If healthcare workers had responded faster and in full force in Dallas three weeks ago, they might have prevented two healthcare workers from getting Ebola, CDC director Tom Frieden said in a call with reporters for the first time on Tuesday.
That might have happened, had there been an “Ebola czar” to spearhead efforts to contain the virus.
As it turns out, we should already have one of those — it’s the Surgeon General. The position was created for the express purpose of maintaining public health by coordinating efforts between various national agencies and the states to enforce a uniform public health policy.
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.
On Friday, President Obama announced he would appoint Vice President Joe Biden’s former chief of staff Ron Klain to take on the newly created Ebola Czar role.
Also missing in action, at least publicly, is Rear Admiral (RADM) Nicole Lurie, the Department of Health and Human Services’ Assistant Secretary for Preparedness and Response, and the Acting Surgeon General — Rear Admiral (RADM) Boris Lushniak.
Things might have gone much differently over the last month if our Surgeon General had been in office from the beginning. Here’s what that position should be doing in the case of an infectious disease outbreak:
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.
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.
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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