So close to Ebola, yet Dallas household stayed well

DALLAS _ After he became sick from the Ebola virus, Thomas Eric Duncan shared brief hugs with five people, a residence with four people and a bed with one person _ even as his condition steadily worsened.tmpplchld None of those people knew that his illness would be fatal and that they could easily become infected. Ebola had never been diagnosed in the United States before Duncan brought the virus to Dallas a year ago.tmpplchld A scientific report, published last summer, mentions these unidentified people as being among Duncan’s 17 contacts in the Dallas area. None of them got sick, not even the three people designated as “high risk” for an Ebola infection.tmpplchld For five days, Duncan, a visitor from Liberia, was getting sicker and sicker in the northeast Dallas apartment. None of them wore protective clothing or followed the strict protocols designed to stop Ebola’s transmission.tmpplchld This remains one of the lingering mysteries about Dallas’ Ebola outbreak. A year later, no scientific study has tackled this conundrum, explaining in any detail what happened when Ebola struck inside a Dallas household.tmpplchld Studies in Africa during previous Ebola outbreaks note that people sharing a household with an Ebola patient have a 10 percent to 20 percent risk of getting the disease. However, African households might lack running water and flush toilets, making transmission more probable.tmpplchld When Duncan’s symptoms worsened, he was eventually hospitalized at Texas Health Presbyterian Dallas, where two of his caregivers became infected. Both nurses were wearing layers of protective gear and following strict protocols intended to protect them. Neither can explain her infection.tmpplchld A recent study of Dallas’ Ebola outbreak, published in the Annals of Internal Medicine, provides a bit of insight into this mystery. It notes that Ebola is not highly infectious in the first few days of someone being sick.tmpplchld However, a “primary caregiver” would be the most likely one to contract the disease, it concluded.tmpplchld The study focused mainly on Dallas’ massive effort to identify the closest personal contacts of the three Ebola patients. The contacts would include household members, ambulance personnel, cleanup crews, health care and laboratory workers _ basically anyone who had any contact with Duncan or either of his nurses or their bodily fluids.tmpplchld More than 280 people in Dallas had some contact with one or more of the Ebola patients, the study reported, and 179 would be confirmed as having had enough contact to require extended monitoring for possible Ebola infections.tmpplchld It was an unusual public health effort in the U.S., forcing so many people to stay home, which required Dallas County’s health department and other agencies to send representatives to visit them daily over a 21-day period. Not only were temperatures monitored, but food and other necessities, such as diapers and medication, had to be delivered to many of these households.tmpplchld Although extreme for Dallas, such isolation has been the most successful way of stopping Ebola’s spread in Africa.tmpplchld During the local monitoring effort, 14 people would be hospitalized with Ebola-like symptoms in Dallas. Only the nurses, Nina Pham and Amber Vinson, would test positive for the deadly virus and be sent to specialty hospitals in other states for Ebola treatment. Both survived.tmpplchld Duncan stayed at Presbyterian, where he died Oct. 8, about 16 days after his first symptoms appeared. He had come to America to build a new life, said those who knew him.tmpplchld The only insight into what actually happened inside the two-bedroom apartment where he stayed comes from a book written by Louise Troh. She is the Dallas woman Duncan had come to visit and the mother of his 19-year-old son, Karsiah. She says Duncan was planning to marry her.tmpplchld Her 260-page memoir of their relationship, “My Spirit Took You In,” was published in April by Weinstein Books. (It was co-authored by Christine Wicker, a local author and former religion writer for The Dallas Morning News.)tmpplchld Their story is both a heartwarming and heartbreaking tale of how Duncan and Troh escaped civil war in Liberia and fell in love in an Ivory Coast refugee settlement. They yearned to be in America, but so did everyone else there.tmpplchld Troh got political asylum and came to the U.S. in 1998, and Duncan kept trying. Last September, he flew to Dallas on a visitor’s visa, 16 years after Troh left Africa. Their reunion was joyous but did not last long.tmpplchld Within days, Duncan was sick, Troh writes, but his symptoms came on slowly and mysteriously. At first, his headache and fever were dismissed as nothing more than jet lag.tmpplchld Troh recalls thinking, “Eric has some minor problem and will get better.” She gave him Tylenol, and he seemed to improve for a while. She told him repeatedly to drink more water. Then he stopped eating.tmpplchld Her book provides the best possible explanation for why Ebola did not unleash its fury in the Dallas area: Troh was working at a Dallas senior living facility, where infection control was an obsession.tmpplchld tmpplchld Her job as a certified nurse assistant involved taking care of elderly residents, who were vulnerable to each other’s infections. Every surface had to be wiped clean, quickly and thoroughly, to kill germs.tmpplchld “Working in a nursing home, where everything has to be clean, I learned these ways,” Troh writes. “I am always washing my hands.”tmpplchld tmpplchld After Duncan’s arrival, Troh’s apartment became a gathering place for friends and family. Even as he was getting sicker, it filled up with visitors, sharing meals and the same bathroom.tmpplchld For nearly 100 pages, Troh describes Duncan’s medical saga: How he was misdiagnosed and sent back to the apartment from Presbyterian’s emergency room. How nobody realized quickly enough what was wrong. How even she did not see the signs.tmpplchld tmpplchld “I cannot say why the nurses did not think of Ebola, but I didn’t either,” she writes of Duncan’s first hospital visit. “Eric was sick, but he was walking around. Maybe we all thought he didn’t look so horrible _ not yet.”tmpplchld tmpplchld Back at the apartment, Duncan became sicker over the next two days, which also was the riskiest time for Troh, her 13-year-old son and two other young men sharing the apartment with him. Classic Ebola symptoms appeared, meaning Duncan was hemorrhaging bodily fluids teeming with the virus. At one point, he was so weak, he could not get back into Troh’s bed and slept on the floor.tmpplchld “I am going back and forth to the bedroom so much and the bed is so high,” Duncan tells Troh. She got pillows and a sheet to make him more comfortable and a plastic bag for him to spit into. Duncan had excessive saliva and diarrhea, key Ebola symptoms, more than 24 hours before he sought medical help a second time.tmpplchld Youngor Jallah, Troh’s eldest daughter and a fellow nurse assistant, would play a key role in preventing Ebola’s spread inside the two-bedroom apartment. While Troh was working, Jallah checked on Duncan, eventually summoning an ambulance when she realized he might be dying.tmpplchld Jallah was the one who urged the paramedics to put on protective gear before entering the apartment. Luckily, they followed her advice. At Presbyterian, Duncan was placed in isolation, which meant Troh and her family would have no physical contact with him again.tmpplchld tmpplchld Even before his diagnosis was confirmed, Troh and her daughter thoroughly cleaned the apartment’s bathroom and every surface Duncan might have touched. They knew it was critical to the family’s survival.tmpplchld “The virus could be anywhere,” Troh writes. “But I calmed myself. I know about viruses. I work around them every day. Keeping things clean is the important part. ... Ebola can only spread through contact with skin or other human membranes.”tmpplchld tmpplchld After Duncan’s illness was confirmed as Ebola, Troh picked up the clothing he had worn and the towels and washcloths he had used, placing them inside a plastic bag. Wearing protective gloves, she sprayed everything else with disinfectant and water, including her bedding. Then she sprayed them again for good measure.tmpplchld “I was afraid, and then telling myself not to be afraid,” she writes. “I decided then that I must not believe we were going to die. I decided that Eric would get better. None of us would get sick. And we would all have the wonderful life we planned for.”tmpplchld ___tmpplchld (c)2015 The Dallas Morning Newstmpplchld Visit The Dallas Morning News at www.dallasnews.comtmpplchld Distributed by Tribune Content Agency, LLC.tmpplchld