Logic is Logic?

The Director of the Center for Disease Control (CDC), Dr.Tom Frieden, seemed a reasonable man. However, his rationales about banning travel from West Africa are far from reasonable. To me his logic in this matter is so flawed that I question my earlier assessment of him. Like many Obama administration flacks, he deflects the real issue into meaningless eddies. Here are his thoughts on this issue (in italics) with my comments (in bold):

The first case of Ebola diagnosed in the United States has caused some to call on the United States to ban travel for anyone from the countries in West Africa facing the worst of the Ebola epidemic.

That response is understandable. It’s only human to want to protect ourselves and our families. We want to defend ourselves, so isn’t the fastest, easiest solution to put up a wall around the problem?

But, as has been said, for every complex problem, there’s a solution that’s quick, simple, and wrong. We don't want to isolate parts of the world, or people who aren't sick, because that's going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak.

We have been more than willing to quarantine people in Dallas who came in contact with Thomas Duncan, the Liberian who recently died from Ebola. Why cannot we now err on the side of caution and expand the perimeter?

A travel ban is not the right answer.  It’s simply not feasible to build a wall – virtual or real – around a community, city, or country. A travel ban would essentially quarantine the more than 22 million people that make up the combined populations of Liberia, Sierra Leone, and Guinea.

The issue is not building a wall around these countries … it is stopping the travel from these countries into the United States. This can easily be done by not issuing any U.S. visas to anyone from these countries. This way those people trying to travel here through third countries can also be stopped.

When a wildfire breaks out we don't fence it off. We go in to extinguish it before one of the random sparks sets off another outbreak somewhere else.

Actually one effective method of stopping wildfires is to clear all fuel from downwind areas around the fire or, if the wind is right, set backfires to stop its spread.

We don't want to isolate parts of the world, or people who aren't sick, because that's going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak.

I sincerely doubt that any more Ebola patients will go underground because they can’t travel to the United States. Already, something like 50% of Ebola victims in West Africa may already be underground … see: Yahoo News. Quite the opposite, this is an even stronger reason to install a visa ban.

It could even cause these countries to stop working with the international community as they refuse to report cases because they fear the consequences of a border closing.

Great Britain and France have already installed travel bans from these countries.

Stopping planes from flying from West Africa would severely limit the ability of Americans to return to the United States or of people with dual citizenship to get home, wherever that may be.

Here Dr. Frieden is changing the subject. There is no need to stop all planes from flying out of West Africa … nor would American citizens be stopped from returning back to the U.S. since they would not need visas … but they would need to endure a more rigorous health screening.

In addition to not stopping the spread of Ebola, isolating countries will make it harder to respond to Ebola, creating an even greater humanitarian and health care emergency.

Dr. Frieden is slipping from disease control into politics. In fact, it seems to me that he is rationalizing President Obama’s irrational policy decision ... carrying his water if you will.

Importantly, isolating countries won’t keep Ebola contained and away from American shores.  Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries, and that we will have more patients who develop Ebola in the U.S

Why? Where is the data? What’s the logic?

People will move between countries, even when governments restrict travel and trade. And that kind of travel becomes almost impossible to track.

If the World Health Organization were doing its job, this would not be an issue.

Isolating communities also increases people’s distrust of government, making them less likely to cooperate to help stop the spread of Ebola.

Another logical stretch without any supporting evidence.

Isolating communities and regions within countries will also backfire. Restricting travel or trade to and from a community makes the disease spread more rapidly in the isolated area, eventually putting the rest of the country at even greater risk.

Now the word “trade” enters stage left. 

To provide relief to West Africa, borders must remain open and commercial flights must continue.

From God’s mouth to Dr. Frieden’s ear.

There is no more effective way to protect the United States against additional Ebola cases than to address this outbreak at the source in West Africa. That’s what our international response—including the stepped-up measures the president announced last month—will do.

What works most effectively for quelling disease outbreaks like Ebola is not quarantining huge populations.

What works is focusing on and isolating the sick and those in direct contact with them as they are at highest risk of infection. This strategy worked with SARS and it worked during the H1N1 flu pandemic. Casting too wide a net, such as invoking travel bans, would only provide an illusion of security and would lead to prejudice and stigma around those in West Africa.

I think that simple logic dictates that we err on the side of caution. Now it does seem that the CDC has become politicized … unfortunately.

Americans can be reassured we are taking measures to protect citizens here.

Today, all outbound passengers from Guinea, Liberia, and Sierra Leone are screened for Ebola symptoms before they board an airplane.

Symbolism only …

Staff from CDC and the Department of Homeland Security’s Customers & Border Protection will begin new layers of entry screening, first at John F. Kennedy International Airport in New York this Saturday, and in the following week at four additional airports -- Dulles International Airport outside of Washington, D.C.; Newark Liberty International Airport; Chicago’s O’Hare International Airport; and Hartsfield-Jackson Atlanta International Airport.

Combined, these U.S. airports receive almost 95 percent of the American-bound travelers from the Ebola-affected countries.

If you were trying to avoid this screening, would you enter via these airports?

Travelers from those countries will be escorted to an area of the airport set aside for screening. There they will be observed for signs of illness, asked a series of health and exposure questions, and given information on Ebola and information on monitoring themselves for symptoms for 21 days. Their temperature will be checked, and if there’s any concern about their health, they’ll be referred to the local public health authority for further evaluation or monitoring.

Did Thomas Duncan tell the truth or exhibit symptoms on his way out of Liberia? No. See my other blog discussion here: A Dilemma.

Controlling Ebola at its source – in West Africa – is how we will win this battle. When countries are isolated, we cannot get medical supplies and personnel efficiently to where they’re needed – making it impossible to fight the virus in West Africa.

I thought the issue was travel from West Africa … not to West Africa.

As the WHO's Gregory Hartl said recently, “Travel restrictions don’t stop a virus. If airlines stop flying to West Africa, we can’t get the people that we need to combat this outbreak, and we can’t get the food and the fuel and other supplies that people there need to survive.”

Citing another illogical source does not make things logical.

We know how to stop Ebola: by isolating and treating patients, tracing and monitoring their contacts, and breaking the chains of transmission.

Until Ebola is controlled in West Africa, we cannot get the risk to zero here in the United States.