EBOLA VIRUS - Why did hospital send Ebola patient home without diagnosis?

Liz Szabo, USA TODAY12:32 p.m. EDT October 1, 2014

While health experts agree that the USA is not at risk for a large Ebola epidemic like the one affecting West Africa, some doctors are concerned that an infected patient was sent home from a Dallas hospital without treatment the first time he sought care.
The unidentified Ebola patient, now in intensive care at Texas Health Presbyterian Hospital in Dallas, arrived in the USA Sept. 20 without symptoms but sought care Sept. 26. He was sent home, only to return to the hospital two days later and be admitted.
He's now in critical condition, according to the Centers for Disease Control and Prevention.
For weeks, CDC director Thomas Frieden has told the public that American hospitals are ready for Ebola patients and that emergency room staff are being urged to check not only a patient's symptoms but also to ask about recent travel. The American College of Emergency Physicians is sending out an alert to all of its members Wednesday to remind them of this protocol.
Patients with recent travel to West Africa and any of the symptoms of Ebola are supposed to be tested for the virus. However, early symptoms of Ebola, such as fever, can be difficult to differentiate from ordinary viruses.
As the disease progresses, patients also can develop heavy vomiting and diarrhea, and more advanced cases can cause people to vomit blood and suffer severe abdominal pain.
"We don't know why the disease was not recognized when he first sought care," said infectious disease specialist Jesse Goodman, professor of medicine at Georgetown University Medical Center and the former chief scientist at the Food and Drug Administration. "One of the things that will be really important for the CDC is to try to understand if it highlights specific weaknesses or gaps in the system."
"We don't know if a travel history, one of our most basic but important diagnostic tools, was obtained and testing considered then," Goodman said. "If indications and protocols for testing were followed, and this patient was not tested, then those protocols should be re-evaluated. And it is critical for hospitals and health-care workers everywhere to be sure they are alert, obtain travel histories, and if there is any question at all it could be Ebola, contact CDC, and while sorting things out, act to isolate a sick patient returning from an epidemic area."
We don't know if a travel history, one of our most basic but important diagnostic tools, was obtained and testing considered then.Jesse Goodman, Georgetown University Medical Center
Emergency department doctors see dozens of sick patients a day, and many have fevers or viruses at this time of year, said Rade Vukmir, spokesman for the American College of Emergency Physicians.
And Vukmir notes that Ebola is not the only catastrophic illness for which hospital staff have been asked to screen patients. In the past decade, hospitals also have developed protocols for screening patients for everything from hantavirus to MERS, the Middle Eastern respiratory syndrome, and monkeypox, he says.
"The symptoms, especially early on, are very non-specific," Robert Murphy, professor of medicine and biomedical engineering at Northwestern University.
"It will happen again if triage staff doesn't get a good travel history and suspect that Ebola is possible," Murphy said. "It is very unfortunate that the patient was seen, exposed numerous people, then sent home to expose more, then finally admitted. This is how Ebola spreads."Still, given the news out of Dallas, Vukmir says it's safe to assume that hospitals now have reminded their staffs about the importance of screening patients for Ebola. That reduces the chance that another Ebola patient will be missed.

"I guarantee you there has been discussion today" in emergency rooms nationwide about the importance of these checks, he said. "They will be doing it today."

Infectious disease experts note that there are huge differences between the USA and the countries hardest hit by Ebola -- Liberia, Guinea and Sierra Leone -- which have been traumatized by war and poverty. Their healthcare systems were weak before the outbreak and have now collapsed. Many hospitals lack such basics as running water and soap, and there may be only one doctor for tens of thousands of people.

People in those countries also use burial practices that involve washing the bodies of dead relatives, which can spread the virus throughout families.

Doctors also got a very late start in fighting Ebola. The first case appeared in December, but health officials didn't realize that they were dealing with Ebola until March. By then, nearly 50 people had been diagnosed. The international community didn't mobilize until the past few weeks.

Ebola has infected 6,553 people and has killed 3,083 in the three countries hit hardest by the epidemic — Guinea, Sierra Leone and Liberia — the World Health Organization says. The number of cases has been doubling every three weeks, and the CDC estimates that the disease could affect up to 1.4 million people by January if it's not quickly controlled.

The longer the virus spreads out of control, the greater likelihood that more cases will appear in the USA, Goodman said.

While Frieden has said that any hospital with the ability to isolate patients can treat Ebola patients, Goodman said, "It is important not to be overconfident and to continuously, now and in the future, re-examine ... how the virus is behaving."

Contributing: Karen Weintraub.

Source: http://www.usatoday.com/