Unprepared against Ebola? [Editorial]

Federal Centers for Disease Control Director Thomas R. Frieden has been saying for weeks that Americans have little to fear from the deadly Ebola epidemic that has killed some 4,000 people in West Africa. But with news over the weekend that a nurse at the hospital in Texas where the first reported case of Ebola in the U.S. was treated has tested positive for the virus, even he now admits the nation may not be adequately prepared for an outbreak. Making sure that it is should be the CDC's top priority until we can be assured that what happened in Texas won't be repeated again elsewhere.

The Texas case is particularly worrisome because heath officials there still do not know how the nurse, 26-year-old Nina Pham, became infected with the virus. Officials say she was part of the team that cared for Thomas Eric Duncan, man who arrived in this country from Liberia in September and soon afterward developed symptoms of Ebola. On Sept. 25, Mr. Duncan went to the emergency room of Texas Health Presbyterian Hospital in Dallas complaining of fever, vomiting and abdominal pain but was sent home after doctors diagnosed him as having nothing more serious than a low-grade viral infection. Three days later his symptoms had worsened, and he returned to the hospital where he tested positive for Ebola and was confined to an isolation room for treatment; he died the following week.

The nurse who tested positive for the virus on Sunday had extensive contact with Mr. Duncan during his treatment, but officials say she always wore a gown, mask and other protective gear to avoid coming into contact with her patient's bodily fluids, the only known way the virus can spread. After she was diagnosed with Ebola despite those precautions, Dr. Frieden suggested Ms. Pham may have breached the exacting safety protocols for health workers treating Ebola patients, possibly during the process of removing her protective gear. But the precise nature of her error, if that is what happened, remains unclear.

Meanwhile officials have doubled the number of people being monitored for Ebola symptoms to include everyone who had treated Mr. Duncan as well as members of his family and friends who may have come into contact with him after his symptoms appeared. All of them are now being regarded as potentially having been exposed to the virus, and Dr. Frieden has warned that more cases of Ebola are possible.

If there are more people infected with the virus, in Dallas or elsewhere, it's likely they'll show up at a community hospital or clinic rather than at one of the four state-of-the art facilities in the country that have specialized isolation and containment facilities and the ability to carry out contract tracing to identify and monitor everyone who might be at risk for Ebola. The CDC is now considering whether all new suspected Ebola cases should be sent immediately to one of those with specialized units where physicians, nurses and other staff have the training and experience to treat the disease.

It's maddening that, despite their best efforts, officials so far have been unable to pin down precisely how the nurse in Texas came down with Ebola despite all the precautions taken against the virus' transmission from patients to caregivers. The episode has raised serious questions about the effectiveness of the training given to health care workers and the procedures designed to protect them.

On Sunday the nation's largest nurses union criticized the CDC for not conducting more active training and practice drills for health care workers or requiring hospitals to provide new or upgraded protective gear for their staff. Until investigators determine how the virus in Dallas was transmitted, however, it's not clear that any of those steps would have prevented the nurse there from being infected. The only thing certain is that the threat from Ebola in the U.S. now seems much more serious than it did just a week ago. The CDC needs to get to the bottom of it as quickly as possible in order to minimize the risk to health care workers across the county who may be in danger of contracting the illness.


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