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Response to Dr. Rahe: We Need Cool Heads on Ebola
I have just finished reading Paul Rahe’s post “The Centers for Disease Control Loses Its Grip.” His post — and others like it on Ricochet — and the World War III style headlines I have been seeing elsewhere, prompted me to reply.
For the last several years, we’ve been in the midst of an epidemic of zombie-related literature, films, and television. Much of it is terrible. Some of it is good. Some of it is excellent. Zombie outbreaks take the form of a disease epidemic. It’s slow burning at first, but then hits everyone like a tsunami and wipes out all of civilization.
This epidemic of zombie media taps into a fear that lingers in the back of our minds: that this level of material prosperity — never before seen in human history — must be a passing phenomenon. That the other shoe must drop at some point. It could be a war with the Russians. It might be global warming. It might be the Second Coming. It might be the zombie apocalypse. But at some point, this decadent, comfortable world of ours with its hot showers, selfies, and decadent boutique pet foods must come crashing down when everything hits the fan.
That may well happen at some point, but Ebola won’t be the cause. Ebola isn’t the super plague that is going to wipe us out. It will rage in west Africa, in the Third World, but it will not wipe out America. Ebola isn’t the Black Death. It’s not Polio. It’s not Spanish Flu.
It’s also something we understand pretty well. Contrary Dr. Rahe’s piece, Ebola isn’t some giant question mark. We know a lot about it. We know how it spreads. Insinuations to the contrary are deeply counterproductive and unnecessarily induce fear.
Ebola is a hemorrhagic fever. In its final stages, your body melts down and you begin bleeding because your organs begin hemorrhaging. It’s so horrific because you begin bleeding from your eyes, nose, mouth, and ears. Everywhere. It’s highly contagious at that point — and if you’re attending to someone in that stage — there’s a good chance you’re going to get covered in blood. That’s why you wear protective gear.
Ah, but this health care worker was wearing that gear and still caught it! They sure did. It’s easy to do.
If you’re covered in infected blood, and then take off your gear, and get a little bit on you, and unthinkingly wipe your eye, that’s contact. That’s all it takes. That’s what they call protocol breach. That’s how it happens. It’s horrible and scary, but it’s not mysterious.
A travel ban is also a terrible idea. First of all, most US air carriers stopped going to places with Ebola months ago. Second of all, in order to accomplish the goal of a quarantine effectively, you’d also have to stop flights from any place that flies to an infected country — and to be safe — from any place that flies to any place that flies to an infected country. At that point, you might as well just shut down all air travel. That is a hysterical overreaction to what we are told is a gigantic epidemic that has caused exactly two cases in the US in the ten months it’s been raging.
A ban like that has the potential to make things worse. It would make it harder for aid workers, health care workers, and anyone else who wants to help to travel to and from infected areas, ensuring that the crisis continues to burn on. It’s an irrational, unnecessary, and heavy-handed response it’s not hard to find out why.
Let’s just say this: Barack Obama is a bad president. He’s terrible at his job. Most government agencies are terrible at their jobs. But some government agencies — given and abundance of cash and talented people — can accomplish great things. God help me, but even I’ll admit that government agencies can sometimes do good work.
So, remember: unless you touch the blood or vomit of someone with Ebola, you’re not going to get it. You don’t need to be afraid. Panic is unwarranted.
Image Credit: Shutterstock.
Published in General
You seem to be missing one of Fred’s key points:
… in order to accomplish the goal (of quarantine?), you’d have to also have to stop flights from any place that flies to an infected country, and to be safe, from any place that flies to any place that flies to an infected country. At which point you might as well just shut down all air travel. That is a hysterical overreaction to what we are told is a gigantic epidemic that has caused exactly two cases in the US in the year it’s been raging.
You see, it’s all or nothing. Your idea would be at best a semi-hysterical overreaction.
The truth is (I think) that there are currently no flights from the infected companies directly into the US. Cutting flights from Europe probably couldn’t be justified at this point for business reasons. Until the US decides to limit entry based on country of origin, Ebola-carrying people will continue to flow into the country.
I think that decision (to restrict) will eventually happen once the problem gets worse because that’s the way this administration works. I’d speculate that it will happen shortly before the Thanksgiving holiday rush.
R,
Your argument is totally ridiculous. The CDC can choose whatever it needs on a case by case basis. This is a most brutal killer virus. There is the possibility of mutations. Why in the world take the travel restriction card off the table. If CDC said “At this time we don’t have enough facts to warrant it but we haven’t ruled it out.” It would make a great deal more sense. Ruling it out completely only sets the stage for a real panic.
They will have destroyed their own credibility and I think blaming George Bush for this one isn’t going to fly.
Regards,
Jim
Why not limit entry to the U.S. from the five countries having the outbreak ?
And subsidize charter flights for caregivers, missionaries and health supplies.
Sorry, Jim. I was channeling the originator of the quote. I should have used a winky.
The Democrats are not letting a good crisis go to waste.
They are blaming Republicans for “slashing” funding for the NIH.
I looked for the history of funding for NIH, and it is hard to find the history in a way that is not adjusted for inflation, which makes it look like NIH funding is less than 2003. It turns out that funding has been flat for three (or four?) years, and had been growing before then. No budget cuts at all, much less any “slashing.”
And this leaves off the whole business of Team Obama in charge for five years, and making all the decisions about budget priorities.
I’ve seen a lot of things: armchair generals, armchair presidents, armchair politicians, armchair supreme court judges.
Now we have a new phenomenon: armchair epidemiologists.
A lot of “…it seems…”, “…it’s common sense…”, “…why wouldn’t they…” etc. Most leading to the conclusion that somehow all these people are either incompetent or liers. A good number leading to the conclusion that this is, obviously, a political problem.
What I don’t see, is any evidence, facts, reasons, experience…or common sense.
One example is this whole “banning flights” argument. What seems to have been missed is that US carriers don’t actually…fly…to most of these places. So how can you stop what isn’t there?
No matter!
I have a question. I looked at four lamestream news articles but did not find the item I would like to know.
It was widely reported on Sunday that there were fifty persons who had been identified as having contact with the first Ebola patient, and who were being monitored.
Was the nurse one of these fifty persons ?
That’s what I was suggesting needs to (and eventually will) happen. My point (in response to She’s query) was that the airlines can’t do that on their own.
I don’t seem to be communicating well right now…
[reaches for 3/4 empty Wild Turkey bottle]
I saw a great piece from someone earlier today that neatly debunked that “slashed funding” theory with this quote :
While protecting Americans from infectious diseases received only $180 million from the Prevention Fund, the community transformation grant program received nearly three times as much…
I can’t seem to recall who wrote that …
Oh yeah. This guy:
I clairvoyantly addressed that objection five posts prior to yours.
Sorry.
“What’s the worst that could (likely) happen? A few of the people under quarantine might get sick. That would be terrible. (Some of them are kids.) But the CDC would be on them like, um…, well, like health officials on an Ebola patient. They would be immediately hospitalized and isolated. It’s conceivable, but unlikely, that a couple of the 12 to 18 less-close contacts also become ill, but they would get the same treatment. The point is if Mr. Duncan infected anyone, those patients won’t have a chance to infect anyone else. That’s good workaday epidemic control and it’s one of the many things that African health officials don’t have the resources for.
“The first is that a very large number of the victims in Africa are healthcare workers. That’s because of the lack of even the most basic equipment for personnel protection, like latex gloves and disposable gowns.
Slightly over optimistic eh Doc?
Opps, says the CDC. “must have been a protocol violation”.
Yup the most basic protocol violation in any epidemic of infectious disease, isolate and contain the spread.
“In the worst-case scenario, the two countries could have a total of 21,000 cases of Ebola by Sept. 30 and 1.4 million cases by Jan. 20 if the disease keeps spreading without effective methods to contain it. These figures take into account the fact that many cases go undetected, and estimate that there are actually 2.5 times as many as reported. ” (NY Times).
So lets keep allowing travel of a couple of hundred people a day on commercial flights from West Africa.
He spoke about his recent visit to the border of Costa Rica and Nicaragua with U.S. Embassy personnel where they saw men lined up waiting to enter Nicaragua.
“The embassy person walked over and asked who they were and they told him they were from Liberia and they had been on the road about a week,” Kelly continued. “They met up with the network in Trinidad, and now they were on their way to the United States — illegally, of course.
Kelly said the men could make it all the way to New York City within the incubation period for Ebola of 21 days. ” (Marine Corps Gen. John Kelly, commander of the U.S. Southern Command)
“predicted last week that the Ebola virus will not be contained in West Africa, and if infected people flee those countries and spread the disease to Central and South America, it could cause “mass migration into the United States” of those seeking treatment.
“If it breaks out, it’s literally, ‘Katie bar the door,’ and there will be mass migration into the United States,” Kelly said in remarks to the National Defense University on Tuesday. “They will run away from Ebola, or if they suspect they are infected, they will try to get to the United States for treatment.
“The potential spread of Ebola into Central and Southern America is a real possibility,” the article written about the general’s speech and posted on the Department of Defense website on Wednesday stated.Or control the flow of people across the southern border… (General Kelly again )
And lets not address our Southern border either.
Panic? Of course not. Take rational reasonable precautions. Absolutely.
Stop commercial travel out of the affected countries.
Send as much aid and supplies as we can THERE. To try and contain it THERE.
Uh, it’s already on the books. Just needs to be enforced.
http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-9-health-considerations-for-newly-arrived/before-arrival-in-the-united-states-the-overseas-medical-examination
The Immigration and Nationality Act (INA), which relates to the immigration, temporary admission, naturalization, and removal of foreigners, mandates that all refugees and applicants for US immigration undergo an overseas medical screening examination performed by a panel physician to screen for inadmissible conditions. A panel physician is a medically trained, licensed, and experienced medical doctor practicing overseas who has an agreement with a local US embassy or consulate general
The purpose of the mandated medical examination is to detect inadmissible conditions of public health significance. These medical conditions include infectious diseases such as tuberculosis, Hansen disease, and sexually transmitted diseases; mental disorders associated with harmful behavior; and substance abuse or addiction (http://www.cdc.gov/immigrantrefugeehealth/exams/ti/panel/technical-instructions-panel-physicians.html).
The testing modalities required for the medical examination include a physical examination, mental health evaluation, syphilis serology, review of vaccination records, and chest radiography, followed by acid-fast bacillus smears and sputum cultures if the chest radiograph suggests tuberculosis. Treatment is also required for certain conditions, such as tuberculosis, specified sexually transmitted diseases, and Hansen disease.
Apparently a number of African nations didn’t get the memo…..
( Please note Americans are now banned from Cape Verde)
Entry restrictions
Flights and other transport
Countries that have implemented Ebola-related travel restrictions:
Details of airlines that have restricted flights to Ebola-affected countries:
What seems to have been missed is that there is a distinction between banning flights and banning travel. One applies to entire planes, the other can be applied to people trying to get on those planes.
Since Fred pitches his post as a response to my own, let me suggest that you read it and ask whether I evidence any hysteria. Here is the gist of my argument:
For the life of me, I cannot see how there is anything in what I said contrary to common sense. I spoke in measured tones. Moreover, as you can see from Comment #74, above, lots of folks in the world seem to have more common sense than our leaders in Washington. If I do not trust the director of the CDC, it is because he is obviously engaged in “damage control” and because the tale he tells changes nearly every day as events prove his reassurances wrong. In matters like this, we should err on the side of caution. Fred’s overreaction to my post suggests to me that he may be the one who has given way to hysteria.
I read Dr. Rahe’s article and thought it a fine, reasoned piece. Now, Fred Cole comes along. So, who are the “cool heads”? I think they are Dr. Rahe and Betsy McCaughey: “A Further Perspective: Ultimatum to Nurses: Make a Mistake and You Die: It’s not true that U.S. hospitals can safely manage patients with Ebola as the CDC claims” 10.14.14.
She,
You’ve pretty much summed up my perspective.
What are the reasonable measures to prevent Ebola or Enterovirus D68, etc? I, too, have children in school & I’d like good information so I can make rational decisions. The CDC stepping away from it’s assertion that the nurse didn’t follow protocol doesn’t increase my confidence in the CDC. How was she exposed? If the CDC knows, please tell us.
All that being said, I think Enterovirus D68 is as more serious public health problem.
And, particularly with regards to protecting healthcare workers, this:
So far, it looks as though airborne primate to primate transmission is difficult, and that the virus would need to mutate to make it possible. If it does, it’s more likely to do so where lots of people are getting sick, which is most likely to happen in a city in one of the affected African countries. (That’s an argument for quarantine: If you’re on a modern Ellis Island, even if that mutation happened and you’re the lucky customer, you’re not on public transit coughing while still think you’ve got the flu. Or you really want that soup in your favorite restaurant, or you’re trying to hold it together until your plane lands and you can head for the hospital in Boston instead of Bumba.)
Also, it wouldn’t take many Ebola cases to take up much of the capacity of the isolation units capable of containing it… and taking up the beds that would otherwise be used for dangerous non-Ebola illnesses. A few cases of Ebola might have a domino effect that makes the spread of other infections more likely.
Enterovirus D68 appears to have followed the distribution pattern of illegal immigrants who have been settled around the U.S. So it’s looking like a human caused outbreak.
You know I watch these Ebola debates and all I can think is that I personally have no fear of the disease. I think coverage of the one now two patients who have it in the US seems overly blown to me. It is obviously of interest, but it is also very sensationalist. Ebola is not a credible problem in the US, but wall to wall news coverage of it I think has magnified the issue beyond its actual size. The poor response to this media coverage by the CDC does not help. If a travel ban is instituted it will be to shut reporters up. If anything they should do it just to squash the story, because the more people ruminate on something like this the bigger their fears and uncertainties grow.
I think we all have to keep in mind that reporters need ratings and there are no ratings in reporting that something isn’t a problem. Really all of this Ebola stuff just reminds me of the H1N1 and Man-Bear-Pig flu.
Yes Ebola is a very nasty disease. Yes it is spreading very fast in parts of Africa, but your odds of getting it and dying from it in the US are a similar to your odds of wining the Powerball.
The real story of Ebola is happening in Africa not in Dallas Texas. But, the average American I don’t think gives a hoot.
Mutations of this kind are incredibly unlikely, they only happen in movies basically. It takes quite a few things for a virus to change its mods of transmission, since transmission is the sum of numerous parts of the virus.
There are apparently enough differences between pig and primate respiratory tracts to make this true. What’s more to the point is the filthy habits of hospital personnel (a close relative is involved in staff training, has done this in several hospitals, and despairs over the decline in hand washing by nurses and especially doctors as observed over nearly 40 years of practice.)
Ebola may serve as a wakeup call, but there’s a lot of bad habits to overcome.
Way back at the top of this thread I quoted an epidemiologist from the CDC (via a CNN story) who said that while it isn’t impossible they don’t know of a single disease that has ever transformed its transmission method. This is unlikely on the level of you being struck by lighting while being texted that you just won the Powerball jackpot at the same time your metal detector finds a a buried horde of Sumerian treasure.
Three things strike me in this discussion. The first is the patent dishonesty of the administration in regard to the actual threat of the disease. NO DRAMA OBAMA is treating this as he does every potential crisis, politically. Since it is already pretty much a downer, he and his party are attempting to switch the blame to the Republicans. Obama’s lack of candidness (his out and out lying on just about every issue and occasion) does not breed any sense of comfort.
Let’s say Fred Cole is right about the 12 cases before January 1st. If one of them is your child does it really matter if it isn’t a epidemic as some predict it will become? In any case, any death of an American on American soil due to the absurd unwillingness of Obama to take act by banning flights and tightening controls on our borders is one death too many.
Second point, and I have mentioned this before in an earlier thread. In 1901 30,000 residents of St. Pierre on Martinique died in the eruption of Mt. Pelee. There was plenty of warning and lots of Jeremiahs screaming warnings about what was occurring, but the government of the city, just like our own and people like Fred Cole, felt that taking a strong action, in the case of St. Pierre, evacuating the city, was way too extreme a choice and completely unnecessary. The results speak for themselves. Everyone died in seconds when and enormous pyroclastic flow that no one predicted flew down the slopes of the mountain and wiped out the city.
There is no real downside to securing the borders and quarantining anyone arriving in the country from one of the infected areas for a period of 21 days. A simple examination of their passport would identify areas that they had visited. That would answer Fred’s view that persons coming from places other than directly from an infected area might get in.
A further point, if I might. I spent more than 40 years of my working career working in schools that served indigent communities. It is easy to talk about Africa as though it is many thousand miles away. However, in our cities we have communities of African immigrants and other third world people who live in crowded homes and communities not unlike those that they left behind in their native homes. Seattle has a very large Somali community, as well as several other groups of African people. Does it seem to anyone unrealistic that just as Mr. Duncan came to a community in Dallas made up of his own nationality that others in other parts of the country might not do the same? I contend that it is more than likely, and that those could easily become the medium in which a full fledged epidemic could arise. The fact that public transportion is a very important factor in the movement of these people around the city, it is not difficult to see how easily Ebola or any other public health threat could be disseminated throughout a city by simply passing it to fellow passengers on a city bus.
The good news…
– Ebola is most likely not going to spread to many people in the U.S.
– Even so, the possibility that it could makes people mad at Obama for not doing more
Now there’s a two-fer!
Like the new title. It’s always good not to be hysterical when you’re accusing someone else of being hysterical. :)
The notion that Rahe was ever hysterical is a bit ridiculous…
As horrific as Ebola disease is, historically it has been relatively self-contained; death tolls in the hundreds (with most of the infected dying) means that either those sick were sick and either died recovered undetected by epidemiologists or that there just weren’t that many.
But in the past, the disease was kept out of cities. Cities are much messier than laboratories. In most experiments, the experimenters want to start with healthy subjects, even if they intend to expose them to a lethal disease. But in cities, it’s much more likely that you’ll come in contact with a number of people with hay fever, colds, flu… and if there’s an Ebola outbreak in the city, it might be Ebola plus…
In non-human primates, the lethal dose of Ebola is 1-10 virus particles when delivered by aerosol. Aerosol as in cough or sneeze. I do agree that it’s unlikely that the virus will mutate to be generally transmissible by the respiratory route, though, or that an epidemic is likely to spread that way.
Much more likely for the flu itself to do the dirty work than Ebola. The same limitation in intensive care beds I mentioned above in regard to Ebola is what’s likely to make a flu that surprises the vaccine makers as lethal as the one in 1918. The real question is what lessons will be learned from this crisis.
Or maybe not:
This is kind of troubling to hear. I think it also illustrates the fact that we focus on things like travel bans, when really it is basic techniques and lack of attention to basic practices that will probably effect the spread of Ebola in the US more.
Fred, you demolish a strawman appearing nowhere in Prof. Rahe’s post. Rahe is not arguing that Ebola is the dawn of the Zombie Apocalypse, only that the CDC and Obama administration are failing to level with the public and implement basic public health measures designed to contain the spread of an extremely lethal infectious disease into this country.
And while civilization will survive, Ms. Pham and other individuals exposed to Mr. Duncan and future travelers from West Africa may not.
A basic step would be to implement a quarantine: Any traveler who has been in one of the identified Ebola pandemic countries within the past 21-days is denied admittance to the US pending lapse of the incubation period.
Simple? Yes. But ideologically unacceptable to the Obama administration since it might send the message to voters that borders–and even documentation–matter.