The Ebola Response Reveals Incompetence Too many mistakes in dealing with just one case. Contrary to what Americans have been told, we are not prepared

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WASHINGTON – Beyond the hysteria, false alarms and exaggerations surrounding just three Ebola cases in the US, the disturbing fact is that this admittedly small crisis revealed an astonishing level of incompetence.

Disconnect

In fact, it is even worse. It shows quite clearly a dangerous disconnect between what US top public health officials claimed regarding total preparedness and lack of any preparedness. Dr. Tom Frieden, the Head of the United States Centers for Diseases Control and Prevention, (CDC), in his capacity as top US Government public  health official, went on TV and told America that he and his team of super qualified infectious diseases specialists were on top of the situation. Do not worry. We are all seasoned professionals. We know how to handle Ebola, or anything else, for that matter.

Well, the first case of Ebola revealed that in practice the state of the art system we were told by Dr. Frieden was in place was completely unable to properly handle just one patient.

Too many mistakes

Every possible mistake was made from day one. When Mr. Duncan (a visitor from Liberia) arrived at the emergency room at the Dallas Hospital with Ebola-like symptoms, the staff there failed to register that he had just arrived from Liberia –a country at the center of the Ebola pandemic. And so they did not test him for Ebola and sent him home, with some antibiotics. (I suspect that, while Duncan said where he was coming from, the nurses did not understand the implications, simply because they –just like most Americans– do not know any geography. Therefore “Liberia” meant nothing to them).

Then, according to various reports, when Duncan was finally admitted the second time, he was not properly handled. Apparently, just as in most cases of people arriving at any emergency room, he was placed somewhere to wait, while the staff had to go through paper work and all sorts of other lengthy preliminary procedures. No effort to isolate him.

But, even worse, it appears that the hospital staff was using inadequate protective clothing, and that they had received no training about safe ways to put it on and take it off. Hence contagion.

Inadequate training, no measures to contain the disease

To put it simply, the doctors and nurses caring for Mr. Duncan were winging it. The fact that two nurses got infected while treating him means that whatever system was in place, it was inadequate.

But wait, it keeps getting worse. All the hospital health care workers who had been in contact with Mr. Duncan were instructed to self-monitor their body temperatures. A fever would be the first sign of a possible Ebola contagion. Fine.

But nobody instructed them to stay at home and to avoid all contacts with other people, so that the opportunity for any additional contagion would be limited. No such instructions. One took a trip by airplane. Another one went on a cruise.

All this reveals an astonishing level of incompetence, bordering on utter stupidity. All these lapses are unforced errors that made the effort of containing the possible spread of the disease much more complicated. The more the infected nurses and/or others who may have been infected got around, the larger the number of people who could have been infected by them.

Chain of contagion

While Ebola contagion from causal contact is highly improbable, it cannot be ruled out. Hence the need to contact all the airline passengers who flew with the sick nurse, so that they could be monitored. All these additional complications could have been avoided had the nurse (and all her colleagues) been instructed to stay at home for the prescribed number of days.

The authorities did not tell the truth

Again, please compare this extremely poor record of mistakes after mistakes with the almost cocky attitude displayed on TV by Dr. Tom Frieden, Head of the CDC, the top US official in charge of public health. As indicated above, at the very beginning, he declared with no hesitation that America was fully prepared for any Ebola case. He said that all US hospitals –the best in the world– knew exactly how to handle any Ebola patient in a swift, competent and ultra-safe fashion.

Well, none of that was true. Just one Ebola patient arrives, and we have an almost complete breakdown. Clearly all the responders, while trying their best, proved to be clueless.

No training

Beyond any finger pointing, it is not surprising that the Dallas hospital staff and all the other local health authorities were clueless.

In order to have a good national response to something rather extraordinary like Ebola you need a lot more than sending around memos outlining safety steps.

You need to get everybody’s full attention. You need targeted training in all the hospitals, you need drills, and lots of them. On any given day, the nurses and doctors in your average emergency room in your average American hospital do not wear cumbersome protective gear. In fact they never do.

Therefore it is really stupid to expect that simply because someone from the CDC issued a warning with some instructions we are all prepared.

We are not prepared.

Hard to be fully prepared

And, if we want to be realistic, even though we can clearly do a better job dealing with the Ebola threat, it is hard and extremely expensive to be fully prepared for all contingencies.

Now we have Ebola. But then we have all sorts of possible terror threats, including the targeting of extremely vulnerable critical infrastructure. And then there is cyber terrorism. And may be  suicide bombers.

It is obvious that we cannot prevent each and every threat. We can and should expect the authorities to be competent. But we cannot expect them to be perfect.

Tell the truth

The truth is that a large, modern, free society is extremely vulnerable to a variety of attacks. It is impossible to create perfect shields against all natural or man-made threats.

While it is the job of public authorities to prevent panic, it would be good to tell the truth: “We shall do the best we can, but we cannot guarantee total safety”.

That said, as it will take months or may be years to contain the Ebola pandemic in Africa, let’s get serious about it. Let’s give proper training to all our health care workers.

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