Infected Nurse in Spain Shows Defense Faults

Barcelona, Spain:  A nurse in Spain has become the first health worker to be infected with the Ebola virus outside of West Africa, raising serious concerns about how prepared Western nations are to safely treat people with the deadly illness.

The nurse contracted the illness while treating a Spanish missionary who was infected in Sierra Leone and flown to Madrid's Carlos III hospital, where he died on Sept. 25, Spain's Health Ministry said. The priest, Manuel Garcia Viejo, died three days after being flown back to Spain, and the nurse entered his room only twice, including once after his death, according to Antonio Alemany, a health official from the regional government of Madrid.

The case is particularly worrisome to health experts because Spain is a developed country that is considered to possess the kind of rigorous infection control measures that should prevent disease transmission in the hospital. Although the Ebola epidemic has killed hundreds of doctors and nurses in West Africa, health officials in Europe and the United States have reassured the public repeatedly that if the disease reached their shores, their health care systems would be able to treat patients safely, without endangering health workers or the public.

While the risk to hospital workers is thought to be far lower in developed countries, the infection of the Spanish nurse, along with the missteps in dealing with Ebola in Dallas, exposes weak spots in highly praised defense systems.

Ana Mato, Spain's health minister, said in a televised news conference that the nurse, who has not been identified publicly, tested positive for Ebola twice, and that the rest of the 30-person team that looked after the missionary would be monitored to see if any of its members develop symptoms of Ebola. She said it was not clear how the nurse became infected.

"It is certainly a sobering moment whenever we see a health care worker infected," said Abbigail Tumpey, a spokeswoman for the Centers for Disease Control and Prevention in the United States. "It really highlights the need for rigorous infection control throughout everything health care workers are doing, starting with the triage of patients, getting patients into appropriate isolation and then appropriately treating and managing the patient. Any lapse could potentially expose somebody."

Health officials in Spain said the team was properly equipped with protective gear, including gloves, gowns, masks and eye protection. The gear is meant to prevent exposure to bodily fluids, which spread the disease. But experts say the greatest risk comes from removing contaminated gear, which must be done according to a strict protocol to avoid infecting oneself. It takes training and practice.

The case in Dallas, Tumpey added, has led the CDC to redouble its efforts to urge hospitals to be on the lookout for potential cases and to handle them correctly.

Mato, the Spanish health minister, said, "We are trying to determine whether all the health safety protocols have been followed."

Infections among health care workers are "an alarming feature of this outbreak," according to the World Health Organization. As of Oct. 1, 382 health workers in West Africa have contracted the disease, including 216 who died. The high rate has been attributed largely to the lack of personal protective gear, disinfectants and running water in many hospitals and clinics.

Doctors without Borders, a group known for its meticulous attention to infection control and success in protecting its workers, also reported on Monday that one of its staff members caring for patients in Sierra Leone had contracted Ebola. The worker is to be airlifted to Europe for treatment, and the group said it is investigating the case to try to find out how the infection occurred. Another of its workers was also infected previously, but recovered.

Situated close to the highway that circles the Spanish capital, the Carlos III hospital is tied to the much larger La Paz hospital in Madrid, but it was selected because it has long specialized in researching HIV and other infectious as well as tropical diseases. In August, an entire floor of the hospital was sealed off and turned into an isolation unit, initially to treat Miguel Pajares, another Spanish priest who had been working in Africa and was the first European to be repatriated after being infected with Ebola. Pajares died Aug. 12, five days after entering the special unit.

In August, when the Spanish government decided to repatriate Pajares, the decision raised some concerns among local medical experts about whether Spain had adequate infrastructure to handle such a case. Daniel Bernabéu, the president of Amyts, a Spanish union representing doctors, said at the time that the government decision was "political and not sanitary." He claimed that neither the government nor anybody else could "guarantee 100 percent that the virus wouldn't escape."

On Monday, Bernabéu told Efe, the Spanish national news agency, that even if Spain had the means to prevent Ebola spreading from the infected nurse as it has done in Africa, her case "should be used by all of us to think about whether we should host everybody and how to do it well."

Mato urged people to remain calm, adding that "all the possible measures" were being taken to guarantee public health safety.

Antonio Alemany, a health official from the regional government of Madrid, told the news conference that the nurse went on vacation a day after Garcia Viejo died. She got in touch with a medical center on Sept. 30 after feeling feverish, but had been leading "a normal life" while on vacation, he added, without giving details on her whereabouts during that period.

Alemany said the nurse initially showed only "low symptoms" of illness, with a fever of roughly 100 degrees. He described her current condition as stable. He would not estimate how many people had contact with the nurse in the past two weeks, saying that a complete list was being drawn up. On the list is the nurse's husband, Alemany said; she has no children. Spanish newspaper websites listed her age as either 40 or 44.

She has been kept in isolation in a hospital in Alcorcon, on the outskirts of Madrid, but not in a unit specialized to treat infections like Ebola. She was transferred to the Carlos III hospital late Monday.