Don’t let what happened in Dallas happen here.
That’s the watchword at U.S. hospitals after Ebola-infected Thomas Eric Duncan was sent home from a Dallas emergency room for two days, only to return in an ambulance and then, 10 days later, die in an intensive care isolation unit.
“This is my entire job” now, said Michelle Peninger, system director of infection control at Inova Health System, which has five hospitals in northern Virginia, referring to Ebola preparation. “It’s all I do every day.”
The incident in Dallas, along with the growing epidemic in Western Africa that has killed almost 4,000, has heightened concerns at U.S. hospitals that a new Ebola patient will emerge, pushing them to buy more protective equipment, build new isolation rooms and enhance treatment plans for potentially infected patients.
Peninger’s Ebola team started with 25 members after hospital staff became concerned about the epidemic this year. Now she cannot even recall how many people are on it at any one moment. Health workers from intake nurses to communications specialists at the 17,000-employee health system have been trained to cope with the virus. She helps run drills, testing each layer of the intake and treatment process, and has even posed as a fake patient.
The team “looks at the screening process, waste disposal, how we’re going to disinfect the room, post-mortem care, everything,” she said. “We’re still adding more people as we identify more issues.”
Initial Visit
Health facilities across the U.S. have been preparing to identify and treat any additional Ebola patients, said Chip Kahn, head of the Federation of American Hospitals. “The seriousness of the Ebola threat has clearly sent a strong message to all hospitals,” Kahn said in a telephone interview. The federation represents about a fifth of U.S. hospitals. “I can tell you they’re from top to bottom in preparation.”
It’s unclear why Duncan was initially sent away from Texas Health Presbyterian Hospital Dallas after walking into the emergency room on Sept. 25 with a fever and stomach pains. Hospital officials initially blamed a flaw in the electronic records system that miscommunicated his travel history in Africa, then reversed course and said it wasn’t the record system’s fault.
Identifying Ebola
“Our care team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care,” the hospital said today in a statement. “In this case that included a four-hour evaluation and numerous tests.”
Failing to identify Ebola, then sending a patient home where they can come into contact and infect others, is a situation hospitals are trying to prevent. It has become increasingly important as worries about new U.S. cases increase and doctors treat anyone with symptoms as a possible Ebola patient.
Lee Norman, chief medical officer at the University of Kansas Hospital in Kansas City, Kansas, was giving a speech about Ebola preparedness when his pager went off, alerting him that a 23-year-old, Josh Seeley, who had recently traveled from Sierra Leone, was at the hospital with fever and body aches.
A care team rushed into action, quickly isolating Seeley and sending off his blood to test for the virus. Doctors eventually determined he had malaria, not Ebola, but it was a valuable trial-run, Norman said.
Learning Opportunities
The way to prevent another situation like Dallas is to use shortfalls as learning opportunities, said Kevin Chason, director of emergency management at New York’s Mount Sinai Hospital. The hospital has had several people who fit the profile of an Ebola patient, he said.
“We try to get a clear message out to the public that we are aware that we understand the risk,” he said in a telephone interview. “Unfortunately when the system doesn’t work, like the incident in Texas, people lose confidence when we tell them we have things in place.”
Since the U.S. Centers for Disease Control and Prevention warned hospitals nationwide about Ebola in July, Mount Sinai staff has re-evaluated its infection control procedures and increased training about when to wear masks, how to use protective equipment and when to ask travel history, according to Chason.
Problem of Fear
Still, Kansas’s Norman said he has concerns. As Ebola fears cause people to buy more equipment, such as protective suits, there could be a shortfall when they’re needed most, he said. He also is concerned that the virus could spread to someone during the process of disposing of hazardous waste.
“If we have a bunch of hospitals around the country disposing of medical waste, do we know enough about permitting?” he said. “Do we know where that is all going?”
He said he canceled a trip to Armenia this week to make sure his hospital can address lingering concerns about an Ebola outbreak in the U.S.
“I’ve never been busier, I have my day job and I have my new job,” he said, referring to preparing for the virus.
While it’s necessary for hospitals to be prepared, public fears in some cases have been blown out of proportion, said physicians who worry that Ebola paranoia may distract from more relevant threats, like the flu.
‘Two Epidemics’
“There are two epidemics going on,” said Pritish Tosh, an infectious disease physician and researcher at Mayo Clinic. “There is the real epidemic in West Africa and there is the epidemic of fear in the United States.”
Preparation for the flu season, including getting a flu shot, should be as high a priority for the general public as Ebola prevention, Norman said.
“We had 22,000 deaths from influenza and one death from Ebola,” in the U.S. in one year, he said by telephone. “If we had 22,000 Ebola deaths there would be rioting in the streets. We need to start rioting about influenza.”
Heightened attention by the public and media can lead to changes in health policy, though not always for the better, said Heidi Larson, a senior lecturer at the London School of Hygiene & Tropical Medicine, who studies public trust in vaccines.
“There’s a line between panic that’s non-productive or even counterproductive, versus organized attention and advocacy,” she said in a telephone interview.
Media attention may have pushed the U.S. government to step up temperature checks at the five busiest airports, which is “smart,” Larson said.
Larson suggests channeling the fear by converting it into empathy.
“In the U.S., there’s just one case that came and died, but if you consider the fear and anxiety of the American public after that, it should give them a lot of empathy for the people in West Africa who are seeing high numbers of people dying around them and being taken away.”
To contact the reporters on this story: Kelly Gilblom in New York at kgilblom@bloomberg.net; Michelle Fay Cortez in Minneapolis at mcortez@bloomberg.net; Caroline Chen in New York at cchen509@bloomberg.net
To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Drew Armstrong, Andrew Pollack
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