UPDATED at 6:10 p.m. March 4 with details on the Dallas County testing facility.
If Dallas-area health care workers are prepared to face the novel coronavirus, they can thank Ebola. And SARS. And swine flu.
Experts say the new disease, called COVID-19, could strain the local health care system if it hits during flu season. On Tuesday, the World Health Organization warned that global shortages of personal protective equipment due to hoarding, high demand and misuse are putting lives at risk.
But North Texas hospitals have had more experience than most with managing unfamiliar viruses. Dallas faced the threat of SARS in 2003, a new strain of swine flu in 2009, the country’s worst-ever outbreak of West Nile virus in 2012 and the country’s first human cases of Ebola in 2014.
”There’s no place I would rather live for this than North Texas,” said Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington’s College of Nursing and Health Innovation. "We have hospitals that are immensely well-equipped to deal with this virus.”
On Wednesday, Dallas County Health and Human Services said that it became the first lab in the state to be able to quickly test for the coronavirus. Dr. Philip Huang, director of Dallas County Health and Human Services, said having a testing facility here "is essential to our preparedness efforts and ability to rapidly respond to this evolving situation.”
One concern about COVID-19 is the heavy toll it has taken on health care workers. More than 2,000 have been diagnosed with the illness in China, and a handful in Northern California and Seattle have either been diagnosed or are being monitored. A paper in the Journal of the American Medical Association last week reported that 14.8% of health care workers who had contracted COVID-19 in China had severe or critical symptoms.
“They are our front-line providers. We have to keep them safe so they can continue to keep us safe," Carlson said.
In 2014, two nurses in Dallas contracted Ebola after caring for a patient who died at Texas Health Presbyterian Hospital Dallas. Nurses unions blamed lax government guidelines and lapses in hospital protocol for the infections. The company has said that its staff was properly trained and that the protective gear used followed U.S. Centers for Disease Control and Prevention guidelines.
Now, nurses unions are again calling for stricter protocols. The CDC says patients suspected of having COVID-19 should be isolated in negative-pressure rooms that exhaust to the outside. Health care workers should wear goggles or face shields, custom-fitted face masks, gloves and protective gowns, the agency says.
Last month, National Nurses United, the largest nurses union in the country, sent a letter to the CDC asking that it strengthen its guidelines for protective equipment to include coveralls with hoods and full facepiece respirators.
Cindy Zolnierek, CEO of the Texas Nurses Association, said she sees little evidence that guidelines need to be upgraded. “The recommendations from the CDC are based on MERS and SARS, two viruses that are similar in terms of infection and transmission [to COVID-19], so I don’t know that there’s much documentation that shows that what’s being recommended is inadequate.”
She added: “It is alarming how this disease is spreading quickly. On the other hand, it’s a virus. It’s a type of infection that we’re well aware of preventive strategies for.”
Carlson of UT-Arlington explained that this viral strain deserves heightened caution because humans have little resistance to it. “Our bodies have a lifetime of seeing different kinds of influenzas, so we have a natural immunity. This is a novel virus, which means we are much more likely to become infected if we become exposed,” she said. For most people, COVID-19 causes only mild symptoms.
North Texas hospitals are actively preparing for the first possible COVID-19 cases. Some have been growing their inventory of protective equipment since December, said Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council. The larger hospital systems have purchasing power in the marketplace and have staff that monitors and adjusts their inventory daily.
Catherine Bradley, media supervisor for Parkland Health & Hospital System, said the hospital has enough N95 respirator masks — fitted masks that filter small particles from the air — and anticipates “an adequate level to accommodate suspected COVID-19 patients in the near future.”
Smaller community clinics may feel squeezed, however. “This is a challenge for smaller private practices,” said John Carlo, a physician who served as medical director of Dallas County Health and Human Services during the 2009 H1N1 swine flu epidemic and is now CEO of Prism Health North Texas. In many parts of the country, “they’re already seeing their vendors not able to supply them.” To address the shortage, the CDC issued guidance for how to optimize the supply of face masks and other equipment.
H1N1, which sickened hundreds in Dallas, put a strain on the system, Carlo said. “There were shortages in hospitals with some protective equipment and lots of concern that we’d run out of supplies,” he said. But they ultimately didn’t.
The key to managing COVID-19 is to slow its spread as much as possible until a vaccine becomes available in about a year, experts said. “Realistically, it’s hard to prepare for a long duration event of unknown consequence, so we’re doing the best we can,” said Carlo. “I think this is going to be a bit of a marathon rather than a sprint.”
Anna Kuchment is a science writer at The Dallas Morning News and a contributing editor at Scientific American.
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