Ebola, Risk Management, and the Case for Principled Pragmatism

Earlier this morning, the State of New Jersey agreed to release nurse Kaci Hickox from forced custody and allowed her to return to her home to serve out the remainder of her government-madated ebola quarantine.

Hickox’s demand to be released was just the latest sub-chapter in what has been a barrage of news media coverage over the the deadly disease.  To date, half-a-half-dozen new domestic ebola cases have been reported and, at least as of now, there is no indication that the disease has not been successfully contained within US borders.  Despite this, ebola coverage is largely dwarfing and crowding out every other national news story, including stories about an impending election which could well shift political power in the US Senate. Mind you, that people might assign greater urgency to ebola than the midterm polls, the World Series, and the cancellation of Honey Boo Boo is probably as it should be. A modern day plague is, after all, about as terrifying a thought as I could imagine.

What I find curious and disconcerting about the ebola coverage is not it’s media ubiquitousness, therefore, but rather how the media has allowed the various risk management strategies considered to be turned into a Republican vs. Democrat/Conservative v.s Liberal issues. They’re not, and treating them as such can actually have disastrous consequences.

To show you what I’m talking about, it’s probably best to start with the risk management piece of the equation.

In risk management terms, an ebola outbreak is one that has limited frequency risk and great severity risk — that is to say, statistically speaking it almost never happens (worrying about an imminent US ebola outbreak has actually been a thing since 1994), but when it does occur the results can be catastrophic.  It’s self-evidently awesome that ebola outbreaks are so infrequent. But one of the downsides to risks that are realized infrequently is that we have less data from which to extrapolate the best response when the event does occur.  Hurricanes happen multiple times every year, and as a result we know with exact precision what to do when one occurs.[1]  But an ebola outbreak on US soil? Not so much. When determining the best strategy to curb a possible domestic ebola outbreak, there are tens of thousands of variables that have to be taken into consideration.  And while some have to do with obvious cultural and legal issues, many more have to do with things that we can neither control nor fully anticipate.

For example, a no-fly zone from West African might reduce the risk of people infected with ebola entering the United States — or it might not. If you assume that people will still continue to enter and exit West Africa, then a no-fly zone might well result in people finding other channels which are monitored either less diligently or scrupulously. And since an infected person forced to exit West Africa by boat or train can pass along the disease to a US citizen in, say, Istanbul just as easily as they can pass it along in Dallas, a no-fly zone is not actually an elimination of risk so much as it is a transfer to a different kind of risk. A no-fly order, therefore, could drastically reduce the number of infecteds that enter the US — but it could also increase the number of infected that enter the US in ways where no monitoring is occurring.

Which is the best single method to ensure the least likely possibility of outbreak — no-fly/low control or allow-flight/high control? The answer is that no now really knows, and that even if we did we’d be talking in terms of various probabilities and not absolutes. And if that sounds overly scary, know I don’t meant it to be.  “No one really knows” is the starting point of most good risk management strategies.

In fact, the best strategy for a scenario as complex as an ebola outbreak is most likely one that incorporates all of the available options at various junctures.  Indeed, long before the first ebola diagnosis was confirmed in Texas there was probably a response matrix already in place that did just this.  And that matrix no doubt goes in different directions, each one depending upon a set of exact and unique circumstances.  In terms of flight restrictions, its matrix almost certainly has Status Quo when we are at Point X, Targeted Flight Restrictions when we reach Point Y, and No Non-Domestic Flights of Any Kind once we get to Scary-Ass Point Z.  Having such a matrix does not guarantee that an ebola outbreak will not happen; one might.  Rather, the matrix simply details the points at which certain risk-trade-offs will be made in various scenarios.  And at least at the moment, the CDC’s ebola strategy matrix appears to be doing an admirable job.  Two infected people entered the US unaware that they were incubators, and the result thus far is one death, one confirmed case of a US infection, and apparent overall containment.[2]

But now, however, there is pressure to abandon the CDC’s risk matrix because ebola has apparently become a Red State/Blue State issue.

Shortly after the first case was recorded in Dallas, the media began to allow conservative politicians to stake out territory that being anti-ebola was somehow conservative. For the past several weeks, we have seen ebola attached to a number of preexisting political conditions, ranging from border patrols to ISIS to immigration policy — none of which have much of anything to do with ebola, and none of which have anything remotely to do with the CDC risk management policy being deployed. The end result of this odd politicization has been that the no-fly option has bizarrely become a Right/Left litmus test.

On one side, you have conservative candidates and journalists taking up the arms for an immediate no-fly response, without — so far as I can see — any consideration at all given to how such an approach would sacrifice the over-all situation control that such a change would carry.  On the other side, you’re beginning to see an almost lockstep pronouncement that a no-fly would somehow be anti-science, despite the fact that at some point under certain scenarios it will certainly be prudent to impose one.  The problem, of course, is that either position — No-Fly Is The Answer! or No-Flys Are Un-Scientific! — is a potentially disastrous  position to take.[3]

When I talk about why I am a principled pragmatist first — and why I think in our increasingly bubbled world ideology is the enemy — this is what I’m taking about.

In my very post post ever here, I said this about what happens when political “values” meet OSHA worker safety regulations:

You might think that the solution is relatively easy, then. In the real world, however, it isn’t – because ideology gets in the way. Battle lines are drawn between Rs and Ds, even though none are truly required. (Management and labor are almost always in agreement on these issues; pols not so much.) … But as so often happens, ideology trumps reality, and data is dismissed as irrelevant or conspiracy. The best the building industry on the whole can hope for is that both sides arrive at some kind of angry compromise that isn’t a total fish up. The worst that can happen is that one side outright wins.

I might have written that about the way we are talking about the ebola crisis. The difference is that now the stakes are potentially far, far greater.

The risks of an ebola epidemic is not the same abortion; the strengths and weaknesses of the strategies involved are not akin to what those who make $200,000 a year should be taxed.  Risk management is neither a conservative nor progressive value. Your political avatars might be telling you that they in fact are, but your political avatars are lying to you in order to get you to feed your ideology.

Listening to these voices to the point where you increase the risk of a bad credit rating is stupid; doing it to the point where you increase the risk of a disastrous epidemic is criminal.

[1] Not that we always do.

[2] A possible third infected citizen, a five-year old boy, might be added to those statistics by the end of today.

[3] Not that there aren’t some admirable exceptions.  Or one, anyway.

Seriously, if you would have told me twenty years ago that everyone in politics was putting the nation at risk to leverage some votes in a midterm election, and that the one Senator who refused to do so was the guy who played Stuart Smalley, I would have thought you a loon.

[Photo: Ebola Verions, via Wiki Commons]

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