CDC plans for more Ebola cases, prepares health care workforce

Second infected health care worker has officials on high alert

With news that a second health care worker in Texas has tested positive for Ebola virus disease (EVD), the focus on preparing hospitals in proper Ebola treatment has become a top priority nationwide.

CDC announced that a second nurse at Texas Presbyterian Hospital who cared for Thomas Eric Duncan—the first person diagnosed with EVD in the United States—has tested positive for EVD. The nurse reported a low-grade fever the morning of October 14, was isolated, and is now being transferred to Emory University Hospital in Atlanta, which is specifically equipped to respond to EVD.

“This second health care worker case is very concerning,” said Thomas Frieden, MD, MPH, CDC Director, on a call with reporters October 15. “And we are planning for additional cases in the coming days.”

Making the situation more alarming is news from CDC that the nurse flew on a plane the day before she started feeling feverish. Although EVD is not contagious before there are symptoms, CDC is reaching out to passengers who flew on the Frontier Airlines flight with the nurse because of the proximity in time between the evening flight and the first report of the nurse’s illness the following morning.

Frieden said the woman should not have been flying. CDC guidance outlines the need for controlled movement for anyone who thinks they may have been exposed to EVD.

CDC revising its protocols

While health officials continue to investigate exactly how both Texas Presbyterian Hospital nurses became infected after caring for Duncan, CDC saw the urgency to make improvement updates to its processes and procedures for health care workers who may come in contact with EVD.

Frieden emphasized that the single most important way to get consistency and ensure safety is with a site manager overseeing every aspect of infection control 24 hours a day—most importantly, how personal protective equipment (PPE) is put on and taken off.

He said a site manager would have helped at Texas Presbyterian Hospital. When CDC reviewed records from Duncan’s case, they found that some hospital workers were applying several protective layers and taping up exposed areas.

“Doing that makes it harder to take off [PPE] and the risk of contamination during the process is much higher,” said Frieden.

CDC will be looking into revising the type of PPE that should be worn, and how it’s put on and taken off.

They are also ramping up education and repeat training efforts—not only with PPE but in all EVD protocols.

Based on news reports, the overall sentiment from the U.S. health care workforce is that protocols are unclear and more training is needed.   

What pharmacists should know

Frieden, as well as U.S. Department of Health & Human Services Secretary Sylvia Mathews Burwell, continued to emphasize that all health care workers throughout the health care system, including pharmacists, who encounter a person with fever or other signs of infection must ask the individual if they have been to West Africa in the past 21 days.

Andy Stergachis, PhD, BPharm, Director of the Global Medicines Program at the School of Public Health at the University of Washington in Seattle, emphasized the important role pharmacists have in controlling EVD here and abroad. 

“In many countries, pharmacists are at the front line as the first point of contact with the health care system,” Stergachis, who is Editor-in-Chief of JAPhA, told “As such, they need to be aware of EVD, its symptoms, and ask people who exhibit these symptoms about their recent travel history.”

In addition to asking about travel history and learning about the signs and symptoms of EVD, Stergachis said pharmacists should participate in trainings that focus on infection control procedures if the pharmacists work in a setting that might treat persons potentially infected.

Pharmacists also need to know where to refer patients who exhibit signs and symptoms of EVD, and they should be prepared to answer any questions the public has about the virus.