On July 17, Mr. Sawyer defied medical advice and left a hospital in Monrovia, Liberia, where he was being held for observation after caring for his sister, who died of Ebola, although it was unclear whether he knew what she had.
Nigerian news reports said he used Liberian government contacts for permission to leave, flying to Lagos by way of Ghana and Togo. He planned to go to an economic development conference there and then fly back to Coon Rapids, Minn., for his children’s birthdays, according to media interviews with his widow.
Taken to a small private hospital after he collapsed, he denied any contact with Ebola victims and was initially treated for malaria. He died on July 25.
“That hospital had zero infection control,” Dr. Frieden said. A nurse who helped reinsert an IV line when Mr. Sawyer was delirious and bleeding wore no gloves, had a cut on her hand and did not wash it, he said. She later died.
After malaria treatment failed, Ebola was “high on the index of suspicion,” Dr. Shuaib said.