A sweeping effort to contain Ebola after the first patient diagnosed in the U.S. was placed into isolation at a hospital in Dallas has already run into problems. Four family members of the Ebola patient, a Liberian national, were apparently not following health officials’ request to quarantine themselves, so yesterday Texas authorities took action and legally ordered them to stay at home and not receive visitors. The family members have a member of local law enforcement posted at their apartment to ensure they will remain in quarantine until October 19 when the incubation period for Ebola has passed and the family is no longer at risk of becoming symptomatic for the disease. Although initial estimates of how many people came into contact with the patient were small, it has since become apparent that scores of people may have encountered the ill patient while he was symptomatic and that many of those potential exposures may have taken place at the hospital.
 
The Texas Department of State Health Services (DSHS) announced today it has a list of about 100 names of people who may have had some type of contact with the patient. “We are working from a list of about 100 potential or possible contacts and will soon have an official contact tracing number that will be lower,” Carrie Williams, a spokesperson with the DSHS, said in a statement. “Out of an abundance of caution, we’re starting with this very wide net, including people who have had even brief encounters with the patient or the patient’s home.”  Ebola is only spread via contact with the bodily fluids of an Ebola patient. People who encountered the patient while he was symptomatic are being instructed to regularly take their temperatures and seek care at the hospital if they spike fevers. Symptoms of Ebola include fever, headache, nausea, diarrhea and abdominal pain.
 
Dallas Mayor Mike Rawlings told CNN earlier today that at least two thirds of the people who came into contact with the patient did so at the hospital; the rest of the encounters took place in the greater Dallas area. The patient was admitted to Texas Health Presbyterian Hospital in Dallas and placed in strict isolation on September 28 after coming to the area to visit family. Although the patient left Liberia on September 19 and arrived in the U.S. on September 20, he only started showing signs of illness on September 24. The patient had sought care at the hospital before September 28, but was sent home despite exhibiting Ebola symptoms and having traveled recently from Liberia. He was screened for fever prior to his flight to the U.S. and did not have a fever in transit.
 
The decision to take legal action to force four of the patient’s family members to stay inside arose “because of a variety of issues” and the need to have “confidence that monitoring would take place,” David Lakey, commissioner of the DSHS told reporters during a press conference today. Monitoring Ebola’s symptoms, like fever, and isolating ill patients is crucial to limiting the disease’s spread. Those four individuals need to be available to immediately report any Ebola symptoms to health authorities, provide blood samples and submit to any other needed testing, according to Texas authorities. Lakey declined to comment further on what those individuals were doing to raise concerns about their compliance to the self-quarantine request.
 
The U.S. Centers for Disease Control and Prevention said today that public health teams had interviewed most of the 100 people identified as contacts of the Ebola patient and that so far only a “handful” of individuals may have had exposure and should be monitored, including those four members of the household where the patient was staying.
 
Authorized health care laboratories have tested the blood of 14 other suspect Ebola cases from around the country after being contacted by health authorities, but all samples have tested negative so far. “The bottom line here is that we remain confident that we can contain any spread of Ebola within the United States. There could be additional cases who are already exposed and if that occurs, systems are in place so they will not further spread Ebola,” CDC Director Tom Frieden said in today's press conference. Any U.S. hospital with a private room, private bathroom, rigorous training for health workers and appropriate waste disposal capabilities should be able to care for an Ebola patient without putting health workers at risk, Frieden said.
 
“We can’t make the risk zero until the outbreak is controlled in west Africa,” Frieden added. “What we can do is minimize that risk as is being done now in Dallas by working to ensure that no more individuals are exposed than have already been exposed.”

 
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