Thousands of people have travelled from West Africa to the U.S. in the last 6 months. While the CDC and others throughout the Obama administration continue to reassure everyone that the U.S. is 100 percent prepared for an outbreak, potential cases and exposures continue to surface all across the country.
In Dallas, the first confirmed case of Ebola has passed away. Even more concerning is the fact that the patient initially presented to the emergency room with a fever at Texas Health Presbyterian Hospital (and even though he provided a high risk travel and exposure history) and was sent home. Initially, the hospital blamed the fact that he was sent home with high risk features (his records documented the fact that he had just traveled from Liberia); that there was a “technical glitch” in the electronic medical record; and that physicians were unable to access the data obtained by the triage nurse. Days later, the hospital rescinded their comments and admitted that the data was there for anyone involved in the case to see but in fact, no one even noted his West Africa travel history and released him from the ER.
These missteps resulted in the potential exposure of nearly 100 contacts and the isolation of several family members. The director of the CDC, Dr. Tom Frieden, continues to proclaim on the national media that the U.S. is well prepared and that all local health care agencies have policies and procedures in place to avoid major outbreaks and exposures.
Really? It’s time for the CDC and our administration to get its collective head out of the sand.
According to the WHO, the number of Ebola cases is expected to continue to rise sharply in the month of October. The CDC estimates that there may be as many as 1.4 million cases before the current outbreak is over. Others worry that the disease is now so far out of control in West Africa that it will soon become endemic. Currently, most families in West African countries actually spend nearly 80 percent of their monthly income on food; now prices are increasing and food is becoming even more scarce. As West African nations become increasingly economically challenged by the outbreak, it is likely that many will flee the country illegally (and untracked and unscreened), resulting in further spread of disease and wider contact with individuals from other nations.
The first U.S. case admitted to lying on his immigration forms before fleeing Liberia and would have been considered high risk due to close contact with family members with documented Ebola. At this point, the CDC and its leadership continue to proclaim that they are “looking at possible actions” to help prevent the entry of Ebola into the U.S. However, there are no specific plans in place and no real travel protocols have been established. U.S. air carriers admit to confusion about what to do and how best to screen passengers. One particular airline has told its employees to treat all bodily fluids on flights as potentially infectious.
Now certainly, we should not panic. I agree that the U.S. is better equipped to handle an outbreak of an infectious disease than any other country in the world. We have state of the art isolation facilities, an abundance of medical resources and the wisdom of many of the world’s brightest physicians. Our advantages in treating any potential Ebola cases in the U.S. are huge. However, we must put policies and procedures in place now, not after more cases appear stateside.
What steps can we take to prevent Ebola spreading in the U.S.?
First, we need to make sure the virus does not arrive here, and when it does we must have a plan in place to isolate and contain any potential carrier.
1. Initial standardized screening of people travelling from endemic countries must be set into place now. We must consider travel bans and pre-flight 21-day quarantines prior to travel to the U.S. in order to ensure that no patients with disease are inadvertently admitted to the U.S.
2. Airline personnel must have standard protocols in place should a passenger become sick. Isolation equipment and protective gear must be readily available and crews should be provided with specific training designed at protecting themselves as well as other passengers.
3. Improved education for health care providers, emergency department personnel and first responders. We must put protocols for response in place that are easily implemented when confronted with a suspected case. Travel history and exposure history must become the first line of defense–we cannot afford to send a high risk patient home again.
4. Immigration and passport control should also screen all high-risk travelers (from endemic countries) upon entering the U.S. as well. Those that are considered to pose a risk must be quarantined upon arrival for 21 days.
5. Private industry resources must be focused on the mass production of vaccines such as ZMapp and other potentially life saving drugs. While government should play a role in development and deployment, the private sector should be leading the charge in order to avoid the inevitable slow downs associated with government led initiatives. These drugs should be fast tracked and studied while being put to use in West Africa. While the science behind their effectiveness is solid thus far, there have not been nearly enough clinical trials and standard safety and efficacy trials put in place. However, these drugs must be tested in practice in areas of outbreak. We do not have time to await months to years of clinical trials in healthy subjects.
So, where is our government in all of this?
At present, both the Obama administration and the CDC continue to downplay the threat of Ebola in the U.S. I fear that while government rhetoric continues to highlight the absolute preparedness of the U.S. in the case of an outbreak, the reality of Ebola cases in the U.S. (the one documented case thus far was sent home from the emergency room with a fever) are quite concerning.
I wonder if we could quickly coordinate an effective response should more cases arise. The situation in Dallas — while contained now — had the potential to spread to more than 100 people during the initial presentation of the patient. It is my hope that we will soon put policies in place to protect Americans from the spread of the disease.
We must act rather than discuss. We must prevent rather than respond.
Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.