Bleeding Hearts

First the NBC health reporter, Dr. Nancy Snyderman, and her crew whose cameraman had come down with Ebola in West Africa broke quarantine to travel to a fast-food restaurant in New Jersey. Then a nurse who treated the Ebola patient Thomas Duncan in Dallas traveled to Cleveland and back by plane even after she detected a low-grade fever which later turned into Ebola. Then a medical clinician who had handled bodily fluids from Ebola patient Duncan in Dallas took an ocean-liner cruise to the Caribbean that cost thousands of passengers their vacations when it was forced to return to port.

Next the doctor who came back from West Africa with a case of Ebola initially lied to police about his activities in New York City … see: New York Post Story. Now the nurse who also returned from West Africa after volunteering to treat Ebola patients there is refusing to observe her quarantine in Maine … see: CBS Story.

What is it about these people … professionals all? Can they not give up twenty-one days of their lives so that their fellow citizens can remain a wee bit safer from this dreaded disease? Have we become such a selfish, me-centered country that so many professionals irresponsibly ignore what appears to be rational public-health policy? Are their neighbors just as worthy of their empathy as those who are already sick? And how can our president encourage such bad behavior on the part of our citizens’ (but not our soldiers’) parts? His logic and that of the CDC and NIH appears to this observer to be so convoluted as to be silly … see: Logic is Logic.

Do liberals somehow lose all their gray matter when their hearts start bleeding?

Afterward: Just heard the president talk on the Ebola crisis ... and imply that anyone, who is in favor of a 21 day quarantine for workers who has been in close contact with Ebola patients, does not appreciate the sacrifice that they have made ... and will discourage others to do the same. Our president's brain must be miswired in that he cannot hold both thoughts at the same time. Clearly these volunteers are wonderfully fine people ... but they still should be quarantined for the safety of their friends and neighbors.

The president also mentioned that Nigeria and Senegal are now free of Ebola. What he neglected to note was that these two countries (and many other African nations too) have closed their borders to the three raging Ebola-infected West African nations.

By the bye, California has just instituted this same 21-day quarantine for returning health-care workers ... see: LA Times Article. (Look out Jerry Brown!)

Mr. X

Emory University Hospital in Atlanta Georgia has treated and released an anonymous male Ebola patient this past Monday. This is independent of the known treatments of the high-profile nurse Vinson from Dallas who contracted Ebola from the Liberian national Thomas Duncan and two American aid workers, Dr. Kent Brantley and Nancy Writebol, who were treated and released in August. This Mr. X apparently might also have been an aid worker who contracted the virus in West Africa, but, according to other reporting, even this is not totally clear … see: Washington Post Story .

Hmmm? This news has peaked my curiosity … why all this government secrecy? How can our government surpress this news? Is this patient an American? Might he have contracted this virus in this country? How did he get Ebola? Have all the people he was in contact with before he was hospitalized been notified and/nor quarantined? How have this patient’s treatment expenses been covered? Could this Mr. X be just the first of many outreach patients as were reported on in this news article: Washington Examiner Story?

Hopefully, we will soon find out the answers to these and many other important public-health questions.

Torn

Yes, I have praised President Obama for his humanitarian decision to send U.S. troops to West Africa to help combat the Ebola epidemic … possible pandemic … see: Ebola. But subsequent events have led me to have some misgivings about this decision. Now, I read that the troops being sent there … 4,000 before its all over … are elite soldiers from the 101^st Airborne Division … see: Pamela Geller Blog.

To me this seems a curious choice … and so my growing doubts about this mission are re-enforced. Clearly this disease is more easily transmitted than we have been previously led to believe ... and the living conditions in an Army bivouac camp are far less sanitary and controllable than in the Dallas Presbyterian hospital.

Is President Obama purposely trying to punish these solders by sending them on a mission for which they seem unsuited and untrained. It is almost a certainty that one or more of them will contract this dreaded disease while there … a far less soldierly fate than being shot at by a RPG. Does Obama have a hidden agenda to this deployment as suggested by Pamela Geller in the above referenced article?

As a result of my current chariness about our fearless leader's decision, I offer three rational suggestions for this mission:

1) All the American soldiers that go to West Africa should be volunteers … and that they should be thoroughly trained beforehand in the hazards of Ebola … with an opting-out choice at the end of this training.

2) Tours of duty there should be no longer than two months … without any re-deployments … and with one month of quarantine on a remote tropical island before returning home. Any soldiers who contracts this disease should be flown back to the U.S. for premier treatment.

3) Like any good commander, Obama should spend two or three days there with his troops … once fully deployed. Leaders should never ask their troops to do anything that they themselves would not do.

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.

Ebola

Chris Matthews, of all people, is questioning our president’s assurances that it was unlikely that we would have a case of Ebola originating here in the United States … see: Real Clear Politics. Now we have … and Obama’s acolytes (like Dr. Ezekiel Emanuel) are still assuring us that everything is contained and will be OK. I do hope so and am somewhat inclined to give the president the benefit of the doubt. 

However, I have less confidence that, once the thousands of our military personnel are returning ... who we have sent to the west of Africa ... that things will be still be so rosy. Another eminent doctor, Dr. Benjamin Carson, has expressed doubt that we are handling this potential major epidemic correctly … see: Breitbart Story.

British Airways has shut down all flights in and out of these Ebola infected countries in Africa through the end of the year … see: Washington Examiner Story . I do wish that our president would step up and explain why we haven’t done the same thing.