When it Comes to Ebola People Lie

I suppose people lie about…just about everything.  Some lies are understandable and even societally justified; for example, when the Nazis knock on your door in the middle of the night and ask if you are Jewish—lying seems appropriate if you are Jewish!   When it comes to life and death, lying is to be expected.  When we learn that Mr. Duncan, the man who brought Ebola to Dallas, lied about having close contact with an Ebola victim (as reported on 60 minutes last week), we should not be surprised.  Yet much of the federal response to the Ebola epidemic relies on people telling (or knowing) the truth.  Airport screening for arriving passengers relies on taking temperatures and asking about contact with Ebola victims.  We know that temperatures rises in about 87% of Ebola patients and only as the disease is progressing.  Enter the U.S. before the virus causes a fever and you pass.  The other component of the federal program is to question passengers as to their contact history with Ebola.  People lie.  Mr. Duncan lied.  And who could blame him?  If you suspect that you might be carrying Ebola what better country to fly into than the U.S. to receive the very best (and free) treatment for Ebola?  Could you think of a better reason to lie—I can’t.

The nurse in a tent violated the Hippocratic oath and the most basic bioethics taught to all health care providers—first do no harm.  She knew the horrors of Ebola, she knew she was in close contact while treating patients with Ebola, yet she protested her forced isolation at University Hospital Newark New Jersey, she escaped from N.J. to Maine, her home, where she has stated that she will leave her home when she so desires.  Sunday, October 30, she left her house to go for a bike ride.  She has caused much anxiety already and may pose an infection risk in addition.

Much more egregious is the case of Dr. Craig Spencer, the N.Y. physician who also violated the Hippocratic oath; who, upon returning from treating Ebola patients carried the Ebola virus replicating in his body into the U.S., potentially spreading his Ebola infection in the N.Y. subways, in a bowing ally, in taxi cabs and to his friends and fiancée.

Now we see signs popping up everywhere in health care facilities stating “if you have a fever and have travelled to West Africa in the past 21 days…”.  Again, relying on people to tell the truth—who are we kidding?

So what does it really matter if people lie about Ebola?  A couple of nurses caught Ebola in Dallas, many were isolated and quarantined, we spent millions of dollars treating Mr. Duncan, millions of dollars treating the nurses, quarantining their contacts and decontaminating the living spaces.  Similarly, we are spending millions of dollars treating Dr. Spencer and tracking down his contacts and isolating and quarantining them—what does it matter?  Hopefully we will get off easy with just a couple of million dollars spent and few if any fatalities in the U.S.  There are many lessons to be learned however—we seriously botched our Ebola response, our federal government failed on many levels, we must learn and improve our response to infectious agents—perhaps next time we will not be so lucky.

Steven Keller, Ph.D.

Professor New Jersey Medical School—Rutgers University

Nurse in a Tent: Ebola Containment in Newark New Jersey

Governor Christi has done the scientifically correct and politically brave action of ordering a 21-day quarantine for anyone coming from the Ebola epidemic who has had contact with Ebola patients.  Remembering that the only effective weapon we have at the present time to stop the epidemic is quarantine and isolation, our governor has acted appropriately—as phrased by Christi, his responsibility is first for the health and safety of millions of N.J. people and not for the comfort and convenience of a few healthcare workers who voluntarily went to the Ebola epidemic and potentially became infected by the Ebola virus.

President Obama has it seriously wrong—his priorities are confused.  In several recent comments Obama has said that our first priority is not to impede our brave health care workers from going to West Africa and caring the victims of the Ebola epidemic.  No, Mr. President, your first priority is to protect and defend the people of the United States, which translates to first and foremost to prevent the Ebola virus from getting into the United States; and, this is by isolation and a 21-day pre- boarding quarantine, and then facilitate and fund efforts to halt the epidemic in West Africa through military enforced isolation and quarantine, and then (third priority) to care for the victims of the Ebola virus. 

There is not a scientist who will dispute the absolute effectiveness of strict isolation and a mandatory 21-day quarantine in stopping the spread of the Ebola virus.  Look at how Nigeria, a country boarding the epidemic, has successfully prevented the Ebola epidemic from devastating its people—strict isolation and mandatory enforced quarantine.  Any credible scientist believes that the best chance we have in preventing the future spread of the epidemic is through vaccination.  Treating victims per se, who are infected with the Ebola virus is only a humanitarian effort, which has no effect on the spread of the epidemic and results in very modest increases in survival rates.

Our military has it correct in that they impose mandatory isolation and quarantine of all returning soldiers from the epidemic—bravo to our Joint Chiefs.  The Air Marshal Service has it correct; they too have mandatory isolation and quarantine for all potentially exposed agents.  Governors Christi and Cuomo have led the states in finally coming to a similar conclusion-- mandatory isolation and quarantine are the only reasonable steps we can take now to protect our homeland.  Many other states are now following their lead.

Why does President Obama have it so wrong?  Is he getting bad advice from his medical advisors who are advising based upon their views of political correctness instead of science?  Is he so wrapped up in the suffering of the victims, that he is missing the big picture? Is it the fact that President Obama is not a decisive, take-charge leader, which compromises his ability to fulfill his primary obligation—to protect The Homeland?

Upcoming posts will explore where are the voices of our health care leaders—why don't they speak out?

Steven Keller, Ph.D.

Professor, New Jersey Medical School—Rutgers University

Kudos to Governors Christi and Cuomo

Ebola Containment:  Lessons Learned and Lessons Ignored

Opponents to an airplane ban from the epidemic area and a 21-day pre-boarding quarantine cite the natural experiment when all air travel was barred following the 9/11 terror attacks and conclude that this experiment proves that a travel ban would fail.  As quoted in VOX Sunday October 26, 2014, “The weeks following 9/11, when people stopped getting on planes, provided influenza researchers with a natural experiment in what a travel ban might do to viral spread. They found it didn't stop influenza from moving, it only delayed flu season by a couple of weeks” and concluded that this proves that a travel ban would fail.  Opponents to a travel ban are grasping at intellectual straws to support their position.  This is a great example of poor thinking, since in fact this natural experiment provided great evidence that a ban would work and protect our citizens.  The air travel ban following 9/11 lasted 2-3 weeks, and the flu was delayed 2-3 weeks it would seem to most thinking persons that if the ban had been for longer, the flu would have been delayed longer—no??  This is not rocket science—simply common sense. 

Another misguided person was interviewed yesterday and said words to the effect that our number one priority is to facilitate medical persons travelling to and from the epidemic.  Given that this person represented the N.Y. Nurses Association this is a huge irony.  Our number one priority is to protect the people in the United States.  Given that all of the U.S. infections occurred in nurses attending a person who flew from the epidemic to Dallas, it would seem to most thinking persons that banning travel from the epidemic would be looking out for American nurses as well as non-healthcare workers! 

I am not advocating banning all travel to and from the epidemic regions, simply, when a person wants to return from the epidemic region they must be quarantined for 21 days in Africa.  After the 21 days and a negative Ebola test they can be allowed to board a plan for the U.S.  Yes, this adds 3 weeks to the burden of health care workers returning from the epidemic, but for national security it is a small and reasonable step to be taken.

The 21-day in-country quarantine must be supervised by our medical teams i.e. CDC and enforced by our military.  We have seen that even a physician can be irresponsible in this matter.  Dr. Craig Spencer treated Ebola patients and flew back to the U.S. without any in-country quarantine.  Once arriving in New York City he lived a normal life, travelled on the subway, went to a bowling ally and had close contact with several persons.  Then after a week of potentially spreading the virus he came down with a fever and was admitted to Belleview Hospital with Ebola.  Several weeks earlier Dr. Nancy Schneider, a news health person, went to the epidemic region, was around many Ebola patients, and told the world that she would self-quarantine when she returned to New Jersey.  Dr. Schneider was caught driving around long before her self-imposed 21-day quarantine was over.  Bottom line--we can’t necessarily trust physicians who should certainly know better to act responsibly.  Furthermore if we can’t trust physicians who have seen and known the horror of the Ebola infection, trusting simple questioning of passengers seems fool hardy at best and dangerously ignorant at worst.

Why don't our political leaders act?  We have been very lucky so far and hopefully we will have a run of good luck, but is this anyway to run a government?  Obama, Biden, Boehner, Senators and Congressmen/Women, why don't you do the only responsible thing and act decisively to protect us?

Kudos to Governors Christi and Cuomo more about these two courageous leaders in my next blog!

Steven Keller, Ph.D.

Professor New Jersey Medical School-Rutgers

Ebola: Dr. Craig Spencer --The Good, the Bad and the Ugly

The recent events surrounding Dr. Craig Spencer demonstrate these three qualities—The Good where a physician goes into battle in Africa against the Ebola epidemic; The Bad where this same physician does not self isolate/quarantine; and The Ugly where our local, state and national elected officials and their appointees hide behind arrogance, political correctness and fear about loosing votes refusing to do their common sense duty to protect the people in the U.S., particularly the nurses, and the people in Africa and around the world.

The Good:  By volunteering to serve in the Ebola epidemic regions to care for victims of this disease Dr. Craig Spencer has shown great courage; he knew he would have direct contact with sick and dying patients with the Ebola virus.  These dying patients were covered with infectious Ebola virus. Out of every body opening a flood of Ebola infectious particles was pouring, and Dr. Craig Spencer was up to his elbows in this Ebola liquid.  I am awed by his bravery and of all volunteers who knowing put themselves in great peril for humanity.  For these acts of courage and commitment to their profession we owe these health workers our respect and gratitude.

The Bad:  By returning from the epicenter of the Ebola epidemic after being exposed to copious amounts of Ebola and Ebola fluids to the uninfected world without self-isolation/quarantine Dr. Craig Spencer has show a great disrespect for the potential harm where he may have been exposing people in uninfected countries.  While it is true that Dr. Craig Spencer reportedly followed all of the guidelines created by the organization Physicians Without Boarders (PWB), these guidelines are as much political as they are scientific and Dr. Craig Spencer as a physician should have known this.  The guidelines of the group PWB take into account the discouraging effect that a 21-day forced quarantine would have on volunteers and have compromised the science for the sake of attracting volunteers.  This is simply unacceptable.  If one is planning to volunteer to help the Ebola victims they must also commit themselves not to contaminate uninfected countries by becoming a carrier of the Ebola virus.  The only way we currently know to halt the spread of Ebola is isolation and quarantine for 21 days and these Ebola volunteers need to take this simple but critical step to protect the rest of the world.  These physicians and nurses are far too smart not to know that the PWB guidelines are insufficient and they need to do the right thing.  Dr. Craig Spencer did not do the right thing, not only did he travel from the epidemic to New York, stopping in Brussels, taking multiple planes and contacting many people once in New York, he continued to lead a normal lifestyle, visiting friends, taking the subway, eating in restaurants and visiting a bowling alley. 

The Ugly:  Our local, state and national elected officials and their appointees have not done their most important sworn duty--protect the citizens of the United States.  This is not mystery-- it is all common sense.  There are only two weapons we currently have to stem the Ebola epidemic: Isolation and Quarantine.  By simply banning all commercial travel from the epidemic regions and surrounding countries we would dramatically reduce the chances of spreading the infection to the U.S.  By imposing a mandatory 21-day pre-flight waiting period between visa application and flight permission we would further reduce the risk of infected persons from entering the U.S. to almost “0”.  Everyone knows this, yet our officials do nothing but ineffective window dressing.  Taking the temperature of deplaning passengers is ineffective for most Ebola carriers and asking questions is foolhardy.  So why don't our officials take the simple and effective steps known to work?  Political concern is the obvious answer—these officials are betting on us getting lucky and being able to contain any Ebola that enterers our country rather than take the politically correct heat generated by taking the appropriate actions.  Yesterday N.Y. and N.J. began a semi-quarantine program for heath workers returning from the epidemic regions—bravo—several months too late and just a half measure.  Obama has a photo op with the recovered nurse—bravo making political points over a complete policy failure.  I prey that we will continue to be lucky, perhaps our politicians should re-read Profiles In Courage and drop the grandstanding.  We are not fooled.

Steven Keller, Ph.D. Professor

New Jersey Medical School—Rutgers New Jersey

Three Good Reasons to Fight the Ebola Epidemic in Africa

There are three compelling reasons to spend our national treasure on fighting the Ebola epidemic in Africa.  First, for those concerned with Ebola coming to the U.S., the very best way to assure that we will be Ebola free is to eliminate the source of the infection by stopping the epidemic, which at the moment is located in West Africa.  Without a source of virus the world can rest easier.  A few months following the last know case of Ebola, travel restrictions related to Ebola can be lifted, airport screening can be halted and hospitals and first responders can resume standard infection control measures.  The second reason to fight the epidemic in Africa is the humanitarian aspect.  The course of the Ebola infection is horrendous, with fever, cramping, bleeding from every body orifice, stupor and finally death due to multiple organ failure.  The Ebola epidemic is causing immeasurable suffering for the Ebola patient, relatives and survivors.   Relatives, loved ones, friends and community members are consumed with fear and remorse witnessing the wrath of the Ebola epidemic. The third compelling reason is to prevent Ebola terrorism.  There are two parts to Ebola facilitated terrorism: First it is not beyond imagination that terrorist fanatics would use human suicide Ebola “bombers”—recruit fanatics, have them infected and send them to our homeland.  This is obviously not unprecedented.  Germ warfare has been used for thousands of years.  Recently, in the 1700s, in our own country Native Americans were purposefully infected by small pox containing blankets.  Anthrax and small pox attacks have been contemplated by terrorists and in the case of anthrax actually carried out in recent years ago.  The obvious difference between these biological agents and Ebola is that we have no specific defenses against Ebola—no antibiotics, no vaccines, no miracle medications - simply  isolation and quarantine.   Second, the Ebola epidemic destroys society, which provides fertile ground for terrorist takeover.   We need not look further than our nightly news and see what havoc societal breakdown has wrought in Syria—the birth of ISIS.  Africa is already ripe with terrorists and only strong societies can withstand terrorist takeover.  Lose society and we have fertile ground for terrorist take over.