The chain of errors that set the Spanish Ebola crisis in motion

A chain of human errors led to the first case of Ebola contagion in Europe and a nation on alert with dozens of people under observation for symptoms of the disease.

As of Wednesday morning, a 40-year-old nursing assistant named Teresa Romero Ramos remained at Carlos III Hospital in Madrid, receiving experimental therapy against the virus she contracted while working with an Ebola patient there.

Six people have been quarantined, including her husband Javier Limón Romero and two nurses who also work at Carlos III. Over 50 others remain under observation.

Of these, 22 are friends, relatives and other people who came into contact with Romero when she was already ill.

The other 30 are hospital workers who, like herself, looked after Manuel García Viejo, a Spanish missionary who contracted the disease working in Sierra Leone and was repatriated for treatment at Carlos III, where he died on September 25.

Both authorities and health workers insist that all safety protocols were followed. While there are still no definitive conclusions as to exactly what happened, sources close to the investigation said there might have been a problem with the way Romero removed the third protective suit she was wearing.

If so, the error went unnoticed by the nursing assistant herself, who did not report any potentially dangerous incidents, such as a torn glove or a needle prick.

Her last job was to clean García Viejo’s room after his death. When the first Ebola patient to be treated at Carlos III, Miguel Pajares, died in August, the room was cleaned out by a robot that belonged to the same US company that cleaned the Washington DC central post office after the 2001 anthrax attacks.

Romero called to say she felt terrible, yet was told to take an ambulance to her nearest hospital in Alcorcón rather than to Carlos III

After that, Romero took a few days off with one sole instruction: to take her temperature twice a day and get in touch with the hospital’s occupational hazard department if she felt anything was wrong – standard procedure for those who have been in touch with Ebola patients.

Romero soon began to feel sick, but this did not prevent her from sitting an official examination along with 20,000 other people on September 27 to try to secure a permanent contract as a nursing assistant in the Madrid public health system.

On either September 29 or 30 – the dates vary according to the sources – the woman called the hospital to report a fever of under 38ºC and general weakness. She was told that her symptoms were indeterminant and to go to her primary health center in Alcorcón (Madrid). Sources there say Romero never explained that she had been in contact with Ebola patients, and was sent home with a prescription for painkillers.

On Tuesday, a Health Ministry official admitted to the SER radio network that Romero perhaps should have been immediately placed in isolation rather than waiting for her to reach a fever of more than 38.6ºC – the temperature at which health protocols consider that a risk of Ebola exists. Below that, the virus is not thought to be active enough to pose a risk of contagion.

But Romero’s work colleagues knew about her fever from the beginning. She had warned them through a chat service that she was running a slight fever and asked when she should alert the hospital. While the official accepted figure is 38.6ºC, the workers say this rule should be applied to the general population but not to someone who has had direct contact with the two Spanish missionaries with Ebola who were treated at Carlos III.

Union representatives at the hospital feel the same way: “Why was she not treated before this?”

What happened next depends on who you ask. According to the union, Romero called the hospital as early as October 2 to report a fever of over 38.6ºC yet no protocols were set in motion nor was she placed in isolation. Official sources claim that she did not reach that temperature until October 6.

In another incomprehensible decision, health sources say Romero phoned the Carlos III Hospital one more time to report that she felt “terrible,” yet was told to call the Madrid emergency services and go to her own closest hospital in Alcorcón. She was taken there in a regular ambulance with no protective measures, and spent several hours in the emergency room. Some of the 21 people now under observation were in contact with her at that time.

The procedures followed at Alcorcón Hospital also lacked sufficient rigor, according to staff. They say Romero told them as she was being brought in that: “I’m afraid I’ve got Ebola.” Yet she was taken out of the ambulance and received initial treatment with no further protective measures than gloves and a mask before finally being transferred to an isolation unit. There she remained all day, from early morning until past midnight, when she was finally taken to Carlos III. Over six hours had elapsed between the moment the diagnosis was confirmed and the time a properly equipped vehicle came to pick her up.