Archive for the ‘Ebola’ category

What’s Gone Wrong in Canada?

November 2, 2014

The Canadian Government announced a ban on all visitors from the Ebola infected African countries. Not a period of restricted movement or even a quarantine, but an outright ban on entry to Canada. How could an otherwise more than rational Country undertake measure not justified by facts on the ground?

The rational provided, of course, focuses upon protecting Canadian citizens. Suspension of commonsense or fact based reasoning seems justified “to protect Canadian citizens”. Hmmm.

This reasoning is not just a Canadian phenomena. It is politicians’ reasoning and would be expected to happen in the US far more often than Canada. Politicians, however, can be found anywhere.

So why care?

The “protect the citizens” argument is worthy, but at what expense. The primary role of government is protecting its citizens but to what extents is a government justified in providing this protection? We normal hear about surrendering individual privacy rights but those coming from Ebola infected countries are not Canadian citizens and in theory do not have Canadian rights. So what else?

Governments have a duty to demonstrate “fact based” decisions as much as possible. This type of behavior should inspire further confidence in government decisions and encourage the population, in general, to adopt fact based reasoning for themselves. For Governments to shun fact based reasoning is to encourage citizens to respond to fear or to ignore genuine threats.

US Congressional demagogues have demonstrated all too frequently the worst of possible public image. Some members have predicted the invasion of ISIS via the Mexican border. Others now have suggested that travelers infected with Ebola will choose crossing the Mexico-US border as a way to avoid airport detection. What should we expect of the average citizen if their elected leaders think this way?

This Canadian decision may seem in the best interest of Canadian citizens but is quite the opposite. The decision sends the wrong message and in no way guarantees protections from Ebola.

I wonder where the Canadian scientific community was in making this decision?

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Kaci Hickox Public Enemy?

October 30, 2014

Kaci Hickox’s restricted travel has now grabbed the front pages and the 7/24 news outlets. The story is perfect for the news media. It requires no intelligence or thought. It simply requires someone to hold an opinion. Is this nurse a public enemy?

Ms Hickox presents a great face for women, and for informed public health. There is no PC with Ms Hickox. She seeks no favors from the public trough and is prepared to stand her ground. Her defense, modern science and recent experience.

Medical experts have said that Ebola is not contagious until the onset of symptoms. Even then, there is a view that during the initial onset, like not feeling well or the first recognition of fever, someone is still not contagious.   It is only when the full presentation of symptoms where bodily fluids (vomit, spit, and diarrhea) come in contact with another unprotected person is there a chance to spread Ebola.

Ms Hickox apparently is confident she will recognize the onset and until then she feels she should be free to move around. Hmmm.

Maine public health officials have asked Ms Hickox to voluntarily isolate herself for 21 days. Ms Hickox has said no thanks. So what might be next?

Most likely the Maine Public Health officials will appeal to a court that Ms Hickox must be forcibly restrained. The Court will decide not on the merits but rather that the Maine Public Health organization has the regulatory power to order restraint. Hmmm.

Next, Ms Hickox side will sue the State of Maine claiming they had instituted controls not justified by the science involved (over stepped their authority). Before long one of two things will occur. Ms Hickox will come down with full blown Ebola, or the 21 days will pass with no occurrence. Maine will in that case offer to drop their charges if Ms Hickox does the same. Hmmm.

The US Ebola scare is a dry run for what might happen if we experience a real influenza outbreak.

There is a clear difference at the extremes between individual civil rights and protection of the population at large. This difference becomes harder to recognize the closer to the center one gets. Common sense and thankfully modern science can resolve this conundrum.

Unfortunately it will require leaders and not run of the mill politicians to sort this out. Even sadder, the country seems to have an excess of politicians and few leaders.

Thanks to Ms Hickox for again making this clear.

Getting Ahead Of The Curve

October 26, 2014

Recently in New Jersey and Pennsylvania, two different school districts shut down their highly successful high school football programs for at least the remainder of this year. These decisions followed revelations that there had been “hazing” incidents involving new football team members conducted by veteran players. As described, the incidents were nothing to be proud about.  Ending the practiced seemed appropriate. But shutting the program down? Was that necessary?

Both school districts emphasized their zero tolerance for this type of behavior and the need to send a clear message that such behavior would not be tolerated. In business terms, the school district’s actions were an attempt to get ahead of the curve of public opinion.  The school districts worried “wha if” these hazing incidents were to have become public knowledge or to have lead to even more unacceptable behavior.

The need to punish the entire team when only a part of the team were instigators, seems excessive. School officials point out, however, that football is an extracurricular event and not the main purpose of schools. Further, officials emphasize that hazing was entirely unnecessary and this behavior to is too close to “bullying” to allow to continue. Ending the season for some students who did not participate is a small price for teaching what is right.

The New Jersey and New York Governors together have taken somewhat similar preemptive action. Governors Christie and Cuomo announced a mandatory 21 day quarantine for all persons entering the US through Newark or JFK airports who had visited Ebola infected areas. A Democrat and a Republican gave their announcement the appearance of bipartisan politics. Hmmm.

On one hand, the idea that someone could enter the country carrying Ebola, only later to develop full blown symptoms is pretty ominous. In such densely populated areas as Northern New Jersey and especially New York City, “getting ahead of the curve” has an obvious popular appeal. No one will later claim that either Governor is not a leader and willing to take action.

On the other hand, health organizations have repeatedly said that the best defense against an Ebola outbreak in the US is to eradicate it in West Africa. Americans who volunteer for this work (as well as any other visitors) will face a mandatory 21 day quarantine on their return. Where would these people stay? Who would pay for this quarantine period’s expenses?

There are two consequences one should expect. First, returning volunteers will get creative on their return routing. Newark and JFK are not likely to be their choice of entry point. And full disclosure is even less likely to occur.

Second, the prospect of an additional 21 days away from their primary occupation will likely discourage potential volunteers from volunteering in the first place. Hmmm.

Unlike the football story, messing with medical advice, is not a wise long term position for politicians. Canceling a football season is small potatoes compared with controlling an infections disease. And what will these good Governors do when an airborne pandemic influenza breaks out in Europe and arrives in the US with ship and air travelers?

21 and Counting

October 22, 2014

Just as quickly as it arrived, Ebola has left the front page. The bulk of the Dallas Hospital healthcare workers as well as those who had community contact with Thomas Eric Duncan have cleared the 21 day isolation period and are free to move around. It seems clearer now that the two infected nurses got Ebola through lapses in the protocol used to protect them. Success, a triumph for medical knowledge and common sense.

Of course there could be more healthcare workers infected from new cases just as it is possible for Ebola could be transmitted from exposed or infected overseas travelers. But other than a complete and total quarantine of the US (no boats, planes or vehicular traffic) there can be no 100% precaution that Ebola could not again enter the US.

The anti diminishing returns argument that the US needs to screen and detain all African travelers entering the US will still be made. These advocates are in fact in search of different objectives than healthcare.  We need to drown out these “sky is falling” voices.

There is a far larger issue hidden in plain sight with this Ebola outbreak. What about a real pandemic, like SARS or bird flu or any other contagion? What if Iran or al Qaeda or whomever decided to use health as the means to attain their goals?
We have been there once with germ warfare. Fortunately, the world did not employ these agents but these are different times. Beheading someone and showing it proudly on the internet does not seem to me far away from turning a biological agent loose in London or New York.

The limited experience in Dallas ought to inform everyone that hospitals that are set up to make money treating common illnesses and injuries will most likely not have prioritized how to handle contagions very high in their sights.  Protocols will be suspect as will be the necessary protective equipment.

The spin doctors, however, can create the necessary PR to keep an outbreak appear under control. The actual health care safety net has too many holes if we judge Dallas’ response.

There is certainly a limit to what medical science can do. There are no cures for some diseases. The question is what should the healthcare industry and government health officials do to contain any outbreak until the disease runs its course with minimum impact on the general population?

The “Every Man” But Not The “Crisis Man”

October 18, 2014

First, apologies to women. The title, written the “every man” could also be written the “every woman” too.

The term “every man” is meant to refer to someone who can do everything, sort of the go to person. So this person could certainly be a woman.

“Every Men” have become extremely popular in recent times. They are the person picked to lead (or at least represent) an organization,especially those which undergo extensive public scrutiny. The “everyman” protects the “board” or the “CEO” or in some case, the President of the US from embarrassment and distraction when something goes astray in the organization in question. Hmmm.

The “every man” can offer lucid testimony before Congress. He is relaxed and smooth with the press. Within government meetings, the “every man” is everyone’s ally and no ones enemy. The “every man” is just great to have around.

This apparently ideal situation often comes to an abrupt and sudden end. Crises demand a much different approach. Crises are fact driven and a few hurt feelings should be expected as normal operating conditions. Crises, as the name implies, are here and now events which only get worse unless corrective measures are taken. Hmmm.

The New York Times today reported that the President is seething over the number of times aids assured him that Ebola preparations were in place, only to find out they were not as advertised. Hmmm.

  • The “every man” assumes the best in others. The “crisis man” assumes the worst (or at least the high probability of human failure).
  • The “every man” expects subordinates to work harder and to be more vigilant simply because they should. The “crisis man” expects subordinates will assume the best when there is no proof.  Therefore the “crisis man” demands evidence.

Catching our breaths, we should recognize there should be no rational fear, in spite of performance to day, whether the US medical system can control Ebola. There should, however, have been a healthy amount of skepticism that the US medical system was ready in the early stages of confronting Ebola. Pandemics are not broken legs or hip replacements.

People do not walk around with signs on their chests proclaiming themselves as the “every man” or the “crisis man”. The leader must find them.

A great virtue of any leader is the ability to spot the every man and the crisis man. It is even a greater skill to know when to use each. (Crises are not normally obvious on day 1)

While President Obama has IMO performed credibly and at times heroically during his Presidency, his choice of subordinates has tended to be of the “every man” variety. Let’s hope that the next President can build upon President Obama’s high principles with a better knack of picking subordinates for the necessary task at hand.

The Law Of Diminishing Returns

October 17, 2014

The American education system has been criticized for many shortcomings. None could be any more important that the short shrift of the Law of Diminishing Returns. Said crudely, if a little is good, a lot more must be much better. Hmmm.

How many times have we heard our political leaders recommend a solution for a problem for which there were no symptoms? Remember the voter photo ID laws or the increased regulatory controls for abortion clinics? Both of these situations could not be described as a defect where the recommended solution could be applied and its impact measured for efficacy. (In these cases, of course, the recommended solutions were for a totally different problem than advertised, voter discrimination and eliminating abortions.

America is now facing a situation where logic and scientific ignorance may lead to severe danger from unexpected consequences. Ebola is coming. What should America do?

Thanks to TV news coverage, Americans have seen the failure of a major Dallas hospital while PR spokespersons have valiantly tried to shift the responsibility somewheres else. The Dallas hospital is a large facility which apparently makes money and attracts a lot of affluent people. The hospital had structured itself to deal with a array of normal illnesses at a profit. Life was good.

Then along came Thomas Eric Duncan and life changed. The PR people knew what to do. Show confidence and keep everyone calm. Unfortunately Mr Duncan succumbed to Ebola, and even worse, apparently his care infected two other healthcare workers. Thankfully, the CDC transferred both patients to other more specialized facilities and saved the Dallas hospital from further embarrassment.

So where does the law of diminishing returns come it?

Check out the Congressional hearings. For Congress members, the possibility that some day we may look back and say we could have done more is something that’s not going to happen on their watch. If science says exposed individuals should be isolated for 21 days, then lets increase that number “to be sure”. If someone enters the country and had originally departed from one of the Ebola infected African countries, lets put those people in quarantine. And while we are at it, lets include a wide range of African countries just to be sure.
But what if the person who departed, say Liberia, in January and has been living in Paris flies to JFK (New York)?   Lets quarantine that person too. Why?

We want NO cases that could have been prevented.

Hmmm.

The law of diminishing returns tells us that getting to zero (NO cases), will cost exorbitant amounts of money and still may not be possible. Does this mean do nothing?

Quite the opposite. What we need is for Congress members to ask the scientific community and agencies like the CDC how they can help, not what outcomes they want. If political leaders insist upon trying to play the role of “boss”, they are in way over their heads and good things are not likely in the outcomes.

Serious members of Congress as well as similar White House members must recognize that Ebola is a test run for what might happen if the US suffered a germ warfare attack. The public cannot be expected to understand the specifics or what to do to avoid or prevent the spread of illness. The role of government is make sure the best people are in charge and then to provide whatever support they may need.

Somehow I am not confident the current Congressional crowd is up to that challenge.