First U.S. Ebola Case Exposes Weakness In Hospital Procedure

As luck would have it, the hospital currently treating the first Ebola patient to be diagnosed in the U.S. had actually held a meeting a week prior on what to do if a case ever presented itself.

“We have had a plan in place for some time now in the event of a patient presenting with possible Ebola,” said Edward Goodman, hospital epidemiologist at the Texas Health Presbyterian Hospital Dallas in a press conference Tuesday about the case. “Ironically enough, in the week before this patient presented, we had a meeting with all the stakeholders that might be involved in the care of such a patient. Because of that, we were well-prepared to deal with this crisis.”

The patient has since been identified as Thomas Eric Duncan.

But apparently not everyone at the hospital got the memo. Mai Wureh, Duncan's sister, confirmed to Associated Press that he told hospital staff he had just arrived from Liberia when he first sought care on Sept. 25, but healthcare workers sent him home anyway.

Dr. Mark Lester confirmed to AP that a nurse had asked Duncan about his travel history, but the "information was not fully communicated throughout the whole team."

Two days later, Duncan was transported to the same hospital in an ambulance and was by that time, “critically ill.” Besides potentially endangering his life, the gap in care also resulted in two extra days that he could expose others to the virus, which is only communicable once symptoms arrive.

Centers for Disease Control and Prevention director Dr. Thomas Frieden had hinted at the gap in care in a press conference Tuesday before the patient’s sister spoke out, but only to say that this was an example of why emergency room doctors should take a travel history of their patients during the global Ebola outbreak.

“That’s why we have encouraged all emergency department physicians to take a history of travel within the last 21 days … and then to do rapid testing,” said Frieden.

The story serves as a cautionary tale for other hospitals in major cities. Brandon Brown, Ph.D., MPH, an assistant professor of public health at University of California, Irvine and the leader of the campus’ global health research program, said that the turn of events around Duncan's initial dismissal and eventual re-admission means the hospital was not adequately prepared.

“That’s a big issue -- since Ebola is all over the news, most of us know that it is highly prevalent in West Africa, and especially Liberia,” said Brown in a phone interview with the Huffington Post. “It’s obvious that the patient shouldn’t have been turned away.” While Brown allowed for the fact that Ebola’s initial symptoms could be mistaken for a common cold, hospital-wide education about global health issues could have prevented the gap in care.

“The first step should be a training session for all hospital personnel and staff in the form of a conference, then followed up with a newsletter about what’s going on in the world,” said Brown on how hospitals in major cities and counties should prepare for Ebola. “What are the symptoms of Ebola? What kinds of steps should they take when patients are sick?”

In other words, raising awareness among staff is key -- something that the staff themselves are well aware of: At a nursing conference in Las Vegas last week, about 1,000 nurses staged a “die-in” protest in part to raise awareness about a lack of adequate preparation they saw among U.S. hospitals.

As the first point of contact for most patients, the nurses said that they would be the “first line of defense” in the fight against Ebola in the U.S. Some felt their hospitals weren’t doing enough to protect and prepare them, reported the Las Vegas Sun.

The first Ebola patient to be diagnosed in the U.S. is perhaps the best public awareness initiative of all, said Brown.

“Now that this case has happened, this is going to raise awareness among hospitals in the U.S., and they’re going to try to take it more seriously and prepare,’ he said.

UPDATED Oct. 2: Due to newly released information, this piece has been updated to say that Duncan first sought care on Sept. 25.

Symptoms of Ebola