It Can’t Happen Here

by Dave Schuler on August 4, 2014

The Wall Street Journal op-ed by Ian Lipkin is a good illustration of what I meant:

An infected individual could board a flight in West Africa, become symptomatic in the air or after landing and then expose others to the virus. At worst, this might result in a few other people becoming infected and possibly dying. But sustained outbreaks would not occur in the U.S. because cultural factors in the developing world that spread Ebola—such as intimate contact while family and friends are caring for the sick and during the preparation of bodies for burial—aren’t common in the developed world. Health authorities would also rapidly identify and isolate infected individuals.

Am I wrong to detect notes of arrogance and patronization in that statement? That’s not a rhetorical question. I genuinely want to know. It seems to me that Dr. Lipkin is assuming things that are not in evidence and failing to take into account the much higher number of deaths and, presumably, infection rate in this most current outbreak compared to others. I see nothing in his profile that suggests firsthand knowledge which implicitly means he’s just repeating what he’s been told.

{ 18 comments… read them below or add one }

Afghaniman August 4, 2014 at 11:08 am

Agreed. What I also find worrisome is that, in all the interviews with the director of the CDC, he repeatedly stresses (or deflects) the decision to return the two medical workers to the States was made by Samaritan’s Purse; the CDC’s role was to ensure the risks of infection to others are mitigated. My problem with this is who the hell is Samaritan’s Purse that they get to make that decision? I don’t want to seem uncompassionate, but that decision needs to be made by a government organization. I’m sure the CDC and the Army wanted to get their hands on a fresh sample of the virus to study and try new treatments, but I don’t want that precedent established (if it wasn’t already) that a private organization can arbitrarily return its people deployed into hot zones and if you don’t like it, deal with it!

PD Shaw August 4, 2014 at 11:53 am

@Afghaniman, I haven’t read those interviews, but I am skeptical that Samaritan’s Purse made the final decision. The CDC could have stopped the transport, and quarantined the flight. That they didn’t do so is the decision.

... August 4, 2014 at 12:31 pm

Can’t access the article. What’s he talking about with intimate contact? Is he saying they fuck the dead and dying, because I’m not buying that as a widespread cultural practice anywhere.

Or does he mean they help nurse and bathe and clean up after sick loved ones? Because I do that for family all the time, and I don’t think I’m all that unusual. And ling before someone here would think about it being anything extremely dangerous, they’d think they were dealing with a flu of some sort. It’s not like someone sneezes in the US and they immediately go into an isolation ward.

Afghaniman August 4, 2014 at 1:24 pm

@PD, Here’s the interview in question, specifically around 12:20 (but mentioned previously in the interview at points)

https://www.youtube.com/watch?v=CkK3lFc17nw

Don’t get me wrong, I believe they want them here for research, but it’s just odd that they’re deflecting responsibility (actually, I shouldn’t be so surprised)

PD Shaw August 4, 2014 at 2:14 pm

@Afghaniman, thanks for the link. It seems to me that the CDC Director is taking pains to distinguish acts of commission from omission. He was asked who “approved” this, and he answers that the decision is really that of those arranging for the medical evacuation. I am not sure that he is being entirely responsive. Approval usually means validating a pre-existing decision. I don’t think anybody thinks that CDC decided to evacuate the individuals.

But in the follow-up question, the Director is asked if the CDC could stop the evac., and he says they can quarantine and isolate people, but he is not sure if that power would apply here, where he thinks the risk of Ebola can be easily contained and Samaritan’s Purse has taken the appropriate precautions.

Sounds to me like they approved this, but don’t want the responsibility for one reason or another.

Cstanley August 4, 2014 at 2:47 pm

@PD and Afghaniman-
Ebola is on the list of quarantinable communicable diseases, so the CDC director does have some authority. It may be though that the authority is just to detain or force isolation on the individuals, not to prevent their entry into the US. And since the isolation was being arranged voluntarily, there may not have been any authority to prevent this (and legally no need for approval, just a need for not disapproving.)

It would have been helpful if the interviewer had asked different follow up questions to clarify what steps could have been taken, and why those other steps were not.

PD Shaw August 4, 2014 at 3:15 pm

@CStanley, the Director does mention that these are U.S. citizens with rights of ingress and egress. He may be chafing at the notion that the CDC (or anybody) has actually made a decision that best addresses all issues. Instead, the presumption is that Americans move freely within and across our borders, unless a demonstrable threat and need overwhelms it. It is simply not sufficient to operate solely on the precautionary principle.

Besides quarantine, I wonder if the CDC could not have also worked with the FAA to inform the plane before take-off that it would not be allowed to land in U.S. airspace. IOW, authority over commercial airlines might be different than individuals. But it sounds like the CDC was working with the evac. group all along, so this would be a complete about-face also.

PD Shaw August 4, 2014 at 3:17 pm

“He may be chafing at the notion that the CDC (or anybody) has actually made a decision that best addresses all issues.”

For example, he insinuates strongly that evacuating these individuals for a nine hour air flight might not be in their best medical interest, given that the appropriate care can be provided for them in Liberia, and they may not be able to provide needed care that arises in flight.

Cstanley August 4, 2014 at 3:40 pm

Yes I noticed that too, PD. I got the impression he wanted to go on the record showing that these issues were raised, maybe implying that they were trying to nudge the decision in the other direction without going so far as to step in with force of law (but also. As I said I don’t know how far his authority would have extended.)

Also as AM alludes to, there would have been other people who wanted this to happen, putting pressure in that direction too.

All that said I personally don’t find it worrisome. Unless the virus mutates it’s not going to cause a pandemic, and even in worst case is be more worried about cases coming in that haven’t yet been identified- not one coming in inder very controlled circumstances like this.

Cstanley August 4, 2014 at 4:57 pm
steve August 4, 2014 at 6:29 pm

The guy I just hired is married to an ID person. Talked with her. First, the guy who wrote the article is an epidemiologist. They study the spread of disease. He is probably as good as anyone at determining the likelihood the disease would spread.

2) The ID people don’t seem that worried about this. They think it can be safely treated and contained in a hospital setting. They worry more about someone entering the country unknown.

3) Not sure what you are referring to as paternalism, but the larger spread this time is largely because it moved to countries that have no experience and few resources. It is not especially paternalistic to think an individual patient could be treated better here. (If they have insurance.)

Steve

PD Shaw August 4, 2014 at 7:04 pm

For the record, most of my insight into the CDC and its procedures comes from The Strain, from which I gather the CDC can be compromised in protecting citizens from foreign invaders by (a) bureaucratic infighting, (b) the greed of those who profit from international commerce, (c) asshole trial lawyers, (d) the iniquities of the weak and selfish, and (e) supernatural forces beyond human understanding, born in ancient eons, and destined to survive the race of man, if not his social welfare states.

Dave Schuler August 4, 2014 at 7:37 pm

First, the guy who wrote the article is an epidemiologist.

That’s the most favorable possible interpretation. Let me offer another. Academics these days are extremely specialized. He doesn’t specialize in Ebola. He doesn’t even specialize in hemorrhagic fevers. He probably doesn’t know much more about Ebola than you do.

Afghaniman August 5, 2014 at 2:48 am

According to CNN, man in NYC who had recently been to west Africa checked himself into Mt. Sinai after suffering early onset ebola-like symptoms. Currently undergoing screening.

http://www.cnn.com/video/data/2.0/video/us/2014/08/04/lead-carroll-ny-patient-tested-for-ebola.cnn.html

I hope its a false alarm, but we may soon find out whether or not it would be difficult to spread here.

Andy August 5, 2014 at 5:20 am
Cstanley August 5, 2014 at 8:37 am

Fascinating stuff about the experimental ZMapp treatment here.

First, very interesting that they are using tobacco plants to bioengineer the drug.

Second, this suggests that there was more to the decision to bring the patients back to the US than has been divulged publicly. It worked out well for this unconventional drug trial, that the patients were out of FDA jurisdiction when they were given the drug, but now brought back where data can be gathered.

Dave Schuler August 5, 2014 at 8:43 am

Not so surprising, Cstanley. More is known about the biology and genetics of the tobacco plant than just about any other plant or animal species. A byproduct of its commercial importance.

Uses for it along those lines been suggested for decades.

Cstanley August 5, 2014 at 9:03 am

Right, but I am not aware of any major successes to date and this sounds promising.

Leave a Comment

Previous post:

Next post: