In spite of two and a half months dealing with Ebola on American soil, experts must now “rethink” aspects of how and where the disease should be treated, the Centers for Disease Control and Prevention said Monday.
That's because a nurse who cared for the Liberian man treated in Dallas for Ebola has tested positive for the virus.
As Texas health officials brace for the possibility of more Ebola infections among staff at the Dallas hospital, a second CDC team has gone to Dallas to interview its staff, pore over procedures and recommend new ones.
In addition, the CDC will “double down” on education and assistance throughout the U.S. health system, said Tom Frieden, the agency’s director. Frieden was joined at a joint press conference in Atlanta Monday by David Lakey, commissioner of the Texas Department of State Health Services, who participated by phone.
“The existence of the first case of Ebola spread within the U.S. changes some things and doesn’t change other things,” said Frieden.
“It doesn’t change the fact that we know how Ebola spreads. It doesn’t change the fact that it’s possible to take care of Ebola safely. But it does change, substantially, how we approach it. We have to rethink the way we address Ebola infection control. Because even a single infection is unacceptable.”
Lakey said the CDC's suggestions on the Dallas hospital's infection controls would "make sure they're even more stringent than what they are right now."
Officials still do not know exactly how a female nurse at Texas Health Presbyterian Hospital contracted Ebola from Thomas Eric Duncan, the Liberian who entered the U.S. with the virus and subsequently died at the hospital.
This weekend, Frieden said it resulted from a "breach in protocol," but on Monday he said he did not mean to be critical of the hospital. He did not directly say Monday whether specific breaches of protocol had been pinpointed. But he did say the CDC had identified "a series of things where we can make the care safer and easier for the health care workers who are providing it."
One potential problem, apparently, is overdressing: the use of additional pairs of gloves or coverings that would seem to provide greater protection.
“Sometimes health care workers may think that more is better,” Frieden said. “And that may actually end up paradoxically making things less, rather than more, safe. Because it may be so difficult to remove those levels of layers that it inadvertently increases risk.”
Other than that, Frieden provided few details as to what changes the CDC might institute.
However, he did suggest policy makers will re-evaluate one stance he and others have repeated in recent weeks: that any well-equipped, well-run hospital in the U.S. could treat Ebola. An alternative would be to transport confirmed cases to designated hospitals with special facilities or higher levels of training.
“We’re going to look carefully at the issue of what’s the optimal way to safely, effectively care for people with Ebola,” he said. “But I would reiterate that whatever we do on that issue, it’s very important that every hospital be prepared to diagnose someone with Ebola.” And that, he said, rests on getting a detailed travel history from any patient with symptoms that might indicate Ebola.
Meanwhile, as new policies are being formulated, he said, the government will launch a new wave of education and outreach to U.S. caregivers through professional associations, local health departments and other organizations.
In Texas, the second CDC team is watching the hospital staff at work, concentrating especially on the procedure for leaving and disrobing after caring for a patient, Frieden said. Working overnight, the observers identified new procedures that the Texas hospital began implementing Monday.
Before the Dallas nurse tested positive, health officials were tracking 48 people who had contact with Duncan before he was hospitalized. Now they are monitoring two other categories of people: those who had contact with the health nurse who is infected, and those who may have had contact with Duncan after he was hospitalized.
Prior to the nurse’s diagnosis, she was monitoring herself, according to a statement from the hospital.
In the end, Frieden said, the American public should still have confidence in the health system’s ability to stop Ebola.
“Absolutely,” he said.
“The bottom line here is reducing risk to Americans,” Frieden said, but until the outbreak is stopped in West Africa, “there is no way to get the risk in the U.S. to zero. What we can do is stop its spread within the U.S. and minimize the possibility that we have other cases here, and that’s exactly what we’re doing.”
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