HHS IG: Hospitals better prepared for Ebola after 2014 outbreak

Far more U.S. hospitals are prepared to deal with Ebola than they were in 2014, when a raging outbreak in West Africa stress-tested the American health system and forced the federal government to rewrite its guidelines for dealing with infectious diseases, a government watchdog said Friday.

Fourteen percent of surveyed hospital administrators said they’re still unprepared for threats like Ebola, a sharp drop from the 71 percent who said they weren’t ready in 2014, when the epidemic was killing thousands in Liberia, Sierra Leone and Guinea, according to the inspector general for the Health and Human Services Department.

Administrators said roping employees into training wasn’t easy, however, and it’s tough to stay ready for infectious diseases that may never arrive at their doorsteps.

Ebola is a serious, often-fatal disease that is transmitted to people from wild animals and spreads from human to human through the bodily fluids of people who exhibit symptoms.

The U.S. was forced to reckon with it after Thomas Eric Duncan, a Liberian, traveled to Texas in late 2014 and was admitted to the hospital wth Ebola-like symptoms.

He was released after Dallas doctors missed warning signs about his travel history. Yet shortly after, he became the first person to test positive for the disease on U.S. soil and then died.

Other persons returning from the “hot zone” in Africa faced quarantine, sparking a debate about how the U.S. handles serious diseases like Ebola or other infectious threats, from bird flu to severe respiratory diseases known as SARS and MERS.

Congress in 2014 appropriated millions for hospital preparedness and the federal government developed a tiered system to direct Ebola patients to specific facilities. It also directed hospitals to hold “tabletop” exercises and full-scale drills that would prepare them for patients caught up in serious outbreaks.

The IG report found significant progress on paper, with Gulf State administrators reporting they’re better prepared for hurricanes, too.

Yet administrators said dealing with a real-life Ebola patient would be challenging. It would strain their resources, for one, and they said it’s unclear if their preparations would actually pay off, since they don’t have firsthand experience.

“There is not enough exposure to [emerging infectious disease] incidents to make staff feel comfortable with their response and training for the situation,” an administrator said.

Indeed, Ebola outbreaks are rare and have only been traced back to Africa since the virus’ discovery in the 1970s, so it’s unlikely most U.S. hospitals will treat a patient like Duncan in the future.

Still, the timing of the IG report is notable, as global health officials sound the alarm over an Ebola outbreak that’s claimed more than 140 lives in the Democratic Republic of Congo.

The World Health Organization said violence in the region is hampering the response, and it’s worried the disease will spread to neighboring countries, though it hasn’t declared it a global emergency.

HHS’s inspector general said each of the roughly 400 hospitals it surveyed took some kind of action to prepare for Ebola in the U.S. after 2014, though it wasn’t always easy.

Some workers didn’t see Ebola training as part of their job description, or felt they were too busy for it, and some were afraid they’d get the disease if they were roped into an actual case.

Administration said it was difficult to find local vendors who could handle hazardous waste from an Ebola situation, though some changed their contracts to be better prepared.

They also said it will be difficult to maintain preparedness for a “what if” like Ebola, since resources are pulled toward scenarios that are more likely to occur.

The IG report says hospitals shouldn’t sideline infectious diseases like Ebola, though federal agencies should update their advice in a “clear and concise” manner and offer “practical advice that hospitals can more easily employ given competing priorities.”

The report says the Centers for Medicare and Medicaid Services should advise hospitals to mix infectious diseases into the broader plans they devise as a condition of participating in the Medicare program.

CMS agreed, saying it would add infectious diseases to the definition of “all hazards” planning its state operations manual.