U.S. Ebola treatment centers switched gears for COVID-19, providing lessons for future pandemics

In response to the Ebola threat that emerged in West Africa in early 2014 and was declared an international health emergency a few months later, the Centers for Disease Control and Prevention designated 56 hospitals in the United States as Ebola treatment centers (ETCs).

Most of these centers were located in or near the cities where the majority of people entering the United States from West Africa lived. They had high-level isolation capabilities for safely managing patients with Ebola virus disease, and their staffs were highly trained in infection control, use of personal protective equipment and waste removal, and many other skills.

A few years later, these ETCs cared for the first COVID-19 patients in their regions. They also provided training to their internal staff and the staff at other hospitals, donating the supplies needed for high consequence infectious disease (HCID) response and helping to adapt and implement plans for this new HCID. They became resources for their states and regions to address the evolving COVID-19 pandemic.

To determine how well these ETCs performed when faced with the novel coronavirus, as well as their ongoing sustainability in the face of potential HCID outbreaks, a team of researchers including Shawn Gibbs, PhD, MBA, dean of the Texas A&M University School of Public Health, and incoming School of Public Health faculty member Aurora B. Le, PhD, surveyed the ETCs. Their study was published in a recent issue of Infection Control & Hospital Epidemiology.

“The United States was fortunate that these ETC facilities had been established in response to the West African Ebola outbreak, and that they were there to serve as a resource throughout the COVID-19 response,” Gibbs said.

Most of those surveyed stated that having adaptable and highly trained ETC staff in place was the biggest contribution to hospital and unit readiness when COVID-19 hit. These staff, who underwent regular and extensive classroom and hands-on training on HCIDs during the five years prior to the COVID-19 pandemic, served as subject matter experts when information on the novel coronavirus was scarce. They also trained health care workers at many other facilities in each region.

In addition, access to—and familiarity with—highly specialized personal protective equipment and existing policies and procedures that could be adapted as more was learned about the novel coronavirus were found to be critically important. As one health care respondent noted, “Our response procedures were easily adjusted as more information was learned about COVID-19.”

Despite this success, ETCs face challenges that might inhibit their ability to respond quickly and efficiently moving forward.

First, the cost of setting up and sustaining an ETC is substantial. In addition to the initial investments required, the responding ETCs reported an average of more than $234,000 in expenses per year to maintain high-level isolation capabilities, equipment and staff training, as well as other costs. Six ETCs reported annual funding shortfalls averaging nearly $164,000 in the areas of staffing and recurring training, replacing expired supplies, equipment depreciation and construction and overhead costs.

Similarly, at least seven of the 56 original ETCs no longer maintain high-level isolation capabilities, in part due to the costs involved. Furthermore, only two of the responding ETCs said they could continue operations at the current level without federal funding, which has largely been drawn down as the pandemic has waned—just as funding for broader public health and biopreparedness is also declining.

The researchers note that although the costs associated with Ebola treatment centers are substantial, they are far less than the cost of starting all over as the next crisis emerges and suggest that the current capabilities that proved so beneficial during COVID-19 could be further leveraged to address non-HCID threats as well, with continued funding and other support.

“These aren’t the types of facilities or skillsets that you can just turn off and on, so if the U.S. loses this capability, it means we will be less prepared for the next HCID outbreak or pandemic,” Gibbs said.