Just before Thomas Eric Duncan was diagnosed with Ebola in Dallas, students in a microbiology class at Texas Christian University read the medical thriller "The Hot Zone."
The 1994 best-selling chronicle introduced them to virus hunters desperately battling outbreaks of Ebola and other deadly viral hemorrhagic fevers in Africa, the dangers the scientists faced and the stringent safety procedures they followed, from the biohazard clothing they wore to chemical showers and ultraviolet scans they used to keep from infecting themselves.
It was enthralling and far away.
And then Ebola arrived in Dallas — sickening a Texas Christian University graduate, Nina Pham, one of the two nurses who became ill after they cared for Duncan, the Liberian man who died at Texas Health Presbyterian Hospital.
When the Ebola scare began unfolding three weeks ago, 19-year-old nursing student Andrea Jumper thought about what she had read, particularly the protective steps the researchers took in "The Hot Zone.”
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"It was all decontamination," the sophomore from Keller, Texas, said. "They had so much protection and they were just dealing with little samples of Ebola.”
She wondered why Duncan’s specimens were sent through the hospital’s tube delivery system during Duncan first visit to the hospital, when he arrived at the emergency room with a fever and complaining of nausea, abdominal pain and other symptoms. That changed when, after initially being sent home, he returned on Sept. 28 and was hospitalized.
“It was really mind-boggling to me that here they sent in the samples with all the other blood samples,” she said. “And they didn't have nearly as much of the protection as they use in the book.”
The hospital just did not know what to expect, she said.
It’s an assessment that Texas Health Presbyterian shares. It has acknowledged that its nurses had not received full training for such a deadly, contagious illness and that it made mistakes.
“On that visit to the Emergency Department, we did not correctly diagnose his symptoms as those of Ebola,” Barclay Berdan, the CEO of Texas Health Resources, the hospital’s parent company, wrote in a letter to the community. “For this, we are deeply sorry.”
At Texas Christian University's Fort Worth campus of yellow brick buildings, green quads and purple depictions of the school's mascot, a horned frog, the nursing students are keeping up with the latest developments on Ebola and here, their discussions have an added urgency. They will soon be on medicine's front lines, battling Ebola and other illnesses.
Kristie Tinh, a 21-year-old junior, said she and classmates are following the news reports and trying to make sure they have the correct information.
"We understand why it's a big deal, but we really just want people to calm down and look at the facts," she said.
Tinh said she was inspired by her father, a survivor of the Cambodian genocide of the 1970s who volunteered at a clinic where the injured were cared for. His work was dangerous, she said.
“He would tell me stories of what he would do and it just seemed really fascinating to me,” she said. “And that's what really pushed me to go into a health profession.”
She and other students said they thought that they were being prepared to protect themselves and that, panic aside, the disease in the United States was being controlled.
“You just need to be smart about it and take the proper steps and just think about what you're going in to,” said Jumper, who plans to work in neonatal care after serving in the U.S. Air Force.
Clark A. Jones, Jumper’s microbiology professor, said that each year he began his course with “The Hot Zone,” reading an excerpt at the start of the first class. It provides an excellent description of epidemiology and shows how agencies such as the Centers for Disease Control Prevention in Atlanta and the U.S. Army work together in public health emergencies, he said.
“It’s been an amazing book to always use,” Jones said. “Did I ever foresee that we would see something like this? Well, we talk about it a lot, especially as the book ends with HIV …a major virus that has affected our world.”
His students have asked about droplet transmission — when a virus is transmitted through fluids as Ebola is — as opposed to airborne transmission, and they understand why the nurses were so much more at risk of infection than Duncan’s fiancee and her family, he said. After reading “The Hot Zone,” they knew the danger of a “Level 4 hot agent” like Ebola and questioned why the protection gear being worn by the Dallas health-care workers as recommended by the CDC in Atlanta seemed inadequate, he said.
“Our students were really surprised,” he said.
Since Pham and the other nurse, Amber Joy Vinson, became infected, the CDC has announced a series of measures to better protect health-care workers, the most recent change coming on Monday, when it issued stricter guidelines for protective equipment worn by the workers. The CDC is now calling for gear that covers the workers’ bodies completely, with face shields, hoods and boot covers, and for trained monitors to supervise them as they put it on and remove it.
Also, on Tuesday, Texas Gov. Rick Perry said that the state would create two new biocontainment facilities for treating patients with Ebola and other contagious diseases. Pham and Vinson are now hospitalized at two of the country’s four biocontainment hospitals specially equipped to handle infectious diseases, Pham at the National Institutes of Health hospital in Bethesda, Maryland, and Vinson at Emory University Hospital in Atlanta.
Suzy Lockwood, the director of undergraduate nursing studies at Texas Christian University’s Harris College of Nursing and Health Sciences, said the school’s students have always been made aware of the need to guard against infectious diseases.
She poined out that the Dallas nurses, in trying to better protect themselves, taped their gear closed, perhaps putting themselves at greater risk as they removed the tape. Some of the protective gear was too large for the nurses. Lockwood noted that Pham, whom she taught and described as very caring, thoughtful and smart, is also small. The CDC recommendation for monitors to watch health-care workers remove their gear is key, Lockwood said.
“We’re all in a living science experiment,” she said. “We’re learning so much. Unfortunately, Presbyterian, the hospital here, ended up being the hospital that got the patient. Any other hospital would have had the same, probably would have had the same experience — just a little bit different but would have had the same struggles that this hospital had. They wouldn’t have had any different equipment.”
Maddy Robinson, a 19-year-old who studied nursing before switching to education, said the Ebola cases at Texas Health Presbyterian showed the importance of nurses, something she had learned from her father, a plastic surgeon in Atlanta.
“We're not prepared for something like Ebola,” she said.
With Pham still hospitalized, students and staff at the Harris School of Nursing have started wearing purple and apricot ribbons as a show of support, purple for the university, apricot because it is the academic color for nursing. After homecoming this past weekend, alumni have been calling asking for them, Lockwood said.
“We’ve been sending ribbons all over the country,” she said.