Mark Jarrett, MD, on Managing Epidemics

Named 2014’s top news story today by Katie Couric, the Ebola epidemic “raised serious questions about the capacity of US hospitals to effectively treat the disease and to protect healthcare workers treating the infected.”

Mark Jarrett, MD, is on the front line of preparation for epidemics. As the North Shore-LIJ’s chief quality officer, Dr. Jarrett discusses how hospitals can address infectious disease threats effectively in the following interview--the second installment of our Health Care Leadership series.

Dr. Jarrett reviews how the news media and the public dealt with Ebola; how the US could have been better prepared; the challenges of pandemics; and how biological containment units help to manage serious infectious diseases.

Question from Interviewer: Why did so many people get panicked over Ebola when we’ve seen these kinds of things before—like the flu and polio epidemics of the 20th Century?

Mark Jarrett, MD: The fear about Ebola was partially fomented by the media. Because Ebola comes from somewhere else and has a high fatality rate, people were much more fearful. Most people who get the flu get sick, but don’t die. Many less get Ebola, but those who do have a high mortality rate. That scares people much more. They feel there is no treatment and that most people are not going to do well if they have the disease.

Q: If you look at American news reports about healthcare--hospitals in particular--it seems that the country was woefully unprepared for something like Ebola.

Dr. Jarrett: Although we’re prepared all the time for infections, the US was not as prepared for a major infection like Ebola as it could have been.

All intensive care units have isolation rooms, so we can handle the standard infections. But an infection like Ebola requires very specific personal protective equipment and additional staff training at a high level. In the United States, we did not have enough personnel trained at that level, nor the equipment ready so that Ebola patients could receive treatment.

Q: Are there other diseases like Ebola that we should be concerned about?

Dr. Jarrett: Unfortunately, there are a lot of diseases like Ebola that we should be prepared for. For example, we all went through the SARS epidemic from 2002 to 2004. Everybody was very concerned then, because the virus affected young people and had a relatively high mortality rate, compared to the flu.

There are many other viruses in other parts of the world. Now that people can travel everywhere, there are many visitors to the United States. It’s more likely that a rare disease that may not spread much in one country could spread much more quickly when released in the United States, Europe or other very populated areas. So we need to be prepared at all times for that possibility.

Q: What threat are you looking at right now?

Dr. Jarrett: There is no one, single threat.

The challenge in American medicine is to change the culture so that everything is always done safely and we develop highly reliable organizations. A frequent example is the nuclear industry. Thankfully, there are almost no accidents in the field. Everything runs pretty much like a clock all the time. That is a model the medical field can follow. Or like an aircraft carrier, where a 17-year-old on the deck can stop all planes from landing because he or she thinks something is wrong. That is the culture that we need to develop in American medicine -- in all facilities, both inpatient and outpatient. When we do that, we will truly have safer care.

Q: There seems to be a loss of public trust in hospitals. And, maybe a little in the medical profession--at least in our government’s handling of infectious diseases. Would you agree with that? And if you do, what should the medical profession do to recapture that public trust?

Dr. Jarrett: There has been a decrease in public trust with both hospitals and doctors in general. The Ebola crisis magnified that.

People got the message that everything would be okay and it wouldn’t come here -- then it came here. That type of thing can make distrust worse. People weren’t, perhaps, as forthcoming. Treating Ebola in the U.S. is very different than treating it in west Africa. For instance, we isolate patients in private rooms. But in west Africa, Ebola patients stayed in open hospitals and open wards. We’re going to learn as we go along. That type of transparency was not apparent in the beginning. I think that further increased the concerns that people had about Ebola.

Threats and Solutions

Q: What are other pandemics we haven’t heard much about that we should look at in the coming years?

Dr. Jarrett: Well, other infections might come up. Clearly, we’re all concerned about the MERS-CoV, which has been seen mostly in Saudi Arabia plus some other Middle Eastern countries. It is a little bit like SARS. Certainly, there can be flu that mutates and spur a flu epidemic. And there are other viruses--Lassa hemorrhagic fever, Marburg--that are very similar to Ebola.

Our biggest risk comes from the fact that any of these viruses--which right now we know a lot about--can mutate and become much more dangerous. That’s why we need to be prepared for any type of infection in the United States, so we can handle anything that comes about.

Q: We’re conducting this interview in a special treatment unit at Glen Cove Hospital created to address diseases like Ebola. Tell us what you’ve done here.

Dr. Jarrett: The Glen Cove Hospital facility was designed not only to address Ebola, but also to handle any serious infectious disease that would would require a lot of intensive care. This unit can last a long time. We’re also talking about building a larger unit to include other equipment for an outbreak that might last for a long time, if there were prolonged exposure to infection. What we have here is great as a temporary and intermediate use, and it will last for years.

Like many major health systems and medical centers, we’re going to have to consider permanent structures that will always last. And again, with that goes the key of training the staff and keeping the staff trained all the time. It’s not just the physical facility. Much more important is our staff who, number one, must know what to do and be trained what to do. And number two, we need to keep them safe.

Q: When we came in today, we saw a lot of training going on.

Dr. Jarrett: We’ve done a lot of in-house training. It’s all about staff protection. One of the tenets of emergency management is to protect your staff. If you don’t protect your staff, there’s no one to care for the patients.

We have three levels of training. First is electronic training on the computer. Number two is learning how to get in and out of protective equipment -- the Tyvek suits, the respirators. They are complicated to put on, and it’s much more complicated to remove safely. The third aspect of training, which the unit is engaging in as we speak, is learning how to work in the protective suits within the actual environment and practicing different procedures with actors who simulate the disease and with simulation mannequins. So you become comfortable doing it and you gain muscle memory. You learn how to work in the suits, doing the things that you’re going to have to do with an actual patient.

Q: There’s been a lot of coordination between the New York State Department of Health, the Centers for Disease Control and Prevention [CDC] and other agencies. Would you talk a little bit about that?

Dr. Jarrett: We have worked very closely with local health departments, the New York State Department of Health and the CDC. They’ve visited all of our sites--including Glen Cove Hospital--several times, to confirm we’re doing the right things and to discuss potential future challenges. Because the way we practice medicine in the United States in the tertiary center is different than what goes on in West Africa. And that may be part of the reason why in the United States, we see Ebola patients who have been treated and survive, whereas, unfortunately, mortality in Africa is anywhere from 40% to 60% to 70%.

For more from this interview and to see a video, click here: http://bit.ly/1tRV8bQ