(CNN) -- The first person to be diagnosed with Ebola on American soil went to the emergency room last week, but was released from the hospital even though he told staff he had traveled from Liberia.
"A travel history was taken, but it wasn't communicated to the people who were making the decision. ... It was a mistake. They dropped the ball," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
"You don't want to pile on them, but hopefully this will never happen again. ... The CDC has been vigorously emphasizing the need for a travel history," Fauci told CNN's "The Lead with Jake Tapper."
Ebola preps difficult for hospitals
Hospital officials have acknowledged that the patient's travel history wasn't "fully communicated" to doctors, but also said in a statement Wednesday that based on his symptoms, there was no reason to admit him when he first came to the emergency room last Thursday night.
"At that time, the patient presented with low-grade fever and abdominal pain. His condition did not warrant admission. He also was not exhibiting symptoms specific to Ebola," Texas Health Presbyterian Hospital Dallas said.
The patient, identified by his half-brother as Thomas Eric Duncan, told hospital staff that he was from Liberia, a friend who knows him well said.
A nurse asked the patient about his recent travels while he was in the emergency room, and the patient said he had been in Africa, said Dr. Mark Lester, executive vice president of Texas Health Resources. But that information was not "fully communicated" to the medical team, Lester said.
The man underwent basic blood tests, but not an Ebola screening, and was sent home with antibiotics, said Dr. Edward Goodman with Texas Health Presbyterian Hospital.
Three days later, the man returned to the facility, where it was determined that he probably had Ebola. He was then isolated.
"The hospital followed all suggested CDC protocols at that time. Texas Health Presbyterian Hospital Dallas' staff is thoroughly trained in infection control procedures and protocols," the hospital said Wednesday.
The Centers for Disease Control and Prevention, which has helped lead the international response to Ebola, advises that all medical facilities should ask patients with symptoms consistent with Ebola for their travel history.
Duncan's travel history "was not acted upon in an appropriate way," said Dr. Sanjay Gupta, CNN's Chief Medical Correspondent.
"A nurse did ask the question and he did respond that he was in Liberia and that wasn't transmitted to people who were in charge of his care," Gupta said. "There's no excuse for this."
A U.S. official told CNN senior medical correspondent Elizabeth Cohen that the situation was clearly "a screw-up." A patient who shows up to a hospital with a fever and a history of travel to Liberia should be treated as an infection risk, the official said.
Asked repeatedly by Gupta whether the patient should have been tested for Ebola during his first visit to the hospital, CDC Director Dr. Thomas Frieden said officials were still looking at details about how the case was handled.
"We know that in busy emergency departments all over the country, people may not ask travel histories. I don't know if that was done here," Frieden said. "But we need to make sure that it is done going forward."
Friend: I called the CDC with concerns
Duncan is a 42-year-old Liberian national, according to his friend. This is Duncan's first trip to the United States, where he was visiting family and friends.
The close associate, who does not want to be identified because of the sensitivity of the case, contacted the CDC with concerns that the hospital wasn't moving quickly enough after Duncan's second hospital visit.
Marie Nyan, whose mother died of Ebola, carries her 2-year-old son, Nathaniel Edward, to an ambulance after showing signs of the virus in the Liberian village of Freeman Reserve on Tuesday, September 30. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 3,000 people have died, according to the World Health Organization.
A health official uses a thermometer Monday, September 29, to screen a Ukrainian crew member on the deck of a cargo ship at the Apapa port in Lagos, Nigeria.
Children pray during Sunday service at the Bridgeway Baptist Church in Monrovia, Liberia, on Sunday, September 28.
Residents of the St. Paul Bridge neighborhood in Monrovia take a man suspected of having Ebola to a clinic on September 28.
Workers move a building into place as part of a new Ebola treatment center in Monrovia on September 28.
Medical staff members at the Doctors Without Borders facility in Monrovia burn clothes belonging to Ebola patients on Saturday, September 27.
A police officer patrols a road in Monrovia on September 27 after a body was found in the center of the city.
Tents are set up as health control centers at an air base near the Senegalese capital of Dakar on September 27. After closing its borders on August 21, Senegal opened an air corridor to allow humanitarian aid to be delivered to the three areas most affected by the Ebola virus.
A health worker in Freetown, Sierra Leone, sprays disinfectant around the area where a man sits before loading him into an ambulance on Wednesday, September 24.
People wait outside a new Ebola treatment center in Monrovia on Tuesday, September 23.
Health workers in protective suits work outside an Ebola treatment center in Monrovia on September 23.
Medics load an Ebola patient onto a plane at Sierra Leone's Freetown-Lungi International Airport on Monday, September 22.
A team that handles the management of dead bodies prays with Saymon Kamara, far right, on September 22 in Monrovia. Kamara's mother died from complications of high blood pressure.
A few people are seen in Freetown during a three-day nationwide lockdown on Sunday, September 21. In an attempt to curb the spread of the Ebola virus, people in Sierra Leone were told to stay in their homes.
A baby pig sleeps in front of an ambulance at the Connaught Hospital in Freetown on September 21.
Supplies wait to be loaded onto an aircraft at New York's John F. Kennedy International Airport on Saturday, September 20. It was the largest single shipment of aid to the Ebola zone to date, and it was coordinated by the Clinton Global Initiative and other U.S. aid organizations.
A volunteer health worker in Freetown talks with residents on how to prevent Ebola infection and identify symptoms of the virus on September 20. Bars of soap were also distributed.
Police in Freetown guard a roadblock Friday, September 19, as the country began enforcing its three-day nationwide lockdown.
A student of the Sainte Therese school in Abidjan, Ivory Coast, looks at placards Monday, September 15, that were put up to raise awareness about the symptoms of the Ebola virus.
Members of a volunteer medical team wear protective gear before the burying of an Ebola victim Saturday, September 13, in Conakry, Guinea.
A child stops on a Monrovia street Friday, September 12, to look at a man who is suspected of suffering from Ebola.
Health workers on Wednesday, September 10, carry the body of a woman who they suspect died from the Ebola virus in Monrovia.
A woman in Monrovia carries the belongings of her husband, who died after he was infected by the Ebola virus.
Five ambulances that were donated by the United States to help combat the Ebola virus are lined up in Freetown on September 10 following a ceremony that was attended by Sierra Leone President Ernest Bai Koroma.
A health worker wears protective gear Sunday, September 7, at ELWA Hospital in Monrovia.
An ambulance transporting Dr. Rick Sacra, an American missionary who was infected with Ebola in Liberia, arrives at the Nebraska Medical Center in Omaha, Nebraska, on Friday, September 5. Sacra was being treated in the hospital's special isolation unit.
Medical workers from the Liberian Red Cross carry the body of an Ebola victim Thursday, September 4, in Banjol, Liberia.
Health workers in Monrovia place a corpse into a body bag on September 4.
A rally against the Ebola virus is held in Abidjan on September 4.
After an Ebola case was confirmed in Senegal, people load cars with household items as they prepare to cross into Guinea from the border town of Diaobe, Senegal, on Wednesday, September 3.
Crowds cheer and celebrate in the streets Saturday, August 30, after Liberian authorities reopened the West Point slum in Monrovia. The military had been enforcing a quarantine on West Point, fearing a spread of the Ebola virus.
A health worker wearing a protective suit conducts an Ebola prevention drill at the port in Monrovia on Friday, August 29.
Senegalese Health Minister Awa Marie Coll-Seck gives a news conference August 29 to confirm the first case of Ebola in Senegal. She announced that a young Guinean had tested positive for the deadly virus.
Volunteers working with the bodies of Ebola victims in Kenema, Sierra Leone, sterilize their uniforms on Sunday, August 24.
A Liberian health worker checks people for symptoms of Ebola at a checkpoint near the international airport in Dolo Town, Liberia, on August 24.
A guard stands at a checkpoint Saturday, August 23, between the quarantined cities of Kenema and Kailahun in Sierra Leone.
A burial team from the Liberian Ministry of Health unloads bodies of Ebola victims onto a funeral pyre at a crematorium in Marshall, Liberia, on Friday, August 22.
A humanitarian group worker, right, throws water in a small bag to West Point residents behind the fence of a holding area on August 22. Residents of the quarantined Monrovia slum were waiting for a second consignment of food from the Liberian government.
Dr. Kent Brantly leaves Emory University Hospital on Thursday, August 21, after being declared no longer infectious from the Ebola virus. Brantly was one of two American missionaries brought to Emory for treatment of the deadly virus.
Brantly, right, hugs a member of the Emory University Hospital staff after being released from treatment in Atlanta.
Family members of West Point district commissioner Miata Flowers flee the slum in Monrovia while being escorted by the Ebola Task Force on Wednesday, August 20.
An Ebola Task Force soldier beats a local resident while enforcing a quarantine on the West Point slum on August 20.
Local residents gather around a very sick Saah Exco, 10, in a back alley of the West Point slum on Tuesday, August 19. The boy was one of the patients that was pulled out of a holding center for suspected Ebola patients after the facility was overrun and closed by a mob on August 16. A local clinic then refused to treat Saah, according to residents, because of the danger of infection. Although he was never tested for Ebola, Saah's mother and brother died in the holding center.
A burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home near Monrovia on Sunday, August 17.
lija Siafa, 6, stands in the rain with his 10-year-old sister, Josephine, while waiting outside Doctors Without Borders' Ebola treatment center in Monrovia on August 17. The newly built facility will initially have 120 beds, making it the largest-ever facility for Ebola treatment and isolation.
Brett Adamson, a staff member from Doctors Without Borders, hands out water to sick Liberians hoping to enter the new Ebola treatment center on August 17.
Workers prepare the new Ebola treatment center on August 17.
A body, reportedly a victim of Ebola, lies on a street corner in Monrovia on Saturday, August 16.
Liberian police depart after firing shots in the air while trying to protect an Ebola burial team in the West Point slum of Monrovia on August 16. A crowd of several hundred local residents reportedly drove away the burial team and their police escort. The mob then forced open an Ebola isolation ward and took patients out, saying the Ebola epidemic is a hoax.
A crowd enters the grounds of an Ebola isolation center in the West Point slum on August 16. The mob was reportedly shouting, "No Ebola in West Point."
A health worker disinfects a corpse after a man died in a classroom being used as an Ebola isolation ward Friday, August 15, in Monrovia.
A boy tries to prepare his father before they are taken to an Ebola isolation ward August 15 in Monrovia.
Kenyan health officials take passengers' temperature as they arrive at the Jomo Kenyatta International Airport on Thursday, August 14, in Nairobi, Kenya.
A hearse carries the coffin of Spanish priest Miguel Pajares after he died at a Madrid hospital on Tuesday, August 12. Pajares, 75, contracted Ebola while he was working as a missionary in Liberia.
A member of the Centers for Disease Control and Prevention leads a training session on Ebola infection control Monday, August 11, in Lagos.
Health workers in Kenema screen people for the Ebola virus on Saturday, August 9, before they enter the Kenema Government Hospital.
A health worker at the Kenema Government Hospital carries equipment used to decontaminate clothing and equipment on August 9.
Health care workers wear protective gear at the Kenema Government Hospital on August 9.
Paramedics in protective suits move Pajares, the infected Spanish priest, at Carlos III Hospital in Madrid on Thursday, August 7. He died five days later.
Nurses carry the body of an Ebola victim from a house outside Monrovia on Wednesday, August 6.
A Nigerian health official wears protective gear August 6 at Murtala Muhammed International Airport in Lagos.
Officials with the Centers for Disease Control and Prevention in Atlanta sit in on a conference call about Ebola with CDC team members deployed in West Africa on Tuesday, August 5.
Aid worker Nancy Writebol, wearing a protective suit, gets wheeled on a gurney into Emory University Hospital in Atlanta on August 5. A medical plane flew Writebol from Liberia to the United States after she and her colleague Dr. Kent Brantly were infected with the Ebola virus in the West African country.
Nigerian health officials are on hand to screen passengers at Murtala Muhammed International Airport on Monday, August 4.
A man gets sprayed with disinfectant Sunday, August 3, in Monrovia.
Dr. Kent Brantly, right, gets out of an ambulance after arriving at Emory University Hospital in Atlanta on Saturday, August 2. Brantly was infected with the Ebola virus in Africa, but he was brought back to the United States for further treatment.
Nurses wearing protective clothing are sprayed with disinfectant Friday, August 1, in Monrovia after they prepared the bodies of Ebola victims for burial.
A nurse disinfects the waiting area at the ELWA Hospital in Monrovia on Monday, July 28.
Liberian President Ellen Johnson Sirleaf, right, walks past an Ebola awareness poster in downtown Monrovia as Liberia marked the 167th anniversary of its independence Saturday, July 26. The Liberian government dedicated the anniversary to fighting the deadly disease.
In this photo provided by Samaritan's Purse, Dr. Kent Brantly, left, treats an Ebola patient in Monrovia. On July 26, the North Carolina-based group said Brantly tested positive for the disease. Days later, Brantly arrived in Georgia to be treated at an Atlanta hospital, becoming the first Ebola patient to knowingly be treated in the United States.
A 10-year-old boy whose mother was killed by the Ebola virus walks with a doctor from the aid organization Samaritan's Purse after being taken out of quarantine Thursday, July 24, in Monrovia.
A doctor puts on protective gear at the treatment center in Kailahun on Sunday, July 20.
Members of Doctors Without Borders adjust tents in the isolation area in Kailahun on July 20.
Boots dry in the Ebola treatment center in Kailahun on July 20.
Red Cross volunteers prepare to enter a house where an Ebola victim died in Pendembu, Sierra Leone, on Friday, July 18.
Dr. Jose Rovira of the World Health Organization takes a swab from a suspected Ebola victim in Pendembu on July 18.
Red Cross volunteers disinfect each other with chlorine after removing the body of an Ebola victim from a house in Pendembu on July 18.
A dressing assistant prepares a Doctors Without Borders member before entering an isolation ward Thursday, July 17, in Kailahun.
A doctor works in the field laboratory at the Ebola treatment center in Kailahun on July 17.
Doctors Without Borders staff prepare to enter the isolation ward at an Ebola treatment center in Kailahun on July 17.
A health worker with disinfectant spray walks down a street outside the government hospital in Kenema on Thursday, July 10.
Dr. Mohamed Vandi of the Kenema Government Hospital trains community volunteers who will aim to educate people about Ebola in Sierra Leone.
Police block a road outside Kenema to stop motorists for a body temperature check on Wednesday, July 9.
A woman has her temperature taken at a screening checkpoint on the road out of Kenema on July 9.
A member of Doctors Without Borders puts on protective gear at the isolation ward of the Donka Hospital in Conakry on Saturday, June 28.
Airport employees check passengers in Conakry before they leave the country on Thursday, April 10.
CNN's Dr. Sanjay Gupta, left, works in the World Health Organization's mobile lab in Conakry. Gupta traveled to Guinea in April to report on the deadly virus.
A Guinea-Bissau customs official watches arrivals from Conakry on Tuesday, April 8.
Egidia Almeida, a nurse in Guinea-Bissau, scans a Guinean citizen coming from Conakry on April 8.
A scientist separates blood cells from plasma cells to isolate any Ebola RNA and test for the virus Thursday, April 3, at the European Mobile Laboratory in Gueckedou, Guinea.
Members of Doctors Without Borders carry a dead body in Gueckedou on Friday, April 1.
Gloves and boots used by medical personnel dry in the sun April 1 outside a center for Ebola victims in Gueckedou.
A health specialist works Monday, March 31, in a tent laboratory set up at a Doctors Without Borders facility in southern Guinea.
Health specialists work March 31 at an isolation ward for patients at the facility in southern Guinea.
The associate said Duncan is "all right" now, but is in pain and hasn't eaten in The patient is now under intensive care and isolated, Frieden said.
He is in serious condition, the hospital told CNN. Neither the hospital nor government officials have identified Duncan by name.
Obama administration recirculates guidelines
It's unknown whether others were infected after Duncan's first visit to the hospital. People who have Ebola are contagious -- but only through contact with infected bodily fluids -- when they display active symptoms of the virus, such as a high fever, severe headache, diarrhea and vomiting, among others. It's not like a cold or the flu, which can be spread before symptoms show up, and it doesn't spread through the air.
Liberia is one of the hotspots in a large outbreak of Ebola in West Africa, with 3,458 cases and 1,830 deaths as of September 23, according to the World Health Organization. Other countries affected include Guinea, Nigeria and Sierra Leone. In total, more than 3,000 people have died in those countries from Ebola, and more than 6,500 have contracted the disease.
This summer, two American missionaries who were working in Liberia contracted the virus and were brought back to the United States, where they were treated with the experimental drug ZMapp. Another American doctor working with the same charity was also infected in Liberia and brought home for treatment. They all have since recovered from the virus and were released from care.
The CDC has ramped up a national effort to stem the spread of Ebola, and in September President Barack Obama spoke at CDC headquarters in Atlanta. He called the virus a global health and security threat, and pledged U.S. assistance to the affected countries to try to stem the tide of the disease.
After the Dallas diagnosis, the Obama administration is recirculating its guidance about how to respond to the virus, White House spokesman Josh Earnest told reporters.
"In light of this incident," Earnest said, "the administration has taken the step of recirculating our guidance to law enforcement agencies that are responsible for securing the border, to those agencies that represent individuals who staff the airline industry and to medical professionals all across the country, to make sure people are aware there is an important protocol that should be implemented if an individual presents with symptoms that are consistent with Ebola."
Finding the people the man came in contact with
The patient came into contact with up to 20 individuals, Dallas Mayor Mike Rawlings told CNN.
A CDC team is in Dallas helping to find anyone he may have come in contact with, Frieden said.
Once those people are identified, they will be monitored for 21 days -- taking their temperatures twice a day -- in cooperation with local and state health officials, Frieden said.
Some school-age children have been in contact with the Ebola patient, but the students haven't exhibited symptoms of the deadly virus, authorities said.
Five students at four different schools came into contact with the man, Dallas Superintendent Mike Miles said.
The children are being monitored at home, and the schools they attended remain open, he said.
First diagnosed case of Ebola in U.S.
Paramedics who transported the patient to the hospital have been isolated, Rawlings' chief of staff said. They have not shown symptoms of the disease so far, Frieden said.
The ambulance used to carry the patient was still in use for two days after the transport, city of Dallas spokeswoman Sana Syed said.
But she emphasized that the paramedics decontaminated the ambulance, as they do after every transport, according to national standards
http://www.cnn.com/2014/10/01/health/ebo...index.html 
