Thomas Eric Duncan went to a Texas hospital on September 26 after he started experiencing abdominal pain and fever. Duncan, a Liberian national who was in Dallas to visit relatives, had helped carry a woman infected with Ebola to a Monrovia hospital four days before he came to the U.S. The hospital, Texas Presbyterian in Dallas, despite knowing that Duncan was from West Africa, sent Duncan back home to his relatives.
Two days later, his nephew called the Centers for Disease Control, and Duncan went back to Texas Presbyterian in an ambulance. On October 8, Duncan died after receiving dialysis, being on a ventilator, and taking an experimental drug called Brincidofovir.
According to NBC News, hospital personnel at Texas Presbyterian had just been through a drill. They'd practiced what they would do if a patient from West Africa presented with Ebola symptoms. However, in spite of knowing that Duncan was from West Africa, health care personnel failed to isolate him. Now, multiple people, including five school-aged children who spent time with Duncan, are being watched in case they display signs of Ebola.
The U.S. needs trained emergency management personnel to deal with crises like the Ebola outbreak. However, Texas Presbyterian’s failure to recognize a possible Ebola infection has caused many to question America’s preparedness for infectious disease outbreaks. The U.S. has known for years that pandemics, including widespread influenza infections, are eventually going to occur. However, a recent federal investigation found that the Department of Homeland Security was “ill-prepared” to deal with a possible pandemic.
Is Anyone in Charge?
The news that Duncan’s relatives had to call the CDC for help highlights America’s poor local preparation for pandemics. However, the recent report criticizing DHS suggests that lack of preparation extends all the way to the highest echelons of government.
Congress appropriated $46 million to DHS in 2006 to enhance its pandemic readiness. With the money, DHS purchased stockpiles of the antiviral medications Relenza and Tamiflu. It also purchased thousands of bottles of hand sanitizer, respirators, and white coverall suits. However, according to a report from the Office of the Inspector General released in September 2014, almost half of the Relenza stockpile and all of the Tamiflu stockpile will expire in 2015. The report also suggested that DHS had failed to maintain the medications at the appropriate room temperature.
Investigators also found over 4,000 bottles of expired hand sanitizer at DHS and reported that many bottles had been expired for up to four years. Additionally, DHS has stockpiled 350,000 white coverall suits and 16 million surgical masks — far more than emergency personnel would ever need — and has thousands of respirators that have passed or will soon pass the manufacturer’s expiration date. According to the OIG, DHS failed to determine what they might need during a pandemic before spending tens of millions of dollars. They also failed to monitor expiration dates and had no procedures for replenishing expired medications and safety materials.
Not Enough Resources
Since the 2008 financial crisis, state and local health departments have shed 45,700 jobs in the U.S. Because these personnel are on the front lines during an infectious disease crisis, local governments might not be equipped to respond to emergencies. Also, funding for public health emergencies has shrunk $1 billion from its highest levels back in 2001. Federal, state, and local agencies need trained emergency management leaders now more than ever before.
In addition to having insufficient personnel, the government illness detection capabilities have received sharp criticism. The National Academies of Science have questioned whether BioWatch, America’s biosurveillance system, could effectively detect pandemics in their earliest stages. Even worse, the Government Accountability Office (GAO) has threatened to cancel upgrades to BioWatch until DHS thoroughly reviews its procurement procedures.
Ebola is not easy to spread from person to person. To contract the disease, a healthy person has to touch the blood, saliva, sweat, or other bodily fluids of an Ebola victim. Ebola can also spread through contact with infected feces, diseased animals, or improper handling of bushmeat. In all likelihood, Ebola won’t spread in the U.S. the way that it has in West Africa. Still, the death of Thomas Eric Duncan raises serious questions about America’s pandemic preparedness.
Ebola news conference image by US Army Africa from Flickr Creative Commons
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