Tracking Ebola by the missed opportunities to stop its spread

I gave some tips for covering the expanding Ebola outbreak on Thursday. Here are four more for reporters and others paying attention to the problems in responding quickly and effectively to the disease.

It’s not all about resources. Perhaps the best story to come out of the crisis so far came from Jason Beaubien at NPR who wrote about a village on a rubber plantation in Liberia – essentially a company town run by the Firestone Tire – that was hit with Ebola. Beaubien reported on Oct. 13 that Ed Garcia, general director of Firestone’s rubber plantation in Harbel, Liberia, acted swiftly when a Firestone employee’s wife was diagnosed with the disease:

The case was detected on a Sunday. Garcia and a medical team from the company hospital spent Monday setting up an Ebola ward. Tuesday the woman was placed in isolation.

"None of us had any Ebola experience," he says. They scoured the Internet for information about how to treat Ebola. They cleared out a building on the hospital grounds and set up an isolation ward. They grabbed a bunch of hazmat suits for dealing with chemical spills at the rubber factory and gave them to the hospital staff. The suits worked just as well for Ebola cases.

Firestone immediately quarantined the woman's family. Like so many Ebola patients, she died soon after being admitted to the ward. But no one else at Firestone got infected: not her family and not the workers who transported, treated and cared for her.

If a rubber plantation with in Liberia – one of the world’s poorest countries – can do it, certainly one of best-funded hospitals in one the wealthiest cities in the world should be able to do it.

Nurses can’t be expected to remember the contents of one random email when a crisis breaks out. This seems to be the biggest reason why Texas Health Presbyterian Hospital in Dallas hasn’t followed the Harbel, Liberia model. Nurses need to be trained. And, guess what? They don’t appear to have been properly trained. Geoffrey Mohan and colleagues at the Los Angeles Times wrote on Oct. 14 that nurses from the hospital were reporting to a nurses union that they did not have the proper training and that crucial steps weren’t followed in the case of the first Ebola patient to arrive at the hospital, Thomas Eric Duncan. They wrote:

Nurses at a Texas hospital where a Liberian man died of Ebola described a confused and chaotic response to his arrival in the emergency room, alleging in a statement Tuesday that he languished for hours in a room with other patients and that hospital authorities resisted isolating him. In addition, they said, the nurses tending him had flimsy protective gear and no proper training from hospital administrators in handling such a patient.

There were also inexplicable delays. NPR's Wade Goodwyn reported that the hospital waited until Duncan's Ebola diagnosis was confirmed to issue proper protective gear:

It wasn't until two days later when Duncan was finally confirmed by the CDC as positive for Ebola that the Hospital issued fully hooded Hazmat suits. This failure of judgment put the lives of its medical staff and especially its nurses at risk. It's also much harder to understand than the hospital's first mistake with Duncan's diagnosis. 

Just as the mess in Dallas indicates, a survey of nurses shows that many hospitals are not taking even basic steps to respond effectively and safely to the arrival of an Ebola patient.

This is a much bigger problem than Dallas.

You will see the phrase  “canary in a coal mine” used a lot in the days to come because it’s as apt a metaphor as any. Texas Health Presbyterian is a well-funded operation, and it does have smart health professionals on staff. There’s no reason a hospital with its kind of community support and a host of high-ranking medical schools in the vicinity should have bungled this assignment. And yet it did. There will be more. A nursing advocacy organization, National Nurses United, conducted a survey of more than 700 registered nurses nationwide. This is a drop in the bucket, to be sure, out of the estimated 3 million in the U.S., but still a sample worth a listen. Of those surveyed, “80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola,” according to the group’s press release. And about “40 percent say their hospital does not have plans to equip isolation rooms with plastic covered mattresses and pillows and discard all linens after use.”

Infections are going to be happening far outside of the hospital, too.

North Carolina has not had an Ebola case, but they did have a suspected case that turned out to be misdiagnosed. And yet the state is geared up for it. So much so that the governor has gone on television along with his state epidemiologist, Dr. Megan Davies. She spelled out a series of steps, reported by Candace Sweat and Stan Chambers Jr. at WRAL in Raleigh:

The completion of ‘extensive’ Ebola preparations for at least 70 hospitals across the state, including drills and reviews of emergency plans.

Establishing isolation and quarantine guidelines for county health departments.

Speedier access to health records of potential Ebola patients.

Providing guidance for funeral directors in the handling of those who succumb to Ebola.

Creating guidelines for the handling of human waste of Ebola patients.

Community outreach efforts to West African communities across the state.

Establishing an information line for those with questions about Ebola – (800) 222-1222

Look at what Dr. Davies is doing: She’s providing information to funeral homes. This is an established practice going back to the origins of Ebola. One of the things that the researcher who helped discover Ebola, Peter Piot, made sure happened in the 1970s was that there were clear instructions given to people on how to handle the bodies of people who died from the virus. She also is reaching out to known communities of West African immigrants.

Why is it that North Carolina has a plan that makes more sense than what we're hearing out of Dallas or the CDC? This isn't about resources. It’s about being smart. Walk in a circle around a potential crisis and be sure you see all your vulnerabilities, then do something about each of them.

Discovering the disease required complicated science. Preventing it doesn't have to.

Related post: Hospitals, reporters miss low-hanging fruit in response to Ebola cases

Photo by Ted Eytan via Flickr.