Streetwise Professor

October 27, 2014

Who You Gonna Believe? Dr. Barry or the US Army?

Filed under: Economics,Politics — The Professor @ 5:43 pm

From day 1 of the Ebola episode in Dallas, the administration has been adamantly opposed to travel bans and quarantines, especially of health care workers who have been to West Africa. When New York and New Jersey implemented quarantines, the administration leaned on governors Cuomo and Christie very hard: Cuomo relented considerably. The administration argues that imposing restrictions on returnees from the Ebola-stricken region will impede efforts to control the outbreak there.

I’ve expressed skepticism about those arguments, but if you don’t give me any credence, what about the US Army?:

The U.S. general appointed to oversee America’s fight against Ebola in West Africa has been quarantined in Italy with at least 10 other Americans upon returning from the disease-stricken continent.

Major General Darryl A. Williams, who was appointed head of the U.S. command center in Liberia that coordinates the response to Ebola, was isolated along with several other Americans over the weekend, CNN reports.

The General’s “plane was met on the ground by Italian authorities ‘in full CDC gear,’” a U.S. official was quoted as telling CNN.

Williams and the others will now be monitored for 21 days at a U.S. military compound in Italy, according to the report.

To steal a phrase, the US military is pretty much the ultimate reality-based community–except when political pressure gets too hard to bear. But in most matters of life and death involving its areas of competence, the military doesn’t bend to political fashions, especially progressive ones. It balances risk and reward, based on its best understanding of the facts (which is often imperfect, admittedly) and decides accordingly.

So for the Army to decide, in the face of the obvious potential for fierce disagreement with the administration, that quarantine is the right thing to do, you can be pretty sure that decision is the result of a sober appraisal of the situation. Indeed, the willingness to buck administration preferences gives you an indication of the strength of the Army’s convictions.

The US military has always been more serious and squared away and apolitical with regards to biological and chemical threats. It should be assigned primary responsibility in dealing with the situation in the US too, but turf wars have ruled that out. (Hot Zone describes the turf fights between CDC and the Army during the Clinton administration during an episode involving infected monkeys in Virginia.)

The Army action is basically calling bull on the administration’s frantic anti-quarantine position. Between Dr. Barry and the US Army, I know whom I trust more.

That said, there are smart ways of doing a quarantine, and dumb ways. The measures initially adopted by New York and New Jersey seem to be  ham-fisted. The quarantined nurse in NJ has something of a legitimate beef (mixing meat metaphors!), although her claims that quarantines are totally unnecessary for returning health care workers comes off as entitled and clueless, especially given the infections of health care workers here in the US and Europe, and the large numbers of deaths among such workers in Africa. One would think that someone who is  selfless enough to risk contracting the disease in Africa would be willing to take prudent precautions to prevent it from spreading at home.

The Army way seems to be the right way. A special facility, outside the US, where those working in the afflicted region are quarantined  in a comfortable, secure facility before returning to the US.

@libertylynx pointed out to me that quarantine can be a financial burden and family hardship on aid workers, many of whom are missionaries without substantial financial resources. That problem is easily solved, as it involves only money, and not a lot at that. There is a way of balancing the need to attract people to West Africa to fight the disease, and limiting the possibility that they can spread the virus back to the states on their return.

Put differently, the cost of compensating the workers for the burdens of a quarantine pales in comparison with the cost of dealing with an outbreak in the US. Even if the probability that  returnee would spread the virus is small, given the huge cost of a US outbreak and the huge benefit of attracting workers to fight the disease the affected region, it is cheap at twice the price (or much more) to compensate them for the time and hardship a quarantine imposes. Pace Adam Smith: compensating differentials in action.

That said, the Army’s action speaks many volumes. It is saying that from a medical perspective, quarantine is a prudent measure. If the administration is concerned about deterring the travel of needed workers to Africa, the costs of that prudence can be easily paid. Rather than stubbornly fighting quarantines and travel bans, the administration should focus its efforts on designing and getting passed financial compensation measures that balance risk and reward.

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  1. The General’s “plane was met on the ground by Italian authorities ‘in full CDC gear,’” a U.S. official was quoted as telling CNN.

    Does this sentence not imply that it isnt the army who ordered the quarantine but Italian authorities?

    Comment by d — October 27, 2014 @ 8:04 pm

  2. @d. No. This was a DoD decision. The administration doesn’t want to acknowledge it though. Earnest was weaseling about this earlier today.

    The ProfessorComment by The Professor — October 27, 2014 @ 9:06 pm

  3. Couldn’t agree with this more. Any claim that the administration has made is easily refuted. There’s that other argument that people will go through Canada or Mexico, but Obama just would need to get on the phone with the Mexicans and Canadians and put together some sort of coordinated response.

    Comment by John Hall — October 27, 2014 @ 9:34 pm

  4. @John-We wouldn’t even have to ask. The minute we impose restrictions the Canadians and Mexicans will say NFW are we going to be the first stop for Ebola carriers who may start bleeding out and barfing in the terminal at Pearson or Mexico City International, and will impose their own bans. But yeah, if we go to them and say “We are going to impose restrictions. Let’s work together on a coordinated response” they would be more than cooperative.

    The lameness of these excuses demonstrates just how weak the administration’s case is, and this weakness further demonstrates that they are opposed not on the grounds of the “Science” that they constantly invoke, but for some other reason which they dare not admit to.

    The ProfessorComment by The Professor — October 27, 2014 @ 9:57 pm

  5. “One would think that someone who is selfless enough to risk contracting the disease in Africa would be willing to take prudent precautions to prevent it from spreading at home.”
    I had the same assumption prior to the NY and NJ cases. I can’t really characterize the actions of some of these returning healthcare workers as anything short of reckless. I find this both puzzling and disappointing. My take away is, of course, that there needs to be much tighter oversight and control over who goes over there, what they are doing, and how they are brought back. If these people cannot be trusted to act responsibly here, I am not sure I trust them there.

    I would add to the point in the above post that the downsides to quarantine can be solved with money, that it shouldn’t be to hard to get people to buy in. If the administration is really that concerned that people will be prevented from helping in West Africa because of the inconvenience of a quarantine, the appropriate response is to explain why the quarantine is necessary and show commitment to making it as effective and convenience as possible. This shouldn’t be a hard sell, but I think the administration has massively misjudged public sentiment on this issue since the beginning.

    Comment by JDonn — October 27, 2014 @ 11:48 pm

  6. Did John Hall just use the words “Obama”, “Mexicans”, and “coordinated” in the same sentence?!!

    Comment by Tim Newman — October 28, 2014 @ 12:32 am

  7. I can’t really characterize the actions of some of these returning healthcare workers as anything short of reckless.

    The skeptical side of me is asking whether these are genuine healthcare workers or people on some sort of crusade masquerading as such. It’s not as though other do-gooders in Africa – such as Oxfam – masquerade as an on-the-ground charity but are in fact stuffed with leftists driving a hard political agenda. Healthcare in the UK is probably more politicised than it is in the US thanks to the NHS, but I would not be surprised if some of these “healthcare” workers turn out to be people who have offered little to no practical help and are only there to drive an ideology (debt forgiveness, free medicine, you name it) and to come back and start (or more likely continue) campaigning on political matters. I find it hard to believe that genuine, serious health workers would return and act so recklessly.

    Comment by Tim Newman — October 28, 2014 @ 4:09 am

  8. Tim, I spent several years living in the UK, and I certainly know the type. I think that here in America these types of volunteers are far less likely to be half-baked leftists seeking to make a political statement. Volunteer healthcare workers are more likely naive adventurers or Christian missionaries. It is worth noting that there are a number of licensed doctors and nurses who do spend time volunteering overseas also. These people can do good work, especially when they are organized, but there are limits to what they can handle. I made the point in my first post on Ebola in an article a couple of weeks ago that if tighter restrictions on travel force people who want to go to West Africa to move through official controlled channels that can only be a good thing. It seems eminently desirable that we monitor who is going over there and what they are doing, and do what we can to coordinate their efforts.

    Comment by JDonn — October 28, 2014 @ 8:24 am

  9. @Tim & JDonn. There is definitely a mix, and I agree that there are a lot of “leftists driving a hard political agenda” involved, but that the proportion of those from the US who fit that description are lower than in the UK. In particular, the missionary component much larger. That said, the nurse raising the stink in the US, Kaci Hickox, does seem to fit that bill.

    It does indeed seem “eminently desirable that we monitor who is going over there and what they are doing, and do what we can to coordinate their efforts” and that those who go agree and consider this just part of the burden of performing their good works. What’s astounding is that such common sense is in such short supply in the USG and the UN/WHO.

    The ProfessorComment by The Professor — October 28, 2014 @ 10:47 am

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