I am shocked, shocked to see governors acting politically in the face of the risks, whatever they may be, posed by Ebola in this country. This morning there seems to be a pitched battle between those who think the governors of New York, New Jersey, Illinois, Maryland, and Virginia have acted injudiciously or prudently. At least they’re taking steps to mitigate risk.
That, I think, is one of the factors missing in the discussion of the conduct of Dr. Craig Spencer, the young physician who, after returning from a volunteer stint with Doctors Without Borders treating Ebola patients, tooled around New York before showing symptoms that he’d contracted the disease: did Dr. Spencer act to mitigate the risk he posed to others? This is a subject to which I’ve returned again and again here: different people have different perceptions of risks and rewards. These perceptions are not right or wrong; they are merely different and that should be taken into account. IMO doctors of medicine have a very different perception of risk than non-physicians.
BTW, I’m old enough to remember when skepticism rather than credulity was the hallmark of science. Those were the days! The word science is derived from the Latin word for knowledge. In the absence of greater knowledge as, for example, why several orders of magnitude more people are being infected by Ebola in West Africa than in any previous outbreak, I’m not quite sure how we can characterize what we think we know about the outbreak as science. There are just too many unknowns.
How do you mitigate the risks posed by Ebola? My view continues to be that the best way for us to mitigate those risks is by aiding Guinea, Liberia, and Sierra Leone with public health problems that have grown beyond their ability to manage. We’ll need to act quickly. The virus is operating in those countries on virus time rather than U. S. federal government time. And it’s indifferent to the elections that take place here in a week.
Dave Schuler: BTW, I’m old enough to remember when skepticism rather than credulity was the hallmark of science. Those were the days!
Skepticism does not mean assigning all propositions equal validity.
Dave Schuler: In the absence of greater knowledge as, for example, why several orders of magnitude more people are being infected by Ebola in West Africa than in any previous outbreak, I’m not quite sure how we can characterize what we think we know about the outbreak as science.
Doctors have been working with Ebola for quite some time, including during the current outbreak. Ebola transmits by body fluid. The reason the disease breaks out is because when someone is sick, people want to help them. A mother holds a sick child, a brother stays with his sick sister. A pregnant woman collapses and a stranger helps her to the doctor. The disease spreads by coopting natural human compassion.
I do not think that 21 days is too much to ask. If it were 6 months, maybe.
BTW, I’m old enough to remember …
Perhaps, that is the problem
… when skepticism rather than credulity was the hallmark of science. Those were the days! The word science is derived from the Latin word for knowledge. …
In my opinion, the problem is that too few people have any idea of what modern science is. They know little math, and they believe that the social sciences are actual science. In truth, they understand science through an interpreter.
I always thought this referred to bringing modern technology to a primitive people, but the primitive people are among us. They profess to believe in science not magic, but because they do not have the simplest understand of math, basic science, or the modern scientific method, it is really magic to them.
When the head of the CDC says “remain calm, Ebola cannot spread,” they believe him because he is a top man of science. He is one of the high priests or the head witch doctor. Anything that disputes the head priest is blasphemy.
It becomes comical, but this is why they can allow no debate over scientific principles. They do not understand the science, and therefore, they cannot debate it.
The modern scientific method was specifically designed to eliminate this methodology, and those who claim to believe in science are attempting to reestablish this methodology.
“The science is settled” is used by a certain class of leftist today to end debate. It is meant to be the modern equivalent of “That’s blasphemy!”
As with Zachriel above. Not that long ago we were discussing a talk given by an actual researcher who was discussing what he didn’t know, and that in his estimation he knows less about Ebola now than at this time last year.
And let’s not forget that researchers have seen transmission “by air” amongst lab animals.
But someone says “Because science!” and they expect everyone to shut up and agree with them.
TastyBits: I do not think that 21 days is too much to ask.
Thousands of doctors are needed in Africa. If you quarantine them without scientific cause, it will inhibit recruitment, and restrict the movement of the very people needed to fight the spread of the disease.
TastyBits: When the head of the CDC says “remain calm, Ebola cannot spread, …â€
Of course, the head of the CDC didn’t say that. Rather, the head of the CDC said “While it is not impossible that there could be additional cases associated with this patient in the coming weeks, I have no doubt that we will contain this.†The outbreak has been contained.
TastyBits: they believe him because he is a top man of science. He is one of the high priests or the head witch doctor.
Well, you could believe the experts on Ebola, or you could believe the guy who used to deliver your pizza who quit and has taped all his doors and windows.
…: Not that long ago we were discussing a talk given by an actual researcher who was discussing what he didn’t know, and that in his estimation he knows less about Ebola now than at this time last year.
Sure, but not knowing everything is not the same as not knowing anything.
Science and commitment are the only weapons capable of stopping this disease.
Commitment to what?
…: Commitment to what?
To stopping the disease wherever it spreads, including Africa.
Zachriel, the CDC told the President, who then told the rest of us, that (a) the screening procedures would keep us safe, (b) the CDC had developed sound protocols for handling a case, and (c) that hospitals around the country could handle this effectively. Also that the chances of an outbreak were extremely low. All of those statements proved false in very short order.
Not to mention various confused directives from the CDC on practically all matters Ebola.
And the Administration overall is guilty of the same thing. Saying quarantines don’t work and aren’t needed while simultaneously quarantining the troops that went to the hot zone? This has been completely mangled, with “the experts” regularly doing 180s and contradicting themselves.
So which part of “the settled science” am I supposed to believe in?
Then how about not bringing the disease to Europe and America?
…: Zachriel, the CDC told the President, who then told the rest of us, that (a) the screening procedures would keep us safe
Yes. No one other than the nurses who worked directly with a late-stage patient have been infected.
…: (b) the CDC had developed sound protocols for handling a case,
The hospital admitted they didn’t follow the proper protocols. This didn’t threaten the public as only those in direct contact with the patient were exposed.
…: (c) that hospitals around the country could handle this effectively.
The CDC has now centralized care.
…: So which part of “the settled science†am I supposed to believe in?
You seem to be confusing science with technical implementation. Because of the mode of transmission, the disease was readily contained in the U.S. Even Nigeria, with far fewer resources successfully contained an outbreak.
Not really surprised someone at the DoD made the decision isolate troops returning from the region – the military is pretty hard core when it come to medical preparation. The military required anthrax vaccinations for Iraq, and currently requires small pox vaccinations for a few areas. Military personnel get tested annually for HIV. A comprehensive vaccination program is mandatory.
Anyway, comparing military and civilian procedures requires some caveats. The legal authority to take precautions with military personnel is very different than for civilians.
Sound science does not preclude sloppy execution.
Zachriel,
A point I have seen made repeatedly elsewhere is that, so far, the combined efforts of “the West” to date have been _unable_ to dent the logistical curve of Ebola’s spread in Africa. If this thing gets established in a new area, it may be all but impossible to stop.
Add that the CDC with its “centralized care” seems only to have the facilities here in the United States to care for a handful of Ebola patients at once…
…and that too many “protocols” are evidently not designed with human nature in mind (uncertainty, error, opportunism, and deception are facts of life at the individual and organizational level)…
…and that the successful advent of transmissibility anywhere in the western hemisphere is likely to set off a damaging economic panic, even if it is contained…
…and you might begin to realize that the design margin we are working with is frighteningly slim.
Personally, I’d like to see aggressive quarantine policies _and_ enhanced efforts in Africa. There is no reason for the two to be mutually exclusive.
I like Mickey Kaus’s suggestion that we need an ebola luxury resort, so that we can keep at-risk health care workers under observation without appearing to punish them and creating a disincentive. There still has to be some over-built construction in this country somewhere, even on the Gulf of Mexico that could be put to good use.
However, I do think the issue of disincentives is overread, given the specific population characteristics. People who volunteer to go to a third-world country to combat a highly deadly disease without the normal comforts of home and the protections of a First World public health system are not operating under the same risk-benefit-comfort analysis that the rest of us are.
An exhaustive ebola case study from Germany, linked and framed within a medical-to-layman translation:
http://raconteurreport.blogspot.com/2014/10/kids-dont-try-this-at-home.html
Guarneri: Sound science does not preclude sloppy execution.
Precisely.
Piercello: A point I have seen made repeatedly elsewhere is that, so far, the combined efforts of “the West†to date have been _unable_ to dent the logistical curve of Ebola’s spread in Africa.
That is incorrect.Outbreaks have been contained in Nigeria and Senegal. As there are animal reservoirs, it may not be possible to eliminate the disease entirely. Most areas that are still uncontained have little access to modern medicine, or even soap and running water.
Piercello: …and that the successful advent of transmissibility anywhere in the western hemisphere is likely to set off a damaging economic panic, even if it is contained…
Sure. Just because the fear is irrational doesn’t mean it isn’t a real phenomenon.
“Submitted for your approval: a nation gripped by fear of an outbreak,†Stewart said as the Twilight Zone theme played behind him. “And yet all this time, the real virus outbreak menacing them was fear.â€
http://www.rawstory.com/rs/2014/10/jon-stewart-why-does-chris-christie-have-to-be-such-a-dck-about-everything/
Zachriel:
Not incorrect, but perhaps overly precise. I view Nigeria’s and Senegal’s successes (and those in the USA, for that matter) as victorious battles in an exponential war we are currently losing. The logistical spread _in Africa_ continues unabated, and if it successfully jumps to other regions there will be hell to pay.
And that is not an irrational fear, but an empirical observation grounded in mathematics and human nature.
The U.S.’s Ebola intervention has adhered to this administration’s pattern of how it treats most incoming crises — “Wait and hope it goes away.” And, when it doesn’t go away react in slow measures, obfuscate data, contradict/deride naysayers, and depend on your dependable low information constituencies to believe you. It has worked so far….
Clearly the only solution is to send cruise ships to West Africa to bring patients back by the thousands were they can be treated safely here, because science.
The death toll from Spanish Flu Pandemic of 1918 was large in absolute numbers, but as a percentage of the population, it was small historically. It was nothing more than clearing some of the brush. The smallpox pandemic among the Inca or the last European Black Plague were serious die offs.
The US could benefit by getting rid of some of the deadweight – thin out the herd. Besides, I doubt any of these Ebola patients will be going to the VFW, monster truck races, NASCAR, or NRA meetings. The world has way too many arugula eaters.
Not the effects of having ONE Ebola patient in a hospital.
Yet another reason for mitigation.
Science is not a collection of facts. Better knowledge is result of science. Science itself involves inquisitiveness, curiosity, skepticism, and agnosticism. It has no room for belief in belief itself, much less for belief in god.
Its language is mathematics, and to progress in thinking like a scientist, one has to master math and, in the Ebola scenario before us, math in the areas of statistics, probability and game theory in particular.
Such mastery is difficult: most people have the natural propensity think like dumb gamblers or the dumb prosecutor who asks, “What are the chances that both his former wives died in the same way?”
Heh. One mans brush is another’s loved one.
And the biggest problem is that the Ebola Zone consists of three countries that basically are damned near free from any efficient organization at all. We could send a billion dollars a week to those countries for treatment and it would accomplish nothing meaningful.
More than anything else, these areas need good institutions. But we can’t REALLY talk about that in a truthful way, can we?
And Andy, the point about the military quarantine is that they (allegedly) aren’t working directly with Ebola patients but ARE being quarantined, while those that ARE working with Ebola patients directly want to come straight home and do everything they would normally do. There’s a double standard from the Administration, and it reeks of either (a) they’re lying their asses off about how dangerous this is, or (b) they’re completely incompetent. Neither situation is likely to inspire confidence in the public.
Shouldn’t the medicos who have had Ebola AND SURVIVED be recruited for one of the emergency response teams? It’s believed that people that survive an Ebola infection are likely immune to that strain going forward. They should still practice the safety protocols, of course, but would be at less risk when the inevitable accidents occur.
@Drew
We all die at some point, and you will be lucky is anybody remembers you after 10 years. I spent enough years with my ass in risky and riskier jobs, and I probably should have been in the ground a long time ago. You do what you can to help people, but history has lessons. It is harsh, but that is reality.
If it were not for the last European Black Plague die off, you would either be wallowing in a shit filled village, or if you had a cavalier attitude towards dying or killing, you might be a knight. Take your pick shit or blood. If you were really blood thirsty, you might have been a noble.
If you are feeling especially compassionate, we could raise taxes on the rich to pay for programs to help the sick Africans.
“If you are feeling especially compassionate, we could raise taxes on the rich to pay for programs to help the sick Africans.”
I’ve never believed in subsidizing systemic poor behavior, decisions or systems. To do so is not compassion, it’s perpetuation. I don’t make charitable contributions to unrepentant addicts either, that’s feeding the beast. In contrast, I do give to organizations like Wounded Warriors.
” It has no room for belief in belief itself, much less for belief in god.”
Belief in God is faith. Belief in literal biblical accounts is mysticism. Agnosticism accounts for the limits of human understanding.
If it were not for the Black Plague, a lot of very successful people would have been rolling around in shit. When you need to get your hands dirty with real blood, a lot of the tough talk is nothing more than talk.
I have seen a few tough talking asswipes from comfortable sofas in safe living rooms learn about life from a hard steel bed in a concrete room. They usually found themselves a husband real fast.
You have the luxury of living in a time and a place where your behavior and decisions have lead to your success. Throughout human history this has been very, very rare, and even today, it is uncommon through the world.
@Andy, as I recall, since 9/11, returning combat troops are required to have a period of adjustment when they return stateside when they are confined to base. I’m not finding any support, but I recall reading about this when a local soldier was given special leave to go home for a wedding (his or a friend’s), and was killed in an ugly drunken driving incident. The coverage spoke of a required adjustment period because of high levels of accidents or drug/alcohol related incidents on coming home, as well as the desire for some mental health screening. Anyway, I thought the DOD response may not have been that unique.
(I don’t think the legal issues are that difficult, however — quarantine of persons, animals, and food are long-standing state (not federal) police powers that state laws handle, but there is a right to file a writ of habeas corpus, just like the Gitmo inmates).
The scientists are still being skeptical. I don’t know where you got the idea that they are not. You even quoted one who voiced his skepticism. Many others have also said they are skeptical about some things going on. However, you still need to respond to what is currently going on.
While most physicians are not scientists, we do use the information that science provides us. We get to be fairly good, not perfect, at evaluating the information science provides us. We then have to act on that information. So, in the case of Ebola, we could wait until science gives us all of the 100% for certain answers. Of course, by then everyone would be dead. Instead, we take the best information that we currently have and act upon it. So far, it doesn’t look like Ebola is the first major virus ever to change its mode of transmission. It is acting pretty much like we think we understand it should act when it faces a reasonably competent response. Which of course suggests that the cultural practices in W. Africa are more than enough to account for its spread in this outbreak.
As an aside, people should understand that in the military, soldiers who get quarantined when they come home will get paid for not working for 21 days. I hope you can understand that this would not meet a lot of protests from most in the military.
Steve
Actually, the one I quoted was a lot more skeptical than the docs from the CDC have been.
Steve, if you weren’t being so credulous you would understand what I’m saying. In every statement they’ve made so far both Dr. Frieden and Dr. Fauci have bundled science, emotion, and politics all together and labeled it “science”, using the label to give weight to their political and emotional reactions. That’s not science. It’s sleight of hand.
Saying that docs won’t volunteer to go to West Africa if they’ll be quarantined is not a scientific fact (it would barely be a scientific assessment if you had an empirical study to support it). It’s a combination of common sense, instinct, and emotion. Statements based on assessments of the risk of Ebola transmission here in the States aren’t scientific facts, either. That would only be true if the risk were zero. We know the risk not to be zero. The statements are value judgements and value judgements are not science.
I oppose quarantines or travel bans but I recognize my reasons are partly based on emotions and political judgement.
“@Andy, as I recall, since 9/11, returning combat troops are required to have a period of adjustment when they return stateside when they are confined to base.”
That’s basically true, but the adjustment period and conditions vary widely. For example, someone who saw combat in Afghanistan would be very different that what I just finished, which was two weeks (at a minimum) to address any medical and admin issues from my deployment. I didn’t have any major issues so it ended up being about 10 days of paid leave as long as I stayed in the local area.
As far as the legal aspect, quarantines are, as you say, legal when justified. However, I don’t think you can just quarantine anyone and everyone. Kaci Hickox, for example, will probably sue and it will be interesting to see how that turns out.
Dave,
“Statements based on assessments of the risk of Ebola transmission here in the States aren’t scientific facts, either. That would only be true if the risk were zero. We know the risk not to be zero. ”
Of course the risk isn’t zero – when is it ever – but transmission is pretty well (not completely) understood. Africa is mostly a dirt-poor continent with shitty institutions, poor governance, limited border control, rampant corruption, etc., yet after 10 months it’s still confined to three of countries in West Africa. We obviously need to take appropriate measures, but the threat of this disease to the US is, IMO, way overstated.
You are missing what I said. Frieden is not a scientist. Fauci might be or might have been. In this case they are actually acting as public health physicians. They need to come up with a response to what is going on, not convey the nuances of the science, which not many people would understand anyway. In that response, I think, they should reflect our current best understanding of the science. Of course there is not certainty, but there isn’t much real certainty about a lot of things in medicine. We mostly work on probabilities. Maybe in short i would just say policy is not and cannot be science, it just needs to be informed by it.
So when they say that the science suggests this can be controlled, they are correct. When they say that the science suggests this is hard to transmit, they are correct. When they say that our best evidence suggests that the PPE works, that is correct. They are not saying that they know 100% for sure about everything, just that the science, as currently understood, supports certain actions. Maybe we find out more, and maybe we are wrong about some stuff we are doing now, but we won’t know until new evidence tells us so.
Finally, I also think it pretty clear in their actions, much more important than words, that they are hedging a bit. I am fine with that. It certainly suggests a degree of humility about what we know and don’t know. Take the infamous airplane trip that the nurse took. Experience with the MSF workers, supported by evidence of how we think the virus spreads, suggested that it really was ok for her to travel. So far, it looks as though that will hold. Not letting her travel was the “unscientific” approach. It has since been regarded as an error by many who want to criticize the CDC, and the CDC has agreed to change that, even though the science doesn’t support it. Ok with me. That seems like part of that hedging just in case they are wrong.
Steve
Distinguishing between appropriate measures and overreactions is a value judgment. Different people can differ in their relative tolerance for risk. That doesn’t mean that one is right and the other wrong.
“Distinguishing between appropriate measures and overreactions is a value judgment. Different people can differ in their relative tolerance for risk. That doesn’t mean that one is right and the other wrong.”
I agree with that, but that’s only half the picture. I would add that, in addition to risk tolerance, people judge threats and threat levels differently as well.
I agree with much of Steve’s last comment, but to the point about acting as public health physicians and not scientists, they need a better understanding of psychology to perform that role well.
Sometimes they really should go farther than the science supports, if that is the best way to tamp down public fear. Science says that certain behaviors will be safe 99 % of the time. Taking measures that will increase that to 99.9% might not be very scientific especially if those measures are also inconvenient and costly. But these measures might be important to convince the public that the public health officials are acting with an abundance of caution.
I think that line of thinking is particularly important at the beginning of an outbreak. It would have been far better if they had acted much more aggressively at the outset, and then started to relax protocols as time went on when the threat was better understood.
In addition to the psychological benefits, this is also the best way to deal with an epidemic. It’s better to act aggressively and deploy a lot of resources initially to contain the threat before transmission branches out and creates an exponential increase in difficulty of containment.
There you go. That’s how you split the baby.
The question that I think should be asked more frequently is does simply dismissing or demeaning the views of those with whom you disagree contribute to a good outcome or make it more difficult? And then of course does roundly condemning a proposal that you’re going to support in 48 hours make good political sense?
Dave Schuler: The question that I think should be asked more frequently is does simply dismissing or demeaning the views of those with whom you disagree contribute to a good outcome or make it more difficult?
Should leaders lead, or just respond to the lowest common denominator?
http://www.hollywoodreporter.com/sites/default/files/imagecache/news_portrait/2014/04/doris_day_rock_hudson_1985_a_p.jpg
“But these measures might be important to convince the public that the public health officials are acting with an abundance of caution.”
Yes, which is why they are tracking all of the contacts of those infected rather than just those during the high risk period. Why they are going to prohibit public travel even when symptom free. Why they went to the more restrictive PPE.
Steve
One thing to keep in mind is that the Governor’s don’t necessarily make these decisions. In Illinois (and as I understand it, New Jersey), it is the state’s top public health official that is authorized to enact quarantines or isolations. In Illinois, it’s this guy:
LaMar Hasbrouck, MD, MPH, Director of the Department of the Illinois Department of Public Health
Part of his background: “Beginning in 1998 with the U.S. Centers for Disease Control and Prevention (CDC), Hasbrouck was a member of the Epidemic Intelligence Service, commonly referred to as the Central Intelligence Agency (CIA) for diseases. During his 11 years with CDC, Hasbrouck worked in Bangladesh, Brazil, Guyana, Haiti, Jamaica, Namibia, Nigeria, Rwanda, Switzerland, Uganda, Vietnam and Zimbabwe. He was actively engaged in two of the largest global health initiatives in history – polio eradication, where he served as a consultant for the World Health Organization to Bangladesh and the U.S. President’s Emergency Plan for AIDS Relief, serving for two years in a diplomatic assignment as the Director and Chief of Party for the CDC in Guyana, South America.”
Yes, which is why they are tracking all of the contacts of those infected rather than just those during the high risk period. Why they are going to prohibit public travel even when symptom free. Why they went to the more restrictive PPE.
Steve- and if they had done those things to begin with, we wouldn’t have the trust deficit that now exists. As Dave points out, it makes no sense to vehemently oppose a measure and then change your mind when pressure builds against your decision. I’m not knocking the general idea of making adjustments- just the manner in which they are being forced to do it. It worsens the trust gap when they appear to be caving under pressure instead of making rational decisions.
@zachriel- my answer is that leading sometimes involves an understanding of how the “lowest common denominator” thinks and how such people will react to your decisions. That doesn’t mean you cater to their whims, but you figure out how to best assuage their fears instead of exacerbating them.
@Andy, I think most of the legal issues pertaining to New Jersey were made moot when they released her. Prior to that, she could of challenged the grounds for her detention in court or asked a judge for the conditions of her detention to be altered. Those issues are now moot, just like the taxpayer lawsuit was mooted when they received their 501(c) determination.
Damages are not necessarily mooted, but she is claiming that she will sue under federal law, which given state sovereign immunity, pretty much means Section 1983, where state officials have “qualified immunity.” She would have to prove that state health officials violated “clearly established law.” I’ve seen “liberty concerns” expressed, but no established law.
Now Maine is interesting . . . Is she being detained?
Clive Crook has written pretty much what Dave is pointing out:
“The argument over the risk Ebola poses to the U.S. is getting cast as a disagreement between smart people who trust science and dumb people who panic for no reason. I don’t see it that way.”
. . .
“To begin with — how shall I put this? — the science on Ebola isn’t settled. Experts are still working to understand the disease. Methods of transmission seem to be well understood, but not yet completely. Some crucial questions (such as the delay between the onset of symptoms and the contagious stage of the illness) involve probabilities, not certainties.”
“The protocols for preventing spread of the disease seem to change every few days. In addition, doctors and other health professionals sometimes make mistakes — and, in the current emergency, mistakes have plainly been made. Given all this, “trust the science” isn’t persuasive. In fact, you have to wonder about the scientific aptitude of anybody who would say such a thing.”
“But here’s the main thing. Even if the science told us everything we need to know about Ebola, that wouldn’t settle the policy question.”
What Science Can’t Tell You About Ebola
CStanley- In the case of the PPE, they were following WHO guidelines. There was no real basis at the time for the higher level of covering, and there are risks associated with going to the more restrictive gear. As to the public travel, they didn’t vehemently oppose anything. They were following what MSF had done, based upon best knowledge, and which appeared to have worked in the past. How were they supposed to anticipate a public freak out, which looks (so far) like it was all wrong? They have been tracking people all along. They have never opposed that.
Steve
PD- Clive Crook is what, an economist? Meh. Science isn’t settled? When is it? Is he advocating that we should wait until the science is settled? By then everyone will be dead. I have to wonder about the (lack of) scientific training of anyone who would write that.
Protocols changed? Why was that bad? We had what we thought were good ones. Once health care workers contracted the disease we changed them. Why was that a bad idea? We were really supposed to get it all correct on our first try?
Trust the science? What should we trust? His feelings? You make your best judgments based upon what the science tells you at the time that you make the policy. Then you hedge a bit understanding that the science is incomplete. You also understand that those hedges might actually make things worse. Since you are just guessing, you might guess wrong. Anyway, that is what they did.
Steve
Clive Crook isn’t writing about economics, he is using his skills as a bullshit detector.
Seriously, Steve- you don’t think the “public freak out” could have been anticipated? If anything I’m surprised at how mild it has been.
And yes,they have been tracking people all along, but what good is that if the people being tracked were not even advised to avoid extensive travel and public contact?
Regarding the protocols, why did they not ensure that the details were communicated and that the healthcare workers had adequate training? And if advanced treatments like dialysis and intubation were more problematic, should that have not been forseen, and the hospital infectious disease specialists notified?
All of these were unforced errors.
Steve doesn’t appreciate the problem presented by the overly enthusiastic confidence that Dr. Frieden expressed in the protocols at first, followed then by changing the protocols. Both can’t be right. Either the protocol needed no change or it did.
I continue to think that Dr. Frieden erred in his initial statements, going beyond the science and that was, as CStanley put it, an unforced error. He had perfectly viable alternatives.
“erred in his initial statements, going beyond the science”
Worse even than going beyond the science, he went beyond the due diligence that his own agency had neglected to perform. How did his agency arrive at the determination that most ordinary hospitals were equipped and prepared to handle this?
So that’s a compound error- first, neglecting to coordinate the proper response, and second, falsely communicating to the public that the preparation had been done.
Regarding Steve’s interpretations- I do think part of it is the difference in the way communications sound to someone who is already knowledgeable compared to reception of the message by a less knowledgeable person.
As a veterinarian, I am frequently aware of this and constantly work to hone my communication skills with clients. I use my staff members as intermediaries and as a sounding board- we quickly debrief after many client interactions to discover whether or not the client seemed to understand what was being conveyed. It is sometimes surprising what people hear which is not what I intended to say…and no matter how much the client may be the “weak link” (because they are less educated, or too anxious or upset to listen carefully, or they’re distracted by their pets or children in the exam room, or whatever), I still feel it’s my responsibility to make the communication as effective as possible.
If I take this seriously as one of many facets of my job, I don’t see why it is too much to ask that the people whose main job description involves public communication to work harder to get it right.
Perhaps if Dr. Frieden’s statements can only be properly understood by medical professionals he should only speak with other medical professionals. Sounds like an acknowledgement he’s not the man for the job.
Heh, agreed.
But here’s an example- when I heard the repeated iterations of “the protocols are working” my interpretation was that they were reassuring other medical professionals that there was no reason to think that this virus had made the leap to airborne transmission (nor other potential mutations, such as the possibility of evading antiseptics in the environment.)
What lay people heard though, was more of an assurance that there would be no transmission of the disease, full stop. So that’s an example of different audiences, and the CDC needs to balance the needs of the various audiences. Of course the best way for them to do that would be to assume their public pronouncements are geared to the general public, while communicating the needs to the medical community through other channels (the latter appears to be seriously lacking.)
But first the people at CDC need to recognize that this is even an issue, and understand that the messaging needs to address these different audiences effectively. They also need to understand that as members of the medical community, they have to get outside their bubble to even see why their understanding is different than a lay person’s.
The key insight or problem with understanding the extent of the science, and where policy takes over is that in the United States there at least 51 policy-makers in public health. I say “at least” because I think most counties and cities have public health bodies that also have autonomous authority to isolate/quarantine and take precautionary measures in the face of dangerous, infectious disease. The federal government doesn’t have the power to order policy on these bodies. So, to the extent the feds want to control policy, it’s either (a) power of persuasion through open and honest dialogue, (b) brow-beating and scorched-earth tactics against science denialists, or (c) seeking power from Congress to restrain state and local government. I placed these in the descending order of likely success.
“…the extent of science and where policy takes over…”
PD describes the bureaucratic issues well, but another point is that policy questions are often framed as if they are science questions when they are not.
Science says that 21 days is the possible window of incubation. What science can’t answer us what to do with exposed people during that period. That is a policy question, which hinges on what our goal is. If it is to catch 100% of the secondary infections before they could possibly infect others, then it is necessary to quarantine everyone who was in contact with an infected person.
You cannot accurately say that science does not support this, because currently we have no way of identifying infected persons during the incubation phase. You can accurately say that this goal goes too far, because the costs to civil liberties and to use of resources to enforce quarantines is too high when weighed against the potential few cases that could slip through if we don’t quarantine until people are definitely ill. But that is a policy debate, not answerable by science.