How the U.S. Healthcare System Would Handle Ebola

The disease is highly unlikely to spread in the U.S., in part because our hospitals are prepared.
Thomas Peter/Reuters

Update September 30, 2014: The Centers for Disease Control and Prevention has said that a man currently in isolation at Texas Health Presbyterian Hospital in Dallas has the first diagnosed Ebola case in the U.S.

The man likely contracted the disease abroad, since he had recently traveled to Liberia. This story, originally published in August, shows how the U.S. healthcare system might deal with an Ebola case.

Let’s get one thing straight: You are not going to get Ebola. Donald Trump is not going to get Ebola. You are more likely to be killed by Batman, the ride. Ebola-like viruses have already breached our borders, and there were no secondary infections. There are airport workers whose job it is to identify passengers who have flu-like symptoms and quarantine them immediately. And the disease is only spread through contact with bodily fluids, so there’s little chance that even the unlucky seat-mate of the Ebola flyer would catch it.

Nevertheless, Ebola is a rare disease, and the fact that it’s both incurable and highly lethal naturally prompts morbid fascination. So let’s say there was a science-fiction scenario in which you, dear reader, were infected with this deadly hemorrhagic fever. The ways in which the American healthcare system have prepared for such a thing offer some interesting insights into infectious-disease protocols and the pharmaceutical industry.

The following is an account of what would happen if you did, in fact, come down with Ebola, according to interviews with a number of infectious disease specialists.

*  *  *

You wake up and feel a little weak. It’s almost like you have the flu. You stumble to the medicine cabinet and grab a thermometer. You have a fever, so you pop two Tylenols and go back to bed. The fever does not go away. You see your primary care physician, who says it looks like flu and to call her if the symptoms change.

The next day, the fever is going strong, and you feel even worse, wracked with chills and a headache. You remember that you recently butchered a West African fruit bat, for some reason. You call 911.

By the time the paramedics come, you look and feel terrible. You spew vomit as they whisk you to the ambulance. The paramedics call the local emergency room to let them know they have a suspected Ebola patient en route.

The hospital tells the ambulance to pull into a special bay. The ER personnel run out of the hospital garbed in infection-control gear—most likely consisting of fluid-impermeable gowns, gloves, masks, and face-shields. If the paramedics weren’t properly outfitted during the ambulance ride, they would be quarantined and tested for the virus. Everything you or your bodily fluids touched would be washed with bleach.

“If the symptoms look unusual, the hospital would immediately contact the infections disease personnel in the city or state they're in,” said John Auerbach, director of the Institute on Urban Health Research and Practice at Boston’s Northeastern University. (Disclosure: Auerbach is married to Atlantic magazine senior editor Corby Kummer.) “In Boston, it's Anita Barry. They'd say ‘Anita, we have a patient in here with very odd symptoms.’ Anita would tell them, ‘Okay, here's my advice to you: Immediately isolate that patient, and we want a full list of everyone who has come into contact with them.’”

You’re wheeled on a gurney to the hospital’s special isolation unit, which has its own air-conditioning system and its own waste-disposal pipeline. The room has negative air pressure, so it doesn’t share oxygen with the rest of the hospital. This seems like overkill—Ebola isn’t transmitted by air—but it helps assuage the worries of the hospital staff. And with some medical procedures, bodily fluids can be aerosolized—blended up into tiny airborne particles—which can spread infection. Your clothes are burned.

The hospital has to take blood tests, but it doesn’t have the right tools for testing Ebola samples on-site. Four milliliters of your blood will be drawn into a plastic vial. A glass vial would be too risky, the CDC says. Specimens must be packaged in a sealable plastic bag, wrapped in an absorbent material, inserted in a secondary, leak-proof receptacle, and stuck in an outer shipping package for transport. The test comes back positive.

The isolation unit has glass walls so that hospital workers can monitor you without exposing themselves. For blood tests and IV changes, a doctor enters through an anteroom, which is equipped with a shower, where he stores his infection-prevention gear. He wears shoe covers because at this point, you are gushing diarrhea and sweat.

Health officials would interview your family and anyone else you’ve interacted with since you began to show symptoms. Your family would be isolated, likely in a similar hospital room, until their lab tests cleared them. Because you’re infected, your family might only be able to wave at you through the glass partition and talk with you through an intercom system.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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