Dallas-area officials, health experts discuss lessons of recent Ebola crisis


Texas Health Presbyterian Hospital Dallas still thinks it was ready to treat a case of Ebola. Some CDC guidelines clearly were not ready. And the tension between science and public fears explained some puzzling official reactions to America’s first case of a terrifying illness.

Those were some of the responses given about the Dallas response to Ebola from experts and journalists Wednesday night at the Vital Lessons forum.

The event, sponsored by The Dallas Morning News at the University of Texas at Dallas, brought together officials whose jobs were quickly transformed by the appearance of the deadly virus and science writers who covered the daily developments.

“Is it over yet? After six weeks of living in crisis mode, it’s hard to believe that anyone doesn’t have that question on their mind right now,” Tom Huang, The News’ Sunday and enterprise editor, said when he introduced a panel that included doctors, researchers and politicians.

Questions posed by reporters, tweeters and members of a live audience of about 300 people offered a way to fill in holes and answer questions that had cropped up since Thomas Eric Duncan was first diagnosed Sept 28.

Does the leadership of Presbyterian think the facility was ready for that first case?

“We were completely and adequately prepared to to treat a patient with Ebola but less than completely prepared for a patient to come in from the streets and for us to give diagnosis of Ebola,” said Dr. Dan Varga, chief clinical officer of Presbyterian’s parent company.

Duncan walked into the emergency room and was misdiagnosed with sinusitis. He returned by ambulance three days later. At that point, Varga said, “he was taken in an isolation room within one minute.”

Varga said a full in-house analysis of Duncan’s case was being written for peer-reviewed scientific journals and would be submitted next month. He said the analysis would hold nothing back, even if it includes criticisms of the hospital.

If Presbyterian was prepared, why did two nurses who treated Duncan get infected?

Dr. Robert Haley blamed decades of American experts who helped craft the CDC guidelines for protective equipment. Now a professor at UT Southwestern Medical Center, Haley had been at the CDC when those guidelines were first written.

“This was not a fault of the hospital or the nurses,” Haley said of the additional infections. “It was not a fault of the CDC. Everybody thought it would work. This was just a blind spot for all the experts in the whole country. I was shocked that our guidelines failed.”

Why was there a gap between the unambiguously known science about Ebola and some of the official reaction? Why, for instance, did Dallas ISD do extra cleaning of a couple of schools attended by children who had contact with Duncan, even though the science is clear that those children posed no danger when they briefly went to the school?

“There is a balance between following the science exactly and letting people feel that their concerns are heard and are somewhat met,” said Dallas ISD Superintendent Mike Miles.

“We struck a pretty good balance,” he said. “We didn’t have a run on the schools. Had we not addressed some of the concerns that people had, we might have had more kids out of school.”

Similarly, Texas Health Commissioner David Lakey addressed one difference between new state guidelines and the CDC policies on screening travelers from countries where Ebola is active. Unlike the CDC, Texas wants all health care workers who treated Ebola patients but have no symptoms to stay out of public gatherings. Science says such people cannot pass along the virus. But what if they do develop symptoms?

“If they were sitting in church, it just becomes a major challenge to identify all those individuals and track them down,” Lakey said.

Why was the relatively isolated Methodist Campus for Continuing Care in Richardson chosen to handle more Ebola cases in North Texas? Why not Parkland Memorial Hospital or another major facility?

Dallas County Judge Clay Jenkins said the risk of panic in shutting down Parkland or another busy hospital would be too great a strain on the local health system. The Richardson facility was not being used and was well-designed for transformation into an isolation ward.

And why would the facility be staffed by doctors from UT Southwestern when that facility has had issues with general infection control? Lakey said this was a different situation. A volunteer squad of doctors and nurses have been training with the specialized gear and were ready if needed.

Why was Jenkins so public in his willingness to spend time with people exposed to Ebola but who had no symptoms?

It simply matched the science, he said. He knew that simply being in a room with people who had been exposed to someone with the virus was not risky unless those people also were ill. And he criticized officials elsewhere who have called for restrictions greater than the doctors say is needed.

“I think we need to avoid doing things out of an abundance of caution and just stick to the science,” Jenkins said.


This post was written by Jeffrey Weiss and shared with permission from The Dallas Morning News.