Fears grew Wednesday that more medical workers may have been exposed to the deadly Ebola virus after a second Dallas nurse fell ill and health officials scrambled to alert scores of airline passengers who had been on a jet with her.
After weeks of assertions that U.S. hospitals were well-prepared for Ebola, the latest developments illuminated lapses on several fronts: at Texas Health Presbyterian Hospital in Dallas, where two nurses contracted Ebola while treating Thomas Eric Duncan, a Liberian who died of the disease; at the U.S. Centers for Disease Control and Prevention in Atlanta, which says it could have reacted more aggressively to Duncan's case; and with a public health system that has no way of preventing potentially contagious people from boarding public transportation, even if they know they may have been exposed to Ebola.
The latest nurse to become sick, Amber Vinson, 29, did not have a high fever when she boarded Frontier Airlines Flight 1143 from Cleveland to Dallas on Monday, and CDC chief Thomas Frieden said the risk to others on the jet was "extremely low."
He said her temperature was 99.5, slightly above normal, but she should not have been on a commercial flight given her role in treating Duncan and the subsequent diagnosis of another nurse, Nina Pham. Vinson tested positive for Ebola early Wednesday; Pham fell ill Friday, the same day Vinson flew from Dallas to Ohio, where her family lives. Pham, 26, was diagnosed two days later.
"These healthcare workers both had … extensive contact with the patient when the patient had extensive production of body fluids," Frieden said. The virus is transmitted in bodily fluids.
Late Wednesday, however, the CDC confirmed that Vinson had permission to travel to Ohio. And hours later, the Associated Press reported that the CDC also gave Vinson permission to fly back to Texas. That could not immediately be confirmed.
Just before midnight, Frontier Airlines issued a statement that mentioned the possibility that Vinson had symptoms while aboard the plane. On Wednesday afternoon, "Frontier was notified by the CDC that the passenger may have been symptomatic earlier than initially suspected, including the possibility of possessing symptoms while onboard the flight," the statement said.
The airline also said that it had "proactively placed six crew members (two pilots; four flight attendants) on paid leave for 21 days out an abundance of caution."
President Obama postponed a campaign trip to meet with top government officials Wednesday about Ebola, which is suspected of killing more than 4,400 people in West Africa and which, until last month, was known to most Americans as a deadly but distant virus.
That changed Sept. 28, when Duncan arrived at the Dallas hospital and subsequently tested positive for Ebola. He died on Oct. 8. Now, the two nurses have the virus, and the number of people being monitored for possible exposure has swelled.
"We're … planning for other eventualities in case we get additional cases in the coming days," Frieden said.
CDC investigators who have been evaluating the Dallas hospital's procedures found that on Sept. 30, the day of Duncan's Ebola diagnosis, healthcare workers were donning "three or four" layers of protective gloves and gowns, thinking that would better protect them from the virus, Frieden said. Actually, he said, such measures may have increased infection risk.
"In fact, by putting on more layers of gloves or other protective clothing, it becomes much harder to put them on; it becomes much harder to take them off," Frieden said. "And the risk of contamination during the process of taking these gloves off gets much higher."
Obama said Wednesday evening that he had directed the CDC to create a "SWAT team" to deploy anywhere in the country to help local healthcare systems respond to any future Ebola cases.
"As soon as someone is diagnosed with Ebola, we want a rapid response team, a SWAT team, essentially, from the CDC, to be on the ground as quickly as possible, hopefully within 24 hours, so they are taking the local hospital step by step through exactly what needs to be done," the president said.
Frontier Airlines said it took the jet that carried Vinson out of service for decontamination, but according to FlightAware.com, the A320 made five additional flights after Vinson's trip before it was cleaned up and restored to service. Vinson's flight to Dallas was the jet's last of the night, but on Tuesday morning it flew to Cleveland, Fort Lauderdale, Fla., Cleveland again, Atlanta, and finally Cleveland once more, said Daniel Baker, chief executive of FlightAware.com.
Public health workers were trying to contact the 131 passengers besides Vinson who were on the Cleveland-to-Dallas trip.
Frieden said those being monitored for possible Ebola symptoms had been advised to stay home and not take public transportation. But now the CDC will require anyone who might have been exposed to the virus to travel by "controlled movement only," meaning no public transportation.
Dallas County Judge Clay Jenkins, the county's highest elected official, quickly issued an order mandating that 75 area residents being "self-monitored" stay home.
They included many of the healthcare workers who helped treat Duncan, he said, emphasizing that the order was not a quarantine. "They are not criminals. They did not do anything wrong," he said.
Jenkins did not say when the order would be lifted, but the incubation period for Ebola is 21 days.
A Jenkins staffer said late Wednesday that the orders must be served on each affected individual, which has not yet been done.
In Ohio, Kent State University, without naming Vinson, said the ill nurse had three relatives working there, and it asked them to stay off campus for 21 days while they were monitored for Ebola symptoms.
Laura Smith, secretary for Vinson's father, Ronald Shuler of Akron, said the immediate family had no comment.
"She's just a lovely person and I'm sad," said Martha Shuler, 80, one of Vinson's other relatives. Vinson grew up in Akron, Shuler said.
Kent State said Vinson received degrees in 2006 and 2008. The nurse arrived in Cleveland on Friday, the university said in a statement. "It's important to know that the patient was not on the Kent State campus," university President Beverly Warren said. "She stayed with her family at their home in Summit County and did not step foot on our campus."
Rep. John A. Boehner of Ohio, speaker of the House, urged Obama to consider a travel ban for flights from West Africa. "A temporary ban on travel to the United States from countries afflicted with the virus is something that the president should absolutely consider ... as doubts about the security of our air travel systems grow," Boehner said in a statement.
Vinson apparently was feeling fine when she flew back to Dallas, Frieden said, but went to Texas Health Presbyterian with a low-grade fever late Tuesday. She tested positive for Ebola early Wednesday.
By evening, Vinson was flown by air ambulance to Emory University Hospital in Atlanta, which has one of four biocontainment units in the country.
Three other Ebola patients, all of whom contracted the disease in West Africa, have been treated at the facility. The first two were discharged in late August. A third patient has been hospitalized there since Sept. 9 and released a statement Wednesday.
"I want to share the news that I am recovering from this disease, and that I anticipate being discharged very soon, free from the Ebola virus and able to return safely to my family and to my community," said the patient, who has not been identified.
Pham, whose condition is listed as "good," may be transferred to Emory too, Frieden said. "She is in improved condition today. We will assess each hour, each day, whether that's the best place for her or somewhere else might be."
It's possible that the Dallas hospital might divert future Ebola cases if more are diagnosed there, Mayor Mike Rawlings said, but no final decision has been made.
As for Pham, Rawlings said, she has "made it clear ... that she loves this hospital and loves the people working for her. Her mother's here. There's a family unit, it's going well, and it would be a little bit more emotionally difficult to pull her out, even if that might be the right thing to do at some point."
The second Ebola diagnosis has made the city anxious, Rawlings said. "This has been a roller coaster for us."
Late Wednesday, Texas Health Presbyterian invited any of its affected employees to stay at the hospital during their monitoring period "to avoid even the remote possibility of any potential exposure to family, friends and the broader public."
The hospital statement emphasized that no one with Ebola is contagious unless he or she has symptoms. "We are doing this for our employees' peace of mind and comfort. This is not a medical recommendation," it said.
"We want to remind potentially affected employees that they are not contagious unless and until they demonstrate any symptoms, yet we understand this is a frightening situation for them and their families," the hospital said. It asked the workers "to be good citizens ... by avoiding using public transportation or engaging in any activities that could potentially put others at risk."
Dallas officials sought to calm residents, as cleanup crews converged on Vinson's sprawling, two-story apartment complex to begin decontaminating it. Police guarded the entrances to the complex, the Village Apartments.
News choppers whirred overhead as residents awoke to news that one of their neighbors was the latest Ebola patient. Officials went door-to-door handing out information.
It was the second time James Coltharp, 50, who lives in the neighborhood, had been awakened by helicopters overhead. The first was when Duncan was diagnosed.
"Obviously they're on high alert," Coltharp said as he stopped at a police barricade around the apartment complex.
"Hopefully they're able to contain it. I'm just worried about other healthcare workers. … I see a lot of people in scrubs here. We're near the hospital."
Nate Brinkley, 44, a single father who lives in Vinson's apartment complex, expressed anger that healthcare workers who had been "self-monitoring" for signs of illness had still been allowed to go out and mix among the public.
"Where are these people going in the 24 hours before they get to the hospital and get tested?" he said. "They're obviously not quarantined. Where are they going that they could be touching things, and how contagious are they?"
Hennessy-Fiske and Mohan reported from Dallas, Susman from New York. Times staff writers Noam N. Levey and Kathleen Hennessey in Washington and Christine Mai-Duc and Hugo Martin in Los Angeles contributed to this report.