Patient Two

Health Care Worker In Dallas Tests Positive For Ebola Virus

On Sunday, the CDC announced a second case of ebola in Texas:

The Centers for Disease Control and Prevention say that a hospital worker who cared for Thomas Eric Duncan, the Liberian patient who died of Ebola last Wednesday, has tested positive for the Ebola virus. This is the first case of Ebola being transmitted in the United States. Officials blame a “breach of protocol” during treatment of Duncan—and although all healthcare workers who came into contact with Duncan were wearing protective clothing, Dr. Thomas Frieden, the CDC director responsible for overseeing agency action against the Ebola crisis, said additional cases are possible because of the breach.

Abby Haglage and Kent Sepkowitz comment on how the nurse managed to contract the virus:

The Dallas nurse, who officials confirmed was wearing gear, was allegedly treating Duncan on his second visit to the ER where he was hospitalized and diagnosed, before eventually dying. This detail is extremely important. Though much remains unclear about Ebola and transmission, we do know that any virus is much more contagious when high amounts of virus are concentrated in the sick person’s blood. It is likely therefore that Duncan was much more contagious farther into his illness, making transmission increasingly likely. …

This may have played into Duncan’s case, which has left officials in Texas such as Health Resources chief clinical officer Dan Vargas, scratching their heads. “We’re very concerned,” Vargas told the press. “[Though we’re] confident that the precautions that we have in place are protecting our health care workers.” In other words, the protocol works but many people’s ability to follow it exactly—really exactly—may pose a substantial challenge.

Jonathan Cohn thinks about how better safety protocols could mitigate the risk to health workers:

Ideally, every facility with Ebola patients would adopt the kinds of practices that groups like Doctors Without Borders have developed and honed over the years. They have thorough checklists, for example, and follow them meticulously. They also use a buddy system or, in some cases, have trained professionals who focus on the disposal of infected material and make sure caregivers take off protective gear properly. Frequently they are “WatSan” specialists, meaning they deal with water and sanitation.

The CDC seems to be moving in that direction already: Frieden said on Sunday that “we are recommending there be a full-time individual who is responsible only for the oversight, supervision and monitoring of effective infection control while an Ebola patient is cared for.” But simply “recommending” hospitals take these steps may not be enough. CDC, or some other arm of the federal government, may need to dispatch these infection control officers and pay for their services.

“A more drastic, but possibly necessary, step would be moving all Ebola patients to hospitals that specialize in these sorts of infectious diseases,” Cohn adds. Sarah Kliff voxplains what sets these hospitals apart:

Emory, the University of Nebraska, and the National Institutes of Health have all received and successfully discharged Ebola patients. These three hospitals are among just four in the nation with specialized biocontamination units. These are units that have existed for years, with the sole purpose of handling patients with deadly, infectious dieases like SARS or Ebola.

While biocontamination units look similar to a standard hospital room, they usually have specialized air circulation systems to remove disease particles from the facility. And, perhaps more importantly, they’re staffed by doctors who have spent years training, preparing and thinking about how to stop dangerous infections from spreading.

(Photo: On October 12, 2014 in Dallas, Texas a man dressed in protective hazmat clothing walks towards an apartment where a second person diagnosed with the Ebola virus resides. By Mike Stone/Getty Images)