Second Ebola case in US tests whether states can handle outbreak

One of the nurses treating the Liberan man who died in Dallas last week has been diagnosed with Ebola. Texas' Ebola response is under intense scrutiny.

Louis DeLuca/The Dallas Morning News/AP
Police guard the residence of a health care worker in Dallas Sunday who was diagnosed with Ebola. The worker, who was caring for Ebola patient Thomas Eric Duncan, tested positive for the disease in preliminary tests.

The announcement that a second person in the United States has been diagnosed with Ebola is emerging as a crucial test for how Texas is responding to the virus and whether a more centralized, national response is needed in such high-profile health cases.

A nurse who helped treat Thomas Eric Duncan, who died Wednesday, was diagnosed with the disease Saturday. Though the nurse wore protective gear while treating Mr. Duncan, there was a "breach in protocol," said Tom Frieden, director of the Centers for Disease Control and Prevention.

Officials have not yet pinpointed the breach, but they noted that the protocol for removing protective gear is very important, for example. They also stressed that, when protocols are followed, nurses and doctors can safely treat Ebola patients without spreading the disease.

But Texas has come under criticism for how it handled Duncan's case – most notably, how a Texas hospital sent him home for two days when, according to correct procedure, it clearly should have diagnosed the disease. Texas officials also kept Duncan's family in the house where he had become symptomatic.

"In Texas, they really were slow to the plate," Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine, told USA Today. "Texas is going to be the example of what not to do."

Texas officials have argued that they have an effective system in place for dealing with Ebola, and there are signs that the system led to the early diagnosis of the nurse, who has not been named. All medical personnel who treated Duncan are required to take their temperature twice a day. When the nurse noticed her temperature was high, she sought treatment.

"The entire process, from the patient's self-monitoring to the admission into isolation, took less than 90 minutes," said Dan Varga, the chief clinical officer of Texas Health Resources, the hospital's parent company, said at a Sunday news conference.

Early diagnosis can be crucially important in medical treatment of Ebola. Dr. Varga said the patient's condition is currently listed as stable. The CDC's Dr. Frieden said the level of Ebola in her system is low.

Yet the fact that a second person has been diagnosed in the US is a concern, officials say. Each state is in charge of its own response to a potential diagnosis of Ebola. The federal CDC merely advises and prepares.

"The states can follow all the guidelines and take the advice, which they usually do, but they don't have to," Professor Murphy told USA Today. "So there really is no one entity that's controlling things."

Some lawmakers are questioning that arrangement. Sen. John McCain (R) of Arizona called on President Obama to create a Ebola "czar" who could coordinate a national response and work across state and federal agencies.

"I'd like to know who’s in charge," Senator McCain said on CNN’s "State of the Union" Sunday.

Two Texas Republicans – Sen. John Cornyn and Rep. Michael McCaul – also called on US Customs and Border Protection to expand Ebola screenings to George Bush airport in Houston and Dallas-Fort Worth airport. The screenings are currently only slated for New York's John F. Kennedy, Washington-Dulles, Newark, Chicago O'Hare, and Atlanta Hartsfield-Jackson.

Many experts say the screenings are more about calming public fear than containing the spread of the disease.

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