Dallas police stood guard Sunday at a two-story tan brick apartment building roped off with red police tape. No-trespassing signs marked the building and the one next door as off-limits, and a yellow biohazard barrel was in front until workers in hazmat suits hauled it away.
The Centers for Disease Control and Prevention has confirmed that a Texas healthcare worker who treated Ebola victim Thomas Eric Duncan tested positive for the deadly virus.
The apartment building appeared to be the home of the worker, who is in isolation in the ICU at the same hospital that treated Duncan, Texas Health Presbyterian Hospital Dallas.
"A close contact has also been proactively placed in isolation," the hospital said in a statement, adding that the worker had asked for privacy.
The worker reported a low-grade fever Friday and was tested, the CDC said in a statement. Preliminary tests indicated Ebola and the CDC confirmed those results on Sunday.
"This development is understandably disturbing news for the patient, the patient's family and colleagues, and the greater Dallas community," the CDC said. "The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures."
On Sunday's talk shows, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the patient is a woman, and CDC Director Dr. Thomas Frieden used the female pronoun.
Theresa Pittard, 56, lives next door to the off-limits apartment building in east Dallas. She stood outside, watching a hazmat crew arrive.
Officials had pounded on her door at 5:30 a.m. and dropped off public health information about Ebola, she told the Los Angeles Times. The apartment management company advised tenants not to walk their dogs outside until the lawn and surroundings had been decontaminated, she said.
"All of this is very intimidating," Pittard said.
Tyler Gattis, 28, lives in an apartment behind the building. He told The Times that he was accustomed to greeting his neighbor when he saw her heading to work in scrubs.
Gattis had been in Austin for the weekend. He learned of the Ebola case when he received an email from his landlord Sunday morning advising tenants to contact officials. He said he called the phone number included in the email and a woman told him about the Ebola case.
Gattis said he wasn't worried, however. Although officials called the patient a healthcare worker, Gattis was more specific.
"I'm sure, being a nurse, she monitored herself pretty well," Gattis said.
About 7 p.m., a hazmat truck drove off with the biohazard barrel and whatever the cleaners had put inside.
Workers removed the red tape from in front of the apartments, and a new crew of workers arrived promptly.
Richard Cameron, general manager of Fort Worth-based Protect Environmental, told The Times that his company had been called in by the governor's office as a state contractor to ensure the apartment area was cleaned correctly.
He said the company has more than 20 years of experience cleaning places exposed to HIV, hepatitis and anthrax, but this would be their first case of Ebola.
Texas Christian University notified students and faculty by email Sunday night that the worker had graduated from the school in 2010, according to the campus newspaper, TCU360.
"TCU has no reason to believe this alum has been on campus recently," the email said. It urged recipients to "please keep this 2010 alum in your thoughts and prayers."
Earlier Sunday, the CDC's Frieden blamed what is thought to be the first U.S. transmission of the deadly virus on a breach in protocol.
"We're deeply concerned about this new development," Frieden said in an interview on CBS' "Face the Nation."
"I think the fact that we don't know of a breach in protocol is concerning, because clearly there was a breach in protocol. We have the ability to prevent the spread of Ebola by caring safely for patients."
President Obama was briefed Sunday on the diagnosis by Lisa Monaco, his homeland security and counter-terrorism advisor. He later spoke with Health and Human Services Secretary Sylvia Burwell, in which he directed that the CDC's investigation of the apparent protocol breach move "as expeditiously as possible."
The White House said Obama also ordered federal health authorities to take additional steps to ensure that healthcare facilities nationwide are prepared to follow infection control protocols in the event they should confront a possible Ebola case.
Frieden said the worker had been monitoring herself and was promptly isolated when she developed symptoms.
"The level of her symptoms and indications from the test itself suggest that the level of virus she had was low," Frieden said in a separate CDC briefing.
Officials at the Texas Department of State Health Services said preliminary test results late Saturday indicated the presence of the virus in the healthcare worker at Texas Health Presbyterian Hospital, where Duncan, a Liberian, died last week.
"We knew a second case could be a reality, and we've been preparing for this possibility," David Lakey, state health department commissioner, said in a statement.
"We are broadening our team in Dallas and working with extreme diligence to prevent further spread," he said.
Frieden said the CDC was identifying the health worker's contacts and conducting a full investigation of procedures at the Texas hospital to determine how the transmission occurred.
Later, the CDC said it had identified one "close contact" who was being monitored.
Frieden said all healthcare workers who cared for Duncan were now being treated as if they had been potentially exposed.
"Infections only occur when there's a breach in protocol," Frieden said. "We know from many years of experience that it's possible to care for [patients] with Ebola without risk to healthcare workers, but we also know that it's hard, that even a single breach can result in contamination, and one of the areas that we look at closely are things like how you take off the gear that might be affected or contaminated."
Frieden said the healthcare worker had extensive contact with Duncan in the days leading up to his death.
"Unfortunately, it is possible in the coming days that we will see additional cases of Ebola. This is because the healthcare workers who cared for this individual may have had a breach of the same nature of the individual who appears now to have a preliminary positive test," Frieden said.
He said CDC investigators will be looking at "the interventions that were done to try desperately to keep the index patient alive," a reference to Duncan's care. This included dialysis and intubation.
It was unclear how the healthcare worker contracted Ebola. According to Duncan's patient records, which the family released to The Associated Press, this is what happened at Presbyterian:
— On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics.
— His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m.
— Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees.
— On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper.
— On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach.
— On Oct. 8, Duncan died.
On Sunday, Dallas County Judge Clay Jenkins said that the second infection was something for which Texas health officials were prepared.
"That healthcare worker is a heroic person who helped provide care to Mr. Duncan," Jenkins told reporters Sunday.
"We expected that it was possible that a second person could contract the virus. Contingency plans were put into place, and the hospital will discuss the way that the healthcare worker followed those contingency plans, which will make our jobs in monitoring and containment much easier in this case than in the last one," Jenkins said.
Authorities provided no information about the identity of the new patient except to say it was a healthcare worker who had provided care for Duncan, 42, who was admitted three days after initially seeking help for symptoms on Sept. 25.
Dr. Daniel Varga of Texas Health Resources said the worker was in full protective gear when providing care to Duncan during his second visit to Texas Health Presbyterian Hospital. Varga did not identify the worker and said the family of the worker has "requested total privacy."
Duncan was the first patient diagnosed in the U.S. with the often-fatal hemorrhagic fever, which is believed to have killed more than 4,000 people in West Africa, according to the World Health Organization.
He apparently contracted the disease in Liberia before traveling to Dallas. Neighbors in the Liberian capital of Monrovia said Duncan had helped a neighbor try to reach a hospital when she showed symptoms of what later turned out to be Ebola.
The neighbor died, and Duncan flew to the U.S. to join his fiancee and other relatives. Days after arriving, he developed a fever.
Sunday's announcement marks a deadly new milestone: the first case of Ebola transmitted in the U.S.
It is significant that it involved a healthcare worker, because U.S. public health authorities have long said they have been expecting the appearance of Ebola and are confident that they are prepared to prevent its further spread.
Hospital officials have said Duncan was treated by more than 50 people in a secure, 24-bed intensive care unit.
Authorities have been closely monitoring 48 people who had contact with Duncan before he was placed in isolation, especially a high-risk group of 10 that includes his fiancee and three relatives. Three paramedics who treated Duncan have also been under observation. The healthcare worker who fell ill was not among the group.
Leaders of a union for registered nurses, National Nurses United, said it has surveyed more than 1,900 RNs across the country, and the majority say their hospital has not told them of any policy regarding the potential admission of a patient who may have Ebola.
"It's eerie because there's a real consistency with these concerns from nurses across the country," said RoseAnn DeMoro, executive director of the Oakland-based union. "We're hearing about protocols, but it seems there's a real disconnect in regard to what those protocols are and what preparations hospitals should be taking. We're sounding the alarm, but the hospitals should really be sounding the alarms."
DeMoro said the union is calling for hospitals to establish across-the-board training on how to respond to Ebola outbreaks.
"Hospitals around the country are acting on their own and no hospitals are working in unison," she said. "More communication is needed. This is urgent because not only could nurses be exposed, their friends and loved ones could be as well."
Meanwhile, in Omaha, Ebola patient Ashoka Mukpo appeared to be improving. "We're happy with his progress," Dr. Phil Smith said. "We think that he has made great progress."
Mukpo, an American journalist, was evacuated from Liberia when he tested positive for the virus. He received the same experimental drug as Duncan: brincidofovir, a broad-spectrum antiviral made by Chimerix.