The bad news is that a second nurse, who had cared for deceased Liberian Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital in Dallas, has herself been diagnosed with the deadly virus. Even worse news is that the woman, who was diagnosed with Ebola on Tuesday, had been on a commercial flight from Cleveland, reportedly with a 99.5-degree fever, just the day before.
This latter of course raises questions about the worth of “active monitoring” by the Centers for Disease Control of everyone who has been in contact with an Ebola patient on American soil. Where was the CDC when this woman bought her plane ticket and took off on Friday? Now the CDC is left to “actively monitor” more than 100 people unlucky enough to also have been on the flight from Cleveland to Dallas.
But there’s a sliver of good news, and it is this: CDC Director Thomas Frieden at last has acknowledged that his agency bears some responsibility for the fact that two nurses from the Texas hospital caught Ebola from Duncan while caring for him. Previously, as noted here, Frieden seemed to blame the nurses for not following protocol, when it turns out that the garb provided by their hospital left their necks exposed.
After nurses and nurse associations across the country verbally lambasted the CDC (and many of the hospitals they work for) for failing to provide clear, accurate safety guidelines for caring for Ebola patients, and failing to provide adequate safety gear, Frieden seems to have seen the light.
“I think we could, in retrospect, with 20/20 hindsight, have sent a more robust hospital infection control team and been more hands-on with the hospital from day one about exactly how this should be managed,” Frieden said at a press conference yesterday. “I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection. But we will do that from today onward with any case anywhere in the U.S.”
The other glimmer of hope is the news that the second nurse infected with Ebola is or has been transported to Emory University Hospital in Atlanta – a medical institution with a demonstrated ability to properly deal with Ebola patients. This is a step in the right direction, although in my opinion Frieden needs to put his agency in charge of an effort in which those few hospitals now able to adequately deal with this plague immediately train health-care teams from several other large hospitals, in order to set up a regional hospital network where all Ebola patients would receive care.
It makes no sense to expect tiny hospitals across the country to be able to provide isolation rooms and a dedicated staff with hazmat suits and all the other gear and equipment needed for an Ebola treatment center. Similarly, it makes no sense for a country with such awesome medical resources as the United States to have no ability on the federal level to coordinate and implement a strategy to deal with a national medical emergency.
According to RoseAnn DeMoro of the National Nurses United nurses union:
The Centers for Disease Control and Prevention issues guidelines but has no authority to enforce them. Hospitals have wide latitude to pick and choose what protocols they will follow; too often in a corporate medical system, those decisions are based on budget priorities, not what is best for the health and safety of patients and caregivers. Congress and state lawmakers put few mandates on what hospitals must do in the face of pandemics or other emergencies, and local health officials do not have the authority to direct procedures and protocols at hospitals.
Where other countries — notably Canada, which took action after its vulnerabilities were exposed by the 2003 SARS epidemic — have empowered their public health agencies to coordinate local, state and federal detection and response efforts for pandemics, the United States cut funding for its already weak system. Federal funding for public health preparedness and response activities was $1 billion less in fiscal 2013 than 2002…
We know what works: a federal agency with the authority to ensure local, state and national coordination in response to outbreaks. In such an empowered public health system, local health officials are assured of having the resources to identify the source of an outbreak, isolate and treat the sick, and follow up with those who have had close contact with the sick. Only greater integration and the authority of a public health system with national, uniform standards can protect Americans.
If it takes an epidemic in America to change this, then maybe, in a perverse way, there’s a silver lining even to the Ebola virus.