Want a straight Ebola story? This is one of the best from Atul Gawande:
“This case is serious,” Rick Perry, the Governor of Texas, said on Wednesday at a press conference at Texas Health Presbyterian hospital in Dallas, where the first patient diagnosed with the Ebola virus disease in the United States was being treated. “Rest assured that our system is working as it should. Professionals on every level of the chain of command know what to do to minimize this potential risk to the people of Texas and this country.”
Then, a few minutes later, hospital leaders confessed that, in fact, the professionals hadn’t done what they had to do. The hospital had prepared for the possibility that Ebola would arrive in its emergency room. It had adopted a Centers for Disease Control screening checklist to identify patients with fever who had travelled from the region of West Africa beset by Ebola. (Full disclosure: my research center and I advised the C.D.C. on the design of its checklists.) The staff had rehearsed the event. And, on September 24th, when just such a traveller arrived, the triage nurse who saw him actually asked the proper questions and flagged in the medical chart that he was a potential concern for Ebola.
But: “Regretfully, that information was not fully communicated throughout the care team,” the hospital’s chief quality officer said.
Did I say politics? Why,
yes I did. See also
Vauhini Vara:
Those who have questioned whether the existing controls are strong enough, such as Senator Ted Cruz, the Republican from Texas, have pointed out that several African countries have restricted or shut down air travel to countries with confirmed Ebola cases. Maybe the U.S. should simply stop airlines from traveling to those countries.
The fact is, U.S. airlines don’t fly to the countries with ongoing Ebola outbreaks. Delta used to fly to Monrovia, but stopped in August. Today, only Delta and United offer direct, nonstop service between the U.S. and West Africa, according to Airlines for America, a trade group for U.S. airlines—Delta to Lagos, Accra, and Dakar, and United to Lagos alone. The Ebola patient in Texas first flew from Monrovia to Brussels on a different airline, reportedly Brussels Airlines, then boarded a United flight to Washington, D.C., and another one to Dallas.
More politics and policy below the fold.
Okay, so banning flights may not make sense, but what about increased screening at airports?
WaPo:
The president did not go into detail about the new screening possibilities, though the White House said Tuesday new measures would be announced in “the coming days.” An official familiar with the options being considered said they include everything from taking the temperature of travelers arriving at U.S. airports from Ebola-stricken countries to doing more to track the travel histories of international travelers arriving in the country. Sen. Charles E. Schumer (D-N.Y.) told The Washington Post on Tuesday that there will be “tougher types of screening” at U.S. airports.
These plans could theoretically prevent some people who are infected with the Ebola virus from entering the country. They also cannot possibly stop every person with Ebola who may arrive in the country. This is because of the simple realities of the disease ravaging West Africa, whose symptoms take time to manifest, as well as the nature of air travel in the 21st century.
Checking a few major airport hubs on arrival here might make political sense but not so much science sense. This is
Helen Branswell from 2013:
A new study suggest airport screening for disease control rarely makes sense, but if it's undertaken, it should be done at the source of the outbreak.
The researchers say the screening of passengers leaving via a few key airports near the epicentre of an outbreak is a better approach than having hundreds of airports around the world screen arriving passengers.
The research is based on a study of air travellers departing from Mexico in the early days of the 2009 H1N1 flu pandemic.
If you want to stop spread, stop it at the source.
Norway does it right! When one Ebola infected health worker returns Norway sends many more to West Africa!
http://t.co/...
— @HansRosling
Politics or public health? From
WFSB, Connecticut:
If the Ebola virus comes to Connecticut, health officials now have the ability to quarantine the individual or group carrying it.
Gov. Dannel Malloy declared a “public health emergency” and signed an order on Tuesday that gives the power to Commissioner Jewel Mullen of the Department of Public Health.
“We are taking this action today to ensure that we are prepared, in advance, to deal with any identified cases in which someone has been exposed to the virus or, worst case, infected,” Malloy said.
The order was not executed because of a specific case, the governor's office said. Rather, it's a precaution just in case someone comes to the state with either a confirmed infection or is at risk for one.
“It is essential to be prepared and we need to have the authorities in place that will allow us to move quickly to protect public health, if and when that becomes necessary,” Malloy said.
Without Malloy's declaration, he said there is no statewide ability to isolate potentially infected individuals. Instead, the authority would rest with local public health directors, at which point it might be too late to prevent further infections.
Quarantine is both a
federal function (at the borders and interstate) and a state by state function (within states) and not all states are the same (you can access your state laws
here):
The federal government, through the Centers for Disease Control and Prevention (CDC), has authority to monitor and respond to the spread of communicable diseases across national or state borders. By Executive Order of the president of the United States, federal isolation and quarantine are authorized for specific communicable diseases: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers, SARS (severe acute respiratory syndrome), and flu that can cause a pandemic. The president can revise this list by Executive Order. Further information on federal law quarantine authority can be found here. State and local governments have primary responsibility for controlling the spread of diseases within state borders. The table below summarizes state law authority for quarantine and isolation within state borders, including authority to initiate quarantine and isolation, limitations on state quarantine powers, and penalties for violations.
Think back to Dallas, where a homeless man exposed to the Dallas hospitalized case needed to be found and monitored. In his case, it was by psychiatric admission, but that raises other questions (including "do you have to be exposed to Ebola to get a needed bed?").
Oh, don't forget the Connecticut Governor is in a tight reelection race. Still, we learned a lot from the 2009 pandemic about what can and can't be done, and what steps need to be in place. And if you watched Dallas scramble on the municipal side in the first few days (they seem to have their act together now, which is why Rick Perry ≠ Ted Cruz), you can see why other places are lining things up.
Speaking of Perry v Cruz, check this out on intra state warfare from conservative Matt K. Lewis:
These supercompelling intrastate fights could define the 2016 GOP race Perry vs. Cruz? Rubio vs. Bush? Sign us up.