Correspondence from Syra Madad and Craig Spencer in The Lancet: The USA's response to the 2014 Ebola outbreak could have informed its COVID-19 response. Excerpt:
There are foundational elements in epidemic preparedness that should have been gleaned from the USA's previous outbreak responses and subsequently applied to all future health threats, including COVID-19. Five lessons learned from the USA's response to the 2014 Ebola outbreak should have informed the country's COVID-19 response, given its roles in responding to both epidemics previously and currently.
First, infectious disease outbreaks expose the shortcomings in health-care systems. The Ebola outbreak pointed to gaps in training and resources as not all US hospitals were ready and equipped to manage a patient with suspected or confirmed Ebola. With COVID-19, all 6090 US hospitals became battlegrounds. Given that pandemic preparedness has not been part of routine health-care delivery, nor has there been an incentive to build a better infrastructure, there must be specific federal funding allocated that is sustained in perpetuity to ensure biopreparedness. A return to pre-pandemic normal is what got us here in the first place. Americans must invest in long-term solutions, build back better, invest in preparedness, and sustain the gains. Regardless of the cost, this investment will pay massive dividends during the next pandemic.
Second, health-care worker safety must be prioritised. Protecting the health-care workforce should always be a top priority. Simply put, there is no patient care without providers. Health-care facilities that were caring for patients with Ebola had a provider-centred approach, containing the virus within a dedicated unit and with a limited number of health-care personnel as part of the care team. With COVID-19, nearly every provider is on the front line and must be supported, and the strategy must be shifted from containment to community risk mitigation. Health-care worker safety goes beyond just physical safety. It must also encompass psychological and mental health support.
Third, a coherent national plan is vital to combat a pandemic, and collaboration with national and international partners, including the US Centers for Disease Control and Prevention, the US Agency for International Development, and WHO—all of whom collaborated at the forefront of the fight against Ebola in 2014—is necessary. That collaboration was two-fold: to work together in mitigation and containment of the contagion, and to share knowledge, best practices, and lessons learned that would better inform processes, public health guidance, and health-care responses. Responding to pandemics by prioritising nationalistic tendencies over global goodwill is doubly damaging—it undermines the USA's important leadership role in global health, but also makes the USA less safe for Americans.
Fourth, health experts must be placed at the forefront to educate the public. Science and risk communication during a public health crisis is crucial. With every epidemic comes the contagion of misinformation. Health experts, such as those in public health and health-care services have a central role in addressing misconceptions, risk behaviours, preventive measures, and providing the latest science-based information. Although the risk of Ebola transmission within the community in the USA was low in 2014–16, the public perceived the threat as much greater, requiring a coherent, one-voice approach from the federal government to better inform the public. COVID-19 is, however, a substantial public health threat with ongoing community transmission in the USA. Sharing conflicting information and largely politicising the pandemic has led to greater loss of trust in science and life-saving public health measures with constant undermining of public health professionals.
Finally, training and hands-on experience are critical. During the 2014–16 Ebola outbreak in west Africa, academic (medical and public health) institutions across the world contributed faculty and staff to aid the response. This global assistance was crucial to ending the outbreak and provided unparalleled real-world and hands-on experience to thousands of health professionals who would subsequently use those skills to lead future responses at home and abroad. Although case studies and simulated exercises are helpful didactic tools in preparedness and response, they do not reliably mimic the on-the-ground complexity of response activities during a disease outbreak. Compared with their counterparts across the globe, the academic institutions and public health schools in the USA were more restrictive and less likely to send faculty and staff, often for logistic or legal reasons. This situation meant that the USA had fewer front-line providers with real-life experience in a rapidly changing disease outbreak. Had more Ebola-experienced providers been on the front lines during the early stages of the COVID-19 pandemic, we would have responded better, faster, and more efficiently.
