A patient checked into Unity Hospital's emergency room with a fever this summer and then said five ominous words: I just returned from Liberia.
The Fridley hospital immediately enacted a public health protocol — isolating the patient, restricting access to caregivers wearing protective garb, and notifying specialists at its parent organization, Allina Health, and the Minnesota Department of Health.
A doctor soon discovered the patient had malaria, not Ebola, but the incident signaled the heightened state of readiness at Minnesota hospitals as they prepare for the deadly virus that has devastated parts of West Africa.
"Everybody is on the watch," said Dr. Wendy Slattery, medical director of infection control for Allina Health, who said the episode gave her confidence that her hospitals are prepared for a real Ebola case.
Long before the first U.S. Ebola case was confirmed in Dallas on Tuesday, Minnesota hospitals were preparing rooms and equipment. Given that more than 30,000 people of Liberian descent live in the north suburbs, the local risk can't be measured by one case in Texas, said Patsy Stinchfield, director of infection prevention and control at Children's Hospitals and Clinics of Minnesota.
"The potential of it being a plane ride away is very real," she said.
Despite Ebola's terrifying reputation, stopping it in a hospital is easier than containing seasonal influenza, which can aerosolize and spread through coughs or sneezes. Ebola doesn't spread through the air, but rather through contact with bodily fluids of infected patients such as blood, vomit or saliva.
But given the mystery and high fatality rate associated with Ebola — the World Health Organization predicted that 70 percent of infected Africans would die in this outbreak — hospital officials acknowledged the need for greater precautions.
"When Ebola comes to your hospital, you do go over and above what you need to do," Slattery said, "because you have people that are watching and there is a certain anxiety in the community and hospital."
At Regions Hospital in St. Paul, for example, crash carts created especially for Ebola cases are stashed with masks, face shields and full body gowns that look like "white bunny suits," said Ryan Aga, a Regions ER nurse supervisor.
While front-side gowns would have met federal safety standards, the staff asked for more protective garb, Aga said. "A lot of it is just putting in a bit more for the staff to feel that they are safe when going in to treat an Ebola patient."
One lesson from the spread of Ebola among health care workers in West Africa is that changing in and out of protective gear is itself risky, Stinchfield said.
ER nurses at Children's are training this week on "donning and doffing" techniques to make sure they don't come in contact with any infectious fluids as they change out of protective clothing, she said. Metro hospitals will also use "buddy systems" in Ebola cases so that staffers watch one another to make sure they change safely.
Because Ebola is not airborne, the U.S. Centers for Disease Control and Prevention indicated that hospitals can isolate patients in ordinary rooms with single beds and private bathrooms. Nonetheless, many Twin Cities hospitals are planning to move suspected patients into "negative airflow" rooms. And while small hospitals can triage Ebola patients, they would likely transfer them to larger hospitals because of the special precautions necessary if they require intensive care or respirators. Ambulance crews throughout the state have consequently undergone training on handling and transferring Ebola patients as well.
Both Regions and Hennepin County Medical Center have conducted Ebola exercises; both, like Unity, also have experienced situations in which they isolated patients who had recently been in Africa but who ended up being diagnosed with other illnesses.
If a suspected Ebola case enters HCMC, a nurse will notify the infection prevention department immediately and make sure that someone is posted outside the patient's room to record all persons coming and going and ensure that they're wearing protective clothing, said Mary Ellen Bennett, HCMC's director of infection prevention.
Samples of bodily fluids would be walked upstairs for lab tests rather than going through the pneumatic tubes, said Dr. John Hick, medical director for HCMC's emergency medical services. The state Health Department recently got equipment that can confirm the disease within hours rather than days, he added.
Hick tried to allay public fears. Fewer than half of those who become ill have any bleeding, and it's usually through the gums, he said. Even on an airplane, an Ebola patient would pose little risk to fellow travelers — unless they wound up in close physical contact like hugging, he said.
Another lesson emerging from the Dallas case is the need for hospital triage nurses to act quickly if they discover that a patient has recently traveled to West Africa and has fever and flu-like symptoms. After a 2011 measles outbreak, when many cases in Minnesota involved international travelers, Children's hard-wired its computer system so that triage nurses must ask patients about international travel and follow certain protocols depending on the responses.
Because of hospital readiness in the United States, the likelihood of an outbreak and deaths is far lower than it is in West Africa, said Kris Ehresmann, infectious disease director at the state Health Department. "Part of the reason there's such widespread transmission in West Africa is because Ebola came into a society with a decimated health care system."
Nonetheless, real cases are always more challenging than drills, she said, so Minnesota hospitals are lucky to learn from what worked and what didn't work in Dallas.
"It's much easier not to be the first," Ehresmann said.