Dallas public health officials are now noting a 2nd individual of interest who may also have been infected with Ebola. This individual was in close contact with the original case. This is an indication that Dallas officials are doing their jobs appropriately, and as we would expect.
For the medical community, however, this experience should be a major wake up call:
- Failure to properly execute screening protocols for suspect Ebola patients may cost you the nurse / physician / EMT your life, the lives of those you work with, and the patients in contact with the suspect case. Failure to take screening procedures seriously may cost a major megalopolitan are in the US unnecessary socio-economic disruption due to an outbreak.
- Taking a travel history is NOT fool proof. We have observed multiple instances, historically and currently, of Ebola patients leaving epidemic zones in Africa, arriving in a foreign country, and failing to disclose their travel or exposure history. This is a trend we are observing now. ANY suspicion of an arrival from Guinea, Sierra Leone, or Liberia should be treated as a suspect case until proven otherwise. Nationality of the patient (i.e. even if a US citizen) should not be a factor in this decision. In other words, "trust but verify". Your life and those around you may depend on it. And your community is counting on you to err on the side of caution.
- There are strong indications the healthcare provider community in Dallas failed to properly execute the screening protocol. It is clear there were several lost opportunities to isolate this patient during his initial presentation to the hospital. This failure may well result in a limited outbreak in Dallas- an unnecessary outcome had proper preparedness and response been executed.
Dallas' medical and public health community are about to experience some difficult lessons in the days ahead. We are fortunate we are not in the peak of RSV or influenza season. Let us hope the experience of Dallas provides ample evidence to those who resist proper preparedness that Ebola is a serious risk to any medical facility and community caught by surprise.