Ebola outbreak: How prepared are Canadian hospitals?

The death of the first patient to be diagnosed with Ebola in the U.S. and the case of the Texas nurse who contracted the virus from him have inevitably turned the focus in Canada to Canadian hospitals and how prepared they are to contain the disease if it shows up here.

"I think it's very variable and it's hard to say," said Dr. Caroline Quach, the incoming president of the Association of Medical Microbiology and Infectious Disease Canada. "I think some are very prepared and others are still in the process of getting prepared."

"I think all hospitals are different because they were built at different periods of time. The older hospitals might not all have the isolation rooms that would be ideal," she said.

• Ebola: Stories, photos, video coverage
• Ebola outbreak: U.S. officials launch review of treatment procedures
• Ebola outbreak: Toronto nurse knows what it's like to treat infectious patients, and to be one
• Ebola screening: Airport fever checks 'mostly a waste of time,' doctor says

Nurse Nina Pham became the first person to contract the disease within the United States while caring for Thomas Eric Duncan, who was infected in Liberia but later travelled to Dallas, where he died. Pham and other health-care workers wore protective gear, including gowns, gloves, masks and face shields — and sometimes full-body suits — when caring for Duncan.

Health officials in Dallas are still trying to determine how Pham could have contracted the virus despite all the precautions taken. But her case has sparked concerns about the readiness of hospitals across North America.

Questions about 'how prepared we really are'

"There’s a lot of questioning within the health-care community about how prepared we really are," said Dr. Brett Belchetz, a Toronto emergency room doctor. "Probably not prepared enough."

On Tuesday, Canada's chief public health officer, Dr. Gregory Taylor, met with the Council of Chief Medical Officers of Health. He later released a statement assuring Canadians that their hospitals "have strong infection control systems and procedures in place designed to limit the spread of infection, protect health-care workers, and provide the best care possible for the patient."

Canada, it said, has become better prepared because of its experience with public health diseases like SARS, H1N1 and H5N1, As well, provincial and territorial health authorities have been provided with "Ebola specific guidance." 

Post SARS, many hospitals in Canada built isolation rooms, or negative pressure rooms that are hermetically sealed, specifically for patients with communicable diseases.

But how ready would other hospitals be, such as smaller rural hospitals that do not have such facilities, for someone walking in with symptoms of Ebola?

Quach said it doesn't take a lot of high technology to turn a room into an isolation unit. The focus, she said, should be on having a single room, ideally with a bathroom attached, so the patient remains in that room.  

"So you really don’t need an isolation unit that’s completely remote from the rest of the hospital," she said. 

​

"There’s an ideal situation, and what you can do if you don’t have that ideal situation. So in the absence of a negative pressure room, you would do it in a single room with the door closed, wearing the full protective equipment."

Even a negative pressure room isn't a must because Ebola is not an airborne virus, said Dr. Joel Kettner, medical director for the Winnipeg-based International Centre for Infectious Diseases.

'No really fancy technology needed'

"There is no really fancy technology needed to do this," he said. "You don't need even a special room. You do need space so you can isolate the person from other patients but for this particular type of infection the people at risk are people who have very direct and close contact with the patient."

That's why some front-line health-care workers are expressing concerns about the safety and readiness of Canadian hospitals.

“We have the protective gear and we have received some instruction on how to use it," said Beltchez, the Toronto emergency room doctor.  "But if you were to ask have I had hands on drills, do I feel comfortable that I know how to put this gear on and use it with a patient and take it off in such a manner as to be utterly foolproof? No, I don’t feel confident at all.

"I have not had the drills and I feel that were I to have an Ebola patient in front of me that I was treating I’d be very concerned about doing things correctly."

Similar sentiments have been expressed south of the border. In Atlanta, Centers for Disease Control and Prevention director Tom Frieden said on Tuesday that he's been hearing "loud and clear" from health-care workers in the U.S. that they are worried and don't feel prepared to treat Ebola. That's why he said the CDC had created an Ebola response team that will travel anywhere in the country where Ebola is diagnosed “within hours."

Linda Silas, president of the Canadian Federation of Nurse Unions, told CBC News that Canada needs to take an immediate risk assessment, looking at who is trained and who is not and which hospitals have the proper equipment.

"I have heard horror stories in the last week," she said.

"We have had about, what, 10 false alarms where the suits, the sleeves, were too short, the mask was not covering the full face. The screening wasn't done properly by the triage at the emergency. So those are all lessons learned and we have to move forward and move fast."

In his statement Tuesday, Taylor said public health officials must "improve our systems and preparedness" and discussed ways "to implement our guidance for how to properly use personal protective equipment in hospitals, and how we further strengthen them, in the unlikely event an Ebola case arrives in Canada."