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Seven to Watch: Hospital epidemiologist led Ebola preparation for Carolinas HealthCare System

It was about 3 a.m. July 30 when Dr. Katie Passaretti got the call from a concerned physician in the emergency room at Carolinas Medical Center. A patient with a fever, who had traveled from Liberia, could be infected with the Ebola virus.

As medical director for infection prevention at Carolinas HealthCare System, Passaretti knew the probability was low. There had never been a case of Ebola in the United States. But with the outbreak raging in West Africa and the ease of international travel, she knew it was possible – and serious.

After making sure the patient was isolated and after asking more questions, she rushed to the hospital for an adrenaline-filled day. It was the first of many as she helped prepare the hospital system for the potential of caring for someone with the highly contagious, often deadly viral infection.

That patient turned out to have malaria instead of Ebola, but the incident got Passaretti and her colleagues focused on improving infection prevention protocols almost two months before most other U.S. hospitals. Many waited until late September, when Ebola patient Thomas Eric Duncan arrived in Dallas, where he transmitted his infection to two hospital nurses. Duncan died Oct. 8, but the nurses recovered.

“We had the first real ‘rule-out’ in the country,” said Passaretti, 38, both an internist and an epidemiologist. “It definitely ramped us up earlier on than a lot of facilities. The system worked just like it was supposed to. The right things happened, and nobody was at risk.”

That Carolinas HealthCare’s system worked well is, in part, because of Passaretti, who has been on the job since April 2011, coordinating infection prevention for 14 Charlotte-area hospitals.

After that July case, Dr. Jim Hunter, chief medical officer for Carolinas HealthCare, said he got an “outpouring” of feedback from employees saying “we’re glad Dr. Passaretti was here. We know that we can rely on what she’s saying.”

When he saw Passaretti’s interviews on national news, Hunter was proud of how she described the situation. “It’s her ability to connect, explain and communicate that sets her apart,” Hunter said. “She can sit with any scientist at the CDC (Centers for Disease Control and Prevention) and then she can turn around and talk to a very different audience and make it very digestible.”

Dr. Scott Furney, chairman of the Department of Internal Medicine at Carolinas HealthCare, said Passaretti is one of the “rare” physicians with both deep medical knowledge and “great communication skills.”

Her leadership in disseminating information to doctors and hospital employees about Ebola resulted in “the best coordinated campaign I have ever seen,” Furney said. That included websites, printed fliers and videos to teach employees how to screen patients by phone or in person and how to put on and take off protective gear. “I’m sure it was a group effort. But Katie is the content expert. She had to be driving much of that process,” he said.

Furney recruited Passaretti to Charlotte from Baltimore’s Johns Hopkins University, where she got her medical training and was first employed as a hospital epidemiologist. In less than five years with Carolinas HealthCare, she has become a local and regional expert and was invited to speak to the national Association for Professionals in Infection Control and Epidemiology annual meeting last summer, Furney said.

Explaining things comes easily, Passaretti said. “To be a good doctor, you really have to be able to break it down in terms that someone with no medical knowledge (can understand). I think I’m good at being able to see things from other people’s perspectives.”

Part of her education came from “being on the other side of things” when her mother was dying of cancer several years ago. Some of the doctors spoke to Passaretti, instead of to her mother, and used language that wasn’t easy for her mother to understand. Observing that “definitely made me a better doctor,” Passaretti said.

Passaretti was drawn to infectious diseases because the specialty seemed “very logical. There’s a bug. There’s a drug. The drug works by this mechanism and kills the bacteria. By and large, you can make people with infectious diseases better.”

That’s not always true for Ebola, of course. But Passaretti said the latest outbreak has proven that early diagnosis and supportive care for Ebola patients works. In Africa, she said, the mortality rate early on was 60 percent but is now down to 35 percent.

Despite fears about the spread of Ebola, the only U.S. health care workers who contracted the infection were the two nurses from Dallas, she said, even though many were involved in the care of the more than 10 Ebola patients cared for in this country.

Passaretti is sometimes frustrated by the “misinformation” spread about Ebola. “My approach is that the best way to fight that stuff is with education and not being reactive to it. Staying calm and knowing the true data. You can’t refute facts.”

That’s what reassured her on that morning in July when Passaretti donned protective gear to meet with the potential Ebola patient at CMC. “I can’t say I was afraid, partly because I know how the virus is transmitted. He wasn’t so sick that I was at risk for bodily fluid exposure.”

Although some hospital employees were “freaking out” about whether it was safe to be around the patient’s family, Passaretti said they “were asymptomatic. There was no way they could cause any problems.” She tried to put herself in their place. “It was a little bit of a scary situation for the family and the patient,” she said. “He was isolated, and the family wasn’t allowed to see him.”

As intense at it was, Passaretti said outbreak management is one of her favorite parts of the job. “It’s like mysteries. Where did it start? How do we stop it? What pieces can you put in place to prevent it from happening again? I like that kind of thinking through how we’re going to respond to an emerging situation.”

That’s good, because there are plenty of antibiotic-resistant bacteria and evolving viruses to keep her busy. “We’re fighting this battle where the bacteria adapt quickly, and we adapt slowly.”

“That’s going to be an ongoing struggle,” she said, adding with a smile, “and will insure my job security for awhile.”

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