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Ebola burden on U.S. hospital system warrants tighter travel restrictions

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Among the arguments in favor of stricter travel restrictions on West Africans wishing to come to the United States without first spending 21 days outside of “the hot zone” are the extraordinary costs that would be born by U.S. hospitals by any significant number of Ebola cases.

Most pundits can guess that the costs are high, but I asked one of my law partners, Lowell C. Brown, to give me some insight into what hospitals are bracing for. Lowell has been representing some of the largest, most sophisticated healthcare systems and health networks for three decades.

“I’ve been advising hospitals about regulatory compliance for nearly 30 years and this is a potential public health crisis unlike any I’ve seen,” he emailed in response to my basic question of what the already stressed hospital system is facing. “It far outstrips the HIV epidemic of the late 1980s because Ebola is much more contagious than HIV.”

What he told me next was a surprise.

“So how does the regulatory framework respond to emergencies?” Lowell wrote. “Generally, legal and regulatory restrictions on healthcare providers are relaxed. Local example: After the Northridge earthquake in 1994, healthcare regulators were not paying much attention to the protocols usually required in hospital emergency rooms. If a patient needed to have a laceration stitched up and only a physician’s assistant was available, that’s who did the stitching.”

That won’t be the case this time. In fact, Lowell is already deep into consultation with our Occupational Safety and Health Administration experts. Hospitals owe their employees duties. Those that aren’t thinking through that duty are exposing themselves to huge liability.

“Ebola’s contagious nature is different,” Lowell noted, “so the regulators can’t simply look the other way while providers freelance. Hospitals and their care teams will need guidance, and the government will need issue it quickly while remaining flexible as the situation on the ground changes. Unfortunately speed and flexibility are not typical characteristics of government healthcare regulators. This will be a major challenge for everyone.”

Then came the economics:

“Apart from the pure regulatory challenges, Ebola care is inherently expensive. It is the equivalent of ICU care until the patient is no longer contagious or is shedding the virus, for an average of 8 days. That’s a long ICU stay and if the numbers of sick patients increases, facilities may be overwhelmed.”

“With that in mind,” he continued, “if this becomes an epidemic situation, specialty hospitals may be necessary. As matters stand only 1 in 4 American hospitals have the staff and infrastructure necessary to provide the isolation care Ebola requires.”

The required protective wear is expensive, he noted. Stocks for companies making this gear may well be great buys at this point, but healthcare stocks…not so much.

Lowell’s closing admonition was that every government agency had to begin planning immediately against a low probability/enormously high risk event. So too must every hospital, clinic and especially the major health centers, which will almost automatically be called upon to assume the lead should the crisis widen.

The World Health Organization said there was a possibility of 10,000 cases per week come December. We have to assume at least a handful of those will reach our shores. Transit restrictions will reduce the marginal risk, but not eliminate it. Get serious, fast, Mr. President. Like the Islamic State of Iraq and Syria, Ebola isn’t the jayvee team.

Tightening travel restrictions — not a ban, but common sense restrictions — is the most obvious of first steps. When will the president or “Ebola Czar” Ron Klain take it?

 

This column was originally posted on WashingtonExaminer.com.

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