On Monday, the Centers for Disease Control and Prevention announced its new Ebola strategy. It includes more training and more protective gear for hospital staff. The CDC is also encouraging states to designate certain hospitals for Ebola preparation. For example, New York Gov. Andrew Cuomo is designating eight Ebola “supercenters.”
The CDC is presuming that a few days is enough time to make a hospital Ebola-ready. That’s a gamble. A safer strategy would be to expand capacity at the nation’s four biocontainment hospitals, which have treated Ebola patients successfully without the virus spreading to a single health care worker.
Most Americans have virtually no risk of getting Ebola. But doctors and nurses treating an Ebola patient are at high risk, despite assurances by the CDC that their “protocols” work.
Until this week, CDC Director Thomas Frieden predicted that Ebola wouldn’t spread “widely” and any hospital could handle it. Those assurances proved untrue when Thomas Duncan, a Liberian traveler infected with the virus, went to Texas Health Presbyterian Hospital last month. He died, two nurses are now infected and fearing for their lives, and 75 other hospital staff are being monitored.
Texas Health Presbyterian, a highly regarded 900-bed hospital, couldn’t handle Ebola. Betting on other hospitals to fare better is risky. It would be safer to transport any patient diagnosed with Ebola to one of the biocontainment centers in Georgia, Maryland, Montana and Nebraska. Last week, infected nurse Nina Pham was brought to the Maryland facility, and nurse Amber Vinson went to Georgia.
The hitch is that these four facilities together can treat only 11 patients. Compare that with the 100 to 150 people who enter the U.S. from Ebola-infected countries daily. Suspending travel visas from these countries is a no-brainer. So is expanding capacity at these four facilities, instead of outfitting hundreds of hospitals to treat Ebola. Hospitals should be prepared to recognize possible cases, isolate them and then call for help. Period.
Last summer, the CDC announced that doctors and nurses treating Ebola should wear a waterproof gown, gloves, goggles and a face shield. That guideline left the user’s head uncovered and skin exposed around the neck and wrists. Sean G. Kaufman, an infection expert at the biocontainment facility that successfully treated Dr. Kent Brantly and Nancy Writebol and is now treating Vinson, called the guideline “absolutely irresponsible and dead wrong.”
At a House committee hearing last Thursday, Rep. Michael Burgess, R-Texas, held up a photo of Frieden in Africa wearing a protective suit that covered him head to toe. Burgess compared it to the flimsy guideline the CDC had issued for nurses and doctors here.
On Monday, the CDC backed off of its double standard and recommended a full-body suit with head cover modeled after what Doctors Without Borders caregivers wear. Will it be enough? Not necessarily. Any error in removing the gear can expose a caregiver to vomit and other bodily fluids contaminating the outside of the gear. So far this year, 16 Doctors Without Borders medical personnel who were experienced and relying on a buddy system to avoid errors became infected despite wearing the full gear. Nine of them died.
The CDC also is no longer claiming that any hospital with a single room can treat Ebola. In an October 14 nationwide conference call with hospital personnel, hospitals were encouraged to consider setting up an Ebola suite with a dedicated lab, because technicians working in the hospital lab are likely to quit if Ebola is brought in, and one spill would force the whole lab to shut down. Having to make such changes, exclaimed Dr. Richard Pitts, “would probably bankrupt our hospital.”
If not the preparations, then actually treating Ebola can put a hospital on life support. At Texas Health Presbyterian, some 100 health care workers exposed to Duncan are furloughed with pay and under observation. The public is shunning the hospital. Two-thirds of the beds are vacant. And Vinson has hired a lawyer.
The best Ebola strategy is to protect our local hospitals, health care workers, and patients by curbing travel and relying on the nation’s biocontainment facilities. That’s what they were built for.
Betsy McCaughey Ph.D. is chairman of the Committee to Reduce Infection Deaths and a senior fellow at the London Center for Policy Research.