During the Ebola epidemic this fall, I was reminded of the chaos and fear we felt in the Senate in 2001. When the first anthrax letter was opened in the office of Majority Leader Tom Daschle, no one really even understood what anthrax was, much less how it was contracted, transmitted, or the disease’s natural history. As a result, it was days before a plan for evacuation, testing, and treating exposures was implemented. We had no mechanism for a coordinated and controlled response to a major health emergency.
Thirteen years later, I am afraid we were just as unprepared. News that the first Ebola-infected doctor was returning home for treatment resulted in outrage about the potential threat, and calls for a West Africa travel ban. Given the rarity of Ebola, the public lacked general knowledge of the disease. Relevant governmental agencies failed to adequately disseminate information, and hospitals and healthcare workers didn’t know how to contain and treat infected patients. Soon, two Texas nurses became infected. It wasn’t until eighteen days after the first case of Ebola was diagnosed in the U.S., that the Obama administration appointed an “Ebola Czar.”
The situation on the ground in West Africa was just as chaotic. People refused to believe the disease even existed, instead believing those providing aid were actually trying to harm or take away their family members. Burial practices raised cultural barriers to containment, and a general distrust of Western medicine that we have been contending with since the onset of the AIDs epidemic overshadowed relief efforts.
The key to being prepared when the next health crisis arrives—and it will—is coordination and communication. We have the technology and the tools. The next step is to implement a preparedness agenda that will ensure the public, healthcare providers, and first responders are well-informed, and the agencies of authority are speaking with one voice. The agenda needs three major components.
One, we need a clear person of authority. The public needs an accessible, reliable source that serves as the spokesman for information from the beginning. During the anthrax attack, I sought to fill the information void by using my personal Senate website as a central location for all information pertaining to anthrax symptoms, treatment, and alerts on the federal and local response. The public was so desperate for knowledge that hits to my website soared. A national response plan should designate in advance the appropriate person to lead this effort – it cannot be an afterthought.
Two, we need a designated healthcare force trained in bioterrorism and the spread of infectious diseases; our next health epidemic could be natural or man-made. Ideally, we would educate all medical professionals about these potential public health threats, but this is not feasible in today’s vast medical landscape. However, we do need a designated cohort of healthcare professionals that are appropriately trained and that can be easily deployed abroad or at home to coordinate a treatment and containment plan.
Three, we need a data infrastructure designed to share crucial information during a crisis. This would include a real-time communications system linking local, state, and federal public health officials with medical providers and researchers to share information and deploy protocols. The Center for Disease Control’s guidance to obtain a travel history on patients being screened for Ebola symptoms was not properly implemented at Texas Health Presbyterian, delaying the treatment of the first stateside case of Ebola. This breakdown in communication can mean the difference between life and death. Moving toward the era of “big data” will be a boon for this effort. An effective data infrastructure would employ data analytics for disease modeling and prediction to help anticipate, communicate, and prevent an outbreak instead of just responding in its wake.
We are not necessarily unprepared to address the next health epidemic, but we are definitely underprepared. And really, there is no excuse. We have the tools needed to build an effective communication and coordination strategy. In all of medicine, we are moving to a paradigm focused on prevention instead of reaction to developed disease. It should be the same for potential infectious outbreaks and bioterrorism attacks. A coordinated and reliable response plan is our vaccine against future health epidemics.
Published: 4/09/2015. By Bill Frist
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