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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

“Losing Services Of Many People”: The Media’s Overreaction To Ebola Is Sending A Chill Through My Coworkers At Doctors Without Borders

One of my colleagues is ill with Ebola that he contracted while working in West Africa for Medicines Sans Frontiers, otherwise known as Doctors Without Borders. Dr. Craig Spencer is having a hard enough time fighting the disease, but it’s only been made worse for him and his family by the criticism and outrage that was heaped upon him by the press, including The New Republic. It has sent a chill through other MSF field workers, whose job is challenging enough without the added burden of facing similar treatment upon return home.

It is neither fair nor accurate to accuse Dr. Spencer of moral failings for not quarantining himself on his return. He did not run about New York while “sick,” as Julia Ioffe contends, and did not put people in danger. As has been made clear since the beginning of the outbreak, only people with symptoms can transmit Ebola. At the first sign of illnessa fever on October 23, when he still would have represented only a minimal risk of contagionhe contacted the MSF office, which then alerted city health authorities. He was then taken directly to Bellevue Hospital, well before he posed a threat to the public.

Armchair physicians note that a couple days before this, Dr. Spencer was feeling “sluggish.” This is not the onset of Ebola, this is the normal condition of those who have been working around the clock for weeks in a stressful setting prior to travel across several time zones. Nor should one read into his abstaining from work a need to protect his patients. He needed rest. MSF advises all aid workers back from the field to get rest before going back to work, and it goes further with people working in Ebola projects, mandating that they not return to work for three weeks to reduce their exposure to sick people from whom they might catch something that might be confused with Ebola and cause unnecessary alarm.

Howard Markel implies that Spencer presumed he would never get Ebola and therefore took a risk with himself and others. MSF does not send people like that to the field. Everyone who departs on an Ebola mission with MSF is made very aware of the risks involved and how to manage them. What’s more, Dr. Spencer worked with a team that had seen people dying from Ebola every day, and this includes MSF staff. MSF has lost thirteen staff members during this outbreak, and two international staff members like Dr. Spencer had to be evacuated from the field after contracting Ebola. No one who works for MSF in the field thinks Ebola could not happen to them or is unaware of its risks to others. No one.

Noam Scheiber is mistaken in writing that “it’s become our policy in this country to quarantine anyone who had direct contact with an Ebola patient.” This was not federal or state policy when Scheiber wrote his story, nor is it MSF policy. If the public feels that things should have been done differently, they should direct their complaints at MSF, not at Dr. Spencer. We are happy and ready to have this conversation. MSF have been bringing people back from Ebola outbreaks for almost 20 years, and we have an evidence-based policy for how they should protect the public on their return; it does not involve self-quarantine. The World Health Organization does not mandate quarantine for their staff, either. Nor does the CDC feel this is warranted. Only now, after Dr. Spencer’s diagnosis and the excessive reaction to it, are some states beginning to require this, even though public health experts know this is a bad idea. Our colleague Kaci Hickox had the misfortune of arriving back in the U.S. just as the new quarantine requirement was announced, and her haphazard and harsh treatment will not be encouraging to others.

Thus far, MSF has had great fortune finding people willing to go to West Africa to fight Ebola. They have set aside fears, reassured their families, and obtained leave from their ordinary responsibilities to join us. This speaks to the character and commitment of the people who work with uspeople like Dr. Spencer and Kaci Hickox. If they are discouraged by the prospect of three weeks of near total isolation on their return, we may lose the services of many good people. That will damage the effort to counter the outbreak at its epicenter, which remains the best way to protect the public at large, in any country.

 

By: Dr. Armand Sprecher, Public Health Specialist at Médecins Sans Frontières in Brussels; The New Republic, October 30, 2014

October 31, 2014 Posted by | Doctors Without Borders, Ebola, Health Care Workers | , , , , , , | 1 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

“The Real Chris Christie”: A Power-Hungry Demagogue Indifferent To Truth

Cgovernor’s behavior even more despicable is the way Christie’s response to his critics revealed that, for him, the relevant criteria have precious little to do with public health. In a circumstance like this, during which the public’s degree of knowledge about a threat is paltry when compared to its capacity to freak out, a politician interested in displaying real leadership — the one attribute the very serious among us have decided is most vital, and one Christie has implicitly claimed for himself on multiple occasions —  would work to educate the people and maintain calm and order. Perhaps mindful of the way that this undramatic style will lead to vapid, narcissistic criticism from a press corps hungry for a flashy headline, the ever media savvy Christie has decided to go in the opposite direction.

“My first and foremost obligation is to protect the public health and safety of the people of New Jersey,” Christie said, defending his grandstanding and obscuring the fact that his actions were contrary to those recommended by experts in the field of public health. “So I’m sorry if in any way [Hickox] was inconvenienced, but the inconvenience that could occur from having folks who are symptomatic and ill out and amongst the public is a much, much greater concern of mine.” As if to make sure everyone could hear the subtext of these remarks — that Hickox was somehow acting fecklessly, despite the fact that she followed normal procedure and determined she was not an Ebola carrier — Christie added, citing no evidence whatsoever, that Hickox was “obviously ill.”

To her credit, Hickox fired back and reminded CNN viewers that Christie is not a doctor, had “never laid eyes on her,” and that she’d been asymptomatic since she arrived back in the States. And if Christie were taking his job as governor seriously, you’d figure her comments might make a dent. But as has been obvious since at least year two of his first term, Chris Christie’s overriding priority has little to do with running New Jersey and everything to do with getting himself elected as president of the United States. Keenly aware, as he no doubt is, that this will be a tall order so long as the GOP’s Tea Party base holds him in contempt, Christie is treating the Ebola, which the GOP base fears disproportionately, as an excuse to differentiate himself from someone Tea Partyers hate even more: President Obama, whose response to Ebola hysteria has, from the start, been a model of responsibility.

By that standard, Christie’s been an overwhelming success. The national discourse on Ebola is dumber, more hysterical and more politicized today than it was just 72 hours ago; and it’s primarily Christie (with an assist from the aforementioned Cuomo) whom the Tea Party should thank, and the rest of us should blame. In the pursuit of winning over a chunk of voters he’ll need to accrue further power, Gov. Christie has stoked irrational fear, demonized a member of a politically unpopular group (Ebola-fighting doctors and nurses) and added heft to some of the most rabid conspiracy theories of a Democratic president lying about a lethal threat for short-term electoral gain. This supposedly brave speaker of truth is reaching out to some of the worst forces in American politics, and he’s telling them malicious nonsense. Why? Because he knows that’s exactly what they want to hear.

 

By: Elias Isquith, Salon, October 27, 2014

October 28, 2014 Posted by | Chris Christie, Ebola, Media | , , , , , , , , | 2 Comments

   

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