Ebola preparedness: The fire this time

The U.S. healthcare system badly fumbled its first unexpected encounter with the deadly Ebola virus. One misdiagnosed patient is dead, two nurses who treated him are sick, and hundreds of people may have been exposed to the virus. Panic is spreading.

The first job for healthcare leaders now is to draw the appropriate lessons from Texas Health Presbyterian Hospital Dallas' multiple failures. They must develop an effective set of best practices on how to manage patients with highly infectious deadly diseases. And they must rapidly execute the mammoth task of ensuring that the nation's frontline hospital and clinic workers are properly trained in how to follow those protocols.

In a world where new infectious disease threats are constantly emerging, this isn't only about Ebola. Frontline healthcare workers need constant practice in how to identify and respond to people who present during outbreaks with symptoms of disease, whether in emergency rooms, physician offices or clinics. They need to remain vigilant about identifying people whose travel history and exposures identify them as risks for spreading disease.

Most importantly, they need protocols that work. Designating major hospitals in big cities as specialized treatment centers, as New York City did this week, may be one part of an overall strategy. But sick people can present anywhere. The protocols have to recognize that basic fact.

Are Dr. Thomas Frieden and the Centers for Disease Control and Prevention culpable because of their failure to provide leadership and offer sound advice? Clearly, there was hubris in their early statements that everything could be easily managed in the U.S. simply because several American healthcare workers stricken in Africa had been successfully treated at special infectious disease units in Atlanta and Nebraska.

This week, international experts fighting Ebola in Africa said the CDC's guidelines for protecting healthcare workers—always the people most immediately at risk—weren't rigorous enough. Frieden said the agency was re-evaluating its protocols and expressed regret it hadn't stepped in more forcefully in Dallas.

But even when it comes up with better protocols, the agency does not have the power to command compliance at hospitals across the country. That is a state health agency responsibility.

The buck ultimately stops on the desks of healthcare system leaders. Only they have the budget authority to create an environment where protocols are well-known, training is rigorous and information technology systems are up to the task.

Whether they have the financial resources to accomplish those goals is a separate question. The Atlanta-based CDC does not have the budget to offer training to the tens of thousands of workers who need it.

As Modern Healthcare reports in next week's issue, preparedness budgets have been shrinking for a decade because of sequestration and other budget cuts. It's a bipartisan affair. The Obama administration's last budget proposal also slashed the CDC's hospital preparedness budget as well as grants to state and local communities for preparedness staff and training.

Moreover, as this space editorialized the week before Thomas Eric Duncan first presented in Dallas' emergency department, spending on preparedness since 9/11 has largely been targeted toward preparing for a bioterror attack—not emerging infectious diseases.

Viral hemorrhagic fever is on the list of potential targets for drug and vaccine development funding under that program. But as everyone now knows, Ebola drew scant attention. Only a couple of experimental drugs are in development and none have even progressed to the point of being tested for safety—much less efficacy.

As of this writing, with the Dallas Ebola outbreak still unresolved, the blame game is well underway on Capitol Hill and in the media. Healthcare leaders cannot let themselves get distracted by that sideshow. They must stay focused on developing better protocols and training.

Follow Merrill Goozner on Twitter: @MHgoozner