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Lessons on preparedness

Ebola in the United States


On July 28, 2014, the Centers for Disease Control and Prevention held its first press briefing about the West African Ebola outbreak, following the infection of two U.S. healthcare workers who were treating patients in a hospital in Monrovia, Liberia. Since the first reported Ebola case in March 2014, the disease has claimed almost 5,000 lives in western Africa, making it the largest Ebola outbreak known to modern medicine.

“I want to underscore that Ebola poses little risk to the U.S. general population,” said Stephan Monroe, deputy director of CDC’s National Center for Emerging Zoonotic and Infectious Diseases, at the July 2014 briefing. “Nevertheless, because people do travel between West Africa and the U.S., CDC needs to be prepared for the very remote possibility that one of those travelers could get Ebola and return to the U.S. while sick.”

On Sept. 29, those preparedness efforts were kicked into overdrive when the first case of Ebola in the U.S. was confirmed at Texas Health Presbyterian Hospital.

“It’s a delicate balance between stressing the importance of preparedness and not creating unnecessary fear,” said Matthew Merritt, Novant Health emergency preparedness manager. “The reality is the risk of us seeing an Ebola patient is still very low, but the situation in Texas, and now New York, reminded us we can’t take that risk lightly.”

“Numerous team members have been entirely focused on helping the organization prepare. We have reviewed our plans, equipment, supplies, training and engagement with community health partners,” said Tom Zweng, MD, chief medical officer for Novant Health. “Our team members and communities should feel secure knowing we are prepared to provide the right care in a safe environment for all.”

The cost of preparation

Across the country, healthcare facilities are vigorously preparing for another patient to walk through their doors. While preparedness is a must, it does not come without cost — even without a single confirmed Ebola patient to treat at the facility.

It is easy to estimate costs related to treating a single Ebola patient. Dan Mendleson, CEO of consulting firm Avalere Health, estimates the final cost of care for Eric Thomas Duncan at Texas Health Presbyterian Hospital may approach $500,000 once direct and indirect costs are factored into the total. Not only was Duncan in strict isolation, but his treatment included fluid replacement, blood transfusions, a ventilator, dialysis and a host of medications. The facility also employed extra security, disposed of Ebola-contaminated waste in a special manner and provided special equipment to his care team — much of it beyond the scope of daily care.

The most recent estimate by the World Bank suggests the Ebola outbreak could result in an economic drain on the world economy of as much as $32.6 billion by the end of 2015 if the epidemic spreads further in Africa. There are no estimates, however, on the cost to a healthcare system to prepare: training, testing, personal protection equipment and, of course, unused beds in isolation areas. All this preparedness is a good reminder of the investments made every day by a hospital to be ready for every patient that comes through its doors — no matter the diagnosis.

“Even without a patient, preparation requires tremendous resources,” said Zweng. “We have purchased special personal protection equipment for all of our physician practices, outpatient centers and medical centers. We are training our team and holding meetings with key staff to ensure we are aware and prepared. We are working as a system and testing our processes at the facilities. We look at this as a great exercise in preparation and we are committed to being prepared to provide the best care to a patient in need while protecting our team.”

Following the events in Texas, the CDC has revised its recommendations for handling Ebola patients. With that, preparation efforts by healthcare systems nation-wide must change as well.

“Being prepared is the greatest service we can provide to our communities right now,” said Merritt. “The CDC provides much-needed guidance, but it’s the hospitals that are shouldering most of the burden.”

To learn more about Novant Health’s efforts in Ebola preparedness, visit NovantHealth.org/ebola.





Published: 9/1/2014