P2JW300000-6-A00800-10DFFB6178D CMYK Composite CL,CX,DL,DM,DX,EE,EU,FL,KC,MW,NC,NE,NY,PN,RM,SA,SC,SL,SW,TU,WE BG,BP,CC,CH,CK,CP,CT,DN,DR,FW,HL,HW,KS,LA,LG,LK,MI,ML,NM,PA,PV,TD,TS,UT A8 | Monday, October 27, 2014 * * * * * * THE WALL STREET JOURNAL. THE EBOLA BATTLE Hospital Shifts Contagion Strategy Sierra Leone Facility Deploys Plywood Walls, Tougher Protocols to Keep Ebola Away From Other Patients BY PETER WONACOTT BY MIKE VILENSKY Peter Wonacott/The Wall Street Journal (2) FREETOWN, Sierra Leone— The woman who came through the hospital’s metal gates wobbly and feverish posed a mortal threat to the very people poised to help her, yet now the Rokupa Government Hospital had a new defense against the spread of Ebola: plywood. West African hospitals have been using common reception areas and shared corridors, even the same wards, to deal with Ebola, offering the virus a swirling petri dish that threatens patients and staff with contagion. At Rokupa, the retrofitted hospital reopened on Wednesday, after being closed for several weeks, with newly installed dividers to create different access points for the sick and the well. Plywood separates a Red Zone for receiving potential Ebola sufferers and a Green Zone for other traffic. Sitting at tables in the Red Zone, three nurses covered headto-toe in hospital scrubs questioned the woozy woman. Then two other nurses in full anticontamination suits ushered her, one on each arm, past a plywood barrier to join another suspected Ebola patient. Trailing behind them, a cleaner sprayed any surfaces they touched. “The terrible risk is that a person comes in with Ebola and infects the others,” said John Carlson, a pediatrician from Tulane University who was part of a three-person World Health Organization team that set up Rokupa’s new infection-control system. “You’re there with malaria, you get Ebola.” The world is rushing to build Ebola-treatment units to alleviate the shortage of hospital beds for the swelling number of new cases. Yet general hospitals continue to serve their local communities for any number of ailments, including the deadly one that often-rundown government facilities here in Africa aren’t ready to handle. One answer is to retrofit the hospitals with safer entry and treatment areas for suspected Ebola patients. At the government hospital in Kenema, Sierra Leone’s third- New York Patient Receives Plasma A cleaner follows a woman who just arrived at Rokupa Government Hospital. Below health workers question a suspected Ebola patient. largest city, 37 health workers— including two doctors—died of Ebola, according to the hospital chief, Dr. Christian Pratt. The WHO and Doctors Without Borders put in barriers, laid gravel and dug trenches. The controls sharply reduced infections and are beginning to persuade general patients it is safe to come to the hospital, he said. The total number of suspected Ebola cases had reached 10,141 as of Oct. 23. Nearly half—4,922 people—have died. Stopping it in Sierra Leone, Liberia and Guinea, and preventing the spread of the virus beyond West Africa hinge largely on keeping health workers alive. Already, more than half of the 443 health workers known to have been infected with the virus in these countries have died, according to WHO figures. “This virus has wiped out a generation of health workers,” said Margaret Harris, a WHO spokeswoman in Sierra Leone. “It’s left us with a terrified cadre whose response will be not to come to work.” The Rokupa Government Hospital reflects the struggle. Early in the Ebola outbreak, 10 of its health workers caught the disease, and most of them died. The WHO team organized the hospital’s protocols to separate suspected Ebola patients. Staff members generally walk in one direction, to prevent any jostling that might pass the virus through contact. The hospital put the most critically ill patients toward the farthest end of the facility, away from others. The nurses brought the feverish woman there. Then they followed their new protocols. They stood in basins of bleach. They had undergone intensive training on how to remove their personal protective equipment and carried out the meticulously choreographed sequence of shedding goggles, gloves and outerwear in front of the WHO doctors. Drained and drenched with sweat, they joined their colleagues in a room with an electric fan, which wasn’t working because the power had gone off. The first morning of Rokupa’s reopening was just getting started. The WHO technical trio would soon depart Sierra Leone. Five patients would die of Ebola in the next 48 hours, including the feverish woman from Wednesday morning. But for many, the hospital would be a less-dangerous place than it had been just weeks before. “With so much misery,” said Dr. Carlson, “it’s nice to have one little triumph.” NEW YORK—The doctor diagnosed with Ebola after returning from West Africa is tolerating plasma treatment well but remains in serious condition, officials said Sunday. “The patient looks better than he looked yesterday” after getting a good night’s sleep, said Ramanathan Raju, president of Health & Hospitals Corp., which runs Bellevue Hospital Center, where Craig Spencer is being treated. “But his condition continues to be serious but stable.” Doctors at Bellevue have begun administering plasma therapy to Dr. Spencer. Several infected patients, including Americans, have received transfusions from Ebola survivors, and researchers plan to study the treatment’s effectiveness. Dr. Spencer, a 33-year-old physician at New York Presbyterian/Columbia University Hospital, tested positive for Ebola on Thursday at Bellevue after working as a volunteer helping Ebola patients in Guinea. New York City Mayor Bill de Blasio said Sunday that he had spoken to Dr. Spencer on the phone Saturday afternoon and described him as energetic and focused, with a sense of humor. Dr. Spencer’s fiancée, Morgan Dixon, was released from the hospital Saturday night and is showing no symptoms of Ebola, city officials said. Ms. Dixon, a 30-year-old grant writer, remains quarantined in the couple’s upper Manhattan apartment where her fever is being checked twice daily, officials said, adding that she wasn’t allowed to see visitors. Jay Varma, deputy commissioner of the New York City Department of Health and Mental Hygiene, said Ms. Dixon will be quarantined in her apartment for 21 days. Someone will be stationed at her door around the clock to ensure that she doesn’t leave or receive visitors, Dr. Varma said. Continued from Page One antine would be paid by the state. New York officials said the new protocols still went further than those recommended by the federal government. “My personal practice is to err on the side of caution,” said Mr. Cuomo. Asked if he got White House pressure to shape the policy, Mr. Cuomo said: “I have had none.” The New York quarantine policy appears designed to strike a different tone from New Jersey, where Kaci Hickox, a 33-year-old Doctors Without Borders nurse, has been held in a tent in a Newark hospital for three days under conditions that she said Sunday were “really inhumane.” New Jersey state officials said late Sunday night that they wouldn’t change their protocols, which allowed for home quarantine. A New Jersey resident who has no symptoms but has come into contact with someone with Ebola would be quarantined at home. Non-residents would be transported to their homes if feasible, or quarantined in New Jersey if not. Ms. Hickox, who lives in Maine, has retained lawyers to challenge her quarantine. New Jersey Gov. Chris Christie held firm on his decision to quarantine returning health-care workers. “I absolutely have no second thoughts about it,” he said on Fox News. Mr. Cuomo’s announcement on Sunday was made with New York Mayor Bill de Blasio, who had criticized how Ms. Hickox was treated. “State governments have the right to make decisions. But this hero coming back from the front, having done the right thing, was treated with disrespect, was treated with a sense that she had done something wrong when she hadn’t,” Mr. de Blasio told reporters. Mr. Christie said Saturday that “I’m sorry if in any way she was inconvenienced, but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine.” Although Mr. Cuomo’s policy appears different from New Jersey’s, the White House declined to comment on the New York measures beyond reiterating the principles guiding its own deci- Reuters White House Pushes Back On State Quarantine Plans Dr. Jay Varma, deputy commissioner of health for New York City. sion-making. Ebola has killed nearly 5,000 people in West Africa. Nine people have been treated for the virus in the U.S., four of whom either became ill or were infected here. One died. President Barack Obama convened a meeting of top public health and national security advisers on Sunday to discuss the issue. Federal, state and local officials are grappling with ways to quell anxiety and protect the public. The different approaches they are taking reflect the layered public health system in the Nine people have been treated for the virus in the U.S. One died. U.S. State and local authorities hold most quarantine powers, while the federal government’s power is more limited, according to legal experts. The federal government technically could find an argument for challenging state decisions to impose quarantines, said Polly Price, professor at Emory University School of Law. But she said she thought it unlikely, given the political environment and public anxiety over Ebola. Craig Spencer, a New York doctor diagnosed Thursday with Ebola after his return from West Africa, appeared to have played a part in the quarantine moves by New Jersey and New York. He was reported in serious but sta- ble condition Sunday at Bellevue Hospital Center in Manhattan. The Christie administration believes it would win any legal challenge because state law is clear on the government’s ability to quarantine people in publichealth emergencies, said a New Jersey state official familiar with the new policy. During a campaign stop in Florida Sunday, Mr. Christie said that no federal officials had reached out to him about revising the mandatory quarantine. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, said Sunday that the administration is considering a risk-based monitoring system that would elevate the required supervision of health-care workers returning from West African nations. But he said the protocols would stop short of a mandatory, 21-day isolation of health-care workers that several states have imposed, which risks deterring volunteers heading to Africa to fight the disease. “You fashion what you do with them according to the risk,” Dr. Fauci said Sunday morning on NBC. “One of the ways you can mitigate against this issue is by…different types of monitoring.” Scientists say that people who aren’t showing symptoms of Ebola don’t transmit the disease, and Dr. Fauci said other steps besides a mandatory quarantine could ensure public safety. —Yoni Bashan, Josh Dawsey and Heather Haddon contributed to this article. P2JW300000-6-A00800-10DFFB6178D Composite MAGENTA BLACK CYAN YELLOW
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