Texas issues Ebola home isolation court order

Texas health officials have issued a control order to make sure that public health workers can conduct fever checks on close family contacts of a man from Liberia who was recently hospitalized as the nation's first Ebola case.

So far no other infections have been detected in connection with the case, the first real test of guidance and systems put in place across the nation to prepare for travel-related cases from West Africa. At a media briefing today hosted by the US Centers for Disease Control and Prevention (CDC), Director Tom Frieden, MD, MPH, said the agency will hold daily joint press briefings with Texas health officials to provide updates.

Court order to help with health monitoring

David Lakey, MD, commissioner with the Texas Department of State Health Services (TDSHS), told reporters that he signed the court order to ensure that the individuals can be monitored twice a day and that law enforcement is monitoring the apartment. So far none of the household members have fever or other symptoms, he said.

Clay Jenkins, Dallas County judge, said the decision to put a confinement order in place for family members requires a delicate balance, but public health officials need to know they can monitor the patients' health and that it's in the public's best interest to know that exposed people aren't leaving the location against medical advice. According to Dallas media reports, the residents didn't follow an earlier request to stay home.

Food and groceries are being delivered to the group, which will be monitored for 21 days.

Lakey said public health workers have gone into the household to see that the man's personal belongings are bagged, assess environmental risks, and ensure that the family knows how to minimize their contamination risk. He said, however, that health officials are grappling with how to dispose of waste and other contaminated items but have identified a company that will clean and decontaminate the home.

Frieden said hospitals have questions about how to handle contaminated medical waste, especially larger items, and that CDC officials are in discussions today with US Department of Transportation counterparts about the issue.

Health officials said they don't yet have an exact number for the people designated as contacts who will be monitored for 21 days, other than that so far it is a "handful" of people. Contact-tracing interviews are under way with about 100 people to gauge the type of contact they had with the patient, but so far authorities don't believe any exposures occurred at community locations.

Hospital, airport screening issues

Lakey and Frieden said the communication breakdown at the Texas hospital—when the patient's travel history was not adequately communicated when he seen 2 days before he was admitted—is a teachable moment for other facilities. Frieden added that the CDC has refreshed its patient screening information for hospitals and is sending a Health Alert Network notice on the topic to providers.

Frieden said the man was screened by a CDC-trained worker as he was departing Liberia and that he didn't have a fever at that point. He said that records show the patient's temperature was 97.3°F as measured with a Food and Drug Administration–approved thermometer.

He added that an investigation is under way into Ebola exposure the man may have had while in Liberia and that exit forms have questions on whether patients cared for or helped bury people infected with Ebola. He added, however, that individuals often don't know what their exposures have been, and sometimes they don't disclose them.

According to a New York Times report yesterday, 4 days before the man left Liberia for the United States he had direct contact with a woman infected with the virus, according to the man's neighbors in Liberia and the woman's parents.

The patient had reportedly helped the woman's family take her by taxi to a hospital in Monrovia, where she was turned away over a lack of treatment beds. He helped carry the woman back into the family's home, where she died later that evening, according to the Times.

"Can we make the risk zero?" Frieden asked. "The plain truth is we can't make the risk zero until the outbreak is controlled in West Africa."

Texas Health Presbyterian Hospital today said the patient is in serious condition, and Frieden said discussions are ongoing between the man's doctors and the patient and his family about the possibility of receiving experimental Ebola treatment.

Global and drug developments

In other developments today:

  • Germany's Frankfurt University Hospital said it is expecting to receive a patient tomorrow who was infected with Ebola in West Africa, Reuters reported. According to German media reports, the patient is a Belgian doctor who got sick while working in Sierra Leone, but the hospital didn't confirm the information. The patient would be the second health worker to be airlifted into Germany from the outbreak region.
  • Federal government officials are in advanced discussions about two different strategies for ramping up the production of ZMapp, an experimental drug that has been used to treat some infected health workers, the New York Times reported yesterday. Quoting unnamed sources, the Times said talks have been held with Caliber Biotherapeutics, a Texas company that can produce the drug in tobacco plants. Also, the government, along with the Bill and Melinda Gates Foundation and Wellcome Trust, are exploring boosting production in animal cells, which would take longer but yield larger amounts because of much greater production capacity.

See also:

Oct 2 Dallas Morning News story

Oct 1 New York Times story on patient's history

Oct 2 Texas Health Resources statement

Oct 1 CDC guidance on Ebola questioning for returning travelers

Oct 1 CDC checklist for patients being evaluated for Ebola in the United States

Oct 2 Reuters story

Oct 1 New York Times story on ZMapp

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