2014 was one of the busiest years for infectious disease in the U.S. in more than a decade (Stobbe, 2014). Ebola dominated the news throughout the second half of the year, garnering more public attention than even the controversial mid-term congressional elections (Altman, 2014). Although Ebola received most of the attention, a number of other infectious diseases were in play, such as Enterovirus 68, the measles, whooping cough, and chikungunya. In fact, the number of threats from infectious diseases is so pronounced, one expert from the Johns Hopkins University School of Medicine contends, we are in the midst of an “epidemic of epidemics” (Bartlett, 2014).

As late as mid-2014, America was confident in its ability to handle such menacing infectious diseases as Ebola, with public officials touting our readiness on nightly news shows and the radio, but more recent experience has taught us a number of things:
• we are not impervious to outbreaks that occur halfway around the world,
• international travel severely compromises our ability to contain a large outbreak of an infectious disease, and
• we most definitely are NOT prepared for even one or two cases of something as serious as Ebola (Stobbe, 2014).

“Ebola has raised attention to serious gaps in our ability to manage disease outbreaks and contain their spread,” Jeffrey Levi, PhD, executive director of the Trust for America’s Health, reported to Medscape Medical News. “It was very disturbing that many of the most basic infectious disease controls failed when tested” (Lowes, 2014).

In response, hospitals throughout the U.S. are taking steps to improve preparedness. When the outbreak in West Africa first began, the message from the Centers for Disease Control (CDC) was that any hospital in the U.S. with private rooms should be equipped to care for Ebola patients (Healio, 2014). However, after the recent experiences in Dallas, the CDC has changed its position. Thirty-five hospitals throughout the country have now been designated
by health officials as Ebola treatment centers. The role of the local hospital is to identify a patient with Ebola and then send the patient to one of these 35 centers.

“All hospitals need to be prepared to identify and triage a potential patient with Ebola. Beyond that, it’s not realistic to think that all hospitals could deliver equally effective chronic care, nor it is practical to have all hospitals be prepared to do so,” says Keith S. Kaye, MD, MPH, professor of internal medicine and infectious diseases at Wayne State University School of Medicine, in Infectious Disease News in late 2014 (Healio, 2014).

Some experts worry that many hospitals have overreacted to the threat of Ebola and over-prepared for this one disease at the expense of other threats. According to several infectious disease experts at the University of California, “hundreds of hospitals have overspent, overconsumed, and overtrained for a rare disease that will most likely never pass through their doors” (Huffington Post, 2014). Rather, many infectious disease experts throughout the world
have voiced concern that we are not maintaining the ongoing vigilance and public health networks that are necessary to be safe from the broad set of threats we face. For example,
• each year, more than two million Americans get sick from antibiotic-resistant bacteria and more than 23,000 die from those infections;
• approximately one of every 25 people who are hospitalized contacts a healthcare-associated infection, resulting in roughly 100,000 deaths per year;
• more than 48 million Americans suffer from a food-borne illness every year; and
• an average of 62 million Americans—20 percent of the population—get the flu each year, causing between 3,000 and 49,000 deaths annually, depending on the strength of that year’s flu strain (Levy, 2014).

Last year, the CDC released its list of the top threats facing the U.S. They recognized several new and emerging infectious diseases, such as Ebola, but they also acknowledged long-standing threats from diseases like AIDS, polio, and the leading causes of death in America.

The CDC’s Top Public Health Challenges
• New Infectious Disease Threats
– Ebola
– Antibiotic resistance and healthcare-associated infections
– Enterovirus D-68 (EV-D68)
– Middle Eastern Respiratory Syndrome (MEARS)
• Continued Fight Against Infectious Diseases
– HIV/AIDS pandemic
– Polio
• Laboratory Safety
• Leading Causes of Death
– Cardiovascular diseases
– Smoking
– Fatal overdose (CDC, 2014)

“When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were.” – Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security

Even though the U.S. faces numerous challenges from infectious diseases and the number of threats is on the rise, a recent report indicates that most states are not ready to respond. The Trust for America’s Health and The Robert Wood Johnson Foundation jointly released a study in 2014 that assessed all 50 states on their readiness to respond to infectious disease outbreaks. They monitored states on such metrics as funding of public health efforts, vaccination rates, infection control at medical centers, attempts to prepare for climate change, and surveillance efforts to track cases of HIV and E. coli. On a 10-point scale, no state received a grade higher than eight.

Half of the states received a score of five or lower. Only five states received a score of eight—Maryland, Massachusetts, Tennessee, Vermont, and Virginia. Arkansas received the lowest grade in the survey, with a score of only two.

The study’s authors refer to a U.S. trend to let its guard down when there is no imminent threat and then to find itself off-guard when threats like AIDS, SARS, or Ebola emerge. “When I was in medical school, the leading experts declared that infectious diseases had been conquered in the United States. It’s now clear how wrong they were,” Dr. Eric Toner, senior associate at the University of Pittsburgh Medical Center’s Center for Health Security, said of
the report (Levi et al, 2014).

The study recommended five steps the U.S. should take to better prepare itself for future threats from infectious disease. These include:
• ensuring that the U.S. has a strong public health system supported by strong laboratories;
• developing and implementing solid containment strategies, including vaccinations for contagious diseases and adequate treatment for chronic conditions;
• regularly training hospitals to be prepared for an epidemic that results in a flood of patients;
• improving communication with the public to keep them aware of threats from infectious diseases without causing panic; and
• increasing federal funding for vaccines, stronger antibiotics, and other treatments that can counter outbreaks (Levi et al, 2014).

In 2014, we came face-to-face with our nation’s lack of preparedness and the potential impact on the public’s safety. Hopefully, we will learn from our experience and work hard in 2015 to improve our readiness to respond to the infectious diseases that are a growing menace to our collective health and well-being.

How Deadly Is Ebola?

Ebola is one of the most deadly diseases known to man, with a fatality rate that is much higher than most other infectious diseases (50 to 90 percent). Since 2013, in the latest outbreak in West Africa, Ebola has infected 17,942 people and caused some 6,388 deaths.

Infectious disease - Ebola

 


References
Almendrala, A. (2014). “How America’s Healthcare System Could Benefit from Ebola,” Huffington Post, www.huffingtonpost.com
Altman, D. (2014). “Poll: Ebola Was a Bigger Story Than the Midterms.” The Wall Street Journal.
Bartlett, J.G. (2014). “ID Update 2014: New and Emerging Threats.” www.medscape.com
Centers for Disease Control (2014). “Top 10 Most Critical Health Threats of 2014.” www.cdc.gov
Infectious Disease News. (2014). “US hospitals step up training, preparation for Ebola.” www.healio.com
Kaiser Family Foundation (2014). “Ebola Characteristics and Comparisons to Other Infectious Diseases.” www.kff.org
Levi, J., et al. (October, 2014). “Most States Not Ready to Handle Infectious Disease Outbreaks.” MedLinePlus, National Institute of Health. www.nlm.hih.gov/medlineplus/news/fullstory_150042.html
Levi, J. (December, 2014). “Lessons for Ebola: The Infectious Disease Era, And The Need To Prepare, Will Never Be Over.” Health Affairs, www.healthaffairs.org/blog
Lowes, R. (2014). “Go Beyond Infectious Disease of the Month.” Medscape Medical News. www.medscape.com
Stobbe, M. (2014). “2014 was a busy, messy year for disease control.” Jacksonville Times-Union.

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