Keeping Ebola at Bay

Editorial published in The New York Times

The Ebola cases in the United States show that American hospitals and public health officials have much to learn about effective ways to protect health care workers and the public from possible infection.

Texas Health Presbyterian Hospital, the first hospital put to the test, failed to protect two nurses, who had cared for the Ebola victim Thomas Eric Duncan, from becoming infected. Perhaps more alarming are the stumbles by the Centers for Disease Control and Prevention, the lead federal agency for fighting infectious diseases.

One of the nurses, who was monitoring her own temperature, called the C.D.C. and was allowed to take a commercial flight from Cleveland to Dallas-Fort Worth even though she had a slight fever, which did not violate current guidelines. That was an incredible lapse in judgment by the C.D.C.

Health officials and the flight’s airline are now scrambling to notify passengers, crew members and janitors who cleaned the planes she traveled on of possible exposure. While the danger to those people appears slight, this incident shows that the C.D.C. needs to lower the fever threshold in its guidance and advise against any travel on public forms of transportation for 21 days by people who have potentially been exposed to the virus.

There is more the agency ought to do. It should be increasing the rigor of its guidelines on protective clothing for health care workers, hospital readiness, and training on the handling of Ebola cases. President Obama said on Thursday evening that he is considering appointing an “Ebola czar” to manage the government’s response.

The C.D.C.’s inadequate advice to hospitals on how to protect health care workers may have contributed to the latest cases. An expert who oversaw the treatment of two American missionaries flown from West Africa to Atlanta for treatment at Emory University Hospital told The Times that he had warned the C.D.C. repeatedly that its guidelines were irresponsibly lax. The guidelines allowed protective garments that left the neck and other areas exposed. It was not until Tuesday night that the agency — essentially acknowledging its error — issued new, stricter guidelines requiring full-body suits covering the head and neck, as well as close supervision of the risky process of taking off protective gear.

Unless the C.D.C. can help hospitals prepare properly, every new case will result in improvised responses that may not work. The hospital in Dallas has sent one of the nurses to Emory and the other to the National Institutes of Health, two of the nation’s four specially designated high-containment hospitals. But there are only a limited number of beds in these institutions (N.I.H. has only two such beds), so other major medical centers must be ready to accept cases if necessary. Some hospitals in cities with large West African populations are taking steps to train their staffs.

While the chance that an infected patient will show up at any particular hospital or clinic is very small, health workers should still know the basics of what to do if a patient arrives at their door. National Nurses United, the country’s largest union of nurses, says there has been almost no hands-on training, just easy-to-ignore guidance documents.

The advice now from the C.D.C. is for emergency room staff to take travel histories, isolate patients who have fevers and have been in West Africa, and call the C.D.C. if Ebola is suspected. Once a case is diagnosed as Ebola, the C.D.C. will fly in a swat team of experts within hours to oversee treatment.

At a congressional hearing on Thursday, House members asked whether the United States was adequately protected against people who might have been infected in West Africa but did not yet have symptoms. The current system relies on screening before they are allowed to fly out of West Africa and again when they reach airports in this country. So far, only one infected patient — the man who was treated in Dallas and later died — escaped detection at the airports since the epidemic was first identified seven months ago. There should be some comfort in knowing that that part of the system is working.

Even so, some members of Congress, mostly Republicans, have called for barring entry to all people who have been in the Ebola-stricken countries as a way to keep the virus out.

The danger is that if other nations followed an American ban with bans of their own, economies in West Africa would be crippled. That could only reduce the ability of those nations to fight the epidemic, and make it even more likely the disease would spread through porous borders to other African nations and beyond.