As nationwide alarm over Ebola begins to fade, hospital officials and public health professionals are trying to ensure that lessons learned don't disappear along with it.
After a Liberian man carrying the disease died last month in a hospital in Dallas and two of his nurses became infected, facilities stepped up training and planning for Ebola cases.
"The mantra is, 'Don't be the next Dallas,'" said Dr. Andrew Pavia, chief of pediatric infectious diseases for the University of Utah health system.
A new Ebola patient arrived Saturday at Nebraska Medical Center. But as the national situation abates, so does the urgency to act. With a quarter of American hospitals losing money in day-to-day operations, according to the American Hospital Assn., expensive and time-consuming training for unknown future outbreaks is not always a top priority, experts say.
Hospitals seek a balance between preparation and overreaction when planning for the possibility of an outbreak of a deadly virus like Ebola, the spread of a pandemic flu or the emergence of another little-known infectious disease, according to hospital and healthcare officials.
In an era of high costs, constrained budgets and tight profit margins, many hospitals struggle to determine what resources they can spare to prepare for an epidemic that may never come.
"You have to walk that fine line between an event happening and not saying the sky is falling all the time," said Dr. Katie Passaretti, head of infection prevention at Carolinas Medical Center in Charlotte, N.C. Her hospital helped isolate and test one of the first suspected Ebola cases in the country in July.
But many say the mistakes made at Texas Health Presbyterian Hospital in Dallas — where staff said they had not been properly trained to handle an Ebola patient — could have happened at virtually any hospital.
"There was 99.9% no planning for this one," said Dr. Lisa Brosseau, who studies occupational health at the University of Illinois. "I think we are still pretty much playing catch-up."
Only about 6% of hospitals said they were "well-prepared" for an Ebola patient, according to an October survey by the Assn. for Professionals in Infection Control and Epidemiology. And 51% of the respondents said their hospitals had one or no full-time infection control professional on staff.
Public health experts say they understand why hospitals struggle to keep themselves ready for disease outbreaks: Epidemics are relatively rare and often hard to predict, preparation and training are costly and time-consuming, and the consequences of previous outbreaks aren't always remembered.
"The level of activity that's required to be a fully prepared hospital is pretty extraordinary," said Dr. Eric Toner, who studies medical preparedness during outbreaks at the University of Pittsburgh Center for Health Security. "If there's not a comparable epidemic in another decade or so, a lot of the progress we've made will be lost."
In addition to some states' designated "Ebola hospitals," federal authorities are seeking funding to create an Ebola treatment center in every part of the country to make it easier for authorities to funnel seriously ill patients to highly qualified facilities, according to the Department of Health and Human Services.
That's good for patients, who will receive specialized care at institutions including Nebraska Medical Center — which will treat the new Ebola patient, Dr. Martin Salia — and Emory University in Atlanta, but bad for overall hospital preparedness, experts say.
"Some hospitals will take this outbreak very seriously," Toner said. "But many will see it as a one-time event, and think they dodged the bullet."
Ebola follows other major health concerns in recent years. In 2009, an outbreak of H1N1 swine flu, a pandemic influenza, resulted in about 60 million cases nationwide. Congress provided $6 billion in funding that helped create a vaccine stockpile, and now flu shots help contain the strain.
In 2006, bird flu led President George W. Bush to request additional federal funding to ramp up vaccine production and detect outbreaks overseas. Earlier in his term, in 2003, the SARS outbreak killed more than 700 people worldwide, including several doctors and nurses in Canada.
"We're getting better every time we're faced with this," said Dr. Melissa McDiarmid, a professor of medicine at the University of Maryland. "If there is any kind of blessing from this Ebola outbreak, it's that we need to stop making excuses regarding preparedness."
States with designated Ebola treatment hospitals have led the country in hospital preparedness. New York, where Ebola patient Dr. Craig Spencer was treated, has run practice drills throughout the state and set aside eight hospitals to treat possible cases.
The state's plan has been held up as a model for future outbreaks, according to Linda Greene, a spokeswoman for the infection control professionals' association and an infection prevention manager at the University of Rochester Medical Center, one of New York's designated treatment hospitals.
Under such a system, hospitals throughout a state would be expected to identify initial cases and then transfer them to one of the designated centers for treatment.
"Any hospital, no matter how small, must be able to identify a case," Greene said. "This is really a model that's been in healthcare for a long time — not every hospital can have a burn unit; not every hospital can have a trauma unit. We're seeing that move into the infectious disease world."
Ultimately, Pavia said, Ebola has been instructive for the nation's healthcare system. But it may not automatically be remembered during the next health scare.
"There's no question that we've learned some lessons from the Ebola outbreak," he said. "The question is, how much and how quickly are we going to forget?"