l. The Lancet 21 February has Correspondence from Zacharowski, et. al., critical care physicians at Frankfurt Hospital, re: the cost of care of physician with EBOV transferred to Frankfurt Hospital from a WHO treatment facility in Sierra Leone. The patient spent 16 days in the ICU and 24 additional days in hospital; the total cost was 1.06 Million Pounds or 1.54 Million dollars. The breakdown of costs is given in a Table in the article. If 1x was the cost of physicians, then closing 4 ICU beds to enlarge treatment space for the EBOV patient cost 4x, nursing cost 1.2x, and infrastructure cost 1x. This patient required ventilator and renal dialysis. See the Table at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60279-3/fulltext
2. The Lancet 21 February has Correspondence from Connor, et. al., of the Royal Center for Defense Medicine in Birmingham, UK, re: access to their Ebola treatment center in Sierra Leone. The authors say that the center has been open to all HCW in Sierra Leone who have become infected with EBOV. The center does not offer ventilators or renal dialysis; the authors do not believe these treatments improve survival from EBOV. Their treatment center has reduced EBOV mortality to 45% even though their patients present late in their clinical course. See the article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60280-X/fulltext
3. CDC’s MMWR 15 February has a report by Kateh, et. al. from the Liberian Ministry of Health and the CDC re: the effectiveness of rapid response EBOV teams in Liberia to reduce the spread of EBOV once infection has been identified in rural villages. The rapid response teams reduced the time to notification of officials on an EBOV case from 25 days (median) to 15 days (median). This allowed the rapid response teams to intervene in the first or second generation of the infection, not the typical third generation of infection. The authors ascribe the effectiveness of the rapid response teams to interacting with village leaders and educating rural persons about EBOV. The most surprising fact to me was that 2/3 of the rural outbreaks began with the index case coming to a village from an urban center (Monrovia, Liberia). See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0220a1.htm?s_cid=mm64e0220a1_e
4. HHS.gov posted today a chart showing how 194.5 Million dollarswill be allocated to states for hospital preparation for EBOV and how 339.5 Million dollars will be allocated to states for Public Health Services preparation for EBOV. See the chart at: http://www.hhs.gov/news/press/2015pres/02/20150220a.html.
5.I have strong reservations about the EBOV hospital triage system as described by HHS. The hospital triage ystem makes no sense to me. Either a hospital is prepared to treat EBOV patients or it is not. There cannot be different care levels for a BSL Category 4 virus. Millions of dollars will be poorly spent unless experts rework the HHS plan. I also do not understand what the Public Health Service money will be spent on.