Liberian Thomas Eric Duncan, who recently traveled from West Africa to Dallas, had been in isolation at Texas Health Presbyterian Hospital in Dallas since Sept. 28. It wasn’t immediately known what would happen to his body, which could remain contagious for several days. Guidelines from the Centers for Disease Control and Prevention call for the remains to be immediately shrouded in plastic and double-bagged in leak-proof bags at the hospital, then promptly cremated or buried in an airtight casket.
Duncan’s death comes four days after his condition was downgraded from serious to critical. Over the weekend, he had begun receiving brincidofovir, an experimental antiviral drug which recently gained emergency approval from the FDA.
Duncan, 42, is also the first person known to die of Ebola in the United States. The highly contagious virus has killed more than 3,400 people in West Africa in 2014, the World Health Organization estimates.
Five Americans who were diagnosed with Ebola in Africa have returned to the U.S. for treatment since late July. Aid workers Kent Brantly, Nancy Writebol and Rick Sacra made full recoveries. WHO said one of its doctors was transported to Emory University Hospital in Atlanta on Sept. 9. No other details have been released. Ashoka Mukpo, a cameraman working for NBC News, arrived at the Nebraska Medical Center in Omaha for treatment on Monday.
Duncan’s illness and treatment have sparked controversy. He arrived in Dallas on Sept. 20 from Liberia, one of the hardest-hit areas of the outbreak.
His neighbors in Monrovia told reporters that five days before his flight, Duncan helped a pregnant woman get to the hospital in a taxi. She was convulsing and vomiting. The woman died at home hours later, after being turned away from a crowded Ebola treatment ward.
It is unclear if Duncan knew the woman had Ebola, but Liberian government officials said they plan to prosecute him for lying on health forms he completed at the airport on Sept. 19.
Duncan answered “no” to questions about whether he had cared for an Ebola patient or touched the body of someone who had died in an area affected by Ebola.
CDC officials said Duncan, who was reportedly coming to Dallas to be with his fiancee, didn’t have a fever or symptoms of Ebola when he boarded his flight in Liberia.
Five days after arriving in Dallas, a friend drove Duncan to the emergency room at Texas Health Presbyterian. Hospital officials said he showed up in the middle of the night with a fever of 100.1 degrees, abdominal pain for two days, a sharp headache and decreased urination. The hospital said Duncan told them he had not experienced nausea, vomiting, or diarrhea — strong indicators of Ebola.
Federal guidelines published in August state that someone in Duncan’s condition and who was known to have been in West Africa should be placed in isolation and tested for Ebola. Instead, Duncan was given a prescription for antibiotics and sent home.
Hospital officials initially blamed a flawed records system for the mix-up but have since retracted that account. No other explanation has been given for how the Ebola diagnosis was overlooked.
Duncan’s condition had worsened by the time he was brought back to Texas Health Presbyterian two days after being discharged. He was reportedly throwing up as paramedics put him in the ambulance at the apartment complex where he had been living with family and friends.
Those paramedics are among seven health care workers who are now being monitored for Ebola symptoms. Three family members living in the apartment where Duncan stayed when he arrived in Dallas are being watched closely for signs of the disease.
An additional 38 individuals, including a man who was treated in the same ambulance after it was used to transport Duncan, are considered low-risk contacts, but they will be monitored for 21 days, the maximum period of time it may take for symptoms to appear.
Texas Health Presbyterian immediately isolated Duncan upon his second arrival. According to the Dallas Morning News, the hospital may have violated federal guidelines by delaying a blood test for Ebola.
According to the report, other testing and blood work was done first to rule out other causes. The Ebola test wasn’t performed and confirmed until two days after Duncan was placed in isolation.
Dr. Thomas Frieden, director of the CDC, called the mishandling a “teachable moment” and issued a nationwide alert to all hospitals updating them on how to appropriately respond to possible Ebola cases.
A day before his death, civil rights leader, Rev. Jesse Jackson called on the public to show compassion to Mr. Duncan and his family, not to ostracize them, the Associated Press reported.
He said the hospital initially discharged the patient because he was poor and did not have medical insurance. The hospital and health officials have said mistakes were made in handling Mr. Duncan, Reuters reported.
Dallas officials have complained that the Ebola virus has cast a stigma over the Vickery Meadow neighborhood, where Mr. Duncan was staying, and neighbors are saying they feel discriminated against.
Dallas City Council member Jennifer Staubach Gates said she met with over 30 community leaders on Monday to try and assess the needs of the residents.
“Unfortunately, they are feeling discriminated against,” she told a local CBS affiliate. “We still have some that have been turned away from jobs, some that have been turned away at retail locations. We’re getting them in touch with legal aid and any resources necessary,” Ms. Gates said and that she believes that educating the public is the only way to reverse the stigma.
“These residents, unless they happen to be one of those that were exposed that are being traced, they are not at risk for getting the disease and are not at risk for transmitting the diseases,” she told the station.