Michael Gerson
WASHINGTON – In any health care setting, it is wise to listen to the nurses, who see all. Their reports from Dallas about the initial procedures used in treating Thomas Eric Duncan are appalling. Safety suits with exposed necklines left nurses to cover skin with tape. When tape is removed, it abrades the skin. One health expert I consulted described this practice in dealing with Ebola as “moronic.”
Proper protocols are now said to be in place. But Ebola in America has been an exacting and brutal teacher.
First, we have seen that the infectiousness of Ebola increases as a patient grows sicker and the level of the virus spikes in his or her bloodstream. To the general public, this should provide some reassurance. When a patient begins to feel weak and achy at home, he or she is less likely to spread the disease. None of the people who lived in tight quarters with Duncan has (as of this writing) reported infection.
But for health workers treating very ill patients, the danger of infection is dramatically elevated. Any crack in a glove, any touching of the eye, might be enough. And when a patient’s viral load is sky-high, it is likely to be found even in his or her saliva and mucus. Theoretically, even a cough spraying sputum on exposed skin might transmit the disease. A person in this condition would be too sick to walk the streets. The risk is to health care workers who are not properly protected.
Second, we’ve learned that providing protection to health workers is a skill not possessed by every hospital. Reading a protocol off a website is one thing. Implementing a protocol, with perfection as the only acceptable standard, is another. It is the distance between reading a book on batting and hitting a pitch in the major leagues. Most hospitals are poorly prepared to take very ill Ebola patients. This demands either the immediate deployment of federal Ebola “SWAT teams” when a case is reported, or the careful transfer of patients to more competent facilities. The hurt feelings of local hospitals or mayors should matter not at all.
Third, we’ve seen that the federal response to Ebola has had serious weaknesses under stress. The Centers for Disease Control and Prevention assumed that any large hospital would know what it was doing in isolating an Ebola patient. The assumption was wrong. The CDC allowed a nurse with an elevated temperature who had been heavily involved with Duncan’s treatment to board a plane. This showed inadequate respect for the disease, and a tin ear on matters of public trust.
The knowledge and dedication of American public health officials are unequaled. But the implementation and judgment of public health systems have sometimes been seriously flawed.
So how should our political system respond? Not an easy question to answer, especially less than three weeks before an election. Those who pursue political sport during a health emergency – either finding a symbol of liberal incompetence or a symbol of inadequate public investment – are not helping matters. Fighting infectious disease is an essential federal role, not an ideological metaphor.
The real questions are: Can government learn from its mistakes, and will it be allowed to? The goal is to strengthen the current disease response and be better prepared for the next one (which might, unlike Ebola, involve the serious threat of a large public outbreak in America). Somehow, even during a politically charged season, our Ebola debate must be an exercise in learning lessons.
In all this, some perspective is necessary. By the end of the year, according to the World Health Organization, there could be up to 10,000 new cases of Ebola in West Africa each week. Information from inside the affected countries is already growing sketchy as ties to the outside world are cut. This problem will not be solved by canceling the few remaining commercial flights out of Monrovia. The economic, political and social collapse of Liberia, Guinea and Sierra Leone would swell the flow of disease refugees and increase the risk of outbreaks in other populous parts of Africa, or in even more distant places such as India.
By all means, do what is necessary in Dallas. But billions in spending and thousands of hospital beds are now urgently required to prevent a human catastrophe involving the destabilization of West Africa. The spread of a global pandemic would make Ebola harder to fight for everyone.
Michael Gerson’s column is distributed by The Washington Post Writers Group.