A stratified biodefense hospital system would provide the United States with a protective shield in the event the country experiences a man-made or natural biological catastrophe, panelists told members of the Blue Ribbon Study Panel on Biodefense.
The suggestion is one the panelists strongly suggested that the Study Panel take again to members of Congress, which this week began Senate hearings on the Pandemic and All-Hazards Preparedness Act (PAHPA), which is due for reauthorization in September.
“Although there are bright spots across the nation … we stand on a very fragile shell of preparedness,” said Dr. David Marcozzi, associate professor at the University of Maryland’s School of Medicine. “It is essential that our healthcare system is ready to respond and the [nation’s] expectation is that hospitals … will stand up and be ready to respond.
“Unfortunately, their ability to do so is largely disjointed and inadequate,” Marcozzi said during a Jan. 17 panel session on hospital preparedness and response.
The session was among several held at the University of Miami during the Study Panel’s public meeting focused on gaining a deeper understanding of how state, local, tribal and territorial (SLTT) governments respond to large-scale biological events, among other objectives. The meeting was co-chaired by former university president and former U.S. Secretary of Health and Human Services (HHS) Donna Shalala and former U.S. Congressman Jim Greenwood (R-PA), who both serve on the bipartisan Study Panel.
The Study Panel already recommended in its December 2016 Biodefense Indicators report that the White House redouble its efforts to share information with SLTT governments and listed specific action points for how to do so.
Marcozzi, along with panelists David Zambrana, senior vice president and CEO of Jackson Memorial Hospital, and Dr. Alexander P. Isakov, executive director of Emory University’s Office of Critical Event Preparedness and Response, delved into not only the benefits of a stratified biodefense hospital system, but also touched on topics such as SLTT leadership in preparedness, training and response, and the need for ongoing federal support — in the form of dollars and policy, to name a few.
For example, since 9/11, the United States has invested $5 billion in health care preparedness, Dr. Marcozzi said, “but we’re far from prepared to respond” to a large-scale biological event. The current economies won’t get the country where it needs to go, he said, adding, “You can’t grant your way to successful delivery of care.”
Dr. Isakov recalled the 2002 SARS outbreak, which spread from China to more than two dozen countries in North America, South America, Europe and Asia before being contained in 2003. From November 2002 through July 2003, a total of 8,098 probable SARS cases were reported to the World Health Organization (WHO) from 29 countries, including 29 cases from the United States, according to the Centers for Disease Control and Prevention (CDC), which said of the 774 SARS-related deaths reported, none were in the United States.
In studying how the U.S. responded to the crisis, Isakov said he learned that, generally, hospitals quickly became overcrowded and they had poor policies in place for assessing patients, regulating medicines, controlling restricted access to patients, and for maintaining basic standards for control and prevention measures like doctors washing their hands.
Then when the Ebola outbreak started in West Africa in 2014 — and the CDC was still working to help contain it in 2016 — Isakov said, “It wasn’t a novel illness — it’s been reported since the 70s — but it was novel for the U.S. health system.”
And it was scary, in part, he said, due to the lack of specific countermeasures and lack of education across the health field on Ebola, generally. For example, professionals weren’t really aware that the disease could be controlled, he said.
“So there was a gap there and I think it was a wakeup call about … managing the high-consequences of such a disease,” Isakov said.
To help solve capacity issues, Isakov agreed that the “nation needs adequate funding.” Federally funded capabilities provide a stronger response infrastructure, he noted, pointing to investments by the Assistant Secretary for Preparedness and Response (ASPR) at HHS in a tiered system national emergency health care centers.
These are episodic funds, however, and “we all recognize this requires more sustained funding,” Isakov said. Congress should provide consistent funding for such a tiered health system, he said, adding that even modest funding would help to maintain and further develop the capabilities of the nation’s hospitals working within such a system.
Someone else also shares the idea of a connected health system. Dr. Robert Kadlec, who currently serves as the ASPR, testified earlier this week during a Senate Health, Education, Labor, and Pensions Committee hearing on reauthorizing PAHPA. Part of the mission of ASPR, he said, is to coordinate across HHS and support state, local, territorial, and tribal health partners in preparing for and responding to emergencies and disasters. ASPR also manages the Biomedical Advanced Research and Development Authority (BARDA), Project BioShield, and the Public Health Emergency Medical Countermeasures Enterprise.
“As with medical countermeasures, the nation’s health care delivery infrastructure is mostly a private sector enterprise,” Dr. Kadlec said during the Senate committee hearing. “We must better leverage and enhance existing federal programs, such as the Hospital Preparedness Program, to create a more coherent, comprehensive and capable regional system integrated into daily care delivery.
“I call this the foundation of a national disaster health care system,” Kadlec testified.
It’s a concept that Marcozzi is on board with and he agreed with Kadlec’s assessment that the nation’s medical sector must do a complete pivot from its current construct of response to biothreats.
“We are not ready to deal with a biological event,” Marcozzi said. “But there are some potential solutions.”
For instance, thinking about how hospitals provide care during disasters needs to change, he said. There needs to be more evidence-based measures weaved in with how care is delivered and then trainings provided at the local level. And better linked emergency care across local areas, regions and states. Significant leadership should be provided, too, he said.
“I hope Congress gives Dr. Kadlec the platform and listens to his advice on the PAHPA reauthorization,” Marcozzi said during the Study Panel session.
Zambrana also agreed that Uncle Sam could step in to better manage how local hospitals prepare and respond.
“The federal government could help acute care facilities cooperate,” Zambrana said, and help them “refine mechanisms for dealing with the threats of a biological event.”
While Miami-based Jackson Memorial Hospital, an acute-level 1 trauma services site for over 26 years, “can handle mass casualty situations, we’re training for them every day,” Zambrana said, opportunities always exist for greater sharing of protocols and information, he said.