Q&A: The state of Ebola preparation in developed countries

Mireia Puig-Asensio, MD, PhD 
Mireia Puig-Asensio
Marin L. Schweizer, PhD 
Marin L. Schweizer

The ongoing Ebola virus outbreak in the Democratic Republic of the Congo was recently declared a Public Health Emergency of International Concern, or PHEIC, although officials have said the threat of spread remains a regional — and not global — emergency.

During the West African Ebola epidemic in 2014-2016 — also a PHEIC — almost all of the more than 28,000 cases were confined to three countries: Guinea, Liberia and Sierra Leone. However, cases also were reported in seven other countries, including the United States, where 11 patients were treated.

In a study published in Clinical Infectious Diseases, researchers wrote about the “unprecedented challenge” of hospitals around the world in preparing to “identify, isolate and treat” patients with Ebola and ensure the safety of their staff in the event of a case. Some hospitals set up dedicated Ebola treatment units.

“Hospitals invested a huge amount of time, personnel and resources to improve their capabilities. Despite these efforts, the lack of preparedness was uncovered in October 2014 when three cases of nosocomial transmission occurred among [health care workers] caring for infected patients in the United States and Spain,” the researchers wrote.

Infectious Disease News spoke with two of the researchers, Mireia Puig-Asensio, MD, PhD, a research scholar, and Marin L. Schweizer, PhD, associate director for education and workforce development and associate professor of internal medicine and epidemiology — both from the University of Iowa Carver College of Medicine — about their systematic review of studies evaluating the benefits and challenges faced by hospitals in developed countries that prepared for Ebola, how health care workers perceived the threat and what effect the preparations had on the long-term response to infectious diseases. – by Marley Ghizzone

How prepared are hospitals in developed countries to handle Ebola patients?

This question is difficult to answer with the information we currently have. Some studies have suggested that some U.S. nondesignated Ebola hospitals did stop performing training exercises after the last 2014-2016 Ebola epidemic. However, the regional preparedness and infrastructure may vary from one country to another. Generally speaking, developed countries are probably much better prepared now that they were before 2016. In fact, it is likely that most high biocontainment units are still well-prepared to deal with Ebola patients and other highly infectious diseases. With that said, we need more updated data to know the real capacity of response. It is uncertain to what extent the 2014-2016 preparations resulted in long-lasting changes or improvements. In fact, how well we did sustain hospital preparedness and maintained health care workers’ skills is what will significantly determine our current and future preparedness.

How did making Ebola preparations benefit hospitals?

There are multiple studies showing that Ebola preparations were highly beneficial, not only in terms of improving health care workers’ skills but also to enhance hospitals’ infrastructure. Among all the benefits detected, we should acknowledge that appropriate infection control measures and health care workers’ use of personal protective equipment (PPE) were particularly improved by preparation activities. Being able to safely care for Ebola patients and avoid the spread of the disease when dealing with infected patients are crucial. These skills were benefits frequently acquired during preparation activities.

What sorts of challenges did it uncover?

There are a lot of challenges that were identified during the Ebola preparedness for the 2014-2016 epidemic. Most of them, if not all, are quite self-evident and could be still applicable at current Ebola preparations. To cite only a few examples, it is well-known that the PPE is uncomfortable and the doffing process is complex. To complicate things further, there is a lack of recommended brand of PPE that should be used. In all, it shouldn’t be a surprise that PPE was a commonly reported challenge during hospital Ebola preparations.

In addition, other frequently identified problems that should be noted comprise the lack of resources, the huge financial investment needed to achieve an adequate preparation and difficulties in finding the time and the adequate number of staff to be trained — without interfering with their daily obligations.

How prepared are health care works, mentally, to deal with Ebola patients?

Prior epidemics have already demonstrated that health care workers need to be mentally prepared to deal with highly infectious diseases. The fear of acquiring the infection and putting other family members at risk can make them feel very anxious, and even make them refuse to take care of Ebola patients. That said, feelings of stress and fear can be mitigated with an appropriate social and psychological support and with adequate training that makes them feel safer and calm.

Reference:

Puig-Asensio M, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz757.

Disclosures: The authors report no relevant financial disclosures.

Mireia Puig-Asensio, MD, PhD 
Mireia Puig-Asensio
Marin L. Schweizer, PhD 
Marin L. Schweizer

The ongoing Ebola virus outbreak in the Democratic Republic of the Congo was recently declared a Public Health Emergency of International Concern, or PHEIC, although officials have said the threat of spread remains a regional — and not global — emergency.

During the West African Ebola epidemic in 2014-2016 — also a PHEIC — almost all of the more than 28,000 cases were confined to three countries: Guinea, Liberia and Sierra Leone. However, cases also were reported in seven other countries, including the United States, where 11 patients were treated.

In a study published in Clinical Infectious Diseases, researchers wrote about the “unprecedented challenge” of hospitals around the world in preparing to “identify, isolate and treat” patients with Ebola and ensure the safety of their staff in the event of a case. Some hospitals set up dedicated Ebola treatment units.

“Hospitals invested a huge amount of time, personnel and resources to improve their capabilities. Despite these efforts, the lack of preparedness was uncovered in October 2014 when three cases of nosocomial transmission occurred among [health care workers] caring for infected patients in the United States and Spain,” the researchers wrote.

Infectious Disease News spoke with two of the researchers, Mireia Puig-Asensio, MD, PhD, a research scholar, and Marin L. Schweizer, PhD, associate director for education and workforce development and associate professor of internal medicine and epidemiology — both from the University of Iowa Carver College of Medicine — about their systematic review of studies evaluating the benefits and challenges faced by hospitals in developed countries that prepared for Ebola, how health care workers perceived the threat and what effect the preparations had on the long-term response to infectious diseases. – by Marley Ghizzone

How prepared are hospitals in developed countries to handle Ebola patients?

This question is difficult to answer with the information we currently have. Some studies have suggested that some U.S. nondesignated Ebola hospitals did stop performing training exercises after the last 2014-2016 Ebola epidemic. However, the regional preparedness and infrastructure may vary from one country to another. Generally speaking, developed countries are probably much better prepared now that they were before 2016. In fact, it is likely that most high biocontainment units are still well-prepared to deal with Ebola patients and other highly infectious diseases. With that said, we need more updated data to know the real capacity of response. It is uncertain to what extent the 2014-2016 preparations resulted in long-lasting changes or improvements. In fact, how well we did sustain hospital preparedness and maintained health care workers’ skills is what will significantly determine our current and future preparedness.

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How did making Ebola preparations benefit hospitals?

There are multiple studies showing that Ebola preparations were highly beneficial, not only in terms of improving health care workers’ skills but also to enhance hospitals’ infrastructure. Among all the benefits detected, we should acknowledge that appropriate infection control measures and health care workers’ use of personal protective equipment (PPE) were particularly improved by preparation activities. Being able to safely care for Ebola patients and avoid the spread of the disease when dealing with infected patients are crucial. These skills were benefits frequently acquired during preparation activities.

What sorts of challenges did it uncover?

There are a lot of challenges that were identified during the Ebola preparedness for the 2014-2016 epidemic. Most of them, if not all, are quite self-evident and could be still applicable at current Ebola preparations. To cite only a few examples, it is well-known that the PPE is uncomfortable and the doffing process is complex. To complicate things further, there is a lack of recommended brand of PPE that should be used. In all, it shouldn’t be a surprise that PPE was a commonly reported challenge during hospital Ebola preparations.

In addition, other frequently identified problems that should be noted comprise the lack of resources, the huge financial investment needed to achieve an adequate preparation and difficulties in finding the time and the adequate number of staff to be trained — without interfering with their daily obligations.

How prepared are health care works, mentally, to deal with Ebola patients?

Prior epidemics have already demonstrated that health care workers need to be mentally prepared to deal with highly infectious diseases. The fear of acquiring the infection and putting other family members at risk can make them feel very anxious, and even make them refuse to take care of Ebola patients. That said, feelings of stress and fear can be mitigated with an appropriate social and psychological support and with adequate training that makes them feel safer and calm.

Reference:

Puig-Asensio M, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz757.

Disclosures: The authors report no relevant financial disclosures.

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