A second Dallas nurse has contracted Ebola. Are more cases to come?

Infected hospital worker was on a flight the day before reporting symptoms

A second member of the care team that treated the first U.S. Ebola patient at Texas Health Presbyterian Hospital has been diagnosed with the virus, Texas and federal health officials announced early this morning.

The first case: Dallas nurse contracts Ebola. Was a protocol breach to blame?

The diagnosis comes three days after Dallas nurse Nina Pham—who cared for Thomas Eric Duncan, a Liberian national who died last week after spending 10 days at the hospital battling Ebola—tested positive for the deadly virus, marking the first known Ebola transmission on U.S. soil. Officials say Pham's condition has been upgraded to "good."

Details of the second case

Officials say the second infected worker, nurse Amber Vinson, tested positive for the virus in preliminary tests performed late Tuesday night after she reported a fever. The tests have been sent to CDC for confirmation, and the woman is now in an isolation unit at Texas Health Presbyterian.

Officials say that Vinson was isolated at the Dallas hospital within 90 minutes of reporting her fever. Officials say Vinson will be transported to Emory University Hospital in Atlanta to receive care.

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Daniel Varga—the chief clinical officer for Texas Health Resources—says, "There was an exposure somewhere, some time during the treatment of Mr. Duncan." However, he says he does not think the hospital has "a symptomatic, institutional problem."

Texas state health officials in a statement said that Vinson has identified individuals with whom she had come into contact who might have been exposed.

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Any individual who had some level of contact with Duncan or members of his care team is being monitored. CDC spokesperson David Daigle says, "Originally we assumed that once the person was in the hospital we should not have any more cases or patients," but "now we've found out that we have to restart the clock."

According to the New York Times, crews in protective gear began cleaning the common areas outside Vinson's apartment complex early Wednesday morning. In addition, city officials have begun handing out fliers and conducting "reverse 9-1-1 calls" of residences within a four-block radius of the woman's apartment to alert them that a person living near them has tested positive for the Ebola virus.

CDC says Vinson took a Frontier Airlines flight from Cleveland to Dallas on Oct. 13, the day before she reported her fever. Public health workers will interview passengers on the flight. "Individuals who are determined to be any potential risk will be actively monitored," the CDC said in a statement.

CDC: We should have been more hands on in Duncan's case

It is unknown how the second health care worker contracted the disease, but the diagnosis "renewed questions about the hospital's infection-control procedures and the CDC's oversight of the hospital and of the initial response to the first Ebola case diagnosed in the United States," the New York Times' Manny Fernandez writes.

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CDC in a statement called the diagnosis "a serious concern" and said it has "already taken active steps to minimize the risk to health care workers and the patient." The agency for the first time has acknowledged that it should have been more hands-on in overseeing the treatment and care of Duncan and that it should have dedicated more health experts to the case.

Going forward, CDC officials plan to send an emergency response team to any hospital with a confirmed case of Ebola. In addition, the agency says it has conducted more training exercises at Texas Presbyterian in the wake of the first diagnosis and increased its oversight of the cases.

CDC director Tom Frieden during a news conference on Tuesday said, "I wish we had put a team like this on the ground the day... the first patient was diagnosed," adding, "But we will do that from today onward with any case, anywhere in the U.S."

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Dallas officials: We're bracing for more cases

Jenkins says the city has not ruled out more cases among the 75 other workers who cared for Duncan at Texas Health Presbyterian. Those individuals are all being monitored by the CDC.

"We are preparing contingencies for more and that is a real possibility," Jenkins says (Fernandez, New York Times, 10/15; Cardona, "The Scoop Blog," Dallas Morning News, 10/15; Levs/Yan, CNN, 10/15; Jervis/Stanglin, USA Today, 10/15).

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