As the US began stepping up Ebola screenings at its five biggest international airports on Saturday, concerned Americans are watching the public health crisis strategy unfold before their eyes – including flaws in the execution.
In Dallas, where Ebola patient Thomas Eric Duncan died on Wednesday after several days of frantic attempts to save him, the Texas Department of Health is considering a probe into the handling of Mr. Duncan’s case. That comes as Texas Health Presbyterian Hospital, where he was treated, is offering “lessons learned” to other hospitals around the US.
Meanwhile, Centers for Disease Control Director Tom Frieden outlined his case in an op-ed on Saturday for why the US should not close its borders to the West African Ebola “hot zone,” where some 4,000 people have now died from the worst-ever outbreak. While understandable, Dr. Frieden writes, the desire to close borders ignores the proven way to stop the spread of Ebola, which is to find, isolate, and treat patients.
Moreover, as the Monitor reported, some health experts say the new airport screenings are in place in part to isolate travelers who might be diagnosed with Ebola, but are “mostly designed so that the government can be seen to be doing something.”
In short, the new developments show that Americans are going to have a “steep learning curve,” says medical ethicist Philip Rosoff, the author of “Rationing Is Not A Four Letter Word.”
To be sure, the case of Mr. Duncan has troubled not just his family – who have noted that it is “conspicuous” that the only person to die in the US from the disease was black – but medical experts, as well.
On Friday, the Associated Press reported that 4,000 pages of Duncan’s medical records showed that his fever had spiked enough on his first visit to the hospital that a doctor had put an exclamation mark next to it. Still, Duncan was sent home undiagnosed, only to return two days later, on Sept. 28, in an ambulance.
Perhaps the major lesson for hospitals is that, despite being told that Duncan had just arrived from Liberia, few alarms were apparently raised. ABC News reports that the hospital has yet to fully explain why Duncan was initially sent home with a standard antibiotic cure.
Dr. Joseph McCormick, a dean at the University of Texas School of Public Health, told Fox News that the hospital’s handling of Duncan’s case amounted to “colossal incompetence … how could you … not have considered him to be a prime suspect for Ebola?”
On Friday, Texas Health Presbyterian released a statement it said was intended to “correct some misconceptions” about Duncan’s care, including criticisms that he wasn’t given full attention because he was a foreign national and didn’t have health insurance. Duncan’s nephew, Josephus Weeks, wondered additionally last week why the Americans who have survived Ebola were all white, while the one person who has died was black.
"Our team provided Mr. Duncan with the same high level of attention and care that would be given any patient, regardless of nationality or ability to pay for care," the hospital said Thursday in a statement. "We have a long history of treating a multicultural community in this area."
Even if Texas health authorities launch an investigation into the hospital’s intervention, health experts say that it’s unlikely they’ll find that Duncan’s care was negligent. So much is unknown about how to treat Ebola that it’s impossible to tell whether experimental drugs helped or harmed the victim. And there may be other differences between Duncan's case and the other five people who have been treated in America so far.
At the same time, medical experts say, it’s possible that Duncan could have had a different outcome if he had not been sent home the first time he went to the hospital.
Concerns about who gets what experimental drug, and which hospital can best treat patients, are legitimate questions, but overshadow a broader strategy against Ebola that is known to work, says Dr. Rosoff, a medical ethicist at Duke University in North Carolina.
“We do have reasonably effective ways of treating people who are sick with good, supportive care, and we have extraordinarily effective means of using standard public health measures, including quarantine and monitoring, to put a halt to the epidemic in its tracks,” he says.