Graduation Date

Fall 12-14-2018

Document Type


Degree Name

Doctor of Philosophy (PhD)


Environmental Health, Occupational Health, and Toxicology

First Advisor

John-Martin J. Lowe


The 2014-2016 Ebola virus disease (EVD) epidemic in West Africa was unprecedented in magnitude and scope. The threat of imported cases of EVD in the United States prompted the Centers for Disease Control and Prevention (CDC) to establish a tiered network of hospitals to enhance domestic isolation capacity, including the designation of select hospitals as Ebola treatment centers (ETCs). As of spring 2015, no information existed on the capacity, physical infrastructure, staffing models, or infection control protocols of these newly-established ETCs, nor was there information on other highly hazardous communicable diseases (HHCDs) these units would admit. Moreover, no documentation was available on the varying preparedness activities of state health departments related to HHCD transport and the treatment center network. The purpose of theses studies was to assess preparations made in the United States in response to the 2014-16 EVD epidemic; specifically, to determine costs incurred by CDC-designated ETCs in establishing their unit, capabilities developed by ETCs, and guidelines established by state health departments for the management and transportation of patients with EVD or another HHCD. Data were obtained through the distribution of three electronic national assessments; two administered to the 56 CDC-designated ETCs in 2015 and 2016 (85% and 64% response rate, respectively) and one to all state public health departments (73% response rate). On average, responding ETCs incurred $1.2 million in establishing their facility and are awaiting $650,000 in reimbursement. Cumulative capacity of reporting ETCs was 121 beds. Although nearly all facilities had written protocols for various infection control domains, procedures and capabilities varied. ETCs and state health departments differed in reports on diseases that would be treated in high-level isolation. The domestic preparedness efforts described in this dissertation are fundamental to the U.S. response to the next HHCD threat; however, questions on the sustainability and scalability of this network and the use of these units for a non-EVD HHCD outbreak remain.