Kai Kupferschmidt:
Peter Sandman, a longtime expert and consultant on risk communication based in Brooklyn, New York, wasn’t especially shocked when he first heard about the patient's case. "My first reaction was: Well, it had to be somewhere. Better Dallas than Mumbai,” he says. But Sandman says the past week has been a missed opportunity. The Dallas case could have been used to explain to Americans what makes Ebola a global threat, he says. “ ‘This was a spark to a place that knows how to extinguish sparks. What is terrifying us is that there are going to be sparks to places that don’t know how to extinguish them.’ That should have been the main message,” Sandman says.
As public health officials and scientists tried to reassure the public that there was no danger and to address the Texas hospital’s mishaps in dealing with the case, they missed that chance, Sandman says. “So far it’s more a distraction and distortion.”
In a long e-mail to ScienceInsider, Sandman and his wife and colleague Jody Lanard discuss what years of work in risk communication have taught them, and where they think government officials as well as journalists are failing. Two big mistakes in how the Dallas case was handled—sending the patient home when he first sought medical care and keeping the family under quarantine in the potentially contaminated apartment for days—have raised questions about how well prepared the United States really is for Ebola. That question has become the focal point of media coverage of Ebola.
"As long as U.S. media are justifiably fixated on ‘exposing’ what went wrong and what keeps going wrong and what might go wrong in Dallas, the conversation here won’t turn to West Africa, where it belongs,” Sandman and Lanard write in their e-mail. "The screw-ups in Dallas need to be acknowledged and apologized for—repeatedly,” they argue. "The more officials continue to sound like cheerleaders, ignoring or minimizing what goes wrong, the more the media will focus on knocking them off their high horse.“
A more detailed response from
Peter Sandman and Jody Lanard covering important topics like border closings and flight restrictions:
Teach the world why “spark suppression” – reducing the number of Ebola sparks emanating from West Africa – is essential to buy time for the desperate attempt to find a vaccine. Don’t settle for the false dichotomy – the claim that since border closings never work perfectly, there’s no point in inhibiting travel. Foster a thoughtful debate about various proposals for reducing the number of sparks, and thus reducing not just the burden of extinguishing those sparks but also the chances of Ebola establishing itself in additional countries. Help assess which proposals will probably backfire, which will do little good at great humanitarian cost, and which will do comparatively more good at comparatively lower cost.
I encourage you to read the full piece. Hopefully, our discussions here about border closings and flight restrictions have and will follow suit.
And same authors (personal communication) on airborne possibilities:
We think we've been a little too careless when describing communication about the remote possibility of "airborne Ebola."
The angry anxious debate among experts has come across as: "It could" versus "It couldn't — so don't talk about it."
We think it should be recast as a debate between: "It could, though it's very unlikely," versus "It could, but it's very very very very very unlikely."
Scientists hate to get pinned down into saying 100% certainty about anything, and
"very unlikely" is more accurate than
"it can't". It's also more reassuring to hear people
avoid complete certainty and to discuss the topic rather than avoid it.
Still, a key point in all of this is recognizing mistakes made in Dallas (see below), apologizing for them, and learning from them.
More politics and policy below the fold.
LA Times:
When Thomas Eric Duncan first appeared at a Dallas hospital, his temperature reportedly soared to 103 degrees, but he was sent home, prompting complaints from his fiancee's family that he should have been admitted.
But such a high fever by itself is not enough to have forced him to be kept in the hospital, according to several experts in emergency room practices.
“I have certainly discharged many people with a 103-degree fever,” said Dr. Kristi L. Koenig, professor of emergency medicine and director of the Center of Disaster Medical Services at UC Irvine.
There are other considerations, such as, “are they able to walk, or talk or eat? It’s not just the number,” she said.
In Duncan's case, the key issue was not the degree of his fever, but that he had just arrived from Liberia, a center of the Ebola outbreak in West Africa, where the disease is believed to have claimed more than 4,000 lives.
Reuters [from 10/6/2014]:
Potential suits against the Dallas, Texas hospital that sent home a patient later diagnosed with Ebola face long odds in the face of state medical malpractice laws.
Texas tort-reform measures have made it one of the hardest places in the United States to sue over medical errors, especially those that occurred in the emergency room, according to plaintiffs’ lawyers and legal experts.
“It’s one of the highest legal burdens of any state in the country,” said Joanne Doroshow, executive director of New York Law School’s Center for Justice and Democracy, who studies U.S. tort law.
Although it appears no lawsuits have been filed in connection with the case, possible legal claims could be brought by Ebola patient Thomas Eric Duncan or his family, anyone he may have exposed to the disease, or hospital workers put at risk.
And in non-Ebola news:
Chris Geidner:
The Kansas Supreme Court on Friday evening put a temporary hold on the granting of marriage licenses to same-sex couples in Johnson County, but allowed applications for such licenses to continue.
In response to a request from the Kansas attorney general earlier Friday, the court issued the Friday evening order refusing to grant the attorney general’s request for an immediate order that the licenses could not be issued — noting that “the Attorney General’s right to relief on the merits is not clear.”
Instead, the Kansas Supreme Court granted the temporary stay and set a schedule for a full briefing of the issues involved — including the question of “whether Kansas’ state constitutional, statutory, or common law bans on same-sex marriage are permissible under the United States Constitution.” The oral arguments will be held “at 10:00 a.m. on November 6, 2014,” according to the court’s order.
Things are moving fast. Blink and you might miss it.
Jason L. Reiley:
New Jersey Gov. Chris Christie , who heads the Republican Governors Association, was in Pennsylvania Thursday stumping for GOP Gov. Tom Corbett, who is facing re-election next month. This would be the same Chris Christie who won’t help New York’s Republican gubernatorial candidate, Rob Astorino, because Mr. Christie considers the Empire State race unwinnable.
When asked back in August whether the RGA would support Mr. Astorino, who is facing off against incumbent Democrat Andrew Cuomo , Mr. Christie responded, “we don’t pay for landslides and we don’t invest in lost causes.” In the most recent Quinnipiac poll, Mr. Astorino is down by 21 points, so does Mr. Christie have a point?
Maybe, except that Mr. Corbett is trailing his opponent, Tom Wolf, by 17 points, according to Quinnipiac. Moreover, the RGA is “Corbett’s biggest campaign donor at $5.8 million so far in this campaign cycle,” reports the New York Daily News. Are four percentage points the difference between a winnable race and “lost cause,” Mr. Christie?
Of course not. The reality is that Chris Christie was in Pennsylvania mainly to help Chris Christie, not Mr. Corbett.
Dana Milbank:
If you’ve been thinking of breaking federal election law, this would be an excellent time to do it, because the chance of being caught is close to nil. There is no cop on the beat.
But this week, a Democratic commissioner took a bold gamble to change all this. She did it with a method that has become arcane in Washington: She offered a concession.