No, it's not Ebola. It's not Coronary Artery Disease. It's not even all the cancers put together.
The biggest threat to public health in the US is the denial of care to everyone.
I trained as a medical student in an hospital that had opened its doors more than two centuries before I first walked through them. For most of that time, almost all of the patients who walked or were carried through those doors were there precisely because they were the ones who couldn't afford the medical care that the well-off got. People of substance were cared for by their families in their own homes, and hospitals were pest houses, places where decent people wouldn't let a family member go because you were sure to catch some horrible infectious disease there. An age much less prosperous than our own made free hospital care available nevertheless, because they had the common sense to understand that you didn't want poor people without homes and families of means out in public with deadly contagious diseases, because that would lead to everyone being at risk to catch these deadly contagious diseases.
We've come a long way since that time. Now we're smart enough to treat medicine as an opportunity to make money, rather than a way to protect the public health. This person in Dallas may have had insurance, maybe the staff didn't make this massive error because there was no way their institution was going to get stuck eating the treatment costs of an uninsured Liberian. But you can bet they made this mistake in large part because they are completely out of the habit of treating people from West Africa, who tend to be uninsured.
I'm not some high speed low drag practitioner. I just do primary care at a (formerly) free clinic. The ER folks at this Dallas hospital could probably run rings around me in terms of knowledge base and procedure skills. But at least my practice, because it involves treating people who can't afford insurance, and therefore are often from exotic places, has not gotten me in the habit of failing to make sure I know where the hell all of my patients are from, and how recently they're from there.
This mistake these providers in Dallas made is not, in my experience, at all rare or surprising. Just this last week I saw a gentlemen originally from Honduras, a country with a high prevalence of tuberculosis, in follow-up from a hospitalization for pneumonia. I asked him whether he had ever been tested for tuberculosis, on his arrival to the US, at a prior hospitalization for a hand surgery, or at this latest admission for fever and a productive cough, and he had not been so tested, or even asked about his testing status by any previous US provider. I reviewed his record from the pneumonia admission, and one rather enterprising entry did confabulate a history of the patient being skin-tested, and showing negative, during the hospitalization. I know he made it up though, because the patient had no memory of having a bubble of fluid injected under the skin in his forearm, with a reading two days later, and the patient was on high-dose steroids the whole time anyway, so even a negative test result would mean absolutely nothing. Nobody who knew anything about TB would have made this claim in a hospital record.
I mention these facts about TB not at all to set myself up as some lone genius on the subject. This is pre-K level knowledge of TB. The point is that I bother to practice at at least a pre-K level because my patients are at risk of TB, while the much smarter, more energetic and infinitely better resourced teams of folks who work in hospitals in the US treat paying customers who do not get TB. But, hey, it's just TB. Decent people in the US don't get TB, just the uninsured rabble. Well, middle class people aren't getting TB here much now -- but give total neglect of TB another few decades to work, and we can turn that right around.
But TB would take decades of neglect to rally sufficiently to start killing many of us who count, I mean many of us who can afford insurance, because those are the ones we seem to think count. Ebola will probably get our attention first. It's a barely contagious disease, and if we as a nation did not have this diseased health care financing system that makes even bright and energetic providers even stupider than I am, then Ebola wouldn't stand a chance in this country. Nigeria seems to have contained their outbreak, with only a fraction of our resources. What worries me is that the Nigerians have this going for them, that they are at about the level of development as the New Orleans of the mid 18th Century that opened a free hospital for everyone because even the wealthy who had to foot the bill realized that we're all in this together when it comes to deadly contagious diseases, that it violates common sense as well as common decency to send people home with high fevers vomiting their guts out when they just got back from a country where just that clinical presentation means a deadly contagious disease. It's very hard to unlearn stupidity, and we may not be able to do it in time to contain even a barely contagious disease.