MONTGOMERY VILLAGE, Md., October 15, 2014 — News of yet another American Ebola victim has dominated the news today. The fact that America’s sophisticated health care system has shown such serious chinks in its armor is of concern to all of us.
Those chinks began to show up from the appearance of the first Ebola patient on American soil. A Liberian national, Thomas Duncan, came into a hospital in Dallas — the Texas Health Presbyterian Hospital — exhibiting symptoms of Ebola. He informed the receiving staff at the hospital of the fact that he came from Liberia. This information was ignored. He was sent home with antibiotics.
Why wasn’t Duncan hospitalized and quarantined immediately, and precautions taken to prevent the spread of the infection? Cynics would say that because he was from a foreign country and without health insurance, he received a different standard of care than he would have otherwise.
Four days after Duncan was sent home, he reappeared at the hospital in worse shape. He was then hospitalized, but not before having to wait in the emergency room with other patients. According to media reports, he was not immediately given the proper treatment, a fact that may have contributed to his demise a few days later.
It gets worse. Since Duncan died, two of the health care workers who took care of him have been diagnosed with Ebola.
The head of the CDC claimed that the first healthcare worker infected had not used proper protocol when donning and taking off protective equipment. In a subtle way, this put the blame on the person and not the system. The second healthcare worker diagnosed had, after the death of Duncan and the Ebola diagnosis of the first nurse, flown to Cleveland and back to Dallas. One has to wonder about her judgement. She has been transported to a specialized hospital in Atlanta.
The nursing organization National Nurses United has responded that nurses are subject to managerial orders and have little leverage until there is a crisis. They have complained that decisions are made or heavily influenced by people not usually trained in epidemiology. The nurses have criticized the lack of training in epidemic response.
This is what should be expected from the management of for-profit hospitals. When nurses are training, the health corporations don’t make any money.
The Centers for Disease Control (CDC) has been put on the spot for not taking prompt action when the first patient was diagnosed, and even earlier, when the crisis in West Africa began to unfold. However, primary responsibility for responding to a public health emergency belongs to the local health departments and the states, not federal agencies. Their ability to exert primary authority in these cases is diminished by their narrow legislative mandate. In general Federal agencies are reluctant to be perceived as usurping local Health departments authorities.
In related news, an NBC news crew led by medical correspondent Dr. Nancy Snyderman broke a voluntary quarantine to go to a restaurant to buy soup. They had been to West Africa reporting on the Ebola outbreak. Their voluntary quarantine was made mandatory. So far, though, quarantines of people exposed to Ebola generally remain voluntary.
Republicans have started to blame President Obama for the crisis, again claiming that his lack of decisiveness has made things worse. However, Obama has taken action by mobilizing the military to try to contain the health crisis at the source. He has also directed the CDC to assist local governments in their planning to prevent a more deadly outbreak.
Several things were made clear by the comedy of errors of the last few weeks:
- Volunteer quarantines are not effective;
- The CDC has to be given more authority and should exercise it decisively;
- Health professionals have to be trained to respond appropriately to epidemics like Ebola;
- In a for-profit health system, we can’t trust accountants to act like epidemiologist;
- Did I say that quarantines have to be made mandatory?
Finally, the fact that President Obama’s father is from Africa does not make him responsible for Ebola.
Mario Salazar, the 21st Century Pacifist, is a ardent supporter of a public, not for profit, health system like the ones in France, Germany, Sweden and other social democratic countries. He is in Twitter (@chibcharus), Google+ and Facebook (Mario Salazar).