The United States must establish a network of Ebola-qualified hospitals both at home and in the West African countries fighting the growing epidemic, experts said Tuesday.
They said the U.S. is in danger so long as the epidemic continues in Liberia, Sierra Leone and Guinea and added that without long-term investments both there and at home, other unexpected infections will threaten.
“There is an urgent need to reinforce basic public health systems in countries, such as those in West Africa, where disease threats can quickly arise and ultimately threaten the health of Americans,” Centers for Disease Control and Prevention director Dr. Thomas Frieden told a hearing of the House oversight subcommittee.
Had such a system been in place in Sierra Leone, Liberia and Guinea, there wouldn’t be an epidemic of Ebola there now, Frieden said.
Ebola has infected more than 14,000 people in Liberia, Sierra Leone and Guinea, and it’s killed at least 5,000 of them. The World Health Organization says those numbers are certainly an underestimate. And at least three people have died in an outbreak in Mali, forcing health experts to scramble to try to contain that outbreak.
The White House has asked Congress to allocate nearly $6.2 billion to fight Ebola in West Africa. Congress has until Dec. 11 to do that.
“Now, it is apparent that a nationwide network of predefined infectious disease treatment centers is needed."
Texas state health commissioner Dr. David Lakey said the case of Thomas Eric Duncan, the Liberian who was the first to die from Ebola in the U.S., shows it’s hard to prepare for Ebola cases.
“Now, it is apparent that a nationwide network of predefined infectious disease treatment centers is needed for the care of patients with high-consequence infectious diseases like Ebola,” Lakey told the hearing.
“These treatment facilities must have a care team identified and carefully trained; a comprehensive plan for care, laboratory testing, waste disposal, patient transport; and mortuary services; pre-stocked medicines and post-exposure prophylaxis (PEP); and a sufficient supply of personal protective equipment (PPE),” he added. He said Texas has prepared two hospitals to care for Ebola patients on short notice.
Public health experts have complained about cuts to such preparedness funding in recent years. But it was planning ahead that led to the University of Nebraska Medical Center’s biocontainment unit, built in 2005, said Dr. Jeffrey Gold, the medical schools chancellor.
That unit came in handy for treating medical missionary Dr. Rick Sacra, NBC News freelance camera operator Ashoka Mukpo and Dr. Martin Salia, the Sierra Leonean doctor who died Monday from Ebola.
The university has paid the entire annual cost of staffing and maintaining the unit at a cost of at least $250,000 a year, Gold said, and spent well over $1 million treating Sacra and Mukpo.
Although the CDC initially said any U.S. hospital should be able to care for an Ebola patient, Gold argued that it really often does require a special biocontainment unit. There are only four in the country: at Nebraska, Emory University Hospital, the National Institutes of Health and Providence St. Patrick Hospital in Missoula, Montana. In addition, as Lakey said, states are setting up facilities and Bellevue Hospital in New York successfully treated Ebola patient Dr. Craig Spencer
“A national readiness plan is absolutely necessary,” Gold said. “The number of actual beds is under 20. The number of usable beds is under 10.”
Dr. Nicole Lurie, who is assistant secretary for preparedness and response at the Health and Human Services Department, said Ebola is very unlikely to spread in the U.S., but it’s essential to be prepared. “We might expect a handful of cases in the United States,” she told the hearing.
“Ebola has told us that we really need high-containment facilities.”
She recommends a broadly dispersed network of hospitals prepared not only for Ebola, which doesn’t spread easily, but for a new strain of pandemic flu, which would.
“We need to be prepared not only for today but for the next decade, and for the next century,” Lurie said.
The only reason Ebola vaccines and drugs are even in development was because such preparedness efforts were started after the 9-11 attacks and the anthrax attacks that followed, Lurie said.
“We need to be prepared not only for today but for the next decade, and for the next century."
And the same approach must be taken for Africa, Frieden argued.
“We must do more, and do it quickly, to strengthen global health security around the world, because we are all connected,” Frieden said. “Diseases can be unpredictable — such as H1N1 coming from Mexico, MERS emerging from the Middle East, or Ebola in West Africa, where it had never been recognized before — which is why we have to be prepared globally for anything nature can create that could threaten our global health security.”
In a separate hearing before the House global health subcommittee, Dr. Darius Mans, president of the nonprofit group Africare Mans, said the U.S. and other countries must stop focusing on individual diseases such as malaria and work to shore up health care systems in general.
“We also need to take advantage of this crisis to build a public health infrastructure,” he said.
“Medical systems in these countries remain weak,” agreed Rep. Chris Smith, a New Jersey Republican who chairs the subcommittee.