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Ebola & The Culture War

The wisdom or unwisdom of public health measures does not depend on whether or not they are good for Rush Limbaugh or the GOP

I have been out of the country all month, returning over the weekend. Staying up on American news while abroad was not a priority for me; I looked in every few days. When I was standing in the customs line at JFK, a fellow passenger told me that the airport was going to begin screening travelers from West African flights for fever starting tomorrow. We talked about Ebola, and took comfort that it isn’t passed pneumonically. But the more I thought about it, the more I realized what a vector for transmission an airplane toilet would be. The BBC asked experts about this, and concluded that the chances of infection via airplane passenger are low.

Anyway, I learned over the weekend that to raise the question of whether or not we should refuse travelers from Ebola-infected countries is to identify oneself as a right-wing nut, and possibly even a racist. Apparently — according to some liberal readers of this blog — Limbaugh and the usual suspects are working Ebola fears into political talking points. It is therefore required of all decent and right-thinking people to take the opposite position. So I’ve learned.

This is crazy, and dangerous. I haven’t checked, but I have no doubt that talk-radio loudmouths are making political hay about this stuff; it’s what they do. They are, in fact, the enemy of clear thinking — but so are those whose thinking is dictated by a compulsion to take the other side of whatever Limbaugh says.

The Ebola reaction in this country is unavoidably a political issue, because it is a matter of public policy. We are being asked to trust the government’s planning — remember Katrina? remember FEMA? remember “heck of a job, Brownie”? — and to trust in the competence of hospital administrators (which, in the case of Texas Presbyterian Hospital, has been a mistake). Those are inherently political acts. Whether or not critics of government policy are right, wrong, or somewhere in the middle does not depend on whether or not the answer is good for Barack Obama or the Republican Party.

Someone sent me last night this sarcastic blog post from an emergency room nurse, questioning the US capacity to care for even a small Ebola epidemic here. Excerpt:

Exactly as predicted, now that the horse is some distance down the road, the government officials paid to prepare for emergencies, after being caught in their usual pants-around-their-ankles condition, are busily trying to find a lock for the barn door, and assuring all and sundry that “We’ve got this.”

And also as I noted going back weeks and even yearsno, they don’t.

But still we get the unicorn-farted happygas from the Dutiful Minions:

At the White House Friday, federal officials sought to reassure the public that the nation’s health-care system was well-equipped to treat the virus and stop it from spreading.

“It’s very important to remind the American people that the United States has the most capable infrastructure and the best doctors in the world, bar none,” said Lisa Monaco, assistant to the president for homeland security and counterterrorism. “The United States is prepared to deal with this crisis.”Okay, yes we do have the best infrastructure and the best doctors in the world, bar none.
But unless we know how high that bar is, that’s like saying you have the world’s largest unicorn. It sounds like a lot, but it’s not as impressive if you find out it’ll fit in your shirt pocket, is it?

So let’s look at that infrastructure.
There are, in fact, a total of four medical isolation units in the entire United States, as we noted yesterday, that are capable of handling infected Ebola patients near endlessly.
Where are they, and what can they handle?
Emory University’s Serious Communicable Disease Unit is in Atlanta, GA. That’s where Brantly and Writebol were treated. It has three beds.
St. Patrick Hospital’s ICU Isolation Unit is in Missoula MT. It has three beds.
The National Institute of Health’s Special Clinical Studies Unit is in Bethesda MD. It has seven beds.
And the biggest, the Nebraska Medical Center’s Biocontainment Unit is in Omaha NE. It has ten beds.

3+3+7+10=23 beds, coast to coast.

So, for the entire country, all 316,100,000+ of us, we’re fully prepared to treat 23 Ebola patients at the same time. (For reference, that’s how many Ebola patients Liberia had last April. It hasn’t gone well.)

But the 316M-person question is, what happens when we have 24?

More happygas, anyone?

The nurse goes on to quote the CDC’s website advising people who don’t wish to contract Ebola to avoid hospitals where Ebola patients are being treated. What does this guideline mean in real life? More:

So, you can either have an Ebola hospital, or a regular one. Personally I work at a hospital with +/- 10 negative airflow rooms, in the entire building. So that’s how many Ebola patients we could care for, max. But 6 of those rooms are in the ER. Let me be more specific: 6 of those rooms are in the ER that sees 300-500 patients a day 24/7/365, 110,000+ patients a year, and of whom 99-and-change% of them go home alive. So we can care for them, or we can take in 6 Ebola patients, of whom 0-3 will likely survive. While all those other patients go somewhere else. Or nowhere else. And we can multiply that times every city that gets an Ebola patient, if we try to use existing facilities. Sorry, if my choice is the entire community, or a handful of individuals of whom 50-90% will certainly die anyways, “Best wishes with your Ebola, we have a bus waiting outside to take you to the treatment center in BFE.”
Not even close to a tough call. And it’s a choice we’ll have to start making if ever the patients coming in overtop our ability to deal with them. And if you’re in a one-hospital locale, that’ll be the choice on Day One. I can’t imagine the community that’ll rather see everybody with a heart attack(stroke/asthma attack/diabetic emergency/car accident…you get the idea) die, just to save a few of the Ebola patients. Call me when the head of the CDC, or the local hospital CMO talks about that on the news, and they’re ready for it.

Read the whole thing. 

It’s impossible to be 100 percent safe from this disease. It’s not the government’s fault that the Liberian who died in Dallas lied about what he had been doing in Liberia. If I were a West African who knew he had been exposed to Ebola, I would lie too, because my life would likely depend on getting into the US and to an American hospital. So it’s not the government’s fault that he lied, nor is it the government’s fault that Texas Presbyterian’s incompetence sent the Ebola patient back out into the community.

But it happened. And it’s going to happen again. We know this. So why not reduce the chance of it happening by refusing visas to citizens of the Ebola-stricken countries? Why is this so unthinkable?

Laurie Garrett, the well-known public health journalist, writes in the Washington Post that we are not prepared for Ebola in this country, and that our arrogant assumption that our money and technology will save us could be very bad for us. Yet she insists that there is no way to keep Ebola out through sealing off the borders. The blogger West Hunter (Greg Cochran) says this is nonsense. We may not be able to prevent every case, but we could dramatically limit them:

It seems highly likely that r in US conditions is well under 1.0 which means you can’t get an epidemic. However,  r is probably not zero.  It doesn’t mean that you can’t get a few cases per imported case, from immediate contact and hospital mistakes.  As an example, suppose that on average each case imported to the US generated a total of two other cases before dying out (counting secondary, tertiary, etc infections).  Then, on average, the number of US citizens infected would be twice the number of infected visitors.

Now suppose that a travel ban blocked 80% of sick people trying to fly here from Liberia.  We’d have 80% fewer cases in US citizens: and that would be a good thing. Really it would.

Why is this incorrect? Seriously, why? “Because Rush Limbaugh might agree with it” is not an acceptable answer.

If you were on a flight into the US from overseas, and you saw someone who looked feverish and unwell coming out of the bathroom, especially if that person appeared to be a West African, would you use that bathroom? Would you send your child into that bathroom? Here’s what happened to the Dallas Ebola patient, on his second visit to the ER:

Now, Duncan was back, only this time his symptoms included vomiting and diarrhea. His temperature was 103.1 degrees.

… By evening, Duncan was suffering from explosive diarrhea, abdominal pain, nausea and projectile vomiting. Efforts to bring down his fever failed.

Perhaps the sweating, shaky man who just came out of the airplane bathroom didn’t have diarrhea. Are you going to take that chance? I wonder how I would have reacted had I been faced with that situation on the Alitalia flight Friday from Rome to JFK. I tell you how I would have reacted: not at all, because I hadn’t been paying close attention to the news. Now, though? I would regret very much having got onto the flight at all.