Clumsy Ebola re­sponse tests coun­try’s faith in health lead­ers

Modern Healthcare - - NEWS - By Steven Ross John­son

The Amer­i­can pub­lic’s deep fears about Ebola and politi­cians’ in­flam­ma­tory rhetoric fol­low­ing the three U.S. cases in Dal­las have prompted pub­lic health ex­perts to think about how the coun­try might re­spond to a more se­ri­ous in­fec­tious dis­ease pan­demic, and what lessons can be learned from the cur­rent limited out­break.

Some see par­al­lels to the hys­te­ria dur­ing the early days of the HIV/AIDS epi­demic in the 1980s. Non­sci­en­tific chat­ter about the Ebola virus abounds on talk ra­dio, in Congress and around kitchen ta­bles, in­clud­ing the al­leged threat of in­fected peo­ple com­ing across the Mex­i­can bor­der and sup­posed trans­mis­sion through the air.

Sen. Rand Paul (R-Ky.) re­cently warned that the 4,000 U.S. troops sent to West Africa to build health in­fra­struc­ture to com­bat Ebola could in­fect each other on trans­port boats and widely spread the virus when they re­turn to the U.S. Other politi­cians have de­manded a ban on West Africans com­ing to the U.S., though some have backed off after be­ing told that could heighten the dan­ger.

What’s needed, ex­perts say, is stronger lead­er­ship from pub­lic health and gov­ern­ment of­fi­cials, in­clud­ing the pres­i­dent. “The pub­lic has told pub­lic health of­fi­cials what they re­ally need to re­main sane and calm,” said Dr. Robert Murphy, di­rec­tor of North­west­ern Univer­sity’s Cen­ter for Global Health. “They need somebody in charge, they need ac­tion, they need a con­tin­u­ous stream of facts that are true and be­liev­able.” By con­trast, in the cur­rent U.S. Ebola sit­u­a­tion, “there has re­ally been no­body in charge, and that has left the pub­lic floun­der­ing and com­ing to their own con­clu­sions, which are not nec­es­sar­ily based on sound pub­lic health pol­icy,” he added. That has helped cre­ate an in­for­ma­tion vac­uum, al­low­ing mis­in­for­ma­tion and hys­te­ria to spread.

Popular anx­i­eties over Ebola have soared since the first case was di­ag­nosed in the U.S. in Septem­ber. That was re­lated to the fed­eral gov­ern­ment’s and the U.S. health­care sys­tem’s botched re­sponses to the case, which led to the in­fec­tion of two nurses who treated the first U.S. Ebola pa­tient and the re­sult­ing need to mon­i­tor hun­dreds of peo­ple.

A poll con­ducted by NPR and Tru­ven Health An­a­lyt­ics ear­lier this month found that more than half of the peo­ple sur­veyed thought the U.S. re­sponse to the Ebola out­break had been in­ad­e­quate. Around 75% said they would pre­fer the U.S. to im­ple­ment a travel ban to and from coun­tries af­fected by the dis­ease.

That’s even though Pres­i­dent Barack Obama and Dr. Thomas Frieden, head of the Cen­ters for Dis­ease Con­trol and Preven­tion, have stressed a travel ban would make it harder to ID and track peo­ple trav­el­ing from af­fected coun­tries.

Frieden ad­mit­ted the CDC should have re­sponded more quickly and ef­fec­tively as soon as the first pa­tient was di­ag­nosed with Ebola at Texas Health Pres­by­te­rian Hos­pi­tal Dal­las. “We should have put a larger team on the ground im­me­di­ately, and we will do that from now on any time there’s a con­firmed case,” Frieden said Oct. 14.

The con­trast be­tween the ini­tial con­fi­dent, even smug, state­ments by Frieden and other of­fi­cials that U.S. hos­pi­tals were fully ca­pa­ble of safely treat­ing Ebola cases and pre­vent­ing the virus’ spread, and sub­se­quent events in Dal­las have deeply shaken the pub­lic’s con­fi­dence.

Dr. Ashish Jha, a pro­fes­sor of in­ter­na­tional health at Har­vard Univer­sity, said gov­ern­ment of­fi­cials and the pub­lic health es­tab­lish­ment will have to work hard to re­gain the pub­lic’s trust. “The les­son mov­ing for­ward is that you have to be very re­al­is­tic with peo­ple, and you have to tell ex­actly what the risks are, and ac­knowl­edge that there might be bar­ri­ers but that peo­ple are on it,” he said.

The New York Post’s front page on Oct. 24 trum­peted the first Ebola case in the city.

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