How Bethesda's NIH Prepared for Its First Ebola Patient, Nina Pham
The behind-the-scenes story
Dr. Tara Palmore, deputy epidemiologist at the National Institutes of Health’s Clinical Center, was a key member of the team that cared for the first Ebola patient to arrive at the Bethesda facility. Photo by Hilary Schwab.
DR. TARA PALMORE WATCHED her husband carry his suitcase from the front steps of their home in Northwest Washington to a waiting cab with a sinking feeling in her stomach. Her husband was heading out of town on a business trip, and Palmore wanted to call out and tell him to stay.
It was 6:30 a.m. on Oct. 15, 2014. Palmore, the deputy epidemiologist at the National Institutes of Health’s Clinical Center, had learned via a text message moments earlier that a Dallas nurse—the first person to contract Ebola in the United States—would be coming to the Bethesda campus for treatment. With three children ranging in age from 7 to 14, Palmore knew this would throw her schedule into a tailspin.
“I watched him walk to the cab and thought, ‘Nooo!’ ” Palmore says. “I knew I’d be spending a lot of quality time, and at least one overnight, at the hospital, and I know how disruptive that could be to family life.”
Palmore spent the day scrambling to find a baby sitter to spend the night on Oct. 16, when the patient, 26-year-old Nina Pham, was scheduled to arrive. As Palmore drove her kids to school in the morning, she explained why she wouldn’t be around that evening.
“Mom’s not going to be here tonight because a special patient is coming very late tonight,” Palmore told them. “But you’re going to have Jess, your favorite baby sitter.”
The car was silent for a beat.
“Mom, is it going to be an Ebola patient?” her first-grader asked.
Palmore paused, and then said yes, it would be. It jarred her that she couldn’t shield her kids from that knowledge.
Palmore dropped off the children at school and headed back home to pack an overnight bag. It was the start of an exhausting but exhilarating week and a half for Palmore and the dozens of other NIH employees charged with a Herculean task: Take a woman with a deadly virus and cure her.
AS THE EBOLA OUTBREAK rocked West Africa in early 2014 and began to spread overseas in the summer, a small army of nurses, doctors, engineers and other NIH staffers prepared to fight the disease at home. And as the nation fixed its attention on Nina Pham in October 2014, those same NIH employees worked around the clock to care for her. The biggest victories along the way stemmed from seemingly minor details such as changes and upgrades in equipment and personal protective gear for clinicians, and the checking and rechecking of the pipes above the unit where she was treated.
Though there are now more than 50 Ebola treatment centers in the United States with biocontainment capabilities and stringent training requirements for clinicians, there were only three such facilities in August 2014, according to a White House press release. The NIH’s Special Clinical Studies Unit (SCSU) was one. Emory University Hospital in Atlanta and the University of Nebraska Medical Center in Omaha were the others.
Ebola patient Nina Pham’s room in the Special Clinical Studies Unit was equipped with an elaborate airflow system and painted with epoxy paint that’s easy to disinfect. Photo by Hilary Schwab.
The SCSU occupies 4,000 square feet on the fifth floor of the NIH’s Clinical Center, the largest hospital in the country devoted to clinical research. In addition to receiving care, every patient there is participating in a clinical study. At any given time, there are roughly 1,500 clinical research studies underway, with dozens of areas of research, ranging from cancer and AIDS to depression and eye problems. Research at the Clinical Center led to the first cure of a solid tumor with chemotherapy, the first chemotherapeutic cures for childhood leukemia and Hodgkin’s disease, and the use of AZT as the first treatment for HIV/AIDS.
The SCSU opened in 2010 to provide support to Fort Detrick, an infectious-disease research lab in Frederick, in case a worker there contracted a serious disease. It consists of four patient rooms with a total of seven beds, and was built to house people in need of isolation. A special airflow system prevents potentially contaminated air from leaving the patient’s room. Access is by key card only.
The only individuals to have stayed in the SCSU as of last summer were healthy volunteers or patients participating in clinical studies, such as influenza trials. But on Aug. 8, NIH Director Francis Collins sent an email to staff, saying they should begin preparing for a possible Ebola patient.
BECAUSE EBOLA IS transmitted via direct contact with infected blood or bodily fluids, rather than through the air, the staff began to discuss how to retrofit their facilities to meet the demands of the disease. Laura Lee, special assistant to the deputy director for clinical care for patient safety and clinical quality, says waste management quickly emerged as a major cause for concern.
Enter Donna Phillips, director of the NIH’s Division of Facilities, Operations and Maintenance. Phillips has worked at NIH for 23 years. She oversees roughly 400 employees who manage all facilities on the main NIH campus and also remote campuses, including those in Frederick, Poolesville and even one in Montana. She handles an average of 250 trouble calls per day—anything from broken pipes to issues with directional airflow in infectious-disease units.