Special Treatment Centers May Be Needed to Stop Ebola in US

Treating Ebola may be beyond scope of regular hospitals, say infectious disease experts

(RxWiki News) As the Ebola outbreak in West Africa spreads and fears heighten in the US, health experts are assessing America's ability to stop an Ebola outbreak at home. Those experts said conventional US treatment centers may not be enough.

On the heels of news that two US nurses had Ebola, a group of infectious disease experts released a statement on the US response to an Ebola outbreak.

They said conventional US medical centers are neither equipped nor prepared to manage an outbreak. They also called for new, specialized treatment centers that could reduce the spread of the virus.

"As many medical centers are no doubt learning in their preparation drills, caring for patients with [Ebola and similar] infections in a conventional setting presents enormous challenges, many of which can be mitigated through the use of specialized facilities with highly trained staff practiced in the nuanced art of safely delivering [high-level containment care (HLCC)]," according to the recent article, written by Mark G. Kortepeter, MD, MPH, and colleagues.

HLCC refers to a highly specialized form of care with a focus on preventing contamination — doctors wear fully sealed suits and workers take disinfectant showers after interacting with patients. Workers pass through an airlocked room when going into and leaving a treatment area.

The authors of the recent opinion piece, published in Annals of Internal Medicine, noted that one example of an HLCC treatment center was the US Army Medical Research Institute of Infectious Diseases. The facility proved effective, but it closed — due in part, the authors wrote, to a change in thinking about protective measures during treatment of highly infectious disease. As it became apparent that viruses like Ebola spread through direct contact with blood and body fluids, the need for HLCC centers dwindled.

But regular treatment centers like hospitals may not be able to contain an outbreak of Ebola in the US, the authors wrote. They cited the death of Liberian Ebola patient Thomas Eric Duncan and the infection of two nurses who treated him at a Dallas hospital as an example.

The authors said that, despite training from the Centers for Disease Control and Prevention (CDC), some hospitals may not be able to handle an Ebola outbreak. They may not have the resources or ability to devote enough focus to the details needed to treat Ebola without spreading it, they said.

In an Oct. 15 press statement, Ira Longini, PhD, co-director of the Center for Statistics and Quantitative Infectious Diseases, said he doesn't believe the US will even see 100 cases of Ebola — so the much-debated response to a large outbreak in the US could be a small issue.

"Unless the epidemic continues to be completely out of control and more countries are affected and it gets much larger, I wouldn't expect to see more than a handful of cases in the US," he said. "Certainly no number near a hundred — maybe four or five over the next few months."

The authors of a separate article published in JAMA also said the problem could lie in hospitals not having enough resources. But they said the solution is not to build separate treatment centers, but to reinvest in existing public health facilities.

"Not enough has been done to support well-functioning health systems in West Africa, but the United States also needs to invest more in domestic health system capacity," wrote Lawrence O. Gostin, JD, of the Georgetown University Law Center in Washington, DC, and colleagues. "After the country has spent more than a decade developing preparedness programs and laws, isolated Ebola cases reveal the vital need to build a stronger system for detecting and treating infectious diseases, evaluating and improving performance, and committing to the basic institutions and professionals charged with protecting the public’s health."

The authors of the JAMA article cited recent budget cuts — such as the 10 percent cut in the CDC's budget in 2013 — that have injured the existing health care system's ability to adequately respond to Ebola in the US.

Specialized treatment centers might have that ability, however, according to the authors of the article published in Annals of Internal Medicine.

To respond to current and potential future cases of Ebola in the US, the authors called for a network of HLCC centers near designated quarantine areas.

These centers would function like normal medical centers, but they would be able to quickly convert into HLCC units.

The authors noted that existing medical centers should continue to prepare to treat Ebola.

The Ebola virus can cause Ebola virus disease. This often fatal disease is marked by high fever, nausea, vomiting and unexplained bleeding.

The Annals of Internal Medicine article was published Oct. 16. The JAMA article was published Oct. 17.

The authors of both articles disclosed no funding sources or conflicts of interest.

Review Date: 
October 16, 2014