Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting patients into isolation. Still, Ebola is different.
"I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it," says Ross, who directs infection control for Hartford Healthcare's five hospitals in Connecticut.
On a tour of Hartford Hospital, Ross explains how his Ebola control plan would affect various parts of the facility — from the emergency room, to the intensive care unit, to the floors of rooms where patients stay.
"This would be an area that we would close off with plastic sheeting," Ross says. "Right here, we'd have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out."
In Connecticut, the idea of taking care of an Ebola patient is still just theoretical; one of the reasons that public health officials are confident that American hospitals could contain an outbreak in the U.S. is because facilities in every state can accommodate the isolation and sanitation measures that are needed to keep the virus from spreading.
The best place to put someone who falls ill, for instance, is at the end of a hall in a room with its own bathroom, anteroom and entrance. "The rest of the floor is safe," Ross says. "I limit the amount of traffic. I'm able to do the care there."
Ross and his team are preparing in other ways, too. With the help of the Centers for Disease Control and Prevention, he has made a specific list of questions that doctors and nurses will ask incoming patients about symptoms and travel. He has inventoried the supplies they would need to treat an Ebola patient.
Ross says he understands the general public's concern when it comes to Ebola; the symptoms and severity of the illness are frightening. But he also says this: Ebola might frighten the general public, but the virus doesn't threaten the public.
"This is not something that will become established in the local general American population," Ross says. Why not? In the United States, a strong medical infrastructure should allow health workers to relatively quickly diagnose the infection, trace contacts, isolate patients with symptoms and offer them the needed intravenous fluids and other supportive treatment. And, in comparison to, say, the flu or measles, the Ebola virus is not spread through the air and is not very contagious. The people at risk of catching Ebola are people who have been in close, unprotected contact with someone who is sick with active symptoms of the disease.
"The risk here in America from an imported case would be to health care workers in a hospital environment," Ross says.
Indeed, so far, the only known case of Ebola that has been transmitted outside of a West African country is a nurse in Spain who fell ill after caring for two missionaries who contracted the disease in Africa and eventually died. While anyone in close physical contact with a symptomatic patient is at some risk, the evidence suggests that the people most likely to be exposed to the virus from these isolated cases are family members and health care workers.
For that reason, Ross says hospital workers have to be painstakingly vigilant. That begins with the triage questions nurses and doctors ask patients coming into the emergency room, and at various other times throughout their treatment.
According to protocol, if a patient is diagnosed with Ebola, health care workers treating that patient need to wear a face mask or goggles, and they also need a buddy with them as they put on and take off their protective clothing. All of that is to make sure they don't come into any contact with the infected patient's body fluids.
The gear used to care for an Ebola patient — the goggles, the clothing, the bed linens — then becomes contaminated waste that has to be treated and sterilized in much the same way as tools being prepared for use in an operating room. Just how that's accomplished will be determined on a case-by-case basis, governed by the CDC and the federal Department of Transportation.
After decades of work in the field of infectious disease, Ross feels prepared. Still, he says, he expects to be nervous if and when he treats a person with Ebola.
"My heart may be pounding, my palms may be sweating," he says. "I think it's only a natural human response that we would have heightened awareness and some nervousness as we go through this."
Ross says he'd be concerned about any caregiver treating Ebola who wasn't at least a little nervous, too.
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