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Hospitals fighting COVID-19 have learned from Ebola-era mistakes

When Ebola struck in 2014, healthcare systems learned a lot about managing sick workers. But if they don’t have enough protective gear, it might not matter.

Hospitals fighting COVID-19 have learned from Ebola-era mistakes
Hospital clinicians get into their protective equipment before testing patients for the coronavirus at Newton-Wellesley Hospital in Newton, Massachusetts, on March 18, 2020. [Photo: JOSEPH PREZIOSO/AFP via Getty Images]

Healthcare workers are under strain as Covid-19 spreads. Dozens of such people around the country have already tested positive for the virus, according to various news reports and public health organizations. The best health systems have measures in place to manage their newly ill workforce.

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Healthcare workers in Baltimore, Connecticut, Florida, Massachusetts, Minnesota, New Jersey, Philadelphia, San Francisco, Washington, and a growing number of cities and states have been diagnosed with COVID-19. With healthcare workers sick, it will be harder for hospitals to take care of patients.

“The . . . big thing that people are very concerned with is, ‘Do we have enough personally protective equipment?” says Brian Garibaldi, head of Johns Hopkins University’s biocontainment unit. “We’re starting to really try to limit people—if you don’t need to be in the room, you’re not going to put on the gear.”

That means that only most essential healthcare workers are in a room at a given time, to lessen the number of people putting on protective gear. Since Johns Hopkins is an academic facility, it’s postponing critical skills lessons where doctors in training put on equipment. Still, even with these measures in place, there might not be enough equipment to go around. And that means workers are at further risk of getting sick.

Governors have called on President Trump to distribute more personal protective equipment to health networks from the Strategic National Stockpile, according to The Hill. Three days ago, Senator Edward J. Markey of Massachusetts called on the president to use his authority under the Defense Production Act to increase support for private production of personal protective equipment. In the meantime, healthcare workers have been trying to find their own additional supplies.

The 2014 experience

While having enough protective equipment remains a concern, hospitals are working in other ways to manage sick employees. If hospitals can catch sick workers early, they have an opportunity to prevent further spread around the hospital. Garibaldi says that many hospitals have updated their systems for looking after sick workers since the Ebola virus made landfall in the U.S. in 2014.

Back then, patients landed at Emory University Hospital in Atlanta, Nebraska Medical Center, and Texas Health Presbyterian Hospital before the Centers for Disease Control and Prevention had set guidance for what to do with healthcare workers who had come into contact with the Ebola virus. By the time Dr. Craig Spencer—who had recently returned to New York after treating Ebola patients in Ghana—arrived at New York Bellevue Hospital and was diagnosed with Ebola in late October of 2014, the CDC still hadn’t published its perspective. At the time, New York City’s Department of Health and Human Hygiene was developing a set of best practices for monitoring healthcare workers caring for Ebola patients, but it was still in early stages and had not yet communicated with Bellevue.

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The CDC updated its guidance a few days after Spencer came to Bellevue. It told hospital workers to wear protective clothing and equipment and suggested monitoring workers who came into contact with an Ebola patient. Hospitals kept track of at-risk workers through a paper ledger. Care providers were instructed to self-monitor by watching for fever and other signs they might be infected. If they started to feel ill, they were supposed to call into the hospital.

The CDC and hospitals learned how to put together a much more robust system for monitoring patients.

However, there were challenges with this system. A debrief written by the Greater New York Hospital Association notes that defining who needed to be monitored in the first place was difficult. Fewer than a hundred people ultimately came into contact with Spencer, but they included contractors. Keeping track of all those people manually was also problematic. The ledger accounting for everyone had missing or incomplete contact information. Furthermore, relying on people to call in if they started getting symptoms was deemed unreliable. Finally, healthcare workers were also not always aware they needed to be monitored.

Ultimately, workers were under surveillance for 21 days to make sure they were symptom-free, according to New York City’s Department of Health and Mental Hygiene.

Over the course of treating Ebola patients, the CDC and hospitals learned how to put together a much more robust system for monitoring patients. In Bellevue’s case, the Greater New York Hospital Association reports, the hospital found it should install a platform for keeping track of healthcare workers that have been exposed. It also set up a 24-7 hotline so that healthcare workers could call in if they got a fever. The call center was used to proactively reach out to sick workers and check in. The whole system is overseen by a senior staff member.

“I think everyone learned from Ebola in 2014,” says Garibaldi.

An app that helps

Johns Hopkins is working with a company called Emocha to monitor employee health. In the past, Emocha’s technology has focused on monitoring patient symptoms and making sure they take their medication. But two years ago, the company realized that more hospitals needed infrastructure for reviewing their own workers’ health. Nurses and doctors can input their symptoms into an app, which is then reviewed by a manager at the hospital. The app allows the hospital to manage who should go home and rest and who can continue seeing patients. Workers can continue updating their condition in the app and managers can then connect workers with additional care if needed. Everyone is accounted for in real time.

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“We are at higher risk of contracting [COVID-19],” says Garibali, referring not just to nurses and doctors, but hospital workers at large including those who work the front desk or maintain the building. Garibaldi says that even though other health systems may not be working with Emocha, many have similar technology and procedures in place.

Of course, a good monitoring system cannot prevent workers from getting sick. Hospitals will need more protective equipment and increased testing capabilities in order to best protect workers. As COVID-19 cases mount, there is a risk of running out of resources, gear, and time.

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About the author

Ruth Reader is a writer for Fast Company. She covers the intersection of health and technology.

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