Envisioning a public health threat, managed care recently notched up its readiness for an Ebola outbreak in the United States. Valuable lessons emerged from the latest effort, adding to the knowledge gleaned from other epidemics, such as the HIV/AIDS and SARS viruses and the bird flu.
“Each of those responses was a combination of building on previous experience and learning new approaches,” says Patrick T. Courneya, M.D., executive vice president and chief medical officer of Kaiser Foundation Hospitals and Kaiser Foundation Health Plan in Oakland, California.
“Even if we never see an Ebola patient, our Ebola preparation makes us much better prepared the next time something else comes up,” Courneya says. He adds that it’s important to “quickly reassure the communities that we serve—that we do have this in hand—and make sure that we are not responding out of fear, but out of abundant confidence and the appropriate level of humility.”
As part of its proactive strategy, the Kaiser Foundation convenes monthly conference calls with its infectious disease specialists across the country. They discuss emerging issues and trends and evaluate evidence-based practices.
Well-thought-out practices were necessary in welcoming back two Kaiser Foundation employees who overlapped in volunteering for six weeks in West Africa during the recent Ebola epidemic. The two physicians also were among the infectious disease specialists who engaged in the monthly phone calls.
Heeding recommendations from the Centers for Disease Control and Prevention (CDC), Courneya and his colleagues decided to honor their service with a 21-day paid period of performing administrative work from home such as answering e-mails and participating in calls, while prohibiting contact with health plan members. During that exclusion from patient care, the team could determine whether the physicians’ potential exposure to Ebola warranted more or less monitoring. The physicians showed no signs of Ebola and are now out of quarantine.
Protective measures underscore the importance of putting safety first. Emergency operations should focus not only on natural disasters such as hurricanes, flooding and power outages, but also on emerging infectious diseases, says Lisa Waldowski, MS, APRN, CIC at the Joint Commission in Oakbrook Terrace, Ilinois.
“This needs to be something that is planned for and drilled for, and staff are comfortable with training and education on an ongoing basis,” she says. “This is not something you want to be caught off guard with and unprepared for.”
In December, the U.S. Congress reached a budget deal that includes $5.4 billion to manage the Ebola crisis and to plan for future infectious disease eruptions. That is 13% less than the $6.2 billion that President Barack Obama’s administration requested. The U.S. Department of Health & Human Services expects to receive about half the allocated funds, of which $500 million will support worker training and other domestic efforts, and $1.2 billion will provide for global initiatives.
Also in December, the National Institutes of Health (NIH) made safety paramount with the return of an American nurse who had been a volunteer in an Ebola treatment unit in Sierra Leone. The patient arrived from an overseas location via private charter Medevac in isolation and entered the NIH Clinical Center for observation and enrollment in a clinical protocol.
Eight days later, the patient was discharged without any clinical or laboratory evidence of an Ebola infection and began a 21-day monitoring period at a private residence under the oversight of the Virginia Department of Health.