The CDC held a press conference this morning to address reports of a Health care worker who has been infected while providing hospital care to Eric Duncan in Dallas (see Dallas Ebola Press Conference & Hospital Statement). The CDC has been pretty quick to get the transcripts and audio files up on these pressers – and so I expect to see those later today on the CDC’s Media Website.
First stop, however, is the CDC’s statement released at the time of the press conference, after which I’ll return with a few notes from the conference itself.
CDC doing confirmation testing today
A healthcare worker at Texas Presbyterian Hospital who provided care for the index patient has tested positive for Ebola according to preliminary tests by the Texas Department of State Health Services’ laboratory. The patient was isolated after the initial report of a fever and remains so now. Confirmation testing at the Centers for Disease Control and Prevention’s laboratory is being done today.
On Friday October 10, a healthcare worker at Texas Presbyterian Hospital who provided care for the index patient reported a low grade fever and was referred for testing. The health care worker had been self-monitoring for fever and symptoms.
The hospital and patient were notified of the preliminary positive result. In addition, CDC has interviewed the patient to identify any contacts or potential exposures in the community.
This is understandably disturbing news for the patient, the patient’s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures including ongoing contact tracing, health monitoring among those known to have been in contact with the index patient and immediate isolations if symptoms develop.
Ebola is spread through direct contact with bodily fluids of a sick person or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it could be from 2 to 21 days) so CDC recommends monitoring exposed people for symptoms a complete 21 days. People are not contagious during the incubation period, meaning before symptoms such as fever develop.
CDC tests results will be shared when confirmatory tests are done, following appropriate patient notification.
The press conference, which included both Dr. Thomas Frieden of the CDC and Dr. David Lakey, Commissioner, Texas Department of State Health Services, covered a lot of territory, but at this time we don’t have a good idea what may have caused this nurse’s exposure to the virus.
By all accounts, this HCW followed the CDC’s recommended infection control procedures. But . . . as anyone who has ever donned PPEs will tell you, it is very easy to make a mistake – particularly when doffing contaminated equipment.
There are concerns over the possibility that other hospital employees who followed essentially the same protocols as this nurse may also have been exposed, and so enhanced twice-daily monitoring has been ordered for all HCWs who may have had contact with the hospital’s index case – even though they wore PPEs.
The CDC, along with local officials, are looking very hard to find how this breach may have occurred.
While we’ve heard all along that any hospital `should be able to safely isolate and treat an Ebola patient’, for that to happen, every healthcare worker has to get the protocol 100% right - 100% of the time.
And in the real world, that doesn’t always happen.
So the CDC is recommending limiting the number of HCWs who have patient contact, reviewing the removal of PPEs for possible risks, and avoiding unnecessary `high risk’ procedures on Ebola patients (i.e. excessive blood draws, Intubation, Kidney dialysis, etc.) whenever possible
Dr. Richard Besser – formerly interim director of the CDC – asked during the Q&A if consideration was being given to transferring Ebola cases to specialty centers like Emory & Nebraska.
Dr. Frieden replied they were looking at all options, but stressed that all hospitals need to be prepared to handle a `walk-in’ Ebola case, even if specialty hospitals are employed.
The bottom line is that while additional cases may turn up in Dallas – either among HCWs who treated Mr. Duncan or his family – there is very little risk to general public. Aggressive contact tracing and monitoring of contacts should be able to contain this virus before it can spread much further.
While the media will no doubt thrash this story to within an inch of its life, the real story is stopping the Ebola virus in Africa.
Because that’s where the humanitarian crisis is, and because if we can halt the epidemic there, we can eliminate repeated introductions of the virus to other countries . . . including our own.
If the epidemic isn’t controlled at the epicenter – and soon – we face the very real possibility of seeing this virus exported to other heavily populated parts of the world (think: India, Pakistan, South America) where it could easily spread faster than local public health agencies could react to contain it.
For now, I believe we are well able to handle sporadic introductions of this virus into North America, Europe, or any other developed nations. Some secondary cases, and even small clusters of cases, are probably inevitable.
But we have the resources, knowledge, and infrastructure to identify and stop them.
But if this virus gains significant traction in large population centers outside of West Africa, I become considerably less sanguine about our long term prospects.