Some hospitals in Georgia may not be able to safely treat a patient with Ebola, national and state officials said Monday.
Dr. Doug Patten, chief medical officer for the Georgia Hospital Association, said every hospital must be able to identify and isolate a person coming into the emergency room with symptoms and a travel history that could indicate Ebola. But he said many hospitals simply do not have the expertise, facilities and resources to safely treat a patient who tests positive for the virus.
“Most of these small and medium hospitals … will need to transfer these patients for longer term care to more specialized facilities,” Patten said.
The likelihood of any U.S. hospital having to deal with a person infected with Ebola who suddenly appears at its door is exceedingly slim. It has happened only once to date.
But Monday, everyone from federal policy makers to individual doctors, nurses and technicians was grappling with the news that a nurse at that Texas hospital is now ill with the disease. That revelation rocked government officials and heightened anxiety among hospital workers, some of whom fear that measures are not in place to protect them.
“It’s terrifying,” said an emergency room nurse in Gwinnett County who asked to remain nameless for fear of reprisals. “There aren’t any protocols in place. I received a handout on what to look for. No training.”
If people come in showing signs of Ebola, the nurse said, she may refuse to treat them.
Meanwhile, the National Nurses United union released a statement citing “steady reports from nurses at multiple hospitals who are alarmed at the inadequate preparation they see at their hospitals.”
The Dallas nurse reportedly had worn protective gear, including a gown, gloves, a mask and a face shield, during her multiple interactions with Liberian patient Thomas Eric Duncan. Officials of the Center for Disease Control said they don’t know exactly how the infection happened, but they have sent a team to Dallas to review in detail the hospital’s procedures.
Dr. Mark Waterman, head of emergency services at Atlanta Medical, said fears among front-line medical staff are understandable.
“It’s very concerning when you have a health care professional getting a secondary case as in Dallas, and that person is using all the appropriate PPE (personal protective equipment),” he said.
“We’re told by the CDC that Ebola itself is not that contagious,” Waterman said. “But it’s such a highly infectious agent that if you are exposed and get it, then you have a terrible illness, and that’s what frightens everybody. It frightens health care professionals who could be seeing that next patient. It puts you on edge quite a bit.”
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ABC’s “Good Morning America” that federal officials should consider requiring that any Ebola patient be sent to a special “containment” hospital. Four such hospitals exist in the U.S., including Emory University Hospital in Atlanta, which has three beds in a special isolation unit.
Other hospitals across metro Atlanta had varied responses when asked about treating an Ebola patient.
The Wellstar Health System “is well-equipped and prepared to handle any infectious disease situation,” said spokeswoman Michelle Robinson in a written statement.
At Atlanta Medical, Waterman said, the hospital has “go-kits” around the facility, which include Tyvek coveralls that cover workers from head to toe, impervious gowns that offer another layer of protection, shoe coverings, masks, goggles and two pairs of gloves.
The hospital has had two or three preparedness drills involving doctors, nurses, administrators, cleaning staff and workers from other departments and is planning more this week, he said.
Meanwhile, staffers in the emergency department, clinics, physician offices and elsewhere are taking travel histories from every patient that shows up at any of the hospital’s facilities.
Piedmont Healthcare spokesman Matt Gove said front-line workers in security and reception have been receiving training on what to look for and what to do.
“Particularly in light of the nurse in Dallas, there will be heightened awareness and a desire to be ready,” Gove said.
But once a potential Ebola victim is identified, Piedmont would likely transfer them as quickly as possible to Emory, he said.
That’s not necessarily what some doctors at Emory envision, though. Even though it has cared for three Ebola victims, Emory should not be considered the sole fail-safe for Georgia, said Dr. G. Marshall Lyon, one of the doctors involved in treating missionaries Dr. Ken Brantly and Nancy Writebol.
Lyon said hospitals in Georgia, “shouldn’t be naïve enough to say, ‘Oh, we’ll just ship that patient to Emory.’” He said hospitals around the state must be able to identify the symptoms of the disease and be able to provide at least initial isolation to a patient displaying symptoms.
On Monday, CDC Director Tom Frieden said the agency will reassess whether an Ebola patient should be treated at whatever hospital they might turn to for care.
Frieden had earlier insisted that any hospital that could isolate an Ebola patient from other patients could handle the disease. Monday, he changed that message a bit, saying that if a hospital spots a case, officials must then consider the safest course of treatment moving forward.
That evolution points up how federal health officials continue to reassess the country’s plans to keep Ebola at bay. In the past week, that has included instituting a new level of Ebola screening at major international airports as well as possible changes to infection control protocols.
“We’re still learning about Ebola as we go,” Patten said. “It’s day by day.”
The Dallas nurse’s case highlights some of the unknowns surrounding Ebola, said Dr. Dennis Maki, a University of Wisconsin-Madison infectious disease specialist. For instance, scientists don’t have a good understanding as to how long the virus lives on surfaces, he said.
He also worries that some federal health officials are “trying to allay anxiety too much. … This is a virus that is much more contagious than we’ve been led to believe.”
Karl Johnson, one of the first U.S. researchers who helped discover the Ebola virus in 1976, said the only way to contain the spread of the virus in a hospital is to keep the staff treating a patient to an absolute minimum.
Johnson said that “nobody” should be allowed in an Ebola isolation unit who hasn’t had extensive training in dealing with deadly infectious diseases and care procedures.
Georgia Public Health Commissioner Dr. Brenda Fitzgerald said her office is participating in weekly conference calls with Georgia medical officials, in which Emory doctors answer questions about Ebola preparedness.
