SECOND TEXAS HOSPITAL WORKER TESTS POSITIVE FOR EBOLA

Three days after a nurse who treated a Liberian man with Ebola contracted the virus, a second worker at Texas Health Presbyterian Hospital has tested positive for the virus in preliminary tests, state and federal health officials said Wednesday morning.
The hospital worker, who has not been identified, was part of the medical team that cared for the Ebola victim Thomas Eric Duncan after he was admitted to the hospital on Sept. 28 and put in isolation. The worker reported a fever Tuesday and was immediately isolated at Presbyterian hospital.
The total number of people being monitored is now 125, health officials said, including 48 who have been watched for more than two weeks after coming into contact with Mr. Duncan before he was admitted to Texas Health Presbyterian Hospital on Sept. 28.
Preliminary tests were performed late Tuesday by the laboratory for the Texas Department of State Health Services in Austin, and the positive results were received at about midnight. Additional tests to confirm the positive reading were underway by the federal Centers for Disease Control and Prevention in Atlanta. Officials interviewed the worker to identify anyone else who might have been exposed, the Texas Department of State Health Services said in a statement, but it was unclear whether any others were being monitored.
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Graphic: How Hospital Workers Are Supposed to Treat Ebola Safely
A second case of Ebola among the nearly 100 doctors, nurses and assistants who treated Mr. Duncan for 10 days at Presbyterian was not unexpected. For days, federal health officials have warned that, in addition to a nurse who was confirmed to have Ebola on Sunday, other cases were likely.
But the appearance of a new Ebola patient replayed a public-health drama that unfolded in this city twice before in a two-week period. It has also renewed questions about the hospital’s infection-control procedures and the C.D.C.’s oversight of the hospital and of the initial response to the first Ebola case diagnosed in the United States.
“An additional health care worker testing positive for Ebola is a serious concern, and the C.D.C. has already taken active steps to minimize the risk to health care workers and the patient,” the agency said in a statement.
On Wednesday, city and county officials were planning a news conference at 7 a.m. in downtown Dallas.
Crews in full-body hazardous-materials suits cleaned the common areas outside the worker’s apartment, in a complex about four miles south of the hospital. As was the case in the neighborhood where the nurse who contracted Ebola lived, city officials handed out fliers and did so-called reverse 911 calls of residences in a four-block radius of the second hospital worker’s apartment, informing people that a person who lived near them had tested positive for Ebola.
The original Ebola victim in Texas, Mr. Duncan, 42, a Liberian who arrived in Dallas last month and died last Wednesday, was diagnosed on Sept. 30, two days after he was admitted to the hospital. At some point while he was in isolation, the critical-care nurse, Nina Pham, 26, became infected. She reported a low-grade fever overnight Friday, and drove herself to the emergency room of the hospital where she worked.
Ms. Pham, now listed in “good condition” at Presbyterian hospital, had extensive contact with Mr. Duncan on multiple occasions while wearing a gown, mask and other protective gear, but officials have not yet determined how she became infected. They said she might have breached safety protocol when removing the protective clothing and gear.
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It was also not known how the second hospital worker contracted the disease, and it was unclear what, if any, monitoring the C.D.C. had conducted of the precautions hospital workers took as they came in and out of Mr. Duncan’s room in the isolation ward.
On Tuesday evening, a nurses’ union released a scathing statement that it said was composed by nurses at Presbyterian hospital. The statement told of “confusion and frequently changing policies and protocols,” of inadequate protection against contamination and spotty training.
“Were the protocols breached?” Deborah Burger, a president of the union, National Nurses United, asked while reading the statement. “The nurses say there were no protocols.”
Officials at Texas Health Resources, the parent company of Presbyterian hospital, defended their efforts to “provide a safe working environment” but said they would review any concerns raised by nurses.
On Tuesday evening, hours before the nurses’ union described the inadequate protections Presbyterian nurses had in treating Mr. Duncan, the head of the C.D.C. acknowledged for the first time that the agency should have put a more robust team of experts on the ground during its initial response and should have played a more hands-on role in overseeing the hospital.
The acknowledgment came as C.D.C. officials vowed to dispatch a newly created response team to any hospital in the country that has a confirmed case of Ebola, and as they bolstered the amount of expertise, oversight and training at Presbyterian hospital. They have sent some of the world’s leading experts on Ebola to Dallas, as well as two nurses from Emory University Hospital in Atlanta who cared for Ebola patients safely and who will train hospital staff on infection control and the use of protective equipment.
“I wish we had put a team like this on the ground the day the patient, the first patient, was diagnosed,” Dr. Thomas R. Frieden, director of the C.D.C., said at a news conference Tuesday. “That might have prevented this infection. But we will do that from today onward with any case, anywhere in the U.S.”
The latest person to test positive was one of 76 health care workers at Presbyterian who were being monitored daily for symptoms of Ebola. All of them were involved in treating Mr. Duncan from the time he was admitted to the hospital on Sept. 28 to his death a week ago, and some may have handled specimens of his blood. “There were 76 people who had some level of contact and therefore are being actively monitored,” Dr. Frieden said.
That is in addition to the 48 people who were already being watched because they had possible contact with Mr. Duncan before he was hospitalized. In addition, one person who had had contact with Ms. Pham was being monitored. The number of people under observation was 125 as of Tuesday.
The expanded pool of health care workers being monitored underscored what other public-health experts had described as a misstep by officials — the failure to regularly monitor the medical team treating Mr. Duncan for signs of Ebola and instead put them on a so-called self-monitoring regimen, in which they checked their temperature twice a day, as Ms. Pham had been doing.
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“Originally we assumed that once the person was in the hospital we should not have any more cases or patients,” David Daigle, a spokesman for the C.D.C. in Dallas, said. “Now we’ve found out that we have to restart the clock.”
Officials with the nurses’ union that issued the statement Tuesday night said it had been prepared by Presbyterian nurses who had knowledge of the care provided to Mr. Duncan and to Ms. Pham. They refused to identify the nurses or their departments, saying the nurses feared retaliation, and refused to say whether any of the nurses who prepared the statement were involved in treating Mr. Duncan. The Presbyterian nurses are not members of the National Nurses United union.
The statement asserted that when Mr. Duncan arrived by ambulance with Ebola symptoms at the hospital’s emergency room on Sept. 28, he “was left for several hours, not in isolation, in an area where other patients were present.” At some point, it said, a nurse supervisor demanded that he be moved to an isolation unit “but faced resistance from other hospital authorities.”
The nurses who first interacted with Mr. Duncan wore generic gowns, three pairs of gloves with no taping around the wrists, and surgical masks with the option of a shield, the statement said.
“The gowns they were given still exposed their necks, the part closest to their face and mouth,” the nurses said. “They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical bootees nor were they advised the number of pairs of gloves to wear.”
The statement said hospital officials allowed nurses who interacted with Mr. Duncan at a time when he was vomiting and had diarrhea to continue their normal duties, “taking care of other patients even though they had not had the proper personal protective equipment while providing care for Mr. Duncan that was later recommended by the C.D.C.”
Told of the statement, a spokeswoman for the C.D.C. said the agency would not be looking at the situation from a regulatory perspective. “That oversight comes from the health department at the state level,” she said.
Alan Cowell contributed reporting from London.