With regard to the November 2014 Ebola scare in the United States, do you think the public health and medical professionals involved in the Ebola cluster investigation followed proper protocols? If so, what best practices were used? If not, what could have been done differently? Remember to cite references where necessary. When responding to classmates, provide additional critiques on approaches used by public health and medical professionals during the U.S. Ebola cluster investigation. Response must be 300 words. 1st Discussion post for response: Communities depend on public health organizations to “come to their rescue” and prevent epidemics from becoming pandemics. It is important that proper protocols are followed to ensure the safety of the public and to maintain trust from the community. When public health officials “drop the ball” community members are less likely to be cooperative during a state of emergency which inhibit proper handling of cases. According to one study, there is a conspiracy among certain individuals who believe the government created AIDS to kill minorities, and another 10% did not trust their provider to give them appropriate medical care (Whetten, et al., 2006). With that said, there is a lack of trust within certain populations. Adding to this distrust, I don’t believe the Ebola scare was handled as well as it could have been, and I’m not convinced that proper protocol was followed by the medical professionals.  The crisis management plan was not followed appropriately and there were many improvisations made which lead to deaths that could have been prevented. According to one article’s documentation of the timeline, the first patient, Mr. Duncan was initially sent home from the hospital with antibiotics because the diagnosis of Ebola was missed, he was then formally diagnosed with Ebola days later on September 30th; Within the first five days after diagnosis there were 15 people being monitored for symptoms, after the first five days there were reports of over 80 people were being monitored and by 10 days after Duncan’s diagnosis he was dead (Andrew, Arlikatti, Chatterjee, & Ismayilov, 2018). There were 76 medical personnel that came into contact with Duncan and it was reported that they wore so much protective equipment that they actually increased the risk of contamination, for this reason the Centers for Disease Control and Prevention (CDC) had determined that it was the Hospital’s fault for the spread and admits that they did not have enough capacity to contain the crisis despite their earlier claims (Andrew, Arlikatti, Chatterjee, & Ismayilov, 2018).  The WHO declared a level 3 emergency, which is the highest level of emergency in an attempt to cease the spread of Ebola, there were reported “overwhelming demands” due to the outbreak that the WHO could not contain without assistance, they would need help of other organizations (decisive government action such as bans on travel and trade) to meet all of the .

1. With regard to the November 2014 Ebola scare in the United
States, do you think the public health and medical professionals
involved in the Ebola cluster investigation followed proper
protocols? If so, what best practices were used? If not, what
could have been done differently? Remember to cite references
where necessary.
When responding to classmates, provide additional critiques on
approaches used by public health and medical professionals
during the U.S. Ebola cluster investigation. Response must be
300 words.
1st Discussion post for response:
Communities depend on public health organizations to “come to
their rescue” and prevent epidemics from becoming pandemics.
It is important that proper protocols are followed to ensure the
safety of the public and to maintain trust from the community.
When public health officials “drop the ball” community
members are less likely to be cooperative during a state of
emergency which inhibit proper handling of cases. According to
one study, there is a conspiracy among certain individuals who
believe the government created AIDS to kill minorities, and
another 10% did not trust their provider to give them
appropriate medical care (Whetten, et al., 2006). With that said,
there is a lack of trust within certain populations. Adding to this
distrust, I don’t believe the Ebola scare was handled as well as
it could have been, and I’m not convinced that proper protocol
was followed by the medical professionals.
The crisis management plan was not followed appropriately and
there were many improvisations made which lead to deaths that
could have been prevented. According to one article’s
documentation of the timeline, the first patient, Mr. Duncan was
initially sent home from the hospital with antibiotics because
the diagnosis of Ebola was missed, he was then formally
diagnosed with Ebola days later on September 30th; Within the

2. first five days after diagnosis there were 15 people being
monitored for symptoms, after the first five days there were
reports of over 80 people were being monitored and by 10 days
after Duncan’s diagnosis he was dead (Andrew, Arlikatti,
Chatterjee, & Ismayilov, 2018). There were 76 medical
personnel that came into contact with Duncan and it was
reported that they wore so much protective equipment that they
actually increased the risk of contamination, for this reason the
Centers for Disease Control and Prevention (CDC) had
determined that it was the Hospital’s fault for the spread and
admits that they did not have enough capacity to contain the
crisis despite their earlier claims (Andrew, Arlikatti, Chatterjee,
& Ismayilov, 2018).
The WHO declared a level 3 emergency, which is the highest
level of emergency in an attempt to cease the spread of Ebola,
there were reported “overwhelming demands” due to the
outbreak that the WHO could not contain without assistance,
they would need help of other organizations (decisive
government action such as bans on travel and trade) to meet all
of the response needs for a disease of this complexity (World
Health Organization, 2015). The CDC did a good job training
airport staff to screen individuals traveling from West Africa
(where the crisis began) to prevent cross-border transmission.
From what I’ve gathered, the Centers for Disease Control and
Prevention thought they could handle the outbreak, but they
were overwhelmed with the severity of the disease.
The 2014 Ebola scare ended on March 29th, 2016 when the
World Health Organization (WHO) lifted the Public Health
Emergency of International Concern (Simon A. Andrewa, 2018).
This spread could have been prevented starting with Mr.
Duncan, if Ebola had been caught during his initial hospital
visit he could have been isolated and monitored. The medical
professionals should have worn appropriate personal protective
equipment, opposed to over-compensating and wearing
excess/unnecessary layers which would have reduced
contamination.

3. References
Andrew, S. A., Arlikatti, S., Chatterjee, V., & Ismayilov, O.
(2018). Ebola crisis response in the USA: Communication
management and SOPs. International Journal of Disaster Risk
Reduction, 243-250.
Simon A. Andrewa, S. A. (2018). Ebola crisis response in the
USA: Communication management and SOPs. International
Journal of Disaster Risk Reduction, 243–250.
Whetten, K., Leserman, J., Thielman, N., Swartz, M., Whetten,
R., Stangl, D., & Osterman, J. (2006). Exploring Lack of Trust
in Care Providers and the Government as a Barrier to Health
Service Use. American Public Health Association, 716-721.
World Health Organization. (2015, January). Key events in the
WHO response to the Ebola outbreak. Retrieved from World
Health Organization:
https://www.who.int/csr/disease/ebola/one-year-report/who-
response/en/
2nd Discussion post response:
According to the Centers for Disease Control and Prevention
(CDC), the Ebola virus has been around for many years, even
before it was discovered in 1976 (CDC, 2018). The first
outbreak occurred in the Democratic Republic of Congo which
is near the Ebola River (hence the name) and the second was in
South Sudan, which is about 500 miles away from the first
location (CDC, 2018). These two cases were thought to be
related by public health officials; however, it was discovered
later that they were indeed two separate viruses (Zaire
ebolavirus and Sudan ebolavirus) (CDC, 2018). It was
concluded that these two viruses must have come from two
separate sources and then spread to those affected in that
specific area (CDC, 2018). The CDC states that both “viral and
epidemiologic data suggest that Ebola virus existed long before
these recorded outbreaks occurred” (2018). Once Ebola had

4. been discovered, it was noted that most of the outbreaks of the
virus had occurred in Africa (CDC, 2018). It wasn’t until the
2014 outbreak that the virus became a global epidemic as it had
spread across the borders to the United States from southeastern
Guinea in West Africa (CDC, 2018).
While Ebola virus is caused by a group of viruses, only
four are known to cause disease in people (CDC2, 2018). While
it had been projected that West Africa was going to have an
outbreak of the Ebola virus disease (EVD) in 2013, the local
and international health groups were not prepared for the
outbreak in Guinea (Cenciarelli et al., 2015). Recognizing the
disease was difficult as it presented very similarly to other
diseases such as malaria and Lassa fever (Cenciarelli et al.
2015). The first weeks of the outbreak went essentially
unnoticed until more severe symptoms developed and deaths
occurred. The CDC and the WHO were involved in issuing
reports to help define the geographical areas affected. With the
untrained healthcare personnel, inability to track down probable
affected persons, allocation of resources to handle the outbreak,
and local distrust in the teams handling the outbreak from the
communities affected (Cenciarelli et al., 2015); the spread of
the disease came to the United States.
It is with this that I believe the trouble began. I think
that our public health officials as well as our medical personnel
were not prepared for an epidemic of this type. As the Ebola
virus is a type of viral hemorrhagic fever (VHF), hospitals are
required to complete an assessment, which is called the hazard
vulnerability analysis assessment, to identify the risk to its
employees and select the appropriate personal protective
equipment (PPE). Scientists have come to the conclusion that
the Ebola virus is transmissible via respiratory/aerosol as well
as through contact with blood or body fluids, regardless that the
CDC advised that it cannot be transmitted by airborne (Eddy &
Sase, 2015). Problems associated with the outbreak in the U.S.
are “misdiagnosis, patient morbidity, and the secondary
infection of health care workers wearing various levels of PPE”

5. (Eddy & Sase, 2015). For example, in the Dallas Ebola case,
the man “died of hemorrhagic fever 14 days after” he was
originally diagnosed as having a sinus infection (Eddy & Sase,
2015). Misdiagnosis, miscommunication, and treatment delay
are possible errors that ultimately impacted the patient as well
as the healthcare professionals (nurses) that provided care for
him (Eddy & Sase, 2015). Both nurses were then taken to
separate research facilities (one of the National Institutes of
Health and the other was the CDC) to be cared for as these sites
contained resources equipped with Ebola emergency treatment
areas (Eddy & Sase, 2015). The hazard vulnerability
assessment isn’t always completed within various hospitals
utilizing the same standardized methods and “a high degree of
variation exists in scope and process” (Eddy & Sase, 2015).
Hospital emergency preparedness depend on correct assessments
being completed and should include a “worst-case-scenario” as
well as designating a hospital command system, designating the
proper PPE, procedures, and completing simulation disaster
drills to prepare the staff for these types of emergencies (Eddy
& Sase, 2015).
In conclusion, I do not feel that proper protocols were
followed. Perhaps if the hazard vulnerability assessment were
utilized more stringently in all healthcare facilities, the first
hospital would have been ready for such a disaster as Ebola.
The proper PPE must be utilized in compliance with
Occupational Safety and Health Administration (OSHA)
standards as well as the awareness that the InterAgency Board
(IAB) assigns a high-risk classification to Ebola (Eddy & Sase,
2015). With that being said, the standard of care for healthcare
staff safety would be the utilization of fully encapsulated
garment for healthcare workers and a respirator with a sealed
helmet/hood that overlaps the garment (Eddy & Sase, 2015).
The use of higher level PPE can be worn, such as a self-
contained breathing apparatus and may even contain HEPA
filtered ventilators in a pressurized suit (Eddy & Sase, 2015). It
is further recommended that correct and immediate diagnosis

6. along with algorithms to determine specific contact sources,
operational communications systems, and bio-surveillance
information be available for future hazards (Eddy & Sase,
2015). As always, the proper PPE must be worn to protect our
health care workers.
References:
Cenciarelli, O., Pietropaoli, S., Malizia, A., Carestia, M.,
D’Amico, F., Sassolini, A., ...Gaudio, P. (2015). Ebola virus
disease 2013-2014 outbreak in West Africa: An analysis of the
epidemic spread and response. International Journal of
Microbiology. doi: 10.1155/2015/769121
Centers for Disease Control and Prevention. (2018). History of
Ebola virus disease. CDC.gov. Retrieved
from https://www.cdc.gov/vhf/ebola/history/summaries.html
Centers for Disease Control and Prevention2. (2018). What is
Ebola virus disease? CDC.gov. Retrieved
from https://www.cdc.gov/vhf/ebola/about.html
Eddy, C., & Sase, E. (2015). The 2014 Dallas, Texas, Ebola
incident: Global implications to all-hazards preparedness and
health care worker protection. Journal of Environmental Health,
78(2), 28-32.