Dr. Jonathan Metsch, a Hoboken resident who was the president and CEO of Jersey City Medical Center from 1989-2006, and an adjunct professor at Rutgers, delivered a lecture Monday on what the state and other authorities should be doing about the ebola crisis.
Metsch also writes a daily column at hudsonreporter.com called “Doctor, Did You Wash Your Hands? ™ (http://www.hudsonreporter.com/pages/more_doctor )
Metsch is the Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health; Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.
Here is the written version of the lecture he presented:
The Case for Regional Centers for Ebola
1. Every hospital should certify its Emergency Room readiness for Ebola, including at least 3 separate drills, using a standardized form – and then be subject to random “secret shopper” inspections
2. Anyone with a confirmed or suspected Ebola diagnosis should be immediately transferred to a regional center, a hospital designated by national standardized criteria and which can demonstrate that it has sufficient nursing staff “volunteers” to staff to care for a least 5 patients, 24/7
3. Isolation hospitals need to be readied for immediate activation, hospitals that can activated “instantly”. This could be a closed hospital set up to be prepared for Ebola right now, or a “virtual” hospital ready-to-go as the military activate right now
4. There is a need to minimize Ebola patients walking into an ER unannounced. Better to have a statewide 800 number so patients can call ahead and be transported by a prepared ambulance team, and taken to a regional center.
Chronology
August 1
How U.S. hospital plans to keep Ebola contained
Emory said in a statement earlier that it has a specially built isolation unit set up in collaboration with the CDC to treat such serious infectious diseases. “It is physically separate from other patient areas and has unique equipment and infrastructure that provide an extraordinarily high level of clinical isolation,” Emory said. It is one of only four such facilities in the country.
August 5
Few Preparations In Event Of Ebola In US – Unclear How To Allot Drugs, Equipment
With no vaccine or drugs to fend off Ebola, they say, an outbreak could overwhelm hospitals as patients compete for supplies of ventilators to help them breathe or beds in intensive care units. If an experimental vaccine becomes available, its supply would be limited at first — as were supplies of vaccine during the outbreak of the H1N1 ‘swine’ flu in 2009 — and determining who would be the first to get it in a national epidemic could cause widespread panic.
October 2
If Ebola arrives here, N.J. hospitals say they’re prepared
“All acute care hospitals in New Jersey are prepared to treat these types of public health threats – whether it’s MERS or H1N1, or now Ebola,” said Kelly, citing two other contagious illnesses that arrived here from other countries. Hospitals here have isolation units, as well as the personal protective equipment, to handle highly contagious illnesses.
The course of the illness varies based on the age and underlying health of the patient. Should the patient develop secondary problems while its body is fighting off the virus – particularly heart problems – a patient might be transferred to a larger hospital that had more specialists in cardiac issues or infectious diseases…
October 9
Amid Concern About Virus in U.S., New York Hospital Says It’s Ready for the Worst
Dr. Ross Wilson, the chief medical officer for the Health and Hospitals Corporation, which oversees the city’s public health facilities, said Bellevue could treat up to four patients with confirmed cases of Ebola in isolation units. They have sliding glass doors that let nurses monitor the patient without entering the room, and private bathrooms and the necessary medical equipment so that a patient who needs intensive care can be treated in the room rather than having to be moved to the intensive care unit. The hospital has nine other isolation rooms that could have the equipment installed if the need arose.
October 9
Gov. Christie Discusses New Jersey’s Ebola Preparations
Said Christie, “In terms of our own sense of our preparedness in our hospitals, I think we’ve already proven that we can do that. We had the one potential incident that came into Newark Airport last weekend that was dealt with very quickly, swiftly. I was in contact all day not only with the federal Homeland Security director but my own homeland security director and Commissioner O’Dowd. We worked with the folks at University Hospital in Newark. The appropriate protocols were followed and screening was done.”
October 9
NYC Coordinates Agencies to Monitor for Ebola, De Blasio Says
De Blasio said New Yorkers who suspect they might be sick from the virus should go to a hospital emergency room.
October 10
Dallas hospital defends its treatment of Ebola patient who died
Duncan was treated by more than 50 people in a secure 24-bed intensive care unit, the hospital said. “The treatment area remains sealed and is being aggressively decontaminated.“
October 10
After Years of Empty Beds, Containment Team Puts Drills to Use
The unit is equipped to treat more than a dozen highly infectious diseases, including SARS, plague, monkeypox and multidrug-resistant tuberculosis. It has a steam sterilizer, known as an autoclave, for linens, scrubs and equipment, and a special air-handling system to keep germs from spreading beyond the patient rooms.
Nurses on the biocontainment team have been working 12-hour shifts in the unit; they take turns spending four straight hours in Mr. Mukpo’s room in full protective gear, including full face shields and three pairs of surgical gloves duct-taped to water-resistant surgical gowns. A police officer guards the entrance to the unit around the clock, and team members who work in the “dirty” section shower before leaving.
Dr. Smith said he agreed with the C.D.C.’s recent statement that any hospital that can isolate a patient can treat Ebola, although he added that proper training of nurses would take time.
October 11
Ebola Patient Sent Home Despite Fever, Records Show
Mr. Weeks said he had requested that the hospital take certain steps to help Mr. Duncan survive, including having him transferred to Emory University Hospital in Atlanta and giving him blood transfusions, but he said he was turned down.
October 11
Doctors Without Borders Evolves as It Forms the Vanguard in Ebola Fight
“Ebola is like having an earthquake that never stops,…..It is a constant emergency for the supply chain.”
October 12
Ebola Victim’s Family Blames Hospital and State
Mr. Jackson said the other Ebola victims in the United States “came back to Atlanta and Nebraska, got quick treatment and early treatment, and their lives have been spared.” “That did not happen with Eric Duncan,” he said. “And the critical hours, critical days, were missed.”
October 12
U.S. lacks a single standard for Ebola response
“The question is, who’s in charge?” Murphy says. “The states can follow all the guidelines and take the advice, which they usually do, but they don’t have to. It’s not a legal requirement. So there really is no one entity that’s controlling things.”
There is no detailed national plan or protocol for Ebola, he said, and “some states are much, much better prepared from a public health perspective to handle (an outbreak) than others.”
October 12
New York Health System Opts for WHO Ebola Protocol -Mount Sinai Includes Handwashing at More Stages
Mount Sinai has observers, with checklists, watching staffers remove their protective gear in the emergency department, and is considering doing so in other areas as well. Mount Sinai, which continues to have infectious-disease drills for its staff, is also working to speed up the recognition of potentially infectious patients. “We’re aiming for less than 15 minutes,” Dr. Koll said, but staffers also need to balance taking precautions quickly with doing everything thoroughly. “Our goal is not to repeat whatever happened in Dallas.”
October 12
C.D.C. Will Offer More Ebola Training to Health Care Workers
“Our goal is to have at least one facility in every state that is thoroughly trained to manage one of these cases.”
October 13
Ebola: Five ways the CDC got it wrong
2. The CDC director says any hospital can care for Ebola patients.
“Essentially any hospital in the country can safely take care of Ebola. You don’t need a special hospital to do it,” Dr. Thomas Frieden said Sunday at a press conference.
“I think it’s very unfortunate that he keeps re-stating that,” said Macgregor-Skinner, the global projects manager for the Elizabeth R. Griffin Foundation. He said when it comes to handling Ebola, not all hospitals are created equally.
Dr. Michael Osterholm, an infectious disease epidemiologist at the University of Minnesota, said some hospitals have more experience with infectious diseases and consistently do drills
October 13
Can All US Hospitals Safely Treat Ebola?
The CDC’s director, Dr. Thomas Frieden, has said that any U.S. hospital with isolation capabilities can care for an Ebola patient. But his stance seemed to soften on Sunday, when asked at a news conference whether officials now would consider moving Ebola patients to specialized units. “We’re going to look at all opportunities to improve the level of safety and to minimize risk, but we can’t let any hospital let its guard down,” because Ebola patients could turn up anywhere, and every hospital must be able to quickly isolate and diagnose such cases, he said.
But once that is done, “then thinking about what the safest way is to provide that care, that’s something that we’ll absolutely be looking at,” he said.
October 14
Questions Rise on Preparations at Hospitals to Deal With Ebola
At Texas Health Presbyterian Hospital in Dallas, mistakes in treating a patient from Liberia — a delay in diagnosing the disease, and its spread to a health worker who had apparently taken all precautions — have raised questions about the general level of preparedness in hospitals around the country. Medical experts have begun to suggest that it might be better to transfer patients to designated centers with special expertise in treating Ebola. Federal health officials are also beginning to consider that idea, though they emphasize that every hospital has to be able to diagnose the disease.
October 14
The Worsening Ebola Crisis
Smaller hospitals will probably have to transfer any Ebola patients to more specialized centers for treatment.
October 14
Ebola Response Strains Hospitals
But such enhanced efforts will be costly. It took a team of 26 medical staff to care for American missionary Kent Brantly, who spent about three weeks at Atlanta’s Emory University Hospital. Those health-care workers had to make a “herculean effort” to continually replace the five to 10 liters of fluid Dr. Brantly and the hospital’s other Ebola patients each lost daily at a critical stage of their illness, said Bruce Ribner, director of the Infectious Disease Unit at Emory University Hospital. Emory also treated Nancy Writebol, and a third patient whose identity wasn’t disclosed.
The Emory experience underscores the challenges for hospitals that have just recently started gearing up for an Ebola threat.
“The people at Emory have been training for, get this, 12 years,” said Trish Perl, a professor of medicine and a senior epidemiologist at Johns Hopkins Health System in Baltimore. “They have teams that are well-formed and well-developed.”
October 14
Our Hospitals Not Ready for Ebola
Then there’s the lack of staff. It takes 20 full-time medical staff to care for one Ebola patient. Texas Health Presbyterian cordoned off its ICU for Ebola, and is diverting emergency patients to other hospitals. Not all communities have several hospitals.
October 14
CDC Promises Special Ebola Response Teams
The Centers for Disease Control and Prevention says it’s moved a team of experienced experts in to help a Dallas hospital where a nurse became infected with Ebola to improve “every step in the process.” And they’ll send in a special response team to help any hospital in the future that gets an Ebola patient.
October 14
Bellevue Hospital to Be a Focus if Ebola Hits New York
Bellevue Hospital Center, the country’s oldest public hospital, would receive any confirmed Ebola cases within the 11-member public hospital system, a Bellevue spokesman said. It would also be available to receive transfers from private hospitals in the city.
City health officials said that the decision to transfer patients would be made by hospital officials in consultation with the health department case by case, and that not all patients would necessarily be transferred: A patient could, for instance, prefer to stay in a local hospital.
October 15
Second Dallas healthcare worker tests positive for Ebola
In the United States, calls are growing for designating a hospital in each state as a specialized Ebola treatment center. New York City already has named its Bellevue Hospital as its Ebola center.
October 15
Dallas Hospital Learned its Ebola Protocols While Struggling to Save Mortally Ill Patient
The hospital that treated Ebola victim Thomas Eric Duncan had to learn on the fly how to control the deadly virus, adding new layers of protective gear for workers in what became a losing battle to keep the contagion from spreading, a top official with the Centers for Disease Control and Prevention said Tuesday.
“It’s a race between you and the virus, but the virus has a head start,”
October 15
Ebola SWAT Team
The Mount Sinai Health System is in the process of creating an Ebola SWAT team that can respond immediately around the clock to a request for assistance from any of its facilities.
October 15
Ebola cases shouldn’t be treated in N.J., nurses group says
Although New Jersey’s 72 critical care hospitals are in the process of staging drills for Ebola, the head of state’s professional nursing group said today his group doesn’t think patients should be treated here.
Instead, they should be transferred to one of the four bio-containment units around the country.
October 15
Why Ebola may pose a greater threat in the ICU
Nurses and others caring for Ebola patients at the end of their lives are at high risk of infection, because the virus replicates wildly as the disease becomes more advanced, says Peter Hotez, dean of the National School of Tropical Medicine in Houston and a professor at the Baylor College of Medicine.
October 16
Paging Dr. Obama – America needs a better Ebola plan
But, by stopping short of issuing mandatory protocols, the President again fell back on the catch-as-catch-can system that produced such disastrous results in Dallas. He did so at the peril of health-care providers and the public — because trust that individual hospitals here, there and everywhere would perform superbly is decidedly misplaced.
October 16
10 Things America Needs to Do About Ebola
The notion that every hospital can deal with Ebola has been shown wrong by the events in Dallas. Every hospital cannot deal with Ebola. But many can. They have the training, the equipment, the experience with other infectious diseases and the skilled personnel to engage Ebola safely. Pride about what any hospital can do must yield to the reality that having a moonsuit does not mean everyone is trained properly in how to put it on and take it off. So let’s designate the national 100 hospitals that can take Ebola patients, figure out how to get them there safely and stop creating more anger among health care workers who we are asking to take unnecessary risks in dealing with infectious patients.
October 16
One Dallas Ebola Patient Flown to Emory, Other Headed to NIH
Dallas Ebola patient Amber Vinson was transferred last night to an infectious disease unit at Emory University Hospital in Atlanta, and today the National Institutes of Health announced that Vinson’s colleague and fellow patient Nina Pham will be flown to an NIH facility in Maryland. Elsewhere, fallout from Vinson’s Cleveland-Dallas flight—taken just a day before she checked into the hospital—continued.
October 16
Transfer of Ebola patients reflects a tacit shift in strategy
The federal government effectively began to restrict the care of Ebola patients to hospitals with special bio-containment units Thursday, and the Obama administration labored to reassure jittery Americans and increasingly skeptical lawmakers that public health authorities can prevent a widespread Ebola outbreak here.
The tacit shift in policy came amid growing concerns about mistakes at Texas Health Presbyterian Hospital in Dallas, where two nurses who treated Thomas Eric Duncan of Liberia have since come down with the disease.
One of the nurses is being treated at Emory University Hospital in Atlanta, and the other was transferred Thursday evening to a specialized treatment center at the National Institutes of Health near Washington.
The U.S. has four specialized facilities, including Emory, the NIH in Bethesda, Md., the Nebraska Medical Center in Omaha and St. Patrick’s Hospital in Missoula, Mont. Altogether, the four units contain 18 beds, some of which are occupied.
October 16
US Has Capacity for 11 Ebola Patients at Specialized Hospitals
There are four hospitals with biocontainment facilities in the United States, and they have 11 beds that can be used at any one time for Ebola patients, officials told ABC News. Four of those beds are currently being occupied by Ebola patients.
October 17
NIH unit treating Dallas nurse for Ebola is one of 4 special isolation facilities in U.S
Patients infected with the Ebola virus require a large number of staffers to provide care around-the-clock. At NIH, that comes out to about 27 people a week — doctors, nurses, support staff — for one patient, Gallin said. With about 50 to 60 such personnel specially trained for infectious disease and critical care, NIH can only care for two Ebola patients at a time, he said.
October 17
Gov. Andrew Cuomo said eight hospitals in the state would provide specialized care should any Ebola cases be identified in the state.
At a news conference in New York City on Thursday, New York Gov. Andrew Cuomo said eight hospitals in the state would provide specialized care should any Ebola cases be identified in the state.
The hospitals are Mount Sinai Hospital, NewYork-Presbyterian Hospital, Bellevue Hospital Center, Montefiore Medical Center, North Shore-LIJ Health System, SUNY Upstate Medical University at Syracuse, University of Rochester Medical Center and Stony Brook University Hospital.
Mr. Cuomo said the more than 200 hospitals statewide will be prepared to identify a case of Ebola.
“But we are going to have eight identified hospitals that have intensive training and protocols and they have already been identified as the hospitals that we would use if we needed them,” Mr. Cuomo said.
“No battle plan ever survives the first encounter with the enemy”
often attributed to Colin Powell, but also to Field Marshal Helmuth Carl Bernard von Moltke
“There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.”
Donald Rumsfeld
Jonathan M. Metsch, Dr.P.H.
Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai
Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.
Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health
http://www.mountsinai.org/profiles/jonathan-m-metsch
http://zicklin.baruch.cuny.edu/programs/healthcare/faculty-and-administration/faculty-practitioners/faculty/jonathan-metsch
https://spaa.newark.rutgers.edu/jonathan-metsch
Doctor, Did You Wash Your Hands? ™
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