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.
