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Why America's health care system can stop Ebola, even though other countries couldn't

Mike Stone/Getty Images

On September 30, the Centers for Disease Control and Prevention announced the first confirmed case of a patient being diagnosed with Ebola in the United States. Although that news is frightening, it does not mean that there is going to be an outbreak in the US on the scale of the one that is currently happening in West Africa.

Public health officials know how to stop Ebola in its tracks. This is a disease that we can control. To do that, a whole system has to work together. Because there is no vaccine for Ebola, and no cure, stopping the disease is a matter of getting the right people to do the right things, at the right time.

In the United States, we have everything we need to make that system work: the health-care workers, the facilities and equipment, the disease surveillance mechanisms, the public sanitation, the education and communications infrastructure — and the public trust that lets all of those individual components work together, as a whole system that is more powerful than the sum of its parts.

By contrast, the worst-affected countries in this outbreak — Guinea, Liberia, and Sierra Leone — all lack those resources. Their systems don't work, and that has left thousands of people in terrible danger from this disease.

Here's what you need to know about the system that will protect the United States, and why the weakness of similar systems in Guinea, Liberia, and Sierra Leone has allowed Ebola to spread so widely in those countries.

Effective public health messaging: the first line of defense

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Epidemiologist Dr. Edward Goodman explains how to prevent the spread of the ebola virus. (Mike Stone/Getty Images)

The first step in combating an Ebola outbreak is educating people about it. People at risk of contracting the Ebola virus need to understand what steps to take to prevent its transmission; how to recognize the symptoms of the disease; and what to do if they believe that they, or someone they know, might have it.

Guinea, Liberia, and Sierra Leone have faced huge barriers to getting that message out. All three countries are extremely poor and suffer from a lack of communications infrastructure, so health officials trying to spread the word about Ebola have had to rely on health outreach workers to make personal contact with villages.

Marc Forget, a doctor with Médecins Sans Frontières, told CNN that because his organization cannot rely on TV or radio to spread the message, "It has to be one-by-one contact that needs to be done through the chiefs, the local authorities, the youth." As a result, MSF has had to send health workers to thousands of small villages to explain the disease, which is "time-consuming and very difficult."

That lack of infrastructure has allowed myths about Ebola to spread much more quickly than reliable information. Because the affected countries' health care systems are weak, public health authorities have not necessarily earned the community's trust on medical matters, which has compounded the damage done by misinformation. Rumors have spread that health workers themselves were spreading the disease, leading some communities to barricade the roads to keep them out. Some health workers have even been met with violence, including an outreach team in Guinea that was murdered by fearful villagers.

In the United States, however, the situation is very different. Our health authorities can reach Americans directly via social media and indirectly via TV, radio, online, and print media. The CDC has 371,000 followers on Twitter, which means it can reach more people in one second through a single tweet than MSF's outreach workers in West Africa can in weeks. And if it does turn out that in-person outreach is necessary, that will still be much easier here, because our roads and transportation infrastructure mean that any affected communities in the United States would be much, much more accessible than those in West Africa.

Disease surveillance: stopping the spread of Ebola

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President Obama speaks at a CDC briefing on the Ebola outbreak. (Mandel Ngan/AFP/Getty Images)

A second core element of effectively combating Ebola is disease surveillance — public-health speak for finding cases of the disease, and acting quickly to stop its spread.

In Guinea, Liberia, and Sierra Leone, effective disease surveillance systems were not in place before the outbreak, and the three countries have struggled to build that capacity since the outbreak began. That problem has been compounded by the fear and rumors mentioned above, which have made people reluctant to report Ebola cases to health officials. When people hide cases from health authorities, that makes it hard to map the spread of the disease, and to do contact tracing to identify other individuals who may have been infected.

In the United States, by contrast, we have a robust public health reporting system that is well equipped to identify, monitor, and trace Ebola cases. The Dallas patient is a good example: the CDC was informed of his case, and has already identified all of the people he came into contact with during the few days when he would have been infectious, so they can all be monitored for Ebola symptoms.

Physical infrastructure: a safe place to get treated

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Possible Ebola patients wait on the ground outside a hospital in Monrovia, Liberia. (Pascal Guyot/AFP/Getty Images)

Of course, it's not enough to identify cases of Ebola. People also need somewhere to go for treatment if they do become infected. Ebola patients need to be cared for in isolation units inside hospitals. If they are treated in normal wards, they risk infecting other patients, and if they don't go to hospitals at all, they risk infecting the loved ones who care for them at home.

Once again, the countries hardest hit by the Ebola epidemic lack that vital component of the public-health response. Guinea, Liberia, and Sierra Leone are all suffering from a critical absence of Ebola treatment facilities. The few isolation facilities they have are full, and have to turn away patients, who may then go on to infect others.

In the absence of sufficient isolation units, Liberia and Sierra Leone have attempted to forcibly quarantine people in their homes, but those measures may be causing more harm than they are preventing. For instance, Liberia's attempt to quarantine the West Point slum in Monrovia sparked violence, and had to be abandoned after 10 days. After the quarantine was lifted, false rumors spread that it had ended because the government had not found any Ebola in the area.

In Sierra Leone, the entire country was under quarantine from September 19 to 21. Fourteen districts remain under complete or partial quarantine, affecting more than one million people. But that may end up spreading infection rather than halting it, by imprisoning healthy people in their homes with their infected family members, and by encouraging people to hide cases rather than revealing them to authorities.

In the US, by contrast, that's not a problem. CDC Director Tom Frieden has said that virtually any hospital in the country could provide proper care and infection control for a case of Ebola. Even if we end up having more Ebola cases, we aren't going to run out of places to treat them.

Equipment: making sure health workers have protective gear

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A health worker in Monrovia, Liberia holds used latex gloves. (Pascal Guyot/AFP/Getty Images)

When Ebola patients receive treatment, it is vital that health workers use proper protective gear to avoid spreading (or contracting) the virus. That includes the use of spacesuit-like PPEs when working directly with confirmed Ebola cases, but also the general use of good hygiene practices, such as wearing gloves and sterilizing equipment, to prevent undiagnosed patients from spreading the disease.

Unfortunately, the health care systems in the three worst-affected countries are so poor that basic equipment, including even latex gloves, is often not available. Daniel Bausch, an associate professor at the Tulane University School of Public Health and Tropical Medicine who is working on the Ebola response, told Vox that "if you're in a hospital in Sierra Leone or Guinea, it might not be unusual to say, 'I need gloves to examine this patient,' and have someone tell you, 'We don't have gloves in the hospital today,' or 'We're out of clean needles' — all the sorts of things you need to protect against Ebola."

In the United States, this just isn't a problem. We have plenty of gloves, needles, PPEs, and other equipment. And if a hospital ran out and needed more, our reliable transportation infrastructure would make it possible to replenish the necessary supplies quickly.

Health workers: enough doctors and nurses to treat Ebola patients

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Health workers put on PPEs outside the Ebola unit in Monrovia's Elwa Hospital. (Dominique Faget/AFP/Getty Images)

Finally, for a health system to work, it has to be staffed. That means doctors to diagnose Ebola patients, doctors and nurses to care for them, ambulance drivers to transport them, and laboratory technicians to analyze blood tests and identify new cases.

The worst-affected countries in this outbreak don't have enough health workers to combat Ebola, and the ones they do have are falling victim to the disease. That's another example how the system to combat Ebola needs to work as a system in order to be effective: because Guinea, Liberia, and Sierra Leone don't have enough isolation units or protective equipment, their health workers aren't safe from infection, and many of them have fallen victim to Ebola themselves. And when that happens, other health workers become afraid to come to work. Liberia and Sierra Leone have seen nurses go on strike, leaving hospitals dangerously understaffed.

Bausch told Vox that when he was in Sierra Leone in July, he and just one other doctor were responsible for an entire Ebola ward housing 55 patients. Because there were no decontamination officers to clean the facility, the floor was often covered in blood, vomit, and feces from the sick patients. And because there were no nurses to staff the ward, patients who fell out of their beds during the night would lie on that floor for hours, unable to lift themselves out of the filth, until Bausch or his colleague returned in the morning.

In an Ebola clinic in Liberia's West Point, the lack of medical staff meant that patients had to be cared for by their family members, without proper protective equipment. In many cases, that act of love will become a death sentence, making today's caregivers tomorrow's victims.

In the United States, we are incredibly fortunate that we have enough doctors, nurses, and other health workers, and that our hospitals and clinics are safe working environments for them. We are fortunate to live in a country whose robust health system means that we do not have to choose between risking our own health, and letting our loved ones die on a blood-covered floor in an understaffed Ebola ward. We are fortunate that our disease surveillance system is robust enough to track this outbreak. We are lucky that our communications and transportation infrastructure means that public health officials can easily educate the public, and keep hospitals properly supplied.

And we are especially, tremendously fortunate that all of those different factors work together in a system that makes them more valuable together than they are individually. That is going to prevent Ebola from spreading here, and keep us safe.

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