US military action against Ebola no guarantee of success, experts say
By NANCY A. YOUSSEF | McClatchy Washington Bureau (MCT) | Published: October 28, 2014
WASHINGTON — President Barack Obama has ordered as many as 4,000 U.S. troops into the epicenter of the world’s largest-ever Ebola outbreak, in West Africa, but even that might not be enough to contain the disease.
A shortage of doctors, the U.S. Army’s decision to quarantine its troops after they return from Africa and the limits of logistics and other support that U.S. troops can provide mean there is no telling how successful the U.S. can be in stopping the epidemic.
This week, the number of Ebola cases surpassed 10,000, including 4,922 deaths, according to the World Health Organization. That is far more than all the cases combined from the 17 previous outbreaks since Ebola was first identified in 1976. Those outbreaks were largely in rural areas; the current one is so severe because it emerged in urban areas, which allowed it to spread faster.
The U.S response comes at a critical point, medical experts say, as Ebola now is threatening to spread beyond Africa to other continents. To prevent that from happening, the world community must stop Ebola at its West African starting point, experts say.
The U.S. troops could be critical to that, though the vast majority of them are logistics specialists, engineers and technical advisers, not medical professionals. But the 17 Ebola treatment units — ETUs — they’ve been tasked to build in Liberia are critical to hopes to stanch the epidemic, by treating the sick before they can infect others. Each center would contain 100 beds.
“There is a real need to have beds and infrastructure. The Defense Department is best to develop that capability,” said Dr. Dan Hanfling, a clinical professor of emergency medicine at George Washington University who lectures on Ebola safety. “I think the challenge remains to take care of patients in those beds.”
Unlike other kinds of disasters that have drawn a flood of volunteer doctors and nurses — the 2010 Haiti earthquake is one recent example — the current Ebola outbreak has driven volunteers away for fear of contracting the disease or spending weeks in quarantine, Hanfling said.
The U.S. Agency for International Development, which is leading the U.S. government effort, said 3,700 health professionals had volunteered to help. But how many actually will qualify to volunteer and will eventually assist in Liberia remains unclear. Where scores of health organizations and academics have volunteered their employees for past medical disasters, only a handful have stepped forward to confront Ebola.
The U.S. Army’s decision Monday to quarantine all its troops who help build the Ebola centers for 21 days after returning from Liberia could exacerbate the health worker shortage, medical experts say.
The Army made the decision despite new guidelines from the U.S. Centers for Disease Control and Prevention that say such mandatory quarantines are unnecessary, based on scientific evidence — particularly for workers, such as the soldiers, who aren’t expected to have any contact with ill people.
If the military imposes an unnecessary quarantine, experts worry civilian institutions that might provide doctors or nurses will feel the need to do the same, a development that in turn likely would limit the number of volunteers willing to work for weeks in difficult conditions, then spend another three weeks in isolation.
Still, on Tuesday, Obama defended the Army’s action as “prudent,” even as he said it would be a mistake to go beyond what scientists deem necessary.
With medical experts warning that the U.S. government’s oscillating on the need for quarantine only contributes to the public sense of fear, the president’s answer to a question about the differing ways of treating returning soldiers and civilians probably didn’t help.
Emphasizing that the soldiers won’t be treating patients and therefore won’t be exposed to contagious Ebola victims, he nevertheless justified imposing a tougher quarantine on them, noting “they are not there voluntarily; it’s part of their mission that’s been assigned to them by their commanders and ultimately by me, the commander in chief.”
As for civilians, “We want to make sure that when they come back that we are prudent, that we are making sure that they are not at risk themselves or at risk of spreading the disease,” he said. “But we don’t want to do things that aren’t based on science and best practices, because if we do, then we’re just putting another barrier on somebody who’s already doing really important work on our behalf.”
Maj. Gen. Darryl Williams, the commander of U.S. Army Africa, and his team of a dozen troops were placed over the weekend in quarantine at an Army base in Vicenza, Italy, for 21 days after returning from a 30-day mission in Liberia. They are the first group from the Army to return from Liberia.
On Tuesday, the Joint Chiefs of Staff recommended that Secretary of Defense Chuck Hagel order any troops sent to Liberia to be placed in “controlled supervised monitoring” when they return, according to Navy Rear Adm. John Kirby, a Pentagon spokesman. Hagel has not yet decided to follow that recommendation, Kirby said. Among the factors he would consider are “the spillover effects on other agencies and the American people.”
There now are roughly 650 U.S. troops on the ground in Liberia, and they have started building three Ebola treatment centers, said Army Col. Steve Warren, a Pentagon spokesman. Most of the troops are from the 101st Airborne Division based at Fort Campbell, Ky.
The 17 Ebola treatment units will not be complete for at least six months, Warren said.
Some cite a slow U.S. response as contributing to the outbreak. The World Health Organization declared Ebola a global health emergency Aug. 8, but the U.S. did not commit troops until weeks later.
Some have called for the U.S. military to provide some of its 100 infectious disease doctors. But the Obama administration has resisted sending in medical personnel, amid rampant fears of an outbreak in the United States.
Josh Earnest, a White House spokesman, stressed that position on Monday. “The (best way the) Department of Defense can help is by offering their logistical expertise to speed the transfer of supplies and equipment and personnel into the region,” he said. As for medical expertise, Earnest said, “There are a large number of American doctors and nurses who are volunteering their time to trying to confront this outbreak … because they believe that it reflects a commitment to their common man.”
So far, two people have contracted Ebola in the United States, both of them nurses who were treating a patient who came down with Ebola in Liberia. On Tuesday, the second of those nurses, Amber Joy Vinson, was declared Ebola-free and released from Emory University Hospital in Atlanta two weeks after being admitted. The first nurse, Nina Pham, also was cured and was released from the National Institutes of Health hospital in Bethesda, Md., last week.
©2014 McClatchy Washington Bureau. Distributed by McClatchy-Tribune Information Services.