DALLAS, Texas — Thomas Eric Duncan left Africa for the United States, by official accounts, a healthy man. Just over two weeks later, he passed away in a Dallas, Texas, hospital with Ebola.
Duncan was admitted into isolation at Texas Health Presbyterian Hospital on September 28 with common symptoms of Ebola: fever, vomiting and diarrhea. He later tested positive for the virus that has killed more than 3,400 people in West Africa.
He was started on the experimental drug brincidofovir on October 4 — far too long after he arrived at the hospital, his family has said. On Tuesday, the hospital reported that Duncan was on a ventilator and his kidneys were failing.
Duncan died on Wednesday at 7:51 a.m.
“Mr. Duncan succumbed to an insidious disease, Ebola. He fought courageously in this battle,” the hospital said in a statement Wednesday. “Our professionals, the doctors and nurses in the unit, as well as the entire Texas Health Presbyterian Hospital Dallas community, are also grieving his passing.”
Who was Duncan, besides the first person to be diagnosed with Ebola in the United States? When did he start to feel sick, and why couldn’t the U.S. health care system save him?
“The past week has been an enormous test of our health system, but for one family it has been far more personal,” Dr. David Lakey, commissioner of the Texas Department of State Health Services, said in a statement. “The doctors, nurses and staff at Presbyterian provided excellent and compassionate care, but Ebola is a disease that attacks the body in many ways. We’ll continue every effort to contain the spread of the virus and protect people from this threat.”
Who was Thomas Eric Duncan?
He was a 42-year-old Liberian citizen. Duncan’s Facebook page indicates that he’s from the Liberian capital of Monrovia, where he attended E. Jonathan Goodridge High School.
Why did he come to the United States?
To visit family and friends. Duncan was visiting his son and his son’s mother in Dallas, according to Wilfred Smallwood, Duncan’s half-brother, who noted this was Duncan’s first trip to America.
When did Duncan leave Liberia?
He departed the West African nation on September 19, CDC Director Dr. Thomas Frieden says.
How did he get Ebola?
Health authorities haven’t said.
Witnesses say Duncan had been helping Ebola patients in Liberia. Liberian community leader Tugbeh Chieh Tugbeh said Duncan was caring for an Ebola-infected patient at a residence in Paynesville City, just outside Monrovia.
The New York Times reported that Duncan had direct contact with a pregnant woman stricken with Ebola on September 15, days before he left for the United States. Citing the woman’s parents and Duncan’s neighbors in Monrovia, Liberia, the newspaper said Duncan had helped carry the ailing woman home after a hospital turned her away because there wasn’t enough space in its Ebola treatment ward.
Was he screened for Ebola before getting on the plane?
Yes, according to Binyah Kesselly, board chairman of the Liberia Airport Authority.
“The first screening was at the gate, before you get to the parking lot. The second time is before you enter the terminal building and the third is before you board the flight. At every point your temperature is scanned.”
His temperature at those checkpoints was a consistent 97.3 degrees Fahrenheit, Centers for Disease Control and Prevention chief Thomas Frieden told reporters Thursday.
Yet on a health screening questionnaire, Duncan answered “no” to questions about whether he had cared for a patient with the deadly virus and whether he had touched the body of someone who died in an area affected by the disease, Kesselly said.
So where did he go next?
Ducan was on two United Airlines flights — Flight 951 from Brussels to Washington Dulles and Flight 822 from Washington Dulles to Dallas-Fort Worth — during his trip, according to a spokesperson for the airline who did not want to be named.
The airline has been voluntarily reaching out to passengers on those flights, an airline source said, though they are not considered at risk.
When did his Ebola symptoms appear?
“Four or five days” after his trip, according to the CDC’s Frieden.
This doesn’t mean that Duncan actually got infected with Ebola in the United States. The incubation period for the virus is 2 to 21 days, meaning that a person could be infected with the disease for up to three weeks before showing any signs of it.
When he did seek medical help?
Duncan first walked into Texas Health Presbyterian Hospital Dallas after 10 p.m. on September 25.
Smallwood reports Duncan had a fever and was vomiting during this first visit to the Dallas hospital. The hospital, in a statement, said he had a “low grade fever and abdominal pain.”
He underwent basic blood tests but wasn’t screened for Ebola, said Dr. Edward Goodman from the Dallas hospital. Duncan left the medical facility after being given antibiotics and a pain reliever, his friend said.
“His condition did not warrant admission,” the hospital said. “He also was not exhibiting symptoms specific to Ebola.”
Were flags raised that Duncan might have Ebola?
After being asked by a nurse, Duncan did say that he’d traveled from Africa, said Dr. Mark Lester, executive vice president of Texas Health Presbyterian’s parent company.
But that detail — which might have raised an alarm that Duncan might have Ebola, since Liberia is one of the countries hardest hit by the virus — was not “fully communicated” to the medical team, according to Lester.
When was he admitted to Texas Health Presbyterian Hospital?
On September 28. By the time Duncan arrived via ambulance, “EMS had already identified potential need for isolation,” the hospital said.
Who did the patient come into contact with in the meantime?
Given the timetable outlined by Frieden, that leaves a few days between when Duncan began to show signs of Ebola and when he was hospitalized. This is significant because someone with Ebola is contagious when they are symptomatic.
Health officials are monitoring around 50 people daily who had contact with Duncan. These are people who crossed paths with the patient either at the hospital, at his apartment complex or in the community while he was contagious. About 10 people are at “higher risk” of catching Ebola; the other 40 are considered low risk.
That number includes five students who attended four different schools in the area, according to Dallas Superintendent Mike Miles.
None has so far shown symptoms of Ebola.