The U.S. health
care apparatus is so unprepared and short on resources to deal with the
deadly Ebola virus that even small clusters of cases could overwhelm
parts of the system, according to an Associated Press review of
readiness at hospitals and other components of the emergency medical
network.
Experts broadly
agree that a widespread outbreak across the country is extremely
unlikely, but they also concur that it is impossible to predict with
certainty, since previous Ebola epidemics have been confined to remote
areas of Africa. And Ebola is not the only possible danger that causes
concern; experts say other deadly infectious diseases — ranging from
airborne viruses such as SARS, to an unforeseen new strain of the flu,
to more exotic plagues like Lassa fever — could crash the health care
system.
To assess
America's ability to deal with a major outbreak, the AP examined
multiple indicators of readiness: training, manpower, funding, emergency
room shortcomings, supplies, infection control and protection for
health care workers. AP reporters also interviewed dozens of top experts
in those fields.
The
results were worrisome. Supplies, training and funds are all limited.
And there are concerns about whether health care workers would refuse to
treat Ebola victims.
Following
the death of a patient with Ebola in a Texas hospital and the
subsequent infection of two of his nurses, medical officials and
politicians are scurrying to fix preparedness shortcomings. But remedies
cannot be implemented overnight. And fixes will be very expensive.
Dr.
Jeffrey S. Duchin, chairman of the Public Health Committee of the
Infectious Diseases Society of America and a professor of medicine at
the University of Washington, said it will take time to ramp up
readiness, including ordering the right protective equipment and
training workers to use it. "Not every facility is going to be able to
obtain the same level of readiness," he said.
AP
reporters frequently heard assessments that generally, the smaller the
facility, the less prepared, less funded, less staffed and less trained
it is to fight Ebola and other deadly infectious diseases.
"The
place I worry is: Are most small hospitals adequately prepared?" said
Dr. Ashish Jha, a Harvard University specialist in health care quality
and safety. "It clearly depends on the hospital."
He
said better staff training is the most important element of preparation
for any U.S. Ebola outbreak. He believes a small group of personnel at
each hospital needs to know the best procedures, because sick people are
likely to appear first at medium-size or small medical centers, which
are much more common than big ones.
Jha pointed to stepped-up training in recent weeks but wondered, "Will it be enough? We'll find out."
___
AN OVERTAXED EMERGENCY CARE SYSTEM
Without
any stress caused by Ebola cases, the emergency care system in the U.S.
is already overextended. In its 2014 national report card, the American
College of Emergency Physicians gives the country a D-plus grade in
emergency care, asserting the system is in "near-crisis," overwhelmed
even by the usual demands of care.
According
to data from the Centers for Medicare & Medicaid Services, patients
spend an average of 4 1/2 hours in emergency rooms of U.S. hospitals
before being admitted. The data also show that 2 percent of patients
leave before even being seen.
In
a U.S. Centers for Disease Control and Prevention study on hospital
preparedness for emergency response in 2008, the latest data available,
at least a third of hospitals had to divert ambulances because their
emergency rooms were at capacity.
Add
an influx of people with Ebola, along with those who fear they might
have the disease, and the most vulnerable segments of the health care
system could wobble.
"Even
though there have been only a couple cases, many health systems are
already overwhelmed," said Dr. Kenrad Nelson, a professor at Johns
Hopkins Bloomberg School of Public Health and former president of the
American Epidemiological Society, referring to new federal procedures
for screening, tracking and treating the disease and people who are
exposed. He added that if a major flu outbreak also occurred, "it would
be really tough."
"We're
really going to have to step up our game if we are going to deal with
hemorrhagic fevers in this country," said Lawrence Gostin, a global
health law expert and professor at Georgetown University....
http://www.startribune.com/lifestyle/health/280789472.html
