Jonathan Cohn:
Are these calls for closing the borders the product of political opportunism? Xenophobia? In some cases they are. But some of them represent good faith attempts to protect public health, both here and abroad. The editors of the National Review have endorsed a travel ban, for example. In their editorial, they went out of their way to stress the importance of helping the victims of Ebola in West Africa, by making exceptions for aid workers and such. But they’d stop others from going to those countries, and handle returning visitors on a case-by-case basis.
These are not crazy arguments. But most public health experts remain opposed to such a sweeping travel ban, because they believe the potential downsides are a lot bigger than the potential upsides. These experts make some pretty compelling arguments of their own.
Mike Leavitt, former HHS Secretary agrees:
A former HHS secretary under President George W. Bush says he sees "lots of problems" with using travel bans to contain diseases like Ebola.
Republican Mike Leavitt was in charge of bird flu preparedness under Bush. He says that at the time, officials studied a travel ban intensely but concluded such an approach might not work.
Leavitt tells The Associated Press that a travel ban is intuitively attractive and seems so simple.
But would the U.S. expand the ban to European countries if people there got exposed? And what to do about Americans who want to come home?
Then again, he's not running for anything.
Speaking of travel bans, NY Times:
No restaurants, grocery stores, movie theaters or other places where members of the public congregate. No travel by airplane, ship, long-distance bus, train or other modes of commercial transportation.
Such are the restrictions that dozens of health care workers who treated the Ebola victim Thomas Eric Duncan are being asked to follow for the 21-day maximum incubation period of the virus.
The documents were drawn up by the Texas state health agency and Dallas County officials after an infected nurse, Amber Joy Vinson, took two flights between Dallas and Cleveland in the days before she developed symptoms of Ebola and was diagnosed with the disease.
County Judge Clay Jenkins, Dallas County’s chief executive and its director of homeland security and emergency management, said he was confident that all of the workers would agree to sign the documents. “These are hometown health care heroes,” he said. “They want to do this. They’re going to follow these agreements.”
Remember, short of crossing state and international borders,
quarantine is a state function. This is TX administering that function.
More politics and policy below the fold.
Sam Baker:
Frieden said this week he would refocus on identifying one hospital in each state to prepare for and handle Ebola patients, and provide a CDC "SWAT team" to support those hospitals. Experts said that's a much better model, but that every health care worker still needs to know what to do for the first 24 to 36 hours.
"The patient's not going to show up at a center of excellence," Jha said.
Jha thinks having an Ebola "czar" can help with this part of the process, particularly by coordinating federal efforts with state health departments. Although the CDC is in the political spotlight now, he said he thinks the agency has done a "pretty reasonable job," but that state agencies have lagged.
CDC is not above criticism, but so much of what they do is based on working with states. They do not replace states. It is not top down.
— @DemFromCT
Maggie Fox on another HHS Secretary,
Tommy Thompson:
Tommy Thompson, a former Wisconsin governor who headed HHS before Leavitt, helped set up the current disaster response system after 9/11 and the anthrax attacks that followed. It’s not a top-down system, Thompson told NBC News.
“It was never set up that way,” Thompson said. “It was always set up that public health is really a joint effort. The states have got to be involved.”
n fact, public health preparedness starts at the state and local level, Thompson said. “You have to do it in conjunction with the states,” he said.
“If you have a quarantine, it requires the involvement of the city. It cannot be done from the top down.”
States wouldn’t stand for it any other way, said an HHS spokesman. “We can’t just come in and take over a state,” he said.
Every CDC critic (and CDC has made their share of errors, they are not above criticism) needs to read and understand this. In fact, I wrote a bit about this topic as far back as
2007. I talked about it in terms of a flu pandemic, and how hard it is to coordinate all the moving parts. And Mike Leavitt talked about the new hire (Ebola czar Ron Klain) as more of a
Federal Coordinating Official than a public health czar. But even in that case, a lot depends on the states. And if you glance at my links, you'll appreciate more the next piece from
Scott Gottleib:
Enter CDC director Dr. Thomas Frieden. And listen closely. His public comments in all of these regards, while too bold in hindsight, have been far more nuanced than other leaders’, including those of his boss, the President of the United States.
And his dominion over this fight is far more restricted than most appreciate.
Don’t get me wrong. The CDC plays a critical role. But the assets that are key to responding to a public health emergency of this magnitude aren’t under his control.
Many belong to the Department of Homeland Security (DHS), while other assets and authorities fall under the direction of the Assistant Secretary of Preparedness and Response. As for the heavy resources and personnel on the ground in West Africa, they belong to the Pentagon.
Maggie Fox on the new's media's over the top coverage:
A bridal shop in Ohio closes its doors because a nurse who later came down with Ebola shopped there. A lab technician who handled samples from the patient who died in Dallas has confined himself to his room on a Caribbean cruise ship. Schools in Cleveland and in Texas with only tenuous links to people infected with Ebola are closed and cleaned with bleach.
None of it’s medically necessary. There’s no reason to think that even a nurse with a very slightly elevated temperature — Amber Vinson had a temperature of 99.5 when she flew home to Dallas from Cleveland — could infect anyone else.
Why the fear? Experts blame the news media, mostly. Politicians don’t help, either, they say.
Asbury Park Press:
When you are manufacturing a bogeyman, the facts take a backseat to the hype. The facts tell us that Ebola is, indeed, a pretty nasty disease and that the number of people who have succumbed to it was 4,447 as of Wednesday afternoon, according to the World Health Organization.
But the vast majority of those of victims are in West Africa. Here at home, the death toll has reached ... one. Two health-care workers in Dallas who helped treat the victim have tested positive for the disease and are being treated.
Surely, all necessary precautions should be taken to prevent the spread of the virus in America. But let's all get a grip here.
Dan Diamond:
One of the most common questions I’ve gotten the past few weeks concerns a seeming paradox:
If Ebola’s so hard to catch, why are there so many photos of health care staff wearing full-body protective gear?
Or a different way to think about it, often asked by skeptics:
If Ebola’s so much of a threat, why aren’t more Americans getting sick?
It’s a visible inconsistency that’s threatened to muddle public health messages about Ebola. For example, the White House has shifted into Ebola “crisis mode,” Reuters reported on Tuesday, even while stressing that other Americans should remain calm.
Here’s how to answer those questions, and understand the nuance behind why Ebola’s so scary — but not an imminent threat to most Americans.
Or as the internet likes to say, know which illness kills more Americans than Ebola? All of them.
National Journal:
{Sen Tom] Harkin this week called on Congress to undo the sequestration caps -- which will take another chunk out of the federal budget in October 2015 -- due to the seriousness of the Ebola outbreak. "With Ebola on our shores, we must lift the sequester, not double down on it," he said.
Romney pollster Newhouse tells Rs to brace for D ground game: "I'm a believer in what Ds can do. Count me converted."
http://t.co/...
— @JohnJHarwood
Liz Szabo:
While the USA has a new Ebola czar, years of budget cuts have left it with far fewer public health ground troops.
President Obama tapped veteran government insider Ron Klain Friday in response to withering criticism of the nation's response to Ebola.
But public health doctors and nurses say the USA's ability to prevent and treat Ebola infections has been hobbled by years of budget cuts.
The budget for the Centers for Disease Control and Prevention -- which has been hammered this week by criticisms of its response to Ebola -- fell nearly $1 billion from 2012 to 2013, or about 10%.
Dana Milbank:
Francis Collins, director of the National Institutes of Health, administered a dose of truth to political Washington this week.
For this honest service, Collins was pilloried.
In an interview published Sunday night, Collins shared with the Huffington Post’s Sam Stein his belief that, if not for recent federal spending cuts, “we probably would have had a vaccine in time for this” Ebola outbreak.
This should not be controversial. His conjecture was based on cold budgeting facts. NIH funding between fiscal year 2010 and fiscal 2014 had dropped 10 percent in real dollars — and vaccine research took a proportionate hit. Research on an Ebola vaccine, at $37 million in 2010, was halved to $18 million in 2014.