News that a second health care worker in Dallas tested positive for Ebola probably has you wondering: What happens if the disease shows up here?
In fact, officials with the California Department of Public Health say it would not be unexpected to find a positive case here.
That probably leads you to another question: Is California's health system ready?
Beefing up protocols
Rest assured, some hospitals in the LA area are now actively preparing for the possibility that Ebola could show up here.
For example, at Cedars-Sinai Medical Center, the hospital is focusing on early detection of the disease. "I think early detection is one of the keys in really taking appropriate action and to protect our caregivers as well as others," Dr. Rekha Murthy, director of epidemiology at Cedars, told me.
At Cedars, that means following guidance from the Centers for Disease Control and Prevention (CDC). Everyone who shows up at a Cedars-Sinai facility will be asked two questions:
- Did you travel to West Africa within the past three weeks?
- And, are you experiencing any symptoms of Ebola?
She said health care workers are also being trained to properly don and doff – that's public health speak for take on and take off – personal protective equipment (those Hazmat-like suits you've seen on the news). They actually use a buddy system, and follow a checklist, to make sure every step is followed.
Putting protocols into action
Cedars-Sinai was scheduled to run an Ebola preparedness drill Thursday, Murthy told me.
Here's how the drill works: Someone pretends to be a patient, who arrives in urgent care. The health care workers practice evaluating the patient and transporting the patient to the emergency department and then to the intensive care unit. They also practice using the proper protective gear.
UCLA is expected to run a similar type of drill today and I’m told UC Irvine has one planned as well.
The California Department of Public Health believes many hospitals here are capable of treating an Ebola patient. But Leah Binder, the CEO of the Leapfrog Group - a nonprofit that rates the safety and quality of US hospitals - is not so sure.
"I think many hospitals are woefully unprepared for a disease like Ebola," Binder told me. "Some are prepared but many are not prepared and unfortunately, infection control is simply not a strength of the American hospital system."
She says some hospitals have much better safety records than others. (For example, this map, from the California Department of Public Health, compares hospitals by infection rates.) That's why she thinks it's important that the CDC – or state health departments – narrow the list of hospitals where suspected or confirmed Ebola patients would be sent.
I'll add: The state health officials did say yesterday that they are considering designating certain hospitals in the state to treat Ebola. That way, they could ensure those facilities are even better prepared to handle the disease.
Clinics keeping up
Someone sick with Ebola could also show up at a community health center or urgent care center.
With that in mind, the Los Angeles Department of Public Health has issued guidelines to help outpatient health care providers safely identify, isolate and, if needed, transfer a patient who may have Ebola.
Among the county's recommendations to outpatient facilities:
- Screen for patients who have a fever, or other symptoms of Ebola, and have traveled from West Africa in the past three weeks.
- Isolate the patient in a single room, with a door and a dedicated bathroom or bedpan. Facility management should limit the number of staff who enter the room. Those who do enter should fill out a sign-in sheet and follow guidelines for properly putting on and removing personal protective equipment.
- Facility staff should take a detailed travel and health history from the patient. However, health care workers should not draw blood, or perform medical procedures, unless absolutely medically necessary, until calling the county's Acute Communicable Diseases Program. This department will advise facility management on the testing and management of the patient, as well as transport and hospital admission.
What questions do you have about Ebola? Let us know in the comments section, or email us at firstname.lastname@example.org. We’ll try our best to get them answered.
This story has been updated.