JAMA on Ebola

Here’s a Journal of the American Medical Association editorial on the level of preparedness in the United States for something like Ebola:

The Dallas case raises significant concerns about national preparedness for public health emergencies. Health emergencies (eg, anthrax, SARS, novel influenzas, and hurricanes Katrina and Sandy) spurred federal preparedness planning and funding, including the Pandemic and All-Hazards Preparedness Act (reauthorized in 2013),2 to ensure that federal, state, and more than 3500 local health departments coordinate their efforts effectively in disasters. Significant investments have been made in staff training, interagency coordination, legal reform, and planning.

Preparedness efforts like these are essential, but inadequate. Overall, investment in key health system functions has been in decline. The CDC’s 2013 budget declined 10%, or nearly $1 billion, from 2012.3 Since 2008, state and local public health agencies have lost more than 50 000 staff (almost 20% of their workforce),4 requiring cuts to preparedness programs. Many EMS agencies and hospitals are also strained, leading the Institute of Medicine to warn in 2012 of an “enormous potential for confusion, chaos, and flawed decision-making”5 in a public health emergency. Insufficient funding in a research and data infrastructure limits the ability to identify weaknesses and learn from mistakes. Rare, novel infections such as Ebola expose the difficulty of diagnosis and adherence to arduous infection control protocols. Following the nurses’ EVD diagnosis in Dallas, future Ebola patients may be directed to centers with advanced training, PPE, and well-equipped isolation rooms. Vinson was transferred to Emory Hospital in Atlanta on October 15.

Now, the American Medical Association is a special interest group. The United States has the world’s largest economy and spends more than any other country on health care, even as a fraction of that economy. So I don’t like to hear that the answer is throwing more money at the problem. I think we have a patchwork of doctors, hospitals, and insurance companies each looking out for their own interests, and what it adds up to shouldn’t really be called a “health care system”. But we’ve been warned – we need to get a lot smarter before we have to deal with something like SARS or a novel influenza.

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