Healthcare Providers Express Fears as CDC Heightens Ebola Response

Oct. 15--Every day, nurse Elda Ramirez cares for people with illnesses that could threaten her own life. She is proud to accept the risks and confident her training will protect her.

But Ebola is different. It's deadly. It's exotic. It's in the news 24 hours a day.

"It's scaring the heck out of us," said Ramirez, a longtime emergency room nurse and professor at the University of Texas nursing school.

The U.S. Centers for Disease Control and Prevention has heard from health care workers like Ramirez around the country, worried about their preparedness and the risk of treating an Ebola patient, said Dr. Tom Frieden, the CDC's director.

Frieden said Tuesday that the CDC will rush large teams of experts to any U.S. hospital with a patient infected with the Ebola virus.

Such a response at Texas Health Presbyterian Hospital in Dallas might have prevented the infection of a nurse caring for Thomas Eric Duncan, the first U.S. Ebola patient, Frieden said. The nurse, 26-year-old Nina Pham, was reported to be in good condition Tuesday, two days after the CDC announced she was infected.

"I think we could, in retrospect, have sent a more robust hospital inspection team and been more hands-on," Frieden said. "Ebola is unfamiliar; it's scary. We should have put a larger team on the ground."

The common tasks of nurses and other health care workers -- inserting breathing tubes, cleaning up vomit and wiping sweat from foreheads -- become risky rather than routine when dealing with Ebola or other deadly, infectious diseases.

"Nurses are on the front line of health care delivery and their work can be inherently risky," the Texas Nurses Association said in a statement Monday. "This fact is generally under-appreciated until a tragedy like this occurs. With proper vigilance and rigorous application of safety protocols, we can minimize these risks."

Knowledge of virus limited

Frieden previously had suggested that a possible source of Pham's infection might have involved tasks such as intubation or kidney dialysis. He said he was unaware of these procedures having been used previously on Ebola-infected patients.

Joseph McCormick, one of the world's leading experts on the virus, said the CDC chief's comment highlights the limited knowledge of Ebola even within the medical community.

"Intubation to help people breathe is very common," said McCormick, an epidemiologist at the University of Texas School of Public Health at Houston. "That's the nature of the disease. It causes fluids to leak out of the blood vessels -- not red cells, just the plasma. One place it leaks out is in the lungs, so these people can't breathe because they've got fluid in their lungs."

Inserting a tube down the nose to clear the lungs and assist breathing is a technique familiar to most nurses. Because of the infectious nature of the fluids removed from an Ebola patient, it is more risky than when performed on a heart or coma patient, for instance.

McCormick agreed with Frieden's suggestion that kidney dialysis might have been unnecessary.

National Nurses United, a union group, has argued that U.S. hospitals are not ready to handle Ebola, with 2,000 members claiming in an unscientific survey that most of their hospitals have not provided specialized training or proved they have the needed isolation equipment.

Frieden said the CDC will have a team, including experts in infection control, lab science, contact tracing and treatment, "on the ground within hours" of a positive Ebola test at a hospital. The agency sent a team to Dallas immediately after Duncan was diagnosed, but the number of experts was increased, from 10 to 20, only after Pham's infection was confirmed.

The CDC is investigating how Pham contracted the virus from Duncan.

Frieden announced that 76 health care workers involved in Duncan's care at Presbyterian are being monitored for fever and other Ebola symptoms. None of the 48 people who came into contact with Duncan before he was hospitalized more than two weeks ago has developed symptoms, which Frieden said makes it less likely they contracted the virus. Though Ebola can incubate over 21 days, symptoms usually occur within 14 days.

Treatment expensive

Some health officials and members of the public have wondered why Ebola patients are not transported to biocontainment units, designed for treating highly infectious diseases, stocked with spaceman-like safety suits and staffed by health professionals practiced at high-risk care.

Frieden said this option is under consideration. He particularly praised the expertise at two of the facilities that have treated Ebola patients, Emory University in Atlanta and Omaha's Nebraska Medical Center.

Dr. Kenneth Mattox, chief of staff at Houston's Ben Taub General Hospital, said he thinks Ebola patients should be flown to Emory and Nebraska for treatment because those facilities can treat the disease more effectively and at less cost. He said it would bankrupt U.S. hospitals to try to replicate what Emory and Nebraska bring to Ebola care.

Mattox said he wants Texas to take the lead on the idea, which he calls "local screen, national treatment." He has begun contacting leading Texas health officials about it.

McCormick said the appropriateness of equipment does not simply hinge on the diameter of the mask's filter or other specifications. It matters most that the worker is comfortable using it.

As a virus hunter for the CDC treating Ebola and other lethal viruses in Africa for more than 20 years, McCormick never became infected. He often wore simple gloves and a paper mask while caring for patients on the bare floors of mud huts.

Ramirez, the Houston nurse, said she is confident that the recent Ebola training her hospital provided will help keep her safe. It is healthy to be a little nervous, she said, but she still will treat any patient.

'We're professionals'

"It's not a whole lot different other than this specific virus is right now killing people in another country that doesn't have the guidelines and precautions that we have in this country," Ramirez said. "Any health care provider makes a choice in their lives, especially in emergency medicine. We all take a risk every day we walk in there. We are who we are. We're professionals. We are trained to manage this -- period."

Theodore Schleifer contributed to this report.

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