Existing protocols might not be enough for Ebola
DALLAS — As Thomas Eric Duncan’s health deteriorated, nurses Amber Joy Vinson and Nina Pham were at the Ebola patient’s side.
They wore protective gear, including face shields, hazardous materials suits and protective footwear, as they inserted catheters, drew blood and dealt with his body fluids. Still, the two somehow contracted Ebola from the dying man.
As health officials try to figure out how that happened, the nurses’ cases have brought new scrutiny to national Ebola protocols that had never before been put to the test at a general hospital. Authorities are examining whether those guidelines need to be rewritten.
A nurse at Texas Health Presbyterian Hospital, Briana Aguirre, said on NBC’s Today show that nurses and other employees were asking their supervisors what they should be doing.
“Our infectious disease department was contacted to ask, ‘What is the protocol?’ ” Aguirre said. “And their answer was, ‘We don’t know. We’re going to have to call you back.’ ”
Aguirre, who did not deal directly with Duncan but helped take care of Pham, said the protective gear they were provided left the neck exposed.
Texas Health Presbyterian had no immediate response to Aguirre’s comments. It had said earlier Thursday it followed federal guidelines in treating Duncan and “sought additional guidance and clarity.”
The U.S. Centers for Disease Control and Prevention protocols for Ebola recommend nurses use personal protective equipment such as gloves, goggles, face shields and fluid-resistant gowns — as Vinson and Pham did. They also recommend diligent cleaning and disinfection of any items containing contaminated materials.
More than 75 people have been identified as being involved in Duncan’s care, including the nowsick nurses.
CDC director Dr. Tom Frieden told a congressional hearing on Thursday that while the CDC is “absolutely looking for other mutations” in the Ebola virus, it hasn’t found any.
“We don’t think it is transmitting in a different way” other than through bodily fluids, he said. He added that the investigators have “identified some possible causes.”
Discovering the cause of the exposure is vital in assessing whether the CDC protocols themselves failed and should be changed. Lawmakers expressed amazement that the nurses were not wearing full-body gear from the moment Duncan arrived. “I would certainly hope that if a patient shows up saying he’s from Africa and is vomiting and has diarrhea that you wouldn’t say, ‘Well, we don’t have the lab results in yet.’ You would start treating that person like they had Ebola,” Rep. Diana Degette said.
Frieden had said earlier this week that health care workers at Texas Health Presbyterian had not followed proper protocols for wearing protective clothing while caring for Duncan, who died from Ebola on Oct. 8.
Yet this allegation is now being disputed by the hospital itself. Dr. Daniel Varga, a senior vice-president at Texas Health Resources, testified protocol was followed.
Frieden also admitted that the CDC last weekend allowed Vinson to travel on a commercial flight from Dallas to Cleveland and back again.
He claimed Wednesday that Vinson had broken protocols that barred health-care workers treating Ebola patients from public transit.
Frieden now revealed that Vinson had asked the CDC for permission to fly and it was granted. Frieden said he was not sure why she was allowed to fly. He added, however, that if Vinson had been wearing full-body protective gear throughout her treatment of Duncan, she would have been allowed to fly.
Pham, 26, who has been getting treatment at the Dallas hospital, will be taken Thursday to the National Institutes of Health in Bethesda, Maryland, which has one of four biocontainment units in the United States. Vinson, 29, who tested positive Wednesday, has been transferred to a highlevel biohazard infectious disease centre at Emory University Hospital in Atlanta.
The World Health Organization and Doctors Without Borders have developed relatively safe ways to care for people during many large and deadly outbreaks in Africa over the past four decades.
But Ebola is a new phenomenon in the U.S., providing an opportunity for health officials to revise protocols.
The current outbreak, the largest in history, is blamed not on protocol violations but on a lack of care. The virus has killed almost 4,500 people, most of them in West Africa.