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A8 | Monday, October 27, 2014
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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.
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