COMMENTARY

The Best Approach for Ebola: Designate Biocontainment Centers for Care

Alexander Garza, MD, MPH

Disclosures

October 23, 2014

It's Time to Reset Priorities on Ebola Care

With the newly minted Ebola "czar" now in place, it is time to take a look at how to treat future Ebola patients. The Centers for Disease Control and Prevention (CDC) has released updated guidelines, including equipment and processes, to better protect healthcare workers from the virus; however, this is just one aspect of the care for such patients.

To date, one patient was taken care of in a community hospital environment, and that endeavor ended poorly. With no slowing of the spread of Ebola in western Africa, the probability of another Ebola patient entering a community hospital in the United States is still concerning. In looking at the lessons learned in the case of Mr Duncan in Dallas and the ensuing social disruption, it seems only logical that all patients with Ebola virus infection should be treated in a biocontainment facility. Here are eight reasons why.

Hospitals are poorly prepared to take care of complex Ebola patients. As we have seen in the case in Spain as well as in Dallas, just because hospitals have medical personnel capable of treating infectious diseases, intensive care capabilities, and an understanding of infection control, these are not surrogates for taking care of complex patients with highly infectious diseases. A lack of respect for the virus, and perhaps some hubris on the capabilities of the US healthcare system, has brought us to this point.

We need to assure a high standard of care. It is a standard of care in medicine to move patients to higher levels of care when a patient has exceeded a hospital's capacity and capability. This occurs every day when patients with significant trauma are taken directly to designated trauma centers, bypassing other community hospitals, or are transferred to trauma centers after being stabilized. This construct is accepted by the medical community and should be used as a model for the treatment of patients with Ebola.

It is essential to lower the risk for community healthcare workers. The prospect of potentially training thousands of healthcare workers to effectively take care of a rare but lethal disease over the course of the patient's illness, where the probability of contracting the virus increases as the patient becomes progressively sicker, is fraught with error. It is unrealistic and unethical to ask healthcare workers who have never taken care of patients with such a disease, have never been trained to work in the required personal protective equipment, and have no experience in working in such a high-risk environment, to care for these patients when an alternative, such as a specially built biocontainment center, is available. Healthcare workers can be trained to isolate, perform diagnostics to confirm Ebola, and then prepare patients for transport. Beyond this and we are beginning to increase risk for little benefit.

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