Friday, October 17, 2014

The Response to Ebola is Straining U.S. Hospitals

As the Ebola epidemic in West Africa expands, more cases could require treatment at U.S. hospitals far from the specialized centers that have handled patients so far. But the challenges even these medical centers have encountered show the steep learning curve others face.
Treating Ebola takes money, space, aggressive care and obsessive vigilance to prevent doctors and nurses from getting infected, say infectious disease doctors at such specialized hospitals in Atlanta and Omaha, Neb. Also important is extreme diplomacy in dealing with suppliers and contractors, which have balked at handling blood samples, soiled linens and hospital waste out of fear of the virus, the hospitals say.
On Monday, the director of the Centers for Disease Control and Prevention, Tom Frieden, said the country needs to boost hospital training and prevention techniques for Ebola. He said experts are examining such things as how protective gear was worn and removed by workers at the Dallas hospital where a nurse was infected while treating a Liberian man who later died of the disease. The nurse’s case is the first known transmission of the virus in the U.S.
Health-care workers attend a CDC safety training course on
Oct. 6. Reuters
Dr. Frieden said there may be additional U.S. cases of Ebola, especially among others who helped care for the man, Thomas Eric Duncan.
But such enhanced efforts will be costly. It took a team of 26 medical staff to care for American missionary Kent Brantly, who spent about three weeks at Atlanta’s Emory University Hospital. Those health-care workers had to make a “herculean effort” to continually replace the five to 10 liters of fluid Dr. Brantly and the hospital’s other Ebola patients each lost daily at a critical stage of their illness, said Bruce Ribner, director of the Infectious Disease Unit at Emory University Hospital. Emory also treated Nancy Writebol, and a third patient whose identity wasn’t disclosed.
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Emory deployed “intensive, aggressive nursing support,” Dr. Ribner said, including emotional support. “At least one of our patients said to us, ‘I thought you guys would bring me back here so that I could die on American soil.’ It took a lot of effort to convince them, ‘No, we actually think we can help you survive.’ ”
The Emory experience underscores the challenges for hospitals that have just recently started gearing up for an Ebola threat.
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“The people at Emory have been training for, get this, 12 years,” said Trish Perl, a professor of medicine and a senior epidemiologist at Johns Hopkins Health System in Baltimore. “They have teams that are well-formed and well-developed.”
Ebola is “a novel disease” with a high death rate, Dr. Perl added.
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The doctors and nurses at Emory who treated the Ebola patients were monitored for three weeks after their last interactions, including twice-daily body-temperature checks, to ensure they didn’t have symptoms of the virus. “Even if they happen to go on vacation, our occupational-injury-management nurses hunt them down” if they don’t report their temperatures online, Dr. Ribner said.
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