Friday, October 17, 2014

My take on the United States response to Ebola.

The Ebola Virus. Wikipedia/CDC

As hard as it is to believe Ebola is currently on the loose in the United States. One man from Liberia was able to spread it despite all the things working against the disease To put things in perspective, Senegal was able to stop the disease dead in its tracks after one person crossed their borders. Senegal is a third world West African country with a primitive health care system and a much smaller budget spent on their citizens health. As of this writing, the United States response has been less effective at responding to Ebola then Senegal has. 

Why is that? Well there are a ton of reasons and I am going to go through a lot of them. Mind you, there are a lot of them and I am sure I will miss some. An "in the wild" Ebola outbreak was extremely unlikely had we taken even the most basic of precautions. But we did not and now Ebola is here. I know that hindsight is 20/20 and that I'm no medical expert but most of this stuff is obvious. The fact that it was obvious to me and not to the government scares me more then the disease itself.

1. There should have been a more robust response to the disease in Africa as soon as the outbreak started. By the time U.S. troops and doctors were there it was too late to do much. It remains to be seen if American troops and aid will do much if anything with their current deployment, but if they had been there when the outbreak had started they might have made a difference. I understand that there was no political will for a deployment of troops or supplies but even a small CDC team could have helped with isolation and contact tracing. It may not have stopped the outbreak but it would have slowed it down and perhaps it could have snuffed the whole thing out before it destroyed West Africa.

2. Once it was clear that the outbreak was out of control casual travel should have been banned from the effected countries. I would have done this immediately, but it was abundantly clear that Ebola could be spread by air travel, and that screening procedures could miss infected people, when Patrick Sawyer, an American citizen, infected the Nigerian city of Lagos. Even with hard proof that Ebola could spread via airplane casual travel was not banned. Even after a case happened in America, casual travel was not banned. It is just insane to me that to this day anyone in Liberia can get onto a plane, with or without the disease and only has underpaid and under-trained screeners to prevent them from entering the country. This should have happened months ago and as of this writing it still hasn't happened. One of the reasons Senegal has no new cases is that they closed their border to the point they had vigilantes patrolling it. We didn't have to go that far but we could have done something. Stopping people that have no critical business here from entering the country would have stopped the outbreak before it began. Not preventing it risks making the outbreak even worse then it is already. There are no excuses anymore. 

3. The government should have been honest about what they knew and what they don't know. specifically they should never have downplayed the chances of the disease coming here. I know that the government was reading the same models that I was and I wrote back on 9/5/14 that Ebola had a 20% chance of spreading to the U.S. that month. By the 30th of that month it was here. The government must have known about this study but the President himself said it wouldn't happen. 

They also claim that the disease can only be spread by contact with infected bodily fluid. I wrote months ago that there were studies that seemed to show that under perfect conditions the disease could spread through the air. (I linked to the studies in the second paragraph if you want to read them yourself). The disease isn't technically airborne, and it doesn't spread the way that the flu does but under perfect conditions it can spread through the air. Unless there have been new studies specifically debunking the linked studies then they can't rightly say that the disease spreads only through contact with bodily fluid. How important the distinction is unknown, but if even one case could be prevented by nurses wearing respirators then it would be worth it. 

4. Thomas Eric Duncan should have never been treated in Dallas. We have four hospitals in the United States capable of treating patients in isolation. Texas Health Presbyterian Hospital in Dallas was NOT one of them. I'll get into their mistakes later, but they never should have been the ones treating Duncan in the first place. I can think of no reason whatsoever for Duncan to have been treated in Dallas when there were hospitals equipped to take him and had already successfully treated Ebola patients.    

5. Duncan's family should not have been left in their apartment for as long as they were. There were still potentially infected materials there and they stayed in a potentially contaminated area for far too long. Time will tell if this was an innocent mistake or a deadly one but it should not have happened no matter what. 

6. Once the decision was made to treat the virus in Dallas the CDC should have stepped in to monitor the treatment much more closely then they did. A nurses union, who contacted nurses involved in Duncan's treatment, detailed how colossally unprepared the hospital was. They accuse the hospital of conducting zero training, having little safety equipment and leaving medical waste piled to the ceiling. I understand that the CDC was there and was involved but they should have realized what was going on and put a stop to it.

7. Once it was clear that the hospital was incapable of treating Duncan, the doctors, nurses and other people that had contact with him should have been isolated. There is no reason whatsoever that Amber Vinson should have been allowed to fly. She never should have been allowed to leave Dallas under any circumstances, let alone allowed to fly with a low grade fever. It was foolish of her to travel but inconceivable to me that she was allowed to travel. If we are lucky then none of the people on either of the plane with her will get infected. But we will still have to monitor them and if even one of them gets infected the whole process of contact tracing will have to begin again. There are 76 people from the hospital that are being "monitored". All of them should be in quarantine. 

So there you have it. The government screwed up and screwed up bad. If I was a more conspiratorial person I would say that they were letting the disease spread on purpose. But always remember Hanlon's Razor. Never attribute to malice what which is adequately explained by stupidity. And if the American Ebola crisis proves anything it is this. Our government is incredibly stupid...       

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