About 80 people are now being monitored for symptoms of Ebola in Texas, a Dallas County Health and Human Services spokeswoman said Thursday.
The people being monitored are the 12 to 18 people who first came into contact with the infected man - which federal health officials have said include three members of the ambulance crew that took the infected man to the hospital, as well as a handful of schoolchildren - as well as others those initial people had contact with, spokeswoman Erikka Neroes said.
"The number of people who are now part of the contact investigation has grown to more than 80," she said.
Neroes was unable to specify how those initial 12 to 18 people came in contact with the larger group, nor could she provide specifics about the ages of those being monitored. No one is showing symptoms, she said, and health officials have told them to monitor their own conditions in the coming weeks.
Health officials are focusing on containment to try to stem the possibility of the Ebola virus spreading beyond Thomas Eric Duncan, who traveled from Liberia to Dallas to visit relatives and fell ill on Sept. 24. His sister, Mai Wureh, identified Duncan as the infected man in an interview with The Associated Press.
A Dallas emergency room sent Duncan home last week, even though he told a nurse that he had been in disease-ravaged West Africa. The decision by Texas Health Presbyterian Hospital to release Duncan could have put others at risk of exposure to Ebola before the man went back to the ER a couple of days later when his condition worsened.
"That's how we're going to break the chain of transmission, and that's where our focus has to be," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said Wednesday.
The patient explained to a nurse last Thursday that he was visiting the U.S. from Africa, but that information was not widely shared, said Dr. Mark Lester, who works for the hospital's parent company.
Hospital epidemiologist Dr. Edward Goodman said the patient had a fever and abdominal pain during his first ER visit, not the riskier symptoms of vomiting and diarrhea. Duncan was diagnosed with a low-risk infection and sent home, Lester said.
Texas Health Presbyterian Hospital is reviewing how the situation would have been handled if all staff had been aware of the man's circumstances. "(Hospital officials) told me that is something they are looking into," spokeswoman Candace White said.
David Wright, regional director of the U.S. Centers for Medicare & Medicaid Services, wouldn't say if the hospital was under investigation. Wright said that in cases they do handle, federal investigators examine if a hospital complied with a "reasonable physician standard" in deciding whether to admit a patient with a potential medical emergency.
But the diagnosis, and the hospital's slip-up, highlighted the wider threat of Ebola, even far from Africa.
"The scrutiny just needs to be higher now," said Dr. Rade Vukmir, a spokesman for the American College of Emergency Physicians.
Duncan has been kept in isolation at the hospital since Sunday. He was listed in serious but stable condition.
Neighbors in Monrovia, Liberia, believe Duncan become infected when he helped bundle a sick pregnant neighbor into a taxi a few weeks ago and set off with her to find treatment. The 19-year-old woman was convulsing and complaining of stomach pain, and everyone thought her problems were related to her pregnancy, in its seventh month. No ambulance would come for her, and the group that put her in a taxi never did find a hospital. She died, and in the following weeks, all the neighbors who helped have gotten sick or died, neighbors said.
Duncan's neighborhood, a collection of tin-roofed homes along 72nd SKD Boulevard in Monrovia, has been ravaged by Ebola. So many people here have fallen ill that neighbors are too frightened to comfort a 9-year-old girl who lost her mother to the disease.
Ebola is believed to have sickened more than 7,100 people in West Africa and killed more than 3,300, according to the World Health Organization. Liberia is one of the three countries hit hardest in the epidemic, along with Sierra Leone and Guinea.
Ebola symptoms can include fever, muscle pain, vomiting and bleeding, and can appear as long as 21 days after exposure to the virus. The disease is not contagious until symptoms begin. It spreads only by close contact with an infected person's bodily fluids.
In Texas, neither the ambulance crew nor the children showed any symptoms and were being monitored at home. It was not clear how Duncan knew the children, but his sister said he had been visiting with family, including two nephews.
Duncan left Liberia on Sept. 19, flying from Brussels to Dulles Airport near Washington. He then boarded a flight for Dallas-Fort Worth, according to airlines, and arrived the next day. He started feeling ill four or five days later, Frieden said.
Dr. Tom Kenyon, director of the CDC's Center for Global Health, said Duncan did not show signs of disease before boarding the plane in Monrovia. Since the man had no symptoms on the plane, the CDC stressed there is no risk to his fellow passengers.
The CDC has received 94 inquiries from states about illnesses that initially were suspected to be Ebola, but after taking travel histories and doing some other work, most were ruled out. Of the 13 people who actually underwent testing, only one - Duncan - tested positive.
Four American aid workers who became infected in West Africa have been flown back to the U.S. for treatment after they became sick. Three have recovered.