Global Passport

dr.thomas.frieden.cdcIt’s October, time for playoff baseball. This year’s games are taking a bit longer than usual, in part because the umpires’ judgment on close calls is subject to replay review. The umps usually get it right, but MLB wants to do everything possible to avoid having human error decide which team wins a championship.

We wish the same standard could be applied to the global Ebola crisis, but alas there are no replays in pandemics. Our chances of stopping Ebola in its tracks before it gains a foothold on all continents have been drastically reduced by a series of human errors and bad calls dating back to the beginning of the outbreak.

Doctors failed to test patients for Ebola for three months after the first illnesses were reported in West Africa, thinking they were dealing with a lesser threat like lassa fever or malaria. It was only after an international infectious disease expert learned that several victims, miles away from each other, had complained of hiccups that blood tests for Ebola were undertaken and the correct diagnosis finally was made (no, we’re not making that up: hiccups is a symptom of early-stage Ebola). By then there already were close to 50 Ebola cases in three neighboring African countries, Liberia, Guinea and Sierra Leone.

We won’t detail the other fumbles here, including the unfolding fiasco in Dallas. Let’s go straight to the worst call of all, one that will have unthinkably catastrophic consequences if it’s not reversed immediately.

Not since Capt. Smith ignored iceberg warnings and ordered Titanic’s mammoth engines ramped up to full-speed-ahead–he hoped to break the speed record for crossing the Atlantic–has the world witnessed such a tragic combination of hubris and carelessness as that which is now being exhibited by the Centers for Disease Control Director Thomas Frieden.

Dr. Frieden has been the most steadfast and outspoken opponent of imposing any kind of an air travel ban preventing people from flying out of the hot zone in Africa to uninfected countries and cities around the globe. Late last week, Frieden chose a notably xenophobic media outlet––to deliver what he no doubt believes is his politically correct message.

Here are the key points of the opinion piece the CDC director posted, followed by our rebuttal:

TF: “For every problem, there’s a solution that’s quick, simple and wrong…A travel ban would essentially quarantine the more than 22 million people that make up the combined populations of Liberia, Sierra Leone and Guinea. When a wildfire breaks out we don’t fence it off. We go to extinguish it before one of the random sparks sets off another outbreak somewhere else.”

BF: The stupidity and unintended irony of this statement are breathtaking. Yes, Tom, a travel ban would quarantine the three countries in the hot zone–that’s the entire point. You apparently know even less about fighting fires than you do about infectious disease control: firefighters always build firebreaks when battling wildfires. It might have been possible to “extinguish” the Ebola outbreak when it was limited to a few dozen cases, but the disease is now spiraling out of control in West Africa, with at least 10,000 infections reported and your own experts predicting that this number will exponentially double every three weeks. The meager medical infrastructure of the entire region is collapsing (healthcare workers have been infected at a rate of 1 in 20); people in Sierra Leone are being told that treatment centers are filled to capacity and survivors should prepare to treat new victims at home. The “random sparks” from the hot zone already have landed on two other continents, thanks to the global passport you’ve handed to Ebola.

TF: “We don’t want to isolate parts of the world, or people who aren’t sick, because that’s going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak. It could even cause these countries to stop working with the international community as they refuse to report cases because they fear the consequences of a border closing.”

BF: Ebola has an incubation period of up to 21 days, during which an infected person may not present any symptoms. People who have been exposed to Ebola in Africa but “aren’t sick” are not going underground, they’re booking flights to take refuge with their friends and relatives overseas, just like the Liberian fellow who died in Dallas. He carried a pregnant woman dying of Ebola to a cab and rode with her to the hospital in Monrovia–then hopped a flight to visit his girlfriend in the U.S. If you’re stuck in the middle of a hot zone surrounded by dying people and “aren’t sick” (yet), wouldn’t you take advantage of CDC’s incredibly short-sighted and dangerous approval of international flights taking off from the region? There are approximately 10,000 Liberian ex-pats living in New York City who are petrified that one of their infected relatives is going to show up on their doorstep any day now. Here’s a pop quiz, Tom: which will make it “infinitely more difficult to address the outbreak,” isolating (by quarantine) the out-of control hot zone in West Africa or letting infected people ride the subway in NYC?

TF: “Stopping planes from flying from West Africa would severely limit the ability of Americans to return to the United States or people of dual citizenship to get home, wherever that may be.”

BF: Once again, that’s the point of a quarantine, Tom. It’s all about preventing people who have been exposed to or infected by the most virulent disease on Earth (with a 70-percent mortality rate) from going to uninfected areas. It’s why the CDC told those people in the Dallas apartment complex (where the Liberian Ebola victim stayed) that they couldn’t step outside for two weeks.

TF: “People will move between countries, even when governments restrict travel and trade. And that kind of travel becomes almost impossible to track. Isolating communities also increases people’s distrust of government, making them less likely to cooperate to help stop the spread of Ebola.”

BF: It’s easy to track airplanes that don’t take off, Tom. As for distrust of government, why would we have any reason to believe that you made a political decision to overrule your infectious disease experts after listening to a bunch of airline industry executives and economists? That would never happen in Washington, would it?

TF: “Isolating communities and regions within countries will also backfire. Restricting travel…makes the disease spread more rapidly in the isolated area.”

BF: We’re not talking about cutting off aid to the hot zone or restricting chartered (read military) aid flights from going to West Africa. We’re talking about nobody leaving there until the battle against Ebola is won (including aid workers and military personnel, who should be quarantined at special facilities for 21 days and tested before boarding military transports to fly home). Permitting commercial flights to take any asymptomatic person out of there who wants to leave is, frankly, insane. It’s already backfiring, big-time. Just ask the nurses in Dallas and Spain who got infected (in the Dallas case, while wearing full biohazard gear) treating the Ebola patients who took advantage of CDC’s ridiculous no flight ban policy to leave West Africa.

TF: “What works is isolating the sick and those in contact with them as they are at the highest risk of infections. Casting too wide a net, such as invoking travel bans, would only provide the illusion of security and would lead to prejudice and stigma around those in West Africa.”

BF: Yeah, limiting isolation to the people who are already sick works–unless somebody who’s sick but doesn’t know it (or show it yet) jumps on the next plane to Dallas. The textbook definition of “the illusion of security” is the pathetically bogus airport screening operation you’ve set up at a few major U.S. airports. Since somebody has to have a fever to get flagged, these checkpoints will not stop anyone who is incubating Ebola but not showing symptoms–like the guy in Dallas. If Ebola breaks out in New York because you thought it was a great idea to let people keeping flying in from West Africa, you’re going to learn the meaning of the word stigma, Tom. You might want to purchase some property on an uninhabited island in the Aleutians.

TF: “We know how to stop Ebola: by isolating and treating patients, tracing and monitoring their contacts, and breaking the chains of transmission.”

BF: Isolating is synonymous with quarantining, Tom. Regarding “monitoring contacts,” are you aware that your own agency is projecting 1.4 million infections in West Africa before the end of January? Your agency couldn’t even monitor the biohazard team that was supposed to clean up the apartment of the Ebola victim in Dallas, but didn’t show up for a week. Your refusal to isolate a single region in Africa will lead directly to a global pandemic that eventually will overwhelm the medical resources of every nation on Earth. Unless you reverse your opposition to a flight ban immediately, our only hope will be that the people now developing Ebola vaccines throw out the CDC guidelines for extended testing before deploying the vaccines. [Editor’s Note: A few hours after this post was published, it was revealed that CDC told nurses who treated the Liberian Ebola victim at the hospital in Dallas to “self-monitor” themselves and avoid public transportation. One of the nurses traveled to Cleveland, began exhibiting Ebola symptoms and reportedly was given permission by CDC to fly back to Dallas on a commercial flight, exposing more than 100 passengers to Ebola.]  

TF: “Until Ebola is controlled in West Africa, we cannot get the risk to zero here in the United States.”

BF: Agreed. That’s why you need to resign (or be fired) so we can put somebody in charge of CDC who isn’t a politically motivated mediocrity.