As she waited for her bus next to an advert urging people to donate money for the fight against Ebola in west Africa, Elena Felican could only shake her head at how close the threat posed by the virus now felt.
“My sister called me first thing this morning, telling me not to go to near the hospital,” said the catering worker. “She told me the patient lived in Alcorcón. How does this happen? It’s really scary.”
Few details have emerged about the first person known to have contracted the Ebola virus outside west Africa. The Spanish nurse, who tested positive on Monday, was part of a team that cared for two elderly Spanish missionaries who both died after being evacuated to Madrid for treatment.
On Tuesday night her husband said she had followed all the regulations. “She did all that they told her to. At no moment was she worried about being infected,” he told El Mundo. The pair had planned to go on holiday, but changed plans after he injured his leg, he told the Spanish daily in a phone interview from the room where he had been isolated.
He complained that health authorities had told him his dog would have to be put down because it had been in contact with his wife. “They told me that if I didn’t give them my authorisation, they would get a court order and enter the house by force to kill the dog. Then what will they do next? Sacrifice me too?”
In Alcorcón, a small city of 170,000 in the outskirts of Madrid, many wondered just how worried they should be. “She might have been living in this neighbourhood for days with Ebola,” said Felican. “Did she go to the supermarket? The gym? We don’t know anything.” Three primary schools ringed the hospital where the nurse had tested positive, she pointed out, and all of them were open on Tuesday.
Her concerns were echoed inside the imposing hospital. Juan Pulido, who sat casually flipping through a newspaper while he waited for his wife to finish her appointment, said his family had urged him not to go. “Every day I sit here, waiting for my wife. I decided today would be no exception,” said the retiree, brushing off their worries. “But it seems like nobody else dared to come – it’s empty today.”
The infected nurse was transported to Madrid’s Carlos III hospital late on Monday night. She was placed in isolation, as was her husband who has shown no signs of the virus. Health officials said on Tuesday that they were monitoring another 50 people who may have come in contact with the nurse.
Authorities placed a second nurse from the same team in isolation after she complained of diarrhoea. Noting that she did not have a fever, the most common initial symptom for Ebola, doctors said her initial test results were negative.
A man who had recently travelled from Nigeria to Spain was also in quarantine at the same hospital but tested negative for Ebola in his first test.
Health authorities said they now had two priorities: compiling a list of all the potential contacts that the woman had before being hospitalised, and determining exactly how she had been infected.
The nurse had helped care for Miguel Pajares, 75, who was the first person to be repatriated to European soil for treatment in August, but she is thought to have become infected while looking after Manuel García Viejo, 69, who died in Madrid after being evacuated from Sierra Leone two weeks ago.
She would have entered García Viejo’s room twice, said Antonio Alemany, from the regional government of Madrid. The first time to was to change a nappy and the second time was to collect material from his room after he died.
After complaining of a fever on 30 September, the nurse was told to check herself into hospital if her temperature exceeded 38.6C. Fernando Simón, of Spain’s health ministry, acknowledged on Tuesday that it might have been better to have admitted her to hospital right away despite her not showing serious symptoms.
When she was admitted on Monday, the nurse remained in a bed in the emergency room, separated from other patients only by curtains, while waiting for her test results to come back, hospital staff said.
Several associations representing health professionals in Spain painted a picture of a healthcare system reeling from cutbacks, drastically underfunded to tackle the challenge of Ebola, and led by a health ministry that was creating policy on the fly.
Elena Moral, of the CSI-F, a union that represents healthcare professionals, said the delay in admitting the nurse to hospital hinted at deep flaws in the protocol. “A patient suspected of having Ebola and a history of working with Ebola patients should have been put in the first ambulance they could find.”
She roundly dismissed any suggestion of human error in the case, instead pointing to a lack of training, infrastructure and safety measures. In some cases, training for health professionals dealing with Ebola was limited to a 15- or 20-minute talk, she said.
In July, a group of nurses in Madrid brought a complaint before a judge in Madrid over the “lack of training and knowledge regarding protocols” when it came to treating potential Ebola cases.
Moral also laid blame on the impact of austerity measures on the Spanish healthcare system. “We’ve been protesting for a long time that the dismantling of the Carlos III hospital could provoke extreme situations like this one.”
In recent years, she said, the Carlos III hospital was closed, gutted of its emergency rooms and then turned into a hospital specialising in tropical diseases. “The repatriation of the two missionaries turned the hospital into something just short of a field hospital. Authorities activated the protocols without keeping in mind the actual state of the hospital.”
Opposition politicians called on the health minister, Ana Mato, to explain the safety lapses, while around 200 health professionals gathered outside a hospital in Madrid calling for her resignation.
The European commission said it had written to the Mato “to obtain some clarification” as to how the nurse had become infected. “There is obviously a problem somewhere,” said the commission spokesman Frédéric Vincent.
Spanish health authorities said medics treating Ebola patients in Spain followed the protocols laid out by the World Health Organisation, but their claims were widely disputed. While level 4 protective equipment is required to attend to Ebola patients, healthcare workers in Spain who treated the missionaries had only level 2 equipment, said Juan Carlos Mejias, of Satse, a union that represents nurses. “Level 4 is what’s being used in other European countries.”
In August, when Satse learned of plans to repatriate a patient with Ebola to Spain for treatment, it asked the health ministry for a written description of the protocols that would be used. “How many nurses would be involved? How would the nurses be monitored afterwards?” said Mejias. He said the union received no response, suggesting “there was a serious improvisation in how the situation was handled”.
Inside Alcorcón hospital, two women working at the hospital gift shop said they knew only what had been reported in the media. “Our co-worker left after her shift last night wondering why there were journalists outside the hospital. Nobody told us anything or warned us that we should be careful,” said one. “At least they could have given us hand sanitiser.”