A No-Drama Ebola Policy


In lieu of a full-on travel ban, which would probably be counterproductive, the government has imposed new restrictions to ensure that travelers from Ebola-afflicted countries enter the US via airports with enhanced screening procedures:

The Department of Homeland Security on Tuesday announced that travelers from Liberia, Sierra Leone, and Guinea—the three countries at the center of the Ebola outbreak—will have to fly into the U.S. through one of five airports: New York’s JFK, Washington D.C.’s Dulles, Atlanta, Chicago O’Hare, and Newark, N.J. Those are the same five airports where officials began secondary screenings of travelers from those countries earlier this month.

The new rules went into effect today. Mataconis approves:

Since the majority of arrivals from the nations in question apparently already come through one of these airports, this is not likely to be a severe disruption to air travel and, at the very least, it seems far more cost effective and efficient than stationing personnel at every possible entry point in order to catch the relative handful of passengers who might arrive somewhere other than these five airports.

Allahpundit shrugs:

So, temperature checks for all west African passengers at five of America’s biggest airports, which will now exclusively handle international flights that made connections from Africa. There’s lots of buzz about that online as I write this but it’s virtually no different from what we’re already doing. Temperature checks at those five airports were ordered 10 days ago; those airports were chosen because they already handle 94 percent of passengers from west Africa traveling to the United States. From what I can tell, the only change that’s been made today is requiring the remaining six percent to connect to one of those airports too to ensure that everyone from west Africa entering the U.S. is subject to a temperature screening.

But that’s pointless because … the temperature checks don’t work. Thomas Duncan passed one when he got on the plane in Monrovia to fly to Europe and eventually on to America.

But Bryan Walsh stresses that the chances of an actual outbreak in the US were extremely low even before the new airport policy:

For all the demand to ban commercial travel to and from Ebola-hit West Africa, this region is barely connected to the U.S. in any case. Only about 150 people from that area of Africa come to the U.S. every day—less than a single full Boeing 757—and many airlines have already stopped flying. But there have been relatively few spillover cases even in African countries that are much more closer and more connected to Guinea, Sierra Leone and Liberia. Besides Nigeria, only Senegal has had cases connected to the West African outbreak—and that nation was declared Ebola-free today as well. (There have been cases in the Democratic Republic of Congo, but that’s considered a separate outbreak.) The worst Ebola outbreak ever is raging in three very poor nations—but it seems unable to establish itself anywhere else. … Even the risk of another Duncan doesn’t seem high.

Ambinder sizes up the response of US officials thus far:

In cataloging some of the early missteps, Ron Fournier writes, “Once again, Americans are reminded of the limits of U.S. social institutions — in this case various state, local, and federal government agencies and private-sector health systems that responded to the Ebola crisis slowly, inefficiently, and with a lack of candor that Americans, unfortunately, have come to expect.”

Sorry, no. They responded quickly, and in doing so, overlooked some of the basics. Then, within hours, they corrected their oversights. The limits of U.S. social institutions? Well, they’re reminded by those limits by people who have set exceptionally high expectations for government, expectations which cannot possibly be met by mortals. Actually, Americans should have faith that the CDC can prevent major epidemics like Ebola. But politicians are willfully or stupidly spreading misinformation.

As are their enablers in the right-wing press:

Indeed, the neoconservative Weekly Standard’s lead editorial this week was entitled “Six Reasons to Panic,” while the Washington Post featured an op-ed by Marc Thiessen, a right-wing Republican commentator and fellow at the American Enterprise Institute (AEI), depicting a “nightmare scenario” in which “suicide bombers infected with Ebola could blow themselves up in a crowded place—say, shopping malls in Oklahoma City, Philadelphia and Atlanta—spreading infected tissue and bodily fluids.” Commentators on Rupert Murdoch’s Fox News have conjured similar scenarios.

You gotta admit that Ebola-filled ISIS suicide bombers is a brilliant touch of hathos. Speaking of which:


(Photo: Employees of the airport emergency medical service on October 17, 2014 make a test with an electronic thermometer as part of the fight against Ebola virus at the Roissy-Charles-de-Gaulle airport in Roissy-en-France, suburb of Paris, before carrying out health checks on travelers arriving from Guinea, one of the worst-hit nations alongside Liberia and Sierra Leone. France joins Britain, the United States and Canada in screening travellers for the disease. By Kenzo Tribouillard/AFP/Getty Images)

Ebolisis And Its Enablers

Derek Thompson blames the media for overhyping – and thereby exacerbating – Ebola panic in the US:

For the last two weeks, the American Ebola panic has been relentlessly overstated. When Gallup asked Americans if they were worried about contracting the Ebola virus, just 23 percent said yes in a October 11-12 poll, days after Thomas Duncan was the first person to die in America from the disease. That was up just one percentage point (well within the margin of error) from a similar survey administered one week earlier. Just 16 percent told Gallup that they actually thought someone in their family would likely get the virus, up just two percentage points from a week earlier.

One in six people thinking they’re about to die from Ebola is a serious matter. But you can get about approximately 20 percent of Americans to say all sorts of crazy things in anonymous polls.

Waldman takes on another trope of Ebolisis – that in the words of Republican Congressman Tim Murphy, “we have to be right 100 percent of the time, and Ebola only has to get in once.” It’s the viral equivalent of the one percent doctrine:

The objection some now have to the federal government’s response is that it isn’t enough like our response to terrorism, which is to say it doesn’t reflect that 100 percent perspective. You can find that perspective in some places — for instance, today the New York Times reports on some of the reaction from people who are both terrified and ignorant, like the parents who kept their kids home from school because the principal had travelled to Zambia, where there has been no Ebola despite being in the very same continent as Liberia, Sierra Leone, and Guinea. So why not close all the schools? And while we’re at it, stop all flights in and out of Texas and post Army units at the highways on the state’s border with shoot-to-kill orders on anyone trying to leave? After all, Ebola only has to be right once.

All of this underscores Saletan’s point that when it comes to public health, giving the public what it wants is simply nuts:

Rep. Sam Johnson of Texas is introducing a travel ban in Congress because Obama “is refusing to listen to the American people.” Virginia lawmakers, citing the views of “the American people,” are calling for a ban on travel from West Africa to their state. Behind these initiatives, an army of conservative media outlets is quoting polls and trumpeting what “the American people want” and “the American people favor.”

On some issues, this kind of thinking is healthy. It’s democracy. But on matters of science and medicine, it’s reckless. The reason why public opinion on Ebola diverges sharply from what experts recommend, not just on a travel ban but on everyday behaviors to avoid the virus, is sheer ignorance. Telling health officials to listen to the public, rather than the other way around, is the worst kind of demagoguery.

What Is The Surgeon General Good For?

Part of the liberal line in the political battle over Ebola is that we’d be much better placed to respond to the crisis if only Congressional Republicans would stop stonewalling the confirmation of Obama’s nominee Dr. Vivek Murthy to the post of surgeon general, which has been empty for over a year. But Mike Stobbe doubts this would really make much difference, considering how the role of the surgeon general has changed over time from front-lines crusader against disease to mere public health advocate:

[I]t was in the 1960s, during the Democratic presidencies of John F. Kennedy and Lyndon B. Johnson, that things really started to go downhill for the surgeon general. Administration officials were pushing to enact Great Society programs, and increasingly viewed the surgeon general and his troops as foot-draggers reluctant to take on the new initiatives—especially Medicare and Medicaid. … Dr. Luther Terry became renowned in 1964 for releasing a report that finally convinced many Americans of the deadliness of cigarette smoking, but he was shown the door a year later, after only one term. By 1968, the HEW Secretary had stripped away the surgeon general’s administrative powers and redistributed them to others.

Since then, the surgeon general has been little more than a health educator—“a pathetic shadow of authority who traveled around the country lecturing high school students on the hazards of smoking,” as the political scientist Eric Redman once wrote.

McArdle takes a broader view, noting that “this is not your grandfather’s public health system”:

Public health experts were, in a way, too successful;

they beat back our infectious disease load to the point where most of us have never had anything more serious than Human papillomavirus or a bad case of the flu. This left them without that much to do. So they reinvented themselves as the overseers of everything that might make us unhealthy, from French Fries to work stress. As with the steel mills, these problems are not necessarily amenable to the organizational tools used to tackle tuberculosis. The more the public and private health system are focused on these problems, the less optimized they will be for fighting the war against infectious disease. It is less surprising to find that they didn’t know how to respond to a novel infectious disease than it would have been to discover that they botched a new campaign against texting and driving.

Don’t get me wrong: Fighting infection is still one of the things that the public health infrastructure does, and though I hope it doesn’t come to that, I expect that our system will do a much better job next time. But the CDC did not botch the job because there’s something wrong with Barack Obama, or government, or the state of Texas, or private hospitals. They dropped the ball because the public health system no longer needs to work so many miracles, and consequently hasn’t had much practice.

The way Steven Malanga sees it, CDC Director Thomas Frieden’s embrace of that new role as nanny-in-chief is part of why he’s not really that good at his job:

As New York City’s health commissioner, Frieden engineered a law requiring food chains to post calorie counts on menus, though there was no evidence that the availability of such information has any effect on eating habits. Frieden also led a campaign to cut salt consumption despite studies that had shown, in fact, that some individuals fared poorly on a salt-restricted diet. Frieden’s campaign led one world-renown hypertension expert to proclaim that New York was attempting to engineer a giant uncontrolled experiment.

As time passed, Frieden’s practice of recommending sometimes outrageous solutions to health problems based on few facts grew more disconcerting. In 2007, he even proposed a campaign to persuade uncircumcised adult men in New York to get circumcised to reduce their risk to HIV; a study in Africa had concluded that the practice helped lower infections there. But Frieden’s proposal was widely derided and quickly dismissed because of the vast differences between the two populations and the preliminary nature of the research.

Ugh. Back to the issue at hand, Byron York blames the surgeon general vacancy on Democrats rather than Republicans:

[H]ere is the basic fact about charges that Republicans are blocking the surgeon general nominee: There are 55 Democrats in the Senate. Since Majority Leader Harry Reid changed the rules to kill filibusters for nominations, it would take just 51 votes to confirm Murthy. Democrats could do it all by themselves, even if every Republican opposed. But Democrats have not confirmed Murthy.

The reason has more to do with Murthy himself than anything else. As doctors go, he is a very political man, so it’s no surprise his politics have created political problems.

York notes that the NRA “took a strong stand against Murthy, a position that caught the attention not only of Republicans but of red-state Democrats seeking re-election.” Weigel adds context:

The NRA actually promised to score votes for Murthy – anyone who backed him would see a drop in his grade from the gun lobby. Among the horribles that made Murthy unacceptable were tweets like this (as York cites):

You can see why the NRA wanted to prevent such a doctor from becoming surgeon general. And you can sort of see why red state Democrats begged Harry Reid to prevent a vote on him.

The Grave Risks Of A Travel Ban, Ctd

With Marco Rubio preparing a bill to ban nationals of Liberia, Guinea and Sierra Leone from entering the US, and with vulnerable Dem candidates hopping on the Ebolanoia bandwagon, our political class appears to be warming more and more to an Ebola travel ban. (Ron Paul, at least, has called out such proposals as bad, politically motivated policy). So the point bears repeating that a travel ban is not as commonsensical as its supporters make it out to be. Julia Belluz and Steven Hoffman look back at past epidemics in which travel bans proved unhelpful, including the AIDS crisis:

After HIV/AIDS was discovered in 1984, governments around the world imposed entry, stay and residence restrictions on people with the disease. As one 2008 study notes: “Sixty-six of the 186 countries in the world for which data are available currently have some form of restriction in place.” In the US, the ban — instituted by President Ronald Reagan in 1987 — was only lifted when Obama came into office. But HIV/AIDS managed to spread anyway, reaching pandemic proportions by the 1990s. This 1989 review of HIV/AIDS travel restrictions found they were “ineffective, impractical, costly, harmful, and may be discriminatory.” Prevention of HIV worked better than travel restriction, the authors concluded.

And swine flu:

After the arrival of H1N1 swine flu in 2009, some countries imposed travel restrictions on flights going to and coming from Mexico, resulting in a 40 percent decrease in overall travel volume. A study looking at this event found it “only led to an average delay in the arrival of the infection in other countries (i.e. the first imported case) of less than three days.” So again, reduced travel delayed (by three days!) but didn’t stop disease spread. The authors wrote: “No containment was achieved by such restrictions and the virus was able to reach pandemic proportions in a short time.”

Another common argument against travel bans is that they would seriously harm relief efforts. Jonathan Cohn elaborates on this:

Experts, along with non-profits like Doctors Without Borders, say that they’d have a much harder time getting volunteers into the countries if those volunteers knew they could not easily return. Even with an explicit exception for aid workers, they say, the extra burden and uncertainty of having to get special clearance would dampen enthusiasm. Meanwhile, a U.S. travel ban would almost certainly cause other highly developed countries to follow, dramatically reducing the demand for flights and other transportation options to West Africa. Agencies already struggling to get supplies into the area would struggle even more.

Lots of people wonder, couldn’t the U.S. government just arrange other transportationmaybe a modern-day version of the 1948 Berlin airlift? I’ve put that question to a number of officials and experts and the answer I keep hearing is “no.” In the real world, they say, making these arrangements would be difficult and solutions would be inadequate. It’s not as if assistance is this highly organized campaign, with all the necessary aid workers and their supplies lined up at Dover Air Force base, just waiting for C-17s to take them across the Atlantic. The flow of people and wares into West Africa is a constantly changing, unpredictable blob that’s heavily dependent on freely available commercial transportation. Replacing that would take resources and time, the latter of which the region really doesn’t have.

Centers For Damage Control

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After its fumbling of the Ebola outbreak, the public has rightly soured on the CDC:

A new CBS News poll shows just 37 percent of American rate the CDC as either excellent or good, while 60 percent rate it as fair or poor — a virtual mirror image of 17 months ago. The worst part: The agency now ranks below the Secret Service, which has dealt with a series of scandals in recent weeks and years. But the CDC is still slightly more popular than the IRS.

Morrissey isn’t surprised:

Back when I worked for a defense contractor in its technical publications department, one worker had a sign in her cubicle which accurately diagnoses the phenomenon in play here: “One aws**t cancels out a thousand attaboys.” It isn’t what the CDC did for the past ten years, but what they’re doing when the spotlight is on them that counts. In fact, the CDC’s performance over the past few weeks will have people questioning just how well they’ve done their job all along, and perhaps they should.

On the other hand, it’s possible that the public perception might be a little too harsh. One amazing aspect of this poll is that the CDC is only seven points up on the VA (30%) and only six over the IRS (31%). Both of those agencies have been embroiled in scandals that involve outright corruption, not just incompetence, and yet they’re almost within the margin of error with the CDC, which to this point is only considered to be well-meaning but failing.

Harold Pollack defends the agency:

Despite the CDC’s budget problems and its recent stumbles, it is a more effective, better-led organization than it was during the Bush years, when five out of six former agency directors publicly criticized the CDC’s managerial hijinks, low morale and lapses from scientific integrity. At that time, the CDC ranked 189th out of 222 federal agencies in workforce morale. It now ranks 49th out of 300 federal agencies on such measures. That’s a striking improvement.

“When the public health enterprise loses political standing,” he adds, “it may not be listened to when it most needs to be heard”:

Almost 40 years ago, the CDC suffered public humiliation when it was perceived as having bungled a massive vaccination campaign for a Swine Flu epidemic that didn’t materialize. Only a few years later, CDC officials tried to sound warnings about a mysterious new pathogen. They were shoved aside, often by government and medical officials who specifically cited the Swine Flu debacle. One unfortunate 1983 Red Cross memo, opposing aggressive measures to protect America’s blood supply, expressed the general mood: “CDC is likely to continue to play up AIDS,” because “CDC increasingly needs a major epidemic to justify its existence.”

Getting Ebola Under Control

Yesterday and today brought a few bits of good news:

According to the BBC, the Spanish nurse who was the first person to contract Ebola outside of West Africa has tested negative for the virus (a second test is required before she’ll be officially free of the disease). And the United States has reached an important milestone: the 21-day monitoring period for the 48 people who had contact with Thomas Eric Duncan, the Liberian man who died of Ebola in Dallas, ended on Sunday and Monday. Aside from the two nurses who cared for him, there have been no new infections.

Things are also looking up in Africa, where two countries have been declared Ebola-free:

On Friday, the World Health Organization announced that Senegal had completely contained the spread of the disease, and now on Monday Nigeria has joined them.

The ruling was made after determining that it has been six weeks without any new cases of the disease. The last reported case was on September 5. Seven Nigerians died of the disease since July, but the country is being praised for swift and decisive efforts to contain the outbreak. In particular, Nigerian officials quickly traced all those who came in contact with the first person to be diagnosed with the disease this summer.

Of course, none of this means the epidemic is over. The CDC is updating its safety guidelines for health workers in order to reduce the risk that other nurses will contract the virus if and when more Ebola patients arrive in American hospitals. And while the news from Senegal and Nigeria is worth celebrating, other West African countries remain in dire straits, with Liberian President Ellen Johnson Sirleaf warning that the disease has brought her country to a standstill:

“Across West Africa, a generation of young people risk being lost to an economic catastrophe as harvests are missed, markets are shut and borders are closed,” the Nobel Peace Prize laureate said in a “Letter to the World” broadcast on Sunday by the BBC. “The virus has been able to spread so rapidly because of the insufficient strength of the emergency, medical and military services that remain under-resourced.”

In neighboring Sierra Leone, emergency food rations were distributed for a third day on Sunday to give a nutritional lifeline to 260,000 residents of an Ebola-stricken community on the outskirts of the capital, Freetown. The Waterloo area in Freetown has 350 houses under quarantine with people suspected of having the Ebola virus and infections in the district are rising, according to the UN World Food Program.

Meanwhile, one new study suggests that the 21-day monitoring period may not always be long enough:

According to Charles Haas of Drexel University, who authored the study, the exact scientific origins of the World Health Organization’s recommended quarantine period for Ebola are murky. The recommendation could be traced to data from the 1976 Ebola outbreak in Zaire and the 2000 outbreak in Uganda, both of which reported incubation periods of 2-21 days, but nobody can be certain.

A more concrete approach is needed to determine an appropriate quarantine period, Haas wrote, so he analyzed data from the 1995 outbreak in the Congo and the current one in West Africa. After examining the newly expanded data set, Haas discovered that the probability of excedence for Ebola incubation was .1 to 12 percent. “In other words,” he wrote, “from 0.1 to 12 percent of the time, an individual case will have a greater incubation time than 21 days.”

Infected With Ignorance

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Aaron Blake flags a new Kaiser Family Foundation poll showing that most Americans don’t know – or don’t believe – that Ebola can only be transmitted by patients who already have symptoms:

In addition, 25 percent of Americans wrongly think that Ebola can be transmitted through the air, and 37 percent think it can be transmitted by shaking hands with someone who isn’t symptomatic. Both of those are wrong, per the CDC. Could some of these folks be aware of the science and the CDC’s assurances and just not believe them? Sure. There are certainly some doubters out there, even in the scientific community, who think the CDC’s blanket assurances might be premature. But even if those doubters are correct that you can’t quite rule out transmission from a person who isn’t showing symptoms, the lack of a negative doesn’t necessarily prove a positive. In other words, there is still no data to support the belief of 48 percent of Americans, even if you think what they believe can’t be completely ruled out.

The area of northeastern Ohio where Ebola patient Amber Vinson had visited her mother just days before being diagnosed is displaying what officials are calling an “abundance of caution” and others might call an overreaction:

Two Cleveland-area school districts shut down entirely on Thursday, citing one teacher who had unspecified contact with an infected patient and another who was on a different flight “but perhaps the same aircraft” as Vinson — a step that public health officials deemed unnecessary. Ohio health officials also issued new guidelines on Thursday that go well beyond what the Centers for Disease Control and Prevention has recommended: The state says that even those who’ve exchanged a simple handshake with an infected individual should be quarantined for 21 days if they’re not wearing protective gear, even though the disease is not airborne and cannot be transmitted through casual contact. Ohio officials also recommend that those who have been “within a three-foot radius” of an infected individual for a prolonged time should monitor themselves — warnings that could further stoke fears of the disease’s contagion.

America: land of the free and home of the completely terrified at all times. The outbreak, such as it is, has become a bonanza for suppliers of the doomsday community:

In the past week, preppers-turned-entrepreneurs Fabian Illanes and Roman Zrazhevskiy say they have seen sales of gas masks and their harrowing-sounding NBC (Nuclear Biological Chemical) kits skyrocket. “Tripled is probably an understatement,” Illanes says. Their company, Ready to Go Survival, sells prepacked survival, or “bug out,” bags and kits. As fears of Ebola grow, they’ve been filling $1,000 orders of gas masks for whole families.

Illanes, who recently moved to Texas from New York, says he imagines a time when Manhattan might shut down all access into and out of the city. “If I’m in a car with my family and each of us has gloves, masks, and bodysuits, and there’s a regular family in a car next to us—who do you think the people controlling borders are going to feel more comfortable letting through?” he asks. In response to the calls they’ve been receiving, they’re putting together a “pandemic kit” that will provide quick full-body protection and will go on sale late next week.

And then there’s the Halloween industry:


The latest in hysteria-deflating perspective comes from Philip Bump, who offers a brilliant illustration of just how unlikely it is that you or I will come into contact with the roughly 0.000001 percent of Americans who currently have the virus, and from Max Fisher, who points out that we are more likely to be killed by our own furniture:

Threat to Americans: According to a report by the Consumer Product Safety Commission, just under 30 Americans are killed every year by “tip-over,” which is when “televisions, furniture, and appliances” fall onto their owners. The report also found that over 40,000 Americans receive “emergency department-treated injuries” from tip-over every year.

Worst-case scenario: This is America. We can always find ways to make a bigger, heavier, deadlier TV.

How freaked out should you be: Council on Foreign Relations scholar Micah Zenko found that tip-over kills about as many Americans per year as terrorism does, and injures many more. In theory, then, you should be just as freaked out by tip-over as you are by terrorism. Based on the fatality rate, you should be much more freaked out about tip-over than you are about Ebola.

Then maybe this lady is just trying to protect herself from the chair:

The “Ebola Czar” Arrives

This morning, Obama appointed political operative Ron Klain as his point-person (er, “czar”) to oversee the multi-agency response to Ebola:

Klain, who served as chief of staff to Vice President Biden and former Vice President Al Gore, helped to oversee the 2009 stimulus bill. He will now be tasked with coordinating both the domestic public health response and the international humanitarian and military efforts to stop the virus in West Africa. Klain will work out of the White House’s West Wing. … Republican lawmakers had been calling on the White House to appoint the so-called “czar” for weeks to lead the Administration’s response. The White House had been cool on the subject until Thursday, when Obama told reporters he was considering making such an appointment.

The right is already making hay out of the fact that Klain is not a doctor, has no public health experience, and has an extensive background in Democratic party politics. Ezra, on the other hand, calls him a great choice for the job:

The Ebola response involves various arms of the Department of Health and Human Services (particularly, though not solely, the Centers for Disease Control and Prevention), the Pentagon, the State Department, the National Security Council, the World Bank, the World Health Organization, President Obama’s office, private stakeholders, and many, many more. The “czar” position requires someone who knows how these different agencies and institutions work, who’s got the stature to corral their efforts, who knows who to call when something unusual is needed, who can keep the policy straight. …

Actual government experience is badly underrated in Washington. Politicians run for office promising that they know how to run businesses, not Senate offices. “Bureaucrat” is often lobbed as an insult. But in processes like this one, government experience really matters.

Mataconis is not so sure:

[W]hile Klain certainly has experience in government, to the extent of being Chief of Staff to two Vice-Presidents counts as experience, I’m not sure that he’s the best choice for this position. The fact that his experience is purely political, and heavily so on one side of the political aisle, suggests strongly that the White House was more concerned with picking someone that they were comfortable with than the were with picking someone who would be the right fit for the job, such as, say, a retired General or Admiral or a former Cabinet Secretary of high prominence. At the least, someone with experience at running a multi-agency effort such as this would seem like a better choice. Perhaps Klain will turn out to be just what’s needed for the job, but on first glance this isn’t a very impressive appointment.

Jonathan Cohn weighs in:

Why not pick somebody whose resume includes a stint at the Department of Health and Human Services, Department of Homeland Security, or maybe the Federal Emergency Management Agency? This is not the first time the federal government has confronted a biological menace. An official who’d lived through and worked intensely on responses to SARS, Avian flu, or even HIV might bring critical and beneficial experience to the table. …

Still, the Administration doesn’t lack for expertise on disease and potential outbreaks. The Centers for Disease Control has made some mistakes, but nobody I know questions the expertise of Tom Frieden, CDC’s director, or Anthony Fauci, who is in charge of the National Institute of Allergy and Infectious Diseases. Fauci, in particular, has been working on these sorts of issues since the 1980s, when he was a key player in the government response to AIDS. (If there’s a need for more medical knowledge, perhaps the Senate could act on Obama’s nominee for Surgeon General?)

The Grave Risks Of A Travel Ban, Ctd

Yesterday, House Republicans dragged CDC Director Thomas Frieden and other health officials onto the floor for a little grilling and grandstanding about why we haven’t instituted an Ebola travel ban yet:

“None of us can understand how a nurse who treated an Ebola-infected patient, and who herself had developed a fever, was permitted to board a commercial airline and fly across the country,” said Rep. Fred Upton (R-Mich.), the House Energy and Commerce Committee Chairman. “It’s no wonder the public’s confidence is shaken.”

Upton joined other lawmakers, including Rep. Tim Murphy (R-Pa.) and House Speaker John Boehner, who want the Administration to consider travel restrictions between the U.S. and West African countries, where the outbreak has killed more than 4,500 people. “It needs to be solved in Africa but until it is, we should not be allowing these folks in, period,” Upton said at the hearing. … Frieden countered that the Administration can better track people from the most vulnerable countries in West Africa without restrictions on travel.

Dr. Steven Beutler, an infectious disease specialist, favors quarantining everyone who travels to the US from an Ebola-afflicted country:

This obviously will result in considerable inconvenience and some expense, and in this respect I realize that it sounds draconian. But the fact is, it will prevent most importation of the disease.

If the quarantine could be established prior to travel, then virtually no cases would be imported from West Africa. Ultimately, it will diminish the total number of people being quarantined and being tracked, since there will be fewer contacts and less transmission. …

Note that I am not advocating travel bans. It is hard to disagree with Dr. Anthony Fauci, the National Institutes of Health director of infectious diseases, and CDC Director Thomas Frieden when they point out the necessity of engaging the outbreak at its source, and being able to provide material support to the affected regions.

John Cassidy sees politics pushing the administration toward a “tougher” response:

The President’s problem is that he appears to be reacting to events rather than dictating them. Initially, his Administration resisted calls to screen visitors from West Africa; the day Duncan died, it announced a system of screening. Until yesterday, the White House insisted that the C.D.C. had established proper protocols and systems for hospitals dealing with Ebola victims. Now it is beefing up federal oversight and promising to fly in SWAT teams.

Will that be enough? In terms of fighting the disease and protecting health workers, we can only hope so. For political reasons, however, Obama will almost certainly have to do more—a point conceded by one of his former spokesmen, Jay Carney, who on Thursday advised the White House to reconsider its opposition to banning flights from West Africa.

Morrissey backs Obama’s decision to focus on containing the outbreak at its African source, partly because he doesn’t trust the CDC to prevent things from getting out of hand once more cases arrive in the US:

In its own way, the CDC’s fumbles over the last few weeks proves the wisdom of Obama’s warning here. Just like terrorism, it is better to fight Ebola on its own ground rather than ours, because once it gets here, it’s almost impossible to contain effectively — or at least at the moment. That is one reason that support for a travel ban from Ebola-impacted countries has become a nearly consensus position outside of the White House. People understand that the first and best defense is to keep the bug from getting to the US at all.

Yuval Levin, who supports a travel ban and expects the administration to impose one eventually, nonetheless argues that we aren’t thinking about the threat correctly:

The very nature of the debate we are now having, including the debate over the travel ban, is evidence of the fact that we probably have not yet learned not to underestimate this outbreak. We are still thinking about it in terms of a crisis in Guinea, Liberia, and Sierra Leone that could reach our shores by the various means that connect us to them.

But the real danger, to us and to others, is probably far greater than that. Our greatest worry should not be that the disease could get to the United States from those West African nations but that it will get to Nigeria’s larger population centers or to, say, India or other places with massive population density and weak public-health systems, and from there will become an epidemic throughout the third world. The scale that this outbreak is now likely to reach in West Africa will make it rather difficult to prevent that, raising the risk of a far more colossal human catastrophe than the nightmare we are already witnessing and of a greater threat to the U.S. population.

That has not yet happened, and so it is likely preventable, but what the world is doing at this point in West Africa is probably not sufficient to prevent it.

Update from a reader, who comments on the original tweet we posted:

I was hoping for you to lay down some sanity regarding the whole “You can give but not get Ebola on a bus” thing, but you posted the tweet without comment, and since I’ve seen the point ridiculed elsewhere already, I’d like to point out what seems like the obvious message behind saying something like that:

If you don’t have Ebola, go ahead and ride the fucking bus. But if you think you might have Ebola, just to be goddamn sure, don’t ride the fucking bus.

Is that such a crazy interpretation? I mean, can you imagine what people would say if Frieden had said something like: “Yeah, if you have Ebola, go ahead and take the bus, who cares, right?” What do people want from the director of the CDC besides a reassurance that if you’re healthy and at low risk you should go about your daily lives, but if you’re sick you should take more precautions than may be necessary?

I haven’t been following the details closely enough to have an opinion on whether the rest of the administration’s Ebola response has been a giant cock-up or not (although it seems like maybe yes), but it seems like people are being lazy in making fun of Frieden’s comment without doing even a little bit of thinking.

The Grave Risks Of A Travel Ban, Ctd


New survey data from YouGov show that the public is pretty enthusiastic about quarantines and travel bans as means to prevent an Ebola outbreak:

Those following news about the virus are especially likely to want to take action.  82% of those who have been following news stories about Ebola very closely would quarantine travelers from countries with Ebola outbreaks; two in three would completely exclude travelers from those countries.

We covered the debate over a travel ban earlier this week. Rebecca Leber outlines how a potential quarantine policy would be enforced:

Authorities generally prefer to make recommendations and rely on people to follow them in good faith. “In the U.S. we tend to try to do a softer approach, not be too coercive, and not scare people so as to drive the epidemic underground,” says Lawrence Gostin, a Georgetown University professor and Director of the World Health Organization Collaborating Center on Public Health Law and Human Rights.  The exceptions are situations in which people are ignoring recommendations. And that’s already happened at least twice in the Ebola saga. …

In Dallas, Texas, four people who were inside the apartment when Duncan became ill are also under quarantine. But local authorities have handled it in a way that highlights the potential danger of the approach. Duncan’s partner and her family were trapped in a contaminated apartment for days, amid soiled bedsheets and clothes, before they finally could move to a clean apartment. Gostin told me this may be unconstitutional. “That’s unacceptable to subject people who are quarantined to that kind of risk to their health,” he said.

Douthat resists the suggestion – one that is gaining traction on the far right – that the Obama administration is avoiding such measures for ideological reasons:

Sure, maybe the Obama White House isn’t wild about the potential implications for immigration politics of giving ground on a quarantine or travel ban … but the potential implications of a hundred Ebola cases spread across five cities are so, so much worse that the political-ideological incentive cuts, if anything, in favor of overreacting. And what’s true of crisis politics around a specific issue like immigration is true of crisis politics writ large: Because there is nothing, nothing that would wreck Obama’s legacy and his party’s immediate fortunes alike more than a real Ebola outbreak in the United States, I have to believe that people in the White House have what they consider sound, non-ideological reasons for why a travel ban isn’t a no-brainer[.]

To J.D. Tuccille, a fear-based response to Ebola is scarier than the disease itself:

To be honest, it could all be a lot worse. In the frenzy of panic over potential bioterrorism post-9/11, many states adopted part or all of the Model State Emergency Health Powers Act, written by Lawrence O. Gostin, a professor of law and public health at universities including Georgetown and Johns Hopkins. Gostin argued that “Although security and liberty sometimes are harmonious, more often than not they collide.” He added, “The central inquiry, then, is not whether government should have the power to act… Rather, the proper inquiry is under what circumstances power can be exercised.”

The resulting legislation, the American Civil Liberties Union noted at the time, “doesn’t adequately protect citizens against the misuse of the tremendous powers that it would grant in an emergency.” Nobody has yet proposed dusting off that fear-fueled legislation. But with the whiff of cold sweat in the air, it’s all the more reason to fear panic more than a virus.