- THE EBOLA EPIDEMIC – New evidence reveals that US hospitals are unprepared to provide reliable infection control for Ebola virus disease (EVD). The Association of Professionals in Infection Control conducted a survey of members completed on October 15, showing that only 6% of more than 1,000 hospitals are well prepared to control infection risks from treating highly contagious EVD patients. The National Nurses United’s survey of members reveals that as of October 21 only 16% of nurses have received education from their hospitals regarding safe and effective infection control that included an opportunity for questions and answers. Healthcare providers as well as the entire nation are threatened by failures to recognize sick contagious patients and inability to provide safe and reliable contact and droplet isolation in the healthcare setting.
New York State and New York City have made good progress. NYS has ordered mandatory requirements for hospital identification of suspected EVD patients, availability and authentic training for use of personal protective equipment, and other rigorous infection control procedures. New York City appears to be handling its first EVD patient safely and effectively through a combination of good preparations and good luck. The NYC patient was a physician who gave an accurate account of his exposure, symptoms, and presumed diagnosis prior to arrival at a well-prepared university hospital. One can imagine greater difficulty, even in a well-prepared metropolitan area, if the contagious patient was evasive about risk factors, or if the patient sought care at a smaller less prepared community hospital.
Costs of preparing for EVD are enormous: staff training, renovations to create appropriate treatment units, diagnostic testing, and personal protective equipment & supplies. Treatment and public health tracking of potentially exposed individuals are labor intensive. Who will pay for all this?
Public finding for emergency preparedness in the US was generous 10 years ago, and great progress was made. However, investments made in the past do not pay enough of the current expenses and declining public funding will limit our national responses to the EVD threat. Federal funding for the Hospital Preparedness Program has been cut by 50% since 2003. Public Health Emergency Preparedness is down by 30% since 2005. As a result the national public health workforce has been reduced by almost 50,000 practitioners. Many states have reduced prehospital emergency medical services funding, limiting operations and training.
Meanwhile, the current national debate on travel restrictions and quarantine has descended into polemics. Conflicts and inconsistencies are emerging among federal, state, and local authorities. The resulting confusion may limit the credibility of quarantine as an essential tool in the future when it is clearly warranted.
Further bad news, the US will probably continue to face patients with EVD as long as the West Africa EVD epidemic acts as a source for international spread. As of October 31, the WHO reports 13,567 cases with 4951 deaths, most in Guinea, Liberia, and Sierra Leone. Mali is the latest West Africa country at high risk. A symptomatic child traveling to Mali from Guinea was not recognized until after exposing dozens of individuals, many of whom cannot be identified. The small number of children affected in the West Africa epidemic may be due to cultural practices that wisely keep children away from sick patients. Unfortunately, controlling the West Africa epidemic will require far greater resources than international assistance has provided so far.
- POLIO – An international partnership of the WHO, CDC, UNICEF, and national governments criticized Pakistan for inadequate efforts to control a polio outbreak that threatens progress toward worldwide polio eradication. Reported cases of polio in Pakistan have reached 220 so far this year.
- CHIKUNGUNYA – In the US, 1,556 cases have been reported by the end of October. Most of these occurred in travelers returning from endemic areas of the Caribbean, South America, Pacific Islands, or Asia. New York State leads with 435 cases, all acquired after travel to endemic areas. 11 locally acquired cases have been identified in Florida.
- MEASLES – Measles infected 592 Americans by late August, the largest number of US cases in the past two decades. Infections are brought back by travelers from other countries and spread among populations with poor immunization rates. Measles is one of the most contagious diseases. One infected person tends to infect 12-18 susceptible contacts. Contrast this with Ebola in which an infected patient tends to cause 1-2 secondary infections in contacts during the current epidemic. For measles, an immunization rate of 92-94% is necessary to interrupt sustained spread. In some affluent American communities, the measles immunization rate is well below this threshold, by choice of parents, not lack of resources. Measles carries a mortality rate of 0.2-0.3% in the US, and much higher in the developing world.
- PERTUSSIS – Another vaccine preventable infection, pertussis, is on the rise in the US. By August, 17,325 cases were reported, a 30% increase over the same time period in 2013.
- EXPERIENCE WITH EBOLA AT EMORY AND THE UNIVERSITY OF NEBRASKA – See the transcript of a CDC conference call detailing prehospital emergency medical services and critical care hospital experience with Ebola patients in the US.
- TORNADO OCCURRENCE – A trend of warming climate raises questions about the resulting impact on severe weather events. Analysis of patterns shows no change in annual numbers of tornadoes. However, variability has increased since the 1970s. There is a trend toward more days with no tornadoes, as well as an increase in numbers of days with multiple tornadoes. The mechanism of this association cannot be determined from the available data.
Edited by: Dr. Bob Kanter