DALLAS – Federal health officials on Monday urged the nation's hospitals to "think Ebola" and launched a review of procedures for treating patients, while medical records showed that an infected Texas nurse repeatedly visited the room of a Liberian man as he was dying from the disease.
The World Health Organization called the outbreak "the most severe, acute health emergency seen in modern times."
Nurse Nina Pham was among about 70 staff members at Texas Health Presbyterian Hospital who were involved in Thomas Eric Duncan's care after he was hospitalized, according to the records. They drew his blood, put tubes down his throat and wiped up his diarrhea. They analyzed his urine and wiped saliva from his lips, even after he had lost consciousness.
The 26-year-old was in his room often from the day he was placed in intensive care until the day before he died last week.
Pham and other health care workers wore protective gear, including gowns, gloves, masks and face shields — and sometimes full-body suits — when caring for Duncan, but Pham became the first person to contract the disease within the United States.
Her family told Dallas television station WFAA on Monday that she was the health care worker with Ebola. A rector at her family's church, Hung Le, told The Associated Press that Pham's mother told him Pham has the virus.
The Texas Christian University nursing school graduate was monitoring her own temperature and went to the hospital Friday night when she discovered she had a low fever. She was in isolation and in stable condition, health officials said.
By Monday evening, she had received a transfusion of plasma from Kent Brantly, a Texas physician who survived the virus, according to her pastor and the nonprofit medical mission group Samaritan's Purse.
Since she tested positive for the disease, public-health authorities have intensified their monitoring of other Dallas hospital workers who cared for Duncan.
Centers for Disease Control and Prevention Director Tom Frieden said he would not be surprised if another hospital worker who cared for Duncan becomes ill because Ebola patients become more contagious as the disease progresses.
Pham's name appears frequently throughout the hundreds of pages of records provided to The Associated Press by Duncan's family. They show she was in his room Oct. 7, the day before he died.
Her notes describe nurses going in and out of Duncan's room wearing protective gear to treat him and to mop the floor with bleach.
She also notes how she and other nurses were ensuring Duncan's "privacy and comfort," and providing "emotional support."
Frieden has said a breach of protocol led to the nurse's infection, but officials are not sure what went wrong. Pham has not been able to point to any specific breach.
The CDC is now monitoring all hospital workers who treated Duncan and planned to "double down" on training and outreach on how to safely treat Ebola patients, Frieden said.
When asked how many health care workers are being checked, Frieden said officials "don't have a number."
Health officials have relied on a "self-monitoring" system when it comes to U.S. health care workers who care for isolated Ebola patients. They expect workers to report any potential exposures to the virus and watch themselves for symptoms.
Besides the workers, health officials continue to track 48 people who were in contact with Duncan before he was admitted to the hospital and placed in isolation. They are monitoring one person the nurse was in contact with while she was in an infectious state.
None has exhibited symptoms, Frieden said.
The case involving Pham raised questions about assurances by American health officials that the disease will be contained and that any U.S. hospital should be able to treat it.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ABC's "Good Morning America" that federal health authorities should consider requiring that Ebola patients be sent only to highly specialized "containment" hospitals.
Duncan, who arrived in the U.S. from Liberia Sept. 20, first sought medical care for fever and abdominal pain Sept. 25. He told a nurse he had traveled from Africa, but he was sent home. He returned Sept. 28 and was placed in isolation because of suspected Ebola.
Among the things the CDC will investigate is how the workers took off protective gear, because removing it incorrectly can lead to contamination. Investigators will also look at dialysis and intubation — the insertion of a breathing tube in a patient's airway. Both procedures have the potential to spread the virus.
Fauci told CNN that the CDC is examining procedures like dialysis to see if they "heighten greatly" the risk of health care workers contracting Ebola. He suggested that in cases where the patient has deteriorated to the point where he or she cannot be saved, such high-risk procedures should not be done.
Every emergency room needs to be prepared to take action because no one can control where an Ebola patient might show up, said Dr. Dennis Maki, an infectious-disease specialist at the University of Wisconsin-Madison and former head of hospital infection control.
However, only large hospitals such as those affiliated with major universities truly have the equipment and manpower to deal with Ebola correctly, Maki said.
Officials said there was a dog in the nurse's apartment that has been removed to an undisclosed location for monitoring and care. They do not believe the pet shows any signs of Ebola. A dog belonging to an infected Spanish nurse was euthanized, drawing thousands of complaints.
Ebola has killed more than 4,000 people, mostly in the West African countries of Liberia, Sierra Leone and Guinea, according to WHO figures published last week.