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Atlanta (CNN) It's a lapse that has Americans concerned and health officials asking how it could happen.
A man who had Ebola but didn't know it walked into a Dallas emergency room September 26. Although his symptoms could have indicated Ebola among other things no one at the hospital asked him if he had recently traveled a source close to the case told CNN.
The man who had just flown from Liberia to the States didn't offer the information either the source said and the man left the hospital. A spokesman for Texas Health Presbyterian Hospital says it's investigating whether he was questioned.
Regardless two days passed between the time the man left and then returned to the facility September 28 where it was determined he likely had Ebola and was isolated. He tested positive Tuesday health officials said.
The CDC advises that all medical facilities should ask for patients with symptoms consistent with Ebola for their travel history. It's possible others were infected because of the lapse.
The virus is contracted through bodily fluids. It's not like a cold or the flu which can be spread before symptoms show up. It doesn't spread through the air.
Ebola virus 9 things to know about the killer disease
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. Workers associated with Doctors Without Borders prepare isolation and treatment areas Friday March 28 in Guinea. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 Photos Ebola outbreak in West Africa CNN reporter talks about covering Ebola Sanjay Gupta explains Ebola virus CDC We will stop Ebola in its tracksIsolating the patient and paramedics
The patient is now under intensive care and isolated at Texas Health Presbyterian Hospital said CDC Director Dr. Thomas Frieden.
He is in serious condition the hospital told CNN Wednesday.
The man flew from Liberia one of the Ebola hotspots in West Africa and arrived in Dallas to visit family on September 20 Frieden explained.
The patient started feeling ill around September 24 and sought medical care on September 26 Frieden said.
CNN Chief Medical Correspondent Dr. Sanjay Gupta asked Frieden Wednesday on New Day if the man should have been tested for Ebola on his first visit to the hospital and if he should have been asked about his recent travel history.
That's one of the things we'll be looking at Frieden said. But we're reiterating the message for every health worker in this country think about travel history. If someone's been in West Africa within 21 days and they've got a fever immediately isolate them and get them tested for Ebola.
Gupta then asked Frieden to explain guidance the CDC has issued on that and again asked Should this person have been tested We weren't there so I can't tell you exactly what that person said... Frieden responded.
Gupta interjected You're advising public health departments. Last time I was here (at the Centers for Disease Control and Prevention in Atlanta) there was a call with many primary care doctors to educate them on this exact issue. That was a couple of months ago. Should this person have been tested
Frieden answered 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. But we need to make sure that it is done going forward.
Air travel testing
Every person who travels by air is screened before departure and at arrival in Liberia Guinea and Sierra Leone but because the man says he began feeling ill days after landing in the U.S. a screening test in West Africa would likely have not turned up that he had Ebola.
However it's unclear what kind of screening someone arriving from West Africa might receive when arriving in the United States said CNN's Senior Medical Correspondent Elizabeth Cohen. She and her crew recently reported in and flew from West Africa where she said they were screened numerous times for Ebola by having their temperatures taken at the airport.
Should we worry
But when they arrived back in the United States and asked travel officials about whether their temperatures would be taken or they'd receive screening for Ebola they were given unclear explanations about how the process worked and ultimately were not tested.
Regardless the CDC maintains that passengers on the Texas man's plane were likely not at risk because the man was not displaying active symptoms on the flight.
Paramedics who transported the patient to the hospital have been isolated Dallas Mayor Mike 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.
How the virus spreads
Finding the people the man came into contact with
During the time he was symptomatic the man had a handful of contacts with people Frieden said.
A CDC team headed to Dallas to help investigate those contacts.
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 Wednesday.
But Gupta pointed out that the people identified as contacts aren't as protocol quarantined unless they are symptomatic.
Frieden explained that people who have Ebola are not able to spread the disease unless they are symptomatic.
We don't want to isolate parts of the world or people who aren't sick Frieden said because that's going to drive people underground and make it harder to contain this outbreak.
CNN's AnneClaire Stapleton Chandler Friedman Greg Botelho and Ed Payne contributed to this report.
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