2:00 Dose of Ebolology: Emory, Omaha, and the Dallas Clustermess

No transmission has occurred from infected patients at the high-containment hospitals at Emory University in Atlanta or the University of Nebraska hospital in Omaha.  However, the index case (and subsequent satellite infections) of the US outbreak did not involve those hospitals until today (10/16/2014).  They all involved Texas Presbyterian Hospital in Dallas, Texas.  The infection of two nurses has been touted as evidence of the coming apocalypse.  Here’s what went down in Texas:

1.) The index patient, Thomas Eric Duncan, presented with a fever of approximately 103 (absurdly high for an adult), and a recent travel history including Monrovia, Liberia.  He had also had extensive contact with a sick woman there, but it is not clear if this was disclosed to hospital staff at this time.  He was inexplicably sent home.  Giant alarm bells should have gone off, yet did not.  Blame is to be shared all around (triage nurses, treating nurses, and attending ER physician), since all had access to the information, and none put it together.

2.) Two days later, Duncan returned to the same hospital critically ill and he was isolated and tested for Ebola.  He was not isolated in high containment, and initial “isolation” was via curtain and not with dedicated nursing staff.

3.) Nurses and physicians wore protective gear after isolation, but were not trained in its operation and use.  Blood samples were not indicated as coming from an isolated, containment-requiring patient, and so laboratory staff were not using protective gear.

4.) Medical staff who treated Duncan were placed on fever watch and voluntary quarantine.

5.) As of now, two nurses who treated Duncan are now infected.  Nina Pham sought treatment under isolation immediately upon presenting with a low-grade fever.  As of now, her prognosis is favorable.  She is currently being treated at NIH in Bethesda, MD

6.) Amber Vinson violated quarantine measures and traveled via aircraft (healthy during outbound travel, febrile during return trip to Dallas).  The passengers on that flight are now being monitored.  Vinson has been transported to Emory for treatment.  The increased number of persons being monitored has accelerated fears.

Can anyone highlight the institutional failures here?  There were several.  This does not mean the CDC is lying and that doomsday is imminent.  This means that a hospital in Texas did an especially crappy job with a patient’s initial assessment, and a nurse did an especially crappy thing by traveling despite quarantine.  The CDC has responded by recommending any positive cases be transferred immediately to Emory, Omaha, NIH in Bethesda, MD, or St. Patrick’s in Missoula, MT.