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Wednesday, October 22, 2014

Disaster Prep Wednesday: In the Globalized World, One Would Think the CDC and U.S. Hospitals Should Be More Ready for Bioterrorism and Pandemics

So, during our 250th Midrats show, I ranted about the lack of a proactive response in the U.S. to the Ebola eruption in West Africa (you can listen here or on iTunes here - starting at about the 1:20 point).

The CDC, at its website, offers up advice on pandemic flu - another viral infection that ought to also offer up guidance for things like Ebola.
An influenza pandemic can occur when a non-human (novel) influenza virus gains the ability for efficient and sustained human-to-human transmission and then spreads globally. Influenza viruses that have the potential to cause a pandemic are referred to as ‘influenza viruses with pandemic potential.’***
So, the CDC is well aware that viruses can become global issues quickly. So, what is it that prevented a proactive response from the CDC that would call for real screenings (as opposed to a questionnaire asking about symptoms) of people arriving in the U.S. from areas already impacted by Ebola or other viruses?

Well, the answer is, now, apparently nothing - because the CDC has now announced that a 21-Day Monitoring for All Coming From Ebola Nations:
U.S. health officials are significantly expanding the breath of vigilance for Ebola, saying that all travelers who come into America from Ebola-stricken West African nations will now be monitored for symptoms of illness for 21 days.

The director of the Centers for Disease Control and Prevention says the program will begin Monday and cover visitors as well as aid workers, journalists and other Americans returning from Liberia, Sierra Leone or Guinea.

The program will start in six states: New York, Pennsylvania, Maryland, Virginia, New Jersey and Georgia.

CDC Director Tom Frieden says state and local health officials will check daily for fever or other Ebola symptoms.

Passengers will get kits to help them track their temperature and will be told to inform health officials daily of their status.
However, this is still dumb - why not let those traveler be monitored before they enter U.S. territory? Why let them in and allow them to possibly spread the virus around the U.S.?

Just think of the cost of the flailing about that the single deceased Ebola victim has caused through his misrepresentation of his status. No, the thing to do is to set up overseas quarantine facilities and allow those who seek from stricken areas to travel to the U.S. sit and wait until cleared. Or even set up blood testing facilities for such would be travelers. See here for info on blood testing for Ebola

I suspect most reasonable epidemiologists would suggest "isolating" persons with known or likely exposure to disease in situ instead of suggesting they be allowed to board airplanes and ships and wander the world. It's not like the CDC isn't aware of the point of quarantine:
Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease.

- Isolation separates sick people with a contagious disease from people who are not sick.
- Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Twenty U.S. Quarantine Stations, located at ports of entry and land border crossings, use these public health practices as part of a comprehensive Quarantine System that serves to limit the introduction of infectious diseases into the United States and to prevent their spread.
Interesting summary of the issues of isolation and quarantine in this study, the summary of which is:
The isolation and treatment of symptomatic individuals, coupled with the quarantining of individuals that have a high risk of having been infected, constitute two commonly used epidemic control measures. Although isolation is probably always a desirable public health measure, quarantine is more controversial. Mass quarantine can inflict significant social, psychological, and economic costs without resulting in the detection of many infected individuals. The authors use probabilistic models to determine the conditions under which quarantine is expected to be useful. Results demonstrate that the number of infections averted (per initially infected individual) through the use of quarantine is expected to be very low provided that isolation is effective, but it increases abruptly and at an accelerating rate as the effectiveness of isolation diminishes. When isolation is ineffective, the use of quarantine will be most beneficial when there is significant asymptomatic transmission and if the asymptomatic period is neither very long nor very short.
We know some groups have been quarantined, why not more?

Don't set aside too quickly the "significant social, psychological, and economic costs" imposed on a society with potentially infected people being allowed to enter so that they can do "self monitoring" - and then ask who is paying the freight for any special care "possible" cases involve?

Why are we being asked to carry the cost of this when there are certainly cheaper alternatives to "let them in and hope for the best?"

And, yes, I am well aware that the odds of an Ebola epidemic in the U.S. is pretty slim. The disease is not that readily transferable if safety precautions are followed. However, we need to use Ebola as a warning for serious diseases that may crop up. We can't afford to be be in a purely reactive mode.

All of this concerning a non-intentional introduction of a disease on our shores really ought to make you wonder how well we would handle an intentional act of bio-terrorism?

There is this CDC website on Preparation and Planning for Bioterrorism Emergencies which includes a link to a 1999 document "Bioterrorism Readiness Plan: A Template for Healthcare Facilities":


I wonder if anything has changed since 1999?

We need a more proactive system.

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