With reports that a nurse who treated Ebola patient Thomas Eric Duncan in Dallas has been infected, one thing urgently needs to be made clear: Our hospitals are not prepared to confront the deadly virus.
It is long past time to stop relying on a business-as-usual approach to a virus that has killed thousands in West Africa and has such a frighteningly high mortality rate. There is no margin for error. That means there can be no standard short of optimal in the protective equipment, such as hazmat suits, given to nurses and others who are the first to engage patients with Ebola-like symptoms. All nurses must have access to the same state-of-the-art equipment used by Emory University Hospital staff when they transported Ebola patients from Africa, but too many hospitals are trying to get by on the cheap.
In addition, hospitals and other frontline providers should immediately conduct hands-on training and drills so that personnel can practice, in teams, vital safety procedures such as the proper way to put on and remove protective equipment. Hospitals must also maintain properly equipped isolation rooms to ensure the safety of patients, visitors and staff and harden their procedures for disposal of medical waste and linens.
We all count on nurses to be there for us when we’re at our sickest and most vulnerable, and it’s everyone’s problem if nurses are not protected. But according to an overwhelming majority of nurses surveyed by National Nurses United at facilities across the United States, many hospitals remain unprepared.
And Ebola is exposing a broader problem: the sober reality of our fragmented, uncoordinated private health care system. We have enormous health care resources in the United States. What we lack is a national, integrated system needed to respond effectively to a severe national threat such as Ebola.
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.
As one CDC official recently admitted to The Washington Post: “We let our guard down a little bit. ... Now that we’ve seen this happen, we know now that we need to do more to make people feel prepared.”
We should have seen this coming. As recently as August, an inspector general’s report evaluating the Department of Homeland Security’s pandemic preparedness concluded that “the Department has no assurance it has sufficient personal protective equipment and antiviral medical countermeasures for a pandemic response.”
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.
It’s time to listen to our nurses. Let’s stop Ebola now and be better prepared for the next pandemic.