First US Ebola case: Why the delayed diagnosis?

Public health officials remain confident that the first case of Ebola in the US, announced Tuesday, will not spread or become an outbreak. But they acknowledge that case was not diagnosed as soon as it could have been.

John Bazemore/AP
Director of Centers for Disease Control and Prevention Tom Frieden speaks during a news conference Tuesday after confirming that a patient in Texas has tested positive for Ebola.

Public health officials remain confident that the first case of Ebola in the United States, announced Tuesday, will not spread or become an outbreak. But they acknowledge that case was not diagnosed as soon as it could have been. 

The man, whose name is not being released and is now receiving treatment, flew from Liberia to Texas on Sept. 20 and was diagnosed with the disease on Sept. 28. But he made his first visit to the hospital on Sept. 26 and was sent home. CNN is reporting that no one at the hospital asked the man if he had traveled recently, despite his symptoms being consistent with Ebola.

Several people who made contact with the patient, including paramedics and emergency room workers, are now under medical observation in Dallas.

The assertion by Thomas Frieden, director of the Centers for Disease Control and Prevention, that “we are stopping this in its tracks” is based on a strong track record. Similar diseases have been introduced in America before and failed to spread, a fact attributed to advanced medical and public health systems. Moreover, the US has already treated four infected US medical professionals, three of them at the Emory University Medical Center in Atlanta. Three of those people are now fine; the fourth remains at the hospital, and his condition has not been updated for several days.

But the apparent oversight in the Texas case is raising questions about whether the US response plan needs to be sharpened further. 

Without addressing the Texas case specifically, Dr. Frieden said hospitals need to be alert for Ebola-like symptoms.

"We know that in busy emergency departments all over the country, people may not ask travel histories," he said on CNN's "New Day." "I don't know if that was done here. But we need to make sure that it is done going forward."

But officials are seeking to calm other public concerns, which they say are unfounded.

According to reports, the man was not tested before departing Liberia, but that was because he showed no symptoms and fell outside the CDC’s protocol to check those who have been in direct contact with the disease.

The CDC also says it is not going to release the man's flight information because "it's just not necessary," a spokesperson told ABC News. The man did not show symptoms until Sept. 24 – four days after the flight – and Ebola isn't communicable unless the person is showing symptoms, Frieden said on CNN.

Meanwhile, Dallas officials acknowledged that the ambulance used to bring the man to Texas Health Presbyterian Hospital was used for another two days. It is now parked in a city parking lot surrounded by red "biohazard" tape. But city spokeswoman Sana Syed told CNN that the ambulance had been decontaminated, as ambulances are after every transport.

Economic and cultural forces are at play in how the disease spreads in impoverished African regions: Lack of sanitary facilities and counterproductive folk remedies and burial customs have aided the virus’s spread.

More broadly, National Institutes of Health officials raised concerns two weeks ago about the impact of budget cuts on epidemic response around the globe. Sequester-related cuts, which amounted to $1.55 billion in 2013, have "eroded our ability to respond,” said NIH representative Anthony Fauci in congressional testimony Sept. 16.

"If even modest investments had been made to build a public health infrastructure in West Africa previously, the current Ebola epidemic could have been detected earlier, and it could have been identified and contained," added Beth Bell, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.

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