Residents of Dallas, Texas are wary as health experts continue to observe those who were in contact with the first Ebola patient in the United States.
The man, who flew to Texas via Brussels from Liberia and later fell ill with the haemorrhagic fever, is in a serious but stable condition.
He initially sought treatment at Texas Health Presbyterian Hospital almost a week ago and was sent home with antibiotics rather than being observed further, even though he told a nurse he had recently returned from West Africa.
A nurse asked about the travel as part of a triage checklist and was told about it, but “regretfully, that information was not fully communicated throughout the full teams”, Texas hospital official Mark Lester said.
“As a result, the full import of that information wasn’t factored into the full decision making.”
Infectious disease experts said that time gap represented a critical missed opportunity that may have led others to be exposed to the virus.
By Sunday, the man needed an ambulance to return to the same hospital, where he was admitted after being seen vomiting on the ground outside an apartment complex.
“His whole family was screaming,” resident Mesud Osmanovic said.
“He got outside and he was throwing up all over the place.”
18 people being monitored after contact with patient
Concerns also remain for up to 18 other people who have had contact with him, many of whom were close family members.
“Is this something we should all be freaking out over?” asked one talkback host.
Texas governor Rick Perry assured residents that the situation was under control.
“Today we learned that some school-age children had contact with the patient,” he said.
“[They] are being monitored at home for any signs of the disease.
“I know that parents are being extremely concerned about that development, but let me assure that these children have been identified, monitored and the disease cannot be transmitted before having any symptoms.”
While the children went to four different schools on Monday, officials said the children were not showing symptoms and chance of them being infectious was low.
Authorities also stressed the man’s relatives had not been placed in quarantine, but had been advised to put themselves into voluntary isolation.
“If they do not follow that advice then additional steps can be taken,” David Lakey from Texas State health services said.
“As of right now we’re working with the family to ensure that they do as we are advising them to limit the spread of the disease.”
The Centres for Disease Control (CDC) has sent a seven-person team to Dallas to help local authorities track any other possible contacts other than the 18 already identified.
“What we need to do first in this particular instance is do everything possible to help this individual who’s really fighting for their life,” CDC director Thomas Frieden said.
“Then make sure that… we don’t have other people exposed in the hospital, identify all those contacts and monitor them for 21 days.
“It’s not impossible that one or two of them would develop symptoms and then they would need to be isolated.”
Ebola spreads through contact with bodily fluids such as blood or saliva, and its incubation period is three weeks.
Among the 18 people identified for monitoring were the emergency crew that brought the man to the hospital on Sunday.
Their ambulance remains outside the Texas Health Presbyterian Hospital in Dallas and has been taped off to stop any further use as a precaution.
US health officials have said the country’s healthcare system was well prepared to contain any spread of Ebola, through careful tracking of people who had contact with the patient and appropriate care for those admitted to hospital.
The Dallas Ebola case has prompted national concern over the potential for a wider spread of the deadly virus from West Africa, where at least 3,338 people have died in the worst outbreak on record.
White House spokesman Josh Earnest said health officials are confident the virus can be contained in the US.
“People can be confident here in this country that we have the medical infrastructure in place to prevent the broad spread of Ebola,” he said.