Unnervingly, the U.S. public health services remain steps behind the Ebola virus. Contact tracing is what we do, Centers for Disease Control Director Tom Frieden assured the nation. It will stop the epidemic “in its tracks.” And yet nurses Nina Pham and Amber Vinson, who developed Ebola, were not even among the 48 contacts the CDC was initially following.
Nor were any of the doctors and nurses who treated the “index patient,” Thomas Duncan. No one even had a full list of caregivers.
The other reassurance was: Not to worry. We know what we’re doing. We have protocols. When, however, we got the first Ebola transmission in the United States, it was blamed on a “breach in protocol.”
Translation: “Don’t blame us. The nurse screwed up.” The nurses union was not amused. Frieden had to walk that back the next day, saying he didn’t mean to blame anyone.
Frieden had said that “the care of Ebola can be done safely, but it is hard to do it safely.” Meaning: In theory, it’s easy; in practice, very dangerous. Unfortunately, that’s not what he said on Day One. When you hear it two weeks later, you begin to wonder.
These missteps raise questions of competence, candor and false confidence. But the problem is deeper. And it rests not in our doctors but in ourselves.
In the face of a uniquely dangerous threat, we Americans have trouble recalibrating our traditional (and laudable) devotion to individual rights and civil liberties. That is the fundamental reason we’ve been so slow in getting serious about Ebola. Consider:
Pham’s identity was initially withheld. In normal circumstances, privacy deserves absolute respect. But these are not normal circumstances. We’re talking about a possible epidemic by an unseen pathogen that kills 70 percent of its victims. Contact tracing is the key to stopping it, we’ve been told. What faster way to alert anyone who might have had contact with Pham than releasing her name? Why lose 24 hours during which people have to guess if they’d had contact with someone carrying the virus?
When Duncan was first hospitalized, the CDC said it would locate his contacts and check regularly for symptoms. For the secondary and tertiary contacts, this made sense. But not for those in the inner “concentric circle.” They had had close contact with Duncan and were living in an apartment requiring massive decontamination. They should have been quarantined immediately.
It’s understandable. Quarantine is the ultimate violation of civil liberties. Having committed no crime, having done no wrong, you are sentenced to house arrest or banishment. It’s unfair. It’s, well, un-American. But when an epidemic threatens, we do it because we must.
Why have we been treating Ebola patients at their local hospital? This is insane. They don’t have the expertise or the training. They will make mistakes — as we’ve now seen repeatedly at Texas Health Presbyterian.
Besides, training and equipping every hospital in America to treat this rare disease would be ridiculously expensive and 99 percent wasted. Every Ebola patient should be evacuated to a specialized regional isolation center, such as the ones in Atlanta, Omaha or Bethesda.
Not because these facilities possess some unique treatment. There is no treatment known to cure the disease. But they know how to prevent contagion. Local hospitals don’t. It took 15 days and Amber Vinson to wake the authorities up to this obvious reality.
4. Travel bans.
British Airways has already canceled all flights to the affected countries in West Africa. We haven’t. A couple more cases of imported Ebola and we will.
Why are we waiting? The CDC argues that a travel ban would stop the flow of medical assistance to West Africa. This is silly. Simply make an exception for health-care workers. They apply to federal authorities, who charter their flights (or use military aircraft already headed there) and monitor their movements until 21 days after their return home. Done.
President Obama, in his messianic period, declared that choosing between security and liberty was a false choice. On the contrary. It is the eternal dilemma of every free society. Politics is the very process of finding some equilibrium between these two competing values.
Regarding terrorism, we’ve developed a fairly reasonable balance. But it took time. With Ebola, we don’t have time. Viruses don’t wait. The sooner we reset the balance — the sooner we get serious — the safer we will be.
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