Whatever deity you believe in, whatever fates you choose to believe guides and protects you, thank them tonight before you go to sleep. Thank them for what? Thank them for dropping Ebola onto our soil as opposed to one of the more virulent and terrifyingly deadly bugs out there.
Ebola, as I discussed here, still isn’t a major panic factor for us since we live in a pretty modern society that is not conducive to the mass outbreaks we see elsewhere in the world. For us, living in the country we do, it’s a containable event. It’s also an easy bug to deal with. Or at least it should be.
Ebola was practically a nice, gift wrapped present for the CDC to allow them to shine and look like they were on top of things. It’s Ebola. Compared to the many of the other infectious diseases out there, hell, compared to some commonplace bugs here, it’s actually fairly difficult to catch. Using the zombie scale, there are plenty of 28 Days Later bugs out there, fast moving, quick spreading, and impossible to escape, but Ebola, certainly in a First World country like the United States, is not one of them. Ebola is more like the zombie from the pilot episode of The Walking Dead, the woman who was only a torso and arms, dragging herself at a snail’s pace through the still rather low cut grass. She’s not going far on her own, and certainly not quickly, she’s easy to contain, and you either have to go to her or just not be paying attention to what you’re doing for her to bite you.
Contrary to the fear mongering and panicked, hyperventilating stupidity by some of the punditry, Ebola, horrible and deadly as it is, is not the kind of superbug that stands a chance of taking us down, let alone taking us out. Any semi-competent organization in charge of dealing with such threats should have been able to come out of this looking like Hollywood heroes.
Sadly, the people in charge of this apparently aren’t doing too well on their semi-competency scores this year.
Now, there are some things that I can’t join in the group whipping of the CDC over. Some of the things people are screaming about, asking why they didn’t do ‘X’ when they “should have” done so, are things that you can only do as the CDC, or do as easily and quickly as some seem to believe, if you are in fact the Hollywood version of the CDC. Like too many “experts” on police procedure who graduated from the University of I Watched CSI, there are far too many people who seem to think that what they’ve seen happen in their favorite outbreak movie is exactly what can be done in reality.
Some of the things called for by some are completely impractical. I’ve seen calls for full CDC teams to be placed in every hospital and clinic, full gear and full equipment at the ready, for so long as deemed necessary. Beyond simply the unimaginable cost of doing something like that, no one seems to be able to define what they mean when they ask that this be done for as long as necessary.
How long is that exactly? Do we keep them stationed there permanently? That’s not really possible, not with the sheer number of staff and new gear that would be required. Is it until the most recent cases are cleared? The idea is to only keep them there until the “outbreak” (and it’s not at this small size really an outbreak) is officially over and then they can be recalled? If so, there’s no reason to condemn the CDC for not having done this before our first patient was declared to have had Ebola last month.
But where something like that does come into play, and is in fact practical, is to have rapid response teams assigned to various regions. And guess what? The CDC in fact has something like that. They just didn’t use them when they should have done so. And there we start the long line of issues that the CDC leadership has created for both the CDC’s credibility, and potentially for our welfare as well.
Two things should have been done the day that they confirmed the first case of Ebola. The first thing that should have been done was sending a full CDC team to Dallas to deal with the situation. This was shot down by Thomas Frieden, the head of the CDC, as unnecessary. His reasoning was that any hospital should be able to set up its own isolation area, and that any staff working the isolation area would be fine if they simply followed the CDC guidelines.
The problems with this line of thought are all related to the fact that, like some complaints against the actions or inactions of the CDC, it’s simply not practical. Not every hospital or clinic has the resources at their disposal to do such a thing properly and effectively, or even staff trained in certain procedures and everyday use of certain protective gear. They should not be asked to learn what they’re doing and figure out their required upgrades to deal with a situation as they hit the ground running in a real contagion event. The odds of experiencing a breakdown or failure in the system when forcing that kind of (in reality very preventable) trial by fire are high, and we’ve seen the results of playing those odds.
The second thing that should have been done, as soon as positive confirmation was made, was moving the original patient to a properly equipped facility like Emory University Hospital. This was also obviously not done, and the reasons given were the same reasons given for not immediately sending a fully equipped CDC team in to deal with the patient. It’s a shame that it’s taken two nurses contracting Ebola for Frieden to come to the realization that, yes, the suggestions made back in September were in fact the correct ways to handle a US Ebola case after all.
Frieden is also the CDC’s own worst enemy when it comes to being a spokesman. His ability to engage in foot-in-mouth disease is incredible. And, no, right off the bat, one of those moments is not the claim being made by many that he (or, depending on who is making the false claim, Obama) stated that Ebola would never come to America. That wasn’t said by anyone in a position of authority, and one of the obvious hints to the people believing that and simply repeating it as gospel is that no one making that claim ever seems to be willing to link a video or transcript of the supposed interview/speech where this was said.
However, they have said something almost as dumb. One of the more foolish comments to make given the state of affairs overseas was made by the powers that be recently when they claimed that it was “unlikely” that we would see Ebola here in the US. It wasn’t unlikely, it was inevitable. Not only was it inevitable, but it had already occurred once before. Ebola Reston is named after Reston, Virginia, the location that the strain was first identified and catalogued at in 1989.
Perhaps I’m making a point that is little more than arguing semantics here, but there are other words that would have, while perhaps being medically or scientifically squishy, worked better. In the world we live in today, a world growing smaller by the minute as our ability to travel it grows, saying that such an event was possible but historically rare might have been the smarter move. But knowing how large the outbreak in West Africa was and knowing the risks with travel, using wording that seemed to imply, or at least cause other to too easily infer, that such an event would not happen here merely creates the appearance of the powers that be not knowing at all what they’re talking about.
When Duncan was declared positive for Ebola, it was suggested by some that intubation or dialysis might have been beneficial treatments for him. Frieden swatted those suggestions down by stating that he had no knowledge of such procedures being used to treat Ebola patients before and that such measures might actually increase the possibility of spreading the virus. The problem with that, pointed out by several when he made the comments, is that these techniques were used, apparently quite effectively, on the infected doctors brought back to Emory only a short time ago.
In many ways Frieden seems like a man out of touch with the on the ground aspects of his job. He seems oddly unaware of what his own organization has done in recent past. He also seems amazingly unaware of the shortfalls that many hospitals and clinics around the country face when it comes to finances, practical training on matters such as these, staffing, and the required equipment. To follow the CDC suggestions, guidelines, and requirements to the letter, some medical facilities would come close to bankrupting themselves, and they would be doing so for worst case scenarios that they might never have to face.
And I don’t say that last bit in the same foot-in-mouth manner that was used with the “unlikely” comments. I say it because most hospitals and clinics should never have to do that. We have facilities around the country that are capable of dealing with such matters, and the first thing the CDC should do in these cases is come in, take over, assess the local capabilities from that location rather than from a DC or Atlanta office, and move the patients to these properly outfitted facilities if so required. In other words, exactly what they should have done with Duncan.
Frieden’s inability to speak well has also led him to answering questions in a way that only causes additional overall erosion in confidence by those asking the questions. Using an example of a bus, he would tell you that you should have no worries about traveling if you were healthy as you’re fine and Ebola is hard to get unless someone is symptomatic and you’re making direct contact with that person’s bodily fluids. He would then turn around and tell you that, if you were sick with Ebola you should avoid travelling on a bus because you could infect others. So, apparently, you’re fine traveling with someone who is infected, but no one is okay traveling with you if you’re infected. I (sort of think) I know where he was going, but he didn’t get there at all. And traveling…
One of the wonderful failures of Frieden and the CDC went on full display in the last day. A second nurse who cared for Duncan became infected with the Ebola virus. The nurse, who was supposedly being monitored by the CDC, boarded a commercial airplane to take a trip.
My first thought was wondering why she was allowed to travel at all. You can say that someone has to be symptomatic to be infectious and that, not being symptomatic she was not infectious and thus “safe” to the general public. This might well be true under normal, everyday circumstances, but for flying in a plane?
I’m sure anyone who reads this has had some past experience with a flu bug of some sort or another. I’m sure you know that you can wake up feeling fine, maybe even go to work feeling fine, and then, sometime during the day, sometimes in the span of only an hour or two, you go from feeling just a little “off” to being full on sick. Ebola can act the same way. Four hours in a plane could be all the time needed to go from feeling only barely noticeably “off” to full on fever.
But as forehead smacking as that seemed to come be at the time, even worse news came a day later. The nurse knew she was becoming ill. And let me be clear here that I blame the nurse for this part as well. I’m sorry, but if you tell me that I may have been exposed to Ebola, that fever should be one of my first symptoms, and I start developing a fever in the outlined timeline… I’m not going to assume that it’s nothing at all and that I’m fine and dandy. But, amazingly, as dumb as some might find the nurse’s actions, although possibly excusable given the human need for denial in some situations, the CDC absolutely took the first place medal for dumb away from her here.
The nurse had contacted the CDC multiple times with regards to getting permission to fly. In the last few conversations she had with them, she told them that she was developing a fever. One of the people she spoke to, someone who was supposed to be monitoring her for symptoms, cleared her to fly. Why? Because she only had at that time a fever of 99.5 degrees and the check sheet they had in front of them listed the symptomatic fever as 100.4 degrees.
So a nurse who was repeatedly exposed to an Ebola patient, occasionally with less than full protective gear, during the most contagious period of his infection begins to develop a fever within the predicted timeline for possible signs of infection, and it’s written off by someone on the phone looking at a check list because, apparently ruling out the idea of the fever still developing, she was still 0.9 degrees short of a full “Ebola” fever. If you wrote this up a plot device for a story, you’d be laughed at for coming up with something that farfetched and stupid.
To, yet again, make matters worse, Frieden and the CDC announce that it’s okay because she wasn’t symptomatic and there’s no worry at all about the other people on the plane. Then, shortly after that, Frieden and the CDC announce that they just want to track down and check up on the people, no worry, just for tracking and observation purposes, that were on the one flight with her. But everything is fine.
About few hours ago at the time of this writing, just a around late evening EST, the CDC announced that the nurse may in fact have been more symptomatic than they first let believed. They released information on two flights and requested that anyone who had flown on those flights contact them as soon as possible.
So now we have an entirely new number of people to add to the total count of “possible exposure” that we should never have had to add in. Yet this was a stunningly simple operation to handle, and one dealing with a virus that is in this country an easily containable bug. All that needed to be done was to treat this as a serious threat requiring immediate response teams on Day #1. Get on TV, tell the country that it’s handled, send the teams, transport the patient to a facility like Emory, contain, control, quarantine, and test the then very small number of people with risk of possible exposure, and let the timeline play out. 21 days later, or 30 if you want to play extra safe, you let those people go back to their lives.
But that’s not how they let this play out. We started out with one patient, rather than maybe a dozen or so isolated as possible exposure risks with likely no additional infections we instead have two new cases, over 70 possible exposure risks being, and I use this term as loosely as does apparently the CDC, observed, and now two planeloads of people that get to be added to the list of possible exposures along with, I’m sure, anyone she saw while out of state.
Again, this was, and still is, manageable. But, damn it, it shouldn’t have gotten this far into playing with unmanageable. And the simple act of getting information out and giving the public a person they can hear that information from and feel that they can rely on that information when given it, the simple act of messaging, has been abysmal.
And, I’m sorry, but I have to say something to my dear friends on the Left that’s similar to what I’ve said to many on the Right. Please stop the bullshit politicizing of this. Blaming anyone for this because we don’t have a Surgeon General is asinine. Having a Surgeon General, a figurehead, would not have changed the inept actions on the ground. Having a Surgeon General to play spokesman would not have eliminated the mistakes made by people mindlessly checking boxes on a list. Having a Surgeon General would not have changed the factors in the clinics and hospitals around the country.
The only thing that having a Surgeon General might have done was give as a better, more coherent spokesman for the CDC’s messages. But, honestly, when that became an obvious issue, why couldn’t Frieden and the CDC simply appoint someone in their organization to be their official spokesperson as some other government agencies do? You would get the same effect in the end as you might have someone who can clearly convey what needs to be said to the public in ways that Frieden obviously cannot. Although, in the end, that might not have changed anything either. A spokesperson can only give the message that he or she is given. If the source of the message is garbled, even a good spokesperson is going to have trouble making the message clear.
The people at the CDC are not stupid. Some of the people in charge may in fact be out of touch with the reality of what’s on the ground, and some others may be clueless as to how you best handle your PR, but they’re not stupid. They’re actually very smart. But the problem is that they’ve made themselves look very stupid. You can be the smartest guy in the room, but if you can’t show it or, even worse, you make basic errors that actually make you look really stupid; no one is going to believe that you’re the smartest guy in the room.
Frieden and the CDC have now failed to show it and compounded that mistake by making basic errors that make them look really stupid to many. Bit by bit, misstatement after misstatement, mistake after mistake, and full on error after full on error they have chipped away at their own image of being an agency that can handle such matters. Day by day, announcement after announcement, they’re eroded the trust that the public needs to have in them.
You can’t do that if you’re in a position like the CDC. Beyond creating a vote of no confidence in the mind’s eye of the public with regards to actual ability to handle matters such as this, the erosion of trust creates other issues. If you look stupid, if you act incompetently, especially on the big, showy things, people will start to think that you are stupid in more areas than one. The public doesn’t merely lose faith in the ability of such an organization to act as needed, but it spills over into people not trusting even the accurate information that is disseminated by that organization. And when that trust goes away, when the belief in the facts weaken because of the messenger, that’s when people start to more easily believe anything else that comes down the pike passing itself off facts and vital, needed information.
So, again, thank whatever deity you believe in, whatever fates you choose to believe guide and protect you, that this is only Ebola. That may seem a strange turn of phrase, to say “only Ebola” after all of this, but it’s not. Again, this is not the worst bug that could have hit our shores by a long shot, and it’s still containable now that it seems like they’re finally trying to act like they should have from day one.
But this isn’t going to be without a price. We now have two people infected who never should have been infected. We now have well over a hundred who will now be dreading the worst for the foreseeable future. What should have only ever ended with, worst case scenario, one death may in fact now end with two, three, five or ten, before it’s all over and done with. It should never have gotten higher than one infected patient, infected overseas at that, and a relative handful of possible exposure subjects kept for observation.
As for what the CDC needs to do in the long run- Frieden needs to go, to step down and leave the public eye, and the organization itself needs to have its procedures looked at, revised, and brought up to speed as soon as possible. As an organization, the CDC needs to get a major, and public, overhaul. They’ve become the FEMA of this Katrina. The only thing that’s missing is Obama walking out during a press op with Frieden and telling him that he’s doing a heck of a job to complete the picture.
Ebola was one of the possible US “outbreak” scenarios that should have been one of the easiest possible situations to deal with for an organization like the CDC. Instead we got what feels like an organization sleepwalking through the situation until finally forced to start waking up and paying attention. They’ve damaged their credibility horribly, and they’ve damaged their ability to effective lead the public in situations like this, because, one does wonder, if this is how they handle an “easy” outbreak scenario, how badly would they have handled a truly nightmarish one?
To borrow an analogy from a semi-recent Obama gaffe- We need the Varsity Team in our corner when the serious ship hits the sand, not the JV Team bringing its B-game. But, unfortunately, right now it feels like we’ve got the JV Team. It’s time to fix that and trade up ASAP.