‘More Stringent’ Ebola Safety Guidelines In the Works; Travel Ban Debated

The safety protocol used by healthcare workers to treat Ebola patients in Dallas wasn’t adequate because it didn’t require that all skin be covered, said Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases.

A Dallas nurse infected with the deadly virus after treating patient Thomas Eric Duncan probably contracted the disease through exposed skin, Fauci said on the “Fox News Sunday” program Sunday.

The protocol recommended by the World Health Organization “is best fitted for out in the field,” Fauci said. It was not designed for “very invasive-type procedures” in a hospital.

Fauci made the rounds of all five Sunday network talk shows after a week of heightened concern about the Ebola virus that has killed more than 4,500 people in west Africa and drew calls from U.S. lawmakers for a ban on travel to the U.S. from affected countries.

Officials from the Centers for Disease Control in Atlanta have said the release of new guidelines for U.S. health-care workers is imminent.

‘More Stringent’

“Pretty soon we’re going to be seeing new guidelines,” Fauci said on CBS’s “Face the Nation” program. “I can tell you they’re going to be much more stringent.”

The current CDC guidelines were modeled on WHO guidelines designed for treating patients in rural settings in poorer African countries where Ebola had been seen earlier, Fauci said. Conditions in U.S. medical centers are very different.

“You do things that are much more aggressive with patients: intubation, hemodialysis,” Fauci said. “The exposure level is a bit different, particularly because you’re keeping patients alive longer.”

WHO officials didn’t immediately respond to e-mailed requests for comment.

Fauci said the U.S. should also provide more hospital staff advance training on treating the disease, which spreads through contact with bodily fluids. He also called for expanding the number of hospitals capable of treating Ebola patients.

“We want to make sure we have people who are pre- trained,” Fauci said on NBC’s “Meet the Press” program Sunday.

Four Hospitals

New Ebola patients in Dallas, where two nurses were diagnosed with the disease, will be transferred to three top infectious-disease centers in the U.S., with a fourth center also available, Judge Clay Jenkins, the county’s top executive, said yesterday.

Fauci said the number of hospitals prepared to deal with the disease should be expanded: “It can’t just be four.”

The Pentagon took a step toward providing more patient care in the U.S. by announcing the creation of a 30-person medical support team that will be trained to assist if needed in domestic Ebola cases.

The team of doctors and nurses will get a week of training at Fort Sam Houston in Texas and will then be available to deploy within the U.S. for 30 days, Rear Admiral John Kirby, the top Pentagon spokesman, said in a statement issued today. The team would not be used outside of the U.S., Kirby said.

Two Cases

Since the death of Duncan on Oct. 8, two nurses who treated him at Texas Health Presbyterian Hospital have been diagnosed with Ebola. They are the only people so far with confirmed cases of Ebola transmission inside the U.S.

The first nurse, Amber Vinson, is receiving care at Emory University Hospital in Atlanta, while the second nurse, Nina Pham, has been admitted to the National Institutes of Health Clinical Center in Bethesda, Maryland, where Fauci works.

“She’s doing well,” Fauci said of Pham on NBC. “Her condition is fair. She’s stable. She’s comfortable.”

In addition to those two hospitals, St. Patrick Hospital in Missoula, Montana, and the University of Texas Medical Branch at Galveston are also available to treat future patients, Jenkins said yesterday.

U.S. lawmakers have been divided, often along party lines, over whether to impose a travel ban on the west African countries most affected by the disease — Liberia, Sierra Leone, and Guinea.

Travel Ban

Senator Roy Blunt, a Missouri Republican, said on NBC he favors suspending travel visas for affected countries “until we have this under better control.” By contrast, Senator Bob Casey, a Pennsylvania Democrat, said on the same program that there’s “no medical consensus yet” on whether a travel ban would be good health policy.

Fauci, on CBS, said a travel ban “could be counterproductive” because the U.S. would “lose the direct control of knowing exactly who’s coming over so you’ll be able to track them. That’s one of the disadvantages.”

Moreover, few people from affected countries are trying to get into the U.S., and screening at airports appears to be working, he said.

Of the 36,000 people who tried to leave the three west- African countries over the last two months, 77 were blocked because of health issues, Fauci said. Many were sick with malaria; none had Ebola.

“You have to look at the numbers,” he said in an interview on CNN. “There’s not a lot of people trying to get into the country. That’s the thing that needs to be understood.”

Richard Umbdenstock, president and chief executive officer of the American Hospital Association, said hospitals have already been retraining workers.

Hospitals Waiting

“We’re anxious for this next set of guidelines,” he said on CBS. “We’d been hoping to have them before this.”

Jean Ross, co-president of National Nurses United, the largest U.S. union representing registered nurses, said nurses had been asking for better equipment and procedures, such as hazmat suits, respirator masks and a “buddy system” to prevent the spread of the disease.

“The nurses and other workers did anticipate what they needed before these errors occurred,” she said on CBS. “So some of this could have been anticipated, and should have.”

–With assistance from Greg Giroux in Washington, Chris Fournier in Ottawa and Harry R. Weber in Dallas.