Ebola, Risk Management, and the Case for Principled Pragmatism

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Tod Kelly

Tod is a writer from the Pacific Northwest. He is also serves as Executive Producer and host of both the 7 Deadly Sins Show at Portland's historic Mission Theatre and 7DS: Pants On Fire! at the White Eagle Hotel & Saloon. He is  a regular inactive for Marie Claire International and the Daily Beast, and is currently writing a book on the sudden rise of exorcisms in the United States. Follow him on Twitter.

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40 Responses

  1. Avatar Kazzy says:

    I didn’t click through the links, but 538 did an analysis of the impact of a flight ban. They found relatively few direct flights from the infected areas to the US. But many, many, many flights that involved connections in Europe or the Middle East. The latter group could not be controlled for. We can’t tell Nigerian Air they can’t fly to Istanbul and we can’t block all flights from Istanbul. For me, this was more or less the definitive argument, at least given the facts as we currently know them.

    One of my favorite games to play is to identify a hot button political issue (“EBOLA!”) and construct an argument for each side of the aisle both for and against it. The reality is, you can do this almost all the time. For instance, if a Republican was in the White House, I could easily see conservatives insisting that Ebola was a bunch of unsubstantiated media hype while liberals would probably insist the President was ignoring the crisis because it was African in origin.

    Good post, Tod.Report

  2. Avatar greginak says:

    In this case it seems that ideology is the secondary enemy, politics is the first. Politics wouldn’t even be that big a deal if pols and media types weren’t rewarded with fear mongering and there was more focus on letting people who know something about the sporking subject lead us (yes the dreaded techocrats).Report

  3. Avatar Mike Schilling says:

    Like you’d say Ebola was more important than the Series if the Bums had made it in.Report

  4. Avatar Mike Schilling says:

    The one I don’t get (or wish I didn’t get) is this: it has now become a right-left isue whether people who are known for a fact to have been exposed to Ebola should be quarantined until it’s certain they weren’t infected. This after a doctor who had been exposed walked around freely not knowing he was both sick and contagious. How is quarantine not a sensible, low-cost, high potential reward precaution?Report

    • Avatar Kazzy in reply to Mike Schilling says:

      Being a bit of a devil’s advocate, does that mean we can threaten the anti-vax crowd with quarantine?Report

      • Avatar Mike Schilling in reply to Kazzy says:

        If an anti-vaxxer has been exposed to a deadly communicable disease, than quarantine within the period he might be infected without showing symptoms seems reasonable to me.

        If you mean “lock up everyone who hasn’t been vaccinated for measles forever” the risk-reward calculation changes quite a bit.Report

      • Avatar Kazzy in reply to Kazzy says:

        I’m not saying we do it. I just want to be able to threaten to do it.

        I understand the practical desire for forced quarantine. And we obviously have a history of forcibly separating people from society if they pose a threat. But that is usually because of choices they’ve made that violate the law.Report

    • Avatar Mo in reply to Mike Schilling says:

      Define exposed? Should everyone that was on the same subway as that doctor be quarantined? The issue is one of incentives. If all aid workers are guaranteed a 21 day quarantine, no matter their condition, then we’ll get a lot fewer aid workers and it’s much more likely that the Ebola problem will get worse, rather than better.Report

      • Avatar Mike Schilling in reply to Mo says:

        Really, going to Africa for months of living in primitive condititons with the constant risk of contracting Ebola isn’t a disincentive, but a few weeks of isolation in relative comfort in the US is?Report

      • Avatar Kim in reply to Mo says:

        Mike,
        what is your risk assessment here? We’re not talking having to jury rig protective gear out of anything you can, like we were when Marburg struck Uganda. And Marburg had a higher deaths per infection rate.Report

      • Avatar Mo in reply to Mo says:

        @mike-schilling You mean helping people out and doing good with your skills is somehow less appealing than being locked up because someone wants to ignore epidemiology to pander to constituents? If a 4 week stint with MSF is actually a 4 week stint with MSF and a 3 week stint locked in a hospital (or worse a 1 week stint with MSF and 3 weeks in a hospital because you only want to take a month off), the incentives change significantly. Especially if you’re a nurse and you can’t afford to take that much extra time off work.Report

      • Avatar Mike Schilling in reply to Mo says:

        Ignore epidemiology, as in insist that someone treating Ebola victims may himself become infected, just because it actually happened?

        And, by all means, compensate people for the time they’re quarantined. Find them useful work to do: research, planning, relating their experiences. Give them pleasant surroundings. But don’t jerk your knee against isolating them just because it’s something Sean Hannity likes.Report

      • Avatar Mo in reply to Mo says:

        I’m not against isolating high risk cases or if the disease was more contagious. There are significantly more people that did work in Ebola areas that did not get Ebola. And despite bringing it back, the doctor didn’t infect anyone else because he checked himself in before he was contagious. What;s the percentage of health care workers that brought back the disease? 1%? 2%? There’s a line where a universal quarantine is valid, but we haven’t hit that point yet.Report

      • Avatar Kim in reply to Mo says:

        Mike,
        Are you listening to me at all???? Quarantine is ONLY NEEDED when they’re contagious. This isn’t Tuberculosis, this is FAR MORE like AIDS. You KNOW IT when you’re contagious.
        Quarantine is completely missing the point, anyhow. This is far more of a “sanitation” issue than a “oh my fucking god influenza” issue — the logistics on “how you deal with contaminated bedding’ are FAR MORE IMPORTANT than isolating people who might be a problem.

        See HIGHLY INFECTIOUS DISEASE. It takes ONE virus, as far as we know, and you could be infected. EVERY SINGLE PERSON you quarantine now is generating LARGE AMOUNTS of biohazardous waste. Or at least you ought to be treating it like that, if you want to be an idiot, and think that a quarantine needs to occur with perfectly healthy individuals (who may become sick later).Report

      • Avatar Mark Thompson in reply to Mo says:

        I don’t have much of a problem with mandating a limited quarantine for health workers returning after having treated Ebola patients in Africa – indeed, it seems worth mentioning that MSF itself discourages its staff from returning to work within the 21 day period even though they take issue with the need for a complete quarantine. Where I take serious umbrage is the insistence that they essentially be arrested upon setting foot in the US and forced to go to a hospital. Especially given what we know about the epidemiology, why not allow them to at least stay at home and see family members provided that they be subjected to mandatory monitoring?Report

      • Avatar Kim in reply to Mo says:

        Mark,
        these people are by definition not contagious. so why the fuck a quarantine?
        I don’t think that it’s a good idea to further penalize these heros. They’re responsible people, that’s why they went there (I’m pretty sure banging the nurses is NOT A GOOD IDEA in this sort of epidemic…).

        A quarantine for a virus that can spread with one virus intake to one human body, is one where you need biohazard treatment for everything. More than normal biohazard, too. It’s not something most houses are equipped for — and one that most hospitals don’t have procedures for (at least not automatically. that means untrained personnel)Report

      • Avatar Mark Thompson in reply to Mo says:

        @kim I’m just ambivalent about the notion of a limited quarantine – not supportive, but not passionately opposed either. Additionally, the problem isn’t about what they do while they’re asymptomatic. The problem is about where they are if they do become symptomatic. The NY doctor was not symptomatic when he went to the bowling alley, but he became symptomatic the next day, right? Well, what if he had become symptomatic a few hours earlier, while he was at the bowling alley?

        Sure, the risk of transmission at that time would be incredibly small, which is why I’m not really supportive of this, but can we really say that it would be zero?

        Again, MSF’s protocol itself indicates that returning volunteers should not go back to work within the incubation period, which means that if they follow the protocol, they’re time away from work is the same either way. And I’m sure everyone here is fully in favor of ensuring that they get reimbursed for that time away.

        While it may not be the best policy, requiring that they stay at home for that period strikes me as being far from outrageous.Report

      • Avatar Kim in reply to Mo says:

        Mark,
        I’m all in favor of government issued “quarantine gear” in case they do become symptomatic (to be carried with all potential Ebola victims until they pass the 3week mark). And a decently designed escort to the nearest quarantine-capable facility.

        Keeping a person at home does you jack-all good if their bedding hits a laundromat, though. In a 3 week quarantine, that’s pretty likely.

        (The “don’t work for a bit” seems pretty obvious. )Report

    • Avatar Kim in reply to Mike Schilling says:

      Mike,
      Ebola is HIGHLY infectious, and VERY MUCH NOT contagious. If you know enough to not bleed/barf on someone else, you’re not really “walking around contagious.” This is NOT an airborne disease, unless you’re in the middle of very specific procedures.

      We don’t quarantine AIDS patients (granted, that has a much higher threshhold for infection).Report

  5. Avatar Kazzy says:

    Also, this seems as good a place as any to share that Hannity recently wondered aloud about the possibility that a terrorist would go to West Africa, get ebola, and ride the American subway system until he keeled over.

    Of course, when he said it, it sounded even more ridiculous.Report

  6. Avatar James Hanley says:

    “being anti-ebola was somehow conservative”

    Let’s be serious here. We all know that 1) liberals hate America, 2) environmentalists want to depopulate the Earth, 3) Obama was born in Africa. Just connect the dots, sheeple!Report

    • Avatar Glyph in reply to James Hanley says:

      It’s worse than you think.

      O B A M A
      E B O L A

      5 letters (3 vowels, 2 consonants) in each. It nearly rhymes!

      I would bet money that some Republican operative somewhere was OVERJOYED that *this* was the disease making headlines right now.

      This will be their “Uma, Oprah”.Report

      • Avatar Bert The Turtle in reply to Glyph says:

        This will be their “Uma, Oprah”.

        Hmmm…considering that Tod name-checked “The Hot Zone” I suppose that’s an acceptably topical reference…Report

  7. Avatar Damon says:

    Couple things:

    We kept hearing early on how Ebola could not be contracted via the airborne method, and that those health care workers MUST MUST have failed in their protection protocols. Then we also heard that these folks were not trained in the protocols. We also hear that it’s possible to contract Ebola from spit or other body fluids ejected from a sneeze or cough. Because the disease so rarely manifests that no one knows FOR SURE exactly how it’s transferred.

    My first comment when the CDC guy was on tv saying that the nurses MUST have failed in following the protocols was “yah, you PROVED that or are you just speculating (and covering you ass)? And let’s not forget that the Dallas hospital wasn’t a NIH level 4 biohazard facility that is used to handling weird nasty bugs like Ebola.

    I see no reason NOT to have health care workers quarantined after a stint tending to infected folks, here or there….just in case. Will it impact HC workers by limiting the number that go over? Maybe. But wouldn’t you want to be sure you weren’t infected before exposing your co workers when you came back?Report

    • Avatar Kim in reply to Damon says:

      No, not really. Ebola is like AIDS. If you aren’t dropping blood/vomit/sneezing around, you’re fine.
      (protocols do include facemask, by the way).
      We already have procedures for children with influenza in the hospital. They wear a facemask. If that’s all it takes to avoid contamination, quarantine is called massively overdoing it.Report

      • Avatar Damon in reply to Kim says:

        Yes because it’s been PROVED that Ebola isn’t transferred that way. Statistically significantly proved. Post the peer reviewed article.

        There this: http://www.washingtonsblog.com/2014/10/new-york-times-may-carry-ebola-without-showing-symptoms.html

        Indicating that it folks who are asymptomatic can transmit the disease. Links to the original Lancet article are there as well.

        And there’s this: http://www.nj.com/politics/index.ssf/2014/10/christies_quarantine_policy_attacked_by_aclu_cdc_and_even_the_un_is_embraced_by_2011_nobel_prize_win.html#incart_river

        “Dr. Beutler, an American medical doctor and researcher, won the Nobel Prize for Medicine and Physiology in 2011 for his work researching the cellular subsystem of the body’s overall immune system — the part of it that defends the body from infection by other organisms, like Ebola.

        He is currently the Director of the Center for the Genetics of Host Defense at the University of Texas Southwestern Medical Center in Dallas — the first U.S. city to treat an Ebola patient and also the first to watch one die from the virus. In an exclusive interview with NJ Advance Media, Beutler reviewed Christie’s new policy of mandatory quarantine for all health care workers exposed to Ebola, and declared: ….

        “I favor it, because it’s not entirely clear that they can’t transmit the disease,” Beutler said, referring to asymptomatic healthcare workers like Kaci Hickox, a Doctors Without Borders nurse returning from treating Ebola patients in Sierra Leone who was quarantined in New Jersey for 65 hours before being transported to her home state of Maine on Monday
        afternoon. ”

        Color me unconvinced you’re correctReport

      • Avatar Kim in reply to Kim says:

        Damon,
        your article proves my point. We don’t quarantine people with AIDS, we don’t need to quarantine people who may have Ebola. (we take reasonable precautions. if they encounter the health system, they’re going to get quarantined)

        I’ll take it as a given (for now) that your articles are a bit better than what the CDC is putting out. They’re still talking about STD level transmission from infected but not feverish individuals.

        NJ.com isn’t talking about either the adaptive or the innate portion of the immune system, so color me skeptical that he’s actually done research on this damn thing, until you cite a scientific source.

        You’re still missing my point — we have an incipient disaster on our hands — that website you’re linking — nuke it with fire? Sure, we need those vaccines stat.

        But don’t miss the point that the contaminated bedding, silverware, towels are the REAL issue, not just “keep person in house and you win.” We don’t really have the procedures in place to deal with viruses that spread by single virus intake. And we need them, because this will generate massive volumes of “possibly contaminated stuff” that you can’t just bury.Report

      • Avatar Damon in reply to Kim says:

        Actually KIM, my point is it’s not known for sure that ebola cannot be transmitted by non personal contact with fluids, and there is evidence that it is. That alone makes a lot of what the CDC (the very guys who are supposed to KNOW) dubious.

        Read the quote I posted. The guy is recommending quarantine.Report

      • Avatar Kim in reply to Kim says:

        Damon,
        A duckbill facemask (what you’re calling a respirator) can be provided to someone without using a quarantine — and is standard CDC approved procedure for if someone’s vomiting/etc. Facemasks are cheap. EFFECTIVE QUARANTINE is not (see logistical issues with biohazards). You want anyone who is quarantined for this disease in particular to be at a safe biohazard disposal place.

        “The Lancet study does not warn of an apocalyptic scenario where any casual contact could cause infection. It is more focused on contagion through sex or blood transfusions.”Report

      • Avatar Damon in reply to Kim says:

        I’m just going to give up now….Report

  8. Avatar notme says:

    Jersey didn’t release the nurse as much as they were bullied into it by the Obama admin. At the same time the Army is going to quarantine all the troops that serve over there in our efforts to help.Report

  9. Avatar Roger says:

    Why Ebola has anything to do with tribal politics is beyond me. But then again I have only personally met a couple other classic liberals (that I know of) through my entire life. If I had a libertarian tribal meeting at my house I would be the total population.Report

  10. Avatar Kim says:

    Principled politicians would have come up with a decent plan (even if it included quarantine) months before now. If you only start taking action after something gets to the USA, when something getting to the USA was a completely predictable occurrence…. you’re succumbing to hysteria.

    … at least have the balls to admit it, guys.Report