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Guarding Against the Next Ebola

“I think the biggest thing I think the CDC [Centers for Disease Control and Prevention] learned is, you have to deal with the uncertainties,” Donat says. “You have to admit that they’re there, and let adults deal with the issues as they actually exist — not as you want to couch them. Because as soon as there’s one exception, you look like you don’t know what you’re doing. Or that you’ve withheld it purposely.” Obviously, neither of these outcomes is desirable for management of a crisis of unknown proportions.

Donat is careful to caution about a fundamental difference separating Ebola from diseases that are much more communicable, in particular, those that are spread via the respiratory system. “At the same time Ebola was happening, there was an enterovirus that was respiratory-spread [that ran] across this country — and actually killed a lot more people,” he says. “I always looked at it this way — two things: Number one, sometimes we focus on some things that are scarier at the loss of what may be more important. The other thing is that if we had a respiratory-spread virus — the classic would be influenza — how far behind the eight ball would we really be? It would spread so rapidly. … They couldn’t get ahead of it. … Say it had only 10-percent mortality, not 50 or 90 — they wouldn’t be able to do it.”

Information and Prevention Are the Key
Organizations like the CDC and the National Institute for Occupational Safety and Health (NIOSH) represent only roughly 20 percent of the healthcare system nationwide. The overwhelming majority of healthcare industry is in the private sector. This is why, Donat asserts, it’s so important that individuals and institutions in the private sector begin to adjust their perspectives with regard to their roles in preserving the security of the population. “They haven’t really seen themselves as the response,” he suggests. “Number one, the private sector, in healthcare especially, really has to see itself as part of the security in this country. Apart from just providing healthcare, they have to be at least aware and theoretically more able to respond than we [in public health] probably are. The second thing I think is, the need to have information. The military has an armed forces medical intelligence center at Fort Dietrich. We have nothing like that in the private sector.”

Nothing so formalized, in any case. What we do have to work with, Donat says, is a service called ProMED-mail (Program for Monitoring Emerging Diseases, ProMEDmail.org). ProMED-mail is an Internet-based resource for reporting up-to-date information on any situation with the potential to affect the health of a populace or the worldwide population, be it infectious disease, radiation or other toxic exposure. Say, for example, that you witnessed peculiar, acute symptoms in a group of people in a particular location on any given day, for which you have no explanation. Testing has ruled out the most obvious problems, but you’re still without an answer and a treatment plan. By posting your observations to the ProMED-mail site, you can ask an audience of tens of thousands of professionals worldwide if the symptoms match anything familiar in their experiences.

“Basically, you’re using distributed intelligence or intellect to bear on a problem,” Donat explains. “February and March is when they started to see Ebola, of last year — well ahead of all the crowdsourcing that proved that Ebola was coming.”

In tandem with the dissemination of information, swift and effective vaccination will be of critical importance in preventing the spread of viruses. “That’s going to be the key for Ebola,” Donat says, “because we have no direct treatment.”