Wednesday, October 22, 2014

Tinicum Quarentine hospital (Philadelphia)

From Atlas Obscura:

The current Lazaretto complex was originally constructed in 1799 to deal with the devastating Yellow Fever Epidemic of 1793 which killed thousands in Philadelphia alone, and forced the government from the city which had been the seat of power up to that point. The disease center held a large main building with a number of smaller support structures, and as with many disease hospitals, its own burial ground. Once completed, the center became the gate through with anyone (and anything, as goods were inspected for contagion just as thoroughly) coming to the city in the early 1800's had to pass before entering the city. According to some estimates, a full third of Americans have ancestors whose first steps on American soil were walking into Lazaretto. 
The facility operated until 1895 when the use as a disease hospital ceased and it became an airbase for a number of years until it was finally abandoned

it's just south of the airport, although putting yellow fever victims in that area, which is swampy and presumably full of mosquitoes, was probably not a good idea...yellow fever is spread via mosquitoes...

more at wikipedia

Nowadays, they'll probably put ebola into specialized rooms in the hospital (we had one such room in our IHS hospital, where the air pressure kept air from escaping into the hallway, but instead kept the air through filters to outside the hospital. We used it for our TB cases, usually until the cultures came back negative or they had 2 weeks treatment meaning that they were probably not producing enough germs to be contageous.

Ebola is a matter of strict procedure with body fluids of very sick people with vomit and fluid coming from all orifices that can kill you.

However, smallpox, SARS and other air borne disease (e.g. birdflu) can infect passersby...

In such attacks, there simply would not be enough rooms so separate hospitals would have to be designated for these diseases.

when I was in medical school, there was still a TB hospital and older docs told us about the children's infectious disease hospital that closed in the 1950' had a bell, to call for the nearest doctor to do an emergency tracheostomy when children's throats became blocked by Diphtheria membranes...


related item: CDC has a report on how Firestone kept Ebola from spreading among their 80 thousand employees.

Firestone implemented administrative and environmental modifications to convert an outpatient health clinic separated from the main hospital to meet the infection control standards of an Ebola treatment unit (ETU) following guidance developed by Médecins Sans Frontières (Figure 3) (1). The facility can house 23 patients, including those separated as having confirmed, probable, or suspected Ebola (Figure 3). By April 9, Firestone had completed the construction and certification of its ETU.

lower risk patients were kept separate from other patients (the problem being that malaria and other diseases look like early Ebola infection).

 Patients with suspected Ebola were sent to the ETU. From August 1 to September 23, three patients were sent to the ETU with suspected Ebola following this screening protocol; one of the three had confirmed Ebola.
Additional triage was conducted to prioritize patients who required hospitalization but were not suspected of having Ebola based on their signs and symptoms. Patients who had some signs or symptoms of Ebola but not those meeting the national Ebola case definition were isolated in a single, dedicated room. HCWs used standard precautions (combined features of universal precautions and body substance isolation depending on levels of care required during hospital admission) (2) and periodically screened for additional signs and symptoms of Ebola throughout the hospital admission. Patients with illnesses subsequently meeting criteria for suspected Ebola were transferred to the ETU. During August 1–September 23, 10 patients initially admitted for care at the hospital with non-Ebola diagnoses were housed in individual rooms. Among the 10 patients, four had suspected Ebola and were transferred to the ETU; three of the four were eventually confirmed as having Ebola. After establishing this secondary triage of patients admitted for standard non-Ebola care, no additional high-risk exposures were identified among HCWs.
the article also goes on how teams monitored contacts as outpatients...if you want the details go read the whole thing.

this article gives details of the CDC's work in Liberia starting in July..

and this one is about the health care workers infected. The problem is that patients presented to the ER and were not immediately diagnosed and so infected others.

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