Dr. Randy Gordon is a Deloitte Consulting LLP director in the Life Sciences and Health Care practice, focusing on health care transformation and clinical care improvement, and leads the Global Health Services Activation solution.
Dr. Charles Bruce Green, former 20th Air Force Surgeon General, is a Deloitte Consulting LLP director who serves as chief medical officer for Deloitte’s Federal Health practice.
Recently, they sat down to discuss the Ebola outbreak in West Africa, its potential ramifications for public health in the US, and what changes the health care industry should be considering in training health care workers, preparing medical facilities, working with policy makers, and preparing a rapid and effective response to Ebola and other public health emergencies.
Q: What is the health care industry in the US learning about Ebola in terms of how to prepare and respond to an outbreak?
Dr. Green: One of the things the health care industry is learning is that while we are familiar with universal precautions to prevent the spread of disease, Ebola has created a need for a protection beyond the norm. The industry has been dealing with new guidelines from the US Centers for Disease Control and Prevention, and there has been some angst within hospital organizations since some health care workers who thought they were protected have tested positive. The reality is that many hospitals may have been comfortable with their level of training, but they’ve had to reevaluate that.
Dr. Gordon: The first lesson on the preparedness side is that when there is such a threat to our health, there needs to be scenario planning and proper training. Problems like Ebola are going to come through the emergency room, which means unless preparation and response is 100-percent effective, organizations shouldn’t rest. That’s the first lesson of preparedness. The second is risk communications. Being prepared with appropriate risk communication techniques is important, and organizations should be prepared to do a thorough job of communicating the risks to the public and to staff. The third lesson is about coordination – coordinating well with other hospitals, patients, and caregivers, and most importantly with government authorities is critical in these situations.
Q: What are some of the biggest potential threats to the health care industry’s ability to monitor and treat Ebola?
Dr. Gordon: In my opinion, the biggest threat is the eventuality of a decrease in vigilance. By which I mean, once Ebola fades from the headlines, we shouldn’t let our guard down. The story will be replaced by other medical situations and news, but we will continue to see an occasional case get through screening to arrive in this country. The US authorities and health care organizations have to continue to be vigilant. It could show up in a small Midwestern town out of the blue, and the organizations in that town will need to be prepared.
Dr. Green: Besides vigilance, the other thing we’ve learned is there is a need for focused training and specialized teams. Even though the decontamination process for Ebola is relatively straightforward and not unlike that for other afflictions like the flu, the reality is there is a high rate of mortality associated with Ebola. Stakeholders have to think about how the mortality rate will affect the concerns of the “worried well.” Health care professionals should work with their teams to reassure the public that they know how to deal with this. That will likely increase their level of comfort.
Q: What have been some of the difficulties in communicating with the public about Ebola?
Dr. Green: One of the difficulties in getting the word out to the public was that the story was being combined with what was going on in West Africa. So you had people learning about the high transmission rates in West Africa, where there are inadequate sanitation and public health systems. Here in the US, there have been two imported cases, including one death, and two locally acquired cases in health care workers.
Q: Some public officials have called for a travel ban or tougher quarantine policies, positions that may be at odds with scientific assessments. Can governmental agencies and public health officials get on the same page? And if so, how?
Dr. Gordon: That’s a public policy issue. Public policy is probably never going to be scientifically pure, nor should it be. The industry continues to develop the science, and it’s the policy makers that have to balance the science with economic considerations, public opinion and everything else. Public policy doesn’t necessarily come up with the best answer in balancing all the perspectives. I’m not saying these policies you mentioned are good or bad but most of them haven’t been implemented – we’re not banning travel, or keeping people quarantined in their homes for 21 days or more. The scientific community pushed back on it.
Q: How are federal agencies responding to Ebola, particularly the Department of Defense (DoD) and the Veterans Administration (VA), with its management of the network of VA hospitals?
Dr. Green: The DoD has been very aggressive with planning, both in its response to West Africa and how they are going to manage any positive cases presenting to military facilities here in the U.S. VA leadership has run scenarios, emphasized travel histories in emergency departments, and established specialty centers where they are training their teams to manage any positive Ebola cases.
Q: Are the industry and public health agencies doing a good job of communicating?
Dr. Green: My impression is that they actually did a good job of communicating the threat. They were talking about training and risk precautions. But there are always things that happen outside the norm. Health care organizations should try to make sure they don’t over-promise, but they still have to reassure the public. The industry is learning more about how the public feels about the 21-day observation periods, what happens when people exposed develop a fever, and realities of transmission of a blood-borne illness.
Q: How do you think this issue – the potential spread of Ebola globally, the potential impact in this country — will eventually play out?
Dr. Gordon: My general feeling is that Ebola will be contained in West Africa. All of the predictive modeling of the spread of an epidemic is catastrophic, meaning that there is exponential spread to tens of thousands, to hundreds of thousands, of cases. I think there may be some natural order of restraint. Maybe it is just learning how to better deal with the disease. I think it might burn out in six, 12, maybe 18 months. And there’s a hope that someone will develop a vaccine to help treat the current epidemic and stop future transmission of the disease. I anticipate some sort of treatment protocol developing that could help improve the chances of survival for those afflicted, and that it may develop over the next few months.
Dr. Green: I don’t want to predict what will happen in West Africa, but I believe it will burn itself out. In this country, I think we’ll continue to see sporadic cases of people infected, but I don’t think we’ll see an outbreak. The industry and other stakeholders will be working to develop new immunizations. Our public health infrastructure is strengthening bonds with the treatment facilities. It’s very unusual for us to track people for 21 days. I think this threat could lead to better tracking and better collaboration among the public health agencies.
For more on this topic, read The Ebola outbreak: A call to action for a translational approach to R&D and Ebola outbreak: Turning fear into action.