One year later, reporter explores how Ebola has changed the American health system

Ebola ravaged three countries in West Africa, killing more than 11,000 and sickening over 28,000.

His name was Thomas Eric Duncan. He was a recent émigré from Liberia. He walked into an emergency room in Dallas on Sept. 25, 2014, where he was misdiagnosed with sinusitis, only to return three days later with ever-worsening symptoms. During the course of his stay, he passed on the disease to two nurses who were caring for him: Nina Pham and Amber Vinson. 

The United States was in shock when this happened. For months beforehand, health officials at the highest level had continually assured the public that any hospital in the U.S. could safely care for a patient with Ebola. 

Now, a year after Duncan’s death (and Pham and Vinson’s recovery), what’s different about health preparedness in the U.S.?

I wanted to follow up on the story because I — and so many other health journalists in the field — had breathlessly covered each tiny update about the handful of Ebola cases in the U.S., as well as the political grandstanding that took place about how to welcome medical mission workers back into the country and whether or not we should apply travel bans against the effected countries. I wanted to follow up on the story because I refused to believe that, one year later, all of the fury and hysteria and anger hadn’t resulted in some kind of long-term structural change to train first-line health care providers to recognize symptoms, as well as protect them against exotic pathogens.

Well, it did and it didn’t.

The largest and most official change was that the U.S. Department of Health and Human Services spent millions of dollars helping 55 hospitals around the country prepare for receiving and evaluating a potential Ebola patient. Of those 55 hospitals, nine centers were chosen to be regional centers for the actual treatment of Ebola, as well as other dangerous exotic pathogens like Anthrax, MERS and Marburg virus. 

These nine centers (the HHS hopes to make it 10) are at the most elite level of preparation when it comes to deadly communicable diseases. Tracing their evolution was relatively easy for me; all I had to do was take note of which hospitals had been chosen for the job, and then ask for access to the hospital and the leadership that made the decision to be a part of HHS’s network. Thankfully, the University of Minnesota Medical Center welcomed me in, showed me around their new Ebola ward, and helped me meet hospital administrators who were willing to admit that they were not ready for Ebola when Duncan had showed up with the disease in Dallas. Seeing how agile they were in adjusting to the realities of Ebola care, as well as how diligent they were in applying for federal funds after the fact, was impressive and worthy of applause. 

But it’s the other 5,000 or so hospitals that were more intriguing to me. The majority of U.S. hospitals didn’t get any extra funding or training to prepare for Ebola; the Centers for Disease Control and Prevention didn’t visit their facilities to make sure they were prepared for the worst. For instance, Texas Health Presbyterian Dallas was a respected hospital, but they would have never even made the short list for joining some federal regional network to prepare for Ebola. Yet it was their facility that first received Duncan; one year later, how do hospitals like Texas Health rate when it comes to exotic disease preparedness? 

It’s likely that research on how these hospitals have changed won’t emerge for a number of years — or until the next global pandemic reaches America’s shores. For now, it’s clear that federal health officials and public health experts are confident — indeed, they have no other choice — that a cultural change has penetrated these hospitals. In a post-Ebola world, these experts argued, all hospital triage systems should incorporate a travel history question and be able to quickly isolate infectious disease patients, regardless of whether or not they received federal training and funds to do so. Of course, there’s no way to federally regulate these cultural changes. 

The CDC also recommends that all hospitals that provide emergency room services (which means they could theoretically see an Ebola patient walk in the way Duncan did) have at least 24 hours worth of Ebola-level personal protective equipment for their staff — enough time for them to evaluate a patient and transfer them to an official assessment and/or treatment center. Again, there’s no way for the federal government to make sure hospitals have this bare minimum of equipment. 

These two things were probably the most difficult things for me to report on for this series. I had never really interacted with the federal government beyond press releases before, and I learned (probably too late) that you need a long lead time to work with HHS, OSHA and the CDC. Days and weeks would pass before I saw a response — not necessarily because they were ignoring me, but because they were gathering information themselves and didn’t want to reply until they had answered my questions. 

And once I was on the phone with them, there was also another gulf between their expertise on the minutiae of their agency’s work, and my struggle to comprehend which agency was in charge of what. There were many times my emails and calls got tossed from agency to department to agency, compounding the wait times and heightening my anxiety about the project. If I had it to do over, I would have made all those calls at the beginning of this summer, instead of in the month before I published the stories. 

By far the most rewarding aspect of reporting this series was getting to meet West African immigrants who suffered an immense burden during the Ebola outbreak. While mainstream media seemed to be making themselves hysterical with hypothetical situations about the disease “invading” the country, the deadly virus had already penetrated tens of thousands of Americans’ lives in that these immigrants had to watch from afar as the disease decimated their families and home communities.

Talking to Fomba Konjan, who lost 37 family members in Liberia, was heart wrenching. He cried and cried as he recounted his sister’s death, and I felt immense guilt at asking him to dredge up the past for my interview. I sat in awe as Victor Peacock, a man from Sierra Leone, humbly describe a harrowing year of scraping by in Minnesota so that he could send the bulk of his modest paycheck to family and friends back home. The outbreak was real for these Americans in a way that no one watching the pandemic on TV could possibly comprehend, and now that it was over, it was up to them to take stock of the stressful year they’d had and try to massage some meaning into it. In fact, when I met with Konjan and Peacock back in June, it was clear they were still processing the year’s blur; they were dazed at the experience, and could only recount specific details like dates and death counts with a lot of prodding from me. 

My biggest regret in the series was not being able to find a way to bring Decontee Sawyer’s story into the fold. You may not know her name, but you probably heard of her husband’s actions during the height of the outbreak; he was the Liberian-American man who got on a plane to Nigeria with Ebola. It is unclear whether he did this knowingly, as he died of Ebola soon after his arrival. But health officials in Nigeria claim he hid his disease risk from airport personnel and hospital staff, which resulted in the fatal infections of four more people. Actor Danny Glover is set to make a film about the incident. 

Hearing how she suffered after he died, as well as knowing that her three daughters are now without a father, was a sharp reminder that Ebola was not a faraway problem in a faraway place. The world is smaller than ever now. It’s up to us to open our eyes to the pain of those who live right next door.

GIF by Caroline Yang. 

Top photo by DFID via Flickr.