If Ebola started spreading inside the United States, the responsibility for quarantining Americans who fell ill with the deadly virus would fall to local hospitals, and many health professionals question whether the facilities would be up to the task.
A senior press officer at the Centers for Disease Control in Atlanta confirmed to WND Friday that the CDC’s 20 quarantine stations located at ports of entry and border areas are not designed to house domestic patients.
“Those are for people entering the states and for travelers,” said Benjamin Haynes, spokesman for the CDC’s Infectious Disease Team.
He said the 20 stations “were strictly designed to stop the spread of diseases through travel and ports of entry. If there were a serious outbreak (inside the country), I’m not sure. Usually hospitals will set up those quarantine stations – it just really depends on the situation. I don’t know if there’s ever been a situation of a major outbreak like that, and if so I’m not aware of it.”
Asked if American hospitals are prepared to treat Ebola patients even in small towns and rural areas, Haynes deferred to Kristen Nordlund, another CDC spokesperson.
“Basically any U.S. hospital that follows CDC safety guidelines, infection guidelines, can isolate a patient in their own room and safely manage a patient suspected of having Ebola or a patient with Ebola,” Nordlund told WND. “We don’t really expect an outbreak to happen, so people in the U.S. really don’t have much to worry about.”
To worry or not to worry?
CDC Director Dr. Tom Frieden testified before Congress Thursday that it’s only a matter of time before someone with Ebola gets on a plane and arrives in the U.S., but the CDC still considers the likelihood of the disease spreading in the U.S. as almost nonexistent. That rosy scenario is not shared by all medical doctors. And even if the threat of an outbreak here is low, some physicians insist that the CDC should be doing more to prepare doctors and hospitals for a worst-case scenario.
Dr. Elizabeth Lee Vliet, MD, and a past director of the Association of American Physicians and Surgeons, is one of those doctors with concerns.
She recently did a series of radio interviews with noted virologist and bio-weapons specialist Dr. Steven Hatfill, who said Ebola presents hospitals with challenges that are greater than the typical infections present in such environments.
Hatfill studied the Ebola virus at the U.S. Army’s Institute for Infectious Diseases at Fort Detrick in Maryland. What he found was intriguing. There doesn’t need to be much of the virus present for it to infect.
“He confirmed Ebola is unique in that it can initiate an infection in from one to 10 viral particles, so I think it is minimizing the risk by saying it is like other viral infections, when you’re dealing with a high death rate and such a minute number of particles,” Vliet said.
She also pointed to a 2012 Canadian study in which healthy and infected monkeys were housed side by side in cages but had no physical contact. The healthy monkeys contracted Ebola.
And, according to a Canadian public health advisory, airborne spread of the virus among humans is “strongly suspected, although it has not yet been conclusively demonstrated.”
Generally, it takes far more than one to 10 organisms to transmit a virus.
“That’s one reason the virus is so out of control, is it takes so few particles,” Vliet said. “Dr. Hatfill, and the Canadian public health advisory, which is more detailed than the CDC, they talk about airborne transmission in much more specific terms than the CDC does.”
Ebola virus also stays active longer in body fluids such as blood and semen than most other viruses.
According to the Public Health Agency of Canada fact sheet on Ebola, the virus remains communicable “as long as blood, secretions, organs, or semen contain the virus.”
The Canadian alert also states that Ebola virus can remain active in a man’s semen 61 days after the onset of illness, and transmission of the disease through semen has occurred up to seven weeks after a man has recovered from the illness.
“This is why I’m concerned, as a physician, that perhaps our hospitals are not as well prepared as we would like to think. Because if other doctors don’t know this and if the CDC is not saying anything, if somebody recovers from Ebola and 60 days later the man ejaculates, he could infect his partner,” Vliet said. “I just think it’s huge. I think they are really underestimating the risk. I understand they are not wanting to create panic, but if doctors are not used to treating Ebola and they’re not getting the same information from the CDC as the Canadian doctors are getting … I’m not trying to create a panic. I’m just saying let’s get the information out.”
Infections already out of control in U.S. hospitals
Vliet said American hospitals already have a problem with prevention of MRSA, a type of staph infection, and clostridium difficile, or C. difficile. According to the CDC’s own estimates, 5 to 10 percent of hospital patients in the U.S. get some kind of preventable infection. Approximately 1.7 million of these infections occur in U.S. hospitals each year, resulting in 99,000 deaths and an estimated $20 billion in health-care costs.
“U.S. hospitals already have difficulty controlling the growing spread of in-hospital acquired infections particularly with MRSA and C. difficile, and I am very concerned, based upon that difficultly, that they would not be well equipped to handle the extreme precautions needed for Ebola, if they had large numbers of patients to treat,” said Vliet, who has spent the past five years practicing medicine in Central and South America.
She said even 20 Ebola patients in a single area would pose concerns.
“They’re not going to have the isolation rooms they need. I was impressed with the more stringent infection control procedures in use in Santiago, Chile, where I have been working on medical projects the last two years,” she said. “They do not even allow flowers to be sent to patient rooms because they carry infectious agents. It was absolutely prohibited. And family members couldn’t even bring in to the hospital outside food for patients because of the risk of infections.”
Ideally, patients with such deadly infectious diseases as Ebola would be treated in negative-pressure rooms. These systems allow air to flow into the isolation room but not out, thus preventing contaminated air from escaping the room.
Dr. Jane Orient, president of Oregon-based Doctors for Disaster Preparedness, also believes hospitals should be getting better prepared for an Ebola outbreak, starting with negative pressure upgrades.
“I think there are very few hospitals that have negative pressure isolation rooms and, if they do, it’s probably only one or two. This has been one of the problems with treating patients with drug-resistant tuberculosis,” Orient said. “Tuberculosis is transferred by aerosols and Ebola is not, but it’s not inconceivable it could be.
“Smaller hospitals, they really are not prepared to do a high-level quarantine and a lot of bigger hospitals aren’t, either,” she continued. “It requires some structural engineering.”
Orient said an outbreak would likely require people in small towns or rural areas to be transported to larger hospitals in urban centers or suburbs.
“I would guess that (transfer to larger hospitals) is what they would try to do, but I don’t think our ambulances are prepared to deal with high-level infectious threats, either,” she said. “So you do the best you can, and having gowns and masks and impermeable suits is better than what they have in Africa.”
Canada and the United States have led the world in spending to upgrade surveillance and detection, isolation and treatment of Ebola virus. Yet, one is giving out more information than the other.
“Look at the two public health alerts,” Vliet said. “This is what they put out to educate the public and the doctors. It’s pretty detailed on Canadian side. And I think it raises concerns that we in the United States should pay attention to. You can’t prepare for something if you don’t know its coming and you aren’t prepared for the best ways on how to deal with it.”
She said doctors could better prepare themselves and their hospitals if they knew all of the risks involved and were given the chance to prepare for the worst.
“I’m tired of the government glibly downplaying something as important as this,” Vliet said.