The difference between the almost right word & the right
word is really a large matter – it's the difference between
the lightning bug and the lightning.


Mark Twain




October 29, 2014


Ebola

      One Crisis, Many Lessons


Cynics say the only thing experience teaches us is that experience teaches nothing, and that rings true when one hears of school officials in the U.S. banning a teacher because she had travelled to Dallas, or closing facilities because some students had been on the same flight as an Ebola-infected nurse.

Closer to home, a TV station in Greenville, SC reports “despite a rumor rampant in the Upstate, even being spoken of on radio shows and internet sites, there is no case of Ebola at Greenville Memorial Hospital.” The horror of it! A regional hospital treating a viral infection!

Those of us with long memories recall similar panic in 1985 when 14 year-old Ryan White was expelled from a middle school in Indiana because he was HIV-positive, as a consequence of receiving contaminated blood. Back then, as in the case of Ebola, a not-small number of people refused to believe health authorities when they said one could not become infected with HIV from casual contact.

Indeed, as regards Ebola, officials at the highest levels are not dissuaded by reassurances from the CDC and the NIH. Governors in several states have adopted quarantine policies which go beyond scientific consensus, and even the Department of Defense is leaning towards quarantining soldiers serving in West Africa, where Ebola is rampant.

So, perhaps the first lesson of Ebola is there is no telling how local communities will react in the face of a new threat. Don’t assume the public or politicians will be persuaded by the weight of evidence. Expect the unexpected. Whether or not the Dallas hospital that treated the now-deceased Ebola patient was adequately prepared, there is no way the hospital could have anticipated the community reaction. “Revenue drops 25 percent at Presbyterian Dallas, ER visits decline 50 percent after Ebola case,” reports the Dallas Morning News.

Texas Health Presbyterian Hospital in Dallas had the unfortunate luck of being the first one to treat an Ebola patient as it seems probable most facilities would not have fared much better. But the hospital’s PR problems were compounded when nurses took the stage to express their concerns. One nurse recounted to NBC the hospital’s initial experience with the Ebola patient. “It was just a little chaotic scene. Our infectious disease department was contacted to ask, what is our protocol. And their answer was, we don’t know. We’re going to have to call you back,” she said.

Lesson number two: hospital leaders in the eye of the storm should not assume their version of events will be the only one; all the more reason to have only knowledgeable representatives speaking to the media. “Clamp down on leaks. No cell phones or cameras,” counsels Dr. Shabaz Hasan, an infectious disease specialist at Presbyterian Hospital in Dallas.

“Staff will be tantalized by large sums of money to provide insider photos and details. Patient privacy is paramount. Have your IT constantly survey the electronic records for unauthorized access to the charts,” he adds in an interview with the Houston Chronicle.

Third, but not finally, be wary about over-estimating your understanding of the problem or your organization’s capabilities. Dallas learned that lesson the hard way, and even CDC director Tom Frieden appears to have stumbled in saying a Dallas nurse became infected when she breached infection-control protocol. Many experts now think the problem may well have been CDC’s guidelines which were not stringent enough and have since been modified.

Dr. Frieden has also drawn heavy criticism for saying initially most any hospital in the country could take care of an Ebola patient. “Everybody accepted that everybody was great and this was no problem. I think there was overconfidence on every side,” noted Dr. Joseph McCormick, who spent 25 years at the CDC and has helped contain Ebola outbreaks in Africa. He made his comments to the Wall Street Journal.

On a more mundane level, Dr. Hasan of Presbyterian Dallas offers advice one could test tomorrow: “If you are bursting with confidence that your ER would never miss a case, well, test your premise out with a few fake patients with rehearsed stories. Try different scenarios and random shifts. You may not like what you find,” he says.

It is difficult enough for hospitals to cope with strange, exotic threats without stonewalling from patients. But healthcare workers have to keep in mind patients may be embellishing their accounts or withholding critical information. In the case of Ebola, heavy stigma is associated with the disease and patients may not reveal all fearing deportation or incarceration.