The West African Ebola Virus

The West African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history, causing major loss of life and socioeconomic disruption in the region, mainly in the countries of Guinea, Liberia, and Sierra Leone. On September 16, 2014, the White House released a statement describing Ebola epidemic in West Africa as a national security threat to the United States.  In response to the epidemic, our government deployed troops to provide emergency assistance to these countries, such as treatment units and medication, in hope of controlling the spread of the epidemic. Although this was a quick response from our government, these troops were not trained for pandemic and humanitarian relief services, which made it more difficult for them to deal with the situation.

In my opinion, the United States were not prepared to handle such a major health threat. The first case of Ebola in the United States was a man that had traveled to Liberia and when he developed symptoms he went to the Dallas hospital where he was misdiagnosed and sent home. Not properly diagnosing this patient could have caused the spread of the virus to others who were in contact with the infected individual.  Being able to quickly identify those suffering from Ebola would enable early treatment and, perhaps more critically, isolate victims from family members and surrounding communities. At the same time, the hospital personnel didn’t have appropriate training and experience to deal with such cases and as a result a couple of its employees got infected. From the beginning of the Ebola crisis, disease experts and Frieden (CDC Director) in particular have insisted that U.S. hospitals have the training and equipment to handle a highly contagious patient. On July 21, Frieden said that “Ebola poses little risk to the U.S. general population.” And that any advanced hospital in the country would have the capacity to isolate a patient. “There is nothing particularly special about the isolation of an Ebola patient other than it’s really important to do it right,” he said at the time. But the revelations in Dallas suggested that Texas Health Presbyterian Hospital was not fully prepared for the unfamiliar virus and had to adjust its protocols as Duncan’s illness progressed. The CDC’s Rollin, who spent nearly three months in West Africa fighting the Ebola outbreak, said the hospital originally had no full-body biohazard suits equipped with respirators but now has about a dozen. Protocols evolved at the hospital while Duncan was being treated, he said: “Collecting samples, with needles, then you have to have two people, one to watch. I think when the patient arrived they didn’t have someone to watch.” (CDC, 2015).

Diseases that are new to or rare in the United States will impose significant challenges to the U.S. health care system even in the future. To better prepare for cases like this, I believe that there should be certain medical facilities all over the country with expertise in particular infectious diseases that would be the first response for victims. Also, adequately fund research and development of medical countermeasures should be established. Erratic funding has caused serious delays in many programs critical to biodefense. Medical countermeasures are similar to sophisticated weapon systems in that they have very long lead times for development and deployment. Therefore, investments in medical countermeasures must be made years before the outbreak or pandemic, not during it (heritage.org, 2014).

 Early in the response, individual healthcare centers independently stockpiled PPE regardless of their specific risk. Although such stockpiling was not always appropriate, the impulse for centers to do so was understandable, especially since supply of PPE was not coordinated, and neither CDC nor any other authority provided guidance on how much PPE a facility should stockpile, based on the facility’s level of risk. The first incidence of Ebola transmission in the United States led CDC to recommend more stringent PPE guidelines. HHS adjusted its PPE guidance to reflect the more invasive and comprehensive treatment of Ebola patients in U.S. hospitals. This tacit acknowledgment that the original guidelines did not afford sufficient protection undermined CDC’s credibility with its stakeholders. This development, along with the absence of guidance for PPE stockpiling based on a facility’s level of risk, contributed to nationwide shortages of some recommended PPE items, such as powered air purifying respirators. (Public Health Emergency, 2016).

Another way of controlling the spread of the virus was through the airports and the visitors coming in from areas that were infected with Ebola. CBP and CDC had closely worked together in coordinating and developing policies, procedures, and protocols to identify travelers at all ports of entry who may potentially have been infected with the disease.  The problem with these screenings was that it was only placed at five airports within the whole country, where 94% of travelers from the affected regions entered the US. The Department of Homeland Security was working closely with the airlines in redirecting all those flights to the five airports (Department of Homeland Security, 2016). I believe that for a country like ours where we have millions of people coming in and out on a daily basis, there should have been screening areas in all major international airports to make sure no one goes by undetected. Although these screenings were an important strategic public health action, it was also a large resource burden, requiring both time and money for the U.S. government and state and local health departments. These screening points should have been implemented at every airport long in advance before an epidemic like Ebola hit our country.