There will probably be more U.S. cases
Public health experts agree that Thomas Eric Duncan, the first person diagnosed with Ebola inside the U.S., probably won't be the last. They expect more infected people to reach American hospitals, with or without a travel ban from West Africa.
"We surely have to expect it could happen," said Michael Osterholm, a professor of public health at the University of Minnesota and an expert on infectious diseases.
Even Duncan's case wasn't a big surprise to the public health community—as the Ebola outbreak spread through Africa, experts from CDC and elsewhere said consistently that a U.S. case was probably inevitable. And even if the domestic response is perfect from now on, they're expecting to see more. In other words, another person with Ebola won't necessarily be a reason to panic or assume that the government is failing to protect us.
Some of those patients could die
Other than Duncan, every patient treated in the U.S. so far has lived. But no one knows exactly why. Remember, there is no treatment for Ebola. No cure, no vaccine, not even a proven therapy. Kent Brantly and Nancy Writebol, the first two aid workers treated in the U.S., received an experimental drug called ZMapp; but doctors who got the same drug in West Africa didn't make it. Some patients have responded well to massive doses of fluids, and others to blood transfusions from Ebola survivors, but developing a proven cure for Ebola will take years.
The big test: Controlling each new infection
Think of Duncan as a sort of nucleus. He got infected in West Africa, then came to the U.S. Here, he infected two people—the nurses from the Dallas hospital. There will probably be more of those patients—more people who get infected outside the U.S., but then make their way here, either intentionally or because they didn't realize they were sick.
The big test for CDC, hospitals, and state health departments is how well they can control the spread from each nucleus. That's the biggest criticism of how Duncan's case was handled at Texas Health Presbyterian Hospital in Dallas. His one initial infection has generated two new infections—the same rate at which the virus is spreading in Liberia.
"The next time a patient comes in, we just can't have doctors and nurses coming out with Ebola," said Ashish Jha, a public health professor at Harvard.
Depending on the number of additional cases and where those patients show up, it might not be possible to ensure that not a single additional health care worker becomes infected. But that should be the goal, Jha said.
"Is it realistic to expect zero? I think we should be able to get pretty darn close to zero," he said.
Better hospital practices
The way to get there, experts said, is to handle new cases much differently than Duncan's. Whether you blame CDC for unclear guidelines, or the hospital for breaking protocols, or a little of both, it's clear that Texas Health Presbyterian wasn't equipped to handle this the right way.