After Texas Ebola patient's death, 'what ifs' haunt loved ones



(CNN) -- Several Ebola patients treated in the United States have survived, but the first person ever diagnosed with the deadly virus on American soil didn't.

Thomas Eric Duncan died Wednesday at a Texas hospital, 10 days after he was admitted.

"Mr. Duncan succumbed to an insidious disease, Ebola. He fought courageously in this battle. Our professionals, the doctors and nurses in the unit, as well as the entire Texas Health Presbyterian Hospital Dallas community, are also grieving his passing," hospital spokesman Wendell Watson said in a statement.

Duncan's family is devastated, their pastor told reporters. And the woman he had planned to marry is haunted by "what ifs" about his care.

One question family members have asked repeatedly: Would the outcome have been different if doctors had admitted Duncan to hospital on September 25, the first time he showed up with a fever and stomach pain?



"What if they had taken him right away? And what if they had been able to get treatment to him earlier?" Pastor George Mason of Wilshire Baptist Church in Dallas told reporters.

"He got sick and went to the hospital and was turned away, and that's the turning point here," the Rev. Jesse Jackson, a spokesman for the family, told CNN's Wolf Blitzer.

Louise Troh, Duncan's longtime partner, said through a public relations firm that she believes "a thorough examination will take place regarding all aspects of his care."

"She is not seeking to create any kinds of divisions in our community over this. She certainly, like all of us, would want to see justice done," Mason said. "She wants to see that people are treated well and treated fairly, and that includes Mr. Duncan. But this is a human drama. It's not a political drama. ... It is a drama of human grief."

Asked whether there was any difference in the care Duncan received compared to others who've been treated for the virus in America, Centers for Disease Control and Prevention Director Dr. Tom Frieden said "each patient's situation is different."

One notable difference: the supply of the experimental drug used to treat Americans Dr. Kent Brantley and Nancy Writebol in August ran out.

"Unfortunately, Zmapp, which is a promising, but unproven experimental treatment for Ebola, is not available," Frieden said. "There is, as far as we understand, no more of it in the world, and while people are working hard to manufacture more, it takes a long time to develop."

Duncan lay sick in his hospital bed for nearly six days before the hospital tried a different experimental medication.

"He is a face that we associate now with Ebola. Since the start of the epidemic, 3,742 patients in West Africa have been documented to have died," Frieden said. "So we think about this and we remember what a deadly enemy Ebola is, and how important it is that we take every step possible to both protect Americans and stop the outbreak at its source in Africa."

Questions about the case

The historic case, which sent officials scrambling in the days after Duncan was admitted to the hospital, has raised questions about America's readiness to handle a possible outbreak. On Wednesday, federal officials announced new screening measures at five of the country's busiest airports to help guard against Ebola.

Community leaders, family members and medical experts have raised questions about how the Dallas hospital handled Duncan's care.

Duncan came to the United States to visit family and friends, departing Liberia on September 19, according to the CDC. Liberian authorities said he was screened for Ebola before flying.

It's unclear how he got Ebola, but witnesses have said that he had been helping victims of the virus in Liberia, and The New York Times said he'd had direct contact with an Ebola-stricken pregnant woman. Duncan answered "no" to questions about whether he'd cared for someone with the virus.

His symptoms first appeared "four to five days" after he landed in the United States, Frieden said.

Duncan went to Texas Health Presbyterian Hospital after 10 p.m. on September 25 and was treated for a fever, vomiting and abdominal pain -- all symptoms of Ebola -- but he was sent home with antibiotics and a pain reliever and was not screened for the virus. Family members say he told hospital staff he'd come from Liberia.

Hospital officials have defended their handling of his case, describing Duncan's treatment as "compassionate, quality care."

But they've offered different explanations of how the case was handled.

Initially, they said Duncan's condition the first time he came to the hospital "did not warrant admission" because he was "not exhibiting symptoms specific to Ebola" and details about Duncan's travel history weren't communicated to doctors. Later they said a flaw in electronic records had kept doctors from seeing his travel history. Then they said his travel history had been documented and was available to his care team.

Duncan returned to the hospital three days later and was then tested for Ebola. He was confirmed last week to have the deadly virus, becoming the first person diagnosed with Ebola on American soil.

The lag time between Duncan's hospital visits could have been "significant," said Dr. Alex Van Tulleken, an expert in tropical diseases at Fordham University in New York who is not involved in the case.

Dr. John Carlo, chairman of the Dallas County Medical Society's community emergency response committee, told CNN earlier admission to the hospital wouldn't have made a difference.

"Keep in mind, this is an emerging infection. We don't know a lot about Ebola. ... Amazing work has been done at the hospital so far," he said. "And you know, I do think that they really stood up and did what was necessary."

Others aren't convinced.

Jackson has said he thinks Duncan's financial situation may have impacted his treatment.

"I would tend to think that those who do not have insurance, those who do not have Medicaid do not have the same priorities as those who do," the civil rights leader said.

In a statement before Duncan's death, a spokeswoman for Dallas' Texas Health Presbyterian Hospital said Duncan was being "treated the way any other patient would have been treated, regardless of nationality or ability to pay for care."

Dr. John Carlo

Officials: Duncan will be cremated

Duncan will be cremated, state health officials said. A memorial service was held Wednesday evening, Mason said.

Officials, in announcing the planned cremation, cited the strict federal policies on the handling of Ebola victims. "The cremation process will kill any virus in the body so the remains can be returned to the family. No protective gear is needed to handle the remains after cremation," said a statement from the Texas Department of State Health Services.

Duncan had been in critical condition after being diagnosed with the virus. People who had contact with the 42-year-old Liberian national are being monitored for symptoms.

Some members of Duncan's family are being monitored for the virus -- their temperatures taken twice daily -- to make sure they don't have symptoms. Ebola can take 21 days to show itself. The CDC said that as of Tuesday, they had not shown any symptoms.

Several who have had contact with him were moved to a secure location Friday.

Five Dallas schoolchildren who possibly had contact with Duncan remain on the school district's homebound program during the 21-day wait, and none are showing symptoms, the district said Wednesday.

Duncan's family members are grief-stricken over his death, and afraid they could meet a similar fate, their pastor told reporters.

Because of precautions put in place over their possible exposure to Ebola, Mason told CNN's "AC360" he was forced to deliver the devastating news while standing three feet away.

"I'm used to hugging someone in a situation like that," he said.

Instead, he said, Troh fell to the floor, left to suffer alone.

"We were there together," Mason said, "but we were not able to be together."




CNN's Gary Tuchman, Alexander Felt and Rene Marsh contributed to this report.