Ebola Lessons from Sweden: Health Care Preparedness is Vital

The outbreak of Ebola virus disease continues in the Democratic Republic of the Congo (DRC), as cases surpass 3210, and 2146 deaths. For many, this outbreak is a stark reminder of why continued readiness and public health infrastructure is critical. For those in health care, it is a painful reminder of the long days spent preparing one’s health care facility to rapidly identify, isolate, and treat a patient who could potentially have the viral hemorrhagic fever.

More recently, a European hospital experienced a reminder that continued preparedness is vital when a patient in southern Sweden’s Skane University Hospital sought care after returning from an affected area. The patient has not been identified, but they arrived at the hospital last Monday, September 30, 2019. Following the algorithms provided by the World Health Organization and other public health agencies, the hospital placed the patient in isolation when it was discovered that they not only had relevant travel history to an affected area, but also a fever. This algorithm has been active since 2014: symptoms + travel = isolate until we can rule things out. In coordination with public health officials, health care workers at the Swedish hospital drew samples and sent them for analysis, which yielded the results we all like to hear: negative for Ebola virus disease.

While this was a fortunate situation, it should be seen as a reminder to those of us in health care, especially infection prevention, to conduct an internal audit to see how well the training and process mapping has persevered since 2014. Despite the efforts that were put in place nationally, like the tiered health care approach to special pathogens, many in frontline facilities struggle to maintain readiness.

In a paper published in Health Security in April 2019, I wrote: “Since the EVD [Ebola virus disease] cases in Dallas, Texas, the continuity of hospital preparedness has been questionable. While certain hospitals were designated as EVD treatment facilities, the readiness of most American hospitals remains unknown. A gap analysis of a hospital system in Phoenix, Arizona, underscores the challenges of maintaining infectious disease preparedness in the existing US health care system.”

While many hospital administrators might cite that they are more prepared than they were in 2014, one-third of administrators were unaware of where their hospital fell on the tiered framework. For those designated treatment facilities, the cost was roughly $1.2 million to create and prepare their biocontainment units. A bigger issue though, is that the financial cost of preparing all health care facilities is considerable. In fact, in a recently issued Office of the Inspector General report, hospital administrators note that the financial cost of preparedness diverts resources from other critical hospital efforts and for a “what if” situation, has many concerned.

Ultimately the scenario in Sweden played out with the best possible outcome — the patient did not have Ebola virus disease. Many hospitals in the United States have also quietly managed patients under investigation for special pathogens. The truth is that we should see what happened in Sweden as a not-so-gentle reminder to continue training for basic infection prevention efforts, by asking travel-screening questions and using proper isolation precautions, while also working to re-educate staff on Ebola personal protective equipment and processes.