How Do We Proceed?
Immediacy of information is one of Pro-MED-mail’s strongest assets that it offers to those in the field. From the minute a post identifies a trouble spot on the globe, those concerned with issues of public health at any level can begin an analysis of the potential risks and begin to develop immediate strategies aimed at containment and minimizing exposure. And even with that advantage, it’s still a daunting problem with dimensions and dynamics that are nearly impossible to grasp completely, especially when you consider that it’s not just those in the public or private sectors of the healthcare industry, but businesses and travelers of every sort who may come into contact with those who are at risk.
“What you have to do is say, ‘Where does [the outbreak of contagion] exist? What are the means that it gets transmitted?” Donat offers. “And, ‘Do I or any of the activities that I have with my employees or family or anyone cross paths?’ I think while many people in security have not looked at those things before, they certainly do when it comes to criminals, or their supply lines, or their resource lines, or physical access to buildings. It’s sort of underutilized [in healthcare].”
A case study: According to the CDC, on March 30, 2014, Liberia’s Ministry of Health and Social Welfare reported to Firestone officials the first known case of the Ebola virus inside the company’s Liberian rubber tree plantation. Firestone Liberia took immediate action to prevent further spread of the disease among its workers and the local population. They set up an incident management system, established procedures for recognizing those with Ebola symptoms and immediately isolated them. By enforcing strict adherence to Ebola infection guideline standards, and offering variable levels of management for those who had come into contact with the infected based on their exposure — such as voluntary home quarantine or quarantine in facilities designed to treat the infected — Firestone officials successfully contained the threat.
“Whatever past controversies Firestone has had from their rubber plantation there, as far as dealing with Charles Taylor and the genocide and that, they’ve done an excellent job [dealing with Ebola]. When there was a person who came back from an infected area who had Ebola, they quickly quarantined and took care of that person. They quarantined him and the contacts very quickly. Then they made sure everyone was aware what was going on, and if anyone had symptoms, they said, ‘We’re going to take care of you. We’ll quarantine your family. We’ll take care of them.’ They made awareness [a priority], and then they had resources committed that people trusted. And they were able to lock it down. … I think it was a great success story for the private sector.”
The speed with which Firestone responded to the threat made all the difference. That immediate effort to get in front of the disease and to contain it before it could spread to the rest of the worker population paid off in lives saved, and demonstrates the importance of having an actionable plan in place before an epidemic occurs. It behooves members of the public and private sectors of the healthcare industry to be proactive in their monitoring of contagious diseases worldwide and to be remain open and up front about the threats posed by any of them so that healthcare as a whole can — hopefully — stay ahead of the next Ebola, whatever it may be. 
Update: The Saline Shortage
One of the ongoing concerns for the healthcare industry in the U.S. is the continued shortage of saline. For a country facing a possible epidemic outbreak of Ebola, this is potentially cataclysmic. “The reason people die in the 50-to-90 percentile over there [in Africa] is that they mostly die from dehydration,” Donat explains. “If you had to look at a confluence of bad things … if your fluid for rehydration and mixing medicines and irrigating wounds is at a low, and you were to get [a viral epidemic] at the same time where your basic source of making saline is down, you’ve got a major, major problem.”
For example, if a great influenza epidemic were to hit — as with Ebola, influenza patients require a tremendous amount of rehydration, particularly intravenously if they are too sick to actively swallow and keep the fluids down — an inability to meet the demand for saline could, for a measurable percentage of infected persons, mean the difference between life and death.
“I think the importance there is — whether you’re in health or not — to know about what’s going on,” Donat asserts. “How do we make sure we have our supply chains ramped up for these things? Those are the critical, important things, because you can’t just throw people at it without the logistics and support behind that.”
Currently, saline is being imported from Europe to compensate for the shortage in the U.S., but at a time when the world is looking to the thousands who have died in Sub-Saharan Africa, the imperative to return production levels to normal — and to keep existing saline-production facilities worldwide secure — should be considered a global priority.