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MISSTEP OPENED A PATH FOR EBOLA

New York Times

DALLAS - Health officials in Dallas are monitoring at least five schoolchildren in North Texas who came into contact with a man after he became sick and infectious with Ebola.

The authorities also said that an early opportunity to put the patient in isolation, limiting the risk of contagion, may have been missed because of a failure to pass along critical information about his travel history.

The patient was identified by Liberian health officials and the Associated Press as Thomas Eric Duncan, a Liberian national. Duncan came to the United States on Sept. 20 aboard a commercial airliner, and officials said that he had shown no symptoms of the disease while on the flight and that he had posed no threat to other passengers.

Duncan worked at a shipping company in Monrovia, Liberia, but had just quit his job, giving his resignation in early September, his boss said. He had gotten a visa to the United States and had decided to go, his neighbors said. He lived alone but has family in the United States, they said.

Duncan may have become infected after his landlord's daughter, Marthalene Williams, fell gravely ill in Monrovia, where more than 2,000 people have died from the virus. On Sept. 15, Duncan helped his landlord and his landlord's son carry the stricken woman to the hospital, his neighbors and the woman's parents said. She died the next day.

Soon, the landlord's son also became ill, and he died Wednesday in an ambulance on the way to the hospital. Two other residents in the neighborhood who may have had contact with the woman have also died.

Health officials in Dallas said Wednesday that they believed Duncan came in contact with at least 12 to 18 people when he was experiencing symptoms. So far, none has been confirmed infected.

The five children, who possibly had contact with Duncan at a home over the weekend, attended four different schools, which authorities said would remain open. As a precaution, they said all the schools - one high school, one middle school, and two elementary schools - would be thoroughly cleaned.

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

Health officials Wednesday continued to track down other people who might have been exposed to Duncan after he began showing symptoms, on Sept. 24, and will monitor them every day for 21 days, the full incubation period of the disease. Most people develop symptoms within eight to 10 days. As a patient becomes sicker and the virus replicates in the body, the likelihood of the disease spreading grows.

Even as U.S. officials sought to reassure the public that the situation was under control, there were questions about how the patient was treated when he first went to an emergency room in Dallas on Sept. 26.

Dr. Mark Lester, executive vice president of the Texas Health Resources System, said the hospital staff had been instructed to ask patients about their travel history, following the advice of federal authorities.

That checklist, he said, was utilized by a nurse and the patient volunteered that he had just come from Liberia. "Regretfully that information was not fully communicated" to the full medical team, Lester said.

As a result, that information was not used in the clinical diagnosis. Duncan was sent home, with the diagnostic team believing he simply had a low-grade fever from a viral infection. He returned to the hospital two days later, his condition having significantly deteriorated. He remains in isolation at Texas Health Presbyterian Hospital of Dallas in serious condition.

In the time between Duncan's trips to the hospital, health officials said he came into contact with more people while he was symptomatic and infectious. The contacts possibly included the five children who saw him over the weekend before going to school on Monday.

Other people who came into contact with him include relatives and the medical technicians who took him by ambulance to the hospital. At least three Dallas Fire and Rescue emergency medical technicians were being monitored and were in isolation at home, according to officials.

Even the emergency vehicle that was used - Ambulance No. 37 - is in isolation.

The five children who had contact with Duncan are being kept home from school, according to David Daigle, a spokesman for the federal Centers for Disease Control and Prevention team that is working with local health officials to trace the contacts. Adults without symptoms do not have to stay home or be quarantined, but will be visited once a day for 21 days by health teams to have their temperatures taken and be checked for signs of illness. The first round of visits to contacts took place Wednesday afternoon, Daigle said.

Duncan, who was visiting relatives in the United States, was not ill during the flight to America, health officials said at a news conference Tuesday. Indeed, he was screened before he boarded the flight and had no fever.

Because Ebola is not contagious until symptoms develop, there is "zero chance" that the patient infected anyone else on the flight, said Dr. Thomas R. Frieden, director of the CDC. Ebola is spread only by direct contact with body fluids from someone who is ill.

Since the outbreak in West Africa, there have been more than 100 reports to the disease centers from local health departments concerned that a patient might have been exposed to the virus, according to officials. Roughly 14 of those cases led to blood tests to determine if the virus was present. The man in Dallas is the first one whose test came back positive.

The Dallas-Fort Worth region is among the state's most ethnically and racially diverse. There are an estimated 10,000 Liberians living in the four-county area known as North Texas. One active community group, the Liberian Community Association of Dallas-Fort Worth, was founded more than 30 years ago. It appeared that Duncan had been staying with relatives who lived near the hospital in the Fair Oaks section of Dallas.

"The CDC is on the ground, and we are going individual by individual that he had contact with, making sure they are in the appropriate isolation," Dallas Mayor Michael Rawlings said. "There is very little risk at this point for folks that just live in the general area."

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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