The US health care apparatus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clusters of cases could overwhelm parts of the system, according to an Associated Press review of readiness at hospitals and other components of the emergency medical network.

Experts broadly agree that a widespread outbreak across the country is extremely unlikely, but they also concur that it is impossible to predict with certainty, since previous Ebola epidemics have been confined to remote areas of Africa. And Ebola is not the only possible danger that causes concern; experts say other deadly infectious diseases — ranging from airborne viruses such as SARS, to an unforeseen new strain of the flu, to more exotic plagues like Lassa fever — could crash the health care system.

To assess America’s ability to deal with a major outbreak, the AP examined multiple indicators of readiness: training, manpower, funding, emergency room shortcomings, supplies, infection control and protection for health care workers. AP reporters also interviewed dozens of top experts in those fields.

The results were worrisome. Supplies, training and funds are all limited. And there are concerns about whether health care workers would refuse to treat Ebola victims. Following the death of a patient with Ebola in a Texas hospital and the subsequent infection of two of his nurses, medical officials and politicians are scurrying to fix preparedness shortcomings. But remedies cannot be implemented overnight. And fixes will be very expensive.

Dr Jeffrey S. Duchin, chairman of the Public Health Committee of the Infectious Diseases Society of America and a professor of medicine at the University of Washington, said it will take time to ramp up readiness, including ordering the right protective equipment and training workers to use it. “Not every facility is going to be able to obtain the same level of readiness,” he said.

AP reporters frequently heard assessments that generally, the smaller the facility, the less prepared, less funded, less staffed and less trained it is to fight Ebola and other deadly infectious diseases.

“The place I worry is: Are most small hospitals adequately prepared?” said Dr Ashish Jha, a Harvard University specialist in health care quality and safety. “It clearly depends on the hospital.”

He said better staff training is the most important element of preparation for any US Ebola outbreak. He believes a small group of personnel at each hospital needs to know the best procedures, because sick people are likely to appear first at medium-size or small medical centres, which are much more common than big ones.

Dr Jha pointed to stepped-up training in recent weeks but wondered, “Will it be enough? We’ll find out.” A high ranking official at the US Department of Health and Human Services said on Wednesday that the government does not expect every hospital in America to be able to treat an Ebola patient, but “every hospital has to be able to recognise, isolate and use the highest level of personal protective equipment until they can transfer that patient.”

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