There are now two confirmed cases of deadly Middle East Respiratory Syndrome in the United States, and neither was discovered at a big teaching hospital like Massachusetts General in Boston or Mount Sinai in New York. Which only emphasizes the need for all health-care personnel to be ready to respond to new crises the way medical authorities at Community Hospital in Munster, Ind., did when this country's first MERS case showed up at its emergency room April 28.
Community Hospital is not some tiny facility in the middle of nowhere. It's in a bedroom community 30 miles from downtown Chicago, has 430 beds and sees 70,000 people in its emergency department annually. Still, MERS might not have been the first thing on the minds of doctors and nurses when a still-unnamed patient came into the emergency department with symptoms of what looked like a bad case of the flu.
And that's the point, Alan Kumar, the hospital's chief medical information officer, told me Monday: Staff are drilled on proper procedures for handling infectious diseases regardless of what they might be, so if they ever face a situation like this one, the danger can be contained.
"If they all know the protocols and standards, [and follow them]," he said, "when something like this comes in, the exposure is minimized."
Thomas Frieden, head of the Centers for Disease Control and Prevention, praised Community Hospital for its infection control and the rapid isolation of about 50 health-care workers who were exposed to the MERS patient so they did not create a chain of transmission.
In fact, one of the most interesting aspects of Community's handling of the case is how it figured out who had been near the patient. Officials there reviewed security tapes, tracked the sign-ins required of everyone — from doctors to housekeepers — who entered the patient's room and tracked them via the RFID badges they wear, which show their locations at all times. About 50 were sent home and kept isolated there until the hospital could be sure they did not have MERS. They are returning to work Monday and Tuesday, Kumar said.
The patient, a U.S. resident who had been working in a health-care facility in Riyadh, Saudi Arabia, arrived in the Emergency Department on a busy Monday afternoon and was immediately taken to a triage room. (A bit of luck for the Community staff: The emergency room wasn't slammed with patients as it was when I talked to Kumar on Monday.) The room was private and equipped with a negative airflow system, so that even when someone opened the door, air flowed inward, not outward, containing the virus, Kumar said. The air is not vented through the hospital's regular ducts, but sent through a special system with filters designed to destroy bacteria and viruses.
Three hours later, the patient, who needed oxygen and fluids, was admitted to the hospital's medical floor, where he was again placed in a private room with special ventilation and seen by a primary care physician. By Tuesday, when an infectious disease specialist interviewed him over the phone, everyone who came in contact with him was required to wear gloves, gowns, masks and eye protection, Kumar said. The patient was put on a course of intravenous antibiotics because doctors weren't sure whether his symptoms, which looked like pneumonia, were bacterial or viral.
The specialist asked the patient about his recent travel — if that question was asked in the emergency department, it didn't trigger suspicions of MERS — and ordered a test for the virus, which has killed 145 people so far, the vast majority of them in Saudi Arabia. The specialist sent a sample of the man's sputum to the state Health Department, and the CDC confirmed the MERS diagnosis Thursday before holding a news conference on the situation Friday afternoon.
The patient was better within a week but spent a few extra days at the hospital as his discharge was planned, Kumar said.
"At this point, it appears that MERS picked the wrong hospital, the wrong state and the wrong country to try to get a foothold," Indiana Health Commissioner William VanNess said at a news briefing Monday.
Perhaps the most difficult problem for the hospital was reassuring the community after the news conference that the danger had been contained, Kumar said. For that, Community turned to an outside public relations firm for help, he said. By Monday, when officials were able to say that none of the 50 people exposed to the patient had shown signs of the virus, anxiety began to die down, he said. Now officials at the Dr. P. Phillips hospital in Orlando, who are caught up in the second U.S. MERS case, have asked Community Hospital for advice on how to handle relations with their surrounding area, he said.
Kumar said when the hospital does a post-mortem examination of its response to extraordinary events, "typically you find things that were done incorrectly that you want to fix the next time. We really haven't had much of that."