Texas Ebola case exposes readiness gaps: Our view

When Thomas Eric Duncan walked into a Dallas emergency room last week, he might as well have been wearing a sign shouting: "Ebola." He had flown in from virus-ravaged Liberia. He told a nurse where he was from. He was suffering from flu-like symptoms. Everything hospitals have been warned to watch for.

Yet, he was examined, given some antibiotics and sent home — only to return by ambulance three days later, deathly ill with the nation's first reported case of Ebola.

The hospital's breathtaking blunder is no reason for panic. Duncan is now isolated in a hospital room, authorities are tracking those he might have come in contact with, and four people are under quarantine. But the way events unfolded in the past week revealed a pair of serious gaps in the still-emerging system for countering the disease:

• ER response. That Texas Health Presbyterian Hospital, a sophisticated institution in a major city, could drop the ball so badly is troubling, especially after weeks of warnings and headlines about Ebola.

A nurse, using an Ebola "checklist" instituted by the hospital, learned that Duncan had come from Africa. Yet that was apparently not communicated to the team that cared for him in his first visit and dispatched him back into the community.

Poor communications are a common problem in hospitals, which use wristbands and other measures to avoid problems. But the Dallas experience ought to prompt every hospital administrator to develop surefire systems tailored to Ebola. Impressive-sounding federal strategies to fight Ebola won't mean much if front-line health professionals don't follow them.

• Air travel. The glib response — banning flights and travelers from West Africa — might become necessary at some point, but imposing a quarantine of that scale is more problematic than it might seem at first blush. It would disrupt efforts to stop the infection at the source by interfering with the flow of doctors and aid. What's needed is tighter screening of people flying from Liberia, Guinea and Sierra Leone — at departure and arrival.

People boarding planes in West Africa are now routinely checked for fever and must answer written questions about whether they have been in contact with Ebola. This is far from foolproof: Fever typically doesn't show up until two to 21 days after exposure to the virus, and Liberian officials allege that Duncan lied about whether he had had contact with an Ebola patient.

What's needed are layers of protection, but customs officials at ports of entry in the U.S. have not added any special screening for travelers coming from West Africa. Since Wednesday, they've been handed informational "tear sheets" — a transparently inadequate step that is matched by failings elsewhere in the system.

On Thursday, for example, local public health officials were still scrambling to get a cleanup crew to the apartment where Duncan had been so ill and where occupants are confined.

Top federal health officials are doing an excellent job of keeping the public informed. If Americans are to remain calm, though, people throughout the system need to earn their trust.

USA TODAY's editorial opinions are decided by its Editorial Board, separate from the news staff. Most editorials are coupled with an opposing view — a unique USA TODAY feature.