Mistakes and Reversals Shake Trust in Ebola Response, in Dallas and Beyond

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DALLAS—Their city has become an unwanted focus of the growing concerns about Ebola contamination in the United States, but ask most anyone here and they'll say they're not that worried about becoming infected. Even so, local drug stores have been selling out of hand sanitizer and masks.

Dallas’s Texas Health Presbyterian Hospital has come under fire over lapses in its care of Thomas Eric Duncan, the Liberian who was the first Ebola patient in the United States. At least two nurses who cared for Duncan became infected. But residents here are quick to defend “Presby,” as the well-regarded hospital is known, saying that the U.S. government initially failed to provide the hospital’s staff with adequate protective gear and training.

In that sense, the Ebola crisis that so randomly landed in Dallas has become wrapped up in the suspicions that many people in this conservative city have about the federal government. There is a consensus among scientists that Ebola isn't an airborne virus and is not at all likely to become one, for example, but not everyone here believes what scientists are telling them.

See graphic:
Ebola: Tracking the Outbreak

"Viruses can mutate and become airborne," Grace Joines claimed during a recent town hall meeting on Ebola in the Lakewood Theater, an Art Deco movie house here. Joines, who identified herself as a health-care worker, said she believes the government is "holding something back."

Such are the contradictions, anxieties, and budding conspiracy theories that have circulated in Dallas since Duncan traveled here from Liberia last month, fell fatally ill, and became the United States' patient zero for a disease whose ravages seem torn from the pages of the Bible. (See: "Amid Ebola Panic, Separating Fact From Fiction.")

The sprawling metropolis around Dallas and nearby Fort Worth is where the Ebola crisis landed in the United States—and where the diagnosis of two nurses who cared for Duncan, Nina Pham and Amber Vinson, ignited concerns about the disease's potential to spread.

Reassurances by government and hospitals that the situation is under control were undercut by early missteps, followed by dramatically shifting responses. (Related: "Every Newly Emerging Disease Like Ebola Begins With a Mystery.")

For months, Centers for Disease Control and Prevention Director Thomas Frieden had been promising that Ebola could not spread in the United States, where the medical system would be able to handle a few travelers who'd arrive with the disease.

Although Frieden says he still wants every hospital in America to be able to safely identify and treat anyone with Ebola, it became clear that Dallas's Texas Health Presbyterian was not adequately prepared to treat Ebola patients. Frieden announced that federal government was revamping its recommendations to hospitals, and the two infected nurses were moved from Dallas to facilities in Atlanta, Georgia, and Bethesda, Maryland, that have more experience handling infectious diseases. Both appear to be suffering, but are in stable condition.

Visitors walk past Jeff Hulbert of Annapolis, Maryland, as he protests in front of the White House on Thursday in favor of a ban on flights from West Africa.

Photograph by Jim Bourg, Reuters

Frieden's initial defense of the United States' front line against Ebola rang particularly hollow to many Americans after reports that Vinson, one of the infected nurses, had been allowed to fly from Dallas to Cleveland and back although she had been in close contact with Duncan and reported an elevated temperature to the CDC. She should not have been allowed to fly, the CDC says now.

A number of people in Dallas are being monitored for an elevated temperature or other signs that they might be infected.

The last of 45 people who came into direct contact with Duncan ended their 21-day watch period Sunday, three weeks to the day after Duncan was taken by ambulance to Texas Presbyterian. Seventy-five others who came into contact with Duncan in the hospital between September 28 and October 8, when he died, are still being monitored. Passengers who flew on the same flights with Vinson to and from Cleveland have been asked to call a CDC hotline, 800-232-4636.

Five schools in Texas and Ohio were closed late last week for extra cleaning because they house students who had a parent or other family member on one of Vinson's flights—a sign of how the anxiety over Ebola is rising despite assurances from the CDC and other government agencies that it can be spread only through direct contact with an infected person's bodily fluids, and only after they have begun to show symptoms of the disease. A woman who handled Duncan's sealed blood samples at the hospital and then went on a cruise has since tested negative for the disease, though the cruise ship was prevented from docking in Cozumel, Mexico, as scheduled, because she was a passenger.

To try to contain the hysteria and avoid any more missteps, President Barack Obama Friday appointed an "Ebola czar" to coordinate the government's response to the crisis—a step he had initially resisted.

Americans' growing concern about the crisis was captured in a poll conducted by the Kaiser Family Foundation from October 8 to 14. The poll found 45 percent of respondents worried that they or a family member would contract the disease. At the same time, 73 percent said it was more likely that Ebola would be contained to a small number of cases in the United States.

Molly Ann Brodie, Kaiser's executive director of public opinion and survey research, said those mixed feelings suggest that Americans are struggling to figure out basic facts about the disease.

"It's too early for opinion or for people to really have a set take on this issue," she said. "They're still trying to sort out for themselves what it means for them and their families and what their risks really are."

Custodial workers leave after cleaning Davis Elementary School in Texas, which was closed Friday out of an “abundance of caution” after officials of the Royse City Independent School District learned that a health-care worker who treated one of the nurses diagnosed with Ebola lived with children who attend the school.

Photograph by Chip Somodevilla, Getty

Worried Nurses

If trust in government and medicine continues to erode, public panic could feed on itself, hurting the economy, health analysts say.

They point to the SARS epidemic in 2003, which led to 800 deaths mainly in and around China and Canada and cost the world an estimated $40 billion—mostly from the response to the outbreak, rather than from the disease itself. Tourists canceled travel plans; customers avoided movie theaters, restaurants, and shopping malls; and demand for goods in affected countries fell, hurting economies all over the world. SARS is more contagious than Ebola, passing via coughs and sneezes, though less deadly.

More recently, Daniel Barnett of the Johns Hopkins Bloomberg School of Public Health has found that as many as a third of nurses and nearly as many doctors would stay home during a flu pandemic out of fear of falling ill themselves.

Hospital workers who felt well prepared for a crisis and part of a team were more likely to come to work, Barnett said last week.

In West Africa, 420 health-care workers are known to have been infected with Ebola, and 239 have died, compromising already weak health-care systems in Liberia, Guinea, and Sierra Leone. (Related: "Doctors and Nurses Risk Everything to Fight Ebola in West Africa.")

Although no one expects that kind of spread in the United States, health-care workers are the most exposed in any outbreak. A national nurses' union has been complaining that America's nurses have not been adequately prepared to cope with anyone who might arrive at their hospital with the disease.

Police cordon off a home in Tallmadge, Ohio, on Wednesday. One of the nurses diagnosed with Ebola stayed there last weekend.

Photograph by Mark Duncan, AP

Horror Movies

Ebola has never traveled outside Africa before, so new questions have been popping up: Could it be passed on airplanes or sweaty gym equipment? Will running water and plenty of supplies help protect nurses from exposure? How long must a pet dog be kept in quarantine?

These are questions that never surfaced in rural villages in central Africa, where the disease has popped up periodically for nearly 40 years, or in the small towns and urban slums of West Africa, where more than 9,100 people have been infected, with 4,500 confirmed deaths this year.

But this uncertainty eats at many people. Perhaps more so in Dallas.

"Why doesn't anybody know anything?" asked Lissa Scherer, whose house is in the same M Street neighborhood where one of the nurses came down with the disease. "Didn't anybody watch all the movies?" asked Scherer, referring to fictional accounts of medical disasters in films like 1995's Outbreak, about an Ebola-like virus.

Scherer said she likes to be ready for anything. When she lived in Oregon, she had an earthquake plan. Here, she'd like to be prepared, but she doesn't know what to do, other than wash her hands more often.

Public health officials have been telling people to get a flu shot. Not only will it afford protection from influenza, which kills thousands of Americans each year, but fewer people will come down with the fever and pains that can be mistaken for symptoms of Ebola. "I don't think any of these people really know," what the public should do to stay safe, Scherer said, referring to government and hospital officials.

Health-care workers line up at Texas Health Presbyterian Hospital Dallas to show their support for Nina Pham, a nurse who contracted Ebola while caring for Thomas Eric Duncan, who later died. Pham was flown on Thursday to a National Institutes of Health facility in Bethesda, Maryland.

Photograph by Tony Gutierrez, AP

That perceived lack of certainty about the virus seeds doubt. Missy Gregory, a Dallas resident who took a visiting friend to the George W. Bush Presidential Center this week, said she doesn't believe the government assurances that Ebola can't pass through the air.

"It's not like a cold," she said. "But you can be anywhere and anyone can sneeze on you and you've got to be prayed up."

Pastor Andrew Forrest organized a prayer vigil October 13 at Munger Place Church in East Dallas to try to tamp down fear about Ebola.

"I don't want fear to be the dominant emotion in East Dallas," he said after the service, which was attended by about 100 locals. "Let's choose love over fear," he repeatedly told those at the vigil, leading them in prayers for health-care workers, public officials, and West Africans.

But as uncertainty continues, people feel uneasy.

A group of Tri Delta sorority sisters at Southern Methodist University, eating dinner Wednesday at a casual French restaurant, said some of their classmates are creating their own anxiety by imagining that the virus could magically become airborne and waft through campus.

"I don't think anyone at SMU has anything to worry about," said Katarina Sipan, a sophomore majoring in communications and biology who is planning to become a physician's assistant.

She volunteers in the maternity ward at Presby and felt guilty skipping work this week; she wants to be there for her patients. But her parents didn't want her in the hospital complex this week, and part of her agreed with them. "My fear is I would give it to everyone at SMU," Sipan said.

The young women around her table joked about a classmate whose parents brought her three weeks of food so she wouldn't have to go out.

"It's the uncertainty that's making people freak out," said Hayley Metcalf, a double major in communications and business management. "I'm going to be more careful, but I'm not scared."