By SABRINA TAVERNISE, ANEMONA HARTOCOLLIS, SHARON LaFRANIERE and ABBY GOODNOUGH
When Craig Spencer, a young doctor just back from treating patients with Ebola in Guinea, fell ill with the virus in New York on Thursday, the paramedics who went to get him were dressed in protective suits. He entered Bellevue Hospital through a rear door, far from the busy emergency room, and was taken to a state-of-the-art isolation ward that was locked and guarded.
The carefully planned response was a world apart from the scene that unfolded in a Dallas hospital last month when a Liberian man, Thomas Eric Duncan, became the first person to test positive for Ebola in the United States.
It was Ebola’s first surprise encounter with a modern medical system, and it was, by all accounts, a bumpy one. Mr. Duncan lay in an emergency department room at Texas Health Presbyterian Hospital for hours, with a fever and frequent diarrhea, while other patients in nearby rooms were treated by the same doctor and nurses, medical workers said. A lab technician had to comb through his inbox to find an email from the government on procedures for Ebola blood samples, only to find that he had handled them improperly, the workers said.
The handling of Mr. Duncan, the first person to test positive for Ebola in the United States, is detailed here, based on medical documents provided to The New York Times. Rules for protective gear seemed to change with the weather, and some of Mr. Duncan’s nurses, unsure of what to wear, resorted to looking for help on the website of the Centers for Disease Control and Prevention, according to a health worker involved in the response.
The often rudderless response lasted two weeks, and in the end, two nurses, Nina Pham and Amber Joy Vinson, fell ill with the virus. Both have recovered, but the searing experience stunned experts, and shook Americans’ confidence in their health care system.
“I’m just gobsmacked,” said David P. Fidler, a law professor at Indiana University and a fellow at Chatham House Centre on Global Health Security. “Ebola was supposed to be something we could handle easily.”
The response also prompted a national reckoning, both by the Centers for Disease Control and Prevention, the federal agency that contributed to the wobbly response in Dallas, and among hospitals nationwide that are now scrambling to prepare, having learned from mistakes in Texas that many say could have happened to any of them.
“There had to be a first hospital, and unfortunately for Texas Presbyterian, it was them,” said Dr. Sean P. Elliott, medical director of infection prevention at the University of Arizona Health Network. His Tucson hospital, Dr. Elliott said, is now “burning through our supplies of protective gear and putting in tons of people hours” to prepare.
“Dallas has touched a very sensitive nerve,” he said.
Dallas also shattered the fundamental assumption among most American health officials that almost any large American hospital could safely treat Ebola. Many of the procedures that have been put in place in New York and elsewhere since Dallas reflect that change in thinking — for example, the designation of specific hospitals, like Bellevue or Dr. Elliott’s, as point places for Ebola treatment.
If there was ever a moment for redemption, Dr. Spencer’s case was it. Even before the result of his Ebola test, a C.D.C. team was on its way to New York from the agency’s base in Atlanta. It was whisked there on a Defence Department plane, which turned right around with a sample of Dr. Spencer’s blood that it delivered to a C.D.C. lab around 4 a.m. More C.D.C. disease trackers followed on Friday morning for a total of seven people.
Nina Pham, who became infected with Ebola as she treated a dying patient, Thomas Eric Duncan, spoke to the media on Friday after she was cleared of the virus. The initial team that deployed to Dallas last month was bigger — 10 people — but was hampered by inconsistent protocols for gear at the hospital and a lack of leadership on the ground, for which the team itself was partly responsible. And far from being zipped to a lab on a military flight, the blood sample for Mr. Duncan did not arrive at a state laboratory in Austin until almost 48 hours after he got to the emergency room.
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