Tuesday, November 11, 2014

Lessons From Three Months Of Dealing With Ebola In The United States


Photo Credit- CDC


# 9306


Later today, America’s last hospitalized Ebola patient – Dr.  Craig Spencer – will be released from the New York Hospital where he has been treated for the past 3 weeks, cured of his Ebola virus infection (see Maggie Fox’s report Last U.S. Ebola Patient Is Cured: Dr. Craig Spencer to Be Released).  


Since the epidemic still rages in West Africa, our respite may be short-lived.  Our next Ebola case could literally step off an airplane at anytime.


But the next time we’ll have an advantage we didn’t have last August when the first patient arrived in the US -  we’ll have a track record of dealing successfully with the virus. 

  • To date, the United States has dealt with 9 Ebola cases, and of those, 8 have recovered.  Only one case – that of Thomas Duncan who arrived from Liberia in September– resulted in a death.  For a disease that was expected to kill anywhere between 50%-90% percent of its victims, an 88% success rate is a reassuring result. 
  • Despite two separate unplanned introductions of the virus (Duncan & Spencer) – both of whom had contact with others after becoming symptomatic – only two secondary cases resulted.  Both were nurses who treated Mr. Duncan before his diagnosis was confirmed (Nina Pham & Amber Joy Vinson)
  • Of the hundreds of public contacts of Duncan, Spencer, and the two nurses from Texas – not a single Ebola infection resulted. 
  • Despite initial concerns and protests - in hospitals that knew they were receiving an Ebola patient – no secondary transmission occurred.


Arguably, we’ve gotten lucky more than once over the past 90 days, and there are no guarantees that the next introduction of the virus will turn out as well as these previous ones have. 

The next imported case might spread the virus further before seeking medical care, or the next hospital (prepared or not) may not be as exacting in their infection control procedures. 


But at least we will know going in that a good outcome with our modern public health system is not only possible, it appears likely.  And that should calm some of the public’s jitters the next time, particularly if the media shows a bit more restraint in their handling of the subject. 


A little less P.T. Barnum and a little more Edward R. Murrow would go a long way.


But none of this suggests that we can be complacent, or that Ebola doesn’t pose a threat to America.  Sparks will continue to fly off the viral conflagration in Africa as long as that epidemic rages, and some will inevitably land in developed countries like the United States and in Europe.


While they may do some initial damage, there they will likely be contained.  Regardless of the outcome, they will prove both expensive and very inconvenient.

More ominously, some sparks may land in nations far less able to contain the virus – places like India, Pakistan, or some of the mega-cities of Africa or Asia – with the potential of seeing another regional hotspot for Ebola transmission emerge. 


Simply put, if the virus isn’t contained in West Africa, it could become an endemic global threat for years to come with potentially horrendous economic, societal, and public health impacts we can only begin to guess at.


While the good news is we seem reasonably able to handle a limited number of Ebola sparks landing in our country, the bad news is we seem far from ready to deal with a real pandemic threat. As scary as Ebola is, it doesn’t have the `legs’  to spread the way that a respiratory virus – like a novel influenza (or perhaps a coronavirus) – can.


While the governments of the world quietly prepare, creating  and testing dozens of candidate vaccines (see NIH: H7N9 Vaccine Candidate Works Much Better With An Adjuvant), and holding major training exercises (see UK: Updated Pandemic Response Plan & Exercise Cygnus) the private sector – which was so engaged in pandemic planning 8 or 9 years ago - seems to have lost interest, and remains dangerously unprepared to deal with a virulent and fast moving pandemic virus.


The biggest lesson from Ebola is one I fear we haven’t learned yet. 


That the shot across our bow from Ebola should be a head’s up, a hint of things to come.  That the next global public health threat may move far quicker, and be much harder to contain, than Ebola.


And that the smart money is on being well prepared – both in the public and  private sector – for when that inevitably happens.


For some earlier blogs on pandemic preparedness, you may wish to revisit:


MMWR: Updated Preparedness and Response Framework for Influenza Pandemics
It’s Not Just Ebola
NPM14: Because Pandemics Happen
Pandemic Planning For Business

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