After Sept. 11, 2001, a lot of money was dumped into ‘biopreparedness’, something most microbiologists thought would not be very effective. So one would like to think, in light of all of the money spent on bioterrorism/biopreparedness, there would have been a better response to the Ebola epidemic. Here’s a very interesting take on why we haven’t responded very well (boldface mine):

Which brings me to a point made forcefully by Guillaume Lachenal: Ebola happened despite, and indeed as a result of, over a decade of pandemic preparedness efforts costing billions. These efforts not only failed, they produced this Ebola epidemic. As Andrew Lakoff pointed out, the billions poured into a national security apparatus in the name of Global Health were devoted to “preparedness,” a nebulous construct that highlighted surveillance and simulation as key to readiness for bioterrorism and other epidemic threats. Huge sums of money were spent on vaccines for epidemics that never materialized. Yet there were already clear and unambiguous signs that the key to preparedness would lie in hospitals. All those efforts devoted to pandemic preparedness did not involve investing in health systems at the front line of epidemics: hospitals.

When Ebola struck, health care workers sickened and died in large numbers. Lack of basic infection control equipment—such as gloves and masks—doubtlessly played a role. Front line workers will inevitably come into contact with Ebola patients since the majority of patients in West Africa come to health care centers with fever as their chief complaint, and, in an epidemic setting, it is difficult to screen out potential cases without a systematic triage mechanism. Hospitals are therefore particularly vulnerable, even more so when understaffed and underequipped.

Scary Disease Woman (aka ‘Maryn McKenna’) sounds a similar note (boldface mine):

We already know — have known for years, in fact — that our emergency-care system is underfunded, overstressed, and asked to bear a larger burden for the health of the mass public than either hospital or outpatient care do. It is very disappointing that Duncan’s travel history was ignored in his first encounter with Texas Presbyterian — but as Texas health journalist Laura Beil pointed out on Twitter yesterday, not even slightly surprising given the churn of uninsured patients through the state’s big ERs. I noticed in my email this morning that the annual scientific assembly of the American College of Emergency Physicians takes place in two weeks in Chicago, and the organization has scheduled two expert sessions on Ebola and ERs. It is smart for them to do so; they may be the real front line.

Look, I do surveillance for a living. It is important. But our emergency rooms are the first response, both in terms of treatment and surveillance (regarding the latter, where else are we going to get our surveillance from?). If U.S. nurses are to be believed, it’s not clear that we’ve done enough hospital training to safely manage an Ebola patient:

Proper training, of course, costs money, and, unfortunately, we live in a country where people erroneously believe that the federal government can run out of money, so we’ll just have to hope for the best.