Unexpected Lessons From the Ebola Outbreak

It's been just over a year since the Ebola outbreak erupted in Africa. And while its spotlight in the news cycle has faded, cases continue to plague a very vulnerable area of the world. The outbreak and its aftermath in Africa are devastating. We should not add to the toll by ignoring critical lessons for health care systems in developed countries.

The most recent statistics available show that 24,842 suspected cases of Ebola have been identified in the African hot zone. More than 10,200 people are known to have died. Both of these statistics are likely underestimates as there could be many more victims of the virus that never make it to a care facility.

Financial metrics show a different type of cost from this yearlong outbreak. It has resulted in the largest emergency response from both the World Health Organization and U.S. Centers for Disease Control and Prevention in history, with a price tag of $1 billion. The incredible need for clinicians to go and serve in the affected countries is often going unmet, perhaps due to the documented deaths of at least 500 health care workers among the known statistics. The devastation has been widespread.

Lessons learned have been shared across the health care domain -- a few insights into the virus itself and how to prevent it. The majority of patients who've received care in the U.S. have recovered. As we celebrate those successes, we must make sure we face certain harsh realities that have come to light. The most unsettling? We are a less-than-nimble care system.

The ability of our massive U.S. health care system to adjust to emergencies is limited. Despite significant time investment by institutions on emergency management protocols, there is little ability to respond rapidly to an urgent situation. Most of the planning is focused on surviving forces of nature such as tornadoes and hurricanes -- not on responding to emerging health threats, which are all-too real in today's climate of global travel. Despite the constant drumbeat of news reports from every outlet for months regarding the growing numbers of Ebola cases in Africa, there was no urgency to plan for potential influx into the U.S.

Take, for example, the situation at Texas Health Presbyterian Hospital in Dallas.The lack of infection-prevention protocols to respond to an Ebola-like situation was not unique to that institution: It's a truth faced by most U.S. health care institutions. Minimal supplies; lack of ongoing emergency simulation and training of dedicated staff; and slow public health responses like monitoring travel are system issues that belie a level of complacency in our disease preparedness. Texas Health Presbyterian, which had the tough luck of being first, unfortunately became the poster child for the inertia of the hospital- preparedness effort.

As with all lessons, there were many positives that emerged in the last year as well. Texas Health Presbyterian upheld the long-standing tradition of academic medicine by sharing their experience, both the good and the bad, so that others could learn and not repeat less-than-optimal situations. Their willingness to be transparent not only impacted medical care, but also showed the true spirit of those who provide care to others by going in where others might fear to tread. The pain they felt over their colleagues who became ill, while almost unbearable to watch, made everyone stop and take notice, not wanting to walk in their shoes. It sounded an alarm to the rest of the nation, including the CDC, to take stock and improve -- a huge price for Texas Health Presbyterian but a stroke of luck for other health care systems.

As more patients were treated in the U.S., several other positives occurred. We learned more about the enigmatic Ebola virus, such as how to better prevent its spread and that transfusions from survivors could hold therapeutic value. We've also discovered new leads that might jump-start vaccine research. In addition, the CDC began identifying hospitals to care for patients with the deadly virus, and started offering support for their development, including updating current facilities and building new, highly specialized hospitals to deal with these emerging threats. These findings and activities will not only improve care in the U.S., but have the potential to change the face of fighting this disease in areas where it has taken life after life.

We have also learned many human lessons. A recent symposium at Emory illustrated that teamwork has rarely been as obviously important in patient care as in this situation, where truly the patient's life -- and your teammate's life -- reside in your hands. Professional pride swelled at what we can accomplish in health care when the stakes are incredibly high. We learned that the true culture of safety is achievable and necessary to really care for others in grave times of need. We learned that great clinicians and researchers are still asking the questions and finding the answers to eradicate the next plague lying in wait, regardless of where it is.

To ensure that each of these lessons is lived out to the fullest, our public health system must step up and help us prepare for medical, not just natural, emergencies. We need better reflexes so that we can respond early with set protocols for safety, faster diagnostic tests, better and more flexible facilities and teams that work together in a true and total environment of safety. Perhaps we should take a cue from the Department of Defense and begin honing early warning systems for emerging health care threats, so we can be in the offensive -- not defensive -- position. We must have a plan for when the alarm sounds.

One U.S. Ebola survivor recently spoke at Emory and likened dealing with these deadly diseases to cutting down a tree. You spend four hours sharpening the ax and only two hours actually cutting down the tree. Yes, planning for these emerging medical threats will take resources in people, physical plant and dollars, but will position us to be able to respond to the next emerging invader, be it infection, bioterrorism or some unanticipated scourge we have yet to encounter. In a nation that spends the most on health care than any other country, we need to fight hard against complacency. We must keep sharpening our ax.

Dr. Elaine Cox is the medical director of infection prevention at Riley Hospital for Children at Indiana University Health in Indianapolis. She is also the Riley clinical safety officer. Dr. Cox practices as a pediatric infectious disease specialist and also instructs students as a professor of clinical pediatrics at the Indiana University School of Medicine. The former director of the pediatric HIV and AIDS program, Ryan White Center for Pediatric Infectious Diseases at Riley, Dr. Cox helped lead the effort to change Indiana law to provide universal HIV testing for expectant mothers.