Second Ebola Case in Dallas

http://news.yahoo.com/texas-health-care-worker-tests-positive-ebola-095758341.html

A second Ebola case has been reported in Dallas in a health care worker who attended Mr. Duncan and reportedly wore full personal protective equipment (PPE) without a specific breech. When Mr. Duncan returned to the hospital on September 28th he was in day 5 of his illness. Thus far none of his household contacts have become ill and none of them wore PPE. So, what does this tell us about Ebola and how we can attain control?

One, that Ebola patients become more infectious as the illness progresses. The newly reported case in a healthcare worker had onset on October 10th. If we take 9 days as the mean incubation period for Ebola this means the healthcare worker's exposure was sometime around October 1, which was day 8 of Mr. Duncan's illness.  This is similar to what was seen with SARS, that patients become more infectious (and dangerous) with time.

Second, that only hospitals that are well prepared to care for highly infectious patients should be allowed to do so. Standard practice is to have a staff person dedicated to observing the donning (putting on) and doffing (taking off) of PPE. This observation should continue throughout the period of clinical care (from an ante-room with a window).  Perhaps gentle reminders during the doffing can avoid the presumed situation in Spain where the nurse may have touched her face with a gloved hand.

When a patient presents to a hospital early in the illness there is time to transfer to such a facility. That's the plan here in NYC. Bellevue hospital has a specially equipped ward to care for Ebola patients. Their staff are well trained. The number of healthcare workers entering the room should be kept to a minimum, especially after day 7 of the illness.

Still holding my breath.