Monday, the Centers for Disease Control and Prevention announced its new Ebola strategy. It includes more training and more protective gear for hospital staff. The CDC is also encouraging states to designate certain hospitals for Ebola preparation. For example, New York Governor Andrew Cuomo is designating eight Ebola “supercenters.” The CDC is presuming that a few days is enough to make a hospital Ebola ready. That’s a gamble. Texas Health Presbyterian, a highly regarded 900-bed hospital, couldn’t handle Ebola. The CDC is betting on other hospitals to fare better. A safer strategy would be to expand capacity at the nation’s four bio-containment hospitals, which have treated Ebola patients successfully without the virus spreading to a single healthcare worker.
Most Americans have virtually no risk of getting Ebola. But doctors and nurses treating an Ebola patient are at high risk, despite assurances by the CDC that its “protocols” work.
Until this week, the CDC director Thomas Frieden predicted that Ebola wouldn’t spread “widely” and any hospital could handle it. Those assurances proved untrue when Thomas Duncan, a Liberian traveler infected with the virus, went to Texas Health Presbyterian Hospital last month. He died , two nurses are now infected and fearing for their lives, and 75 other hospital staff are being monitored.
Looking ahead, any patient diagnosed with Ebola should be transferred to one of the bio-containment centers in Georgia, Maryland, Montana, and Nebraska. Last week, infected nurse Nina Pham was brought to the Maryland facility, and Amber Vinson to Georgia.
The hitch is that these four facilities together can treat only eleven patients. Compare that with the 100 to 150 people who enter the U.S. from Ebola-infected countries daily. Suspending travel visas from these countries is a no brainer. So is expanding capacity at these four facilities, instead of outfitting hundreds of hospitals to treat Ebola. Hospitals should be prepared to recognize possible cases, isolate them, and then call for help. Period.
Last summer, the Centers for Disease Control and Prevention announced that doctors and nurses treating Ebola should wear a waterproof gown, gloves, goggles, and a face shield. That guideline left the user’s head uncovered and skin exposed around the neck and wrists. Sean G. Kaufman, an infection expert at the biocontainment facility that successfully treated Dr. Kent Brantly and Nancy Writebol and is now treating Vinson, called the guideline “absolutely irresponsible and dead wrong.”
At a House committee hearing last Thursday, Congressman Michael Burgess (R-TX) held up a photo of CDC director Frieden in Africa wearing a protective suit that covered him head to toe. Burgess compared it to the flimsy guideline that the CDC had issued for nurses and doctors here.
On Monday, the CDC backed off its double standard and recommended a full body suit with head cover modeled after what Doctors Without Borders caregivers wear. Will it be enough? Not necessarily. Any error in removing the gear can expose a caregiver to vomit and other bodily fluids contaminating the outside of the gear. So far this year, sixteen Doctors Without Borders medical personnel who were experienced and relying on a buddy system to avoid errors, became infected despite wearing their gear. Nine of them died.
The CDC is also no longer claiming that any hospital with a single room can treat Ebola. In an October 14 nationwide conference call with hospital personnel, hospitals were encouraged to consider setting up an Ebola suite with a dedicated lab, because technicians working in the hospital lab are likely to quit if Ebola is brought in, and one spill would force the whole lab to shut down. Having to make such changes, exclaimed Dr. Richard Pitts of Arrowhead Regional Medical Center, “would probably bankrupt our hospital.”
If not the preparations, then actually treating Ebola can put a hospital on life support. At Texas Health Presbyterian, some 100 healthcare workers exposed to Duncan are furloughed with pay and under observation. The public is shunning the hospital. Two-thirds of beds are vacant. And Amber Vinson has hired a lawyer.
The best Ebola strategy is to protect our local hospitals, healthcare workers, and patients by curbing travel and relying on the nation’s bio-containment facilities. That’s what they were built for.