By Kelly Marie Holt, DAP Intern

When the first cases of Ebola were identified in the United States, our nation had only four level-4 bio-containment units capable of quarantining, treating, and disposing of patients’ waste.

The apparent shortage of units, located at the National Institutes of Health in Bethesda, MD; St. Patrick’s Hospital in Missoula, MT; Emory University Hospital in Atlanta, GA; and the Nebraska Medical Center in Omaha, NE, led to questions about overall U.S. public health preparedness.  Most Americans thought our nation was better prepared.

In the past month, the number of level-4 bio-containment units increased to five, with the addition of the University of Texas Galveston Medical Branch. There have also been increases in the numbers of facilities able to treat Ebola patients, specifically in New York, New Jersey, and Texas, but the biosafety levels of these newer locations are not known.

Biosafety level denominations fall between 1 and 4, low to high respectively. The level is related to the level of risk associated with the diseases which could be present in the facility. All of the five biocontainment units listed above are considered level-4 “maximum” containment facilities.

The CDC recommended that biosafety facilities falling between level-2 and level-4 are able to manage the Ebola virus, depending on the amount of the virus present; the more virus, the higher the recommended biosafety level. This disparity in virus amount or concentration might explain why Ebola treatment centers, like the recent 8 New York centers, are able to be quickly constructed.

In New York, Michael Dowling, President and CEO of the North Shore-LIJ’s Glen Cove Hospital, confirmed the intent to construct a level-3 or level-4 bio-containment unit in the New York hospital. Although seven other hospitals have been designated in the state of New York as treatment centers for Ebola, this will be the first full infectious disease treatment center and higher-level bio-containment unit in the northeast.

Terry Lynam, North Shore-LIJ spokesperson, says that the project is estimated to cost to the hospital approximately $15 million, will take about 18 months to complete, and will be modeled after the Nebraska Medical Center and Emory University units, both of which are level-4 units and have treated Ebola cases in the past month.

Nothing further regarding timelines for opening the facilities or beginning construction has been announced yet.

New York’s Bellevue Hospital Center, another of the eight NY hospitals named as Ebola treatment facilities, is currently treating one case, admitted late on Thursday, October 23. He is occupying one of the 4 isolated rooms within the hospital’s infectious disease ward. The ward also added its own laboratory to deal with potentially contaminated bodily fluid samples. It remains unknown precisely what biosafety level each of these eight hospitals is maintaining.

New Jersey announced the state has three Ebola treatment facilities after making news attempting to quarantine a nurse who returned from West Africa. University Hospital in Newark, Hackensack University Medical Center (Hackensack, NJ) and Robert Wood Johnson University Hospital (New Brunswick, NJ) are all located in northern New Jersey.  The biosafety level of each of these hospitals is unknown.

Texas also announced the opening of two bio-containment facilities. On Wednesday, October 22, the North Texas Ebola Treatment and Infectious Disease Bio-Containment Facility opened in Richardson, Texas announced that it had capacity of 10 patients. On October 23rd, the Galveston National Laboratory at the University of Texas Medical Branch went on record as able to “treat up to three Ebola patients at a time”.

The UT Galveston Medical Branch was already deemed a level-4 national biocontainment research laboratory, according to the NIH, so the transition from laboratory to medical treatment facility is much easier than that of a typical regional hospital. Accommodations had to be made for human patients, but the air filtration systems, equipment, and entry/exit avenues were already in place.

The creation of new level-4 bio-containment units in the southwest and northeast, in addition to the other existing units, is a significant improvement, and yet the nation is still not prepared for more than a couple dozen concurrent cases.

Elsewhere, Hawai’i announced a plan for providing a bio-containment chamber sufficient for transporting suspected patients with infectious diseases to the mainland for full treatment, without risk of contamination to others. Although the risk of Ebola in Hawai’i is low, Health Director Dr. Linda Rosen indicated that more intense preparation would be required for infectious diseases other than Ebola.

Alaska has similarly been deemed a low-risk state for Ebola instances, but according to state officials, Alaskan health care providers are prepared for potential Ebola cases. As for other infectious diseases, there is not a readily-available plan in place for constructing any bio-containment units.

Although there are calls for constructing more units, the Center for Disease Control’s (CDC) position is unclear. Abbigail Tumpey, a CDC outreach and education official was quoted as saying, “[The CDC]’d like to have at least one hospital in every state that does feel they could manage a patient from start to finish”. It is unclear what biosafety-level (2-4) is necessary in each state to achieve this CDC goal.

A goal of having at least one level-4 unit in every state is good and some states have taken encouraging steps. However, we should not have to wait for an actual epidemic or public health emergency to get prepared.  Our nation can do better than having a couple dozen patient beds available in a handful of bio-containment units.