The Cinch Review

U.S. Ebola Response Resembles a Dog’s Dinner

Dog Ebola Bentley—Except, that is, when it comes to handling the dog. Bentley, the beloved pet of Nurse Nina Pham (who thankfully is now apparently well), has been cared for with compassion, a compassion directed not merely at the dog but at the health care workers everywhere who have to show up and potentially face the threat of Ebola in their jobs, a threat which (despite all the knowing talk about it by countless experts and wannabee experts) still contains plenty of uncertainties.

(The phrase “dog’s dinner” is a quaint one from the British Isles, where I spent some formative years; it’s a way of describing a hopeless mess. The teacher might observe, for instance, that you’d made “a dog’s dinner” out of the copybook containing your homework, right before administering some spontaneous corporal punishment.)

The only things yours truly has written about this Ebola issue were centered on the handling of the dogs (beginning with the quick killing of a health care worker’s dog in Madrid) but that is not because I believe dogs are more important than people, or even indeed that their lives are of equal value, morally speaking, to those of humans. I don’t believe those things, even though I think of dogs as being perhaps uniquely empathetic and lovable animal companions, and even if I love my own dog beyond measuring. Ebola is a tragedy for human beings; at this point it is most dramatically so for those in West Africa, where thousands are dead, many thousands more are mourning for their lost loved ones, and entire communities and societies are either breaking down or at very real threat of collapse due to the damage and stress of this epidemic.

The dog issue does provide, however, an interesting angle into the whole subject of the Ebola outbreak in the West and how it is being handled by governments, and I imagine it might even continue to do so. It has to do with the subject of compassion, juxtaposed with fear, and it also has to do with the issue of foresight. I opined in an earlier post that the first impact of Ebola to be feared in the West was not the disease itself but “the ham-handed actions of government authorities trying desperately to contain both it and the panic it will generate.” Invoking a public health emergency fills government officials with a sense of virtually unlimited power. Yet these ham-handed actions could be avoided by instead acting earlier and more intelligently. The time to act early is sadly past. The potential for acting intelligently seems more and more slim.

In West Africa, one of the early signs that this Ebola outbreak (unlike previous ones) was heading into out-of-control territory was when health care workers began abandoning hospitals and clinics in afflicted areas. There can be little doubt that having a steady job in that part of the world is a good and a greatly-valued thing, but what is the value of a paycheck when you’re six feet under (and you’ve also brought home a deadly and incurable virus to the people you love most)? No one is more threatened by Ebola than the first responders and the hands-on workers in the hospitals. They have to deal constantly with sick people who may or may not be infected with Ebola and with their bodily fluids in the most unavoidable and intimate manner. And at the same time no one’s work is more crucial than theirs. Any doctors, nurses, and other health care workers who have abandoned their jobs in West Africa have likely done so not because they didn’t care about people’s lives but rather because they reached a point where they felt no one cared about their lives; they were overwhelmed, insufficiently equipped, and expected to take a hit for the sake of higher authorities who were not adequately supporting them. Would you or I do any different? And that is the vital question when it comes to something as terrifying as Ebola: At what point do the people who are most needed to deal with it simply give up?

In Spain last month, an Ebola patient needed to be cared for, and a nurse’s assistant named Teresa Romero was among those who stepped up to administer care. She became infected, and one of the first things the Spanish authorities decided to do in response was to kill her pet dog, without bothering to do any waiting or testing. The message to others who would care for Ebola patients was clear, and it was not compassionate. The notion that in all of Spain there was not to be found the resources to safely quarantine a single dog is absurd. The decision-makers simply decided it wasn’t worth it. Not a good harbinger, I would suggest, for the future.

In Dallas, Texas, by contrast, local officials stepped up and guaranteed the safety of Nurse Nina Pham’s dog. Dallas County Judge Clay Jenkins and Dallas Mayor Mike Rawlings deserve credit for this decision. They also saw the value of studying the dog, as the way in which pets might become infected and/or contagious is surely a very important thing to understand as this virus continues to spread. Nina Pham is now considered virus-free, thank God; her dog Bentley will continue to be quarantined until November 1st. Nina Pham therefore has not been punished by the government for the crime of being willing to care for a person sick with Ebola. If we assume it’s so easy to find such people here in the U.S., maybe what occurred at Bellevue in New York City after Dr. Craig Spencer was checked in should make us think again.

A stark truth needs to be faced when it comes to a plague—because that is what this is—like Ebola. Many decent people who are ordinarily willing to help a neighbor in need will instead turn around and flee when faced with the possibility of this kind of infection. It is simply human nature: a visceral and instinctive reaction to avoid deadly disease. What’s the point in helping someone if you too will die, and likely infect those you love most? It is a devastatingly powerful calculus, and even health care professionals who deal with other better-understood pathogens on a regular basis are very far from being immune to this.

So, we now have a record of how government has been handling this in the United States, and we have two opposite extremes, neither displaying foresight or intelligence. From the federal government, and the C.D.C. (Centers for Disease Control and Prevention) we have had a great deal of bromides and pablum, which have exacerbated public distrust and fear. No less than the head of the C.D.C., Dr. Thomas Frieden, publicly asserted that there is no need to fear catching the Ebola virus on a crowded bus, but if one already has it, one shouldn’t take the bus, in case one might transmit it. A five-year-old child could perceive the illogic and dishonesty of this. It perfectly illustrates the contempt that Frieden and his ilk have for the general public, and the intent to “handle” and calm the restless peasants. Well, the peasants are not amused. The C.D.C. under Tom Frieden currently has zero credibility on the issue of Ebola, not only for this absurd lie, but for their incompetence and arrogance in asserting that all U.S. hospitals were fully equipped to handle an Ebola infection.

Another stark lack of foresight at the federal level is in the deployment of resources to stop the disease’s spread in West Africa. Approximately three thousand U.S. troops have recently been sent to set up tented treatment centers and provide supplies. Like lots of other people, I feel awful for these brave soldiers being sent to fight an enemy that they can’t shoot back at, but what makes it even more horrendous is the fact that this effort is too little too late. If this kind of thing had been done several months ago—when all the relevant information was right in front of the decision-makers—there would likely be no Ebola epidemic today. But this is an example of what “leading from behind” means for the current U.S. administration. And we can see what it costs.

Now the lack of foresight and proper seriousness regarding Ebola is producing at the opposite extreme some blunt-instrument kinds of responses. New York Governor Andrew Cuomo and New Jersey Governor Chris Christie on Friday announced some kind of blanket mandatory 21-day quarantine for anyone possibly exposed to Ebola who arrives at a New York or New Jersey airport. The same day, a nurse named Kaci Hickox arrived at Newark airport, and—although when she left Sierra Leone she believed she was simply a free American citizen returning home—when she arrived she was treated as a criminal without rights and tossed into mandatory quarantine, though displaying no signs of infection. Governor Christie, asked where the nurse had been sent, responded, “She’s not in the United lounge. I have no damn idea where she is, probably at Sbarro getting pizza.”

Is this how a Governor should respond to a question about the whereabouts of an American citizen who has been taken somewhere against her will, having committed no crime? And she is one of those few who, instead of running from this terrifying disease, ran towards those suffering from it, in an effort to do good. Although the C.D.C. has spewed an enormous amount of garbage in the last month or so, one thing that they have said is true: the best way of protecting Americans is by eliminating this virus at its source in West Africa. We need to bear in mind that there are many other places in the world this can spread, and all will produce spill-over effects. It won’t go away until it’s gone away everywhere. Nurse Kaci Hickox was trying to help achieve that end, at enormous risk to herself. All Americans should be deeply proud of her and people like her. It is inexcusable (and likely unconstitutional) that someone like her should be treated with this kind of disrespect and cruelty.

And the evidence is that Cuomo and Christie chose the wrong woman to use as Exhibit A in making the case on how tough they are.


So it goes from one extreme to another. Certainly, the idea that an entirely voluntary “honor-system” should exist for those possibly exposed to Ebola who return to the U.S. is reckless, and Dr. Craig Spencer’s behavior in New York City made that clear (but it should have already been clear to policy-makers). However, treating everyone who returns as diseased and contagious with mandatory 21-day quarantines in medical tents without flush toilets is both absurd and dramatically counter-productive to the effort to fight the disease at its source, and it also sends a message poisonously devoid of compassion. There are intermediate measures that can be taken. For example, instead of the enormous expense of quarantining a non-symptomatic person under these circumstances, how about having a medical professional travel daily to where that person lives and personally take his or her temperature and evaluate his or her condition? (If the individual does not cooperate, then mandatory quarantine becomes a valid option.) It would be dramatically cheaper, much more commonsensical, and properly respectful of people’s freedom.

The lack of foresight and leadership at the federal level has instigated this overreach at the state level, but no one who is elected and paid to employ proper judgment with regard to the public welfare should be excused.

When it comes to hot button issues that intersect politics, there is customarily an either/or response. On Ebola, there are those who say we should batten down the hatches to keep the virus out and to hell with the rest of the world, and then there are those who say, “Don’t worry, it’s hardly any risk at all, really, and we just have to remain totally open and welcoming.” For my part I have no hesitation in saying a pox on both their houses. We have to fear not only the virus itself but the stupid and counterproductive measures that government takes in dealing with it and in trying to “handle” the masses. So far, we have seen vast vistas of incompetence and knee-jerk day to day adjustments. This Ebola outbreak is the kind of event that exposes the fault lines in human nature, and we are in the process of seeing the result. At this point we can only pray that the better angels triumph and that competent, smart and courageous people on the ground and dealing with the infected victims ultimately win this battle.

May God bless those who are doing that good work, and may God help those who are suffering.

……

Addendum 10/27/2014: Not long after this post was published, Governor Cuomo of New York dialed back from the position he’d been taking on Friday, and announced that home quarantine with twice-daily checks from medical professionals would be sufficient for those returning to the U.S. after possible exposure to Ebola. And then this morning, Governor Christie announced that Nurse Kaci Hickox would be allowed to leave her confinement in a New Jersey hospital and return to her home in Maine, with arrangements to be made with state officials there.

(We don’t often post on topical issues here at THE CINCH REVIEW, but boy, when we do, we get results.)

The above is a belated but more reasonable approach by the NY and NJ state governments, although there will continue to be fighting over the details. However, the points made previously still apply: There has been an atrocious lack of foresight displayed by those elected to government and paid to make these important decisions in a timely and intelligent way. It has all been excessively reactive, clumsy and late, and the whole sorry gang, from President Obama on down, have so far failed pathetically, and it does not bode well for how they will handle it as events progress.