Ebola outbreak: How U.S. health systems should be preparing

The Ebola outbreak in Africa is worrying healthcare leaders around the world, and hospitals and health systems in the United States should be paying attention as well.

There are more than 1,000 suspected cases and 246 suspected deaths tied to the Ebola outbreak in the Democratic Republic of Congo, according to the World Health Organization. Additionally, there are seven suspected cases and one confirmed death in Uganda, the WHO says.

No Ebola cases have been found in the U.S., federal officials say. An American doctor treating patients in the Democratic Republic of Congo is being monitored in Germany to see if he has the virus, The Washington Post reports.

Bhakti Hansoti, an associate professor of emergency medicine at The Johns Hopkins University and director of the Center for Global Emergency Care, tells Chief Healthcare Executive® that she’s concerned with the rapid spread and lethality of the Ebola outbreak in central Africa.

Hansoti says the Bundibugyo variant of the Ebola virus “seems to have significantly higher mortality.” She says the mortality rate of 22-25% is higher than the Ebola variant in the West African outbreak of 2014-16.

“It has spread multi-country very quickly. And then within those countries, there's been more local-to-local transmission,” she says.

Other challenges involve more patients needing ICU support and suffering respiratory failure, and with countries that don’t have critical care capacity, she says there could be more fatalities.

‘A system in place’

Health systems should be taking steps now to deal with suspected cases, and some hospital systems are already acting, Hansoti says.

Hospital systems that are close to international airports have created regional protocols to establish where patients would be treated, she says. Health systems should be aware of where biocontainment units are available.

Hospitals have the benefit of experience from the COVID-19 pandemic.

“Most health systems will have a trained special pathogens ‘go team,’” she says. “So, we've done this. This is not our first rodeo. We lived this in COVID-19, so health systems know how to do this.”

Still, health systems should be going over their plans.

“Who is going to be your frontline emergency team? Have they been updated on EVD (Ebola virus disease) preparedness? Do they have access to purpose and equipment? So, you need a system in place for a nimble, well-trained team of five to six people who will be activated when the first suspected case comes in,” Hansoti says.

Patients, such as those with a non-specific viral illness, typically enter the hospital through a primary care provider, or they enter through the emergency department. She says both primary care physicians and emergency department staff need to be prepared to understand symptoms of Ebola virus.

With its location in Baltimore and its proximity to Washington, D.C., Johns Hopkins has robust experience in procedures for dealing with infectious diseases from international travelers.

Hansoti says that she is worried about hospitals that may have less experience with Ebola.

“My biggest concern is that about only 25% of EVD cases actually present with hemorrhage, and so its identity is sometimes challenging,” she says.

State and local health departments should be issuing memos to all health facilities to have a high index of suspicion for those with fevers or general flu-like symptoms. Noting a flu outbreak is happening in the Northeast, hospitals should be using tests for flu, Covid and RSV for those with symptoms.

Hansoti also stresses the value of pattern recognition.

“I think most people can tell what a common cold looks like,” she says. “And if it doesn't look like the common cold, flag that case. Most facilities do have recent travel screening, and so I think that is just something you have to implement again. Have you been out of the country in the last 21 days?”

Being trusted messengers

State health departments have been effective in communicating with health systems about past outbreaks, Hansoti says.

“State health departments have done a great job of getting those notifications out to registered providers … and they are a trusted messenger, so I think they need to continue doing that,” she says. “I think their job is to raise the index of suspicion, and then also provide clarity on what the reporting line is. So, how does the doctor or the nurse who identifies that suspected case inform their superiors, and how do those superiors inform the state department?”

Health departments also need to employ evidence-based messaging for community engagement and help inform physicians, while also preventing unwanted panic.

“Our job is not to make people panic,” Hansoti says. “Our job is to be trusted purveyors for the health system and for the community.”

The Centers for Disease Control and Prevention has done a good job putting out clinical guidance documents, which are very balanced and very clear, Hansoti says.

But the CDC, which has seen upheaval under President Trump’s administration with staff reductions and the departures of key leaders, isn’t providing the same level of information on Ebola as in past outbreaks, she says. She says the eroded trust in the agency poses problems.

“I think it's a shame that we are operating not at 100% capacity when there's plenty of furloughed staff from CDC, who, this is their bread and butter,” she says. “They were there in West Africa. They could be there supporting us here in the U.S. right now. And so it just feels like a shame that we have a lot of expertise countrywide that is unable to do the job that they are trained to do.”

The Trump administration announced last year that the U.S. was pulling out of the World Health Organization, and the withdrawal took effect this year. Hansoti says she’s “torn” on the impact of the U.S. leaving the WHO.

Many American academic institutions and non-academic institutions still have significant roles with WHO, she says. Hansoti runs the WHO collaborating center for emergency critical operative care at Johns Hopkins University.

She also points to improved “country ownership” in Uganda to track suspected cases. But Hansoti says it’s unclear what happens if there’s a surge in cases, and whether African countries will have the resources and medical countermeasures without U.S. government support.

“Right now things are holding,” Hansoti says. “But if something changes or there's a new variant, I don't know what's going to happen next.”

Keeping Americans in Kenya

The U.S. government announced plans to build a facility in Kenya for Americans traveling abroad to be monitored and treated if they have been exposed to the Ebola virus. Federal officials say the goal is to ensure the virus doesn’t enter America, CNN reports.

Some healthcare leaders criticized the government’s plans, and they argued that Americans would get better treatment in U.S. hospitals. Ronald G. Nahass, MD, president of the Infectious Diseases Society of America, said in a press statement Thursday that Americans exposed to the virus deserve the best care possible.

“The United States has already invested heavily in specialized treatment centers specifically designed to safely care for patients with Ebola and other dangerous infectious diseases,” Nahass said. “Building and staffing a new unit in Kenya during an active outbreak for Americans exposed to Ebola is deeply concerning. It raises serious questions about resources, timing and the level of care Americans sent there will receive.”