Only a handful of the 100 or so people identified as having had contact with Thomas Eric Duncan, the first person diagnosed with the Ebola virus in the Unites States, or his family's home, will need to be monitored for exposure to Ebola, health officials said Thursday.
Members of Duncan's household and healthcare workers who had been in contact with him were among those being monitored, said Tom Frieden, the director of the Centers for Disease Control and Prevention, during a conference call.
Not all of the 100 or so identified have been interviewed yet, and the CDC does not have a specific number of people who will be monitored, he said.
Dallas health officials are currently only looking at 18 people who have had close contact with Duncan, though Zach Thompson, the director of Dallas County Health and Human Services, said he expects that number to increase and that it may include a second diagnosis for Ebola.
"I would not be shocked if we see that second case, but to date there has not been any indication that any of the contacts that we have been tracking show any signs or symptoms," Thompson said. "The only close contact that we're aware of [with] this patient was with his immediate children and his wife. So now we're looking at close friends."
Officials are investigating Duncan's background and trip from Liberia. Liberian officials now say they intend to prosecute the 42-year-old for allegedly lying on his airport screening questionnaire before flying to the U.S.
Dallas County health officials have ordered four of his family members to stay home and to accept no visitors to prevent potential spread of the disease, according to a news release.
Officials expect the list of 100 "potential or possible contacts" to narrow as they "focus in on those whose contact may represent a potential risk of infection," a spokeswoman for the Texas Department of State Health Services said Thursday.
"Out of an abundance of caution, we're starting with this very wide net, including people who have had even brief encounters with the patient or the patient's home," spokeswoman Carrie Williams said in a statement. "The number will drop as we focus in on those whose contact may represent a potential risk of infection."
Hospital officials, meanwhile, said they’re optimistic that Duncan, a Liberian national, will recover. He is listed in serious condition at Texas Health Presbyterian Hospital.
Duncan tested positive for Ebola less than two weeks after he arrived in the U.S. from Liberia, health officials confirmed Tuesday. He initially sought care at a hospital Sept. 25, shortly after showing symptoms, but was released. He returned Sept. 28 and was flagged as a potential Ebola case.
The timing has raised questions about why Duncan wasn't treated as a possible Ebola patient sooner, given his recent travel.
Duncan's nephew Josephus Weeks told NBC News he had reached out to the CDC out of fear that he might infect other people. He urged doctors to give Duncan the same experimental drugs credited with saving the lives of American aid workers, including Dr. Kent Brantly of Fort Worth.
"He's doing all right. He's in our prayers. We are really rooting on him," Weeks told NBC News. "I'm hoping that he can get the same kind of treatment that was given to the four other patients that survived, and that's my concern."
Officials Focus on Those Facing Exposure Risk
Dallas County Health and Human Services Director Zach Thompson initially said that up to 80 people came into contact with Duncan or Duncan's family. A spokesperson for the Texas Department of State Health Services later said they are "working from a list of about 100 potential or possible contacts and will soon have an official contact tracing number that will be lower."
Officials did not say whether Duncan was symptomatic during the interactions. Not all had close, physical contact. Officials previously confirmed that several school-age children came into contact with him.
Ten CDC officials are looking at Duncan's trip from Liberia to Dallas, which spanned more than 9,000 miles and included stops in Brussels and a major airport servicing the Washington, D.C. area. Officials said they'll determine whether fellow passengers need to be contacted.
Family Under Legal Order
After previously being told to stay home and isolated, Duncan's relatives could now face legal action if they don't comply.
Texas and Dallas County health officials issued a legal order requiring the four family members to stay home and not have any visitors until Oct. 19, the Texas Department of State Health Services said in a news release.
Dallas County Judge Clay Jenkins said Thursday that the four "were noncompliant with the request to stay home, " though he did not specify where they went.
“We have tried and true protocols to protect the public and stop the spread of this disease,” Dr. David Lakey, Texas health commissioner, said in the release. “This order gives us the ability to monitor the situation in the most meticulous way.”
The order also requires the family to provide blood samples, agree to any testing required and immediately report any symptoms. The family members do not have symptoms at this time.
Symptoms include fever above 100.5 degrees, headache, nausea, diarrhea and abdominal pain.
Texas law allows the health officials to issue such control measures. If a person does not follow these orders, they can be enforced by the courts, and the person can face criminal charges.
Dallas ISD Children Being Monitored
Five Dallas Independent School District children had contact with Duncan and are being monitored at home, Texas Gov. Rick Perry said Wednesday, though the school district says they are not showing any symptoms.
Two students at Sam Tasby Middle School possibly came into contact with Duncan, and one student each at Dan D. Rogers Elementary, L.L. Hotchkiss Elementary and Emmett J. Conrad High School, according to DISD Superintendent Mike Miles.
The students are being advised to stay home and are being closely observed by the Dallas County Health and Human Services Department, the school district said in a news release.
"Since the students are not presenting any symptoms, there is nothing to suggest that the disease was spread to others including students and staff," it said.
The district has launched a recorded hotline to provide updates to parents. The hotline number is 972-925-5810. Parents can also visit www.dallasisd.org/healthupdates for information.
Nephew: Patient Not Properly Treated
Duncan's nephew Joseph Weeks said his uncle was not properly treated during his initial visit to a Dallas hospital.
Health officials acknowledged that Duncan was initially sent home from Texas Health Presbyterian Hospital after complaining of fever and abdominal pain. He returned days later in an ambulance.
"I called CDC to get some actions taken, because I was concerned for his life and he wasn't getting the appropriate care," Weeks said. "I feared other people might also get infected if he wasn't taken care of."
Weeks said the CDC referred him to the Texas Department of Health and Human Services, which took appropriate action. He added that he hoped "nobody else got infected because of a mistake that was made."
"I called the CDC and they instructed me of the process, and that got the ball rolling," Weeks said.
A CDC spokesman told NBC News the agency could not comment on Weeks' claim. The hospital did not immediately respond to a request for comment.
Hospital officials said they'll review why Duncan was allowed to leave during his initial visit.
Neighbor Witnessed Patient Vomiting
Two days after initially being sent home from the hospital, neighbor Mesud Osmanovic said he saw Duncan vomiting on the ground outside an apartment complex in the 7200 block of Fair Oaks Avenue as he was loaded into an ambulance.
"His whole family was screaming," Osmanovic said. "He got outside, and he was throwing up all over the place."
Three paramedics took Duncan to Texas Health Presbyterian Hospital by ambulance. At the time, though, they had no idea they were dealing with a patient with the Ebola virus.
“What our paramedics saw was this could be a contagious person, not knowing what it would turn into,” said Lieutenant Joel Lavender with Dallas Fire-Rescue.
The three paramedics are currently at home being monitored for 21 days. Health officials are also keeping a close eye on anyone who they have confirmed has been in contact with Duncan after he showed symptoms of the disease about a week ago.