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VOL. 129 | NO. 205 | Tuesday, October 21, 2014

Local Ebola Response Relies On Experience

By Bill Dries

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Five years ago this month, there was a triage tent on the grounds of Le Bonheur Children’s Hospital and Memphis was a hot spot for the H1N1 flu pandemic.

U.S. Sen Lamar Alexander is briefed by Dr. Jon McCullers, a pediactric infectious disease specialist at Le Bonheur.

(Daily News/Andrew J. Breig)

Doctors, nurses and respiratory therapists from the hospital’s emergency room and intensive care units were the first in the nation to get vaccinations against H1N1. So were pediatricians and Shelby County Health Department employees on the front line of the city’s battle with the pandemic.

Some of the same health care professionals cited that preparedness and level of awareness as they briefed U.S. Sen. Lamar Alexander Friday, Oct. 17, on the city’s preparations for Ebola.

“Memphis was the epicenter for that,” said Dr. Jon McCullers, pediatrician in chief for Le Bonheur and chairman of the pediatrics department at the University of Tennessee Health Science Center. “We dealt with that then. I think we are appropriately prepared to deal with this now.”

But McCullers, who is also a virologist involved in researching deadly diseases, makes a distinction on the level of preparedness.

“Notice I didn’t say we are perfectly prepared,” he added. “Preparedness in this context is really an ongoing evolving process. It changes from day to day as we gain new information. … We have to have some flexibility. When you talk about battle planning, no plan actually survives the battle.”

Shelby County Health Department Director Yvonne Madlock referred to the contingencies as “if the bell does ring here in Shelby County.”

Those plans include what to do if someone presenting symptoms of Ebola walks into an emergency room filled with people including health care providers who might potentially be exposed and how to gauge accurately who is at risk.

The plans also include some kind of centralized area for the treatment of those with Ebola rather than all hospitals being prepared to treat someone because such a decentralized method of treatment could take down a good portion of a hospital’s staff in a later quarantine.

Pam Castleman, chief nursing officer at Regional One Health, said she hears from nurses and others on the front line in terms of initial response that they are willing to take the risks but want adequate protection to minimize that risk.

Castleman is also hearing fears from some that there might be a stockpiling of protective gear that could make it hard for hospitals to keep the necessary protective garb stocked through a prolonged emergency.

Dr. Reginald Coopwood, the president and CEO of Regional One, acknowledges that missteps in Dallas with the first Ebola cases this month caused him and others to further review their long-held plans.

“We all kind of thought we were prepared,” he said of the mindset before Dallas, which has prompted even more planning to take into account new information learned from those mistakes. “I’m a lot more comfortable as we approach the possibility,” he added.

But Coopwood said the coming of the flu season and concerns about enterovirus, which has already been reported in Shelby County, are “complicating factors” because they include some of the same symptoms that are present with Ebola.

“There will be a lot more confusion with someone presenting with the flu and a lot more paranoia,” Coopwood said. “So we talk about the rapid diagnosis of finding a quick way to determine if a person has a virus. That will be very critical in the next couple of months.”

Dr. Manoj Jain, an infectious disease consultant to Baptist Memorial Health Care, said Ebola should be regarded as “a completely unique entity in our health care management system.”

He called for a “bio-containment model where when we have a case we treat it as a biohazard – that we are able to bring a select team that’s able to contain and take that patient to a center.”

And he pitched to Alexander a plan for a set of centers in 300 U.S. cities to be built and set up for approximately $50,000 each at a total cost in federal funding of $15 million.

Alexander said later the idea is “well worth considering.”

“I’ll have to think more about what he said,” he added, saying there are currently a smaller number of such centers, the closest to Memphis being in Atlanta.

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