The Washington PostDemocracy Dies in Darkness

U.S. readiness for a viral outbreak has improved, but there’s a long way to go

A man wears a mask while walking in the street on Jan. 22 in Wuhan, China. (AFP/Getty Images)

A Liberian man walked into a Dallas emergency room in September 2014, at the height of the West African Ebola epidemic, complaining of high fever, abdominal pain and other symptoms of the fearsome virus. He was sent home with acetaminophen and a diagnosis of a sinus infection.

Two weeks later, Thomas Eric Duncan was dead, two nurses who attended him were infected with Ebola and the shortcomings of U.S. preparations for a viral epidemic were vividly exposed.

Now, with word of the first U.S. patient to contract the new virus that has killed 17 people in China comes the inevitable question: Is the United States better prepared for the catastrophic outbreak authorities have long feared?

“The big picture,” said Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, who oversaw the Ebola response, “is that we’re better prepared than we were before, but not nearly as prepared as we need to be.”

There is little doubt the country has made big leaps in preparedness since the anthrax scare of 2001, the SARS crisis in 2003, the MERS outbreak of 2014 and the West African Ebola epidemic that ended in 2016, according to experts and reports that evaluated the response to those crises.

What we know about the mysterious, pneumonia-like coronavirus spreading in China and elsewhere

Twenty years ago, the nation had few programs or resources dedicated to coordinating the response to an outbreak among federal, state and local agencies and the hospitals that are the front-line protection against an epidemic, said Thomas V. Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

Now, he said, agencies like the Office of the Assistant Secretary for Preparedness and Response, part of the Department of Health and Human Services; the CDC; the Defense Department; and the Department of Homeland Security have spent years and countless millions of dollars training, testing and coordinating with the nation’s health-care facilities for just such an occurrence.

Inglesby said he is confident that hospitals in the five cities that could receive passengers on flights from Wuhan, China — the epicenter of the outbreak — have been warned to be on alert. Under new precautions, anyone traveling from Wuhan will be funneled to airports in New York, Los Angeles, San Francisco, Chicago or Atlanta.

“In major hospitals in big cities, and definitely in the ones where flights will be landing from Wuhan, those people are very well aware of what’s going on,” he said. “It doesn’t mean everyone in the country is properly trained, but the front line is.”

At Vanderbilt University Medical Center, front-line health-care workers who have long asked patients about travel to the Middle East as a way of screening for MERS are also raising questions about travel to China with anyone who complains of the respiratory problems and fever caused by the new virus.

At UCLA and Emory University hospitals, nurses and doctors in the emergency room already ask open-ended questions about travel, officials said.

“I would think my colleagues in hospitals across the United States are doing something very, very similar,” said William Schaffner, an infectious disease specialist at Vanderbilt School of Medicine.

The stockpile of drugs and equipment such as ventilators has been expanded, Frieden said, and training for disease response in Asia and Africa has been stepped up.

The science necessary to respond to an outbreak also has progressed rapidly. When the first U.S. patient in the current epidemic, a man in his 30s in Snohomish County, Wash., exhibited symptoms, the CDC was able to test specimens and confirm his diagnosis in 24 hours. The National Institutes of Health and other agencies are already working on a vaccine and treatments. And the Chinese rapidly sequenced the virus’s genome, then distributed the information around the globe within weeks, Schaffner and other officials noted.

Identification of the SARS virus in 2003 took months, and developing a reliable test for the virus took even longer.

But any system is only as good as the information fed into it, and Frieden pointed out in an interview Wednesday how little is still known about the new coronavirus.

How were 14 health-care workers in China infected — from one incident or from numerous patients? Why are some patients in China asymptomatic? How long do the infections last? How many are severe? What characteristics do the 17 people who died share?

Mapping the spread of the new coronavirus

“Large parts of the world have really bad diseases spreading that could bite us tomorrow and we don’t know about it,” Frieden said.

At home, the list of deficiencies that could undermine a quick and effective response is lengthy. When an independent panel evaluated the U.S. response to Ebola in 2016, it found “the U.S. government was not well prepared to respond to emergent crises that require a rapid, integrated domestic and international response.” It said U.S. officials “did not demonstrate an appreciation of the public’s perceptions and fear,” and even had trouble supplying enough of the protective suits health-care workers had to wear while treating Ebola patients.

When HHS’s inspector general evaluated hospitals after the Ebola crisis, it found that 71 percent of administrators considered their facilities unprepared to receive Ebola patients in 2014 — a figure that had dropped to 14 percent by 2017.

The first U.S. coronavirus patient offers little evidence of how well the system responded. After returning from two months visiting family in Wuhan and developing symptoms on Jan. 16, he guessed he could have been infected by the virus and sought care at a clinic Jan. 19, John Wiesman, secretary of health for the state of Washington, said Wednesday. The patient appears to have a mild case of the infection. Health authorities said they are monitoring 16 people he came into contact with.

The next person may not be so healthy or well-informed. The question remains: What will happen when he or she walks through the doors of a health facility somewhere in the United States?

“Well-trained and resourced health-care workers will be the key to detecting new cases, implementing infection control procedures — including isolating suspected ill individuals — and treating those who are ill,” said Alexandra L. Phelan, a faculty research instructor at Georgetown University’s Department of Microbiology and Immunology.

“The good news is there has been real progress globally, so progress is possible,” said Frieden, now president and CEO of Resolve to Save Lives, a program aimed at preventing epidemics and saving lives from cardiovascular disease. “The bad news is it takes a lot of time. This is not something that gets fixed overnight.”

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Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some frequently asked questions about the bivalent booster shots.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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