Saturday, December 20, 2014

Ebola watch

Here are some random thoughts about Ebola.  Remember when it used to be in the headlines?

A friend wrote:

I recently read Jose Saramago’s fictional 1997 novel, Blindness, in which mass hysteria ensues as an inexplicable epidemic of white blindness sweeps through a town. Widespread panic marches through the community. The government, in an attempt to control the contagion, reacts by enacting increasingly repressive and ineffective measures. Victims are quarantined in a derelict asylum under armed guard, and left largely to fend for themselves. Social order breaks down rapidly both inside the crowded, filthy asylum and outside of it, in the community, as people begin to treat one another with fear and suspicion. The breakdown of social infrastructure and basic decencies leads to even worse afflictions. It is a remarkably prescient account of how humans react to something that scares us. 

Another friend who has been working on the front lines of Ebola planning and response humorously noted that the most significant advance in rational American preparedness for the disease occurred on November 5.  Why? This was the day after election day. My friend noted that the bad behavior of several governors, most notably Chris Christie and Andrew Cuomo, had simultaneously made outcasts of the extremely dedicated health care workers who had volunteered in Africa and unnecessarily raised undue concern among the American public as to the actual danger to the US population.  It remains unreported whether the governors had read Saramago's book.

Meanwhile, recall that the federal government originally designated under two dozen hospitals nationwide to accept Ebola patients.  Here's the map from October.  But many places felt left out--both for reasons of ego and finance (i.e, looking for a share of the multi-billion emergency appropriation, including $166 million for hospital preparedness and support).  So by December, there were 35 designated hospitals (with more to come--at least one in each state suggests the President, counting votes in the Congress.)  I'm sure the list, though, is based solely on a logistical and scientific determination of need.

Wait, did I mention the amount of requested funding, over $6 billion?  Here's the page with the CDC case counts, both for the US and abroad.  Fewer than 20,000 cases worldwide, and 4 in the US.

Let's compare this to another, ongoing public health hazard. This site notes:

In American hospitals alone, the Centers for Disease Control (CDC) estimates that hospital acquired infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year. 

How does the US government respond to the need for training and process improvement in this arena? By penalizing hospitals, especially those with the sickest and poorest patients:

An analysis of the penalties that Dr. Ashish Jha, a professor at the Harvard School of Public Health, conducted for KHN found that penalties were assessed against 32 percent of the hospitals with the sickest patients. Only 12 percent of hospitals with the least complex cases were punished. Hospitals with the poorest patients were also more likely to be penalized, Jha found. A fourth of the nation’s publicly owned hospitals, which often are the safety net for poor, sick people, are being punished.

Priorities? Even Saramago would be unable to write a fictional account that is more strange than reality.


Tom said...


No Ebola cases in our state. 3 deaths in 6 mos from C. dif at our hospital. What takes up all of the time of our ID team?

Bob said...

Christie and Cuomo both deserve placement in one of Dante's circles - not sure which one, it's been a while since I read Inferno.

nonlocal MD said...

I agree with everything you say but you and I both know you are over simplifying to some degree. Preventing HAI's is not rocket science but many hospitals just were not paying sufficient attention. The poorest performance by the safety net hospitals is entirely predictable given their challenges of money, resources and staffing; I am sure they underperform on most other metrics also. However, penalties are appropriate for those hospitals which do have the resources but were ignoring the issue.
As for Ebola, we are basically lucky that the Texas outbreak was not worse. It could easily have blown up suddenly and it was clear that hospitals were not ready. As to the money appropriated, yes that was panic, but once again, entirely predictable behavior of fearful humans and the politicians who pander to them. What disturbs me about the Ebola situation is that our scientific leaders who were supposed to know about these things were apparently also caught flat-footed. But guess what? Our public health system has been systematically de-funded over decades.