Hartford Hospital got a test of its readiness to spot the Ebola virus about three weeks ago, when a patient from a “country of interest” showed up in the emergency room with a fever.
The patient was isolated and staff conducted an evaluation before determining the patient wasn’t at risk for the virus, said Dr. Jack Ross, the hospital’s director of infectious diseases. The Hospital of Central Connecticut tested its preparedness with an actor, who showed up in the emergency room pretending to have a travel history and symptoms that could indicate Ebola, Ross said.
And state public health officials have been working to reinforce existing preparedness measures and looking for gaps in the health care and public health systems. Officials say there’s no reason to think anyone in the state has been infected by Ebola, but they’re asking medical providers to ask patients about their travel histories and collect phone numbers for local and state health departments in case they need to report a possible case.
The state Department of Public Health is also asking hospitals to review their Ebola preparedness checklists and report back, so officials can identify gaps. “It’s always a nice challenge to be able to reassure people at the same time that you remind them not to let their guard down,” Public Health Commissioner Dr. Jewel Mullen said Thursday.
Public health officials often say that when things are going right, their jobs are largely unnoticed. But the presence of Ebola in the U.S. has put a spotlight on public health preparedness — and on what some experts say has been a problematic reduction in steady federal funding for public health efforts.
How prepared is Connecticut?
By one measure, an annual evaluation of how states perform on 10 indicators related to protecting against infectious disease threats, Connecticut scored near the top. Connecticut met seven out of the 10 preparedness criteria in the most recent report, released in December by the Trust for America’s Health and the Robert Wood Johnson Foundation, one of only eight states with that score. New Hampshire was the only state to score higher, with eight.
According to the report, Connecticut met two benchmarks related to public health laboratory capacity — having the ability to handle a threefold increase in testing over a six to eight week period, and having the capacity to assure timely pick-up and delivery of samples 24-hours a day, all year.
It was also one of 17 states that increased or maintained funding for public health services between the 2012 and 2013 fiscal years.
Even so, Connecticut hasn’t been immune from tightening public health budgets. Most money devoted to preparing for infectious diseases, storms and other public health events comes from the federal government, and that’s been declining, said Dr. Matthew Cartter, Connecticut’s state epidemiologist and director of infectious diseases.
“We peaked in our ability to respond probably around 2007 to 2008, and funding has been decreasing since then,” Cartter said. “Our local health departments have lost people. Our state health department has lost people. It’s the people that respond to these things.”
Cartter spoke Thursday during a roundtable on Ebola hosted by Sen. Chris Murphy, Sen. Richard Blumenthal and U.S. Rep. Rosa DeLauro, D-3rd District.
During the event, DeLauro held up a piece of paper listing funding cuts to public health infrastructure since 2010: a 10 percent cut to the National Institutes of Health, 8 percent to the Centers for Disease Control and Prevention, 16 percent for the CDC’s public health preparedness and response funding, and 44 percent for the U.S. Department of Health and Human Services’ hospital preparedness funding.
But Cartter pointed to a different problem with the funding: When it comes, it tends to be in “episodic spurts” in response to outbreaks, rather than a sustained amount. That makes it hard to hire young public health professionals because it’s not clear the money for their jobs will be around in a year or two. And Cartter noted that experienced epidemiologists and other public health workers can’t be hired instantly, when a crisis arises.
“If you send us a lot of money right now,” he told the lawmakers, “we can’t use that money.”
Fewer public health workers
Nationwide, close to half of all local health departments reduced or eliminated services in at least one program area in 2012, said Richard Hamburg, deputy director of the Trust for America’s Health, a nonprofit organization that advocates for disease prevention. The most frequently targeted programs were related to immunization, maternal and child health, and emergency preparedness.
Connecticut’s state health department had 846 employees in 2013 and 754 in 2014, according to department reports, which reflect positions funded by both the state and federal governments.
The number of fulltime positions funded in the state budget fell from 565 in the 2009 fiscal year to 476 in the 2014 fiscal year. Spokesman William Gerrish said some of the drop reflects the recent move of about 40 positions related to day care and camp regulation from the health department to the new Office of Early Childhood.
Some of the steps Connecticut officials are taking to address Ebola are specific to the situation, like urging medical providers to ask patients about recent travel. But much of it comes on top of preparedness efforts that Mullen said must be in place at all times, like having the ability to communicate information and receive feedback, making sure enough staff can get to the office during a big event, and connections to other parts of the public health and health care systems, such as emergency medical responders, hospitals and other state agencies.
The state held a drill earlier this year on responding to coronavirus, a respiratory infection, in part to review issues related to quarantining and isolating people and to identify gaps in the system.
Earlier this week, Gov. Dannel P. Malloy declared a public health emergency to give Mullen the authority to quarantine and isolate people she “reasonably believes” have been exposed to Ebola. Officials said the declaration was a precaution, since without a declaration, the authority to isolate or quarantine people would rest with each local public health director, rather than with any statewide official or agency.
“When you look at the potential for something like this, you don’t want to have to put that system in place in a hurried way if you need to implement it immediately,” Mullen said.
Fear of the unknown
During the roundtable Thursday, Cartter said that people who have Ebola would likely go to an emergency room. “These people get very sick and do seek emergency care,” he said.
But he said health care providers should be prepared in case they show up at a clinic or urgent care center. The health department is urging every medical office to ask patients about their travel history in the past 21 days. If a patient was in one of the three countries most affected by the outbreak — Guinea, Liberia and Sierra Leone — the medical provider should put the patient in an exam room with a door, close the door, get additional information about the patient’s illness, and notify the state and local health departments, Cartter said. It’s also important to notify the emergency department and figure out where to best take the patient for evaluation.
Mullen said it’s important for health care organizations to address staff members’ concerns.
Dr. Krystn Wagner, an infectious disease specialist at Fair Haven Community Health Center, said it will also be important to educate the public about why medical providers are asking about their travel. In the Fair Haven neighborhood of New Haven, where many immigrants live, people might wonder how the travel information will be used and whether they’d be stigmatized, she said.
Ross, the Hartford Hospital doctor, noted that Ebola is unfamiliar to most people, even health care workers. “It’s the fear of the unknown that’s probably the hardest thing right now,” he said. “People are not familiar with this.”