Report gives USA low grades on preparing for disease

Ebola exposed significant weaknesses in the USA's ability to handle infectious disease outbreaks, according to a report that gives the nation low grades in preparedness.

On a scale of 1 to 10, half the states and Washington, D.C., scored a 5 or lower, according to the report released today by the Robert Wood Johnson Foundation and the Trust for America's Health. Arkansas received a 2, the lowest score. The highest score was an 8 earned by five states: Maryland, Massachusetts, Tennessee, Vermont and Virginia.

The report scored states on measures as diverse as food safety, vaccination rates, hospital-associated infections and being prepared for emerging threats. Those threats included not just Ebola but also respiratory viruses such as pandemic flu, MERS (Middle-East Respiratory Virus) and enterovirus D68, a respiratory virus that has been diagnosed this year in 1,149 people, including 12 who died.

"The Ebola outbreak is a reminder that we cannot afford to let our guard down," says Jeffrey Levi, executive director of the Trust for America's Health.

The USA made numerous missteps with Ebola, says Lawrence Gostin, faculty director at Georgetown University's O'Neill Institute for National and Global Health Law.

"Where we erred badly with Ebola -- and where our greatest vulnerabilities lie -- was at the state and local level," Gostin says.

While many people look to the Centers for Disease Control and Prevention in a crisis, Gostin notes that the foundation of the public health system is local health departments and hospitals, because those are the places where sick people show up.

A Dallas emergency room sent home a Liberian national with a fever, for example, instead of testing him for Ebola. The man, Thomas Eric Duncan, was the USA's first Ebola case. He infected two of his nurses. While both nurses survived, Duncan died. Nurses around the country staged protests, saying hospitals were't adequately protecting them from Ebola.

In spite of widespread fears, though, Ebola has not caused widespread outbreaks. Thanks to excellent hospital care, eight of the 10 Ebola patients treated in U.S. hospitals survived, including all of the Americans, Gostin notes.

The USA could have fared far worse if Ebola spread as easily as influenza or other airborne viruses, Gostin says.

"We got off very easy," Gostin says. "We have been extraordinarily lucky. ... We've dodged a bullet. But if we don't learn lessons from Ebola, we are going to pay for it someday."

One of the biggest hurdles to preventing and controlling outbreaks of infectious disease is the lack of consistent funding, Levi says.

The nation increased public health funding after the 2001 terrorist attacks, only to slash that funding during the recession.

The CDC's budget shrank by 10% -- nearly $1 billion -- from 2012 to 2013. Twenty-two states and Washington, D.C., reduced their public health budgets from fiscal years 2012-2013 to 2013-2014, the new report says. State and local public health agencies have lost more than 50,000 staff members -- almost 20% of their workforce -- since 2008, according to the Association of State and Territorial Health Officials.

In response to Ebola, Congress approved more than $6 billion in emergency funding.

The USA can't maintain a robust public health system by careening from one crisis to the next, Levi says. It takes time to train staff and develop public health systems that work well with surrounding cities, counties and states.

"When a fire breaks out, we don't hire and train a fire department that day," Levi says. "And when the fire is out, we don't send them all away. We know there is a core capacity that we need to protect the public."

Ebola has infected more than 18,600 people and killed 6,915, mostly in Guinea, Liberia and Sierra Leone.

Millions of Americans suffer from serious infectious diseases that get far less attention, the report says. More than 2 million preschoolers are vulnerable to life-threatening infections because they haven't received all of their vaccinations on time, the report notes. Low vaccination rates have contributed to measles outbreaks in recent years. The CDC has reported 609 measles cases so far this year, compared with 187 cases in 2013 and 55 in 2012.

According to the report:

• More than 20,000 Americans die each year from antibiotic-resistant infections, which are becoming more common due to inappropriate use of antibiotics.
• About 722,000 Americans develop a hospital-acquired infection each year and about 75,000 die. From 2011 to 2012, only 10 states reduced a major cause of these deaths: ones that begin in a catheter and spread to the blood stream.
• More than 48 million Americans suffer from foodborne illness each year and 3,000 die. Twelve states failed to meet a national standard of testing all reported E. coli cases within four days.
• An average of 62 million Americans get the flu each year and 3,000 to 49,000 die. Only 14 states vaccinated at least half their population for influenza during the 2013-2014 flu season.
• Nearly 50,000 Americans a year are infected with HIV.
• Nearly 10,000 Americans a year are infected with tuberculosis.