
Here are five things to know about the new Ebola cases in Dallas and how the U.S. is responding to the first known transmissions of the Ebola virus on American soil.
1. Two Dallas healthcare workers now have Ebola. Nina Pham, a 26-year-old nurse, is the first person to transmit the virus after caring for Thomas Eric Duncan, the patient at Texas Health Presbyterian Hospital in Dallas who contracted the disease in Liberia and died at the hospital in October. Ms. Pham was admitted to Texas Health Presbyterian on Oct. 10, and the Centers for Disease Control and Prevention confirmed she had Ebola Oct. 12. Ms. Pham received a blood transfusion from Kent Brantly, MD, an American missionary who received treatment for the Ebola virus in August at Emory University Hospital, and she is "doing well."
A second healthcare worker from Texas Health Presbyterian — identified in many reports as Amber Vinson, a 29-year-old nurse from the hospital — tested positive for Ebola Oct. 15. She was admitted to Texas Health Presbyterian the morning of Oct. 14 with a low-grade fever.
The CDC had said 76 staff members from the hospital could have been exposed to Mr. Duncan after his second visit to the emergency room, when he was admitted.
2. The second patient traveled on a commercial flight the day before exhibiting symptoms. According to the CDC, Ms. Vinson traveled from Cleveland to Dallas on a commercial flight Oct. 13, the day before she reported symptoms of Ebola virus disease. Though the crew from Frontier Airlines flight 1143 reported Ms. Vinson exhibited no symptoms of the illness while on the flight, "because of the proximity in time between the evening flight and first report of illness the following morning, CDC is reaching out to passengers" who were on the flight, according to a CDC news release.
The flight had 132 passengers. Those passengers are asked to call 1 800-CDC INFO, and public health professionals are interviewing passengers about the flight. Passengers who are potentially at risk will be "actively monitored," according to the CDC.
Frontier Airlines has removed the plane the patient traveled in from service.
3. The second patient will be transferred to Emory University Hospital. Ms. Vinson will not be treated for the illness at the hospital where she worked; instead, she will be flow to Emory University Hospital in Atlanta, according to an NBC News report. Emory University Hospital is one of four hospitals in the nation equipped with a biocontainment care unit designed to care for patients exposed to highly contagious and dangerous diseases, and the hospital has successfully cared for and released two other patients who contracted Ebola while in West Africa.
Emory University Hospital is also sending support to Dallas, as two infection control nurses from Emory who have experience treating Ebola have been sent to Dallas to provide support and training.
4. Nurses cite sloppy Ebola protocols. Nurses across the country were skeptical on the nation's ability to handle Ebola, as more than 60 percent of RNs who participated in a survey said their hospital is not prepared for the virus. Many felt their hospitals did not prepare them to treat the deadly virus: 80 percent said their hospital had not communicated to them policies regarding potential admission of an Ebola patient and 85 percent reported their hospital did not provide Ebola education.
More specifically, some nurses from Texas Health Presbyterian have claimed faulty infection control procedures at the hospital, including reports that they had to use medical tape to secure openings in their protective gear, according to a Washington Post report. They also noted that they were allowed to follow whatever Ebola guidelines they chose, as the guidelines continued to evolve.
In response to the nurse's statements, a hospital spokesperson told the Post, "Patient and employee safety is our greatest priority."
5. CDC is rethinking its infection control approach and sending teams to Texas Health Presbyterian to help. In wake of the first Ebola transmission, Thomas Frieden, MD, the director of the Centers for Disease Control and Prevention, announced the CDC had to "rethink" how it and the U.S. healthcare system address Ebola infection control. Some changes the CDC is eyeing at Texas Health Presbyterian include different, easier-to-use personal protective equipment and applying a spray substance onto healthcare workers who exit an isolation unit that would kill any Ebola virus that came out with them. Also, the CDC is looking into what medical procedures were done that may have led to the exposure.
Additionally, the CDC is taking numerous steps to ensure further spread of the disease is stopped. For example, the team has set up a dedicated CDC Response Team that could be on the ground within hours at any hospital that receives a confirmed Ebola patient. The team would work with healthcare staff to follow strict protocols and keep patients and healthcare workers safe.
In Dallas specifically, the CDC is sending an additional team that has successfully controlled Ebola in Africa, and there is now a site manager in place at Texas Health Presbyterian who is overseeing workers putting on and taking off PPE.
To ensure healthcare workers across the nation are prepared for caring for an Ebola patient, the CDC has set up many training and educational sessions. Find the full list of opportunities here.
The Ebola outbreak in West Africa — the largest Ebola outbreak in history — has resulted in 4,033 deaths as of Oct. 10, according to the CDC.
Find more information on the Ebola outbreak in West Africa here.
For more information on the nation's first Ebola case and the U.S.'s history with the disease, click here.