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Possible Ebola patient in Kansas City heightens worries over keeping disease in check

and DIANE STAFFORD

Dr. Lee Norman, chief medical officer of The University of Kansas Hospital, spoke with the media Monday night about a patient that came to the hospital Monday morning with a high fever and other serious symptoms.
Dr. Lee Norman, chief medical officer of The University of Kansas Hospital, spoke with the media Monday night about a patient that came to the hospital Monday morning with a high fever and other serious symptoms. The Kansas City Star

The University of Kansas Hospital reported late Monday afternoon that it was testing a patient to determine whether he was infected with the Ebola virus.

The Kansas City, Kan., man had worked as a medical officer on a commercial vessel off Africa’s west coast and went to the hospital early Monday with a high fever and other symptoms, said Lee Norman, the hospital’s chief medical officer. He was isolated in an infectious-disease unit for tests.

Norman said it appeared the patient was “at low to moderate risk of Ebola,” but the hospital was following Ebola guidelines of the Centers for Disease Control and Prevention.

Test results on the patient were expected by this evening.

Other diseases can start with high fevers and similar symptoms to Ebola. While on board ship, Norman said, the man treated patients for a variety of conditions and was exposed to typhoid. Norman said that was a likely cause of his illness.

“I’m hopeful he doesn’t have Ebola,” Norman said.

Putting the patient under the strict isolation used for Ebola is “really about an abundance of caution. ... We can’t let our guard down.”

Norman spoke at an impromptu news conference called by KU Hospital after anxious rumors about the hospital and its patient lit up social media Monday afternoon.

Public anxiety and the demand for extreme caution by health care institutions took hold across the nation Monday as nurses openly expressed doubts about hospitals’ Ebola preparedness training, U.S. airports started screening passengers from Ebola-plagued countries in West Africa, and the CDC said it would “double down” on prevention measures.

Norman described the KU Hospital patient as a medic in his 40s. He was on the ship until about five days ago, Norman said.

“The gentleman today has done well,” Norman said, and seemed to be regaining strength.

Hospital staff members wear protective equipment while seeing him, Norman said, and will not treat other patients until the person’s diagnosis is complete. The patient is being treated in an area with its own ventilation system. Nurses and other health care providers attending to the patient are assigned “spotters” who make sure that infection control guidelines are followed.

The patient has been given intravenous fluids to counter severe dehydration caused by vomiting and diarrhea, symptoms of Ebola and of many other diseases. All bedding and medical waste were being isolated from the regular hospital material under federal CDC and state transportation guidelines, the hospital said.

The case is the second time a patient has been tested for possible Ebola at KU Hospital. About seven weeks ago, a 23-year-old man who had been in Sierra Leone in Western Africa showed up at the hospital worried that he had Ebola. That man had experienced brutal chills, fever and muscle aches, all symptoms of Ebola. But tests showed he had a severe bout of malaria and never had Ebola.

In a statement this month from the Mid-America Regional Council, 10 Kansas City area health departments said they were prepared to handle infectious diseases like Ebola.

Medical experts point to two essentials for stopping an infectious disease outbreak: having adequate facilities to effectively isolate and care for infected people, and having personnel to locate and quarantine people who have been in contact with someone who’s infected.

KU Hospital has designated three intensive care isolation rooms for Ebola patients. The rooms have negative-air-pressure ventilation systems, so air from the room won’t escape when the door is opened. As further protection, each isolation room has an anteroom. If its door is left open more than 30 seconds, an alarm sounds.

Anyone going into the isolation room will suit up in an impermeable gown, gloves that go up to the forearms, booties, a surgical mask and a plastic face shield.

About 15 nurses at KU Hospital have volunteered for special training in taking care of Ebola patients.

Ebola has a 21-day incubation period. Infected people don’t become contagious until Ebola’s symptoms — fever, headache, muscle pains, diarrhea, vomiting, stomach ache and bleeding, and bruising — start to appear.

The virus is spread through direct contact with an infected person’s blood or body fluids, like sweat and saliva. It isn’t spread through the air.

Dallas nurse identified

The Kansas City, Kan., incident was reported on the heels of a Dallas nurse who was diagnosed with the virus over the weekend. The nurse — the first person known to contract Ebola on U.S. soil — had cared for Ebola victim Thomas Eric Duncan before he died at Texas Health Presbyterian Hospital.

The nurse was identified Monday as Nina Pham, 26, who has been a nurse since June 2010. She is in isolation at Texas Health Presbyterian.

The Rev. Jim Khoi, the priest at the church Pham’s family attends, said her mother had told him that Pham had been given blood from an Ebola survivor as part of her treatment.

Pham was said to have worn a gown, gloves, mask and face shield when she cared for Duncan. The CDC is investigating whether the gear was removed correctly after patient contact. So far, the exact source of Ebola transmission to Pham has not been announced.

Health officials are monitoring all people known to have been in close contact with Duncan and Pham. A team of 70 hospital workers had attended to Duncan before he died.

The employees drew Duncan’s blood, put tubes down his throat and wiped up his diarrhea. They analyzed his urine and wiped saliva from his lips, even after he had lost consciousness.

Thomas Frieden, director of the CDC, initially said Sunday there had been a “protocol breach” at the Dallas hospital, but the exact nature of that breach has not been confirmed, and Frieden on Monday apologized for that statement.

He said hospitals should “think Ebola first” whenever presented with Ebola-like symptoms. Meanwhile, he said the CDC would “double down” on outreach to spread information about how to safely treat Ebola patients.

In other Ebola-related developments:

Ebola worries Monday caused health providers in hazmat suits to take to Boston hospitals five people who were exhibiting flu or Ebola-like symtoms. The passengers arrived at Logan airport on a United Arab Emirates flight from Dubai. Authorities said the actions were taken as a precaution, and there was no word as to the passengers’ diagnoses.

President Barack Obama met Monday with some of his top national security aides and health officials to assess the government’s response so far, to recommend what it should be, and to push quick investigation of the Dallas infection.

Ebola screening began over the weekend of passengers who arrived at New York’s John F. Kennedy International Airport from flights that originated in West Africa.

Similar screening of passengers from Liberia, Sierra Leone or Guinea was scheduled to begin Thursday at Washington’s Dulles International Airport. Such screening also is set for Chicago’s O’Hare International, Atlanta’s Hartsfield-Jackson International and Newark Liberty International airports.

Authorities said there are no direct U.S. flights from the three West African countries, so passengers who arrive at Dulles are aboard flights from European cities.

Reacting to the worldwide situation, the World Health Organization called the outbreak “the most severe, acute health emergency seen in modern times.”

WHO Director-General Margaret Chan, citing World Bank figures, said 90 percent of economic costs of any outbreak “come from irrational and disorganized efforts of the public to avoid infection.”

Staffers of the global health organization “are very well aware that fear of infection has spread around the world much faster than the virus,” Chan said in a statement read out to a regional health conference in the Philippine capital, Manila.

“We are seeing right now how this virus can disrupt economies and societies around the world,” she said, but added that adequately educating the public was a “good defense strategy” and would allow governments to prevent economic disruptions.

Nurses’ concerns

Although many acute care hospitals in the Kansas City area and nationally have strict procedures and training to deal with infectious disease, a group of U.S. nurses on Monday said too many U.S. health centers are inadequately prepared to handle Ebola.

About 2,000 nurses responded to a National Nurses United survey by Sunday, saying that their facilities may be unprepared if an Ebola patient should fall under their care. Nurses in direct patient contact are among health care professionals on the front lines of controlling the spread of this disease or any other.

“Our hospitals are not prepared to confront the deadly virus,” the union’s executive director, RoseAnn DeMoro, asserted in an essay published Monday by The New York Times. “Too many hospitals are trying to get by on the cheap.”

Three-fourths of the nurses who responded to the union’s survey, representing 750 facilities in 46 states, said their hospitals had not yet communicated to them a policy regarding potential admission of Ebola patients. More than 8 in 10 said they hadn’t had a meeting with their hospital officials to ask questions about Ebola care.

The nurses union also reported that about one-third of the nurses said their hospitals lacked sufficient safety gear or adequately outfitted isolation rooms to handle a communicable disease like Ebola.

Some infectious-disease experts suggested Monday that only large hospitals — typically those affiliated with major universities — generally have the equipment and manpower to deal with Ebola correctly.

There are an estimated 2.7 million to 2.8 million registered nurses and about 700,000 licensed practical nurses working in the United States, according to national labor reports.

Officials at Level One trauma centers, such as Truman Medical Center and KU Hospital, think they are prepared for their front-line health care workers to protect themselves from Ebola infection.

“We’re reiterating the training and protocol we use every day,” said Shane Kovac, spokesman for Truman. “It’s no different from any other infectious disease protocol. It’s care that a Level One trauma center applies every day.”

The St. Luke’s Health System and Shawnee Mission Medical Center also said their facilities have ramped up their infectious disease training and protocols.

The nurses union pointed out, though, that an Ebola sufferer might not arrive at the emergency room of an acute care hospital that has that training and equipment in place.

Investigators also are looking at dialysis and intubation procedures and their potential to spread the virus. Some health care officials are suggesting that some procedures perhaps should be abandoned in Ebola patients who are expected to die.

Authorities say Ebola is spread through contact with a symptomatic person’s bodily fluids — blood, sweat, vomit, urine, saliva or semen. They say people in close contact with the patient must have an “entry point,” such as a cut or scrape, or touch their own noses, mouths or eyes with contaminant to contract the disease.

Truman’s Kovac said it’s important to “get over the fear factor” but continue to be vigilant. He said that means repetitive training.

“We’re working on a ‘donning and doffing’ video to illustrate handling protective equipment,” Kovac said.

The national nurses union has scheduled a national call-in for Wednesday to allow nurses to discuss “the concerns for registered nurses and other front-line hospital personnel who would be among the first to respond and interact with other patients about whether their hospital is doing enough to protect health workers as well as the general public,” DeMoro said in a press release.

“Nurses locally have the same concerns as nationally,” said Julie Perry, a registered nurse and labor representative for nurses at Research and Menorah medical centers in the Kansas City area. “It’s all about preparedness … about nurses making suggestions about what those preparedness plans should include.”

The nurses union also is asking for better training about how to dispose of medical waste and linen and how to remove protective gear.

The CDC has published detailed guidelines about Ebola patient care, but nursing representatives on Monday said there are doubts about how thoroughly that information is shared with front-line workers.

In some cases, hospitals “post something on a bulletin board referring workers and nurses to the CDC guidelines,” Bonnie Castillo, a disaster relief specialist at National Nurses United, told the Reuters news service. “That is not how you drill and practice and become expert.”

CDC spokesman Tom Skinner said the agency may consider designating specific hospitals in each region as Ebola treatment facilities. One recommendation suggested a designated Ebola-treatment hospital in every state.

Currently there are four hospitals in the United States that have specialized biocontamination units with extensive training to handle Ebola. They are Emory University Hospital in Atlanta; the University of Nebraska Medical Center in Omaha, Neb.; the National Institutes of Health in Bethesda, Md.; and St. Patrick Hospital in Missoula, Mont. The latter hospital is the only one of the four that has not yet treated an Ebola patient.

The four hospitals have extensively equipped rooms and staff training, including periodic infectious disease drills. But, as happened in Dallas, an infected patient is more likely to show up in the emergency room of any hospital.

Star news services contributed to this report. To reach Diane Stafford, call 816-234-4359 or send email to stafford@kcstar.com. To reach Alan Bavley, call 816-234-4858 or send email to abavley@kcstar.com.

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