The emergency room at Grady Memorial Hospital has placed a handful of patients in isolation recently because their symptoms and travel histories indicated possible Ebola exposure.
“Grady is a natural place for people to show up. We are the biggest hospital next to the busiest airport,” said Dr. Hany Attalah, chief of emergency medicine at Grady. “We are on a high alert for this kind of thing. There is a higher-than- average risk for Atlanta.”
Hospitals and health departments nationwide are all on high alert – particularly after a well-regarded hospital in Dallas failed to identify the first case of Ebola in the United States. Last week the Texas health commissioner ordered four people into quarantine because they’d been exposed to the Dallas patient. His Georgia counterpart can do the same thing.
“Absolutely the state health officer has the ability to order a quarantine should that be necessary,” said Dr. Brenda Fitzgerald, commissioner of the state Department of Public Health.
On Monday, Fitzgerald’s department hopes to complete a “guidance” – essentially a set of instructions – for public schools, including colleges and universities, to follow in the event of an Ebola exposure.
Whether in Texas or Georgia or Oregon, though, the most important risk factor for Ebola in this country is not where you are but where you’ve been.
“The No. 1 thing is travel history,” Fitzgerald told The Atlanta Journal-Constitution. “This is isolated in a certain part of the world right now. If you have a fever and headache and you’ve just been visiting your grandma in Indiana, you do not need to get a work-up for Ebola.”
Is air travel still safe?
A big city’s airport is such an important link in the chain of infectious disease exposure that the CDC runs a quarantine room at about 20 U.S. airports. (The quarantine area at Hartsfield-Jackson is in the international terminal.)
In Boston, Massachusetts General Hospital and Logan Airport have worked together before on combatting infectious disease, including SARS and avian flu, said Dr. Erica Shenoy, assistant chief of infection control at the hospital.
“Because we’re in Boston and we’re right next to the airport, we are used to taking travel histories, that’s been reinforced over and over again,” Shenoy said.
Travel history, and not travel itself, is the key phrase. Although airline passengers may be nervous about the safety of sitting for hours in close quarters with 200 strangers, air travel remains reasonably safe, experts say.
“The concern about travel is understandable, but the risk of transmission is relatively low,” said Kristina Talbert-Slagle, senior scientific officer of the Global Health Leadership Institute at Yale University and a lecturer at Yale’s School of Public Health.
“I would travel through Atlanta,” she said.
‘Any question whatsoever, we will just isolate you’
At Grady Memorial, Dr. Attalah said that emergency room workers ask all people coming in whether they have traveled outside the country within the past 30 days; if they say they’ve been in West Africa, ER workers then ask whether they have symptoms such as fever or cough.
“If they do, they will be handed a mask and escorted to an isolation room,” Attalah said. “Our primary concern is keeping our patients and our staff safe… . If there is any question whatsoever, we will just isolate you. And then get the answers.”
At that point, the staff will put a sign on the door that says “droplet” isolation, referring to sweat, sneezes and coughs. Anyone who enters the room from that point on will be in full personal-protection regalia: masks, gowns and goggles, Attalah said.
Then the patient will be tested. Of the three or four who have been isolated so far, all have been cleared.
If the test results warrant it, Attalah said, the medical team will discuss whether to send the patient on to Emory University Hospital, which has more advanced isolation rooms.
It was Emory’s special isolation unit — one of four such facilities in the nation — where at least three Ebola patients flown in from West Africa have been treated.
‘Every single level of the medical community’
Most public health experts agree that education is fundamental to combatting the Ebola virus – particularly in light of the Dallas hospital’s failure to diagnose Thomas E. Duncan the first time he came in.
“Education is one of most important things a hospital can do,” said Shenoy. “Every ambulatory care facility, nursing staff, managers, pretty much every one at all levels have gotten multiple communications.”
The same is true at public health departments, said Dr. Fitzgerald, who runs Georgia’s.
“We have been attempting to get the information out to every single level of the medical community,” she said. Doctors have received letters describing symptoms and listing the number to call if they have a case or just a question; nurses have received guidance; all first responders have been given laminated cards with instructions.
Dr. Patrick O’Neal, the public health department’s director of health protection, is in charge of emergency medical services and preparedness in the state. He said Georgia has a health care emergency coalition with 800 members, including public and emergency health experts, school superintendents and representatives of power companies and water systems.
“I think our hospital community is better off than in many other states,” he said. “But do I think it’s perfect? By no means.”
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