Ebola Patient in Dallas, Thomas Eric Duncan, Dies

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Oct. 8, 2014 -- Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, has died of the disease.

He died at 7:51 a.m. Central time on Wednesday, more than a week after tests confirmed he had Ebola, according to Texas Health Presbyterian Hospital in Dallas, where he was being treated.

Also Wednesday, U.S. officials said enhanced Ebola screening would begin this week for travelers arriving at the country’s five busiest airports from West Africa.

Travelers from Guinea, Liberia and Sierra Leone – the three nations hardest-hit by the Ebola outbreak – will be escorted to airport areas set aside for screening, observed for signs of illness, given a health questionnaire, and have their temperatures taken, the CDC and the Department of Homeland Security said. 

If they have a fever or symptoms, or if the questionnaire reveals possible Ebola exposure, the travelers will be checked by a health officer. They'll be referred to “the appropriate public health authority” if further evaluation is needed.

The CDC is sending additional staff to the five airports, which are:

  • JFK in New York
  • Dulles outside of Washington, D.C.
  • O’Hare in Chicago
  • Hartsfield-Jackson in Atlanta
  • Newark outside New York

"These five airports represent nearly 95% of the 150 travelers per day who arrive from these three [West African countries]," said CDC Director Tom Frieden, MD, at a press conference. He said the thermometers being used are highly effective. "They don't require touching the patients, and they give an accurate result.''

Screening at JFK will begin Saturday, according to the CDC. Screening at the other four airports will begin next week.

More on Duncan

Duncan, 42, was a citizen of Liberia. He was evaluated and had his temperature taken before he flew to the U.S. from Monrovia, but he did not have a fever or other symptoms before he arrived in Dallas on Sept. 20 to visit his family, officials have said.

On Sept. 24, he began feeling unwell. The following evening, a low-grade fever and some abdominal pain prompted him to go to Texas Health Presbyterian Hospital, where he told a nurse that he'd recently traveled from Liberia.  Despite that, he was prescribed a course of antibiotics -- which would have been useless against a viral infection -- and released.

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The hospital has since admitted that Duncan’s travel history wasn't properly relayed between staff members, and as a result, the doctor who treated him didn’t suspect Ebola.

Two days later, when he was taken back to the hospital by ambulance, his fever had spiked, and he was vomiting and having bouts of diarrhea. He was immediately placed in isolation. More tests by a Texas state lab and the CDC confirmed the Ebola diagnosis.

By that time, health officials determined he had made contact with around 48 people, including five school-aged children, though most of those exposures were considered to be low risk. Ten people, including four family members, were being closely watched. The family members are under a court order to remain home and avoid contact with others, the Texas Department of State Health Services says.

Frieden said the 48 people are being monitored by the public health system and have had their temperatures taken daily. “None of them have had symptoms, fever,” he said. ''As of today, the only patients with Ebola in the U.S. are in the hospital."

Over the past week, Duncan’s condition worsened from stable to critical. He was getting dialysis to support his failing kidneys, and was on a ventilator to aid his breathing. He also received an experimental medication, brincidofovir, an antiviral drug that was being developed to treat smallpox. He got the dose on Oct. 6, just hours after the FDA announced it had cleared the drug for emergency use. 

On Tuesday, he showed some signs of improvement. The hospital said his liver had improved, but cautioned that could change over the coming days.

“He fought courageously in this battle. Our professionals, the doctors and nurses in the unit, as well as the entire Texas Health Presbyterian Hospital Dallas community, are also grieving his passing,” said the brief statement Wednesday, which was signed by Wendell Watson, the hospital’s director of public relations.

The Texas Department of State Health Services said it was following guidelines outlined by the CDC in handling Duncan’s body.

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Those guidelines recommend placing the body in two bags before moving it and disinfecting the bags, the department said. “After this process, the body can be transported without the need for protective gear for a driver or others who are near the body but don’t handle the remains.”

CDC guidelines say bodies of deceased Ebola patients can be cremated or buried promptly in a hermetically sealed casket. Duncan’s family has agreed to cremation after learning the state recommends it, officials said. “The cremation process will kill any virus in the body so the remains can be returned to the family.”

Duncan's case quickly became the center of a widening public health scare. The CDC said that after his diagnosis, questions about Ebola jumped from an average of 50 to about 800 calls a day.

The Texas State Senate held hearings to investigate weaknesses in its public health response.

“The past week has been an enormous test of our health system, but for one family it has been far more personal. Today they lost a dear member of their family. They have our sincere condolences, and we are keeping them in our thoughts,” said David Lakey, MD, commissioner of the Texas Department of State Health Services, in a statement to the press.

The Washington Post reported that before he became too weak to speak, Duncan told Louise Troh, the mother of his son, that he was sorry he’d put the family in danger. The Dallas Morning News reported Duncan had come to the U.S. to marry Troh.

According to a family friend, he told Ms. Troh he would have “preferred to stay in Liberia and died than bring this to you.” 

Infected Cameraman and Nusing Assistant

Also on Wednesday, Ashoka Mukpo, an American freelance cameraman for NBC News who was flown back to the U.S. Oct. 6 after catching Ebola, received a blood transfusion from Ebola survivor Dr. Kent Brantly. That's according to officials at The Nebraska Medical Center in Omaha, where Mukpo is being treated. The thought behind this treatment is that blood from people who recovered from Ebola has antibodies that could help recipients fight the virus.

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Brantly, who was released from Emory University Hospital in late August after recovering, also gave blood to Rick Sacra, MD. Sacra was treated in the Omaha hospital and has since been released. Both he and Brantly were medical missionaries who caught Ebola in West Africa.

Mukpo is also receiving brincidofovir, hospital officials say

Earlier this week, a nursing assistant in Spain became the first person known to catch Ebola outside of Africa. According to media reports, she was part of a medical team that treated a Spanish priest who died after being flown back from Sierra Leone.

Spanish health officials have reportedly quarantined several people at the hospital where the woman became infected. They also decided to euthanize her dog.

The woman told doctors she remembered touching her face with protective gloves while treating the priest, media report say. Spanish health officials were investigating how she became infected.

Kathy Doheny contributed to this report.

WebMD Health News Reviewed by Michael W. Smith, MD on October 08, 2014

Sources

SOURCES:

Statement, Texas Health Presbyterian Hospital Dallas.

Statement, Texas State Department of Health.

Press conference, CDC.

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