By Kevin Kavanagh
Ebola is scary but even more concerning is the window it opened onto our health-care system. I use the term "system" loosely because one of the main emerging problems is the absence of the kind of uniform response and preparedness that the term "system" usually implies.
Do not rush to point fingers at the Centers for Disease Control and Prevention, however. Despite all its perceived prominence, the CDC is really just an advisory organization. We are stuck in a one size does not fit all mentality with lack of uniform standards and too many health care institutions not knowing what their shoe size is.
Let's recap what happened to the first patient who had Ebola in the United States. He was seen in the ER of a major health care facility, not a small rural hospital in Appalachia, but an 866-bed hospital with almost $2 billion in annual patient revenues. He related the history of being from West Africa and had symptoms of a 101 degree fever and abdominal pain compatible with an Ebola infection.
Instead of immediately donning protective gear and isolating the patient, the task-oriented nurse just entered the information into the computer. The treating physician who then saw the patient appeared to have prescribed an inappropriate antibiotic and discharged the patient home.
For many patient advocates who have watched the fumbling and excuses in handling the deadly MRSA and C. Difficile superbugs, this was all but predictable. Many would argue that the same almost lackadaisical approach to how Ebola was initially handled is why the United States has one of the highest rates of multi-drug resistant organisms in the world. The Ebola case demonstrates two major problems in U. S. health care:
■ Antibiotic overuse is rampant and fueling the epidemic of resistant organisms. It is all too easy to save time by not fully evaluating patients and to make them happy with a useless and expensive prescription for an antibiotic.
■ Just because the CDC makes a recommendation there's no guarantee it will be followed. In the case of Ebola, the CDC has issued numerous reports on how to handle this organism. However, as described in a 2008 Government Accountability Office report, the one size does not fit all approach has resulted in a myriad of non-prioritized protocols for controlling dangerous bacteria. This may have led to confusion on how to handle individual cases.
I have heard reports that some patients are now afraid to enter the "Ebola hospital" in Texas. But let's be realistic: One in 25 hospitalized patients acquires a health-care associated infection. Like Ebola, both MRSA and C. Difficile are also not airborne and live in the environment far longer than Ebola, thus represent a much greater risk of spreading and causing death. And there are other virtually untreatable organisms, such as the deadly gastrointestinal superbug CRE, that impose an increasing threat to public safety.
One must then ask, why are we not requiring reporting for all of these organisms? Why are we screening and isolating for Ebola but not for MRSA? MRSA is very dangerous and much more common.
Naysayers insist that no well controlled studies show screening and isolation work for MRSA. But I am confident there are none for Ebola either. However, screening and isolation do work — that's just common sense. Hand washing is important, but no one would see a patient with Ebola and only wash their hands. The same should be true for other deadly infectious organisms.
The two most important lessons to be learned from the Ebola incident are:
■ We need a more integrated health-care system, one that can more quickly respond to biological threats. All health-care facilities of all types should be on the same page; any one which deviates from a protocol places all of society at risk. Such deviations need to be quickly detected and corrected.
■ Most important is the power of transparency. If this first Ebola case had been swept under the rug and covered up, other facilities might have been destined to repeat the mistake. But through transparency and all of the news media coverage, it is unlikely other facilities will make the same mistake. Public reporting and centralized tracking of these dangerous infectious is imperative.
In Kentucky, the new public health regulations, soon to be enacted by Gov. Steve Beshear, are an excellent step in accomplishing this goal.