Issue link: https://www.epageflip.net/i/406903
ByJeffDonn TheAssociatedPress The U.S. health care ap- paratus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clus- ters of cases could over- whelm parts of the system, according to an Associated Press review of readiness at hospitals and other com- ponents of the emergency medical network. Experts broadly agree that a widespread nation- wide outbreak is extremely unlikely, but they also con- cur that it is impossible to predict with certainty, since previous Ebola epidemics have been confined to re- mote areas of Africa. And Ebola is not the only possible danger that causes concern; experts say other deadly in- fectious diseases — ranging from airborne viruses such as SARS, to an unforeseen new strain of the flu, to more exotic plagues like Lassa fe- ver — could crash the health care system. To assess America's abil- ity to deal with a major outbreak, the AP examined multiple indicators of read- iness: training, staffing, funding, emergency room shortcomings, supplies and protection for health care workers. AP reporters also interviewed dozens of top experts in those fields. The results were wor- risome. Supplies, train- ing and funds are all lim- ited, and there are concerns about whether health care workers would refuse to treat Ebola patients. Following the death of a man suffering from Eb- ola in a Texas hospital and the subsequent infection of two of his nurses, medical officials and politicians are scurrying to fix prepared- ness shortcomings. But remedies cannot be im- plemented overnight. And fixes will be expensive. Reporters frequently heard assessments that the smaller the facility, the less prepared it is to fight Eb- ola and other deadly infec- tious diseases. The U.S. has many more medium-size and small medical centers than large hospitals. "The place I worry is: Are most small hospitals ade- quately prepared?" said Dr. Ashish Jha, a Harvard Uni- versity health care qual- ity specialist. "It clearly de- pends." Other findings: • The emergency care system is already overex- tended, without the extra stress of a new infectious disease. In its 2014 national report card, the American College of Emergency Phy- sicians gives the country a D-plus grade in emergency care, asserting the system is in "near-crisis." • Federal data shows pa- tients spend an average of 4 hours in emergency rooms at U.S. hospitals be- fore being admitted, and 2 percent of patients leave be- fore being seen. Add an in- flux of patients diagnosed with Ebola, or those who fear they have the disease, and the system's vulnerable segments could wobble. • While most provid- ers are willing to care for people infected with Eb- ola virus, an August study shows many feel unpre- pared. Health care research group Black Book Rankings sought opinions from hospi- tal administrators and staff about Ebola readiness and nearly 1,000 personnel at 389 facilities, including 282 hospitals, participated. Per- sonnel at almost all hospi- tals in the survey said their facilities were not capable of quarantining large num- bers of people possibly ex- posed to Ebola. And 14 per- cent of isolation care doc- tors and nurses and one in four emergency and critical care staff said they'd call in sick if Ebola patients were admitted to their hospitals. • There are only four specialized containment care facilities set up to iso- late and treat patients with Ebola. In any sizable out- break, those dozen or so beds would fill up quickly. • Despite sizable federal investments in Ebola re- search, there is no Ebola vaccine. And as of last week, there were no national emergency stockpiles of the waterproof gowns, full face shields and boot covers rec- ommended by the U.S. Cen- ters for Disease Control and Prevention. The CDC's $6.2 billion Strategic Na- tional Stockpile placed an order Thursday for some such equipment, but offi- cials would not say when it could be distributed. • Since 2002, CDC has given states and territo- ries more than $10 billion to help public health care systems ramp up when fac- ing a disease outbreak. The program has been cut by 30 percent since fiscal year 2007, which led to thou- sands of layoffs by state and local health departments, according to the National Association of County and City Health Officials. • A recent survey of 2,500 members of the same asso- ciation found that only one in three local health depart- ments had participated in full-scale emergency pre- paredness drills. Experts concur that training health care work- ers on safe Ebola treatment and education is one of the antidotes. SHORT ON RESOURCES UShealthcareunprepared for Ebola, AP review finds ERICGAY—THEASSOCIATEDPRESSFILE Members of the Department of Defense's Ebola Military Medical Support Team go through special training at San Antonio Military Medical Center in San Antonio. JACQUELYN MARTIN — THE ASSOCIATED PRESS President Barack Obama greets Dr. Kent Brantly, 33, an Ebola survivor, a er speaking at an event with American health care workers fighting Ebola. By Jim Kuhnhenn The Associated Press WASHINGTON Pushing to confront Ebola at its West African source, Pres- ident Barack Obama said Wednesday the United States was not immune to the disease but cau- tioned against discour- aging American health care workers with restric- tive measures that confine them upon their return from the afflicted region. "We can't hermetically seal ourselves off," he declared. Obama said doctors and nurses from the United States who have volun- teered to fight Ebola in West Africa are American heroes who must be treated with dignity and respect. His remarks came amid debate between the federal government and several states over how returning health care workers should be monitored. The White House has pushed back against overly restrictive measures, including pro- posals for travel bans or isolation measures ad- opted by some states. "Yes, we are likely to see a possible case elsewhere outside of these countries, and that's true whether or not we adopt a travel ban, whether or not you adopt a quarantine," Obama said from the White House, surrounded by health care workers who have volun- teered or will volunteer to serve in Liberia, Sierra Le- one or Guinea, where the disease has killed nearly 5,000. "We have to keep in mind that if we're discour- aging our health care work- ers, who are prepared to make these sacrifices, from traveling to these places in need, then we're not doing our job in terms of looking after our own public health and safety," he added. Obama did not men- tion any specific case, but a nurse who treated Eb- ola patients in West Africa and has shown no signs of the disease was isolated in a hospital tent in New Jer- sey and now is abiding by a voluntary quarantine in her home state of Maine. The nurse, Kaci Hickox, said Wednesday that she planned to defy those guidelines if the state's pol- icy didn't change by Thurs- day. The White House has argued that stricter mea- sures adopted by states such as New Jersey and New York could hurt ef- forts to recruit doctors and nurses to volunteer their services in West Africa. Obama says US can't seal itself off RESTRICTIVE MEASURES By Martin Crutsinger The Associated Press WASHINGTON The Fed- eral Reserve cited an im- proving economy Wednes- day as it ended its land- mark bond-buying program and pointed to gains in the job market — a key condi- tion for an eventual inter- est rate hike. The Fed did reiterate its plan to maintain its bench- mark short-term rate near zero "for a considerable time." Most economists pre- dict it won't raise that rate, which affects many con- sumer and business loans, before mid-2015. But in a statement ending a policy meeting Wednes- day, the Fed noted that the job market is strengthen- ing. Its statement drops a previous reference to "sig- nificant" in referring to an "underutilization" of avail- able workers. Instead, the Fed said the excess of would-be job hold- ers is "gradually diminish- ing." It also noted solid hir- ing gains and a lower un- employment rate, now 5.9 percent. One of the Fed's major goals is to achieve maximum employment, which it defines as an un- employment rate between 5.2 percent and 5.5 percent. That all suggested that the Fed is looking toward an eventual rate hike. Investors responded to confirmation that the Fed would end its bond buying program and perhaps move closer to a rate increase by positioning themselves for higher rates. The dollar rose against other curren- cies, bond yields ticked up, the price of gold fell and stock prices slipped. The Dow Jones industrial aver- age closed down a modest 31 points, or 0.2 percent. The Fed repeated previ- ous language that the like- lihood of inflation running persistently below its 2 per- cent target has diminished, even though inflation is be- ing slowed by lower energy prices and other factors. The Fed noted that expec- tations for inflation have re- mained stable, something it strives to achieve. On balance, economists saw the Fed's statement as showing less concern about unusually low inflation, which has helped delay a rate increase. Some analysts said the market reaction Wednesday suggested that investors saw the Fed state- ment as at least setting the stage for rate hikes starting sometime next year. David Jones, chief econo- mist at DMJ Advisors, said he was struck by the ab- sence in the statement of any mention of global eco- nomic weakness, including the threat of another Euro- pean recession. Conservative critics of the bond buying program hailed the move to end the purchases, a step they saw as long overdue. The bond buying "has overstayed its welcome by years and by trillions" of dollars, House Finan- cial Services Chairman Jeb Hensarling, R-Texas, said in a statement. Michael Hanson, senior economist at Bank of Amer- ica Merrill Lynch, said the Fed still appears likely to put off any rate increase un- til at least mid-2015. "This isn't the Fed rush- ing to the exits," he said. Hanson noted that while the Fed kept its "consid- erable time" phrasing, it added language stress- ing that any rate increase would hinge on the econ- omy's health. Previously, many analysts had inter- preted the "considerable time" phrase to mean the Fed wouldn't raise rates for a specific period after it ended its bond purchases. The Fed's statement was approved 9-1. The one dis- sent came from Narayana Kocherlakota, president of the Fed's regional bank in Minneapolis. He con- tended that the Fed should have signaled its inten- tion to maintain a record- low benchmark rate until the inflation outlook has reached the central bank's 2 percent target. He argued that the Fed should have continued its bond pur- chases at the current pace. Kocherlakota is con- sidered one of the Fed's "doves" — officials who are more concerned about unemployment than are "hawks," who worry more about the risk of high in- flation. At the September meeting, two "hawks" — Presidents Charles Plosser of the Philadelphia Fed and Richard Fisher of the Dal- las Fed — had dissented. On Wednesday, they voted for the statement. The U.S. economy has been benefiting from solid consumer and business spending, manufacturing growth and a surge in hir- ing that's reduced the unem- ployment rate to a six-year low. Still, the housing indus- try is still struggling, and global weakness poses a po- tential threat to U.S. growth. Fed chief Janet Yellen has stressed that while the un- employment rate is close to a historically normal level, other gauges of the job mar- ket remain a concern. These include stagnant pay; many part-time workers who can't find full-time jobs; and a his- toricallyhighnumberofpeo- ple who have given up look- ing for a job and are no lon- ger counted as unemployed. The Fed's decision to end its third round of bond buying had been expected. It has gradually pared the purchases from $85 billion in Treasury and mortgage bonds each month to $15 billion. And the Fed had said it would likely end the program after its October meeting if the economy con- tinued to improve. Even with the end of new purchases, the Fed's invest- ment holdings stand at $4.5 trillion — more than $3 tril- lion higher than when bond purchases were launched in 2008 at the height of the fi- nancial crisis. The Fed has said it won't begin selling its holdings until after it starts raising short-term rates. EVENTUAL RATE HIKE Federal Reserve ends bond buying while citing brighter job market SUSAN WALSH — THE ASSOCIATED PRESS Federal Reserve Chairwoman Janet Yellen speaks during a meeting of the Board of Governors of the Federal Reserve System at the Federal Reserve in Washington. By Sarah Dilorenzo The Associated Press DAKAR,SENEGAL The rate of new Ebola infections in Liberia appears to be de- clining and could repre- sent a genuine trend, the World Health Organiza- tion said Wednesday, but the epidemic is far from over. The disease is still rag- ing in parts of Sierra Le- one and there is still a risk that the decline in Liberia won't be sus- tained, Dr. Bruce Ayl- ward, an assistant di- rector-general for WHO, warned reporters. Several times dur- ing the outbreak officials have thought the disease's spread was slowing, only to surge again later. Offi- cials have often blamed those false lulls on cases hidden because people were too afraid to seek treatment, wanted to bury their relatives themselves or simply weren't in con- tact with authorities. But now there are some positive signs: There are empty beds in treatment centers in Liberia and the number of burials has declined. There may be as much as a 25 percent week-on-week reduction in cases in Liberia, Ayl- ward said. Throughout the Eb- ola outbreak, WHO has warned that its figures have been incomplete and the number of cases are likely vastly underre- ported. That is still a con- cern, Aylward said, but the trend nonetheless appears to be real. "The epidemic (in Libe- ria) may be slowing down," he said during a telephone press conference from Ge- neva. The slowdown could be attributable to a rapid increase in safe burials of Ebola victims, an uptick in the number of sick peo- ple being isolated and ma- jor public awareness cam- paigns on how to stop transmission. So far, more than 13,700 people have been sickened in the outbreak, which has hit Liberia, Guinea and Sierra Leone hard- est. That figure, released Wednesday by the World Health Organization, in- cludes cases from earlier in the outbreak that were recently found in patient databases but had never been reported — another sign of the difficulty of pro- viding real-time, accurate data. Nearly 5,000 people have died. Liberia alone has re- corded more than 6,500 cases. Aylward cautioned against reading too much into the decline there, say- ing that any let-up in the response could allow the disease to surge again. "Am I hopeful? I'm ter- rified the information will be misinterpreted and peo- ple would start to think, oh great, this is under con- trol," he said. "That's like saying your pet tiger is un- der control." EPIDEMIC WHO: Ebola decline in Liberia could be trend THURSDAY, OCTOBER 30, 2014 REDBLUFFDAILYNEWS.COM |NEWS | 5 A