Last July, the Department of Health and Human Services (HHS) announced it hadestablished a network of medical centers capable of responding to outbreaks of severe, highly infectious diseases as part of a larger effort to further strengthen the nation’s infectious disease response capability. HHS said it selected nine health departments and associated partner hospitals to become special regional treatment centers for patients with Ebola or other high morbidity infectious diseases.
But not all veteran public health authorities who’ve been involved in combating infectious disease outbreaks and developing response planning are completely supportive of HHS’ initiative, which we’ll get into.
HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) awarded approximately $20 million through its Hospital Preparedness Program (HPP) to enhance the regional treatment centers’ capabilities to care for patients with Ebola or other highly infectious diseases. ASPR will provide an additional $9 million to these recipients in the subsequent four years to sustain their readiness.
Each awardee will receive approximately $3.25 million over the full five-year project period. The funding is part of $339.5 million in emergency funding Congress appropriated to enhance state and local public health and health care system preparedness following cases of Ebola in the United States stemming from the 2014 Ebola epidemic in West Africa.
HHS said the facilities will be continuously ready and available to care for a patient with Ebola or some other equally as dangerous and severe, highly infectious disease, whether the patient is medically evacuated from overseas or is diagnosed within the United States.
These regional facilities are part of a national network of 55 Ebola treatment centers, but will have enhanced capabilities to treat a patient with confirmed Ebola or other highly infectious diseases. Even with the establishment of the nine regional facilities, the other 46 Ebola treatment centers and their associated health departments will remain ready and may be called upon to handle one or more simultaneous clusters of patients, HHS emphasized.
“This approach recognizes that being ready to treat severe, highly infectious diseases, including Ebola, is vital to our nation’s health security,” said HHS Assistant Secretary for Preparedness and Response (ASPR) Dr. Nicole Lurie. “This added regional capability increases our domestic preparedness posture to protect the public’s health.”
HHS announced its new HPP Ebola Preparedness and Response Activities funding opportunity on February 20, stating that a total of $194,500,000 is to be awarded to states and other grantees for Ebola health care system preparedness and response, and the development of the regional Ebola treatment strategy.
This funding, in addition to the Ebola emergency funds awarded through the Public Health Emergency Preparedness (PHEP) program, provides a total investment of $339,500,000 to enhance state, local and health care system preparedness for Ebola through the emergency appropriations passed with bipartisan support in Congress last December. These funds are supposed to build on gains made in health care and public health preparedness efforts over the past decade through the HPP and PHEP cooperative agreements with states.
The Centers for Disease Control and Prevention’s (CDC) Office of Public Health Preparedness and Response, Division of State and Local Readiness, administers funds for preparedness activities to state and local public health systems through the PHEP cooperative agreement.
“I’d like to thank cities, states and hospitals across the country and the public health community for stepping up and taking action,” Lurie said. “We are building on the work we’ve already done and further investing in domestic preparedness to protect the public’s health from Ebola, as well as boosting preparedness for many other types of health threats.”
The nine awardees and their partner hospitals are:
- Massachusetts Department of Public Health in partnership with Massachusetts General Hospital in Boston, Massachusetts;
- New York City Department of Health and Mental Hygiene in partnership with New York City Health and Hospitals Corporation/HHC Bellevue Hospital Center in New York City;
- Maryland Department of Health and Mental Hygiene in partnership with Johns Hopkins Hospital in Baltimore, Maryland;
- Georgia Department of Public Health in partnership with Emory University Hospital and Children’s Healthcare of Atlanta/Egleston Children’s Hospital in Atlanta, Georgia;
- Minnesota Department of Health in partnership with the University of Minnesota Medical Center in Minneapolis, Minnesota;
- Texas Department of State Health Services in partnership with the University of Texas Medical Branch at Galveston in Galveston, Texas;
- Nebraska Department of Health and Human Services in partnership with Nebraska Medicine – Nebraska Medical Center in Omaha, Nebraska;
- Colorado Department of Public Health and Environment in partnership with Denver Health Medical Center in Denver, Colorado; and
- Washington State Department of Health in partnership with Providence Sacred Heart Medical Center and Children’s Hospital in Spokane, Washington.
Proposals from these facilities were reviewed by a panel of experts from professional associations, academia and federal agencies, and were selected based upon extensive criteria published in the funding opportunity announcement HSS released in February.
The facilities selected to serve as regional Ebola treatment centers are required to:
- Accept patients within eight hours of being notified;
- Have the capacity to treat at least two Ebola patients at the same time;
- Have respiratory infectious disease isolation capacity or negative pressure rooms for at least 10 patients;
- Conduct quarterly trainings and exercises;
- Receive an annual readiness assessment from the soon-to-be-established National Ebola Training and Education Center composed of experts from health care facilities that have safely and successfully cared for patients with Ebola in the US, and funded by ASPR and the CDC, to ensure clinical staff is adequately prepared and trained to safely treat patients with Ebola and other infectious diseases;
- Be able to treat pediatric patients with Ebola or other infectious diseases or partner with a neighboring facility to do so; and,
- Be able to safely handle Ebola-contaminated or other highly contaminated infectious waste.
Since last fall, HHS said, the US has been working to strengthen domestic pathogenic preparedness and response efforts. State and local public health officials, with technical assistance from CDC and ASPR have collaborated with hospital officials across the nation to increase domestic capacity to care for patients with Ebola and other highly infectious pathogens.
In layman’s terms, that means they hope to be prepared for an unprecedented surge of patients as well as people who believe they’ve been infected. But the problem is – and every virologist and pathogenic specialist knows this — in the United States, the public health care system has never faced a tsunami of the citizenry sickened by a pandemic-level globally spread pathogen. HSS’s plan may work in the initial stage of the pathogen’s spread, but the exponential spread will quickly overwhelm the nation’s healthcare system on a magnitude never before experienced – except in movies like, “Contagion,” or, “Fatal Contact: Bird Flu in America.”
There’s a paucity of doubt that America’s public health care system will collapse under this scenario.
When the surge comes
“I’m more than a little concerned that we haven’t accommodated an adequate surge capacity for the sudden presentation of novel strains [of pathogens] that might suddenly whipsaw through a population-at-risk (PAR). If we are by definition concerned by emerging special pathogens in a virgin soil population, how is capacity for 2-10 patients at each of these centers going to accommodate an outbreak that could impact hundreds, if not thousands of people?” asked Homeland Security Today Senior Contributing Editor Peter Marghella, a long-time expert in emergency public health planning at the military, federal and public level.
Homeland Security Today investigated the problem of hospital surge capacity in the event of a mass casualty event in a two part series on May 20, 2008, and May 13, 2008. The problems we uncovered at that time haven’t, unfortunately, gotten much better, public health authorities say.
Compounding this problem in a frightening was is that in recent years there’s been a global spread of pathogens resistant to antibacterial and anti-viral drugs.
“We’re looking at a little known, and largely ignored, health crisis secondary to – but perhaps equally as deadly in the end – as a pandemic or large-scale terrorist bombing like a nuke or something” which causes a catastrophic surge of people into hospitals and any medical facility they can find – including mobile triage tents and enclosures conducive to spreading hospital acquired infections (HAI), said a source involved in federal emergency medical preparedness planning.
Because of this possibility, and the fact that the spread of HAIs like methicillin-resistant Staphylococcus aureus (MRSA) are already at alarming levels during non-catastrophic emergency conditions, HAIs are seen as a national security threat by the US Intelligence Community.
If too many hospitals are unable to address HAI control and prevention during a non-medical crisis, how will they possibly be able to deal with them during the real thing, health care crisis planners ask.
“So what do you think it’s going to be like during a catastrophic medical crisis where we’re having to put the sick anywhere we can?” and supplies and resources are stressed to their limits, an emergency health planner commented. Indeed. The Centers for Disease Control and Prevention (CDC) estimates nearly 2 million hospitalized patients acquire these preventable infections each year, and that nearly 90,000 die from them, which is as many as AIDS, breast cancer and auto accidents combined.
Authorities said statistics show the number of people injured in a catastrophic terrorist attack who will die from HAIs will be disproportionately higher than the normal 1 in 20 who will die during a routine hospital stay.
“That’s just the way it’s going to be in the environment of a post-catastrophic attack,” one of the authorities explained, adding, if “antibiotic resistant infections begin to run rampant in such a crisis, we could find ourselves with another medical crisis on our hands.”
For example, this and other sources envision a scenario in which an avian flu pandemic leads to widespread unsterile conditions due to the sheer numbers of people needing medical attention that antibiotic resistant infections could nearly become a pandemic unto themselves, quickly depleting available antibiotics that might work in some patients.
In January 2000, the National Intelligence Council, the US Intelligence Community’s (IC) center for midterm and long-term strategic thinking which produces National Intelligence Estimates (NIEs), released an unclassified version of the NIE, “The Global Infectious Disease Threat and Its Implications for the United States.” That NIE said in no uncertain terms that this problem “represents an important initiative on the part of the IC to consider the national security dimension of a nontraditional threat.”
The NIE responded to a growing concern by senior US leaders about the implications — in terms of health, economics and national security — of the growing global infectious disease threat. “The dramatic increase in drug-resistant [pathogens], combined with the lag in development of new antibiotics, the rise of megacities with severe health care deficiencies, environmental degradation and the growing ease and frequency of cross-border movements of people and produce, have greatly facilitated the spread of infectious diseases.”
A catastrophic public health crisis will compound the problem, the NIE stressed, saying, “Alone or in combination, war and natural disasters, economic collapse and human complacency are causing a breakdown in health care delivery and facilitating the emergence or reemergence of infectious diseases.”
The IC made it very clear in its NIE that it considers “hospital-acquired infections … will pose a threat” to national security, adding, “Inadequate infection control practices in hospitals will remain a major source of disease transmission in developing and developed countries alike.”
Nevertheless, HHS said, “Important lessons were … learned during the [Ebola] response effort. Safety of health care workers must be foremost in health care system preparedness and response activities; the care of Ebola patients is clinically complex and demanding; and early case recognition is critical for preventing spread and improving outcomes. Assuring that Ebola patients are safely and well cared for in the UShealth care system and that frontline providers are trained to recognize and isolate a person with suspected Ebola are the cornerstones of the Hospital Preparedness Program Ebola funding announcement.
But what about other emergent pathogens … or some mutated, more fatal strain of Ebola … or the H5N1 avian influenza virus?
Through HPP Ebola funding, HHS explained that it seeks to build upon the tiered approach outlined in HHS’ Interim Guidance for US Hospital Preparedness for Patients under Investigation or with Confirmed Ebola Virus Disease: A Framework for a Tiered Approach, to establish a nationwide, regional treatment network for Ebola and other infectious diseases.
“This approach,” HHS assured, “balances geographic need, differences in institutional capabilities and accounts for the potential risk of needing to care for an Ebola patient. It builds on Congress’ call for a regional strategy and also recognizes the tremendous work done by cities, states and hospitals.”
This network will consist of:
- Up to 10 regional Ebola and other special pathogen treatment centers, including one hospital in each of the 10 HHS regions from among those that have already been designated by their state health officials to serve as Ebola Treatment Centers and have been assessed by CDC-led Rapid Ebola Preparedness (REP) teams. These facilities will have enhanced capabilities to receive a confirmed Ebola patient;
- State or jurisdiction Ebola Treatment Centers that can safely care for patients with Ebola as needed;
- Assessment hospitals that can safely receive and isolate a person under investigation for Ebola and care for the person until an Ebola diagnosis can be confirmed or ruled out and until discharge or transfer are completed; and
- Frontline health care facilities that can rapidly identify and triage patients with relevant exposure history and signs or symptoms compatible with Ebola and coordinate patient transfer to an Ebola assessment hospital.
The HPP Ebola funding opportunity will provide funding to all 50 states, Washington, DC and select metropolitan jurisdictions to support health care facilities that are capable of serving as regional Ebola and other special pathogen treatment centers, Ebola Treatment Centers and assessment hospitals for their states or jurisdictions, HHS said.
“The funding will also support health care coalitions to prepare frontline hospitals, emergency medical services agencies and the overall health care system,” HHS said, noting that, “As with past preparedness grants, states and other awardees have appropriate flexibility in how funding is distributed to community-level healthcare coalitions and local jurisdictions.”
Additionally, to date, four non-federal hospitals have cared for one or more patients with Ebola. Congress provided HHS with the authority to reimburse hospitals using Ebola emergency funding for the care of Ebola patients not covered by health insurance and workers compensation programs, HHS is developing the mechanism for that process.
Public health authorities not convinced
“In one way, the Department of Health and Human Services’ effort to identify nine regional Ebola treatment centers is typical of the federal government’s propensity to that of fighting the last war phenomenon. It’s also indicative of its propensity at knee jerk reactivity, i.e., along comes a threat we were completely unprepared for; it caught us napping; and it could have stung us badly; and now we’re going to spend billions after the fact to make sure we’re not caught in a doze again,” Homeland Security Today was told on condition of anonymity by a seasoned senior public health official familiar with these issues.
“At the big picture level,” the official continued, “this is what I’m most concerned with,” adding, “As a species, we continue to demonstrate the embracing of culture of reactivity, instead of embracing a culture of preparedness and proactivity.”
“It’s also how we dealt with aviation security following 9/11 and the shoe bomber – we’ve ignored the role the airline industry might unwittingly play by propagating the next great disease pandemic.”
The official referred to medical historian, R.S. Bray, who wrote, Armies of Pestilence: The Impact of Disease Upon History, in which he stated the single inexorable truth about disease is that it “will always travel along man’s lines of communication.”
“The international airline industry may end up being the vector accelerant of the next pandemic,” the official warned.
The role international air travel may unwittingly play in the spread of a highly infectious disease is especially disconcerting, authorities acknowledged.
Marghella said Michael Osterholm — an internationally recognized expert in infectious disease epidemiology who is director of the Center for Infectious Disease Research and Policy and a member of the National Academy of Science Institute of Medicine who has led investigations into infectious disease outbreaks during his 15 years as state epidemiologist at the Minnesota Department of Health – “noted during the Ebola outbreak that it wasn’t the disease that had changed; it was the culture, environment and geography of West Africa that had changed (e.g., increase in the population size, increases in population density, the phenomenon of ‘clustering’ in cities, increased access to transportation, over-reliance on critical infrastructure assets already strained to support the population, etc.). Since all of these trends were noticeable, why did the event become such a ‘predictable surprise?’”
Marghella said, “A culture of preparedness would take us to a place that recognizes extant threats across the spectrum of hazards and takes the necessary steps to emplace barriers to their ability to become disasters.”
He pointed out two recent points made by the UN: there’s no such thing as natural disasters, only natural hazards; and disasters occur at the confluence of where hazards meet vulnerabilities.
“Another point to make is that Ebola in West Africa is very different than Ebola in the United States,” Marghella said. “Dr. Frederick ‘Skip’ Burkle — a veritable giant in the field of humanitarian and disaster medicine — suggested a couple of month’s back that we could have significantly decreased the scope and scale of the West African outbreak if we’d introduced cultural anthropologists to the mix of the initial response assets.”
“Ebola spread like wildfire there during the 2014-15 outbreak because we couldn’t get the indigenous populations affected by the disease to stop the practices of family-based nursing care and funerary preparation,” Marghella explained. “While we still have a long way to go in infection control here in the US, we are light years ahead of the impacted West African nations, and I simply never saw Ebola rising to the level of threat we whipped ourselves into about it here.”
“One of my colleagues noted that the nine centers, prepared above all others, is the risk,” Marghella said, noting that, “The greatest risk is really in the point of first exposure (always at the most primitive local level) prior to accessing the right people at the regional center and in a timely manner. The missing piece in [the HHS’s plan] is that we must know what has been, or will be sent out, to educate the locals and the other non-center states regarding the role they’ll have to play (i.e., what is expected of them), and what the time period from initial suspicion at the local level to reaching the regional center will be. There are some simple dynamics of medical planning here that may have not been completely accommodated for yet.”
“All that said,” Marghella offered, “there are positive things about this initiative. The fact that they included ‘other special pathogens’ gives recognition of the fact that we are seeing an up-tic in emerging novel viruses (e.g., SARS and MERS-CoV) in the first 15 years of the 21st Century, and it’s just prudent medical practice — and good preparedness — to set up special centers to accommodate their potential presentation here in the US.”
The following are additional “positive points derived from some of my high-level medical readiness colleagues on this matter,” Marghella said.
- The initiative is in keeping with the trend of regionalizing specialty care delivery (e.g., trauma, burn, pediatric advanced life support, etc.). This is the model that has emerged as the most economical and supportive of the population in the US for the past 20 years;
- It follows that when it comes to resource intensive environments of care, it makes more sense to concentrate the delivery of those capabilities into the hands of a few rather than dispersing it widely;
- The presumed follow-on to this has to be healthcare networks that are prepared and coordinated via the proven model of healthcare coalitions, with coordinated plans for patient referral, transportation, surge capacity, medical logistics, etc.;
- The funding model is sound. It would have been a travesty to divide the funding Congress had appropriated for enhanced Ebola/novel virus preparedness through the HPP grants stream amongst everyone (i.e., all the states andtheir major healthcare systems) and have an expectation of enhanced readiness.
The bio-threat monitoring system problem
Meanwhile, the co-chairs of the Blue Ribbon Study Panel on Biodefense recently expressed serious concerns over the considerable lack of budgetary support for the BioShield procurement fund for medical countermeasures [MCM] in the proposed Fiscal Year 2016 budget derived by the House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.
“The BioShield Special Reserve Fund — which provides money to develop and purchase vaccines to be used in the event of a biological attack — is level funded at $255 million. From FY 2004 to FY 2013, this fund was advance-appropriated $5.6 billion in an unprecedented, bipartisan commitment to biodefense that brought a dozen countermeasures into the national stockpile,” The panel noted.
“The President has requested $646 million for the Special Research Fund. We are at a loss to understand why, with Ebola lingering in Africa, a MERS outbreak in East Asia and the President’s request, Congress failed to allocate more to this crucial fund.” said panel co-chair Tom Ridge, the first secretary of the Department of Homeland Security.
“Increases for the National Institutes for Health and CDC are encouraging,” the panel said, but, “They are difficult to reconcile with the cut to the procurement fund request, which is what would actually be used to purchase any medical countermeasures [MCMs] that the NIH developed, and that the CDC would want to stockpile. Biodefense and emerging infectious disease are an enterprise, and all facets of the enterprise must be coordinated and supported.”
“We hope that the final bill that goes to the President takes our recommendations into account,” said former Sen. Joe Lieberman, the panel co-chair. “Ebola proved that we weren’t ready. We have to be ready next time.”
The final report of the Blue Ribbon Study Panel on Biodefense will be issued this fall.
DHS lacks stockpile of protective gear, MCMs for its own personnel
On top of all this, a recent audit by the Department of Homeland Security’s (DHS) Inspector General (IG) to determine whether DHS effectively manages its pandemic preparedness supply of personal protective equipment and medical countermeasures for its workforce, especially its essential personnel, found DHS isn’t prepared at all, which sparked sharp criticism from public health sector authorities.
DHS is responsible for ensuring it is adequately prepared to continue critical operations in the event of a pandemic. If it isn’t, DHS — including the Federal Emergency Management Agency — will be hard-pressed to protect its critical emergency response, infrastructure, intelligence and counterterrorism personnel, which would contribute to the massive societal breakdown authorities have long warned will rapidly breakdown in the event of a highly virulent and transmissible influenza virus.
But the IG’s audit found “DHS did not adequately conduct a needs assessment prior to purchasing pandemic preparedness supplies and then did not effectively manage its stockpile of pandemic personal protective equipment and antiviral medical countermeasures.”
“Specifically,” the IG reported, DHS “did not have clear and documented methodologies to determine the types and quantities of personal protective equipment and antiviral medical countermeasures it purchased for workforce protection.”
The IG’s audit found DHS “has no assurance it has sufficient personal protective equipment and antiviral medical countermeasures for a pandemic response. In addition, we identified concerns related to the oversight of antibiotic medical countermeasures.”
Nor does DHS have “assurance that the supplies on hand remain effective.”
Since the IG’s audit, there’s been blistering criticism from lawmakers and public health officials, some of whom previously worked for the government to plan for widespread pathogenic outbreaks and bio-threats.
“The funny thing (if you can laugh at things like this) is that this DHS OIG report dings them for their inability to even prepare their own department adequately for a pandemic,” a former senior government public health preparedness official told Homeland Security Today. “All that money, and all that preparation was supposed to be for DHS workforce protection. To the extent that they mismanaged that, someone should be taking a seriously hard look at what other failings might be expected when it comes to taking care of the entire American Public.”
“It really doesn’t matter how much you have in your stockpile, or if it is in date or out of date, or if you have a restocking program in place or not … if you don’t even know where it is stored … well …,” what good is it, the former government official said.
“I’m thinking that the single most telling item in the report is: "DHS and its components do not know where its personal protective equipment is located, how much it has and the usability of the stockpiles that exist,” added Dr. James Phelps, Assistant Professor of Border and Homeland Security at Angelo State University.
“As we discuss this, remember that local emergency services are not protected by these stockpiles. The provisioning for federal employees did not get to the frontlines. They were expected to continue operations, move into the event and not considered ‘priority one,’” said Tim Stephens, CEO of the MESH Coalition, an innovative non-profit, public-private coalition that enables healthcare providers to respond effectively to emergency events and remain viable through recovery.
“We have developed extraordinary supply and inventory management systems to manage JITT diapers (Amazon’s busiest zipcode is the upper east side of Manhattan, where space is at a premium), and any number of pharmaceutical and medical products, but our emergency stockpiling has yet to leverage this capacity to enable the frontlines to have early, necessary access to these vital products,” said Stephens, who has more than 20years experience in public health preparedness, communications and strategic management. He was director of preparedness for the Association of State and Territorial Health Officials in the immediate aftermath of 9/11, and founder of the Emergency Services Coalition for Medical Preparedness.
“I am deeply troubled with the Department of Homeland Security Office of Inspector General’s report finding that the department had not adequately managed its stockpile of personal protective equipment and antiviral countermeasures for its workforce,” said Rep. Bennie G. Thompson (D-Miss.), ranking member of the House Committee on Homeland Security.
“DHS is among the chief federal agencies charged with helping state and local governments improve capabilities to prepare for and respond to catastrophic health threats. Unfortunately, we do not know whether [DHS] even has the capability to protect its own workforce in the event of a pandemic,” Thompson said. “It is unclear what data or methodology drove the investment decisions DHS made with approximately $47 million Congress appropriated to help DHS plan, train and prepare for such an event. It also appears DHS invested millions of dollars in equipment and countermeasures without establishing a lifecycle plan – this is unacceptable. DHS should immediately implement a plan to address the 11 recommendations laid out in [the IG’s audit] report.”
“The backdrop for this fiasco was the absolute dysfunction between DHS and HHS and CDC,” a former federal public health preparedness official told Homeland Security Today. “They wouldn’t even have civil conversations with one another.”
The former official also had blunt words for current CIA Director John Brennan when he worked at the White House as Deputy National Security Advisor for Homeland Security and Counterterrorism, and Assistant to the President responsible for overseeing plans to protect the country from terrorism and response to natural disasters.
“The guy thought he was tighter on all things pandemic-related than John Barry, author of, The Great Influenza. Even if we gave him good advice through [the] Operations Coordination and Planning Directorate, more often than not it would get screwed up by the time it reached the President’s ears.”
“Perhaps the worst part of this epic goat-rope was the lack of coordination between DHS as the overall Homeland Security Presidential Directive 5 lead for domestic response, and the state and locals, who were pretty much looking like deer in the headlights waiting for some executable strategy and advice from the Feds (which never came),” the former official continued. “The Federal Implementation Plan for Pandemic Influenza was an exercise in planning masturbation by the Federal Partner Agency Working Group, who — with the exception of the DoD resource … couldn’t have spelled P-L-A-N on their best day, never mind figuring out actually having to do one that might be, I don’t know … executable?”
Continuing, the former official said, “we dodged a serious bullet in that the H1N1 strain never reached anything close to the virulence and pathogenicity that we were worried about. If it would have had even 25 percent of the attack rate and the matching case fatality ratio of [the] 1918-19 [Spanish Flu], this would have been a nightmare compounded by the fact that the lead federal agency for the whole thing wouldn’t have had a clue what to do.”
“As far as the DHS IG report goes, I can’t say that I am the least bit surprised [at its conclusions]. When the 2009-2010 H1N1 pandemic was declared … The agency was nothing short of dysfunctional … The medical end for the department … and the rest of the DHS organization simply lacked an adequate background on medical preparednessand response planning. It was like watching the Keystone Cops — and they weren’t the least bit happy about bringing in” outsiders to advise on “really delicate issues like” the following:
- Accommodating surge capacity in the Nation’s hospitals if the pandemic had really turned south;
- Coordinating the development of a utilitarian vaccine with HHS and national and international pharmaceutical companies;
- Figuring out just how useful the antivirals were going to be for the H1N1 strain, and whether or not we could surge logistically to meet demand requirements;
- The utility of the containment strategy (which we found to be useless, because influenza is spread by contact with respiratory particulate matter and has a latency period between time of exposure and onset of illness; with plane travel hyper-speeding people all over the planet, there never would have been a way to accommodate a "containment" of the outbreak from the start);
- The national ventilator shortage conundrum;
- Mass fatality management planning, which frankly scared the s#&* out of everyone and no one wanted to touch with a ten foot pole; and
- Coordinating the national public health crisis communications message with the American Public (which no one — from CDC to the White House — wanted to take responsibility for to tell people that if that outbreak was anything to being near to close to what happened in 1918-19, that we were looking at deaths in the US alone in the millions.
Analysis
Marghella said the Ebola “outbreak should represent a serious wake-up call for our healthcare infrastructure … every hospital in the United States should be taking a hard look at how well positioned they are to deal with the demands of even a small number of these kinds of patients.”
“The unique requirements for disease identification, patient transportation, patient isolation and quarantine, staff protection, laboratory processing, fatality management, public health crisis communications and psychosocial support to the diseased patients and the community are enormous,” he stated. “And if the C-Suite leaders of healthcare organizations think they can sort it all out when the first patient arrives, they should strongly reconsider. One only has to look at the 2003 SARS outbreak to find out how ill prepared healthcare organizations in North America were for dealing with that disease’s unheralded arrival.”
“Time, and time again, by failing to engage in deliberate planning ahead of an event (even when we know the event looms large on our horizon), we invariably fail to meet the demands of the medical and public health incident management requirements that are imposed on us after the threat of the event occurs,” Marghella said. “This isn’t rocket science — prepare now or suffer the affects of the event later.”
“Finally,” he pointed out, “the number of cases and the associated fatalities that are a result of the current Ebola outbreak in West Africa should be looked at closely and then closely compared with another insidious disease threat that has impacted the US for quite some time now –Clostridium difficile diarrhea.”
This “is a type of infectious diarrhea caused by the bacteria of the same name — often referred to by clinicians as “C-diff” — that, according to the CDC, kills more than 14,000 people a year in America alone. C-difficile infections (CDI) are a growing problem in healthcare facilities. Outbreaks occur when humans accidentally ingest spores in a medical facility. But if hospitals would just increase contact precautions to the point of even moderately reducing the risk of C-diff exposure, planning to contend with the contact precautions necessary to manage other highly infectious patients might actually become relatively easy in comparison.”
Marghella noted that during the argument “for the Anthrax Vaccine Immunization Program (AVIP) in the Department of Defense, the action officers who attempted to move the policy forward to include advance force health protection, used the following axiom: If there is a known weaponized disease threat, and a proven and safe vaccine to administer as a counter, prudent medical practice dictates we vaccinate. If we change that axiom only slightly to say: If there is a known threat of disaster (any type of disaster, whether Ebola, C-diff or a hurricane), and there’s a proven and safe way to administer counters to prepare, then prudent medical and public health practice dictates we do so.”
Photo: Mass casualty disaster drill at Penn Care.
