Many American hospitals unready for ebola

Ebola poses virtually no risk to most Americans, but hospital workers and their patients could face real danger if someone unknowingly infected with the deadly virus travels to the U.S. and visits an American emergency room for care.  Many hospitals are poorly prepared to contain any pathogen. That’s why at least 75,000 people a year die from hospital infections. If hospitals can’t stop common infections such as MRSA, C. diff and VRE, they can’t handle Ebola.

On July 20, Patrick Sawyer, an American working in Liberia, collapsed after an air journey from Liberia to Nigeria. He had no idea he had Ebola, but five days later, he died from it. He could have been getting off at John F. Kennedy International Airport in New York. At least 11 flights leave Liberia daily with connections to JFK. Dr. Sanjay Gupta, CNN’s medical correspondent, says it’s a “real possibility” someone unknowingly sick with Ebola will fly to the U.S.

In three West African countries, the Ebola outbreak has infected over 1,400 people and killed 826 of them.

Last week, the World Health Organization issued guidelines for airlines. If a passenger is diagnosed with Ebola after the flight, all passengers who were on the plane should be tracked down and tested.

As Ebola victims become sicker, they experience vomiting, diarrhea, and internal and external bleeding. Those bodily fluids contain high concentrations of the virus, which can infect anyone exposed.  Airline cleaning crews are instructed to wear disposable gloves and wipe down armrests, seatbacks, trays and light switches if any passenger is sick.

Two Nigerian-based airline companies and Emirates, the Dubai-based airline, already have suspended service to the affected countries.  But Centers for Disease Control and Prevention Director Dr. Thomas Frieden rejects that approach.  “Were not going to hermetically seal the borders of the U.S.,” he said on ABC’s “This Week With George Stephanopoulos” on Sunday. “We’re reliant and interdependent with the world for travel, for trade, for economy, for our families and communities.”

Frieden argues it’s unlikely people sick with Ebola with board planes, because the symptoms are so debilitating. Despite what Frieden is saying, the institute sent bulletins to U.S. hospitals on diagnosing Ebola, providing protective gear for health care workers, and preventing the spread to other patients.

But will hospitals follow the precautions? Unlikely. For example, an estimated 14,000 patients die each year from Clostridium difficile, a health care infection spread by diarrhea. Invisibly small fecal particles contaminate bedrails, curtains, nurses’ uniforms and other surfaces, carrying the disease from one patient to another. The same could happen with Ebola if precautions are ignored.

Rigorous adherence to prevention rules will mean the difference between life and death, if a person carrying Ebola comes to a U.S. hospital. That is the lesson of SARS, four letters that turned into a death sentence at a Toronto hospital.

On March 7, 2003, two middle-aged men with undiagnosed cases of severe acute respiratory syndrome brought from Asia went to the hospital in two different cities. In Toronto, this caused an outbreak that killed 44, infected another 330, and forced hospitals to close. In Vancouver, British Columbia, according to a government report, a “robust worker safety and infection control culture” enabled the hospital there to prevent the disease from spreading. One hospital thwarted an epidemic, while another made deadly mistakes.

Vancouver General isolated the patient within five minutes of his arrival, recognizing the possible seriousness of his symptoms. But the Toronto hospital kept its SARS patient waiting 16 hours in its crowded emergency ward. Two patients waiting nearby contracted SARS. A government report later concluded that for the hospital overcome by SARS, “infection control was not a high priority.” Eventually, 77 percent of the people who contracted SARS there got it while working, visiting or being treated in the hospital.

Similarly, whether Americans die of Ebola will depend largely on what hospitals do when the first victims unknowingly carrying the virus are admitted.

The CDC also needs to improve its own infection-control rigor. In the last three months, three incidents of the CDC mishandling pathogens — anthrax, avian flu and smallpox — have come to light. Why assume the agency is ready for Ebola?