Momentum builds for designated Ebola hospitals, New York acts first

Federal health officials increasingly are talking about the possibility of having specific hospitals around the country, perhaps in each state, designated as Ebola treatment centers as the country continues to wrestle with how to deal with the deadly virus.

But while some say having a certain number of hospitals throughout the country with the specific kinds of trained health personnel and resources needed to handle Ebola cases would be the most efficient means of combating the disease, others argue that the logistical challenges such a plan raises would still make it vital for all healthcare facilities to be prepared for such cases.

“The nurse, and probably the physicians there too, just did not have the level of training they needed to really use the equipment in a way that could keep them safe is probably the explanation as to what happened,” said Dr. Ashish Jha, professor of international health at Harvard University, referring to treatment of the U.S.' first Ebola patient in Dallas. “The attraction of having these designated centers is you don't have to train 100 people at each hospital. Maybe you just need to train 30 or 40 people at one hospital in each state.”

Jha said it could be argued that such specialized centers for Ebola care already exist, referring to the country's only four facilities with biocontainment units designed to isolate patients with deadly infectious diseases, which include Emory University Hospital in Atlanta; Nebraska Medical Center in Omaha, Neb.; St. Patrick Hospital in Missoula, Mont.; and the National Institutes of Health Clinical Center in Bethesda, Md.

While designating special hospitals is a viable option, Jha stressed that it did not mean other healthcare facilities would not have to remain aware of what to do in the event they encounter a patient with Ebola.

“A person walks in tomorrow to a community hospital, they're (healthcare personnel) still going to have to know how to carry out how to identify them, how to diagnose them, keep them isolated and safe until a transport is doable,” Jha said.

But Dr. Melinda Moore, former Centers for Disease Control and Prevention official and currently a senior scientist at the RAND Corp., sees designating certain hospitals to treat Ebola as more of an interim step, to be employed as all healthcare facilities work toward becoming more prepared to provide Ebola care.

“When you think about it, we really don't know where the next case will show up and having someone show up at somewhere other than those four hospitals, which is more likely than not, how would you transport one of those cases,” Moore said. “You still have to protect the health workers who are making the diagnosis in the first place.”

Linda Greene, a nurse who is an infectious disease control expert and member of the regulatory review panel for the Association for Professionals in Infection Control and Epidemiology, said the high likelihood that a person will not got to a designated site to care initially made it more feasible for all hospitals to each train a few care professionals who could act as a special unit and be deployed when a patient is suspected of having Ebola.

“It's not feasible that every single healthcare worker in every single hospital is going to be ready,” Greene said.

While a national model is still being conceptualized, New York City health officials Tuesday said Bellevue Hospital Center has agreed to take any confirmed case of Ebola from any of the 11 hospitals within the New York City Health and Hospitals Corp. It will also take patients from all city hospitals as well as any identified at the city's airports, according to NYHHC spokesman Ian Michaels. Bellevue also is in the process of building an onsite laboratory that would be able to test patient blood samples, he said.

“Bellevue has nine isolation units in its ED (emergency department) where patients can be isolated if they are suspected of having Ebola,” Michaels said in an e-mail response. “It has prepared four single-bed rooms in its infectious disease ward to receive high-probability or confirmed Ebola cases. Additional rooms can be made available if necessary.”

CDC Director Dr. Thomas Frieden Monday said the agency was looking at “all possibilities” when asked by reporters whether the CDC would push for setting up Ebola-designated hospitals.

“We're certainly looking at all of the possibilities and all of the opportunities,” Frieden said. “Caring for a patient with Ebola requires a particular attention to detail, and we're looking at every aspect to see how we can make it safer and easier.”

On Tuesday Abbigail Tumpey, associate director for communications science at the CDC's Division of Healthcare Quality Promotion told Bloomberg News the agency would like to dedicate at least one hospital in each state for Ebola patients.

“We'd like to have at least one hospital in every state that does feel they could manage a patient from start to finish,” Tumpey was quoted as saying.

Follow Steven Ross Johnson on Twitter: @MHsjohnson