Ebola Response Strains Hospitals

Ebola Response Strains Hospitals

Experience of Specialized Centers Shows Challenge Other Facilities Face

By Betsy McKay and Peter Loftus in the Wall Street Journal

As the Ebola epidemic in West Africa expands, more cases could require treatment at U.S. hospitals far from the specialized centers that have handled patients so far. But the challenges even these medical centers have encountered show the steep learning curve others face.

Treating Ebola takes money, space, aggressive care and obsessive vigilance to prevent doctors and nurses from getting infected, say infectious disease doctors at such specialized hospitals in Atlanta and Omaha, Neb. Also important is extreme diplomacy in dealing with suppliers and contractors, which have balked at handling blood samples, soiled linens and hospital waste out of fear of the virus, the hospitals say.

On Monday, the director of the Centers for Disease Control and Prevention, Tom Frieden, said the country needs to boost hospital training and prevention techniques for Ebola. He said experts are examining such things as how protective gear was worn and removed by workers at the Dallas hospital where a nurse was infected while treating a Liberian man who later died of the disease. The nurse’s case is the first known transmission of the virus in the U.S.

Dr. Frieden said there may be additional U.S. cases of Ebola, especially among others who helped care for the man, Thomas Eric Duncan.

But such enhanced efforts will be costly. It took a team of 26 medical staff to care for American missionary Kent Brantly, who spent about three weeks at Atlanta’s Emory University Hospital. Those health-care workers had to make a “herculean effort” to continually replace the five to 10 liters of fluid Dr. Brantly and the hospital’s other Ebola patients each lost daily at a critical stage of their illness, said Bruce Ribner, director of the Infectious Disease Unit at Emory University Hospital. Emory also treated Nancy Writebol, and a third patient whose identity wasn’t disclosed.

Emory deployed “intensive, aggressive nursing support,” Dr. Ribner said, including emotional support. “At least one of our patients said to us, ‘I thought you guys would bring me back here so that I could die on American soil.’ It took a lot of effort to convince them, ‘No, we actually think we can help you survive.’ ”

The Emory experience underscores the challenges for hospitals that have just recently started gearing up for an Ebola threat.

“The people at Emory have been training for, get this, 12 years,” said Trish Perl, a professor of medicine and a senior epidemiologist at Johns Hopkins Health System in Baltimore. “They have teams that are well-formed and well-developed.”

Ebola is “a novel disease” with a high death rate, Dr. Perl added.

The doctors and nurses at Emory who treated the Ebola patients were monitored for three weeks after their last interactions, including twice-daily body-temperature checks, to ensure they didn’t have symptoms of the virus. “Even if they happen to go on vacation, our occupational-injury-management nurses hunt them down” if they don’t report their temperatures online, Dr. Ribner said.

Fear of Ebola complicated Emory’s efforts. Dr. Ribner said commercial courier services refused to take blood samples from infected patients “down the street” roughly three quarters of a mile to the Centers for Disease Control and Prevention for testing. Emory used “less formal mechanisms” to transport the specimens, he said. He didn’t specify what those mechanisms were.

Dr. Ribner said someone from the county sewage-management department told him the department would disconnect Emory from the sewage system if the hospital planned to discharge waste that contained Ebola virus into the sewers, despite guidance from the CDC that sanitary sewers can safely accommodate patient waste.

Dr. Ribner said Emory disinfected all liquid waste from the patients with bleach before discharging it into the sewage system.

A spokesman for the DeKalb County Department of Watershed Management said: “At no point did we say we would disconnect the hospital from public sewage lines. Early on, there was a preliminary call between our watershed director and the CDC regarding protocols for planning and community-awareness purposes.”

The contractor that disposes of Emory’s medical waste, such as soiled linens, asked the hospital to certify that sealed bags of linens didn’t contain live virus, Dr. Ribner said. To ensure there was no live virus, Emory used a device called an autoclave to sterilize 350 bags of medical waste, weighing 3,000 pounds, over the course of a few weeks, he said.

Even some pizza businesses refused to deliver to Emory because of concerns about the virus, he said.

The hospital won’t recoup all the money it will spend on Ebola treatment, Dr. Ribner said. “We learned that caring for patients with Ebola virus disease is extraordinarily expensive,” he said.

The Nebraska Medical Center in Omaha has faced similar challenges.

Though the unit has 10 patient beds, it wouldn’t be able to handle that many patients because it has used some of the rooms for equipment, such as a lab it set up to test patient blood samples, said Shelly Schwedhelm, the unit’s nursing director. It set up the lab to avoid having to waste time sending the samples to a lab across the street, as it did with its first patient, Richard Sacra, she said.

The unit tries to limit the amount of soiled linen and waste it generates because it must run all of it through an autoclave before it disposes of it, she said. “We autoclave everything,” she said, noting that “there is a lot of concern from trash removal companies.”

The biocontainment unit has a team of about 40 workers, with five or six at a time caring for an Ebola patient. Specialists who need to be called in often advise by a video unit hooked up in the room. “We try to minimize the number of people in the room, the hot zone,” Dr. Smith said.

Even the human resources department is busy. Surprisingly, the Nebraska hospital has been “flooded with applications” from nurses wanting to be on the Ebola team, Dr. Smith said.

Dr. Smith said he, Dr. Ribner and other physicians treating Ebola patients outside of Africa are sharing tips about treating the disease. “We feel like we’ve learned a lot,” he said. “There’s a lot of information-sharing.”

—Ron Winslow contributed to this article.