What the US did — and didn't — learn from past outbreaks

The Spanish flu, swine flu and Ebola outbreaks all drastically altered the U.S. healthcare system.

Below is a brief breakdown of the affect the three outbreaks had on the U.S.:

1918: Spanish flu

U.S. case estimate: 25.8 million (25 percent of 1918 U.S. population)

U.S. death estimate: 675,000

The Spanish flu, considered the deadliest pandemic in modern history, had an estimated fatality rate of at least 10 percent, according to Live Science. The flu strain is thought to have infected a third of the world's population and caused at least 50 million deaths. Many physicians didn't know how to prevent the illness, and many Americans lost confidence in the U.S. healthcare system, according to PBS Wisconsin. It wasn't until 1997 that scientists began to identify the gene structure of the virus, along with its source. 

2009: Swine flu

U.S. cases: 60.8 million

U.S. deaths: 12,469

The swine flu, also known as influenza A (H1N1)pdm09, was declared a pandemic June 11, 2009, and officially ended Aug. 10, 2010, according to the CDC. Globally, an estimated 151,700 to 575,400 people died from swine flu in the first year of the pandemic. 

The outbreak forced hospitals to dust off emergency preparedness plans and reconfigure inpatient surge plans. Amid the outbreak, the nation focused on scientific breakthroughs while failing to ensure adequate infection control and hygiene practices that could have slowed the pandemic, according to a 2011 report in Emerging Health Threats. Furthermore, vaccines were produced only after the epidemic ended, proving of little efficacy, while mass population strategies misused scarce medical resources.  

2014: Ebola

U.S. cases: 11

U.S. deaths: 2

The 2014-16 Ebola outbreak originating in West Africa had an average fatality rate of around 50 percent, according to the World Health Organization. Worldwide, there were 28,652 suspected or confirmed cases amid the outbreak, along with 11,325 related deaths, the CDC reports.

In the U.S., the CDC designated 35 hospitals as Ebola treatment centers to provide more intensive care in isolation, according to Time. The negative pressure units used when treating patients with Ebola are now being used amid the COVID-19 outbreak. 

In 2014, 71 percent of U.S. hospital administrators said their facilities were unprepared to receive Ebola patients, according to a 2018 report from HHS' Office of Inspector General. By 2017, only 14 percent of hospital administrators said their facilities were unprepared for patients with an emerging infectious disease. Hospitals had updated emergency plans, purchased additional supplies and conducted EID-focused drills.  

President Barack Obama's White House established the National Security Council Directorate for Global Health Security and Biodefense after the outbreak, according to The Washington Post. The committee used government resources to prepare for an upcoming disease outbreak and prevent it from becoming an epidemic or pandemic. The committee was disbanded in May 2018 under the Trump administration, though biological experts do remain in the White House.

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