Ebola Shows What Ails Us

The Commentariate seems to be treading rather lightly regarding he Ebola mess in Dallas. Yes, the victims have been blamed, Thomas Eric Duncan for not reporting he’d been exposed to Ebola, though he may not have known he had been, and Nina Pham for managing to get exposed while treating Duncan.

Bt surely this is all a huge deflection from others with culpability for the troubling situation. Surely those dead or dying of or exposed to Ebola as well as the pubic at large have been ill-served by institutions that should have known better and exercised more foresight.

It began well enough when stricken health workers in Africa were brought home for treatment. Seemingly elaborate precautions were in place and the sufferers were installed in medical facilities at Emory and elsewhere with the supposed expertise to cope with so dangerous a pathogen as Ebola.

But already there was a bit too much happy talk and a whiff of hubris from the President, undoubtedly briefed by CDC and other experts who also suggested that our superior healthcare system and knowhow would assure that any cases brought here would be contained and that no epidemic spread such as we are seeing in Africa could possibly occur here.

Even since Duncan showed up at the ER of Texas Health Presbyterian Hospital in Dallas those optimistic sentiments have begun to seem badly off the mark. Any public confidence that those trying to calm fears knew what they were talking about has been eroded. The events of the last several weeks are likely to be taught some day in a case study of bungling — medical, governmental and informational.

At the time of a scary epidemic abroad, a man arrives at an ER with symptoms of the disease. He is not admitted. He is not quarantined. Though he reveals he has recently arrived from the epicenter of the epidemic, that fact is lost track of and not passed along. He is misdiagnosed and even if the wrong diagnosis had been correct he is prescribed the wrong medicine for it.

Worst of all, he is sent home with the opportunity to expose family and bystanders to potential infection. He’s finally brought back by family who try to get doctors to understand that what he’s got is probably Ebola. Finally they get the point and isolate him. But it now appears healthcare workers were not adequately instructed in how to avoid infection. The fear one now can see in the eyes of Texas Presbyterian spokesmen is not just of the disease they may have let loose but the lawsuits likely to result.

Meanwhile, the civil authorities fell down on the job. No one could be found to remove infected objects and disinfect Duncan’s last stop before he entered the hospital. His contacts are eventually identified and tracked for possible contagion. His family members are isolated, but the CDC didn’t cast a wide enough net, apparently not bothering to mount a crash effort to monitor, track and educate all the hospital personnel coming into contact with Duncan. Perhaps they made the same mistake as Duncan and Pham, trusting Texas Presbyterian to know its business.

Now CDC is backpedaling furiously and has concluded that only a handful of hospitals with the specialized training and competence to deal with Ebola patients should be used in future cases. The talk is less happy and more rueful than at the beginning. Our vaunted medico-industrial superiority is no longer being trumpeted, having shown itself to be fallible, all too fallible. And yet,in mid-Mea Culpa, we learn a second Dallas nurse is not just infected with Ebola, but before diagnosis was flying across the country potentially infecting who know-how many.

No one who has ever visited an ER can possibly be surprised by this trail of tears. No doubt while Duncan was potentially allowed to infect a roomful of people the first and most important step in his admission was completed correctly — the ascertaining of his insurance information or the extraction of a promise to foot the bill personally in its absence. After that, however, it all went sideways. Records were lost. Vital information was not communicated. A misdiagnosis was made. Protocols were not observed.

It all happens everyday as the soaring number of bungles and hospital caused infections attests. In most cases this sort of clumsiness may not matter too much. If you come in with an accidental wound, an appendicitis, an allergic reaction or angina, you have a reasonable chance of surviving your encounter with American medicine and may even be correctly diagnosed. But Ebola and other infectious diseases require big league levels of skill and most of our healthcare infrastructure is too bush league to cope.

A few honest voices have begun belatedly to admit as much and suggest the emperor has no clothes. Most politicians, by contrast, have been hyperventilating about closing the borders and have done their best to deflect attention from their own failings. They are legion.

Cuts in CDC and public health funding, opposition to healthcare reform, the refusal to realize threats don’t end at the water’s edge but require a global concern for disease with the funding and manpower to match, the idea that the cure for healthcare errors is to prevent doctors from being sued for malpractice, the notion that best practices are a socialist plot against free enterprise.

But too much is at stake to wait while laissez faire medicine heals itself. Human aren’t Toyotas and the recalls when medicine fails are to the graveyard. As this epidemic reminds us, the idea of boutique medicine for the wealthy and Dollar General (or no medical care) for the poor is fatally flawed. Infectious disease observes no such socio-ecomonic lines of demarcation.

We are all on this planet together. Once upon a time, in a town where I lived, a black kitchen worker at the segregated country club unwittingly passed hepatitis on to a sizable fraction of the white membership. Today a germ from a poor Liberian can find its way to Texas oil billionaires as fast as you can say jet airliner.

This truth seems not to be lost on billionaires, though Congress hasn’t caught on. The foundation of Bill Gates has given $50 million to the CDC Foundation to aid in the fight against Ebola and that of Mark Zuckerberg has given $25 million. Maybe altruism is at work, but enlightened self-interest can’t be ruled out.

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