Chicago Braces for Ebola

Local health care leaders describe preparedness efforts
By Scott Warner

Now that the United States has seen its first confirmed cases of Ebola Virus Disease in Dallas and New York, many cities are on edge. As a major transportation hub, can Chicago be far behind? “It’s not unlikely that Chicago will have a case of Ebola,” says Jorge Parada, MD, MPH, medical director of the Loyola University Medical System infection prevention and control program.

He pointed out the recent event in Dallas, where Liberian Thomas Duncan died from Ebola and infected two nurses at Texas Health Presbyterian Hospital. Because of an apparent misstep at the hospital, Mr. Duncan was not initially checked for Ebola. “What happened in Dallas is a heads-up to medical centers everywhere,” says Dr. Parada. “We need to do a better job with communications. It’s the responsibility of everyone on the health care team to ask questions about travel history, and possible contact with anyone who had Ebola,” Dr. Parada stressed.

He outlined the steps Loyola is taking to prepare for possible Ebola cases:

• We have a 20+ “code e” Ebola response plan. It is a live document in constant evolution as new information and CDC recommendations become available. It addresses triage/screening, activating the incident command center, use of infection control precautions/PPE, patient placement and flow of materials such as lab specimen handling, infectious waste, and contacts with public health agencies and departments.
• Additional training is an ongoing top priority. We are making major efforts with ED and ICU staff, and expanding to ID, urgent care, and lab staff. I cannot overstate how much we consider this to be of maximal importance. However, unlike Emory University Hospital in Atlanta, and the Nebraska Medical Center in Omaha, we did not have a substantial number of well-trained individuals certified in high-level PPE donning and doffing. We are using the “buddy” system.
• We are all hanging on every recommendation from the CDC, which has provided more information and guidance than any other source. That said, this is also the first time that Ebola has been treated in an advanced health care system, as well as the first time we could compare and contrast care at a bio safety level 3 facility with a “normal” hospital. We would all like better guidance, but I think we have to recognize that we are learning as we go, and have received lots of guidance from the CDC.
• We are doing a lot of things differently than before the crisis erupted. We are screening patients for signs and symptoms, plus travel history. We have modified our electronic medical record; we have trained staff on high-level PPE use; we are re-examining lab specimen processing, waste processing and disposal; we have built and activated an Ebola website on our intranet with our plan, facts, contacts, links, and more.

Speculating on the possibility of an Ebola outbreak in Chicago or throughout the United States, Dr. Parada foresees more cases in this country, but he is confident the disease will be contained by quarantine. Dr. Parada’s chief concern is what he calls the completely inadequate containment response in West Africa. “They do not have resources to contain Ebola, and so the disease is likely to spread to other countries. We need an international response, and unless there is one, things will get much worse.”

Other health care leaders are also offering their opinions and advice on how to deal with the Ebola Virus.

LaMar Hasbrouck, MD, director of the Illinois Department of Public Health, says the IDPH is working with the CDC, hospitals, the Chicago Department of Public Health, and the newly established screening center at O’Hare International Airport to establish guidelines for evaluating patients and handling specimens. Dr. Hasbrouck says IDPH continuously provides all updated CDC guidance through SIREN (State of Illinois Rapid Electronic Notification) to infectious disease physicians, health care providers, health facilities, and EMS systems.

Stephanie Black, MD, medical director of communicable disease for the CDPH, says the department has been working with health care staff in hospitals and in other settings to ensure they are aware of diagnostic, testing, reporting and infection control recommendations. She defers to the CDC guidelines for the handling of Ebola patients. If Chicago physicians are concerned that they could have an Ebola patient in their office, Dr. Black says they should immediately call 311 and ask for the communicable disease doctor on call.

David Schwartz, MD, division chief of infectious disease at John H. Stroger, Jr., Hospital of Cook County, concurs. “We need to keep the possibility of Ebola infection on our radar. The biggest risk is for people to be hospitalized but not recognized as possible Ebola patients.”

Danny Chun, spokesperson for the Illinois Hospital Association, states that, “The Ebola situation is rapidly evolving, and our hospitals are working closely with and diligently following the guidelines and near-daily briefings from the IDPH and the CDPH.”

Anthony Fauci, MD, director of the National Institutes of Allergy and Infectious Diseases, says multiple vaccine models are being researched at the moment. Proper testing is paramount, he emphasizes. “You can’t just give it out,” Dr. Fauci said recently on CBS News. “You have to determine if it works. That will likely take place in the first quarter of 2015.”