On Monday, Frieden said that the second Dallas case "does change substantially how we approach" Ebola. He explains, "We have to rethink the way we address Ebola infection control. Even a single infection is unacceptable.”
One key change: CDC for the first time is considering transferring any further U.S. Ebola cases to one of four hospitals equipped with special containment units and experienced Ebola workers. Frieden admitted on Sunday, "The care of Ebola can be done safely but it's hard to do it safely... Even an innocent slip up can result in contamination."
Three of the facilities in question—Emory University Hospital in Atlanta, NIH in Bethesda, Maryland, and the University of Nebraska Medical Center—have already treated confirmed or suspected Ebola patients. The fourth facility is St. Patrick Hospital in Missoula, Montana.
Unlike regular hospitals, these four hospitals are equipped with specialized biocontamination units that have separate air circulation systems that eliminate disease particles from the facility. Moreover, they are staffed with physicians who have spent years focusing on the treatement and containment of infectious diseases.
"The comments from CDC early on that this could be done in any hospital that is used to doing isolation just doesn't ring true to me," says ABC News chief health and medical editor Dr. Richard Besser.
CDC has not yet said whether it will transfer the infected nurse in Dallas to one of those four facilities. "We are going to look at all opportunities to improve the level of safety and to minimize risk," Frieden says.
Regardless, Frieden says all hospitals should be prepared to safely care for Ebola patients. "We do want hospitals to have the ability to rapidly consider, isolate, and diagnose people who may have Ebola," he says.
Among other precautions, CDC now is urging hospitals to keep the number of workers caring for Ebola patients to a minimum. It also says a full-time worker should be dedicated to supervising and monitoring infection control measures.
Gavin Macgregor-Skinner, a Pennsylvania State University expert on public health preparedness, says that all hospitals should know how to diagnose and isolate an Ebola patient, but they should be able to send a patient to a facility that is better equipped to handle the virus.
CDC spokesperson Tom Skinner says the agency plans to step up its efforts to teach employees how to triage and handle patients.