Hospitals focus on preparedness as risk of Ebola spread increases

As health officials fail to contain West Africa's Ebola outbreak, recent scares at two Baltimore-area hospitals highlight the need for hospitals here and across the United States to prepare space and equipment for what some consider inevitable — the arrival of the deadly virus here.

While experts say the chances of an epidemic spreading in the U.S. are low, there is a real possibility that someone could come down with Ebola after returning from a trip to Africa, they said. Hospitals routinely ask patients with flu-like symptoms whether they have visited that continent recently.


There have been no confirmed cases of Ebola here, but hospitals are tailoring existing plans for pandemics of other diseases, such as SARS and avian flu, to be ready for Ebola as the epidemic grows exponentially, already more deadly than all previously recorded Ebola outbreaks combined.

"If you look at the epidemic curve and the global travel, I think there's a risk that we could" see an Ebola case, said Dr. Trish Perl, senior epidemiologist for Johns Hopkins Health System. "That's what we're trying to plan for."


The outbreak's persistence prompted President Barack Obama to announce plans Tuesday to send 3,000 troops and more money to help contain it. The first planeload of hospital equipment will arrive in Liberia on Friday, U.S. aid official Nancy Lindborg told a House of Representatives committee Wednesday.

At Howard County General Hospital, two patients' symptoms and their answers to questions led doctors to believe Ebola was possible, but the disease was ruled out quickly, said Dr. Gabor Kelen, director of the Johns Hopkins Office of Critical Event Preparedness and Response.

A similar scare occurred recently at one of MedStar Health's Baltimore-area hospitals but also was quickly determined not to be Ebola, said Shawn Mueller, director of infection control at MedStar Union Memorial Hospital.

Privacy concerns prevent health officials from releasing more detailed information about such cases. State Department of Health and Mental Hygiene spokesman Christopher Garrett said no one with "high-risk exposures" to Ebola has been identified in Maryland.

In the Hopkins and MedStar systems as well as the University of Maryland Medical System, hospitals are working to designate areas that would serve patients quarantined with Ebola, officials said. While Hopkins is considering whether it might make more sense to transfer Ebola patients to a single location, for example, under its current plan, all of its facilities, including Howard General, are prepared to accept and treat such patients.

Other hospitals similarly have set aside quarantine space, gathered supplies and trained staff. The Centers for Disease Control and Prevention issued a checklist for U.S. hospitals last month that includes training clinical staff to spot Ebola symptoms, maintaining communication with local and federal health officials, and readying protective equipment and isolated beds.

Hospitals are urged to watch for patients with high fevers and other symptoms, including headache, muscle pain, vomiting and diarrhea. From there, the main step in screening is a simple one — asking patients whether they have traveled to Africa within the past three weeks or been in close contact with someone who has.

"That's our job — to make sure the hospital is aware and prepared for any novel pathogen that's presenting either locally or internationally," said Michael Anne Preas, director of infection control and hospital epidemiology at the University of Maryland Medical Center. "Because we serve an international community, we have to be ready."

The World Health Organization said last week that Ebola had killed more than 2,400 people out of 4,784 cases in West Africa, more casualties than all outbreaks since Ebola was first uncovered in 1976.

Dr. Thomas Kenyon, director of the CDC's Center for Global Health, said the outbreak was "spiraling out of control" and warned that the longer it went unchecked, the greater the possibility the virus could mutate, making it more difficult to contain.

"Guinea did show that with action, they brought it partially under control. But unfortunately, it is back on the increase now," he said during a conference call. "It's not under control anywhere."

The CDC recommends patients be isolated in a private room and that health care workers entering the room wear impermeable gloves, gowns, eye protection and a face mask. The disease is spread through bodily fluids of infected people, including blood, urine, feces and vomit.


In many cases, improper use of such protective equipment — or lack of it altogether — is driving the continued spread of the disease in West Africa, Perl said. Perl and a team of infectious disease and critical care experts wrote in a commentary last month in the Annals of Internal Medicine that improper removal of the equipment also was exposing health care workers to the virus.

"The physical exhaustion and emotional fatigue that come with caring for patients infected with Ebola may further increase the chance of an inadvertent exposure to bodily fluids on the outside of the personal protective equipment, leading to unwanted contact when the gear is removed," the authors wrote. "The impulse to wipe away sweat in the ever-present hot, humid environment during personal protective equipment removal may lead to inadvertent [exposure]."

Public health experts don't expect such risks to be as much of a concern in the United States because of its comparably clean and safe medical settings. Four health care workers infected with Ebola have been transported to the U.S. for treatment, without incident. Three were treated at Emory University Hospital in Atlanta and the fourth was being treated at Nebraska Medical Center in Omaha.

Health care workers in Africa have been hit hard by the disease. As of late August, more than 240 of them had developed the disease and more than 120 had died, according to the WHO.

"What scares everyone is that a little over 50 percent of the people seemingly die from this," Kelen said. "Here it might not be all that high, but still there's no cure at this point."

Hospital officials said they would follow CDC "supportive care" guidelines in treating suspected or confirmed cases of Ebola, which include isolating the patient, providing intravenous fluids, balancing electrolytes, and maintaining oxygen status and blood pressure, while the patient fights the disease.

In many cases, U.S. hospitals are prepared to go above and beyond the CDC guidelines, which also suggest that if the patient has "copious" secretions, health care workers should add shoe and leg coverings plus a second pair of gloves. During procedures that might allow viruses to become airborne, such as inserting a breathing tube, workers should wear respirators.

But some worry the precautions could backfire. Adding extra, unfamiliar equipment could increase chances of improper use, and also could have the effect of limiting caregivers' time spent with patients.

"As health care professionals, we strive to provide evidence-based care driven by science rather than by the media or mass hysteria," wrote the authors, led by Dr. Michael Klompas of Harvard Medical School. "We need to apply these principles to planning for Ebola as well."


To address some of those issues, Perl suggested Hopkins and other hospitals might consider identifying key personnel who would be part of any Ebola response and ensuring they are well-trained.


But at hospitals used to screening for possible pandemic diseases, officials say the routine is the same — only the red flags are different. As the Ebola epidemic grabs headlines, for example, Preas said officials at the University of Maryland Medical Center are also on the alert for possible cases of Middle East Respiratory Syndrome, a viral respiratory illness.

"It's a different pathogen, but the state of readiness has to be maintained regardless," she said.

Reuters contributed to this article.


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