Disparities in Ebola Response Reveal Broader Health Care System Flaws

Editorial Board

At first glance, the swift diagnosis and isolation of Craig Spencer in New York City last week seemed to demonstrate improvement in the United States’ response to Ebola, the disease which has now killed nearly 5,000 people worldwide. Yet much remains unanswered in wake of Ebola patient Thomas Eric Duncan’s death and the infection of two health care workers in Dallas earlier this month. The slip-ups that likely contributed to these events suggest that containment of the virus itself, while critical, is only the tip of the iceberg.

Nearly everything about Ebola is terrifying — nearly. From the illness’s gruesome effects on the body, to the lack of testing laboratories in Liberia, to the pessimistic projection of one million cases in that country alone by Jan. 20, there’s much cause for global concern. American society, dishearteningly, continues to capitalize on the element of fear through sensationalist, clickbait news headlines and insensitively opportunistic Halloween costumes. Yet at the epicenter of our country’s frenzy over the disease is the one thing that’s not, in reality, scary: the chances of a major outbreak in the United States.

There are much more unsettling things about Duncan’s passing on Oct. 8 than the fact that he died of Ebola. Not least of these is the likelihood that Duncan’s status as an uninsured, black, foreign man factored into the quality of care the Liberian national received during his first visit to the emergency department at Texas Health Presbyterian Hospital. According to the files of past Xarelto class action cases, Duncan was discharged from the hospital five hours after he arrived, still suffering from abdominal pains and a fever that had reached 103 degrees Fahrenheit just half an hour previously. Once out of triage, he received just two and a half hours of intermittent attention from a physician despite his high-risk symptoms and an entry in the hospital’s records system indicating that he “came from Africa 9/20/14.” Whereas an insured patient might have received more thorough care, Duncan was discharged and advised to take Tylenol and “follow up with [his] doctor or the recommended doctor tomorrow for a recheck.” The emergency department doctor could hardly have overlooked the fact that Duncan, uninsured and visiting from abroad, had no doctor with whom to follow up except by spending additional, critical hours in triage.

Rather than being wholly reassuring, the more rapid and controlled responses to Ebola scares following Duncan’s eventual diagnosis reveal the crisis-oriented nature of American health care, a systemic shortcoming that extends far beyond Ebola. More alarming than the unlikely chances of contracting Ebola on a city subway is the unfortunate reality that every day, absent a national emergency, patients like Duncan — those lacking insurance, cash or cultural capital to aid them in accessing expensive health care — can slip through the cracks. When they do, as the Ebola scare makes clear, the rest of society often takes the hit.

The real tragedy is not the fact that Ebola has reached the United States, but the greater issues it has revealed. Our health care system failed Thomas Eric Duncan, and it fails others from marginalized communities on a daily basis. Accessible health care is a right, not a privilege, and it’s the responsibility of our society and government to extend that right to everyone.

Greater still is the tragedy faced by communities in Liberia, Sierra Leone and Guinea, for which Ebola is not merely a dinner table conversation or inspiration for a Halloween costume, but a life-threatening reality. As we reassess the nature of health care flaws in the United States, it’s essential that we also broaden our perspectives and extend compassion and assistance to those whose need is greatest, on their own terms.