CCHC implements Ebola protocol

A day after Ebola claimed its first victim on American soil, local hospital officials announced they have updated plans to identify and contain the rare but deadly virus on the chance it shows up on Cape Cod.

Patients arriving at the emergency centers at Cape Cod and Falmouth hospitals with Ebolalike symptoms — including fever, body aches, diarrhea and vomiting — will be asked if they have recently traveled to countries in West Africa where the virus has been rampaging, Cape Cod Healthcare officials said in a notice sent out to employees and associates on Thursday.

In cases where Ebola is suspected, the patient will be treated in special isolation rooms in the hospital’s emergency center and evaluated by an infectious disease physician in consultation with the Centers for Disease Control and Prevention, the notice says.

The health care organization — the parent company of Cape Cod and Falmouth hospitals — has developed a chain of command for reporting cases that aims to prevent missteps such as initially occurred at a Dallas hospital where Liberian patient Thomas Eric Duncan showed up with Ebola symptoms.

Duncan became ill a few days after arriving in the United States. A Dallas hospital sent him home with antibiotics even after he told medical staff he had been in Liberia, one of several West African countries experiencing an Ebola outbreak.

Duncan, 42, died Wednesday while being treated with an experimental drug at Texas Health Presbyterian Hospital.

There have been more than 3,400 Ebola deaths reported in West Africa, although the World Health Organization said the true number is likely much higher.

Humans transmit the virus through contact with each other’s bodily fluids, including sweat.

“This is not an easy illness to get,” Dr. Donald A. Guadagnoli, senior vice president and chief medical officer of Cape Cod Healthcare, said recently. “It’s not transmitted through the air. It’s not (from) people you ride a subway with.”

Health professionals are at particular risk from Ebola cases, since they touch and care for vomiting, sweating and bleeding patients.

Cape Cod Healthcare officials say they are stocking a “special pathogens precautions cart” at both Cape Cod and Falmouth hospitals’ emergency center isolation rooms to protect health workers and the public in suspected Ebola cases.

Personal protection equipment includes respirators, full-face masks, double gloves, gowns, leg and shoe covers and disposable linens, said registered nurse Georgia Dash, director of infection prevention at Cape Cod Healthcare.

The emergency centers’ isolation rooms provide an extra layer of protection since they are “negative pressure rooms” from which air can be forced outdoors instead of being vented into corridors and re-circulated among patients and staff, Dash said.

Once the expelled air is outdoors, ultraviolet radiation emitted by the sun kills any bacteria and viruses that are present, Dash said.

The negative-pressure rooms were set up to treat patients with contagious illnesses including measles, SARS, chicken pox and pulmonary tuberculosis, but could also be used for Ebola cases, Dash said.

Cape Cod Healthcare officials have been working with officials with the Centers for Disease Control and Prevention and the Massachusetts Department of Public Health on preparedness plans in case they see imported cases of Ebola.

Air travel means that people carrying the contagious disease could easily cross international borders. The incubation period before symptoms start showing is two to 21 days.

The first step is to correctly identify Ebola, Guadagnoli said.

“The disease itself looks very much like the flu as it starts,” he said. Symptoms include fever, intense weakness, muscle pain, headache and sore throat followed by vomiting and organ distress.

“It can progress to unexplained hemorrhage,” Guadagnoli said. “It can be deadly with or without hemorrhage.”

Cape Cod Healthcare’s urgent care centers at Stoneman Outpatient Center in Sandwich and Fontaine Outpatient Center in Harwich as well as its physician office affiliates also will screen patients with Ebolalike symptoms by asking them if they have recently traveled to countries including Guinea, Liberia, Nigeria, Senegal and Sierra Leone, health care officials said.

They said the screening protocol was developed by the U.S. Centers for Disease Control and Prevention. Patients who need to be treated for Ebola will be transferred to a facility specially identified by the CDC, the notice says.

There is no vaccine for Ebola although four people have been treated with experimental drugs in hospitals in Atlanta and Nebraska.

In general, treatment consists of trying to keep the patients alive long enough for their bodies to fight off the illness by providing them intravenous fluids and pain relief, Guadagnoli said.

Gov. Deval Patrick said on his monthly radio show Thursday on WGBH-FM that the likelihood of Ebola making an appearance in Massachusetts is very low.

But he said the state’s health care system has been gearing up just in case, according to The Associated Press.

He also said the CDC has certified the state’s public health lab to do diagnostic tests in cases of suspected Ebola to quickly determine if an individual has contracted the disease.

By Cynthia McCormick
cmccormick@capecodonline.com
October 10, 2014