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CDC Director Thomas Frieden today said the second health care worker to become infected in Dallas "should not have traveled on a commercial airline."

CDC Director Thomas Frieden today said the second health care worker to become infected in Dallas "should not have traveled on a commercial airline."

One more question, Dr. Frieden: Eleven things we'd like to know about the new Ebola case

A second health care worker at Texas Presbyterian Hospital in Dallas has tested positive for the Ebola virus. Today, the U.S. Centers for Disease Control and Prevention (CDC) said that its investigations “increasingly suggest” that she and a colleague diagnosed with Ebola on 14 October were at highest risk of infection between 28 and 30 September, when Thomas Eric Duncan had been admitted to the hospital but had yet to receive confirmation that he was infected.

“These two health care workers both worked on those days, and both had extensive contact with the patient when the patient had extensive production of body fluids because of vomiting and diarrhea,” said CDC Director Thomas Frieden at a press conference today.

The second health care worker flew from Cleveland, Ohio, to Dallas on 13 October, the day before she developed symptoms, leading CDC to try to contact the 132 passengers and the crew on that flight. (The woman had an "elevated" temperature of 99.5°F, or 37.5°C; that's below the threshold for a fever, which is at 100.4°F, or 38.0°C.) Frieden said the woman, whose job he did not specify, “should not have traveled on a commercial airline” but stressed she did not vomit and was not bleeding during the trip. “The level of risk of people around her would be extremely low,” he said.

Frieden vowed that this lapse would not happen again. “We will ensure from this moment forward that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement,” he said, which can include chartered planes or cars but puts restrictions on the use of public transport. The new patient will be transferred to Emory University Hospital in Atlanta, which has a specialized unit to provide Ebola care, later today.

From now on, CDC will send a rapid response “go” team to any health care facility that has an Ebola patient. CDC has also sent staff to Dallas and two Ebola-experienced nurses from Emory will provide training and supervision of the Texas Presbyterian health care workers.

As often happens with major breaking news stories, CDC could not answer all the questions of the reporters who attended the press conference or joined by telephone. ScienceInsider had two reporters on the call who were not selected. They were left with the following questions.

  • Q: You said that the two health care workers may have been particularly vulnerable between 28 September, when Duncan was admitted to the hospital and isolated, and 30 September, when he received his diagnosis. Was infection control inadequate during those days—and how so? Why is it less likely that they became infected after his diagnosis?

  • Q: Nurses at the Dallas hospital have specified shortcomings in the way their hospital has handled Duncan's case. Has your investigation confirmed these mistakes?

  • Q: What training, specifically, did health care workers receive prior to treating Mr. Duncan? Who provided the training and how long did it last?

  • Q: Why is the second case being moved to Emory? Are you concerned about the level of care at Texas Presbyterian, further infections, or both?

  • Q: Should all future patients be moved to one of the four Ebola-specialized treatment centers in the United States if their condition allows it?

  • Q: What Ebola-specific training is provided now at Texas Presbyterian and at other hospitals around the country?

  • Q: In West Africa, some health care workers have been afraid to care for Ebola patients, and some have not shown up for work or even left their homes. Has anyone at Texas Presbyterian refused to take care of Ebola patients?

  • Q: At CDC's Ebola training course in Anniston, Alabama, health care workers are told to strictly limit shifts in Ebola treatment units, starting with 1-hour rotations. Is Texas Presbyterian using a similar strategy? Are Emory and the other dedicated centers?

  • Q: You said that about 50 health care workers entered Duncan's room and that you want to limit the number of people exposed to Ebola patients. How do you do this? What is the minimum number needed for a single patient?

  • Q: Are people taking care of Ebola patients allowed to help other patients?

  • Q: You have repeatedly assured the United States that we know how to stop Ebola. Are you concerned about the impact the two cases have on your credibility?

  • Q: Do you think the media are paying too much attention to the U.S. outbreak and too little to the epidemic in West Africa?

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.