Saturday, October 18, 2014

Ebola, Government, the Health System, and Unrealistic Expectations

Oft expectation fails, and most oft there

Where most it promises.

Shakespeare (1564-1616), All’s Well That Ends Well

We must scrunch or be scrunched.

Charles Dickens )1812-1870), Great Expectations

It may seem a strange thing to say. But I believe the U.S. suffers from unrealistic expectations. We expect government, health, and hospital officials to get things right the first time around. This is unrealistic. People, and believe it or not, including politicians, are never perfectly competent in things they are never experienced before. Disease prevention, diagnosis, and treatment are learning curves.

When the story of Ebola is the U.S. is written, it will be about how the center for disease and prevention, hospitals, and health care professionals made mistakes . It will be about what occurred when the virus first surfaced in a Dallas hospital, how the hospital ER personell were caught off guard, why the hospital was unprepared to deal with the virus, why it infected two nurses on the wards, why the CDC faltered in not forbidding an infected nurse to take a flight from Dallas to Cleveland, how government officials made false reassurances and misleading statements, and what the impacts were when these miscues rippled across the land.

It will also be about political finger pointing, about casting blame. It will be about blaming President Obama, Doctor Friedman and the Centers for Disease Control and Prevention, airline companies, hospital executives, emergency room personnel, faulty disease prevention protocols. Unfortunately, as a WallStreet Journal"editorial says, “Life does not obey protocols. Failure, uncertainty, and error are inevitable in human affairs. And institutions learn from mistakes.”

Whomsoever we blame, do not blame the nurses. They are on the frontlines, the bear the brunt of exposure to infectious disease, and they do what they have to do, even without proper training and protective personal gear. The nurses are the ones most likely to be exposed to infected blood and body fluids and to direct skin contact.

Do not blame the nurses. Do not blame hapless government bureaucrats, do not blame the CDC, do not blame the hospitals, do not blame the doctors, do not blame the public health system. Blame the Ebola virus. The little SOB has a mind and mutations of its own.

Our job is to collaborate across government, private, and health care sectors to contain and kill the virus. Our job is to cooperate to find a vaccine to prevent it and a drug to treat it. Our job is to spot Ebola outbreaks more quickly. Our job is to develop a fast finger-prick blood test for Ebola. Our job at the point of care is to diagnose the disease on the spot and to hydrate and isolate the patient. Our job is to prevent the victim or exposed person from entering or leaving an Ebola victim’s home, to prevent he or she from travelling, and to monitor every person with whom the infected person came in contact for as long as necessary. Our job is to develop computer systems to facilitate this tracking. And lastly, our job is to work together to prevent his hybrid of Ebola and fear from spreading. We can do it. We have done it or are doing it with measles, polio, smallpox, HIV/Aids and we can do it with Ebola.

As Doctor Larry Brilliant, previously part of the WHO team that eradicated smallpox, has remarked, “The Ebola outbreak in West Africa is a humanitarian and public health crisis, and we must do more to help the victims while avoiding our own ‘panic fever.’”

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