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“A Public Health Triumph”: Republicans Call Ebola A Federal Government Failure. It’s Exactly The Opposite

If you live in a state with a competitive Senate race, chances are you’ve seen an ad recently that told you to vote Republican because of Ebola. According to the media tracking firm CMAG (reported here by Bloomberg), there has been a significant increase in Ebola-themed ads in the race’s final days.

These ads are meant to stoke a general sense is that the world is spinning out of control, and only a Republican Senate can save us. As conservatives like Charles Krauthammer have argued: “Ebola has crystallized the collapse of trust in state authorities,” showing us that the Obama administration is too incompetent to handle the dangers confronting us.

But what if Ebola demonstrates exactly the opposite?

Imagine that a year ago, I told you that a few months hence, west Africa would see the largest Ebola outbreak in history. Then I explained that despite regular travel in and out of the affected countries by health professionals and ordinary people, there would be a grand total of two — not two hundred, or two thousand, but two — Americans who contracted the disease here, and both of them would be nurses who had treated a dying patient who had contracted the disease in Liberia. And I told you that both of them would be treated, and would survive and be healthy. If I had told you that a year ago, would you have said, “Wow, that sounds like a gigantic federal government failure”?

Of course not. You’d say that sounds like a public health triumph.

To be clear, I’m not arguing that there have been no mistakes. In the early days, the CDC didn’t offer clear enough guidance on prevention measures for health care professionals, which is what made it possible for those two nurses to become infected. But if you actually look at the facts, the disease has been completely prevented and contained here in the United States. It makes you wonder what the administration’s critics are talking about when they cry that the government has failed.

And right now, while the federal government is proceeding in a methodical, sober fashion to keep the disease contained, it’s state governments that are acting like fools. Governors Andrew Cuomo and Chris Christie first announced that health care workers returning from the affected countries would be quarantined for 21 days, and Christie essentially imprisoned one nurse at Newark airport. Then, when they came under withering criticism from people who actually have some expertise in this subject, they changed the policy to request that those workers quarantine themselves in their homes.

The nurse held in New Jersey, Kaci Hickox — who has no Ebola symptoms, shows no sign of being infected, and poses no danger to anyone — returned to her home in Maine and is now fighting with Paul LePage, perhaps America’s most buffoonish governor, over whether she should be confined to her home against her will. You wouldn’t trust LePage to help your third-grader with his math homework, but he professes to know something about this disease that actual public health specialists don’t.

I have little doubt that the GOP fear-mongering on Ebola will be effective in these elections, at least to some degree. People are easily frightened, and it’s always easier to get them to vote on their fears than on the facts. But if you look objectively, it’s hard to reach any other conclusion but that the federal government has done quite a good job protecting the public from Ebola.

 

By: Paul Waldman, Contributing Editor, The American Prospect; The Plum Line, The Washington Post, October 31, 2014

November 3, 2014 Posted by | Ebola, Public Health, Republicans | , , , , , , , | Leave a comment

“Forcible Isolation”: Are Mandatory Ebola Quarantines Legal?

The coercive mandatory quarantine of Kaci Hickox, the nurse placed in what amounts to Ebola jail after returning to the United States from West Africa, raises troubling questions about the power that state and federal governments have to forcibly isolate individuals.

Hickox, who told CNN that her “basic human rights have been violated,” was only released Monday, two days after testing negative for Ebola. While quarantined, she was seemingly powerless to challenge her banishment to a tent in Newark.

The nurse’s treatment, as well as the quarantine policies of New York and New Jersey, have been roundly criticized as heavy-handed. A top National Institutes of Health official called the quarantines “draconian.” And former Ebola patient Rick Sacra, a doctor infected in Liberia, likened the mandatory quarantine for returning health-care workers in New York and New Jersey to a “police state approach.”

So is it legal for the government to quarantine individuals or groups of people?

State and federal officials do have the power to quarantine or isolate individuals suspected of having an infectious disease, according to a dizzying patchwork of laws. But beyond the general authority, there are many questions about how quarantines should be implemented.

At the federal level, much remains undefined defined: What would be the basis for quarantining individuals? Where would they be quarantined? What recourse would they have to prove that they should be eligible for release? What access to communications would they be given during quarantine?

“I’ve long been concerned about the quarantine authority because it is so broad, not easily subject to challenge, and exceedingly absolute,” Scott Gottlieb, a physician and a fellow at the American Enterprise Institute, told The Daily Beast.

Gottlieb, who served in the Food and Drug Administration under President George W. Bush, had a hand in a previous effort to set out clearer parameters for quarantine policy.

New quarantine regulations were proposed in 2005, amid fears of the pandemic flu and bioterrorism.

Those rules compelled airlines to keep records that would allow health officials to keep track of passengers. They also introduced the concept of a “provisional quarantine” that would have allowed the federal government to detain individuals for up to three days, with no method for appeal, if the Centers for Disease Control and Prevention believed that a person was infected with certain illnesses.

“It didn’t work because once you start to debate these things, people were so uncomfortable about the answers to these questions they decided not to answer them,” Gottlieb said.

The rules were withdrawn in 2010 by the Obama administration, after civil-liberties organizations protested and airlines complained about compliance costs.

Today governments have the right to put individuals in quarantine before they have the right to argue that they shouldn’t be placed there. Suspicion of exposure to Ebola, for example, is sufficient to justify mandatory isolation.

“That is lawful due to the sheer nature of public-health powers,” said James Hodge, a professor of public-health law at Arizona State University. “You don’t have to let them off the plane, circulate around… and then proceed to a courthouse… You can isolate now and provide due process after.”

The federal government is responsible for quarantining individuals traveling from outside the United States or between states, while state and local governments have control over individuals who are traveling only locally.

The nurse who had traveled to West Africa to fight Ebola became caught up in the quarantine policies issues by the state of New Jersey. She was held in a presumptive quarantine that rounded up an entire class of people—in this case health-care workers who battled the infectious disease in a hot zone—and forcibly segregated.

Overreaction is still a concern that worries public-health experts. For Gottlieb, the disaster scenario is an outbreak of an infectious disease in a major city that overwhelms local health authorities, who then quarantine dozens or even hundreds of people in crowded facilities.

“That’s not far-fetched,” Gottlieb said. “In that kind of scenario, they will over-quarantine people.”

There are still legal limits to how far quarantines could extend. Entire towns or neighborhoods could not be targeted for quarantine, Hodge said.

“Courts have been very reticent to let health authorities at any level to simply rope off a community,” he told The Daily Beast, adding that exposure does not mean simply proximity to infected individuals. “Just because you’re in the vicinity of someone who was infected doesn’t mean you’re exposed.”

Quarantining passengers who have been exposed to a dangerous infectious disease on a plane or a group of children who have been in the same classroom with an infected patient, for example, would be situations with stronger legal standing.

In order to maintain constitutional compliance, Hodge explained, the quarantine or forced isolation needs to be limited to those who were infected or known to be exposed to Ebola; the quarantined individuals need to have access to due process; and the government needs to justify the restrictions placed on these individuals.

Legal challenges to quarantine also could be based on these standards. The recently released Hickox is considering suing over her mandatory quarantine, her lawyer’s office told The Daily Beast on Monday. If she files a lawsuit, the New Jersey state government would have to defend its actions and perhaps, in the process, come up with improved quarantine protocols.

 

By: Tim Mak, The Daily Beast, October 28, 2014

November 1, 2014 Posted by | Ebola, Mandatory Quarantine, Public Health | , , , , , , , | 1 Comment

“Stop Bashing The CDC”: Government Is The Enemy Until You Need A Friend

After a rough start dealing with America’s first Ebola cases, the Centers for Disease Control and Prevention appear to be getting the problem under control. This doesn’t mean that there won’t be more incidents; a health care worker was diagnosed with the virus in New York yesterday after returning from West Africa. But the CDC now seems better able to control secondary infections, particularly among health care workers, who are at the greatest risk.

As the 21-day incubation period lapses without new infections in Texas, dozens of people are being cleared from the watch list. But Ebola lingers as a reminder of how easily safety organizations can weaken and what we must do to keep them effective.

“Government is the enemy until you need a friend,” said former Secretary of Defense William Cohen. Government organizations like the CDC, the Army Corps of Engineers, the Federal Emergency Management Agency and the Federal Aviation Administration exist mostly to be our friends when we need protection from harm.

Unfortunately safety organizations like these don’t get much love in between disasters. They get attacked by those who covet their budget. They get attacked by those who hate government in general. They get attacked by corporations that don’t want to spend the money to comply with regulation. And they face political pressure to paper over potential problems that could embarrass some elected official. It’s hard to retain talent under conditions like that.

When we don’t take care of our safety organizations and don’t listen to them, they atrophy. Then disasters happen, and whoever is on watch ducks the blame. The person on watch always uses words like “Nobody could have foreseen …” For example: “Nobody could have foreseen” that the Army Corps’ levees in New Orleans would crumble during Hurricane Katrina. “Nobody could have foreseen” that terrorists might hijack an airplane and fly it into a building on 9/11. “Nobody could have foreseen” that dismantling Glass-Steagall Act protections would lead banks to gamble with taxpayer-guaranteed deposits. Not true. In most cases, agency staff anticipated the problem and tried to warn their bosses, but the boss didn’t pay attention because it was politically inconvenient or too expensive.

Frankly it’s a wonder that our safety agencies work as well as they do. The CDC is a case in point; they got many things right after their original poor response:

  • They quickly acknowledged that procedures were not working.
  • They didn’t circle the wagons. They listened to international medical organizations that had more experience in handling Ebola in the field.
  • They rapidly rolled out new procedures and equipment for protecting staff and training people in the proper use of the equipment.
  • Without succumbing to hysteria and political pressure, they updated travel regulations to ve rify the health of travelers from Africa while allowing essential aid workers to move unimpeded.

CDC did not do what so many agencies and private sector entities do in similar situations: Deny the problem, conceal data, refuse to change and retaliate against critics. The CDC responded and recovered more quickly than most. For example, they responded even more quickly than the U.S. Army did in giving our troops adequate protection against improvised explosive devices in Iraq.

Whatever the mistakes of government safety organizations, private sector safety organizations – the ones that exist inside corporations – are often much, much worse. Halliburton Co. and their contractors undercut internal safety processes in the prelude to the Deepwater Horizon disaster, and four years later, they’re still fighting over who’s to blame. American International Group Inc.’s internal risk-management processes failed dismally in the subprime mortgage crisis, and rather than accept responsibility, they’re still arguing over the terms of the taxpayer bailout that saved them from bankruptcy.

Fast recovery is perhaps the best we can realistically ask of any safety organization, public or private, which faces infrequent, catastrophic risks. If we want these organizations to do the job, we need to treat them right. We need to give them the budget they need to conduct drills and stay sharp. We need to give them professional leadership and not put political appointees in charge. And we need to drop the hypocrisy of treating them as the enemy in between those rare but inevitable moments when we need them to save us. Far from failing, the CDC performed well under the circumstances. We won’t always be so lucky.

 

By: David Brodwin, Economic Intelligence, U. S, News and World Report, October 24, 2014

 

October 29, 2014 Posted by | CDC, Ebola, Federal Government | , , , , , , | Leave a comment

“Christie’s Questionable Judgment”: The Curious Case Of Kaci Hickox’s Quarantine

On Friday, Kaci Hickox, a Doctors Without Borders nurse, arrived back in the United States after helping treat patients in West Africa. It was not a happy return: after arriving at an airport in New Jersey, officials put her in quarantine.

Hickox’s isolation is the result of a new policy endorsed last week by Govs. Chris Christie (R) of New Jersey and Andrew Cuomo (D) of New York, who announced new guidelines requiring 21-day quarantines for those arriving from West Africa – whether they’re showing symptoms or not.

The result is a scenario that seems hard to believe: New Jersey has effectively detained a nurse in a tent with no shower, not because she’s showing symptoms of the Ebola virus, but because officials fear she might at some point show symptoms of the Ebola virus.

Christie defended the mandatory quarantine, saying the nurse was “obviously ill.” This was apparently obvious only to the governor – who has no background in medicine or public health – and was clearly not obvious to Hickox herself.

Christie boasted on one of the Sunday shows yesterday, “I absolutely have no second thoughts about it,” adding that he expects his policy to soon become “a national policy.” A few hours later, however, second thoughts emerged.

Facing fierce resistance from the White House and medical experts to a strict new mandatory quarantine policy, Gov. Andrew M. Cuomo said on Sunday night that medical workers who had contact with Ebola patients in West Africa but did not show symptoms of the disease would be allowed to remain at home and would receive compensation for lost income. […]

After Mr. Cuomo’s announcement, Mr. Christie issued a statement saying that, under protocols announced on Wednesday, New Jersey residents not displaying symptoms would also be allowed to quarantine in their homes.

The shifts came on the heels of White House pressure on Cuomo and Christie, urging them to adopt policies more in line with science. It’s unclear whether the revised approach will allow Hickox to leave her state-mandated tent.

There are a few angles to this to keep in mind, not the least of which the dubious legality of New Jersey imposing a mandatory quarantine on a woman who’s reportedly asymptomatic. Forcing medical professionals to remain in their homes for 21 days is marginally better, at least with regards to their personal convenience, but remains problematic. Indeed, by the same reasoning, states would have to impose similar penalties on doctors and nurses treating an Ebola patient in the United States.

Dr. Anthony Fauci, the top Ebola expert at the National Institutes of Health, warned on “Meet the Press” yesterday of “unintended consequences” – the more we discourage public-health workers from treating Ebola patients, the worse the threat becomes.

This isn’t complicated. The best way to deal with Ebola is to treat the problem at the source: West Africa. There are American medical professionals who are willing to make an enormous sacrifice by traveling abroad to address this crisis, but if the United States discourages them, they’ll help fewer patients, the virus will spread, and the threat will become more severe.

In other words, a policy intended to keep Americans safe will likely put Americans at greater risk.

As for the politics, about a week ago, Christie seemed eager to be one of the more sensible voices in his party, warning of unnecessary “hysteria” surrounding Ebola. To be sure, the governor hasn’t devolved into Rand Paul-esque nuttiness, but Christie unilaterally locking up a healthy nurse for three weeks raises credible questions about his judgment.

 

By: Steve Benen, The Maddow Blog, October 27, 2014

October 29, 2014 Posted by | Chris Christie, Ebola | , , , , , , , , | 1 Comment

“America The Whiny”: Everyone Blames Everyone For An Ebola Disaster That Has Yet To Occur

Is there absolutely nothing left in this country that we can take on as a nation without someone heading for the nearest cable TV news studio or on-line publication to lay the blame for our latest problem on the President, the government, racism or some other convenient entity?

Yes, we know there were mistakes made at Texas Health Presbyterian Hospital who sent Thomas Eric Duncan home upon his initial visit where he complained of symptoms that turned out to be the earliest stages of an Ebola infection.

The result for Mr. Duncan was tragic. But with just one human having passed away in the United States as a result of the Ebola virus, does the situation truly merit the whining and blaming that is now very much underway?

Sadly, the public dialogue, in this instance, began with cries of racism alleged by Mr. Duncan’s nephew—allegations quickly adopted by others despite there being no proof that racism played a role in any way whatsoever.

It is certainly true that an error was made when Mr. Duncan was sent home with a 103 fever, despite having informed the receiving desk at the ER that he had come to Dallas from Africa. It is also just as   true that hospital error is estimated to cause some 210,000 deaths per year in this country, involving victims of all races.

Still, we know that blood tests were performed on Mr. Duncan in the emergency room on the day of Duncan’s first arrival. We know that he was not simply given an aspirin and a prescription for antibiotics and sent on his way without a full exam and a blood panel in order to hold down the price tag to the hospital or in response to his not mattering because of skin color.

I’ve shown up at an ER with a high fever and feeling quite badly. I was given an exam by the attending physician who also took a blood panel. After six hours, most of which was spent waiting to see the Doc, I was sent home with an antibiotic, told to drink lots of liquid so I would not become dehydrated and told to stay down for a few days.

Never was it contemplated that I be admitted to the hospital for what appeared to be a bad case of the flu.

Unfortunately, because the receiving desk at the hospital did not communicate to the physicians that Duncan had recently arrived from Africa, despite having been given this information, his blood tests did not include an Ebola test and he was treated just as I was when presenting with similar symptoms.

Next, contrary to what many have claimed, Mr. Duncan was given the experimental anti-viral drug, brincidofovir, shortly after his ultimate admission to the hospital. Tragically, his case was, by then, too far along for the drug to have a positive impact.

Finally, in answer to the complaint that Duncan was not prescribed a blood transfusion from one of the Americans who has survived the disease, in the hopes that the antibodies in the donor’s blood would be of assistance, this allegation turns out to be untrue. Unfortunately, the donor blood type did not match Mr. Duncan’s type, taking the possibility of such a transfusion off the table.

Accordingly, for someone to assert that racism or lack of health insurance was at work here, one would have to determine that racism or health insurance played a role in the communication failure that kept the treating physician(s) from considering Ebola as a possibility.

I don’t know about you but that seems like quite a stretch to me.

Aside from the actual evidence that would argue against a racial bias in this instance when it comes to the best possible treatment, there is a strong, compelling and virtually irrefutable logic to the argument that Thomas Duncan was not treated differently because of either race or a lack of health insurance.

One can reasonably assume that most everyone who was working at Texas Health Presbyterian on the day Mr. Duncan first appeared complaining of his symptoms lives in the Dallas area—meaning that each of them, and their families, would find themselves at ground zero for the spread of Ebola due to the presence of Duncan in their area.

What’s more, as I suspect that everyone from the clerks and nurses at the receiving desk to all remaining health professionals at the hospital were quite aware that Ebola does not only spread among the same race as the initial victim, it would make absolutely no sense whatsoever to take less of an interest in one individual presenting with Ebola who might be black than it would someone who is white—unless Ebola did not cross their minds as a possible diagnosis. And if that is the case, we should all be able to agree, based on the population of West Africa, that a white person coming into the ER with the same symptoms would be even less likely to capture the medical staff’s imagination and point it towards a possible case of Ebola.

 

By: Rick Ungar, Op-Ed Contributor, Forbes, October 13, 2014

October 14, 2014 Posted by | Ebola, Public Health, Racism | , , , | 2 Comments

   

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