Pat Bagley via politicalcartoons.com
Ebola. There’s nothing like a combo of a serious event and an upcoming election to focus the political mind. Will some good come of it?
— @DemFromCT
Much has been written about the week's Ebola events and CDC's role as well as the appointing of a manager (Ron Klain, not a public health person) as Ebola czar (which the WH says he isn't—he's a coordinating official).
I take the optimistic view that Klain can help. As Tony Fauci said (five times, on five Sunday shows) having a coordinating official still leaves medicine and public health to NIH and CDC. This says it even better:
Pedro Greer, a Miami doctor who won the Presidential Medal of Freedom in 2009 for treating the poor and teaches at Florida International University’s medical school, said Klain’s lack of background in public health isn’t necessarily a deficit for the job of a coordinator.
“You have all the scientists and experts at the CDC but what you need is a manager,” Greer said. “With all due respect, we scientists are not the best managers.”
Fauci so far has shown himself adept in front of a camera, and the WH would do well to let him, not Tom Frieden, be the face and voice of this effort to the American people, for now. Frieden is a public health expert, and knows his stuff. But IMHO Fauci has done a better job adjusting rapidly to the media scrum, walking back certainty when uncertainty exists.
Meanwhile Texas Presbyterian has issued a full apology. It's late in coming but very needed.
@charlesornstein @ron_fournier Obama needs to get into TX hospitals and train medical staff to read nurses notes.
— @DemFromCT
So what else needs to be done? My views below the fold.
Here's my thoughts on what would help, and what comes next:
1. A complete and transparent accounting by Texas Presbyterian as to what happened.
Sure, it might be embarrassing to compare yourselves to Emory. They presented what they knew and what they learned for everyone to use. If TX Presby openly went through what they did and didn't do, it would help every other hospital in the country, and restore confidence in their integrity. That would be so much more effective than an apology. White House and CDC, by the way, are in the process of doing the same. Rewritten protocols (focusing on the buddy system of donning and doffing as per MSF), medical SWAT teams for hospitals with real Ebola patients, tightening quarantine advice (no public travel!) and czar appointment are acknowledging mistakes. State and hospital can do the same.
2. What steps have all state Departments of Public Health and CDC taken to make sure lines of authority are clear?
States don't like to be stepped on, but they sure don't want full responsibility for this, either. Everyone has to be working as a team, and CDC can't be shy about it. I promise you, from working with them in the past, that's not business as usual.
3. What adjustments are Homeland Security making to their National Response Framework?
The Ebola response fits into that. It's an ESF 8 (Emergency Support Function #8 – Public Health and Medical Services Annex). How'd it work? What adjustments do we need to make for the next case from DHS?
Would move heaven & earth to protect Americans from dying of #ebola.
Won't protect those who live from being bankrupted by medical bills.
— @roseperson
4.
Fire the next person who uses "an abundance of caution" as a justification to ignore science and common sense.
Public relations is necessary, mind you, and many concerns need to be taken seriously, but some of this is silly.
• A cruise ship was not only turned away from Mexico and Belize, the Coast Guard used a helicopter to pick up a (negative) blood sample on an asymptomatic patient (who is going to be negative while asymptomatic). Dramatic. Makes good cable footage on the B-roll. But necessary?
• A Marin hospital needed a geography lesson because the suspected Ebola patient had been to the Middle East, not West Africa. (P.S. were they checked for MERS?)
• A Maine teacher attending a conference in Dallas 10 miles from the hospital was placed on administrative leave.
All of the above were done, of course, out of an abundance of caution. What will we be reading next?
5. The family of Mr. Duncan was first exposed in Dallas, and a total of 48 people from that first cohort, are as of this writing negative.
In the early stages, Ebola is not that contagious. This is NOT an experiment we wish to see done, but if those folks are negative and all the airline and cruise ship travelers are negative in due time, this will highlight the point. Get the message out: Ebola is a caregiver's disease. If you do not have direct contact with someone ill, you are safe.
Get your flu shot for the thing you are really going to be exposed to in the next few months.
6. Do not lose focus: there is a crisis in West Africa.
Any waning of Ebola panic in the US should not be accompanied by loss of focus in what West Africa needs. Doctors Without Borders (MSF) cannot do it by themselves. Support them and support the US government in efforts to help there. That's the absolute best way to help ourselves here.