Are Our Hospitals Prepared for Ebola? No!

(This is a continuation the post below with the additional clarity provided on the Ebola situation in Dallas by three days of further developments. I don’t intend to belabor the points I made on the original post except perhaps to reinforce them.)

When I wrote the post below a nurse who had been caring for Ebola patient Thomas Duncan at Texas Health Presbyterian Hospital in Dallas had been herself diagnosed with decease. (Thank God as I write this she appears to being doing fairly well.) The revelation that one of Dunkin’s care givers had contracted the disease from him, when added to many missteps surrounding the original handling of his case, solidified my opinion that the hospital was not prepared for an Ebola patient to enter its doors seeking treatment. Given the relative sophistication and reputation of Texas Health Presbyterian Hospital I offered the additional opinion that hospitals all across the nations were similarly unprepared to deal with such an event.

Unfortunately the events and revaluations in Dallas over the last few days have solidified opinions into facts. It is now clear that Texas Health Presbyterian Hospital was grossly unprepared to treat an Ebola patient. This is best illustrated by the fact that yet another nurse who cared for Thomas Duncan was determined to have contracted the disease from him.

National Nurses United (a nurse’s union) gathered information from some of the hospital’s nurses who were familiar with the conditions surrounding Duncan’s care. (The nurses spoke anonymously with representatives of the union because they feared retribution from the hospital.) The situation they described, especially those when Duncan was first admitted, is shocking. The protective gear furnished by the hospital was inadequate, not providing hospital personal adequate protection against infection. Training of caregivers on Ebola protocol, including the proper donning and removal of protective gear was inadequate; even supervisors didn’t know proper procedures. Upon being admitted to the hospital, Duncan was not isolated for hours, allowing him to possibly contaminate other patients. Samples of his bodily fluids sent for testing were not properly isolated, possibly leading to the contamination of the hospitals entire lab. The bottom line of the union’s revelations is more than 70 hospital workers and other patients may have been exposed to the virus. The situation is so dire that some of the hospitals nurses are threatening to refuse to continue to work in the hospital.

Then we also learned that the second nurse who contracted Ebola from Duncan had flown from Dallas to Cleveland and back over the three day period immediately before she was diagnosed with the disease. Worse yet, she had a low grade fever before she boarded the airplane for the returned trip, potentially exposing the other passengers and crew. Fortunately at the time she was aboard the aircraft her fever was below the threshold where people infected with the virus are thought to be able to transmit the disease to others, but she should have never taken that trip in the first. Ebola protocols call for anyone who may have been exposed to the virus, including caregivers, are to keep themselves in relative isolation to avoid possible transmission to the virus to other people. She was obviously not trained on these procedures, or the lessons were not adequately impressed upon her.

Again, all of the many problems experienced in Dallas beg the question of how well are other hospitals, big and small, across the country prepared to handle a situation where someone with Ebola seeks care at their facility. While I am sure that there would be some notable exceptions, I strongly suspect that had Thomas Duncan had shown up on the doorsteps of many hospitals all across the country, the results would have been much the same as those experienced in Dallas.

Some politicians are trying to score political points by criticizing the Centers for Disease Control and Prevention (CDC) the President’s administration for the fiasco in Dallas. In reality the CDC has absolutely no jurisdiction over hospitals like Texas Health Presbyterian. The CDC can only publish protocols and training and come to the aid of hospitals if they request it. Only the hospitals themselves and the state agencies which regulate them can ensure that proper procedures and equipment are in palace and that hospital staffs are properly trained in execution and use. We can only hope that other hospitals and their regulating state agencies across the country have learned from the mistakes made in Dallas so they can ensure that they are not repeated somewhere else.

Cajun  10/15/14

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