The Center for Disease Control and Prevention released a statement on Aug. 5, 2014 about Zmapp, the experimental drug being used to treat two Americans that have contracted the Ebola virus while working in Liberia. The title of the release is Questions and Answers on experimental treatments and vaccines for Ebola.There is now controversy that the two Americans were treated while over 900 Africans have died from Ebola in this latest outbreak. There is also controversy that the two Americans were brought to Emory Hospital in Atlanta for treatment.
Nancy Writebol and Dr. Kent Brantly were working in a Liberian hospital. Writebol was not working directly with patients, but was scrubbing down care providers that left the treatment area. Dr. Brantly was working directly on patients. Both were involved in a dangerous humanitarian effort to save lives. They will have made the ultimate sacrifice if the Zmapp treatment does not prevent the Ebola virus from killing them.
The plight of these two people put a focus on a moral question that exists every second of every day. Who gets saved in a crisis situation? Merriam-Webster dictionary defines triage.
Triage: the sorting of and allocation of treatment to patients and especially battle and disaster victims according to a system of priorities designed to maximize the number of survivors.
Writebol and Dr. Brantly are in a triage situation. There is a limited amount of Zmapp. Time for treatment is of the essence. The drug is totally experimental with Dr. Brantly and Writebol as the first known human subjects. The FDA approved the use of the drug under its emergency Investigational New Drug provisions.
The Wall Street Journal produced an article that was published on Aug. 5, 2014 titled Giving Americans Drug for Ebola Virus Prompts Flak. The World Health Organization (WHO) is holding a meeting in the coming days to debate the ethics of giving a limited treatment to select people in the face of a mass epidemic.
Triage is typically performed in emergency situations such as treatment of victims of train wrecks, tornadoes, or fires. The choice of which people get treated is done by making decisions on whether the treatment can save the patient. Those that are considered mortally wounded are not treated in favor of those that may be saved.
There is a much more subtle triage that is done in day-to-day health care. This is the allocation of health care resources to patients in the general population. Triage, when using the Merriam-Webster definition, occurs within the US health care system on a continuing basis.
People with insurance get treatment. Treatment is often withheld for those without money. There are laws that say that treatment cannot be withheld. Treatment gets withheld. In an emergency room situation, patients usually get treated. The homeless person lying sick beneath a freeway that has not had routine health care has been subjected to long-term triage.
Triage occurs within the world population. People are dying in West Africa because of poor sanitary conditions, lack of knowledge and lack of basic health care. People all around the world face the same situations. Not having clean water, sanitary sewers, adequate food, and shelter all contribute to people dying prematurely.
In a 2000 ranking of health care done by the World Health Organization (WHO), the US ranked 38 in health ranking. The majority of African nations were in the 100s for ranking. China was ranked 144.
The US ranked 1 in expenditures per capita in the WHO survey. We are tops in spending and 38th in ranking of the health care system. Putting more money into health care does not solve the health issues in the US. One of the major goals of the Affordable Care Act was to increase the preventative care of the population to reduce the need for emergency care. So far, more people are using the emergency rooms because they now have insurance.
The threat of Ebola in the US is minimal versus that in Africa. Hopefully the Zmapp will work for the two patients at Emory. The outlook for those in Africa suffering from Ebola is not good. The outlook for the world for improving health by improving living conditions is also not good. The CDC has provided information regarding the availability and development of Zmapp.
The world needs to see triage in a broader view that includes the day-to-day reallocation of resources to allow more people to live in healthy conditions. Triage on a broad scale would be much less necessary if we spent the money used to kill each other on feeding the world and preventing disease.