Streetwise Professor

October 15, 2014

Dallas Shows That By the Time Ebola Gets Here, It’s Too Late

Filed under: Politics — The Professor @ 6:02 pm

A second nurse in Dallas has contracted Ebola. Better yet, before she was diagnosed but while she may have been contagious, she flew to Cleveland and back.

This puts another nail-and hopefully the final one-into the CDC’s and the administration’s stubborn refusal to countenance a travel ban, or at least far more draconian travel restrictions, from the afflicted countries of western Africa.

The CDC justification was based on two arguments.

The first one was idiotic a priori, and has only been rendered more idiotic by experience. The CDC argued that restricting travel into the US would made it more difficult for health care workers to go to Africa to help in the efforts: they would be less willing to go if they could not return.

But health care workers treating the disease are at far greater risk of contracting it, and hence greater risk of spreading it, than just about anyone. So if they go, it is especially important to prevent them from returning until it is almost certain that they are virus free. Yes, this is a burden, but one that can be ameliorated by special quarantine facilities.

The fact that most of the cases outside of Africa are health care workers exposed to the disease just confirms the risk that they pose that should have been obvious on mere reflection.

The CDC’s second argument was: “We don’t have to restrict travel into the US, because we can stop the disease in its tracks here.” Um, no.

There is a dispute over whether the health care workers failed to follow protocol, or the protocol was inadequate. The dispute is really pointless, and terribly unfair to the unfortunate women who were thrown into a deadly situation totally outside of their normal jobs and training.

The CDC model is that any random hospital in the fifty states and DC into which an infected individual happens to wander is capable of diagnosing and treating him or her while incurring very low risk of having that individual infect others, including most notably the caregivers.

That requires believing that all major hospitals are capable of handling an extraordinary disease which requires extraordinary precautions. That tens of thousands of health care professionals are at this very minute prepared and trained to treat it, will do so flawlessly, and will do so in a way that they poses no risk of  transmitting the disease to the millions of people they interact with.

That is delusional.

This is a disease that requires highly trained, professional, and meticulous caregivers. Specialists, not generalists.

One model would be to dispatch teams to hospitals that have admitted an infected person. Another model is to take the infected person to a special facility where the teams operate. The first model would probably be best if it could be assured that there would be only one or two cases, as it would eliminate the necessity of transporting the patient with the attendant risks. But it is not a scalable model. Since a team can likely handle multiple patients, it’s better to have teams at select hospitals around the country, and bring the patients to them.

Regardless, at present neither system is in place and the CDC’s anybody can do it model is obviously fundamentally flawed. Which means that we can’t rely on it, that we can’t depend on the system stopping each case in its tracks without risk of further spread within the country. This in turn means we have to move the defense perimeter out, and prevent people coming in from the affected regions. Dallas demonstrates that by the time Ebola reaches the US, it’s too late.

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  1. Agreed.

    What a disaster.

    The failure at the highest levels of government is astonishing. It’s as if these people actually want to sabotage their own country.

    Comment by Ex-regulator on lunch break — October 15, 2014 @ 10:27 pm

  2. I enjoyed this story:

    What better protection against Ebola than a clipboard do you need?

    Comment by Green as Grass — October 16, 2014 @ 7:14 am

  3. I am amazed that the CDC was this clueless. Hospitals in general are not set up to handle highly contagious diseases. They are set up to protect the patient from germs on the providers – not the other way around. They also are set up to allow easy access to the patient by lots of hospital employees – not just providers, but clerical staff. Attempting to isolate a highly contagious patient in a hospital not equipped for this purpose would be technically infeasible and so costly as to bankrupt the facility.

    Comment by Ben — October 16, 2014 @ 11:07 am

  4. Congressional hearings currently taking place – the doctor-officer from the Dallas hospital, Texas Presbyterian, said that they’re still investigating how the nurses got infected.

    Travel bans discussed – Waxman claims that travelers would simply “hide” information.

    Ebola is not an efficient parasite. It kills its host. It eliminates itself by killing its host – unless it spreads to other organisms.

    Logically, a travel ban screams out for implementation.

    The virus can be killed by bleach and other chemicals. Problem is – you can’t really treat people by making them drink bleach or other chemicals that kill the Ebola virus.

    So 2 nurses, supposedly trained in dealing with an Ebola patient, nevertheless became infected.

    President Obola and Congress will no doubt come to the rescue.

    God help us.

    Comment by elmer — October 16, 2014 @ 11:31 am

  5. In the fllowing vidoe link after the 1 minute mark, CDC director was asked about a travel ban for west Africans, his answer was,

    ” I don’t have the legal expertise to answer that question”.

    Yes folks, you are going to be expose to Ebola, it’s all legal of course.

    Comment by traveler — October 16, 2014 @ 2:30 pm

  6. (sorry for typo in above comment) To follow up on CDC questioning, after 3 minute mark, CDC director says, “If we restrict air travel to US, they can come by land”.

    Comment by traveler — October 16, 2014 @ 2:42 pm

  7. @traveler: Or swim! Or hang glide! So we should just shrug and put our fate in the hands of the CDC and whatever hospital happens to get the next walk in.

    Unbelievable. Obviously no prophylactic method is perfect. But raising the cost of getting here will reduce the risk. Moreover, a coordinated response with Mexico and Canada (and perhaps Central and South American countries) could reduce the land risk.

    Frieden’s statement is a great example of how the perfect is the enemy of the good.

    I am really starting to despise these people.

    The ProfessorComment by The Professor — October 16, 2014 @ 3:17 pm

  8. There are really only two explanations I can come up with for the CDC’s refusal to budge on this.

    One, the CDC fear that implementing stricter controls now would be some sort of admission that it should have been done earlier, and they refuse to admit a mistake. If this is the case, then it was a massive bet that the initial patient in Dallas would be the only one, and that bet has failed. This scenario screams for leadership from the White House, and makes it look like the leadership in the CDC are badly mismanaging this situation in a failed attempt to save their own skins.

    The second explanation is that the administration are concerned that any kind of travel restrictions would affect millions of travelers and would create resentment, so the refusal to act is originating with the WH and not the CDC.

    Either way this seems to be a massive miscalculation, not only in terms of public health and safety, but also politically. The White House may be afraid that travel restrictions will become campaign fodder for Republicans as some sort of invasive overreaction (of course the question remains open as to whether limited travel restrictions targeted at West Africa would really affect very many Americans, although now that Ebola is here wide ranging domestic restrictions may be inevitable). This seems like a massive missed political opportunity for Obama. It is abundantly clear that there is wide spread concern over Ebola amongst the public. The biggest criticism leveled against Obama is that he is too passive. Ebola represents the perfect opportunity for him to take decisive action on an issue that there is near universal agreement on. This isn’t the Mexican-US border, and this isn’t committing US troops overseas. This should be an absolute slam dunk. Rahm Emanuel must be horrified right now.

    Actually, as I write this, a more conspiratorial scenario comes to mind. Ebola does represent an great opportunity for Obama to take decisive and widely popular action. However in order for that to have any real political impact the crisis would have to be something very real and tangible to the general public. Giving the CDC enough rope to hang itself before a decisive White House intervention could seem like the best way to maximize the political gains. I don’t necessarily agree, we are fast approaching the point at which any intervention runs the risk of being dismissed as too little too late, but I can see the logic.

    Comment by JDonn — October 16, 2014 @ 3:52 pm

  9. @traveler. Given the subject, your handle is ironic 😉

    The ProfessorComment by The Professor — October 16, 2014 @ 6:01 pm


    Dr. Daniel Varga is chief clinical officer for Texas Health Resources, a network of 25 hospitals that includes Presbyterian in Dallas, which treated the first person diagnosed with Ebola in the United States.

    I spoke with Varga today about the lessons the hospital learned in its battle with Ebola. Here are a few highlights:

    — When index patient Thomas Eric Duncan first entered the hospital on Sept. 28, he informed a nurse of his travels from Africa, and that information was entered into Presbyterian’s electronic records system. When he was seen by a physician, the doctor asked his own question about where Duncan lived, and Duncan gave his local address.

    Varga says Duncan is not to be blamed.

    “This isn’t the patient’s fault,” he said. “… People who are sick and are asked the same question by a couple of different people, a couple of different ways, not infrequently give an answer that isn’t identical.”

    — The doctor assumed Duncan was part of Dallas’ nearby African immigrant community, which uses the hospital regularly. As a result a contagious Duncan was released back into the general public. By the time he came back to Presbyterian two days later, he was critically ill with Ebola.

    — Duncan’s symptoms were extremely virulent — projectile vomiting and diarrhea that would not stop. The Presbyterian staff treated him for two days with protection equipment that included caps, goggles, paper masks and plastic face plates. But Duncan was a hot mess of billions of Ebola virus on and around his body. It was only after the CDC confirmed Duncan had Ebola, 36 hours later, that the staffers went to using fully hooded hazmat suits while treating their patient.

    Comment by elmer — October 18, 2014 @ 8:27 am

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