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MISSTEP OPENED A DOOR FOR EBOLA

New York Times

DALLAS - The man who has become the first Ebola patient to develop symptoms in the United States told officials at Texas Health Presbyterian Hospital on Sept. 26 that he had just arrived from West Africa, but he was not admitted that day because that information was not passed along at the hospital, officials acknowledged Wednesday.

Thomas Eric Duncan was sent home under the mistaken belief that he had only a mild fever, a hospital administrator said; the information that he had traveled from Liberia, where more than 2,000 people have died from Ebola, was overlooked.

Duncan returned to Texas Health Presbyterian Hospital on Sept. 28 and was admitted for treatment, but in those two days in between, his contacts with a number of people - including five schoolchildren and the medics who helped transport him to the hospital - potentially exposed them to Ebola, forcing officials to monitor and isolate them in their homes and to begin a thorough cleaning of the schools the students attended.

Duncan is now in serious but stable condition in isolation at Texas Health Presbyterian.

Duncan's case began with him playing the part of good Samaritan on another continent. Duncan - a Liberian national in his mid-40s who had come to America to visit relatives in Dallas - had direct contact with a woman stricken by Ebola in Monrovia, the Liberian capital, on Sept. 15, days before he left for the United States, the woman's parents and Duncan's neighbors said.

The family of Marthalene Williams, 19, took her by taxi to a hospital with Duncan's help after failing to get an ambulance. Williams was turned away for lack of space in the hospital's Ebola treatment ward, the family said, and they took her back home in the evening, hours before she died: Duncan helped carry her because she was no longer able to walk. In the taxi, Williams, who was seven months pregnant, had been convulsing.

Duncan left Liberia on Sept. 19, arriving in Dallas-Fort Worth Sept. 20.

Officials said Wednesday that they believed Duncan came into contact with 12 to 18 people when he was experiencing active symptoms and when the disease was contagious, and the daily monitoring of those people had not yet shown them to be infected.

When Duncan first arrived at the hospital on Sept. 26, six days after he had arrived in America, he told a nurse that he had come from West Africa. Public health officials have been urging doctors and nurses to be on the alert for Ebola in anyone who has been in Guinea, Liberia or Sierra Leone.

But information about Duncan's travel was not "fully communicated" to the full medical team, said Dr. Mark Lester, executive vice president of Texas Health Resources, the parent organization that oversees Texas Health Presbyterian Hospital.

As a result, that information was not used in the clinical diagnosis and Duncan was sent home - the diagnostic team thought he simply had a low-grade fever from a viral infection, Lester said.

The five students who came into contact with Duncan attend four Dallas-area public schools. They have been advised to stay home from school. The students - at a high school, a middle school and two elementary schools - are under observation by Dallas County health officials.

"The students don't have symptoms, so the odds of passing on the virus is very low," said Mike Miles, the Dallas district's superintendent.

The schools will remain open, but will undergo an extensive cleaning. Additionally, at least three Dallas Fire and Rescue emergency medical technicians were being monitored and were in isolation at home, although they, as well as the other adults under observation, were free to leave their homes because they were not being quarantined. The medics helped transport Duncan to the hospital on Sept. 28. Even the emergency vehicle that was used - Ambulance No. 37 - is in isolation, officials said.

"This case is serious," Gov. Rick Perry of Texas said at a news conference Wednesday at the hospital. "This is all hands on deck."

Some of the children and adults under observation are from Liberia, but it was unclear how many. There are an estimated 10,000 Liberians living in four counties in North Texas, including Dallas and Tarrant counties. One active group, the Liberian Community Association of Dallas-Fort Worth, was founded more than 30 years ago.

In Monrovia, Duncan had lived in a neighborhood called 72nd SKD Boulevard, for two years, living by himself in a small room that he rented from Emmanuel and Amie Williams, the parents of the ill young woman he helped carry. Duncan had told them and his neighbors that his son lived in the United States, played baseball, and was trying to get him to come to America.

The way Duncan appears to have been infected with Ebola is typical in Monrovia, where the epidemic is spreading rapidly and most people are dying at home because of a lack of ambulances and Ebola treatment centers. At home, they spread the virus to family and friends who are taking care of them.

The family of Marthalene Williams said they had no choice but to take her back home after being turned away from John F. Kennedy Memorial Hospital, first at its maternity ward and then at its Ebola center.

On Sept. 15, Duncan rode in the taxi in the front passenger seat while Marthalene Williams, her father and her brother, Sonny Boy, shared the back seat, her parents said. Later, after being turned away at the hospital, Duncan helped carry Marthalene Williams back to the family home that evening.

"He was holding her by the legs, the pa was holding her arms and Sonny Boy was holding her back," said Arren Seyou, 31, who witnessed the scene.

Sonny Boy, 21, also started getting sick about a week ago, his family said. In a sign of how furiously the disease can spread, an ambulance had come to their house on Wednesday to pick up Sonny Boy. Another ambulance picked up a woman and her daughter from the same area, and a team of body collectors came to retrieve the body of yet another woman - all four appeared to have been infected in a chain reaction started by Marthalene Williams.

A few minutes after the ambulance left, Williams' and Sonny Boy's parents got a call. It was about Sonny Boy. He had died on the way to the hospital.

Fort Worth Star-Telegram

in dallas: A resident of the Ivy Apartments talks to reporters Wednesday. Ebola patient Thomas Eric Duncan had been staying there when he became ill.

Duncan's flight

Thomas Eric Duncan traveled to the United States on Sept. 20 on United Airlines Flight 951 from Brussels, changing at Dulles International Airport to Flight 822 to Dallas, according to the airline. United said in a statement that there was no risk to any passengers because the patient was not symptomatic until several days after his trip.

In Dallas

Duncan interacted with 12 to 18 people, authorities said. Five were "school-aged children," Texas Gov. Rick Perry said. These children are being watched at home for any signs of the illness.

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