By Kelly Riddell – Washington D.C.
The confirmation Tuesday of the first Ebola case on U.S. soil emerges against a backdrop of increasing concern in America’s medical community that preparedness for a pandemic has stagnated or slipped in recent years because of tough economic times and increasing malaise since the 2001 anthrax threat.
The Centers for Disease Control and Prevention, America’s premier disease fighter, offered an air of confidence Tuesday in declaring that the first Ebola patient in Dallas was carefully contained.
But earlier this year, it sounded less optimistic about the U.S. health care system’s ability to fight a pandemic should a major disease outbreak occur.
“CDC continues to work with reduced financial resources, which similarly affects state, local, and insular public health departments. … These losses make it difficult for state and local health departments to continue to expand their preparedness capabilities, instead forcing them to focus on maintaining their current capabilities,” the CDC warned in a report this year.
CDC flagged several key trend lines, including congressional funding for public health emergency preparedness had shrunk by $1 billion from its highs shortly after the 2001 terrorist and anthrax attacks.
It also noted that state and local public health departments on the front lines of any health emergency have shed 45,700 jobs since the 2008 financial crisis.
The concerns, however, extend far beyond financial resources. The Department of Homeland Security inspector general issued a scathing report in September warning the department was woefully prepared for a pandemic, with expired medicines and inadequate resources to effectively equip its top responders in the field.
“DHS may not be able to provide sufficient pandemic preparedness supplies to its employees to continue operations during a pandemic,” the agency’s watchdog declared in a report made public Sept. 1.
“Without sufficiently determining its needs, the department has no assurance it will have an adequate amount of antiviral [drugs] to maintain critical operations during a pandemic,” the report said, warning of the effects for offices such as the Secret Service, U.S. Customs and Border Protection and the Transportation Security Administration.
Despite having the task of protecting the U.S. from dangerous threats, the Homeland Security Department “did not keep accurate records of what it purchased and it received,” the department’s inspector general found.
Homeland Security officials disagreed with much of the report, saying it was a misrepresentation of the agency’s preparedness for an outbreak.
Other preparedness concerns flagged in recent months include the ability of overburdened Border Patrol agents to screen immigrants for disease and inadequate tools to detect or combat a bioterrorist attack.
For instance, numerous government investigations have questioned the adequacy of the federal government’s premier biosurveillance system, code named BioWatch. The respected National Academies of Science questioned whether the current-generation system can detect hazards, and the next generation of the project is in danger of being canceled after the Government Accountability Office questioned its dealing with contractors.
“Over the past several years, our work has identified significant shortcomings in the department’s ability to manage an expanding portfolio of major acquisitions,” said the GAO report, dated June 10. “We recommended that before continuing the Gen-3 acquisition, DHS should carry out key acquisition steps, including reevaluating the mission need and systematically analyzing alternatives based on cost-benefit and risk information.”
The message from the panoply of reports is clear: Although the U.S. clearly made strides after 2001 on pandemic preparation, those gains have stagnated and in some cases begun to reverse even as the risks for an outbreak grow with global travel and determined terrorists.
People say that Ebola looks “so far away, it’s so remote,” said Dr. J. Scott Ries, vice president of Christian Medical & Dental Associations, who worked with Ebola survivor Dr. Kent Brantly, who contracted the disease while treating Ebola patients in Liberia. “Well now, anyone who has thought that will change their opinion. It’s here, like we predicted, and it’s time to massively ramp up our efforts to address this.”
To be sure, the CDC says it will contain the incident in Texas, and the Ebola virus will not spread in the U.S. like it has in West African countries because of U.S. isolation methods, first-world medical care, and the fact that friends and relatives don’t intimately prepare bodies for burial as is customary in West Africa.
“There is no doubt in my mind, we will stop it here,” CDC Director Dr. Tom Frieden said in a press conference Tuesday. Although Ebola is a “scary disease,” he said, “we are stopping it in its tracks in this country.”
Worrisome, however, is that the infected patient in Texas waited four days after he began experiencing symptoms to seek admission to the Dallas hospital. During that time, he was symptomatic and contagious. Ebola doesn’t spread via airborne methods like the flu does, but only through contact with bodily fluids such as blood, feces, urine and vomit.
The CDC said it was monitoring the people with whom the infected patient came into contact. Ebola starts with a high fever and leads to internal bleeding. In Africa, it has a mortality rate as high as 90 percent.
The West African countries of Liberia, Sierra Leone and Guinea have experienced the worst outbreak of the disease in history, killing more than 3,000 people there and infecting others. A total of 6,574 cases have been reported, according to the World Health Organization. There is a separate outbreak in Congo.
Dr. Ries said news of a U.S. Ebola case is “no surprise,” but there is also “no need to panic.”
“We know how to deal with Ebola. While Ebola is highly infectious, it’s not highly contagious,” he said, adding that the Dallas patient has been isolated and is being treated aggressively.
“That’s the advantage we have here with our health system versus what they have in Sierra Leone, Liberia and Guinea,” he said.
Nevertheless, U.S. policymakers renewed alarm that the African outbreak had reached American shores.
“Communicable diseases do not stop at borders,” said Rep. Edward R. Royce, California Republican and chairman of the House Committee on Foreign Affairs. “While the likelihood of a major outbreak in the United States is still very unlikely, with this case, it is more clear than ever that the rapid spread of Ebola in Guinea, Liberia and Sierra Leone presents a clear and present danger not only to West Africa, but the broader international community.”
Sen. Rob Portman, Ohio Republican, renewed his call for the CDC to direct U.S. Customs and Border Protection to enact active screening of travelers demonstrating Ebola symptoms at U.S. ports of entry.
“While I hope that this is an isolated case, today’s announcement serves as a reminder of the need for increased U.S. prevention efforts,” Mr. Portman said in a statement. “According to reports, the patient had recently travelled to West Africa and would have been a clear candidate for active screening. With this announcement, I hope the CDC will consider enacting elevated screening levels.”
Three American medical missionaries other than Dr. Brantly became infected and fell ill in Africa while treating Ebola patients. All were flown back to the U.S. in isolation and have recovered.
“The lessons learned” from treating those workers at Emory University Hospital in Atlanta and elsewhere showed that “this is a disease that we can manage with tech,” said Michael G. Schmidt, vice chairman of the microbiology and immunology department at the Medical University of South Carolina.
Credit also goes, he said, to “the convalescent serum and ZMAPP” administered to Ebola patients, and the “unsung heroes” within local health departments, public health agencies and the U.S. Army Medical Research Institute for Infectious Diseases “who have been planning for this event since” the Ebola outbreak flared up in March.
A White House statement said President Obama had spoken via phone Tuesday with Dr. Frieden and discussed Ebola isolation protocols and efforts to figure out where the patient may have contracted the virus.
The CDC said the Dallas patient was asymptomatic during his flight from Liberia to Dallas. Although he likely contracted the disease abroad, he was not contagious during air travel or noticeably sick on arrival.
CBP works in conjunction with the CDC to monitor travelers and attempt to contain any diseases that may be spread by travelers from abroad.
However, given CBP’s current resources and other strains at the border given the recent influx of unaccompanied minors, it may not be well-equipped to handle another crisis, the Congressional Research Service warned in a report.
“In the current context of the Ebola outbreak in West Africa, CDC has emphasized exit-based airport screening from areas with Ebola, and not screening at [point of entry] in the United States,” wrote Ruth Ellen Wasem, an immigration specialist in a Congressional Research Service report dated Aug. 13.
Ms. Wasem warned that “from an immigration standpoint, an outbreak of an infectious disease places substantial procedural and resource pressures on CBP.”