Hopkins, UM designated to care for Ebola patients in Maryland as N.Y. case emerges

Maryland has changed course in its strategy should any Ebola cases turn up in the state.

Maryland health officials designated three hospitals to receive Ebola patients in Maryland — including Johns Hopkins Hospital and the University of Maryland Medical Center in Baltimore — changing course from previous plans almost two weeks after the virus infected two nurses in Texas and as a new case emerged in New York.

While all health facilities in the state will continue to be asked to screen for signs of the virus, should any cases be confirmed, those patients would be transferred to one of three hospitals if they could not go to one of the federal facilities that have already treated Ebola patients. The third is MedStar Washington Hospital Center in the District of Columbia.

State health officials said the strategy arises from lessons learned from the Texas cases, which sparked concerns that U.S. hospitals were not as prepared for Ebola as expected.

Fresh worries about the spread of the virus in the United States emerged Thursday when a Doctors Without Borders physician who recently returned from West Africa reportedly tested positive for the disease. The New York Times reported Thursday evening that a doctor, identified as Craig Spencer, tested positive after being isolated with symptoms in a New York City hospital.

Spencer had returned from Africa within the past three weeks, the maximum incubation period for Ebola, and developed a fever and gastrointestinal symptoms. He was rushed to Bellevue Hospital from his apartment in Harlem, the Times reported.

Separately, Connecticut placed six West Africans who recently arrived in the United States under quarantine for possible Ebola exposure. The family, who arrived Saturday and were planning to live in the United States, will be watched for 21 days, Connecticut state health authorities said Thursday. Officials did not say which country the family came from.

Meanwhile, World Health Organization officials questioned how effective heightened airport screening in the United States might be at containing the virus.

And a team of Army chemists from Aberdeen Proving Ground is preparing to travel to Liberia to support response to the outbreak there. Next week the Army will send the infectious disease laboratory group to Liberia for Ebola screening and analysis in a country where more than 2,700 have died of the disease.

Before the Texas cases emerged, Maryland officials had maintained that all of the state's hospitals were capable of caring for Ebola patients, but under the revised strategy, caregivers at the designated hospitals will undergo more intensive training on how to prevent Ebola from spreading. Officials at all three hospitals said they are ready.

"Every emergency room has to be prepared, there's no question about that," state health Secretary Dr. Joshua M. Sharfstein said. "It makes sense for us to focus our support and preparations in facilities that have teams that are ready for the challenge."

Gov. Martin O'Malley's administration developed the local Ebola hospitalization strategy along with the Maryland Hospital Association, Johns Hopkins Health System, MedStar Health and the University of Maryland Medical System, and the Centers for Disease Control and Prevention.

Health providers across the state still are being instructed to ask patients if they have recently traveled to West Africa and to look out for possible symptoms of Ebola, typically fever and diarrhea.

But the responsibility of caring for any Ebola patients — and properly using protective equipment to prevent its spread — will lie with nurses and doctors at the designated hospitals who will undergo "intensive training," according to the hospital association. Those hospitals also can better handle the complex issues of managing the medical waste.

The strategy also streamlines communication between state, federal and international health agencies, officials said.

Maryland hospitals have reported many instances of isolating patients because of suspicious symptoms and travel histories that suggest possible Ebola cases, but none have been confirmed.

Nina Pham, one of the Dallas nurses who treated an infected Liberian man, is being cared for at the National Institutes of Health Clinical Center in Bethesda and was reported to be in good condition. The other nurse, Amber Vinson, is being treated at Emory University Hospital in Atlanta. Her family said Wednesday that health officials were no longer able to detect the Ebola virus in her body.

The Liberian man, Thomas Eric Duncan, died of Ebola on Oct. 8.

On Monday, six states, including Maryland, were to begin enhanced monitoring of any travelers from Liberia, Guinea or Sierra Leone, the three countries where nearly all of the 4,900 deaths during the current outbreak have occurred.

After U.S. officials said Wednesday that all travelers from the affected nations must be channeled through five major airports, the WHO's Emergency Committee on Ebola said Thursday that the strategy may have "a limited effect" in stopping the virus spreading.

"Entry screening may have a limited effect in reducing international spread when added to exit screening, and its advantages and disadvantages should be carefully considered," the committee said in a statement after its third meeting.

Mary Lynn Carver, spokeswoman for the University of Maryland Medical Center, reiterated that all hospitals are prepared to screen and isolate patients with Ebola symptoms. Training is continuing to ensure everyone is prepared and skills remain sharp, she said.

But she said it's often the case in Maryland that patients who need extensive and complex care are sent to the large academic institutions. All three of the designated Ebola hospitals are considered "tertiary" hospitals, meaning they are major hospitals with a slate of specialists and services that make them able to provide sophisticated and intensive care.

"There's a big difference between taking care of a patient for 24 or 48 hours versus needing to take care of a patient for a couple of weeks at their most acute stage," she said.

At Hopkins, Ronald R. Peterson, president of the health system, said in a statement: "Johns Hopkins Medicine has experienced, internationally renowned emergency and infectious disease specialists and we are prepared to leverage that expertise to help address the needs of the state of Maryland and the nation."

MedStar officials also said all hospitals, urgent care centers and physicians offices in the system are being prepared to handle a patient with Ebola symptoms until testing confirms the diagnosis — something the state can do in hours in its own labs. And "core care teams" are ready to treat patients if needed.

Washington Hospital Center was picked from among the system's larger hospitals because of its geography, said Dr. Stephen R.T. Evans, MedStar's executive vice president for medical affairs and chief medical officer. The hospital has an area off its emergency department that allows patients to be more isolated.

"Everyone is ready," Evans said. "Everyone has had training, hands-on training."

Reuters and Baltimore Sun reporter Colin Campbell contributed to this article.

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