Ebola threat in US, and we're not prepared to contain it, experts warn

By LUIS FÁBREGAS, ADAM SMELTZ AND MEGHA SATYANARAYANA | The Pittsburgh Tribune-Review (MCT) | Published: October 5, 2014

Mistakes and missteps in the handling of the first Ebola case in the United States trouble lawmakers, international organizations and some public health experts who say the government needs to step up its strategy to contain the virus.

“Where is the 1-800-Ebola hotline?” asked Gavin MacGregor-Skinner, an assistant professor of public health at Penn State University who helped set up an Ebola treatment clinic in Nigeria a few weeks ago. “This is a Category 5 hurricane. It just happens to be viral.”

Doctors have diagnosed only one person with Ebola in the United States, but as many as 50 people might have been exposed to the virus in Dallas, according to the Centers for Disease Control and Prevention.

Doctors at Howard University Hospital in Washington are monitoring a patient with Ebola-like symptoms who frequently traveled to Nigeria.

The raging epidemic has overwhelmed weak health systems in the West African nations of Guinea, Liberia and Sierra Leone. Although hospitals in the United States are better prepared to handle Ebola, travel restrictions or stricter screening of people coming to the United States from Ebola-affected countries might be necessary to curb the crisis, some health monitors said.

“Unless the World Health Organization and the Centers for Disease Control and Prevention take extreme measures to prevent the universal spread of the disease, we could possibly end up with a pandemic,” said Phenelle Segal, president of Montgomery County-based Infection Control Consulting Services and a former infection prevention analyst for the Pennsylvania Patient Safety Authority.

“I think as soon as we started seeing West Africa go out of control with Ebola, that was the time” to halt air travel from the region, said Segal, who supports exceptions for relief workers and aid missions.

That approach might be the only way to contain the outbreak and prevent a global crisis, Segal said. Federal and global health officials argue isolation would risk more economic instability in West Africa while undercutting humanitarian support, worsening the epidemic in the short term and fostering a greater international threat over time.

U.S. Rep Tim Murphy, R-Upper St. Clair, plans an Oct. 16 hearing with officials from the CDC, National Institutes of Health and others to examine whether tougher measures are needed to screen travelers.

“The propensity of people coming out of those countries may be to get out of there as fast as possible, even if that means lying on their records. We can't necessarily just use that verbal screening process,” Murphy said. “CDC and NIH are going to tell us how they are adapting and changing this, because the current process apparently is not effective.”

Sen. Jerry Moran, a Kansas Republican, urged President Obama to appoint someone to coordinate Ebola-related matters.

“This is a serious development and reiterates the need for us to heighten coordination and vigilance to address this health crisis,” Moran said.

Virus spreading fast

Cases of Ebola have doubled every three weeks in West Africa, where the disease has killed more than 3,400 people.

The United States pledged $750 million in aid to West Africa, and the Pentagon said it could put as many as 4,000 troops in affected countries. The military would help build hospitals and a clinic for infected physicians and health care workers.

Great Britain plans facilities for 700 medical beds in Sierra Leone, and Japan promised $22 million in emergency aid for the region.

The Obama administration's response was not swift enough for organizations such as Doctors Without Borders, whose workers are on the front lines.

“The sick are desperate, their families and caregivers are angry, and aid workers are exhausted. Maintaining quality of care is an extreme challenge,” Joanne Chiu, the organization's executive director, told the United Nations this month.

The Ebola outbreak shows no signs of abating. More than 7,000 people are infected in West Africa, where people often distrust the government and aid workers. The lack of a treatment for the virus has affected the ability of international aid groups to help people with the illness, which causes high fever, vomiting and diarrhea.

Since the identification of Thomas E. Duncan as the first person diagnosed with Ebola in the United States, errors have occurred in the attempt to contain the virus, experts said. Authorities accused Duncan of lying on a form in Liberia that asked whether he had contact with anyone with Ebola.

He fell ill on arrival in Dallas, but a hospital sent him home with antibiotics. When he was finally admitted, local officials stalled in identifying a cleaning crew to remove contaminated linens and furniture from the apartment where Duncan stayed.

Even then, authorities turned away the crew because they did not have appropriate biohazard transportation permits.

MacGregor-Skinner cited poor communication between federal agencies — and with state and local agencies — on which hospitals are equipped to handle Ebola patients, how to safely contain and transport people, and what to do with contaminated waste.

Tamping down panic

Ebola kills up to 90 percent of those who get it, but CDC officials caution that it is not a respiratory virus and can be contracted only though direct contact with bodily fluids.

“This is not like flu. It's not like measles. It's not like the common cold. It's not as spreadable. It's not as infectious. What's scary is that it is so severe if you get infected,” said Dr. Thomas Frieden, the CDC's director.

Yet the CDC appears to be avoiding hysteria by downplaying how easily the disease can spread, including through sweat, said Segal, the infection consultant. She once treated patients in South Africa with similar viruses and covered up with body gear to protect herself.

“I'm not sure the CDC can do anything differently — because what is the public going to do, knowing that it's contagious? What are we going to do?” Segal asked.

Others question the CDC's communication strategy.

MacGregor-Skinner said the use of text messaging to trace contacts with infected individuals was key to containing the virus in Port Harcourt, Nigeria, where he recently was based.

“Contact tracing is the key,” he said. “Let's not stigmatize people who have been in contact with this patient.”

Researching, preparing

Federal authorities at the National Institutes of Health have yet to begin human testing of an investigational vaccine to treat Ebola.

“We need to be sure the vaccines are safe and effective before they're used widely,” said Dr. Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases.

Experts say it's only a matter of time before Ebola hits cities such as Pittsburgh. When that happens, it is important for hospitals to be prepared with equipment and infection control training for health care workers.

“Every city in the world, technically, could have an Ebola case and should be preparing at the hospital level,” said Dr. Amesh Adalja, an infectious disease physician at UPMC. “I don't think this outbreak is going to be over for quite some time.”

Adalja said Ebola is on everyone's mind because it has been portrayed in movies thatstrike fear and provoke people's imaginations.

“Ebola has this mystique about it. It's a mysterious disease that comes out of nowhere. It's very deadly, very scary, and then it disappears,” Adalja said.

Luis Fábregas, Adam Smeltz and Megha Satyanarayana are Trib Total Media staff writers.


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