http://news.yahoo.com/cities-states-scramble-dallass-ebola-missteps-expose-planning-181958319--finance.htmlCities, states scramble after Dallas's Ebola missteps expose planning gaps
Reuters
By Sharon Begley and Yasmeen Abutaleb 2 hours ago
NEW YORK (Reuters) - The missteps in Dallas's handling of the first Ebola case diagnosed in the United States have revealed an uncomfortable reality: state and city plans for handling the deadly virus are based on generic recommendations for everything from measles to floods, to hurricanes and dirty bombs.
Even before Sunday's news that a health worker who treated the Dallas case had herself contracted the disease, officials acknowledged they need to do more.
Reuters checks with health departments in six states and cities that have large West African communities, Philadelphia, Boston, New York City, Minnesota, New Jersey, Maryland and Rhode Island, show that they are scrambling to adapt those generic plans to Ebola.
If they are not able to stay one step ahead of any cases, then lapses that characterized Ebola patient Thomas Eric Duncan’s treatment in Dallas could recur. In the Texas case that led to unnecessary exposure to the victim.
“To think the first patients would go flawlessly are an overestimation of our systems,” said Dr. Craig Smith, medical director for infectious disease at University Hospital in Augusta, Georgia. “I would expect there would be a few stumbles.”
CDC: Breach In Protocol Suspected In Spread Of Ebo … Play video
CDC: Breach In Protocol Suspected In Spread Of Ebola …
As it turned out, those stumbles included infection of a Texas health worker who treated Duncan. The infected worker, identified as a woman but not named by authorities, is believed to be the first person to contract the disease in the United States.
In terms of preparedness around the United States, there is a lot to do: hospital drills, 911 emergency operator guidelines, quarantine rules, even details such as checking that plastic body bags meet the minimal thickness - 150 micrometers - recommended by the U.S. Centers for Disease Control and Prevention.
“It takes a certain amount of reverse engineering to get the plan to where it can respond to new, emerging threats,” said political scientist Chris Nelson, an expert on public health systems at Rand Corp.
While departments contacted by Reuters said they were confident they would be able to identify, treat and contain Ebola, "nobody is charged with reviewing all 2,800 departments' plans," said Jack Herrmann, chief of public health programs at the National Association of County & City Health Officials.
Among the lapses in Dallas, even before the case of the infected health worker, were the hospital's failure to admit Duncan when he first went to the emergency room and told staff there of his recent arrival from Liberia, delaying his treatment by at least two crucial days. It took almost a week to clean the apartment where he stayed. And health officials briefly lost track of a homeless man who they were monitoring for Ebola symptoms.
“We're learning from what's going on in Dallas, too," said Dr. Jay Varma, a deputy commissioner at the New York City Department of Health. "We have a plan that we think is strong but we don't have the final answers to a lot of questions."
While the CDC advises states on 15 “preparedness capabilities” they need to respond to public health emergencies, the list was last evaluated in 2011 and is fairly general— “emergency operations coordination” and “information sharing”.
Local health departments have varying capabilities, preventing the CDC from crafting a single national plan, so it provides guidelines. Thus local authorities decide what is an “adequate” stockpile of protective gear, and which community and other “partners” need to be involved.
That reflects the common view that states and localities should lead health emergencies as a matter of right and responsibility, said Dr. Michael Osterholm of the University of Minnesota, an expert on infectious disease.
There is no detailed national plan or protocol for Ebola, he said, and "some states are much, much better prepared from a public health perspective to handle (an outbreak) than others."
Texas nurse tests positive for Ebola Play video
Texas nurse tests positive for Ebola
The closest things to nationwide plans are those developed for pandemic flu and for so-called "all-hazards emergencies," said Herrmann.
Still, it would be difficult if not impossible for those preparing for a health emergency to learn separate protocols for every individual contingency.
The generic plans cover obvious needs such as calling in additional staff to handle a flood of patients. There are also less obvious needs: if schools are closed, hospitals will need to provide daycare for their workers’ children, said Jeff Levi, executive director of the private non-profit Trust for America's Health, a research and advocacy group.