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ER doctor who treated Ebola victim taken into isolation for monitoring

In his official report, Juan Manuel Parra complains that protective clothing was too small

Dr Parra arrives at Carlos III Hospital.Photo: atlas
Elsa García de Blas

When Spanish Ebola patient Teresa Romero was taken to her local hospital in Alcorcón on Monday, Doctor Juan Manuel Parra was in charge of her care. Before she was diagnosed with the virus and taken to the Carlos III Hospital, the 41-year-old was the sole person responsible for saving the life of the nursing assistant, who is the first person to be infected with the virus outside of West Africa.

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From 8am on Monday until after midnight the same day, the emergency room doctor took on the risk of dealing with a patient whose status got progressively worse, with symptoms such as diarrhea, vomiting and chesty coughing.

Doctor Parra had to put on and remove his protective clothing as many as 13 times during the day, but it was not until 5pm that he donned the highest-level protective suit available in the hospital – a suit that, what’s more, was not his size, leaving his bare skin exposed.

“At all times the sleeves were too short,” the doctor wrote in a report. The document, to which EL PAÍS has had access, covers all of the events of those 16 hours and was sent to his superiors.

At his own request, Parra was taken into isolation for monitoring on Wednesday night at Carlos III Hospital in Madrid.

Dr Parra, who is a specialist in family medicine and has 14 years of experience, began his shift at 8am on Monday, when Romero was already in an isolation unit in Alcorcón Hospital. She had been brought to the center in a conventional ambulance. The center activated its protocols for dealing with a possible case of the virus after the patient herself advised staff that she had been in contact with Ebola after working as an assistant nurse treating two missionaries repatriated from West Africa in Carlos III.

The patient got progressively worse, with symptoms such as diarrhea, vomiting and chesty coughing

“From the moment I took the decision to take on the patient and take charge of the situation, I was the only doctor who looked after her while she was here, accompanied by nursing staff when I visited her room,” he wrote in his report. “I prohibited anyone from entering the room if I was not in there.”

At that point the patient was presenting the first symptoms of Ebola: a raised rash on her torso and groin, aching muscles and general discomfort. She also had a “chesty cough,” the doctor reported, at which point he sought permission to test her for the virus. Until that point, the ER doctor had been in the room with the patient wearing “first-level suits,” which consist of an impermeable lab coat, double gloves, a cap and a surgical mask. Parra gave the order to change to high-protection masks, but the medical staff were still not wearing the highest level of protection. “During that time, the patient began to show worsening clinical signs, with hypotension, nausea and discomfort, requiring support measures,” his report continues.

I prohibited anyone from entering the room if I was not in there”

The state of the nursing assistant rapidly deteriorated, and by around 11am Parra advised his superiors of the situation, calling for “immediate action to be taken.”

At that moment, Dr Parra had ultimate responsibility for Romero’s state of health, and was running the greatest risk of contracting the Ebola virus himself. But like Romero, he was not officially told that she had tested positive for the virus, and only found out through the media.

“Although the first test came back positive, I didn’t find out about it directly except through the press,” his report reads. However, he had, he wrote, been treating the patient as an Ebola victim throughout the morning thanks to “clinical intuition.”

By 5pm he had been advised of the “possibility” that Romero had tested positive for Ebola. That was when he and his staff took the highest security levels possible, wearing full protective suits, masks, goggles, double gloves and footwear protection.

I didn’t find out about the patient’s diagnosis directly, only through the press”

But the clothing was too small for him. “The sleeves were too short at all times,” he wrote, leaving part of his wrists exposed.

From that moment, the medical team was probably facing the highest risk of infection. The state of the nursing assistant “continued to worsen, with diarrhea, vomiting, aches and a fever of 38ºC.” Her condition obliged them to enter and leave the isolation unit repeatedly.

Romero herself was aware at all times of the danger that the medical staff were facing by treating her, warning them to take care when dealing with the biological waste in the room. The team, Parra wrote, was working as carefully as possible, “in strict accordance with the protocol assigned and closely observing each other when removing the protective suits.”

The patient herself was aware at all times of the danger that the medical staff were facing by treating her

At 6pm, the doctor requested that the patient be moved to Carlos III Hospital, the key center for Ebola cases, “given the high risk of complication and instability and the constant requirements given her conditions of diarrhea, coughing, and vomiting with the presence of blood.”

An hour later, confirmation arrived, after a second test, that the patient was infected with Ebola. Once again, no one informed Dr Parra. “I found out again through the media rather than through the corresponding authorities,” he reported. Once again he requested that Romero be moved to Carlos III, given the “clinical complications of the patient and her progressive deterioration.” It would still be five hours, however, before the ambulance arrived at just after midnight, when Dr Parra’s efforts came to an end.

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