Dallas nurse with Ebola is flown to Atlanta

Hospitals with Ebola: designate a site manager dedicated to ensuring proper disrobing, other procedures

Monitored patient contacts: Stay off public transport

Source: CDC

In their first concession that a major U.S. hospital is not up to the task of treating an Ebola patient, federal health officials on Wednesday transferred an infected health care worker from Dallas to Emory University Hospital.

The patient, identified in news reports as a 29-year-old nurse, arrived at Emory Wednesday evening.

The move served to contradict the mantra recited for weeks by the nation’s top health officials that any well-equipped, well-staffed hospital could safely treat Ebola. (While the hospital in Dallas continues to treat one nurse who came down with the virus, it evidently could not care for two.) It also raised questions about the path forward should many more diagnoses arise.

Emory’s isolation unit can accommodate three beds, a hospital spokeswoman said, and three other U.S. hospitals have similar highest-level isolation units. An official at one of the three, in Montana, told The Atlanta Journal-Constitution Wednesday night that the hospital isn’t prepared to handle Ebola patients and may not be ready for some time.

By December, the virus could be infecting up to 10,000 people a week in West Africa, the World Health Organization reported, and scientists have tagged the United States as one of the Western countries more likely to see the virus appear. Phoenix Air, the Cartersville-based air ambulance service that transported Ebola-stricken missionaries from Liberia to Atlanta, has now flown about a dozen Ebola-related missions, officials there said Wednesday. They said Phoenix is under contract with the State Department to fly at any time on 12 hours’ notice.

The U.S. Centers for Disease Control and Prevention, which made the transfer request along with Texas Health Presbyterian Hospital, did not say what made Emory a better choice than the Dallas facility. The Atlanta hospital has successfully treated two Ebola patients and is caring for a third who is recovering and hopes to be released soon, virus-free, the anonymous patient said in a statement released by Emory Wednesday.

Texas Health Presbyterian, where nurse Amber Vinson and her colleague, Nina Pham, caught the virus from Liberian patient Thomas Eric Duncan, does not have the image of a bush-league clinic. It has 898 beds, and bills itself as “treating some of the most complicated cases [while] transforming health care in North Texas.”

But the patient’s move came amid new revelations of mind-boggling breaches in protocol associated with the Texas hospital, including that Vinson, monitoring herself, boarded a commercial jet bound from Cleveland to Dallas on Monday with a fever of 99.5. Medical records obtained by the Associated Press showed that Vinson was closely involved in caring for Duncan, drawing his blood, inserting catheters and dealing with his bodily fluids. Frieden said she and Pham cared for Duncan on his most dangerous days, when “the patient had extensive production of body fluids because of vomiting and diarrhea.”

Vinson went to Ohio to plan her wedding, authorities said. Earlier reports that her plane stopped in Atlanta as she made her way home proved untrue. (The aircraft did go to Atlanta after Vinson disembarked in Dallas, but Frontier Airlines said it was properly cleaned before it left Texas.)

Under CDC guidelines, the fact that Vinson was under monitoring meant that she was not supposed to take public transport, said CDC Director Tom Frieden.

Several news organizations reported late Wednesday that Vinson called federal health officials on Monday before boarding her flight to report that her temperature was elevated but that she was cleared to make the trip. None of the reports was attributed to an identified source, and they could not be independently confirmed right away.

“We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement,” Frieden said.

The news this week began to leave the impression of leadership learning the pitfalls of public infection control as they go, in spite of months dealing with Ebola in this country, half a year suspecting this outbreak could wind up here, and years to prepare.

“Blood is on the hands of the CDC,” said Richard Ebright, a biosafety expert at Rutgers University who has been a critic of the agency. He said the CDC had flouted the advice of some experts, including that full-body suits should be required for treating Ebola.

Emory did not always use full-body suits, and as the virus wound down they scaled back their coverings, doctors there said. They have also said that Ebola, if approached properly, does not require the highest-level isolation units.

Some of the most disturbing allegations about the Dallas hospital came anonymously, through the group National Nurses United. The organization said it was relaying concerns from some nurses associated with the Ebola care in Texas: that on his return visit to the hospital, the Liberian patient, Duncan, was first left for several hours with other patients; that when a nursing supervisor arrived and demanded his isolation, hospital authorities put up resistance; and that his lab samples were sent through the hospital tube system, without being specially sealed, instead of hand-delivered.

The union did not identify the nurses, it said, out of concern for their jobs, and the claims could not be independently verified.

As for Emory, it has sent nurses to Texas to help the CDC team there educate the Dallas staff. A spokeswoman said those emissaries won’t deplete the crew Emory needs to care for its new patient, as well as the one who is recovering. So far, Emory has reported no infections among its staff.

But Emory has its limits.

“The plan to rely on just these special units is not sufficient,” William Bornstein, Emory Healthcare’s chief quality and medical officer, said in an e-mail. While Emory is prepared to treat any patient with Ebola, he said — even outside its isolation unit — it only has so many resources. “We think it is imperative that other hospitals prepare to take care of these patients,” he said.

Special units similar to Emory’s exist in Nebraska, which currently has patients, Maryland and Montana.

Joann Hoven, a spokeswoman for Providence St. Patrick’s Hospital in Missoula, Mont., told the AJC that the three-bed “care and isolation unit” was not ready to accept Ebola patients, and the hospital didn’t know whether it would be able to in the near future. Completed in early 2008, the unit has never been used beyond drills, said Hoven.

“We have the capacity to treat maybe one patient, and right now we’re not going to accept any,” Hoven said.

The Special Clinical Studies Unit at the National Institutes of Health's Clinical Center in Maryland has seven beds. The Nebraska facility has 10. But officials said not all of those beds are necessarily free for Ebola patients.

In Georgia, leaders seemed caught between hope and realism.

“I am told that all of our hospitals have the capacity to deal with infectious diseases, and with that kind of ability and isolation we should be able to take care of them, at least in the short-term,” said Gov. Nathan Deal.

“And,” he continued, “hopefully transfer them to facilities in the state that would be better prepared to deal with them on a long-term basis.”