Your Ebola Update

Alex Berezow summarizes the CDC’s actions to date:

The CDC is one of the great institutions of our federal government. Microbiologists, such as myself, idolize the scientists who have dedicated their careers and lives to making the planet safer. But the CDC has made some major missteps. Some understandable mistakes are clearly from inexperience in dealing with Ebola, but others are harder to explain. For instance, effective communication is a vital part of all crisis management, which should be a core function at the agency.

But that’s also harder than it looks. CDC has found itself in a Catch-22. It’s a nearly impossible balancing act to provide accurate information without unnecessarily frightening the public. Whether CDC said too much or too little, it was going to be criticized by the news media. The outbreak spread, so the CDC was condemned for being unprepared. But if the outbreak had fizzled, it would have been chastised for fear mongering.

Likely aware of this, the CDC chose the worst possible action: In an effort to keep the public calm, the CDC pretended to know more about Ebola than it actually does.

while Alexis Simendinger outlines the CDC’s course correction:

An Ebola SWAT team from the CDC in Atlanta traveled to New York to exercise a beefed up regimen of care, one that has evolved dramatically since the country’s first and fatal case of the disease showed up in Dallas last month.

The CDC “surged” treatment experts to New York to help the patient and guide the health care workers responsible for his care. The CDC has established a new policy to bring experts to Ebola patients, and then transfer the stabilized patients to a handful of pre-trained and designated health facilities around the country, if necessary.

This, too, is a calculated risk. It presumes that the number of patients being treated in the United States remains very low, less than 20 which is the capacity of the “designated health facilities around the country.” Prudent risk mitigation requires that steps be taken to ensure that assumption remains good which is piece I think is missing at this point.

We can only hope that the no further secondary cases show up in New York.

10 comments… add one
  • CStanley Link

    We can only hope that the no further secondary cases show up in New York.

    But the self-monitoring is going so well, so why should we worry?
    /sarc

  • The first step on the road to recovery is recognizing you have a problem. We do have the challenge that in the United States doctors of medicine by training and temperament are not predisposed to self-awareness.

  • CStanley Link

    Right, and it’s one example of the protocols being based on best case scenario (in this case, assuming that humans act logically and cautiously 100% of the time.)

    One thing that should be stressed with the general public and healthcare workers in particular is that the monitoring process itself eats up resources and creates a simmering panic. The doctors and nurses who have circulated in public have already caused a problem even if we get lucky and no one gets sick from those contacts (frankly I think we’re just getting lucky because the viral load is low during those early phases of the disease.)

    It seems like our public health officials are concerned about the possibility of panic if they put in place more robust measures (advising a more strict quarantine of contacts instead of just self monitoring.)*

    This would require a lot of resources for the patient zeros in each location, but it would prevent the branching out of secondary contacts which is when the system will become overwhelmed, A stitch in time saves nine.

    *that is assuming good faith and basic competence, while there are other possible explanations for the policy choices.

  • As I have tried to make clear I think the more strenuous measures are ones to be undertaken in West Africa. If we just write West Africa off, we’ll have more stray cases and outbreaks of Ebola than present strategies will be able to handle.

  • CStanley Link

    Agree but it’s not either/or. Our system can quickly become overwhelmed by either new cases entering the US or by cases of people becoming infected in the US.

    The new policy of treatment at the specialized centers should help reduce the risk of the latter, but the protocols for contact persons need to be tightened up as well.

  • CStanley Link

    Also one would hope that they have identified a few more locations in the US that can be brought online if needed, and that they might be embedding more people for training (without allowing them direct contact since that would run counter to the goal of reducing the number of healthcare workers for each patient.)

    Based on performance to date, I doubt that this is happening but hope that it might be.

  • TastyBits Link

    The problem with leaving gaps in information is that people will fill in those gaps, and they tend to fill it in with the worst possible cases. This is human nature. These gaps are the unknown unknowns.

    It is better to state what you do not know. These are the known unknowns, and people can deal with them. It indicates you have a handle on the situation.

  • steve Link

    One of the problems we have is that people expect docs to be omniscient. We aren’t. In this particular case, the CDC followed best practices as they understood them at the time. When that resulted in 2 nurses still getting infected they quickly changed plans. So, when facing a disease that no physician in the country had ever seen walk in off of the street before, the results look pretty good to me. For those who think House is reality TV, i guess it was disappointing.

    Now that hospitals are taking this seriously, it really is a disease that can occur int he US, people area really training for it. I believe, based upon talking with other hospitals, that a number of academic centers would now be able to manage some of these patients adequately.

    We have yet to resolve what to do with those who have cared for Ebola patients. We need to decide what they can safely do and how long to monitor.

    Steve

  • we have is that people expect docs to be omniscient

    Do they? Or do docs cultivate an attitude of omniscience? I think that if the CDC’s docs hewed a bit more closely to what they actually know to be true rather than getting beyond it in a mad dash to avoid blame, it might help. You may recall that I complained about Dr. Thomas Frieden’s remarks when, in the absence of concrete knowledge, he blamed the transmission of Ebola in Dallas on nurses. I think that’s hard to explain on the basis of a general perception of doctors as omniscient but easily explained by his assumption that doctors could not possibly make a mistake.

  • steve Link

    No. It is best explained by the belief that the guidelines work. In other reported transmissions they believed that protocol had been broken. (The MSF people in particular believe that to be the case) Really, I don’t understand your bias and departure from reality to blame the CDC for stuff they are not doing or really saying. You are focusing on the messaging and if they don’t say it the way you want them to do, they must be trying to cover up something. They continue to tell people what we know based upon our best evidence, which so far happens to be true. They are also continuing to be cautious and following those people who had casual contacts just in case our best evidence is wrong. They have altered PPE guidelines in case those were not correct and they have changed where they are treating people. This is clearly not a group that is arrogantly clinging to their preconceived ideas and refusing to change. What else do you want?

    Steve

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