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Sunday, October 05, 2014

Ebola response - follow the money

Ebola patients who find their way to early treatment appear to have a better chance of survival than those whose symptoms are already acute by the time they reach medical facilities. Even more of a correlation between Ebola and survival appears to be access to money to reimburse for state of the art treatment.

Fortunately, several Ebola patients who were American caregivers in Africa were able to survive the virus because they were air transported to US hospitals where preparations were made to care for them, in anticipation of the acuity of their illnesses. Their transportation and treatment were obviously expensive. 

Air transport of one ill patient to an exclusive hospital for the purpose of treating a disease, heretofore not seen before, is expensive. Nevertheless, these three particular patients recovered from the Ebola virus because, apparently, they received state of the art curative treatment. 

Evidently, the groups who sponsored these infected medical professionals when they were in Africa also paid for their recovery from Ebola.  

Of course, the Liberian man who was diagnosed with Ebola in Texas, named Mr. Duncan, didn't have a sponsor to pay for his care, when he presented with a fever at the Texas Presbyterian Hospital in Dallas. Instead of being immediately placed in isolation, Mr. Duncan was sent home. More than likely, Mr. Duncan was sent home because he didn't have enough money to pay for isolation care. More than likely, if Mr. Duncan had been sponsored by an international relief group, rather than visiting his family, he would have received isolation care immediately. Although my "more than likely" hypotheses are speculative, they're more than likely correct.

Mr. Duncan's health has deteriorated since he was finally admitted to Texas Presbyterian, after being sent home after his first visit. Meanwhile, between the time he first asked for care and when he was eventually admitted, dozens of people were exposed to his Ebola virus, meaning it's more than likely that those individuals are at risk for becoming ill. It's very difficult for me, as a nurse, to believe that Mr. Duncan's illness hasn't already infected at least one other person who he was in contact with while exhibiting a fever and symptoms of Ebola, before he was isolated. Incubation time for the virus is up to 21 days, or three full weeks.

Hopefully, Texas Presbyterian administrators should forget about who's paying for Mr. Duncan's intensive care while he's in isolation, but worry a lot about keeping him alive, whatever the cost. Otherwise, the alternative to Mr. Duncan surviving the Ebola virus ravaging his system is the potential for an infectious disease nightmare.  

Obviously, Mr. Duncan's care is expensive and more than likely much of its cost will never be reimbursed. In the event anyone in contact with Mr. Duncan becomes an Ebola patient, it's more than likely their care won't be fully reimbursed, either.

Texas is in a difficult situation regarding Mr. Duncan being the first Ebola patient diagnosed in the US. The Lone Star State of Texas is now the lonely ground zero site for Ebola in the U.S.  This is an embarrassment for the US and particularly for Texas. Nevertheless, the reality is, more than likely, if Mr. Duncan had money to pay for his care, much of this chaos and anxiety about Ebola in the US would have been preventable because he'd have been urgently isolated the minute he was assessed for being at risk. Yet, he wasn't aggressively treated, more than likely, because he couldn't pay for it.

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