Since a Liberian man showed up at a Texas hospital two weeks ago showing symptoms of Ebola, Pierce County’s major medical systems have been preparing to handle someone infected with the deadly virus.
Like the director of the Centers for Disease Control advised Monday, they’re “thinking Ebola.”
Both CHI Franciscan Health and MultiCare Health System have distributed Ebola-specific screening guidelines to every place a sick person might go first: to clinics, urgent care centers and emergency departments.
The guidelines are the first essential steps toward diagnosing Ebola: Take a travel history and take a temperature.
Ebola’s symptoms don’t stand out in the early stages, particularly during flu season: Fever, aches, weakness, fatigue, diarrhea, vomiting and abdominal pain. But if a person has a fever, any of the other symptoms, and has been to West Africa in the past month, it’s time for a mask, a closed door and a call to the Tacoma-Pierce County Health Department.
“That location is a key differentiator,” said Dr. Mark Adams, Franciscan’s chief medical officer. “If you have these symptoms but haven’t been out of the Puget Sound region, you don’t have it.
“More people will die of flu this year than Ebola in the United States,” he said.
On Sunday, officials in Dallas announced the first case of Ebola transmitted within the United States: a nurse who cared for Thomas Duncan, the Liberian man who died of Ebola last week. The five other people with Ebola treated in the U.S. have contracted the disease while out of the country.
The country’s largest union and professional association of registered nurses, National Nurses United, raised an alarm Sunday after that announcement, saying hospital systems aren’t adequately communicating with employees on how to handle Ebola patients. It referenced a survey of 1,900 nurses from across the country.
The Washington State Nurses Association, whose labor arm represents about 1,400 each at Franciscan and MultiCare, has a different take.
On Friday, the WSNA began surveying its 12,000 members across the state. About 400 have responded. Preliminary results Monday show a mixed level of concern both over communication from their hospital system and their own level of safety, said Heather Stephen-Selby, an assistant director who works directly with nurses.
“Responses are growing by the hour,” she said. Nurses also are reporting to the WSNA that some facilities had only begun thinking about Ebola, and others are further along.
Both systems have distributed information widely, through emails, postings on internal websites, department meetings and town hall-style meetings.
Both systems have created a map of rooms across their hospitals that can be turned into isolation rooms. Each emergency department has a handful of rooms designed to isolate infected patients, with features such as an anteroom — a small room where nurses and doctors put on protective gear before entering the main room — and special air circulating systems.
At Tacoma General, for example, the emergency department has five isolation rooms, with 24 more across the rest of the hospital. Beyond that, other rooms could be converted to isolation rooms if needed.
MultiCare has created a task force to go through the hospital checklist created by the CDC. One of the first gaps it identified was a lack of protective clothing for doctors and nurses at its urgent care clinics, Koch said. MultiCare has purchased more of those kits, which include gloves, gowns, face shields, masks and goggles. The kits will arrive by Tuesday or Wednesday, Koch said.
The task force also is working on details not anticipated by the checklists, Koch said – things such as designing a schedule and designating a route for a cart to take supplies out of an infected person’s room.
The disease is not airborne. It is spread through direct contact with a sick person, including their skin and bodily fluids.
MultiCare plans Ebola-specific drills this week. Franciscan plans to begin “secret shopper” drills, Adams said, to determine if front-line medical staff can spot a potential infection.
Are the health systems prepared? Absolutely, said Nigel Turner, the director of communicable disease control at the Tacoma-Pierce County Health Department. “Our best weapon is putting resources into controlling the disease in Africa,” he said.
Both Adams and Koch emphasized that detecting the disease quickly is essential.
They want to ensure good treatment. But they also don’t want to send someone home who is contagious, as Texas Presbyterian Hospital did with Duncan just a few days before he was admitted to the hospital.
“The community depends on us and expects us to know what to do,” Adams said. The medical workers in Dallas “had all the information they needed. They just didn’t put two and two together.”
“I think perhaps what happened in Dallas may save a lot of lives,” Koch said.
Health care providers also are anxious about their own safety, she said, especially in light of the Dallas nurse’s diagnosis.
“I talked to my daughter, who is a physician assistant in an urgent care clinic,” Koch said. “She didn’t sleep well after hearing that.”
Neither she nor Adams has heard of anyone who plans to refuse to treat an infected patient.
Stephen-Selby of the state nurses association said the CDC must quickly determine how the Dallas nurse was infected.
“I think it’s really imperative that the CDC find out what happened with Mr. Duncan and the health care staff working there, so that if we need to make further adjustments (to protocol), we can get that out quickly,” she said.
In the meantime, “People need to be vigilant and calm.”