Health officials say Ebola in Phila. is conceivable

Hospital and public health officials are acutely aware of the public dismay at the poor handling of the first case of Ebola diagnosed - too late - in this country.

Thomas E. Duncan, 42, arrived in Dallas from Liberia on Sept. 20. He became sick and went to a Dallas hospital on Sept. 25, but was misdiagnosed and sent home. He returned to the hospital by ambulance on Sunday and is now in isolation, in serious condition.

About 50 people who came into contact with him after he developed symptoms - which is when the disease is contagious - are being monitored closely, including four family members who are under quarantine for 21 days at a Dallas apartment complex.

"It's a full-court press to make sure it doesn't happen again," said Thomas Grace, vice president of health services and disaster preparedness for the Delaware Valley Healthcare Council, which represents hospitals in Southeastern Pennsylvania.

Several area health officials said it's possible that someone infected with Ebola in Africa could come to Philadelphia. The incubation period is 21 days, long enough to leave Africa without symptoms, as Duncan did, and get sick after arriving here.

But they remain confident that the disease would not spread widely.

"The big message is, it's very hard to get the disease and it should be very easy for us to control the spread of the disease once we know we have a case," said Steven Alles, a physician who manages the preparedness program for the Philadelphia Department of Public Health.

Infection requires contact with bodily fluids from a person who is symptomatic.

Because the deadly disease's early symptoms - fever, muscle aches, and weakness - are common, experts are emphasizing the importance of asking about travel history.

Carrie DeLone, Pennsylvania's physician general, wants paramedics to ask about it before they transport anyone with Ebola symptoms. She says private doctors' offices should also be asking.

"We want that office to get a travel history before that patient ever walks into the waiting room," she said.

So far, no one in either Pennsylvania or New Jersey has even been tested for Ebola.

Since March, when the Ebola outbreak began in West Africa, the Centers for Disease Control and Prevention has equipped 14 U.S. labs to test blood samples for the virus. So far, samples from 15 people have been tested, said Beth Bell, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.

She said Friday that the CDC was "aware of" and helping to evaluate a suspected case at Howard University Hospital in Washington.

That hospital on Thursday admitted a patient with Ebola-like symptoms who had recently traveled to Nigeria, according to news reports.

Given his travel history and symptoms, Duncan should have been placed in a hospital isolation room the first time he went to the emergency room, according to guidelines from the CDC.

He told a nurse where he had been, and it was noted in the hospital's electronic record. Because of a "flaw" in the system, the doctor who released Duncan hadn't seen the note, the Texas hospital said. Other experts, however, wondered why the nurse didn't just tell the doctor and said it was premature to conclude that the record system was flawed.

Grace said the "handoff" between various caregivers has been the focus of quality-improvement efforts for hospitals in this area.

The CDC wants patients who have been to Ebola-affected areas of Africa and have symptoms to be isolated while blood samples are being tested. Hospitals are to call their local health departments, which are responsible for figuring out who is at risk for infection.

Those at highest risk - usually people who have been in the same household with the sick person - may be placed in quarantine in their homes until danger of illness has passed. Health department employees would check them often for fever and symptoms. Those at lower risk might be allowed to take their own temperatures.

Surveillance starts in airports. Passengers leaving Liberia must have their temperature taken and fill out a form that asks whether they have had contact with anyone who had Ebola. The Liberian government says Duncan lied.

Once passengers reach Philadelphia International Airport, which has a CDC quarantine office, their temperatures are not taken again. Arriving passengers are not referred to the CDC unless Customs and Border Protection agents think they look sick.

All passengers from West African nations are given a fact sheet about Ebola.

"We haven't seen any signs of illness here from Ebola or any other type of respiratory disease or illness," said Steve Sapp, public affairs officer for U.S. Customs at Philadelphia airport.

If passengers do look sick, the CDC steps in. "We do this all the time - we've done this for SARS, for other contagious respiratory diseases, the H1N1 influenza," Sapp said.

Customs officers in Philadelphia have seen only two medical issues in the last three weeks: a woman complaining of chest pains who later said she was fine, and two children arriving from Asia with high temperatures who were taken to Children's Hospital of Philadelphia by the Fire Department, Sapp said. "None had a connection to Africa or anywhere that's been affected by Ebola."

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