The Ebola Crisis Has Exposed A Huge Gap In The Obama Administration

Dallas ebola hazmatAP Photo / LM OteroA hazmat worker cleaning outside the apartment building of a hospital worker diagnosed with Ebola. The worker, a nurse, cared for Ebola patient Thomas Eric Duncan, who later died.

This weekend, Senator John McCain (R-Ariz.) called for President Obama to nominate an Ebola “czar” to coordinate the US response to the virus.

There’s a problem with that idea, though: We already have one.

Or, to put it more accurately, we already should. The Surgeon General, aka “the nation’s doctor,” is tasked with commanding the country’s more than 6,800 federal public health researchers, nurses, and investigators, as well as serving as a key liaison to the National Institutes of Health, the Centres for Disease Control and Prevention, and global health groups like the World Health Organisation. The man Obama nominated for the job back in November never got confirmed, however, thanks to controversy over his position on gun violence.

For now, CDC Director Tom Frieden has essentially been serving as Ebola czar, though there’s no designated person coordinating the public health efforts of the CDC and the research efforts — including experimental vaccines and treatments — of the NIH. Also missing in action, at least publicly, is Nicole Lurie, the Department of Health and Human Services’ Assistant Secretary for Preparedness and Response. Her job is “to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies.”

There is an Acting Surgeon General — Boris Lushniak — but he’s been notably absent since Ebola emerged as a public health concern. Even the Ebola page on the Surgeon General’s website merely redirects readers to a CDC page. Here’s what our Surgeon General might be doing now if he were in office.

Domestic Communicator

The Surgeon General would oversee the US Public Health Service Commissioned Corps, which include some of the people sent in to track down and contain dangerous viruses like Ebola. He or she would also work closely with US public health agencies like the NIH and the CDC to clearly communicate to the public and to healthcare workers information about new and emerging public health issues, such as Ebola. His or her role would be complex, but critical: Prepare healthcare workers to treat people with the virus while simultaneously educating the public to quell irrational fears about its spread.

Surgeon general's reports on AIDS HIV historicalNational Library of MedicineCovers of Surgeon General’s Reports: ‘Understanding AIDS’ and ‘The Surgeon General’s Report on Acquired Immune Deficiency Syndrome.’

When AIDS first took hold in the US, the Surgeon General served a crucial role in helping the public understand what was at the time a frightening and largely misunderstood threat.

“By educating Americans about the causes, transmission, consequences, and prevention of AIDS, the Surgeon General materially changed medical and public conceptions of the disease,” notes an account from The National Library of Medicine.

The Surgeon General’s “report on AIDS was crucial in changing public understanding of the disease.”

Today, the ongoing situation in Texas underscores how important that kind of thoughtful, scientifically sound communication can be. So why isn’t it happening? Without a Surgeon General, relaying information about infectious disease falls on the states. This is where the CDC comes in.

The CDC works as a reference center for each state — it provides them with recommendations and guidelines to prepare doctors and nurses to treat patients with Ebola and contain the virus. Unfortunately, the CDC doesn’t enforce those recommendations, as Northwestern University Director of the Center for Global Health Robert Murphy told the New York Times . “It’s strictly up to the states as to whether they follow those guidelines or not,” said Murphy.

This state-by-state enforcement was a clear problem in Dallas, where despite having more than enough trained staff and equipment, healthcare workers failed to properly diagnose and treat their first Ebola patient , Thomas Eric Duncan . He died from the virus on Wednesday, Oct. 8 . This weekend, the hospital announced that a healthcare worker who treated Duncan was also sick with Ebola even though she was doing her best to follow all CDC safety precautions while caring for him.

Public misinformation about Ebola has only worsened the situation. Since Thomas Eric Duncan became the first person to be diagnosed with the virus in the US on September 30, the CDC has received more than 800 calls a day from healthcare workers who suspect a patient has Ebola. Without clear communication about what the virus looks, sounds, and feels like, it’s no surprise that most of the public — not to mention some trained doctors and nurses — think every fever, cough, or bloody nose could be Ebola.

International Liaison

Vivek Murthy Surgeon General Nominee committee hearingAP Photo/Charles DharapakDr. Vivek Murthy, President Obama’s Surgeon General nominee, prepares to testify before the Senate Health, Education, Labour, and Pensions Committee.

Three people in the US, including an NBC videographer and a Dallas healthcare worker diagnosed this weekend, remain ill with Ebola. In Spain, a nurse in Madrid who contracted the virus has worsened.

Yet the brunt of Ebola’s damage continues to be felt in West Africa, where more than 4,000 have died and more than 8,000 are sick with the virus. While the CDC and the WHO could likely have contained the outbreak early on had they acted in full force when Ebola first emerged, both agencies are now simply struggling to keep up with the virus as the number of infected in West Africa doubles every 30 days.

In all seven countries where Ebola cases have been reported, the health agencies are following the same protocol they have been using for every former Ebola outbreak: contract tracing. The procedure involves tracking down every person who’s come into contact with an infected person so the outbreak can’t continue to spread unchecked. In West Africa, however, it may be too late for the procedure to work. With so many sick — and so many being turned away from hospitals to die at home and pass the virus to family — the total number of infected people could climb to 1.4 million by the end of January.

If the Surgeon General led communication between the CDC and the WHO, that person could not only coordinate efforts to send aid to the most affected countries in West Africa, but could also implement airport health screenings and spearhead hospital trainings.

Many of the airport screeners who were dispatched at five US airports last week are supervised by members of the US Public Health Service, the Surgeon General’s boots on the ground. In 2003, after meeting with health professionals in California who proposed implementing airport screenings to battle the SARS outbreak (a much less deadly virus than Ebola), then Surgeon General Richard Carmona decided to give an official go-ahead to the procedure. The same year, the Surgeon General identified several infectious disease quarantine sites where SARS could be contained.

Why We Have A Surgeon General

Our most recent Surgeon General, Regina Benjamin, says the job serves the critical function of digesting all of the information about a particular public health scenario, such as Ebola, and telling the public what they need to know to stay safe.

The position was initially created in 1798, when President John Adams created the Marine Hospital Service. That group’s lead doctor was called the Surgeon General. Years later, the MHS became the US Public Health Service, and the Surgeon General began to take on health issues related to immigration, national safety, smoking, and many other public health issues.

Since then, the position has been significantly weakened. In the midst of what is perceived to be a massive public health crisis, however, a Surgeon General could serve a critical role. “Not having [this person] right now, you don’t have that face and that person that the American people can identify with as their doctor who’s looking out for them on a large scale,” said Benjamin.

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