With the news that a person in the United States has been diagnosed with Ebola, many questions have been raised by employers. The questions range from concerns for individual health and wellbeing to what the medical costs might be for the treatment of such an infection, and what is covered under the employer’s benefit plan.
Ebola Basics
Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). Active symptoms of Ebola can appear two to 21 days after exposure. The virus is characterized by a sudden onset of fever (usually at least 101.5F/38.6C). Headache, muscle pain, diarrhea, vomiting, and unexplained bleeding or bruising will follow. When an infection does occur in humans, the virus can be spread through direct contact (through broken skin or contact with the mucous membranes of one’s eye or mouth) with:
- Blood or other bodily fluids (including but not limited to urine, saliva, feces, vomit, and semen) of a person who is sick with Ebola
- Objects (like needles and syringes) that have been contaminated with the Ebola virus
- Infected Ebola animals
Ebola is not spread through the air or by water, or in general, food. It’s only contagious if the infected individual is experiencing active symptoms. Once a human is infected, the Ebola virus is highly lethal. Mortality rates range from about 50 to 90 percent. There is no commercial vaccine or Ebola-specific therapy that has been tested for safety and effectiveness. There has been very limited experimental anti-serum or drug therapy. Work is being done to accelerate development of both vaccines and potential therapies.
Ebola Treatment and Care Costs
Once a person contracts the Ebola disease, medical care is effectively limited to “supportive therapy.” This often involves Centers for Disease Control and Prevention (CDC) isolation procedures to protect from the spread of the Ebola virus within an intensive care unit (ICU) or critical care unit setting. The intensity and duration of such intensive medical care varies; average costs for an ICU bed per day are close to $6,000 a day. An Ebola individual is likely to need at least two weeks of ICU care, if not more. For instance, Dr. Kenneth Brantley, the first American to be treated in the U.S. for the Ebola virus, was treated by five physicians and 21 nurses during a 19-day hospital stay in confinement/isolation Additional costs are likely due to the following factors:
- Special isolation equipment and decontamination procedures
- Additional medical personnel required
- Variable costs related to additional medical complications.
The more common complications are shock and internal bleeding. These complications require additional medications and/or blood products such as platelet therapy, factor replacement, and blood, items which would likely be covered by a patient’s health insurance. Conservatively, this could add several thousands of dollars of cost per day for several days or possibly longer. Potential therapies for Ebola are also being developed. Treatments in use today are experimental, and are not required to be covered by the health plan. Since the drug therapies are considered experimental, stop loss carriers are highly likely to consider payment of any experimental drug as an exclusion under the stop loss contract. Whether anti-serum or mono-clonal antibodies, the amounts available just for testing are limited. Trials are also needed to determine safety and effectiveness.
ZMapp is the most widely discussed experimental drug; it has been tried with a handful of patients, including Brantley. Its manufacturer, Mapp Biopharmaceutical, has been working with the National Institutes of Health and the Defense Threat Reduction Agency (an arm of the military) to develop an Ebola treatment for several years. It’s possible, although not highly likely, that the manufacturers of ZMapp could apply for “Emergency Use Investigational New Drug” approval from the Food and Drug Administration to fast-track its availability. At this point, ZMapp’s own website says as of August 12, 2014, “the available supply of ZMapp has been exhausted.” ZMapp is a single course of therapy delivered via IV treatment so, if approved and covered, would typically fall under the medical plan rather than a plan’s pharmacy benefit. There has been no public release concerning the cost of ZMapp. We anticipate that insurers will not consider these to be “normal circumstances” and will likely evaluate each patient on a case-by-case basis. Sometimes manufacturers of yetto-be-approved products will provide them at no charge under compassionate use guidelines. It’s also possible, but by no means certain, that the Federal government might intervene to pick up the drug costs in the interests of forestalling a public health emergency. The impact to a business with a self-funded plan could be similar to the impact seen with high cost claimants, potentially pushing against the stop loss deductible. For example, at $6,000 per day in the ICU, plus $2,500 per day for additional costs such as blood products, more aggressive supportive therapy, physician fees, etc, one could see a total cost of $8,500 per day and thus a minimum expected expense of $100,000, excluding experimental medication expenses, based on a two week confinement.
Additional Employer Concerns
Travel Should employees stop traveling because of the Ebola virus? As a recent New York Times Health Guide section advised, “Avoid areas in which there are epidemics.” To help avoid those areas, please see the Outbreak Distribution Map from the CDC. Because the Ebola outbreak is quite fluid, please consult the CDC for the latest information, including travel notices. Employees at risk working in impacted countries may require immediate evacuation if infected or are at risk of Ebola infection. This can cause complex logistical and financial burdens. Be advised that evacuation coverage under Business Travel Accident policies typically does not cover the cost of voluntary evacuation because of an epidemic or pandemic Ebola disease.
Worker’s Compensation In determining coverage for potential workers’ compensation losses, insurance carriers will initially attempt to determine if the exposure to the virus occurred while the individual was in his or her scope of work. Traditionally, workers exposed to a higher risk than the general public will be covered, such as healthcare workers.
However, increased exposure due to business-related travel or the epidemic disease coverage under the foreign voluntary extension of a worker’s compensation policy may ultimately trigger coverage for other groups of workers as well.
More Information
Please click for a fact sheet you can share with your employees to help increase awareness of the facts surrounding the virus. We also have provided posters you can print after customizing with your logo. For additional information, please consult these sources: CDC on Ebola CDC on Prevention of Ebola CDC on Diagnosis of Ebola CDC on ZMAPP and Experimental Vaccines Find out more about C2’s Workers Compensation & Safety.
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