The Ebola virus, which has now touched our shores and taken the lives of two victims in the U.S., is a threat lethal enough to demand full mobilization of our health care resources, which is what federal officials have urged. Consequently, hospitals in recent weeks have been arming themselves with the necessary knowledge, supplies and resources to confront the danger and ensure it is contained and managed skillfully.
These efforts have involved extensive strategizing, equipping, training, and drilling. Such preparation does not come free. Indeed, the expenses are steep, costs that hospitals cannot be expected to bear on their own.
Across the nation, hospitals have responded to the call of duty with a mobilization that has been far faster, better coordinated, and more expensive than any prior response to an infectious disease outbreak, including HIV/AIDS. Here in New York State, the governor has designated ten academic medical centers as Ebola treatment centers, but all hospitals must be ready to safely admit, handle and transfer patients presenting signs of the deadly disease.
We understood the preparations would be costly, yet fully expected the federal government to lend support to what is, in fact, an unfunded mandate. The financial response from Washington, however, has not been commensurate with our efforts, not even close.
President Barack Obama’s $6.2 billion spending plan provides very substantial sums for responding to Ebola in Liberia, Sierra Leone and Guinea, a strong commitment to the task of fighting the disease at its source. But the amount allocated to U.S. hospitals at the frontline of our efforts to protect the American public pales in comparison. New York’s congressional delegation has been informed the plan would distribute just $7.5 million to hospitals in the state — 1/8 of one penny for every dollar in the President’s proposal — even though the preparedness costs for the state’s designated Ebola treatment centers will likely be ten times that amount, according to a Greater New York Hospital Association survey.
For New York City and its public facility Bellevue Hospital, which expertly nursed Ebola patient Dr. Craig Spencer back to health, Ebola expenses are $20 million to date. Nationwide, hospitals’ Ebola preparedness expenses could reach $500 million. The failure to recognize the cost of standing up to Ebola is dismaying, particularly for New York City metropolitan area hospitals, considering that two of the five U.S. airports accepting and screening travelers from the Ebola-ravaged nations are here.
The Mount Sinai Health System alone already has spent approximately $8 million on appropriate facilities, equipment and training. To maximize safety to our staff, patients and visitors we have constructed a standalone biohazard unit with its own entrance, allowing an Ebola patient to be admitted directly without ever entering the main hospital or even its emergency room. The biohazard unit has its own specially-designed septic and air circulation systems, and a freestanding laboratory where specimens can be securely handled and tested without risk to the laboratory that serves our entire hospital.
Over the past two months the Mount Sinai Health System has trained 3,000 employees — doctors, nurses, technicians and housekeepers — to properly put on and remove personal protective equipment, a process that is extremely costly because it requires hours and hours of practice. Proper “donning and doffing” is so critical to protecting against infection that workers must do so in the presence of both an observer and a coach, and perform their jobs while fully protected, which is challenging when one is wearing what is essentially a space suit. It becomes so hot inside those layers of protection that a person can work no longer than two hours at a time.
This is one of several reasons care for an Ebola patient requires multiples of normal manpower. Six nurses need to share the tasks that one normally performs in an intensive care unit. Given that there are five shifts during a 24-hour period, caring for an Ebola patient requires 30 nurses during one full day and night. We have been meticulously rehearsing such exacting care, a very significant drain on our staffing resources. This spending presents a huge financial challenge because there is no mechanism for an insurer, public or private, to compensate hospitals for their massive preparations in the national interest.
Hospitals have stepped up to face the Ebola challenge. Now it is Congress’ turn, so that hospitals have the ability to continue protecting the public health, even when confronted with the threat of a deadly infectious disease.
Kenneth L. Davis is president and CEO of Mount Sinai Health System; Kenneth E. Raske is president and CEO of the Greater New York Hospital Association.