Our Silly National Conversation On Ebola

Ebola-story

I have been pretty active discussing our national response to the Ebola threat over the past month on various social media outlets, but have refrained largely from writing a more extensive explanation of my thought processes here.  There were two good reasons for that: one, I didn’t think I had anything unique to add; and two, because people were largely being rational about the discussion, after the debate was over.

This last week, however, the Ebola discussion has entered a new level of silliness.

I guess it was to be expected, with the midterm elections approaching, but the political partisanship now permeating the Ebola debate hit a new peak this week.

This largely started with the events of last weekend. On Friday, New York Governor Andrew Cuomo and New Jersey Governor Chris Christie, a Democrat and Republican respectively, decided that it was time to respond to the Ebola threat.  This was instigated by the discovery of a Ebola infected physician living in Manhattan, who had been traveling around the city with little or no supervision.

In response, Cuomo and Christie instituted a universal quarantine for all health care workers who had come in contact with the Ebola virus in West Africa.

The reaction was swift and loud, both in the media, medical and in political circles.  The White House, with personal telephone calls from President Barack Obama, lobbied Gov. Cuomo to reverse his policy.

This left Chris Christie holding the bag on Sunday morning, just as he was on numerous Sunday talk shows defending his bipartisan joint position.

The media, as it is wont to do, made Christie out to be the villain. This was compounded by the story of Kaci Hickox, who had the unfortunate bad luck to be the first person apprehended under the new policy. She was quickly quarantined in an unheated tent at a New Jersey academic center.  Hickox proceeded to make her case on social media, and successfully convinced people who the policy was ill-conceived.

Now, during this entire episode, I was on social media criticizing the quarantine as well (for reasons I will describe below).  However, the events of this week would just show how silly the conversation has become.

On Wednesday, the Defense Department announced that all military personnel serving in West Africa on Obama’s Ebola mission…would be quarantined for 21 days upon their return to the United States.

The point of this is not to attack the President or the Governors.  It is to show how non-scientific the discussion has become.  If we were basing this discussion on the best science medicine has to offer, neither quarantine makes much sense.

Note that the Obama Administration’s quarantine decision has no scientific support either; but there was virtual silence from the media on this.  In fact, some liberal commentators tried to argue that Obama’s policy somehow was scientifically superior to Christie’s…for reasons reasons I cannot fathom.

Instead of simply admitting that Secretary of Defense Chuck Hagel and the Obama Administration made a blatant, political decision similar to governors in Republican and Democrat states such as New York, New Jersey, Minnesota, and recently California, people were trying to cover up the decision under some vague blanket of ‘science’.

See Obama’s own explanation of the difference:

“Well, the [U.S.] military is in a different situation, obviously, because they are, first of all, not treating patients,” the president said. “Second of all, they are not there voluntarily, it’s part of their mission that has been assigned to them by their commanders and, ultimately by me, the commander-in-chief.

“We don’t expect to have similar rules for our military and as we do for our civilians. They are already, by definition, if they’re in the military, under more circumscribed conditions,” he added.

If anything, this is an argument against the quarantining of soldiers, and in favor of quarantining of civilians.  Our returning civilians are far more likely to have come in contact with Ebola patients than the military personnel.  Once they return, the military personnel largely would be living on base, and could easily be sequestered and watched, unlike civilians.  As for ‘voluntary’…isn’t our entire military a voluntary force?

Simply put, Obama’s explanation doesn’t meet the smell test.  He is not making a rational, medically sound decision here; his making a blatant, politically based one, no different from Govs. Christie and Cuomo did.  Furthermore, the media focus on Christie shows a blatant bias, when Democrat governors in many states, including Minnesota and California, have done exactly the same, without any of the same level of scrutiny.

So, medically speaking, why doesn’t  a quarantine make sense? There have been several excellent articles on this subject that are linked here.   But here is a brief synopsis.  Simply put, quarantine is useful in diseases that are highly virulent, airborne, spread quickly, are infectious even when patients are not necessarily symptomatic, and have a high mortality rate.   Other than the last, Ebola does not fit with any of these criteria.  Ebola is virulent, but only upon contact with fluids.  It is infectious usually only upon the arrival of symptoms.  It does have a high mortality rate if not treated, but recent successful treatment in the U.S. makes some experts wonder if early and aggressive hydration and treatment can greatly reduce the 50% mortality rate we have seen in Africa.

However, I and others have been critical of the Centers for Disease Control and others in their approach to handling this outbreak.  There are many proactive policies short of quarantine that could have been put in place much earlier that would not only have medically made sense, but also would have increased the public’s faith in the government’s ability to confront the disease.

For example, as early as August I suggested a regimen where the CDC would closely monitor all individuals who had been to afflicted countries in west Africa, as well as any other individuals who had come in contact with Ebola infected patients.  The CDC finally accepted such a regimen last week, where they recommend twice daily monitoring by local public health officials.  Their guidelines also suggest strict restrictions to travel and other public exposure, which would have greatly limited the public’s distrust that built after the stories about the nurse traveling on a commercial airliner to Cleveland, as well as the more recent story of the physician in New York City.

Frankly, however, these criticisms are minor.  I believe Dr. Tom Frieden and the CDC have almost totally been correct in their medical advice.  It is only in their handling  of public relations and instructions to the public where I have been highly critical.   Recent CDC adjustments to earlier vague and ill-advised recommendations make me believe they are on the right track, and recent public polls reaffirm that these changes have helped rebuild the trust with the public that was lost earlier.

I do think the administration, as well as both political parties, would serve the country well by avoiding politicizing any of these issues, but that is probably wishful thinking.  I would rather not discuss the President, or any Governors, when discussing what the proper handling of these public health issues should be.

I also think that those that discuss these issues should hold all public officials to the same standard.  If quarantine doesn’t make sense for civilians, there is no scientific or medical reason to institute one for military personnel.  Having two standards, regardless for the rationalizations given, further confuses the public, and to most laymen, makes them think that politicians are willing to expose the public to a double standard only because of political considerations, instead of a consistent medical standard based on the best evidence available.

Additionally, if we could move past the politics, there are many serious issue regarding the Federal and State powers in regards to quarantines that is worthy of discussion.  Who retains what power to quarantine?  When is the reasonable time to enforce that power?  If medical science is uncertain about the virulence or threat of a disease, does that give the state-wide latitude in the power it wields?  What recourse and judicial oversight should exist?  And should there be a uniform standard nationwide?  These are all legitimate arguments we should be having, but instead, we have entered a political silly season on the subject.  Fear mongering and hyperbole largely preclude us from having these serious conversations.

This is some what a repeat of the entire discussion surrounding travel bans.  I have stated that a complete travel ban is counterproductive and inefficient.  At the same time, I think a partial travel ban (or if you prefer another term, travel restrictions) could prove useful to limiting the spread of disease, and also allowing us to track civilians that have the potential to spread the disease better. There is a reasonable middle ground to be had here.

One final point that I have been thinking extensively about: in many ways, we are lucky that this major test of our public health system came with the Ebola virus, and not some of the alternatives.  As a slow-moving, non-airborne virus that apparently can be treated with supportive treatment alone, the public health system was able to make mistakes and not suffer huge consequences for it.  The same would not be true of a potential airborne, virulent, deadly virus, which could quickly move through certain populations before hospitals and health care workers could find the proper footing to react to the crisis.  This is not some fictional, ‘Hollywood’ scenario either.  Every few decades or so, the world is confronted with pandemics that stretch the ability of governments to react.  It was true with the Spanish Flu pandemic of 1918, and was true many times before, going all the way to the Black Death of the plague in Europe.

Centers for Disease Control, the National Institutes of Health, the Department of Homeland Security, and others should learn their lesson here: when new, potentially dangerous infections reach our shores, public health officials should react quickly and forcefully to stomp out the threat.  In the case of Ebola, the CDC was for weeks reacting to events rather than proactively getting ahead of events.  Instead of taking decisive action, even if those actions were over-cautious in nature, we left ourselves open to creating wider epidemic, while at same time sowing distrust in the general public.  Ebola is not a threat that had the potential to spread in that manner, but the next new disease might.  The lessons we learn today should be implemented to avoid the same mistakes in the future.

And that is a rational, scientific, medically relevant discussion the nation really should have.