Ebola Response: A Sense of Urgency is Still Needed

The president re-emphasized to the nation this Tuesday that the best way to defend the U.S. from Ebola is to stop it in West Africa and further that West Africa is “nowhere near out of the woods.”  The need for a sense of urgency to support the efforts in West Africa should continue to be stressed going forward with sustained attention.  Yet that chord, though appropriately struck by the President, has not rung loud enough.

A succinct characterization of the U.S. response at the outset of the Ebola outbreak in West Africa in late 2013 is that the Administration, the CDC, and the State Department committed themselves to a false choice between acting with a sense of urgency and avoiding panic.  The choice to play it cool did indeed cost a proper sense of urgency in the initial response.  A vivid and detailed historical account quietly went on record from the testimony of Ken Isaacs of Samaritan’s Purse back in August.  With the exception of the President’s statement, this underwhelming sense of urgency is unintentionally being channeled through this week’s third wave of congressional hearings.

Isaacs testified again yesterday, this time in the House Energy and Commerce subcommittee while earlier hearings were held again in the House Foreign affairs committee.  He described a disconnect where government officials come across as if they completely understand the nature of the Ebola virus in West Africa and how to handle it when they, in fact, do not.  Further, 5% of reported Ebola cases can remain asymptomatic for up to 42 days.  This doubles the CDC’s recommended quarantine timeline for those displaying the disease.  Mr. Isaacs also noted that the CDC estimates approximately 1.5 million Ebola cases will be reached by mid-January, while the World Health Organization – the international agency responsible to contain the spread – fears that there could be up to 10,000 new cases of Ebola per week. Mr. Isaacs also pointed out to the committee the following questions have not been answered:

-How are the doctors that were properly protected with gear who are returning to the USA becoming infected?

– As with other viruses, could Ebola continue to be carried by a human who displays no symptoms but contains enough viral load to be contagious?

We do not yet know the answer to these basic questions.

The Oversight subcommittee chairman, Tim Murphy, pointed out that though there are cases where health care workers who had followed all protocols still contracted Ebola and yet there was no CDC policy to monitor movements of undiagnosed workers who followed protocols in terms of tracking there movements after they returned.  Isaacs’ group, Samaritan’s Purse enforces much more stringent protocols on it’s own workers.

Common sense still calls for a robust and urgent sense of mission in West Africa.  It is too late to wish the response had been handled differently and too soon to discuss ‘lessons learned’, which, in Washington is a short hand for telling Congress not to focus on how bad something was handled.  Yet, the weight of the President’s words have been diminished by a list of poorly calibrated responses to other crisis.  The play-it-cool response to ISIS perhaps most strongly shapes the interpretation in the American psyche of any warning that may follow perhaps seconded by the VA scandal.

There are have been two key challenges in responding to the threat that the Ebola virus strain poses to the U.S. and to West Africa.  The first is an appropriate sense of urgency at leadership levels in the U.S. at the Executive branch, CDC, and State Department.  The second is the need for better statistical data gathering on the outbreak, especially on human mobility tracking of those traveling within or from the African Continent.

Travel ban debates delayed effective action

Both sides of the travel ban debate failed to address the conflict between moving resources needed to stop the spread of the virus and limiting the travel of infected victims.   There was unity of message at an October 2nd panel at a Washington think tank where representatives from the Department of Defense, the State Department, the Army, and CDC, all agreed that the unintended consequences of a travel ban policy would hurt the effort to send response teams and medical equipment.

They were all correct except that they stopped the discussion there without a problem solving approach to inhibiting the spread of Ebola by air travel.   Another false choice entered into the debate as policy makers new to situation saw the logical appeal of travel bans on the surface.  In the November 18 testimony, Isaacs of Samaritan’s Purse advised on the topic.  He explained that he would not advise against air travel bans to countries who are not equipped to screen and contain within in their own systems; places such as Pakistan or Myanmar where hygiene standards could rapidly increase risks.  Most significantly he proposed a solution in the form of a dedicated humanitarian bridge where the government could provide a conduit for aid workers separate from public travel.  Such practical solutions and clear-eyed assessments are drowned out in the current public debate.  This gives credence to news and commentary that examines national focus and sense of urgency in the policy discussion as a factor in itself.