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Monday, October 13, 2014

The Worsening Ebola Crisis

The Worsening Ebola Crisis

Photo
An Ebola burial team carried the body of a woman through New Kru Town, a suburb of Monrovia, Liberia, on Oct. 10.  Credit John Moore/Getty Images
Recent days have brought two alarming developments in the struggle to contain Ebola. The campaign against the epidemic in West Africa, the only sure way to eliminate the risks of transmitting the virus to the United States and other countries, fell even further behind. And the discovery that a nurse treating an Ebola patient in Dallas had herself become infected despite wearing protective gear raised questions about the readiness of American hospitals to deal with Ebola patients.
Reassuring statements by health officials that virtually any hospital with an isolation unit could treat such patients now look rashly optimistic.
That said, the risk that the Ebola virus might cause outbreaks in this country remains small. By far the greater danger lies in the very real possibility that the virus will continue to spiral out of control in Guinea, Liberia and Sierra Leone and spread from there to other parts of Africa or other continents, opening a wider range of pathways for infected people to reach the United States.
Many countries and international organizations, led by the United States, have pledged money, equipment and manpower to fight the epidemic in West Africa. But the aid has been slow to reach the front lines, leaving health care workers with too few treatment beds to accommodate the sick.
In Sierra Leone, on Friday, health officials — facing just such a shortage of beds — adopted a new policy of having families treat patients in their homes by distributing painkillers, rehydrating solutions and gloves to hundreds of Ebola-afflicted households. But if a nurse in Dallas, clothed in protective garments, could not escape infection, it is hard to believe that less well-equipped households in Sierra Leone will be able to escape contamination from an Ebola patient in their midst.
The pace of international aid needs to be stepped up dramatically. This is not a task that can be left to such nongovernmental organizations as Doctors Without Borders, which has heroically provided much, if not most, of the care in the stricken countries. The United States has taken the lead in providing aid to Liberia, a country with long ties to the United States.
The Army has started deploying thousands of troops to the area to help build new treatment centers, perform laboratory tests and train health care workers in how to treat patients, but most of that help has yet to arrive. It was thus disheartening to hear Maj. Gen. Darryl Williams, the commander of the United States Army Africa, dismiss criticism that American aid had been “too little, too late” with the excuse that the Pentagon was simply filling a “small gap” left by other health organizations.
The United States’ obligation is greater than that; President Obama needs personally to ramp up the urgency of the American response and the level and speed of the resources provided.
Perhaps the Dallas case will add urgency to those efforts to control the epidemic abroad. The case is not cause for domestic panic, but it is cause for greater vigilance among health care workers. Even without knowing fully what happened with the nurse, the Centers for Disease Control and Prevention is exploring ways to make it easier to don protective gear, wear it while treating a patient and take it off afterward without infecting oneself.
The task of treating Ebola patients can clearly be carried out by experienced personnel. Five Ebola patients were flown back to the United States from West Africa and have been treated safely at specially designated hospitals in Atlanta and Omaha.But the Dallas hospital made mistakes in handling this case from the start, and the infected nurse was reportedly a young graduate of a nursing program with little experience in infectious diseases. It seems possible that additional health care workers who cared for the patient will come down sick as well.
The C.D.C. is urging all hospitals, no matter how small, to take travel histories to identify any patients who have been in West Africa within the past 21 days, and immediately place those with Ebola-like symptoms in isolation. The C.D.C. plans to increase its training efforts for hospital personnel, a vital need given that a survey of nurses found a vast majority had received no instructions from their hospitals on how to deal with Ebola. Smaller hospitals will probably have to transfer any Ebola patients to more specialized centers for treatment.
But all of these efforts, however useful, pale against this country’s much larger responsibility to help defeat the disease at its source. http://www.nytimes.com/2014/10/14/opinion/the-worsening-ebola-crisis.html?_r=0