NOTE: This is a long post.. so grab your latte and settle in!
Yet another thing to fear in our daily lives. Like everything else in life it seems this Ebola thing has gotten lost in the vast wasteland of imperfect and misdirected communication. Ok.. let’s explore this one a little bit (ok.. maybe a little more than just a little bit; possible BORING alert!).
TV Coverage –
If you listen to the broadcast news networks and the 24/7 coverage on the cable news networks one might think that Ebola is lurking just down our street. Now, I have a certain loyalty (good or bad) to watching CNN for most of my news and I am a kind of news junkie these days and even I am getting really bothered by all this Ebola coverage. You get to the point where reporting the news is different from getting ratings. After all, news network or entertainment network , the numbers of viewers watching dictates how much a network can charge for their TV commercials, that ultimately pays for the network to operate. That’s simple business. The balancing act (for news reporting) comes when news is presented with some real urgency in timing and utmost credibility in prioritizing for the public good, compared to reporting only the interesting aspects… pushing a somewhat different information priority that will retain the greater viewing public. We trust our news agencies and TV reporting with giving us credible information as it happens, with timely updates, with a profound sense of priority in our lives. That trust we give them also exposes us to being led.. or mislead… into believing something being reported should matter to us… or even have greater importance to us than what our common sense might be telling us.
That’s where I think we are with news reporting about Ebola. We are getting barraged with the latest suspect quarantine victims, our having to wait out their quarantine literally with them until they are declared safe or one has to get treatment. Then we hear how the one who tested positive for it has “touched” some 500 people, and how they all have to be tracked down. Intermixed in all this are the occasional blurbs of some latest CDC or the WHO finding (no.. not the rock band, but rather the UN’s World Health Organization). It all adds to the confusion and subsequent misdirection of the seriousness of this outbreak. Oddly it seems the news is more transfixed on reporting those that have died from Ebola in Africa rather than those that have survived here in the States (a distinct difference). There’s more drama in death. Very little is upbeat about the survival stats here in the States. That would mellow the fear. We can’t have that or people would turn off their TV sets. Uh, huh.
Hooray For Hollywood…!
Let’s face it, we’re all groomed by what Hollywood spews out as entertainment and when it comes to apocalyptic end-of-the-world themes and sci-fi plots, world-wide epidemics top the charts. Hollywood has educated us that epidemics of any kind are not just bad, they are end-of-the-world events. Imagery in our heads include victims with flesh rotting from their faces or traveling bumps going up and down their arms and legs and across their faces… and politicians and the military looking at maps showing the how fast the disease will spread by 6 o’clock this evening unless we nuke St. Louis. Hollywood epidemics spread within hours. I’m sure you recall the movies, “Outbreak” (with Dustin Hoffman) or “Contagion” (with Kate Winslet)… or even Brad Pitt’s recent “World War Z” (not to mention AMC TV’s “The Walking Dead”). That particular disease that turns us all into zombies is the worst. We are zombie obsessed.
Ok.. so when this recent Ebola “outbreak” occurred the CDC announced it was an “epidemic” fairly quickly… with “pandemic” looming on the horizon. I confess I was rather thinking that meant the politicians and military were looking over some map of the world and seeing a computer rendering of how fast this would spread to the U.S. and down my street. Ebola was the nastiest of nasty diseases on our planet.. even mentioned in those three films as the kind of baseline comparison for illustrating how nasty the Hollywood disease was in those respective films. It’s a “hemorrhagic fever” disease… meaning bleeding oozes from nearly every orifice and the eyes. So at first when all this hit the news with great fanfare and consternation I had mental images of an apocalyptic plague spreading in spite of anything we could do about it, other than pray. That’s how little I knew about Ebola, and what little I did know was inspired by Hollywood rather than any facts. I am sure I was not alone.
Besides the news people, here are the other two players in the Ebola fear factor.
The Centers For Disease Control and Preparedness and The World Health Organization…
The CDC is kinda like NASA and the nation’s paramedics combined. Scientists and doctors keep clinical track of diseases, perform disease research, and monitor statistics on who’s getting sick, what it might be, and sending out the alarm if it spreads and can kill. On any normal day the WHO seems to get more press because they are affiliated with the UN and are constantly doing things regarding Third World countries… sanitation precautions, medical aid for traditional things that any Western nation can treat at a corner health clinic, and nutritional food basics. Here’s the official explanation from their respective websites…
The CDC –
“CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.
CDC increases the health security of our nation. As the nation’s health protection agency, CDC saves lives and protects people from health threats. To accomplish our mission, CDC conducts critical science and provides health information that protects our nation against expensive and dangerous health threats, and responds when these arise.
CDC in the 21st Century
- On the cutting edge of health security– confronting global disease threats through advanced computing and lab analysis of huge amounts of data to quickly find solutions.
- Putting science into action– tracking disease and finding out what is making people sick and the most effective ways to prevent it.
- Helping medical care– bringing new knowledge to individual health care and community health to save more lives and reduce waste.
- Fighting diseases before they reach our borders– detecting and confronting new germs and diseases around the globe to increase our national security.
- Nurturing public health– building on our significant contribution to have strong, well-resourced public health leaders and capabilities at national, state and local levels to protect Americans from health threats.”
(more at http://www.cdc.gov/vhf/ebola/)
“WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.
In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.”
Well, all that is great to know but there’s something lacking in all these descriptions for why these organizations exist… where’s communication to the public? On one end you have the WHO banging away from their end on trying to get nations to send medical aid to those Third World countries stricken the most with Ebola. That’s part of their job.. a sounding board to the world on severe conditions; using their international organizational efforts to issue cries for help and to spread the alarm. On the other end you have the CDC… and the deep pockets of good old Uncle Sam… throwing all cutting edge medical science has to offer against any and all threats to public health; a “Pentagon” of the medical world set to respond anywhere in the U.S. (and its territories) to counter all medical threats, foreign or domestic…. or so we thought.
I have no doubt whatsoever that the people at both these organizations are truly dedicated and I am not casting a layman’s critical eye toward any form of impropriety. But it’s very apparent since the Ebola outbreak that there’s been some very confusing information coming from the CDC, the military, and the WHO,along with a curious measure of action and non-action, and there truly appears that the CDC is not taking leadership of the situation here in the States as I might have expected. Granted, this is the CDC’s first real test of a serious outbreak coming from outside the country. One can spend all the time in the world behind plot boards and microscopes, testing computer models of possible epidemics, mustering up action plans and medical strike teams… but until any of that is really tested in a real world event all that preparedness is only a “best guess” based on what we know. No question, the CDC has the best and most qualified people in the world to be making that “best guess”. But it’s apparent that there’s a lot of work to do in epidemic, or pandemic, preparedness.
Some Ideas the CDC Could Try In The Future –
Yeah, I know. Everyone has an idea of how things should be done. It’s easy to be on the outside looking in, especially if you are the only one taking action and you just can’t make everyone happy no matter what you do. I don’t want all this to sound like that. I know absolutely nothing about the CDC’s mandate and how far they can go in circumventing our freedoms for the greater public good. Some of this is addressed on their website and we’ve certainly witnessed the start of that debate with some states passing regulations about how and when someone should be quarantined beyond that stated by the federal government. As “they” have been saying, some laws are being passed based on emotion and not factual science. But therein lies the issue; information confusion leads to grasping at the unknown to try and control the unknown. I am also not any sort of a medical professional. What ideas I toss out in here are just that… ideas. Common sense might suggest some of these likely have already been considered.
- Disseminating Information – When you think of any threat to the public safety you immediately think of those weather warnings when tornadoes are coming and those TV and radio tests of the Emergency Alert System. The EAS system is set up to allow for the President to address the nation within 10 minutes (the EAS replaced the old Emergency Broadcast System back in 1997, which itself replaced the very old CONELRAD system of the 50’s). This system is reserved for national use in the event of local weather emergencies, or national emergencies more along the lines of immediate threat to public safety such as a war attack, in the event the information is unable to be reported by regular broadcast news sources. For example, on 9/11 the EAS system was never used because adequate conveying of information, such as FAA immediately grounding all flights, was made by the regular broadcast networks in normal reporting of events. My point in mentioning this at all is suggesting that there is already an alert notification in place for any national emergency, whether it be in utilizing regular broadcast networks or the EAS system. I am guessing (hopefully…) if the CDC were to declare some sort of national emergency and any disease entered the country and was spreading like a Hollywood movie disease the EAS system would be put into action. BUT… our current Ebola epidemic is far from that kind of emergency. Yet it’s still necessary to get the word out and to get it out accurately.. and not piecemeal through different agencies.
It seems to me the CDC should take control of all disease event information dissemination by reporting directly to the broadcast networks utilizing frequent public service announcements (called PSA’s) and certainly utilizing C-SPAN for continuing announcements and progress of disease containment and action to be taken by the public. In fact, if there is not a system already in place, get all the cell phone companies to contribute toward a smart phone EAS system (similar to what all the TV cable companies do in contributing to pay for C-SPAN). In the event of a national emergency the government can send out text messages to all cell phone users. But the important thing here is…. C-O-M-M-U-N-I-C-A-T-E… and the CDC people are the only ones that should be doing that.
One more thing.. the U.S. PostalService. Admittedly not as fast to send information in a hurry but it certainly can serve as a point of distribution of general information to every mailable address in the country. That’s 153 million locations. In this Ebola event the CDC could have sent to every address an official Ebola public awareness publication/notification; giving threat information, preventive procedures, what to watch for in others, and where to tune in for radio/TV broadcast updates (hopefully this notice would be stuck on every kitchen refrigerator in the country). That in itself, if done correctly, would certainly have left people less confused.
Hey, by the way… where’s that new Ebola czar, Ron Klain? Two things enter my thoughts here. Whenever a president appoints a “czar” for anything it usually means he’s putting someone in charge in order to reduce inter-agency confusion. That in itself tells me that the CDC is unable to lead us through this epidemic for some reason. Or maybe it’s director Tom Frieden (and where is HE for that matter?). Wait, don’t I recall a couple events in the past where accidents occurred inside the CDC regarding safety practices? Maybe Frieden is the wrong guy to run that show. My second thought here is, why aren’t one or both of these guys in front of the cameras trying to reassure the population and give the nation progress reports on containing the disease? Going a step further here… why isn’t the President involved getting things in order? Why do we have to rely on Wolf Blitzer, and some producer whispering in his ear, to give us Ebola updates?
- Special Hospitals/Quarantine Centers – At the CDC website I was surprised to learn that the CDC currently has only 20 point-of-entry quarantine centers in the U.S. to which they can dispatch teams when necessary. These centers seem to be located at strategic airports receiving international flights. Some of this has been loosely revealed in the recent government announcement of five Eastern airports that will check out all passengers arriving into the U.S. from those Ebola-affected African nations. . that seems to make a level of sense. But I have a question about hospital treatment centers.
- From what I can piece together the following is a list of hospitals that have treated or accepted for transport patients to other hospitals:
- Bellevue Medical Center, NYC
- Emory University Hospital, Atlanta
- Texas Health Presbyterian Hospital, Dallas
- National Institute of Health, Bethesda
- Nebraska Medical Center, Omaha
- University of Massachusetts Memorial Medical Center, Worcester, Mass
- That’s six hospitals thus far that have had some contact with Ebola (with Texas Health being ground zero thus far). Now, I realize that the CDC likely has a list of cooperating medical centers in major cities that can serve as some sort of major disease mass isolation trauma center (let’s hope they have at least this much planning). But common sense suggests that the staffs at these locations likely have not kept up to date with training and preparedness exercises, much less being in some critical direct communications loop with the CDC in event something does break and new immediate precautions need to be taken.
- It seems to me, given all the recent isolations of medical staffs at these various hospitals who have had Ebola patients, one wonders about the rest of the patients in these hospitals who just happen to be there on that day… and visitors, vendors, etc. Of course these places have isolation units but does that include separate air circulation systems from the public population? Also, a hospital exists to do business with the public. If there’s a massive influx of Ebola patients are there procedures in place to lock-down a hospital from the outside world? When a medical team staffer leaves the hospital at the end of his/her shift does he/she simply exit the building from the regular employee exit thus mixing or passing the public who just happens to be there that day? Who is going to control access of the curious press wanting to find answers?
Here’s a suggestion… being a military veteran I’ve been to a few VA medical facilities… and two hospitals. Why not utilize the VA medical centers as advanced CDC major disease quarantine and treatment centers? The are 153 of these places all over the country.. big cities.. small cities… (as compared to those 20 CDC airport quarantine centers). Most, if not all of these VA hospital facilities, are like mini-Ft. Knox’s; high fences, restricted entry gate/guard access capabilities (guards themselves are generally under VA control, sometimes armed, and not usually “mall guards” from some vendor), and by comparison to public hospitals, less public activity in general. Likely they all have heliports to receive isolation medi-vac flights or to transport CDC personnel from local airports quicker. It’s got to be way easier to shut down one of those places in the event of a major disease outbreak, and since the locations are all government controlled anyway, the CDC can store and equip each facility with the necessary just-in-case technology for future use of those CDC medical strike teams. What do you do with patients already in the facility? Shift all outpatient activity to a local hospital or to clinics set up in advance as treatment partners. Longer term patients can be transferred over time to community partner hospitals. The whole idea here is that VA medical centers seem a perfect solution for something like this Ebola outbreak. Stronger security, very limited public exposure in the hospital (compared to public hospitals), far more immediately available geographically to the general public, and a treatment buffer that keeps regular hospitals available for routine public needs.
I think what makes me a bit scared is not Ebola itself, as that seems to be looking as manageable. The fear is in how badly this has been communicated to the public and the seemingly ill-prepared our government agencies seem to be in this kind of medical preparedness. A lot of work needs to be done and us folks in the general public should be aware of exactly what the CDC is supposed to do, how they are going to do it, and how will they let us know the ways we can protect ourselves. If the CDC is just going to be a huge medical research lab with samples of nasty diseases and stats of mortality rates, then ok. We need that. Then let’s set up another agency (ugh.. yet another one) that acts in the direct public interest for mass treatment preparedness.
Here’s my contribution to public safety. The following was taken from the CDC website as of this writing. You can read it for yourself at… www.cdc.com
When an infection does occur in humans, the virus can be spread in several ways to others. Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with
- blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
- objects (like needles and syringes) that have been contaminated with the virus
- infected fruit bats or primates (apes and monkeys)
Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only a few species of mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.
Healthcare providers caring for Ebola patients and the family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with infected blood or body fluids of sick patients.
During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital). Exposure to Ebola can occur in healthcare settings where hospital staff are not wearing appropriate protective equipment, including masks, gowns, and gloves and eye protection.
Dedicated medical equipment (preferable disposable, when possible) should be used by healthcare personnel providing patient care. Proper cleaning and disposal of instruments, such as needles and syringes, is also important. If instruments are not disposable, they must be sterilized before being used again. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak.
Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. Abstinence from sex (including oral sex) is recommended for at least 3 months. If abstinence is not possible, condoms may help prevent the spread of disease.