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Texas Health Worker Tests Positive For Ebola
Thomas Eric Duncan, the first person to have been diagnosed in the U.S. with Ebola, and who subsequently died of the disease, was treated at Texas Health Presbyterian Hospital in Dallas. Now, in a second diagnosis for the U.S, an unidentified health-care worker from the hospital has tested positive for Ebola as well. According to the linked Reuters story, Texas officials did not identify the worker or give any details about the person, but CNN said it was a woman nurse.
The worker was wearing full protective gear when in contact with Duncan, Texas Health Resources chief clinical officer Dan Varga told a news conference.
"We are very concerned," Varga said. "We don't have a full analysis of all of the care. We are going through that right now."
...
The worker was self-monitoring and has not worked during the last two days, Varga said.
The worker was taking their own temperature twice a day and, as a result of the monitoring, the worker informed the hospital of a fever and was isolated immediately upon their arrival, the hospital said in a statement.
(Also covered by the Associated Press, as carried by the Boston Globe, which notes that "If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S.")
I'm sure that there's a protocol you could follow to prevent catching the flu from flu patients, too, but I doubt it would be practical to practice medicine at the same time. I think that as Western medical personnel are beginning to be infected, it becomes less easy to just say "the training/equipment/conditions were the problem". At some point, we need to look at how the containment protocol interacts with the treatment protocol, and see if it actually works.
Remember, correctly executed withdrawl is just as effective a form of birth control as a correctly applied condom, but a greater share of condom users use them correctly than those who attempt pulling out.
"Because Science" is one step from "Because old book". Try "Because of my experiment testing my falsifiable assertion".
There is virtually nothing (not even Ebola) that can get through basic procedures, even with humans treating them. Even without full isolation, just making sure that direct bodily contact does not occur is enough to stop basically anything - hence why doctors wear rubber gloves even if they digging into your internals with blood everywhere.
Such a thing would be so unbelievably infectious that we'd all have it - planet-wide - within a couple of days. It's just not in the nature of such things to be that infectious. Ebola is actually no worse than AIDS, from what I can tell from a quick search. So long as there's no bodily fluid contact, you're fine.
To get to the point that a nurse is infected means that protocol wasn't followed. That it wasn't EVERY nurse and EVERY doctor that touched the patient is quite telling.
And, think about it... something THAT infectious, it wouldn't matter - you wouldn't GET to the hospital before you'd infected dozens of people.
Ebola is being blown out of proportion. Sure, it's serious. It's not to be fucked with. But it's just a disease.
I have friends who work on the frontline of medicine - checking samples that come in for everything from cancer to Ebola. Sure, they have precautions. There are grades of danger for particular samples, etc. There are "classes" of labs that handle the more dangerous stuff. But pretty much it's rubber gloves at the end of the day. The chemicals they use to break samples down and analyse them are actually ten times more dangerous than anything they have come in.
Just don't lick it, and you're fine.
As someone who lived through the SARS panic in Asia, I would say no, we're not "there" yet. Apparently it has taken a bit longer than it should have for the rank-and-file health workers in the USA to get clued in on this, but I would venture to say that the number of them who remain unaware of this threat today is approximately zero. If anything, I'd expect to see a lot more "false alarms" than actual infections in the next few weeks.
Once the public is aware, the infection rate will plummet. Because of SARS, I still avoid doorknobs and elevator buttons whenever possible (use your keys, lighter, sleeve, etc. to buffer such contact), it just makes sense to do so. Once the protocols for avoiding Ebola become widely known, this so-called "epidemic" will quickly dissipate.
XML is like violence. If it doesn't solve your problem, you're not using enough of it. --AC
The fact that the nurse in Spain, and the one in Dallas both contracted the disease despite wearing full protective gear - and in full knowledge that the patient was infectious - is pretty scarey. You have to imagine that both of those people were fully aware of how dangerous the situation was and were doing their very best to avoid doing anything to compromise their own safety. Clearly we either need better suits or better training, or some kind of a 'buddy system' where two people watch each other to ensure that they don't accidentally do something wrong.
There was a piece on NPR a few days ago that said that the Doctors Without Borders people use a buddy system like this - and despite having hundreds of people on the ground in Africa for a month or more, have only had three staff infections.
Without some improved level of protection, asking doctors and nurses to expose themselves to a disease with a 70% mortality rate (latest WHO estimate...up from 60%), no immunization and no known cure, is asking a lot. Clearly we aren't going to be able to make a vaccine or a cure in any reasonable timescale - so we really need to be working hard to improve protection. The idea of using robots for at least some of the jobs is interesting - but probably impractical for all but the simplest tasks.
We know that this disease can spread exponentially the "base reproduction" figure (the number of people who catch the disease from one infected person) is between 1.7 and 2.3, and it takes 2 to 3 weeks for the infected person to develop symptoms and pass it on. So there is a potential for the disease to double every 3 weeks. We have just a couple of victims in the USA right now, so in a year, we could have a million victims and 700,000 deaths. Clearly, we have to reduce that base reproduction number below 1.0 - but if...with proper protection gear and highly aware workers...both the Spanish and Dallas initial cases were able to spread to one additional victim, we're clearly not going to get anywhere close to a 1.0 rate anytime soon.
But last week it was reported that Sgt. Michael Monning contracted ebola while trying to get the quarantine order signed.
No, it says a possible second Ebola victim. He didn't actually have the symptoms of Ebola, but felt sick, and since he had been in Thomas Duncan's apartment, he went to get checked out just in case. But his test for Ebola was negative.
Does anyone know how the virus can penetrate a hermetically sealed suit?
It cant, but when the health worker does not use care to disinfect and properly remove the gear, he/she may not as well have worn the suit in the first place.
One of the workers infected in africa admitted that that was the cause of their infection; accidentaly touching their bare skin with the outside of the suit.
yet Ebola continues spreading.
No, no really. There are more and more victims in Guinea, Sierra Leone, and Liberia. But it was stopped in Senegal and Nigeria. All African nations are not the same. In terms of institutions and infrastructure, Guinea, Sierra Leone, and Liberia are at or near the bottom. While primitive by Western standards, Senegal and Nigeria are far more functional countries. If they were able to control and contain the disease, then more developed countries should not have much difficulty doing the same.
Simplest explanation is always right.
No. Most likely. But in the absence of more information, most certainly NOT "always right".
AIDS doesn't cause contagious blood, spit, diarrhea, and vomit to go everywhere. Ebola does.
AIDS doesn't infect health care workers who are treating patients unless there's a needlestick or sexual contact. Ebola does, with alarming frequency. Even if you DO have sex with someone with AIDS, it's not 100% that you'll get AIDS.
AIDS can't be spread by sneezing or coughing. It's possible Ebola *is*.
In terms of contagiousness, Ebola seems 10x worse. It's like saying "smallpox is no worse than chickenpox". Maybe if you put them both on a logarithmic plot and back up 50 feet!
--PM
There is virtually nothing (not even Ebola) that can get through basic procedures, even with humans treating them. Even without full isolation, just making sure that direct bodily contact does not occur is enough to stop basically anything - hence why doctors wear rubber gloves even if they digging into your internals with blood everywhere.
Such a thing would be so unbelievably infectious that we'd all have it - planet-wide - within a couple of days. It's just not in the nature of such things to be that infectious. Ebola is actually no worse than AIDS, from what I can tell from a quick search.
There are so many things wrong with this, it is hard to know where to start...
Many diseases are much more infectious than ebola. I recall from medical school that you can catch chicken pox (if you haven't had it or been vaccinated) from the air two hours after a patient has left the room. Influenza is also much more infectious than ebola, which is why is spreads around the world in weeks/months every year.
Fortunately ebola is not nearly so infectious. But if someone is having continuous watery diarrhea and bleeding everywhere (e.g. Ebola) and your job is to roll them over every hour, while they are thrashing around, to clean up their bloody virus-laden excrement, and your only protection is mask/gloves/gown - well, good luck.
HIV requires that you get infected bodily fluid (usually blood) into your own bloodstream, which is much hard than catching Ebola.
No.
We MIGHT (and I stress "might") be getting to time to panic the first time we get an ebola victim who hasn't been to Africa, and hasn't been in contact with any known Ebola victim.
Note that this case is one of the 48 people who are currently being monitored due to contact with that ebola victim who brought it here from Africa.
"I do not agree with what you say, but I will defend to the death your right to say it"
So you honestly believe those thousands who got infected licked another's bodily fluids?
Yes. In the countries with widespread Ebola, they have funeral rites that involve touching and kissing the corpse. In some instances, relatives washed the corpse, and then, as a sign of respect, drank the water. These countries have a deep distrust of official authority, including health workers, so there has not been much success at discouraging these traditional practices. Except for a few isolated and quickly contained instances, Ebola has not spread beyond the regions with these practices.
To get to the point that a nurse is infected means that protocol wasn't followed. That it wasn't EVERY nurse and EVERY doctor that touched the patient is quite telling.
We know some details about the nurse that was infected in spain: She touched her face with her hands before disinfecting them.
Yes, protocol wasn't followed. But here's the point: You need to follow protocol 100% of the time to be safe. You only need to make one mistake to be infected. For a virus with such a crazy lethality rate, that's not good. Treating an ebola patient is a lot like playing russian roulette.
Just don't lick it, and you're fine.
Very few of the people who are now dead licked it. Yes, the media loves fear stories and it's overblown, but you're underblowing it.
Assorted stuff I do sometimes: Lemuria.org
well no, I bet a dollar there was a tear in his suit. Simplest explanation is always right.
Be prepared to lose a dollar. The protocol for donning and removing the protective gear is very complex, and very hard to get perfect. When putting the suit on, it's possible to get gaps between the goggles and suit without even knowing it. And when taking it off, a tiny flap of the contaminated suit brushing against a clean surface is almost impossible to detect.
In contrast, Tyvek suits are very hard to tear unless you're doing hard physical labor in a rough environment. Most hospital settings don't have the infectious care nursing staff crawling through piles of dirty rebar or squeezing along rough mortared brick walls.
John
Dear Texas,
After careful consideration, we do actually think that your secession plans make sense after all!
With Best Regards,
The Other 49 States
sigs are for losers (except to point out that sigs are for losers)
The barrier protocols are quite onerous. It doesn't need to be idiocy, fatigue is enough to induce human error. Experts have pointed to this as a factor in the spread of Ebola in West Africa; aside from the fact that most people have access to medieval levels of health care, or facilities that lack things like latex gloves, supplying hospitals with equipment is not enough. The workload of health care workers has to be kept light enough that they can take the extreme precautions needed without making errors.
It is also possible that the barrior protocols have a bug somewhere in them.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
What I don't understand: Wouldn't it be possible to put the wearer through a disinfectant decontamination shower before he or she takes off the suit?
Last I saw, that debate wasn't split on party lines. Some of each party said both. Oh, but no, let's just treat every single event that ever happens like one US political party is always right and the other wrong. Because when you get elected in one party you become a god. They're not at all just people with their own opinions and ideas who make mistakes. And when you get elected to the other party, you sit around wringing your hands trying to think about how to screw up. Because they too aren't just people trying to stumble through awesome responsibilities.
Behold the brilliance of American politics. Nothing in the world is more important than choosing which group you'll worship.
For those who said "No need to panic" ... are we there yet?
Nope. And we never will be. Panicked people make stupid decisions that make the situation worse.
One thing these outbreaks in Europe and the US show - we don't know enough about Ebola.
There is no "outbreak" in the US or Europe. And not knowing enough about Ebola is not the same as saying we know nothing about Ebola, and what we know says there is not going to be an outbreak here -- just a few isolated cases of transmission. Thus far there have been one confirmed case of endemic transmission in the US and one in Europe, both nurses. The other "cases" were people with other viral diseases. One transmission does not an "outbreak" make, except to people who are panicky. It's normal in a situation like this for "suspected cases" to pop up all over the place. What do you expect, with the media spreading panic.
The CDC is now saying that the transmission in TX was caused by a "breach of protocol", which is not surprising given that the barrior protocols are exacting and onerous.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
In some instances, relatives washed the corpse, and then, as a sign of respect, drank the water.
Here's a reference, in case anyone finds that incredible
Also, in some places they don't trust health workers, and actually attack them. They are afraid of the disease, but they are more afraid of the health workers.
"First they came for the slanderers and i said nothing."
You know, I've heard that many times now, yet Ebola continues spreading.
And it is still correct. There is no need to panic. Ebola gets WAY more press than the severity of the actual risk justifies.
Basically stop freaking the hell out. The people that can and will deal with this outbreak are dealing with it. Panic will accomplish nothing productive. Quite the opposite in fact.
So perhaps it would be better to panic and spend some serious dough to crush the outbreak while it's still possible, rather than wait for it to turn into the doomsday scenario a deadly and highly contagious disease has every potential to become?
First off, ebola is NOT "highly contagious". It's actually rather hard to get. Unless you have been in direct contact with the sweat, blood, tears, feces or other bodily fluids of a symptomatic ebola patient then you have nothing to worry about. Medical personnel who are treating such patients directly are at highest risk for obvious reasons. This is nothing shocking though it probably means someone made a mistake.
It is incorrect that "every" pathogen has to potential to become a "deadly and highly contagious disease". Go talk to an infectious disease doctor and they will tell you that the biology of most viruses and bacteria prevents them from ever becoming a threat to humans. It's actually quite hard for that to happen even in a rapidly mutating virus which ebola is not. What you are suggesting is almost as unlikely as all the air in the room suddenly deciding to be on just one side of the room because, hey, it's theoretically possible. The real world probability of most viruses and bacteria mutating into something harmful to humans is actually vanishingly small if not actually zero.
Let's see: total number of Ebola Patients in the U.S. is ... 1. Mssr. Duncan is dead and cremated and no longer spreading the disease. So, the answer is "no".
You didn't bother reading the summary or the article, did you? Not just 1, Mr. Duncan. The next victim is the trained, well-equipped health care professional who - despite having far better protection and awareness than the vast majority of people in the world - just tested positive for having caught the virus from him.
What's your point in ignoring that glaring little dose of reality?
Don't disappoint your bird dog. Go to the range.
Don't let facts get in the way of your rant.
This latest case arose because of a man who arrived in the US like any normal person would. He was not flown under quarantine for treatment, he developed the disease already in the US.
Considering the record so far, it's far safer to fly people back to the US for treatment than to let them arrive on their own even if they show no signs of the disease. This allows us to reach a single conclusion and no other: that Dallas hospital has some explainin' to do.
If your advice had been followed, that man would still have died in the US, infecting this other person, and those who were successfully treated in the US may have died due to not having access to the same level of care.
You're kidding me right?
A woman working under biohazard 4 conditions, wearing a hermetically sealed suit, working with a patient she KNOWS has ebola and is infectious; gets Ebola herself, and you are seriously trying to play it off like it's no worse than HIV? Acting like a know-it-all expert on infectious diseases and trying to reassure everyone that this isn't going anywhere and isn't dangerous?
Look, I'm not trying to fear-monger here for the sake of it, and I'm certainly no ebola-expert, but trying to reassure everyone that this is just going to blow over with this idiocy about how safe Ebola is and how nobody can catch it unless they fucking lick infected blood when that is increasingly not the case just sets me right off. Even the media has done a complete 180 on their usual fear-mongering. Let's suppose for a moment that this woman did something out of procedure - she didn't clean her suit or something, and she touched it, then rubbed her eyes.
That's not HIV-level infectious. That's influenza/cold-level infectious, and that is extremely worrying, because the CDC seems to be grossly incompetent in this entire situation and I'm beginning to wonder if the corporations involved who have the potential to make literal billions to trillions off Ebola vaccines aren't giving little nudges here and there to maintain a certain level of incompetence in the matter. We aren't even quarantining Africa - the CDC says that wouldn't do anything. Like hell it wouldn't. The first thing we did when SARS was worrying people was to quarantine and shut down air travel, but apparently we're finding out only just now that this didn't work and won't work for Ebola, so let's just spend millions trying to screen for it ineffectively at the airports into our countries? I'm sorry, I'm not buying this. I'm not buying anything the mass media are telling us about this disease anymore. How many times does the mass media have to lie to people before they stop actually trusting them?
Did you know that one of the Ebola strains quite possibly moved through an air gap to cause infection?
http://www.nature.com/srep/201...
We also know that the Filovirus family can easily become airborne:
http://www.nature.com/nbt/jour...
This virus is spreading into the tens of thousands range in West Africa. That's an immense breeding ground for it to adapt to a new host. We know that Ebola strains can become airborne, and we keep having doctors getting sick with the virus in spite of hefty precautions against it. So why are we assuming it can't be airborne and can't be transmitted during its incubation period? Why are we assuming it has low infectivity when doctors in full protective gear are getting it? When people are literally getting this virus from just touching things that ebola victims have touched? Why is nobody taking precautions in case it IS highly infectious? This isn't some joke of a virus that kills 2% of the people it infects; almost everyone who gets it dies. This isn't something to be jovial and careless around, yet we took more precautions around SARS than anything we're doing with Ebola. It's fucking madness, and I keep seeing people parrot this bullshit that we shouldn't be worried, have nothing to fear if we aren't literally bathing in Ebola-blood like West Africans obviously are, and so on.
No, we DO have something to fear from this - you'd be foolish not to be worried - and I am not satisfied in the least with the way our governments are treating this whole thing. It's almost flippant. I think some serious discussion about this virus getting into western countries uncontrollably needs to seriously start happening. What are you going to do if Ebola ends up in your town? Have you even considered talking about it with your family? With your local community? Is the effort involved in being prepared really worth the risk o
well no, I bet a dollar there was a tear in his suit. Simplest explanation is always right.
Be prepared to lose a dollar. The protocol for donning and removing the protective gear is very complex, and very hard to get perfect. When putting the suit on, it's possible to get gaps between the goggles and suit without even knowing it.
Goggles?! - Proper biohazard suits are full-body and pressurized, with a full-head hood and absolutely
no openings in the vicinity of the head. Or any place on the front side of the body for that matter.
And when taking it off, a tiny flap of the contaminated suit brushing against a clean surface is almost impossible to detect.
Eh, again? - There's a multi-step decontamination procedure before taking off the suit.
Taking off a still-contaminated suit would be a major fuckup, and a (potentially) contaminated suit should never
be in an environment where any "un-suited" contact can happen.
Have a look at how this works at the BSL-4 level (skip to about minute 13).
What kind of amateurs are running this place?
Highly trained workers... hmm...
Before you go on a tangent, think about this:
Look at the average person who works with you.
Note his abilities, how he handles himself, how he acts and how he does his work.
Note that this is what we call "a professional"
Now reevaluate that statement about "highly trained workers".
In my experience, 9 out of 10 times "professional" only means getting paid to do it. It's not a statement of quality.
We used to have a Bill of Rights. Now, with the rights gone, all we have left is the bill.
I had brunch with my friend this morning, who is an MD PhD in infectious disease and works in a BSL-4 laboratory from time to time, so I asked about this.
BSL-4 is a standard that only applies to laboratories, the same standards aren't necessarily applied to clinical environments, and in the case of Ebola are major overkill. Ebola can't travel through the air, so positive pressure suits aren't appropriate, and they still have to be taken on and off, and that's when health workers seem to get infected. People who "test positive" for Ebola are not contagious, only people who have symptoms are, and they can only pass the disease through contact with bodily fluids -- this usually implies touch, since hemorrhagic fevers cause people to give off all kinds of gross effluent, but it's just not like a "virus" one gets from casual contact, like, say, rubella.
The fact is, Ebola isn't that contagious -- HIV is more virulent, and these two are nothing compared to the influenza or SARS. It's bad that health workers can get it, but this is still one person, so on a completely epidemiological basis it's really not a big deal. Characterizing a single case as somehow indicative of the safety of these procedures is sensationalism.
Don't blame me, I voted for Baltar.
One problem is to most healthcare workers, all of their training on blood-borne pathogens is geared primarily toward AIDS, unfortunately HIV is a very labile with a fairly high infectious dose, so basically if you do just about anything you kill it and it remains infectious in the environment for minutes to an hour if you do nothing. Ebola on the other hand is a robust virus with a very low infectious dose (1 -10 virus), anything strong enough to guarantee a 99.999% kill rate is going to also dissolve plastic, peel the paint off the walls and corrode any metals to uselessness.
Apocalypse Cancelled, Sorry, No Ticket Refunds
So basically you're just anxious, because none of this "seems right" in complete absence of empirical evidence?
Somebody in a modern clinical environment who supposedly knew what they were doing got infected.
That right there is empirical evidence of something not being right.
And in your sample of 10 (or 20, who knows!) one person became ill, because, we dunno, but it sounds fishy.
It doesn't to you? "Well, they have to take off those contaminated suits, and some will get infected while
doing that. Shit happens." really isn't the right approach here.
What recommendations would you make, if you were, say, a public health official? Everyone who develops illness has to be treated in something akin to a BSL-4 facility?
No, but how about "don't mix clean and unclean environments, and follow proper decontamination
procedures while moving between them, and before undressing"?
Have you any idea how many plane flights that would require, just to cite one small aspect of the logistics?
Huh? Plane flights? Are we still talking about a controlled clinical environment in a big American city?
And all this to protect from a disease vector that's completely unsubstantiated in the literature?
Or do you do like Judge Clay Jenkins, and personally go to the family's house in shirt-sleeves and drive them to a new home? Which approach is more appropriate? Which one balances our available resources against the actual concrete threat of the disease? Which one is actually workable?
You're losing me here.
What I don't understand: Wouldn't it be possible to put the wearer through a disinfectant decontamination shower before he or she takes off the suit?
There is a strong protocol, and yes, it includes decontamination sprays. As I understand it the protocol includes a disinfectant spray before taking off the suit, a hand spray after removing the first layer of gloves, then another disinfectant spray after stripping. And the gloves and suit are all supposed to come off inside-out, always turning the the hot side to the inside.
Remember that any suit that can protect the wearer against virus is also impermeable to air. That means the suits heat up. They are sweating profusely as soon as they get their suits on, and they can only remain suited up for less than an hour before roasting in their own juices. When every surface is soaked in sweat, it's impossible to recognize when it's the patient's infectious sweat or your own.
We know the best practical approach is to use a buddy system, and have them help each other. Even so, the first buddy to disrobe is still handling the infectious materials while helping the other to strip, so they still have to be vigilant. Repeat that clothing protocol every other hour for a long work day, week after week, and if the wrong piece of fabric ever accidentally brushes on you any time during the process you may get infected with a disease that has a 60% chance of killing you. Or if this is your first time dealing with an Ebola case, how do you know you've followed the protocol perfectly?
Now, cross the ocean. Place all of that in the context of extreme poverty; chronic suit, glove, equipment, and doctor shortages; wailing and shrieking family members; orphaned babies that may be infected; contaminated water supplies; relentless heat; men who tell rumors that Ebola is a disease from the West that is being spread by doctors and is being used to kill Africans, or that Ebola doesn't exist; populations frightened by the presence of workers in "moon suits" coming to collect their dead relatives; a culture that grieves by touching the bodies of the dead; and the dozens of other deadly diseases that still strike Africans constantly, including malaria, dengue fever, AIDS, hepatitis, typhoid fever, and chronic diarrhea caused by rampant bacterial and protozoal infections. Oh, and attacks on clinics by gunmen.
It's almost as if the disease evolved itself to adapt to collapsing health care systems in impoverished nations.
John
No, the protocol needs to be changed if it's inadequate.
For example, Ebola has made this transition to airborne transmission before. Influenza has been transmitted by diarrhea before. Bubonic Plague is another disease that has managed the transition to airborne transmission. And of course, AIDS was readily transmitted by blood transfusion and shared needle use even though that's not its original mode of transmission. So there's four examples right there, including Ebola itself.
The variety of Ebola that is suspected of being transmittable via small particle dispersal is the Reston variant. It has not been proven that the Reston variant is transmittable by small particle aerosol dispersion, just suspected. It's worth noting that the Reston variant is not pathological in humans. No humans who have acquired it have become ill. The presence of influenza virus in children's diarrhea is not necessarily a new mode of transmission. It may have always been present but no one looked for it until very recently. Just as influenza has shown up in bird shit since forever, it doesn't seem unreasonable that it might be present in the diarrhea of children. From what I've been able to find out it does not appear that influenza has mutated and is being transmitted through a new mode. Pneumonic plague is not a new mode of transmission, and the bacterium that causes it is the same as the one that is transmittable by insect bites. Besides, plague is not a virus. AIDS has always transmitted via bodily fluids. Blood transfusions and shared needles are still transfer by bodily fluid.Every virus that can survive in the blood is transmittable by these means by default. None of the examples that you provided qualify as an example of a virus changing its mode of transmission.
I don't want to misattribute something to the CDC, but what I read was glaringly clear on this point.
What the unnamed party said, was, "there HAD to be a breach of protocol, because this person is infected. However, we haven't identified what the breach was yet"
Circular reference?
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