Getting on Top of Ebola

ER staff at Westlake Hospital in Melrose Park got a chilling taste of treating a possible Ebola patient this past October. A young man walked into the ER saying he had been running a fever and had abdominal cramps. Following CDC guidelines to the hilt, registration knew immediately what questions to ask: Any recent travel? Out of this country? “Yes,” the young man said. He claimed he had been doing humanitarian work in Liberia. ER staff immediately gave him a mask to wear and moved him to a separate area. But not before several frightened patients started heading towards the exits. They were intercepted by Mike Ditoro, Westlake’s COO, who explained that this was only a drill; that the “Ebola man” was actually a pharmacy student who no one at the hospital knew, and he was hamming it up so Westlake could test its ability.

“The patients were happy and thankful for what we were doing, and returned to their seats,” Mr. Ditoro said. “We are going to have a continuous focus on these kinds of drills; it’s the only way we can stay safe.” Conceding that Ebola preparedness has cost a considerable amount of money, Mr. Ditoro said it is worth it. “This gives us a re-emphasis on appropriate procedures to keep us safe. It’s no distraction. Nothing is more important than the safety of our patients and caregivers.”

While Chicago hasn’t been visited by an Ebola patient, our local health care community has been working closely together to fine-tune procedures and protocols since the first U.S. Ebola case surfaced this past September in Dallas.

“This is a learning experience for all of us, and we have been very fortunate to have had the time to prepare over the last two months; the entire health care community has responded,” says Stephanie Black, MD, medical director of communicable disease for the Chicago Department of Public Health (CDPH). The department is overseeing a major, multi-pronged effort to deal safely with any Ebola situation that may hit Chicago.

Among the major players in this effort are four hospitals that have agreed to be part of the Ebola Response Network by volunteering to treat, and to take appropriate transfers of patients suspected or confirmed to have Ebola from other hospitals. The four institutions are Rush University Medical Center, University of Chicago Medical Center, Northwestern Memorial Hospital, and Ann and Robert H. Lurie Children’s Hospital. These institutions are working directly with CDPH. The department is:

• Acting as the liaison for the Centers for Disease Control, providing protocols, procedures and updates to all Chicago-area hospitals, in addition to the four network hospitals.
• Holding weekly teleconference calls with area hospitals, instructing them on how to transfer an Ebola patient to one of the four network hospitals.
• Encouraging hospitals to conduct Ebola drills.
• Making sure that hospitals have the proper Personal Protective Equipment (PPE) on hand.
• Going door-to-door to provide information about Ebola to outpatient clinics.
• Establishing protocols for tracing Ebola contacts and monitoring them, carefully following CDC guidelines. “We want protocols that protect the population, yet don’t discourage health care workers from participating in the care of Ebola patients,” Dr. Black said.

At Rush University Medical Center, infectious disease specialist Michael Lin, MD, concurs that all the hospitals are working together to share best practices. “If one hospital runs out of supplies, like PPE, the others are here to share,” he said. “Cooperation is possible because of leadership with CDPH, and from the Illinois Department of Public Health. They are really interacting with us and helping coordinate our efforts.” While Dr. Lin expressed his concern over the time involved for Ebola preparedness (“Everything I normally would be doing at the hospital was pushed aside”), he says the work was necessary.

Northwestern Memorial Hospital’s Robert Murphy, MD, director of the hospital’s Center for Global Health, said care providers spent three days just learning how to properly don and doff PPE appropriately, using the buddy system. “It’s very uncomfortable to wear, and we’ll still need to practice,” he said, “but Northwestern is adhering to the very clearly laid out procedures from the CDPH.” Dr. Murphy is hopeful for the future. “I worked in Nigeria for 15 years. They have been successfully handling the crisis there; we can handle it in the United States.” He also said the Ebola virus could likely be prevented by an immunogenic vaccine, which is being developed with the National Institutes of Health in conjunction with GlaxoSmithKline.

Speaking from one of the smaller hospitals about their Ebola preparedness, Vishnu Chundi, MD, says, “We have rapidly instituted recommendations from the CDPH.” Dr. Chundi, who is head of infection control at Westlake Hospital and West Suburban Medical Center in Oak Park, says his facilities are now fully prepared to screen and triage any suspected Ebola patient to an appropriate room so the rest of ER patients are safe. In addition, housekeeping staff and support personnel are undergoing training to avoid contamination.

“This is the first time Ebola has come to the Western world, but there was no big manual for it,” Dr. Chundi says. “We are getting on top of this and by the end of the day, we’ll have gotten through it.” He says that it’s important for all physicians to keep on top of the Ebola issue to answer their patients’ questions, like, “Can I catch Ebola by riding on the bus or a plane?”

At the north side Chicago office of James McCreary, MD, staff asks any patient who is calling in for an appointment if they have been running a fever, and if they have traveled outside the country. Dr. McCreary’s office supervisor, Theresa Beyer, says they explain to all their patients why they are being screened before they come into the office. “They have been very respectful and understanding,” she says. The office is part of the Presence Health group, which provided its physicians a formal screening plan, as well as continuing Ebola email updates, along with a PPE kit. Ms. Beyer says her office is also in contact with CDPH.

“This is an ongoing effort,” says CDPH’s Dr. Stephanie Black. “Until we get source control in Africa, we need to be ready for cases here, and keep providing more education.”