Wednesday morning brought sad news that Thomas Duncan, the Ebola-infected patient in Dallas, has passed away. It also brings heightened scrutiny of our nation’s strategic plan for dealing with Ebola in the U.S.
Ebola is undoubtedly a frightening disease. In West Africa — without appropriate medical facilities and staff — it is spreading at a truly alarming rate.
And now the disease is here. At home. A geographic spread that was nearly inevitable considering our global movement is sparking questions about what to do next. The CDC and other public health officials are walking a fine line: being realistic about a serious risk while belaying panic.
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It’s not an easy puzzle; global health issues never are. But the same steps we’ve been advocating for in Africa are applicable here.
First we have to understand this disease. Ebola is contagious, but far less so than small pox or HIV. It is transmissible only through direct contact with bodily fluids from an infected person: blood, vomit, urine, feces, saliva and other secretions. As we have seen with the effort in Dallas and the Ebola workers who were brought home, ability to contain and treat in U.S. medical facilities makes a widespread, uncontrollable outbreak extremely unlikely.
I am not minimizing the potential lethality of Ebola. But a response to Ebola needs to be tailored to the natural history of Ebola.
We know that containment is paramount, and isolation is the most important part of an Ebola strategy. But there is no way to isolate everyone in West Africa with a febrile illness given the variety of endemic viruses and infections to the area.
To really stop the spread of the disease—to get ahead of it—we need a rapid diagnostic test (RDT) that can be deployed on the ground, not in a laboratory. A test that facilitates appropriate quarantine of those with disease and release of those without. Not only will this allow us to focus resources, it will also help build trust and allay fears.
The same test could be used at home as well to quickly evaluate travelers and potentially prevent another case like the one in Dallas. Without an RDT, there will always be a window between when the patient becomes contagious, and when we can confirm a diagnosis. Precautionary quarantines and travel restrictions can help, but they will not replace accurate and timely diagnosis.
While we are waiting on a potential test, we must efficiently leverage the resources we have to offer.
Senators Rob Portman, R-Ohio and Lamar Alexander, R-Tenn., have urged President Obama to appoint a single administration official to coordinate the U.S. strategy to contain and combat Ebola. I agree that one individual must coordinate the efforts of key agencies and players to facilitate centralization of American resources to function synergistically and improve impact and speed.
The Centers for Disease Control (CDC), the Department of Homeland Security (DHS), Customs and Border Protection (CBP), and others will have crucial roles to play. They must present a united effort.
The death of the first patient diagnosed with Ebola on U.S. soil should not herald panic. But it is impetus to make sure we disseminate the most accurate information, that our response plan is coordinated and thoughtful, and that our nation’s best minds are focusing on a solution.
The importance of speed cannot be understated. Time is not on our side.
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