Transparency in communication was crucial to confronting the public fear after the first Ebola case in Dallas caught the city’s health officials and providers by surprise, said several renowned panelists at The Dallas Morning News forum on Nov. 5 at UTD.
The panel discussion titled “Vital Lessons: How Dallas Confronted the Ebola Challenge” brought together important public figures, including Dallas County Judge Clay Jenkins, Texas Health Presbyterian Hospital’s Chief Clinical Officer Dan Varga and Richardson Mayor Laura Maczka, to discuss the lessons learned from the Ebola outbreak both for Texas Health and the city.
Since the detection of the disease in the ’80s, the Centers for Disease Control and Prevention, or CDC, has instituted guidelines for hospitals on the treatment of Ebola, which are reviewed by Ebola experts several times a decade, said Robert Haley, a UT Southwestern Medical Center professor. These guidelines are implemented by more than 5,000 hospitals across the country.
The problem was not Texas Health, Haley said, but the guidelines themselves, which everyone thought would work.
“So when it happened, I would like to think it was just a blind spot for all of the experts and the whole country,” he said.
When Thomas Eric Duncan, the first Ebola patient in the United States, came to Texas Health on Sept. 26, he was sent back home. Two days later, he had to be brought back in by the Emergency Services, and on Sept. 30 he was confirmed to have Ebola.
Duncan died on Oct. 8, but three days later, Nina Pham, a nurse who had cared for him in the later stages of the illness, was diagnosed with Ebola. Amber Vinson, another nurse who had treated Duncan, showed Ebola symptoms around the same time.
Both Pham and Vinson have recovered since and no one else in contact with these three patients was reported to have contracted the disease in the 21-day gestation period.
While Texas Health has been unable to identify the exact point of breach in protocol that caused the nurses to contract Ebola, all nurses were aware of how to use protective equipment, Varga said.
Like every other hospital in the country, nurses and staff at Texas Health had gone through drills and knew what to do if an Ebola patient came for treatment, he said.
However, they hadn’t gone through any simulations that would help emergency room nurses to diagnose Ebola symptoms, Varga said.
“If we were to step back and ask of Presbyterian’s preparedness, we would say that we were completely prepared to take care of a patient who walked in with a diagnosis of Ebola but less than completely well prepared to have a patient walk in off the streets with nonspecific symptoms and make a diagnosis of Ebola,” he said.
Duncan’s family has settled a lawsuit out of court with Texas Health.
However, the hospital is expected to have an external review of how well it handled the Ebola cases by the end of the first quarter next year, Varga said. The procedures and protocols followed, as well as how well the information technology system was used for diagnosis are also going to be examined.
Defending Texas Health’s actions during Duncan’s initial misdiagnosis, Varga said the hospital was as prepared as it could have been at the time.
“I think what Presbyterian went through is likely what would have happened at almost any hospital in the country,” he said.
While Duncan was kept at Texas Health for the entire duration of his illness, Pham and Vinson were moved to a National Institutes of Health facility in Baltimore and Emory Hospital in Atlanta, respectively, due to a staff shortage at Texas Health at the time, Varga said. The hospital was already monitoring more than 70 healthcare providers who had come into contact with Duncan and didn’t have the resources needed to care for two more patients.
CDC experts and Dallas County officials had toured several tier one and tier two hospitals after the Ebola outbreak to assess which hospitals would be able to care for several Ebola patients in isolation, should the situation arise, said David Lakey, Texas Department of State Health Services commissioner.
After reviewing different options, the Richardson Methodist Hospital was picked to be the Ebola treatment center, so that large hospitals could continue providing care to patients with other diseases such as the flu, Jenkins said.
Methodist had just moved to a newer facility by the President George Bush Turnpike, and the old facility was being repurposed. It had a direct entry where other patients wouldn’t have to come in contact with an Ebola patient, so it was a perfect choice for treatment that would require severe isolation, Maczka said.
The City of Richardson immediately sent out information to residents that live close to the hospital, allaying fears about the possible spread of the disease.
The community went from being afraid and concerned about the location to being educated about the spread of Ebola and then proud that they would be able to support the care of those in need, Maczka said.
“The lesson we learned is ‘share the information,’” she said.
Communication was also the strategy adopted by the Dallas Independent School District, said DISD Superintendent Mike Miles.
The school district released Ebola factsheets and communicated regularly with parents and students.
“We erred on the side of transparency right away, knowing that if the rumors got out it would be hard to combat that,” Miles said.
Although unnecessary, schools were decontaminated when students came into contact with people who had been around an Ebola patient, he said. The challenge is to not go overboard with the panic and abide by the guidelines while keeping the community safe and happy, Miles said.
At the same time, a fine balance had to be struck between being transparent and disclosing confidential patient information, Varga said.
Outbreaks are difficult to forecast, and just like with other diseases like HIV and West Nile virus, this one was a way to understand what happened and plan best for the next surprise, said Cedric Spak, infectious disease specialist at the Baylor University Medical Center.
With high rates of international travel and diseases with similar symptoms such as Ebola and flu, monitoring international travel will be key to prevention and diagnosis of diseases, said William Sutker, chief of infectious diseases at the Baylor Scott & White Hospital, North Texas Division.
The Texas Task Force, instated after the first Ebola diagnosis in Dallas, reviewed and added more guidelines for Texas hospitals in order to prepare for any future outbreaks of the disease, Lakey said. The task force comprised infectious disease and bioterrorism experts.
As part of the new guidelines, it was also important to state new quarantine rules for healthcare providers traveling internationally to treat patients, Jenkins said.
While they should be monitored after their return as they are high-risk individuals, they cannot be expected to put 21 days of their lives on hold, and these guidelines ensured that healthcare providers were not being disincentivized to provide care, he said.
Meanwhile, Ebola vaccines are still limited in supply, and there are currently only six specialized labs that research Ebola vaccines in the country, said Anthony Griffiths, an associate scientist at the Texas Biomedical Research Institute. While more federal funding will definitely help the cause, the real issue is developing such labs, he said.
The hope is that this incident will translate into more federal dollars toward research in Texas and as a whole, said Dallas County Health and Human Services Director Zachary Thompson.
“This was a wake-up call for the nation that funding cannot be cut in public healthcare,” he said.
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