What New York Learned About Stopping Ebola From the Dallas Ebola Case
Mistakes made in Texas with first case were not repeated..
— -- When New York Mayor Bill de Blasio addressed a jittery public after the first Ebola patient in New York was diagnosed, he spoke of how much city and federal officials have learned about treating and stopping Ebola since the first Ebola-infected patient was diagnosed in Dallas last month.
“We also again learned from Dallas,” the mayor told reporters on Friday. “I think it’s clear that Dallas was in a disadvantageous situation at the very beginning of the process.”
When a New York doctor alerted officials that he might have Ebola Thursday, he set off a carefully calibrated response by the New York health officials designed to minimize the patient’s ability to infect others with the potentially deadly virus.
According to health officials, Dr. Craig Spencer, 33, was removed from his home by a specialized ambulance team designed to deal with hazardous material and was moved to Bellevue Hospital, which was designated by the state to treat Ebola patients, and once Spencer arrived he was immediately put into isolation.
The smooth transition from home to hospital was carefully rehearsed and practiced by New York health teams and seemed to contrast with how the nation’s first Ebola patient, Thomas Eric Duncan, was admitted.
Duncan, who was diagnosed and treated in Dallas, was initially sent home after arriving at Texas Health Presbyterian Hospital with Ebola-like symptoms. Two days later Duncan returned in a regular ambulance with a fever and nausea.
In recent weeks Dallas and federal health officials at the U.S. Centers for Disease Control and Prevention have been criticized for how they handled Duncan’s case. Two nurses became infected after treating him and Duncan’s family was initially told to remain in their home even though contaminated materials were inside.
The ambulance used to pick up and transport Duncan was not immediately pulled out of service, even though officials quickly suspected Duncan might have Ebola.
In the weeks since Duncan was diagnosed at Texas Health Presbyterian Hospital, New York officials said they have worked with the CDC to practice and refine protocols for dealing with the deadly virus, especially after two nurses treating Duncan became infected with Ebola.
Key to stopping the infection among health care workers is practice. In a press conference today the president of the Health and Hospitals Corporation of New York City, Dr. Ram Raju, told reporters that health teams at Bellevue and specialized ambulance teams have been training for two and half months to deal with an Ebola patient.
“Practice works, we have continuously drilled on this,” said Raju. “We are ready to take care of this patient.”
Both Raju and the New York mayor said seeing Duncan’s case unfold in Dallas helped them in conjunction with the CDC to prepare and refine their response to the first New York Ebola patient.
Raju told reporters that everyone working with an Ebola patient at Bellevue has practiced putting on and taking off the layers of personal protective equipment (PPE).
Dr. William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine, said practice is key to keeping medical teams safe when treating an infectious patient.
“Particularly taking [PPE] off in the right sequence and with appropriate care, that’s where potential exposures occur,” said Schaffner, who said his own team had to conduct drills, to see how they would react to an Ebola patient.
“You have a test patient, you see how the system works,” said Schaffner. “When we did that we had to tweak several aspects of our policy…things didn’t work out the way we had planned them.”
Schaffner said everything from getting patients safely out of the emergency room to transferring them out of the intensive care unit suddenly became a problem.
In Dallas, health officials had been warned by the CDC for months to be on the lookout for Ebola patients and were given guidelines to treat them. However, Dr. Daniel Varga, chief clinical officer for Texas Health Resources, which oversees Texas Health Presbyterian, testified to a congressional committee that the hospital staff were given CDC guidelines for treating Ebola patients but did not go through additional training until after Duncan arrived.
Another difference from Dallas was that no one was allowed to remain in the apartment where Spencer was sick. His fiancee is now in quarantine at Bellevue. After Duncan was admitted in Dallas, four of his relatives were initially quarantined in the same home that contained contaminated towels and bedding. They were eventually taken to an undisclosed home for the remainder of their quarantine.
In the weeks since Duncan was treated, Texas Health Presbyterian Hospital has taken stock of how they reacted and worked on refining their ability to identify potential Ebola patients. On Friday, the Texas hospital announced they have implemented changes after Duncan to help identify potential Ebola patients.
“As the first hospital to diagnose and treat Ebola on U.S. soil, we know we have seen and experienced what no other hospital has,” said Barclay Berdan, CEO of Texas Health Resources and Texas Health Dallas. “We know that sharing our expertise may help to save lives, and we are eager to help hospitals learn.”
The hospital is now aiming to more quickly identify any suspected patients and get them out of the emergency room and into an isolation ward immediately. Hospital officials announced they will use upgraded medical software to highlight any travel-related red flags, try new triage procedures and recheck patients who are about to be discharged.