Breaching our Maginot Line: Ebola in U.S. Was Clearly Preventable

For a while, it seemed the U.S. Ebola crisis might be calming down. But it was unrealistic to think we had seen the last case of ebola in the United States. Now, with yesterday's diagnosis of Dr. Craig Spencer, recently returned to New York City from treating Ebola patients in Guinea, the situation is back and more public than ever.

Even before Dr. Spencer's diagnosis, when we were only dealing with the fallout from the first Ebola patient to be diagnosed in this country, it had already become necessary to take a hard look at the depth and breadth of the institutional rot that had been revealed. Who would have thought the arrival of one ailing Liberian could have uncovered such unpreparedness and incompetence within our health care system? On the national and the local levels, from prevention to diagnosis, from crisis intervention to communication to containment, the deficits appear to have been greater than even the most cynical among us might have imagined.

Each line of defense was breached, one by one, in ways that have seemed frighteningly careless. Our Maginot Line failed to protect as promised. Through it all there were repeated attempts to reassure us, but as the problems mounted, those confident assurances were exposed.

Health authorities did not lack warnings or time to prepare. Ebola has had outbreaks in Africa for nearly four decades, and the current epidemic in East Africa, the largest by far, has caused worldwide alarm for several months. As long as people were allowed to arrive in this country from Ebola-ravaged areas of Africa, it should have been glaringly obvious that the entry of a patient into the U.S. was a strong possibility and would present unique and serious challenges. We needed to address the issue as if it would happen, and to have stout defenses in place already.

A commonsense first line of defense is a travel restriction. Instead, the administration, for political reasons -- chose to rely on the screening measures in place in African airports to prevent the exit of people who might have Ebola. These efforts were designed to identify those at high risk of recent exposure, as well as those who were already beginning to exhibit symptoms. But the screening depends on self-reported questionnaires and temperature-taking to detect the presence of early disease. Obviously, this system is porous -- and U.S. officials knew this. The questionnaires are susceptible to ignorance or lying, and a fever can be foiled by Tylenol, inadequate equipment, or poorly trained screening personnel.

Because of those obvious vulnerabilities, authorities must have assumed that the measures would fail as a first line of defense, and that someday a patient would walk into a U.S. emergency room exhibiting symptoms of Ebola. That being the case, plans for this eventuality should have been comprehensive, detailed, and communicated clearly and urgently to every hospital in America, and accompanied by training.

It is obvious now that this did not happen, and that preparations were desultory and marked by a strong sense of denial. Even knowing of the flawed screening measures, the administration seemed to believe it almost certainly wouldn’t happen here. This attitude seems to have filtered down through the system.