If (When?) Ebola Comes to
MD Anderson


Leonard Zwelling

       At this point it is reasonable to conclude that the United
States is not entirely ready to handle an outbreak of a deadly disease like
Ebola. And the current cases in Dallas and possibly beyond were not even from a
terrorist attack with weaponized virions. We managed to screw this up all by
ourselves. Why?

       First, it is blatantly obvious that every hospital in the US
is not as prepared as the four designated centers for this sort of infectious
patient. So, right off the bat we should weigh the risks and benefits of
centralized care of these patients only at these centers and identify safe ways
to transport the infected to one of the four sites for care regardless of where
they are diagnosed. If MD Anderson is the place for cancer care, one of these
sites is the place for Ebola care.

       Second, ask any American with common sense (something becoming
harder and harder to find, especially if one looks for it in Washington, DC or
Atlanta), and he or she will tell you to close the borders to all in-coming
personnel from the endemic Ebola areas of Africa and to establish a data base to
make sure that all people coming from these areas can be tracked even if the
travelers make intermediate stops in Europe or elsewhere before heading here.
If FedEx can track millions of packages, we should be able to track thousands
of people coming out of Africa. (This may be the best case for bar codes on
everyone’s forehead as I have suggested before. They could also be used to
prevent medical errors in operating rooms, I suppose, speed up buying tickets
at the movies, and getting us through the TSA faster).

       Third, since it is possible that people can board planes feeling
well and deboard them sick, every single port—air or sea—should also have
screening for Ebola in place and plans to quarantine any one suspected of being
contagious (even TV doctors named Snyderman). Limiting this to five airports
only moves those wishing to by-pass the system to other ports of entry (or as
was the case with Mr. Duncan in Dallas, lie about having contact with ill
people in Africa). And what about water ports? Like Houston! You can put a
whole lot more people on an oil tanker than on a 747. And it only takes one to
create a problem.

       Fourth, as a general rule, it might be time to reconsider the
manner in which clinics at MD Anderson are run by asking a few questions:

1.What are the clinics for? Making a ton of money or
caring for cancer patients better than any place else? I know it used to be the
latter but my conversations with those working in those clinics now indicate to
me that it has become the former. Everyone is rushed. Logistics are not ideal.
And as for places to have a snack break? Forghedaboudit! There is no faculty
dining room any more and there certainly are no time outs in the clinics. How
about closing them for lunch for 30 minutes and mandating hand washing in and
out for all personnel and patients, too? I know the administration favors high
throughput cancer care, but MD Anderson didn’t become #1 (or #2) with a
business model based on volume.

2.Are procedures in place to minimize the likelihood of
limiting the spread of infectious diseases in the MD Anderson clinics? I simply
do not know and Ebola is certainly a good reason to review current policies.
(See Wall Street Journal page B7 on October 15, 2014 re: thoughts on this from
Mt. Sinai in NYC.)

3.Are the doctors and staff sufficiently aware of best
practices to contain any infections and are they sufficiently trained and
equipped should someone with an unexpected fever who traveled from Africa
appear at an Anderson clinic?

think most of this stuff is just common sense, but my contacts working in the
clinics tell me is that the operational decisions in the clinics are being made
by people with anything but common sense. In fact, it is not at all clear how
much of a role patient care physicians actually play in the decisions about how
the clinics operate. (Just be careful you daring docs if you choose to protest.
This is what got me fired at Legacy. It was my unwillingness to acquiesce to a
clinical care delivery model set solely by a non-physician Chief Operating
Officer and a not-even-close CFO with no physician input that put me out to
pasture once and for all.)

would be the height of arrogance to suppose that a patient care facility
dealing with people from all over the globe will be able to side step the
possibility that a case of Ebola will present itself to the emergency center or
clinics. After all, so many people come to MD Anderson with initial symptoms
akin to those of Ebola. How will the people at the reception desk know when a
real case is not just post-chemotherapy neutropenic fever?

MD Anderson ready for the inevitable? I have no idea. Do you? The time to think
about this was yesterday.

Anderson did a great job with this sort of planning for hurricanes and floods. Ebola
is a more virulent challenge and the media may well give the center no warning
on this one as it does with storms.

is a kind of natural disaster, but you can’t track it on radar. And the flood gates won’t help.

Leonard Zwelling