Health officials in Spain rushed to contain the Ebola virus Tuesday after it escaped Europe's defences, quarantining four people at a Madrid hospital where a nursing assistant got infected and even getting a court order to kill the woman's dog.
The first case of Ebola transmitted outside Africa, where a months-long outbreak has killed more than 3,400 people, is raising questions about how prepared wealthier countries really are. Health workers complained Tuesday that they lack the training and equipment to handle the virus, and the all-important tourism industry was showing its anxiety.
Medical officials in the United States, meanwhile, are retraining hospital staff and fine-tuning infection control procedures after the mishandling of a critically ill Liberian man in Texas, who might have exposed many others to the virus after being sent away by a hospital.
In Africa, the U.S. military was preparing to open a 25-bed mobile hospital catering to health care workers with Ebola, before building a total of 17 promised 100-bed Ebola Treatment Units in Liberia. The virus has taken an especially devastating toll on health care workers, sickening or killing more than 370 in the hardest-hit countries of Liberia, Guinea and Sierra Leone, where doctors and nurses were already in short supply.
And as the disease moved from a seemingly distant continent to the doorsteps of the world's largest economies, government leaders faced growing pressure to ramp up responses. Spanish opposition parties called for the resignation of Health Minister Ana Mato, and the European Union demanded answers to what went wrong.
Obama administration spokesman Josh Earnest said Tuesday that more passenger screening measures would be announced "in the next couple of days," even though the White House remains "confident in the screening measures that are currently in place."
The nursing assistant in Madrid was part of a special team caring for a Spanish priest who died of Ebola last month after being evacuated from Sierra Leone. The nursing assistant wore a hazmat suit both times she entered his room, officials said, and no records point to any accidental exposure to the virus, which spreads through direct contact with the bodily fluids of a sickened person.
The woman, who had been on vacation in the Madrid area after treating the priest, was diagnosed with Ebola on Monday after coming down with a fever, and was said to be stable Tuesday. Her husband also was isolated as a precaution. Another quarantined nurse tested negative, but a man who travelled in Nigeria remained in isolation.
Madrid's regional government even got a court order to euthanize and incinerate their pet, Excalibur, against the couple's objections, without even testing the animal. A government statement said "available scientific information" provides no guarantee that infected dogs can't transmit the virus to humans.
Some reports in medical journals suggest that dogs can be infected with Ebola without showing symptoms, but whether they can spread the disease to people is unclear.
Ebola's source in nature hasn't been pinpointed. The leading suspect is a certain type of fruit bat, but the World Health Organization lists chimpanzees, gorillas, monkeys, forest antelope and porcupines as possibly playing a role in spread of the disease. Even pigs may amplify infection because of bats on farms in Africa.
Spanish authorities also were tracking down all the woman's contacts, and put more than 50 other people under observation, including her relatives and fellow health care workers. "The priority now is to establish that there is no risk to anybody else," emergency co-ordinator Fernando Simon said.
Even so, the potential repercussions of Ebola's presence in Europe became clear, as shares of Spanish airline and hotel chain companies slumped in Tuesday's trading. Spain is Europe's biggest vacation destination after France, and investors were apparently spooked that the deadly virus could scare away travellers.
The afflicted woman, reportedly in her 40s and childless, was not identified to protect her privacy, but nursing union officials she had 14 years' experience. Spanish officials said she had changed a diaper for the priest and collected material from his room after he died. Dead Ebola victims are highly infectious, and in West Africa their bodies are collected by workers in hazmat outfits.
An official investigation has begun and aims to "identify ... what is vulnerable: the procedures, or their implementation," he said.
The Madrid infection shows that even in countries with sophisticated medical procedures, frontline health care workers are at risk while caring for Ebola patients. Some two dozen health workers protested outside a Madrid hospital Tuesday, where union representative Esther Quinones complained that they lack resources and training.
In the United States, health care providers are implementing many precautions reviewing triage procedures, creating isolation units, and even sending actors with mock symptoms into New York City's public hospital emergency rooms to test reactions.
"You never know when (an Ebola) patient's going to walk in," said Dr. Debra Spicehandler, an infectious disease expert at Northern Westchester Hospital in Mount Kisco, New York. "Education is key to controlling this education of the public and of health care workers."