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Ebola Treatment Center Opens Its Doors In Texas

By Sherry Jacobson and Randy Lee Loftis, The Dallas Morning News (MCT)

DALLAS — When the first Ebola patient showed up at Texas Health Presbyterian Hospital Dallas, a warning sounded that other hospitals needed to prepare space for a possible influx of new cases.

Methodist Health System quickly identified a place that might work — a small intensive-care unit in its Methodist Campus for Continuing Care in Richardson. The unit had been empty since April but needed only minor alterations to give medical staffers room to change in and out of the protective gear required for treating Ebola patients.

“Initially, we thought it would be just for us,” said Dr. Sam Bagchi, Methodist’s senior vice president and chief quality officer.

Then came telephone calls from the Centers for Disease Control and Prevention, Dallas County and the Texas health department. Officials wanted to see what Methodist was planning and find out how quickly an Ebola treatment center could be set up.

The idea was to meet the needs of all local hospitals in one location.

The nation’s first patient diagnosed with Ebola, Thomas Eric Duncan, had died Oct. 8 at Presbyterian. Two nurses who became infected while caring for him were airlifted to specialty treatment centers in other states.

And the clock was ticking for more than 125 people locally who had been isolated because of possible exposure to the deadly disease. If any of them started showing symptoms, there had to be a treatment center ready to provide immediate care.

“All of the hospitals were working on plans to take care of an extended stay by an Ebola patient,” Bagchi said. “Why not combine those efforts? It’s meant to take the pressure off the community.”

It took only a few days for Methodist to revamp its plan into a ten-bed Ebola treatment center. Parkland Memorial Hospital agreed to supply protective gear along with a team of nurses, lab technicians and other support staff. UT Southwestern Medical Center at Dallas would provide doctors.

Dr. David Lakey, the state health commissioner, toured the Richardson facility with CDC officials, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission.

On Wednesday, the first two beds were ready for Ebola patients, allowing Methodist to officially activate the Richardson unit.

The facility has two negative-pressure rooms — rooms equipped to prevent the escape of contaminated air.

If anyone is confirmed to have Ebola, it would take 12 hours to activate the facility and get it fully staffed. In all likelihood, an Ebola patient would have gone first to a hospital emergency room and been isolated and tested before being transferred to the Richardson facility, Bagchi said.

“This unit is for patients who test positive for Ebola,” he said. “Any patient would go through diagnostic screening before being transferred here.”

The state’s second Ebola treatment facility, at the University of Texas Medical Branch in Galveston, is expected to be ready for patients as early as Thursday. The hospital is home to the Galveston National Laboratory, a federal biocontainment facility that has extensively researched Ebola and other infectious diseases.

The Methodist Ebola center is on the third floor of the 51-year-old Methodist Richardson Medical Center. The hospital was replaced last spring by a new facility.

“We couldn’t have done it without the CDC’s involvement,” Bagchi said of the quick turnaround at the Methodist center. “It’s a really nice collaboration, where everybody is bringing something.”

Some experts outside Dallas questioned having UT Southwestern and Parkland involved together with the new Ebola treatment facility. The two institutions came under federal scrutiny three years ago over lapses in infection prevention and other care.

“This track record of problems is, of course, concerning,” said Dr. Ashish Jha, an associate professor at Harvard University’s School of Public Health. “Have they really put these problems behind them, and do they understand what caused them?”

Parkland and UTSW declined Wednesday to answer questions about their past collaborations. In a joint statement, they spoke of their “70-year history of working as partners and a productive and constructive relationship.”

Diane Jacobs, who lives near the Richardson facility, said she supported using it to care for Ebola patients.

“We’re excited that the city of Richardson can participate in this fight, because that’s what it is,” said Jacobs, who directs a church preschool.

Susan Yost, who also lives nearby, said she was “very proud” that the Richardson facility was chosen. “It makes our city more proactive and prepared. It makes me feel safer,” she said.

Texas officials said the Richardson and Galveston facilities would be available to handle outbreaks of other diseases beyond Ebola.

“Ebola is the current threat, but there are other infectious diseases that pose a risk,” said Goodman, the state Health and Human Services Commission spokeswoman. “These new centers will make sure Texas is well-prepared for whatever comes our way.”

The treatment centers aren’t costing the state any money, she said. “These hospitals already get state and federal funding, and they’re able to support the centers within their current budgets,” she said.

Treatment costs also could be billed to private insurers or Medicaid, she added.
___
(Staff writers Leslie Barker, Julie Fancher, Wendy Hundley and Miles Moffeit contributed to this report.)

AFP Photo/Chip Somodevilla

Nurses Need To Be Listened To, Not Blamed

By Suzanne Gordon, McClatchy-Tribune News Service (MCT)

Stop blaming nurses for the potential spread of Ebola.

In the nationwide hysteria over the Ebola virus, many people are pointing fingers at two of the nurses who risked their lives to take care of Thomas Eric Duncan at Texas Health Resources Presbyterian Hospital in Dallas.

But this scapegoating does not help us focus on the systemic obstacles that make it difficult for nurses to protect their patients, the public and themselves — whether against Ebola or any other dangerous virus or bacteria.

As the caregivers who are with patients 24/7, bedside nurses are the ones who spot critical changes in a patient’s condition. But rather than seeking nurses out to solicit information about a patient’s situation, too many physicians ignore them.

In fact, many don’t even read the nurses’ notes section of patients’ charts, which some consider to be full of extraneous information or, as one doctor put it, “ridiculous nursing jargon.”

When I recently talked to a prominent patient safety physician at a major teaching hospital, he told me that attending physicians and residents in his institution refuse to use a nationally recommended communication protocol known as SBAR (Situation, Background, Assessment, Recommendation), which is designed to facilitate the sharing of information between physicians and nurses.

Why?

Because that’s a protocol nurses use, and doctors don’t want to use “nursing language,” he said.

Nurses are often silenced or even disciplined when they try to draw attention to major safety problems or mistakes — particularly those made by medical higher-ups.

In 2010 in Texas, for example, two nurses were fired — and one was actually prosecuted — when they reported that a physician in their hospital was engaging in serious breaches of safety. This case sent a message to nurses everywhere: Act assertively to protect your patients and you put your job at risk.

Then there’s the issue of protective equipment. During the SARS scare more than 10 years ago, nurses’ organizations warned that hospitals weren’t providing nurses with the kind of equipment (and training to use it) that would actually protect them, as well as their patients and the public.

Another contagious disease and a decade later, and nurses have not been given either adequate gear or training in how to use it, as the National Nurses United union recently noted.

Creating a safe workplace for nurses — and other health-care staff — is a nonnegotiable condition of asking them to risk their lives to care for patients.

This means not only providing them with protective equipment and the training to use it, but also soliciting and welcoming their input.

It will be instructive to see how Texas Health Presbyterian Hospital responds to the fact that nurse Briana Aguirre spoke to the press about her concerns about safety in the hospital.

Will she be supported — and even rewarded — for her courage, or will she be reprimanded or even fired?

This is a real test of whether hospitals are serious about creating a culture of safety.

Health care journalist Suzanne Gordon is the co-author of Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (Cornell University Press).

She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; email: pmproj@progressive.org; Web site: www.progressive.org. For information on PMP’s funding, please visit http://www.progressive.org/pmpabout.html#anchorsupport.

AFP Photo/Mike Stone

Do You Trust Your Government On Ebola?

As I write this column, two health care workers in Dallas have come down with Ebola after treating Thomas Eric Duncan, who traveled from West Africa and died from the disease. By the time you read it, there will most likely be more cases.

Still, there’s no need for panic. I repeat; there’s no need for panic. It’s important to keep what’s happening with the Ebola virus in perspective. Even with the latest news from Dallas, that makes a total of three Ebola cases outside of West Africa: a nurse in Spain and two nurses in the United States, all three health care workers exposed to the virus while performing their jobs. Meanwhile, according to the Centers for Disease Control and Prevention, 480,000 people die in the United States each year from cigarette smoking; 88,000 die of alcohol-related deaths. More people will die of the flu this year than from Ebola.

Did I mention? There’s no need for panic. But there is cause for concern, after watching the CDC respond to the first cases of Ebola in this country. So far they surely don’t inspire confidence that they know what they’re doing and are handling the situation well enough to prevent a potential crisis from escalating into a real one. It looks like they’re making it up as they go along.

At the Texas Presbyterian Health Hospital in Dallas, where health professionals were operating under close supervision of the CDC, it’s been one blunder after another. First, when Mr. Duncan initially visited Texas Presbyterian’s ER, they sent him home, even after telling them he had just come from Liberia. First breach of protocol. When he returned to the hospital, nurses were given only partially secure protective gear to wear. Second breach of protocol. And before she came down with the disease, nurse Amber Vinson, who was supposedly under observation and self-monitoring, was allowed to fly to Cleveland to visit family. Third breach of protocol.

After the fact, in each case, Dr. Thomas Frieden, director of the CDC, readily admitted “mistakes were made” — in not immediately sending a SWAT team to Dallas, in not issuing tough guidelines on gear and in monitoring persons exposed to the disease. But that begs the question: Why didn’t they get it right in the first place? Clearly, even though the Ebola virus has ravaged West Africa since 1976, health authorities were not prepared for its appearance in the United States — and failed to take it seriously until it did.

For years, health officials have warned the CDC that their guidelines for protective gear were too lax. Sean G. Kaufman, who oversaw infection control at Emory University Hospital in Atlanta while it treated the first two American Ebola patients, called them “absolutely irresponsible and dead wrong.” Finally, based on what happened in Dallas, CDC has issued new guidelines in the last week, but they are still not as strict as guidelines used every day by Doctors Without Borders, who’ve been fighting Ebola in Africa for decades. Unlike Doctors Without Borders, for example, CDC has not required, until now, that a supervisor be present every time health care workers don and take off protective gear, to watch out for mistakes.

Meanwhile, the nation’s nurses have received little, if any, training for handling Ebola patients. One nurse at a local hospital told me her team of nurses had received zero training. A nurse from Chicago said her entire training consisted of watching a five-minute online video, with no actual practice donning and removing protective garb. At Dallas, according to National Nurses United, “There was no advance preparedness on what to do with the patient. There was no protocol. There was no system.”

And, of course, there’s still no vaccine for Ebola, for one very good reason: Follow the money. As noted in a recent column by The New Yorker’s James Surowiecki, pharmaceutical companies are most interested in diseases that affect wealthier people who can pay a lot. “When a disease’s victims are both poor and not very numerous, that’s a double whammy,” writes Surowiecki. “On both scores, a drug for Ebola looks like a bad investment: so far, the disease has appeared only in poor countries and has affected a relatively small number of people.”

The series of blunders in Dallas, which is unnerving, to say the least, comes on top of a string of missteps: from cooking the books at the V.A. to letting a man scale the fence and get all the way inside the White House. Do you still trust your government to prevent an outbreak of Ebola?

Bill Press is host of a nationally syndicated radio show and the author of a new book, The Obama Hate Machine, which is available in bookstores now. You can hear The Bill Press Show at his website, billpressshow.com. His email address is bill@billpress.com.

AFP Photo/Nicholas Kamm

A Strategic Shift On Ebola Care

By Noam N. Levey and Michael Muskal, Tribune Washington Bureau (MCT)

WASHINGTON — The federal government effectively began to restrict the care of Ebola patients to hospitals with special bio-containment units Thursday, and the Obama administration labored to reassure jittery Americans and increasingly skeptical lawmakers that public health authorities can prevent a widespread Ebola outbreak here.

The tacit shift in policy came amid growing concerns about mistakes at Texas Health Presbyterian Hospital in Dallas, where two nurses who treated Thomas Eric Duncan of Liberia have since come down with the disease.

One of the nurses is being treated at Emory University Hospital in Atlanta, and the other was being transferred to a specialized treatment center at the National Institutes of Health near Washington.

On Capitol Hill, lawmakers demanded answers from the director of the U.S. Centers for Disease Control and Prevention, Dr. Thomas Frieden, who has acknowledged his agency’s lapses in responding to the disease, including allowing one of the nurses to board a commercial flight after she treated Duncan.

Frieden strenuously defended the CDC’s efforts.

“CDC works 24/7 to protect Americans. There are no shortcuts,” he said. “We have a team of 20 of some of the world’s top disease detectives in Texas now. We were there. We left the first day (Duncan) was diagnosed.”

Despite repeated assurances from Frieden and other top health officials that the risk of a widespread outbreak is extremely low, fear of the deadly disease has led to school closings and a suggested ban on travel from the U.S. to and from West Africa — which President Barack Obama said Thursday evening that he might consider in the future.

Domestic air travel was of more immediate concern in Texas and Ohio, where several public schools closed as a precaution after officials learned that faculty and students had flown on the same plane as Ebola patient Amber Vinson, the second of Duncan’s nurses to be diagnosed with the virus that killed him.

Now hospitalized at Emory, Vinson flew to Cleveland on Friday, returned to Dallas-Fort Worth late Monday and was diagnosed with Ebola on Wednesday.

Eight people who came into contact with Vinson quarantined themselves and are being monitored, according to health officials there.

Officials also are asking anyone who visited an Akron bridal shop that Vinson visited Saturday to contact health officials.

The deadly virus is transmitted by the bodily fluids of a symptomatic person.

In Dallas, where fears about Ebola are highest, local officials signed off on “control orders” Thursday that will restrict those being monitored for Ebola from using public transportation or venturing out to public places such as grocery stores.

Dallas County Judge Clay Jenkins said he expected officials to start serving the orders on 75 health care workers Thursday. During an emergency meeting of county leaders, Jenkins said the addresses of those being monitored would be flagged for first responders but not publicly distributed.

Growing public anxiety has fueled Republican lawmakers’ escalating attacks on the Obama administration.

“People are scared,” House Energy and Commerce Committee chairman Fred Upton, R-Mich., told federal health officials at the Washington hearing. “People’s lives are at stake, and the response so far has been unacceptable.”

GOP lawmakers and some Democrats urged a travel ban on passengers from Liberia, Sierra Leone and Guinea, the three West African countries at the center of the Ebola outbreak.

Many public health experts oppose such a move. And Thursday, Frieden also rejected that call, noting it would likely induce travelers from the heart of the outbreak to go underground.

“Right now, we know who’s coming in,” he said. “If we try to eliminate travel, the possibility that some will travel over land, will come from other places, and we don’t know that they’re coming in, will mean that … when they arrive, we wouldn’t be able to impose quarantine as we now can if they have high-risk contact.”

On Thursday evening, Obama said he might consider imposing a ban on travel to Ebola outbreak areas, but he fears it could encourage the sick to hide their illness and result in “more cases rather than less.” But the president said he “may consider it if experts recommend it.”

Obama emphasized, as have Frieden and others, the need to focus on containing the outbreak in West Africa.

The president signed an executive order Thursday authorizing the Pentagon to call up additional Ready Reserve forces to assist in the ongoing U.S. military effort to combat Ebola in Liberia, Sierra Leone and Guinea.

The order was aimed at calling up personnel with key skills, according to an administration official; so far the Pentagon had identified just eight people for the mission.

Obama also met at the White House for the second day in a row with senior officials coordinating the federal Ebola response.

Administration officials have insisted for months that a wider Ebola outbreak in the U.S. is unlikely because American hospitals can effectively isolate and care for infected patients, a key capacity missing in West Africa.

But the apparent breakdown at Texas Health Presbyterian in Dallas that led to the infection of Duncan’s nurses has prompted growing calls for a new system to concentrate care in designed facilities.

The U.S. has four specialized facilities, including Emory, the NIH in Bethesda, Md., the Nebraska Medical Center in Omaha and St. Patrick’s Hospital in Missoula, Mont.

Officials at Texas Presbyterian have acknowledged that they erred in sending Duncan home when he initially came to the hospital with flu-like symptoms and reported he had recently been in West Africa.

On Thursday, Dr. Daniel Varga, chief clinical officer of Texas Health Resources, which owns the hospital, testified at the congressional hearing that the hospital had not trained the medical staff to deal with Ebola, even after the CDC alerted U.S. hospitals to watch for possible cases.

Nevertheless, Nina Pham, the first nurse to be infected, had remained at Texas Presbyterian since her diagnosis over the weekend.

The hospital said in a statement Thursday that officials decided to transfer her because so many of the hospital’s staff are being monitored for Ebola.

Pham was in good condition, according to health officials.

(Levey of the Tribune Washington Bureau reported from Washington and Muskal of the Los Angeles Times from Los Angeles. Times staff writers Molly Hennessy-Fiske and Geoffrey Mohan in Dallas, Kathleen Hennessey and Christi A. Parsons of the Tribune Washington Bureau in Washington and Christine Mai-Duc of the Times in Los Angeles contributed to this report.)

AFP Photo/Nicholas Kamm