Dallas Exporting New Ebola Cases Biocontainment Centers

New Ebola patients in Dallas will be transferred to three top infectious-disease centers in the U.S., a Texas official said yesterday.

The new treatment strategy follows national scrutiny of cases at Texas Health Presbyterian Hospital, a Dallas facility that has handled three Ebola patients and said it made mistakes in its treatment of Thomas Eric Duncan, who died on Oct. 8. Two nurses at the hospital who contracted Ebola from him have already been transferred, each to one of the top national centers that specialize in treating contagions.

“We’re intaking and sending away from Presbyterian now with an idea that Ebola-positive care will be somewhere else,” said Judge Clay Jenkins, the county’s top executive, at a news briefing yesterday. Spokesmen for the hospital didn’t return e-mails and phone calls seeking comment.

Dallas’s plans may be a harbinger of a new national policy on handling patients with the deadly virus. The Centers for Disease Control and Prevention, which is based in Atlanta, is working with Texas and various hospitals to coordinate a patient placement plan, said Dave Daigle, an agency spokesman, by telephone.

Jenkins said he wanted the three isolation rooms at Presbyterian Hospital to have “plenty of room” for patients who may be under observation for possible Ebola symptoms.

Patients who test positive for the deadly virus will be transferred to Emory University Hospital in Atlanta, the National Institutes of Health Clinical Center in Bethesda, Maryland, or St. Patrick Hospital in Missoula, Montana, all of which have top-level biocontainment units, Jenkins said.

Emory is caring for Presbyterian nurse Amber Vinson, and the National Institutes of Health clinic has admitted her colleague Nina Pham. As the officials work out patient transfer plans, more than 70 health workers continue to be monitored for potential Ebola contact.

The University of Texas Medical Branch at Galveston, about 50 miles south of Houston, also is available to treat any new Ebola patients that test positive in the immediate future, Jenkins said.

Paul Reyes, a spokesman for UTMB, said the hospital hasn’t been asked to accept any new Ebola patients that might come from Dallas but has “every confidence our staff will be able to help.” The other infectious-disease treatment centers Jenkins named did not immediately respond to requests for comment.

The CDC is also planning to issue stricter Ebola guidelines to protect the nation’s medical workers after the caregivers infections in Dallas.

The recommendations follow sharp criticism by some in Congress of existing CDC safety protocols. They increase attention to covering every bit of skin, safely donning and removing protective wear, and properly disposing of infected medical waste.

“The original recommendations that we put out in August provided a lot of flexibility,” said Abbigail Tumpey, an associate director for communications science at the CDC, in an interview

Hospitals “in the past wanted to adapt to what they have locally,” Tumpey said in an interview at CDC headquarters. “What we found in Dallas is that some of that adaptation could lead to potential confusion. These new recommendations are going to be much more specific.”

The new CDC guidelines are being prepared for release as President Barack Obama named former White House official Ron Klain to coordinate the U.S. response to Ebola amid rising public concern about his administration’s response. Klain, 53, a former chief of staff to Vice President Joe Biden, received the assignment after the CDC was criticized at a congressional hearing over its handling of the Ebola cases.

Concerns about prevention protocols arose after National Nurses United, a labor union, said Presbyterian Hospital supplied safety suits with exposed necks, and sent Duncan’s lab specimens through the system without being specially sealed. The group also said the hospital left Duncan for hours in an area with other patients.

Criticism of the CDC grew further after Vinson, one of the nurses, went to the hospital this week with a fever the day after taking an airline flight, and was found to be infected. She has been moved to the specialized isolation unit at Emory. Her trip to Cleveland after Duncan died has touched off widespread precautions and efforts to contact and monitor those she may have been near.

Ohio officials have reached 87 state residents who were on the flights to or from Dallas with Vinson, or were at an Akron bridal shop she visited on Oct. 11, said Donna Skoda, assistant Summit County health commissioner.

Twenty-nine people from six Ohio counties are being reviewed to determine the level of contact they had with Vinson, Skoda said in an interview. Of that number, 12 are being actively monitored by having health officials check their temperature daily, and one has been quarantined, she said.

Frontier Airlines has now taken off duty, with pay, the flight crews from both legs of Vinson’s trip, according to spokesman Todd Lehmacher.

The newest CDC guidelines will contain specific recommendations, such as urging workers to cover all of their skin and use alcohol-based hand sanitizer on protective gloves. They also recommend a dressing room be set up outside medical-care areas, and that hospitals implement a “buddy system,” according to Tumpey.

The buddy system, where workers watch each other put on and take off protective equipment, has been used widely in Ebola outbreaks in Africa and is the standard for Doctors Without Borders, a global humanitarian group.

The CDC also is readying new guidelines for health-care workers performing medical procedures, such as dialysis and delivery of babies, on Ebola patients, Tumpey said.

Duncan received dialysis and respiratory intubation, two areas where a breach may have occurred and led to the caregivers’ infections, CDC Director Thomas Frieden said on Oct. 13. The new guidelines were developed after extensive interviews with health-care workers that had experience in caring for Ebola patients, according to Tumpey.

CDC officials also met with the National Institute of Occupational Safety and Health, the Occupational Safety and Health Administration, and the U.S. Department of Transportation, which oversees disposal of medical waste, to write the new protocol, she said.

Obama said he’s mobilizing the federal government to contain any spread of the virus within the country’s borders. He said the key to stemming the outbreak is battling it in West Africa. More than 4,500 people have died from Ebola this year, mostly in Guinea, Liberia and Sierra Leone.

To contact the reporters on this story: Harry R. Weber in Dallas at hweber14@bloomberg.net; Caroline Chen in Dallas at cchen509@bloomberg.net; John Lauerman in Boston at jlauerman@bloomberg.net

To contact the editors responsible for this story: David Marino at dmarino4@bloomberg.net Gary Putka