By Poorva Gaur, MPH, DAP Volunteer
As Ebola continues to be a present threat in the United States, increased measures are being taken to prevent its entry and spread into this country. In the past week, New York, New Jersey, and Maine placed strict, albeit questionably, quarantine measures on health workers returning from regions in Africa inflicted by the Ebola epidemic.
Though we have been reassured by government personnel like Dr. Nicole Laurie, Assistant Secretary of Preparedness at the Department of Health and Human Services (DHHS) as well as President Obama that Ebola does not pose a significant threat to the U.S., it has become evident that we can only support those claims if we are properly prepared with adequate protocols and enforcement of guidelines provided by institutions like the Centers for Disease Control and Prevention (CDC), National Institutes for Health (NIH), and the DHHS.
In an October 20, 2014 press release, the National Nurses United (NNU) presented the argument for mandated standardized protocols to deal with Ebola. The press release and consequent petition to Congress and the White House calls for mandated Ebola protocols for all hospitals and healthcare workers. This petition follows the death of U.S.’s first Ebola patient, Thomas Duncan at Texas Health Presbyterian Hospital (THPH) on October 8, 2014 and the subsequent positive Ebola tests of nurses Pham and Vinson, both who cared for Duncan at THPH.
On October 15, 2014, nurses from THPH released a statement to NNU describing the procedures and process followed to manage this Ebola case. The statement revealed a severe lack of preparedness, clear protocols, and proper training in the event of an Ebola case. According to the statement, nurses were left to choose among the various protocols with little training. This ultimately resulted in two nurses contracting the disease. With inadequate resources and little guidance, the first Ebola case was handled poorly. Along with the NNU, the general population is left with some pertinent questions: Why was THPH not prepared and why were the protocols provided not clear and unenforced?
In response to the occurrences at THPH, the CDC has released updated guidelines for hospitals and health care workers to deal with potential Ebola cases and positive Ebola patients. The new guidelines consist of better categorization of potential infection risks as well as better personal protective equipment recommendations “focusing on no skin exposure, rigorous training, and a trained monitor who watches healthcare workers take on and off personal protective equipment (PPE)” according to this White House Fact Sheet.
If these guidelines had been provided and followed at THPH, Duncan’s death and the nurses’ infection could have been prevented. However, it is important to note that these are just guidelines and recommendations. Hospitals are in no way required to follow or implement them. Additionally, they are unenforceable. According to this New York Times article, the CDC has no regulatory authority, leaving states and local authorities to ultimately pick and choose their protocols. This leaves a wide range of responses and capacities by various hospitals to situations like an Ebola threat.
An example of the range of protocols that could potentially be followed is best seen in the sharp contrast between how THPH handled their Ebola patient and how Bellevue Hospital in New York City, NY handled their patient. In comparison to the scant measures at THPH previously mentioned, Bellevue Hospital was fully prepared with ample protective gear, well prepared staff, and significant training opportunities including infectious disease drills.
In a recent article, the Associated Press highlights some of the measures Bellevue Hospital has taken: they have been training since August in addition to holding many emergency drills on a regular basis in the past. Bellevue has a full isolation unit and with the coordination and cooperation of NY authorities, fire department ambulance crews have been trained to “transport suspected Ebola patients”.
It is clear that the hospitals in NY and TX had very different approaches to similar situations, resulting in very different outcomes. While it was noted that the CDC guidelines were too lax to begin with in terms of hospital and healthcare worker protocols, the NNU commented “many hospitals ignored even the lax guidelines because they were voluntary”.
The differences among hospital protocols and preparedness again lead us to the question of why the variation existed and why there are no mandated protocols so that every hospital is equally prepared and that varying state and local policies are not the reason one patient dies and another one lives.
Following the NNU’s petition, the U.S. government has taken further action to aide in Ebola management outlined in this Fact Sheet. In summary, the CDC has created a Dedicated Response Team to directly aide any hospital that has a confirmed Ebola patient; the CDC is taking more active measures to educate and train more healthcare workers and local officials; the Department of Defense has created a Medical Support Team under the orders of Secretary Hagel to provide any assistance to civilian medical professionals in the country; Federal, State, and Local coordination is being enhanced with the help of liaisons and FEMA coordinators.
A recent press release by the NNU announced a national “Day of Action” to support the demands for stricter guidelines and support for hospitals on November 12. These strikes will include a two-day strike at 86 Kaiser Permanente hospitals in California, with an estimated 18,000 registered nurses and nurse practitioners participating. Kaiser Permanente released a statement on November 10 expressing their “disappointment” at the announcement of the strike as they claim that Kaiser has worked on Ebola preparations “non-stop”. These preparations include running a commend center and training hospital staff on using protective gear properly.
As of November 11, 2014 the White House or Congress has not mentioned mandated standardized protocols or enforcement of CDC guidelines for hospitals across the country.