Ebola, hysteria and politics

The Obama administration has been trying to maintain calm and restraint in the reaction to now the 4th case of Ebola in this country:  one being a Liberian man infected there who traveled to Texas, two nurses who got it from him, and now a doctor returning to New York from a temporary period of working with Ebola patients in Africa.

New York governor Mario Cuomo just two days ago was also urging calm.  Even road the subway to demonstrate it was safe.  Then, within 24 hours, he reversed that position and joined New Jersey governor Chris Christie in placing a mandatory 21 day quarantine on Ebola health care workers returning to either Newark or J. F. Kennedy airports.   Their authority to do this, I assume, comes from the NY/NJ Port Authority, which they jointly oversee.   Yes, the Port Authority that controls the airports and bridges into New York;  the same one involved in the New Jersey bridge closing scandal last year.

Their sudden action has angered and dismayed New York City mayor Bill DeBlasio and the New York Health Commissioner.   Cuomo and Christie did not consult with the New York Health Commissioner or the Health Department.   The quarantine goes far beyond the CDC guidelines, which of course is the states' legal right to do.   The question is whether it is wise.

This has all the earmarks of a political decision.  With the climate of fear revved up by politicians (Cuomo is running for re-election now, and Christie is clearly running for president in 2016) -- they could not afford to let one more day go by without Doing Something, since one health care worker returning from West Africa has already become ill after roaming around New York for several days.

Cuomo -- very incorrectly and irresponsibly -- blamed Dr. Craig Spencer for "not following quarantine" protocol of Doctors Without Borders, under whose aegis he had volunteered to work in Africa.   He's also saying he should not have been out in public;  and he said this shows that a voluntary quarantine does not work if even a medical doctor violated it.   But that is just not true.  If he based his decision on that misunderstanding, then this could backfire on him big time.

The DWB protocol for asymptomatic, returning health care workers is to monitor themselves carefully for symptoms for 21 days, not return to work with patients, and to stay within four hours of a hospital capable of providing proper isolation, in case they should become symptomatic.   But they are not under quarantine, and they are free to be in public, as long as they have no symptoms.    That also fits with CDC guidelines, and it makes sense with what we know about Ebola transmission.   Dr. Spencer followed those rules correctly and reported himself as soon as he developed a temperature rise -- which, incidentally, was incorrectly reported at first as 103.   It was 100.3.

This Cuomo-Christie mandatory quarantine for non-symptomatic health care workers is an over-reaction.  It is medically unnecessary, and it increases the climate of hysteria and fear.   Further, it is likely to severely decrease the number of health care workers volunteering to go to West Africa to help.

Typically, they volunteer to go over for 3 weeks.    This quarantine will double the time commitment of volunteers and will likely reduce the number of people who can, or are willing to make the commitment.

But was it a politically necessary decision?    Perhaps.  Not doing it would have been a risky and courageous stand to take -- particularly for Cuomo to refuse when Christie was insisting.   Because, if you turn out to be wrong, the consequences politically could be a career-ender for either of them.    How sad that hysteria politics over-rules medical and public health judgment.

It also is now raising legal questions:   Does it violate the rights of free citizens to be involuntarily detained for three weeks when they have no symptoms of a disease?    If it were a rational policy -- say, if it could be spread prior to symptoms -- it might perhaps be defended as necessary to prevent a widespread epidemic of a deadly disease.    But that is not the case, and official CDC guidelines do not recommend it.

As a letter to the New York Times editor said yesterday:  "The fear of Ebola is far more contagious than the disease."

It makes the job of the president and the New York mayor that much more difficult, trying to keep the hysteria and over-reaction down.   So, no Profile In Courage award for Chris and Mario, for sure.

Ralph 

ADDED Sunday morning:    Christie said on Fox News this morning that "The government's job is to protect safety and health of our citizens.  . . .  I have no second thoughts about it."

That's the problem.   He acts without thinking enough, without consulting, and then he does not entertain the possibility he could have been wrong.   That's how we get demogogues and tyrants.