Discussion for article #229318
What does he know? Heās only been involved in fighting infectious disease for his entire career. Clearly Governors Cuomo and Christie know much more on this subject.
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But EVERY policy has unintended consequences. Whether itās red lights that bring about collisions with ambulances, or families that become homeless because the breadwinner went to prison for growing a cannabis plant. EVERY policy has unintended side effects.
The question is ā is the price of conformance greater than the price of non-conformance?
In the case with Duncan, the public turned out to be lucky. It didnāt have to turn out that way. Any person who has had physical contact with an Ebola host is a potential disease vector. But that is also true of other infectious diseases, including drug resistant TB. And in fact a few years ago there was an international lookout for just such a case, where the patient crossed the Canadian border on foot to escape being taken into custody. Weāre talking about an issue of public safety here that is a political hot potato. NO POLICY will make all the people happy ALL the time.
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Wouldnāt a hero be WILLING to quarantine himself?
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I see the ACLU has gotten involved in Jersey over the treatment of the nurse who landed at Newark Airport.
And refrain from going bowling, or attending the Operaā¦
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Hey, you either completely protect yourself from infection while doing your job or you get quarantined? The rest of society cannot be held hostage by your mistakes. No, Iām not a doctor, but I know that doctors are supposed to protect their patients and themselves and anyone they come into contact with.
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Certainly I agree with everything youāre saying, but in general weāve got a situation now where the media reflexively sow fear about every potential threat, especially the exotic, horrific ones that seem often to have an astrally remote likelihood of ever being realized. We also have at least one political party cheerfully willing to exploit those fears, and a public ready to accept if not demand the most draconian countermeasures. So in general Iām willing to support the experts who can make a rational decision on the relative risks of various courses and offer a sensible path forward. I think theyāre less likely to be flat wrong or create an unintended consequences problem than we are if we base our decisions on the permanent Shark Week panic du jour syndrome.
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Itās called infection management, and most hospitals have a specialist on staff. If you examine the protocols now for management for MRSA, now, the suggestions are to test incoming patients immediately, and isolate them if infected. When being transferred, the receiving institution must be notified of the infection. And that is for MRSA. Why should other infectious diseases be handled any differently?
I agree with the concerns you have raised. If ever there was a time to educate the public, it is now ā and anybody who leverages fear mongering to seek political advantage should be pilloried in public. Bad leadership needs to be called out. So where are the Warriors willing to step up and call out the worst offenders? Most are running for cover. Itās a profile in cowardice and social irresponsibility.
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Itās true: doctors make the worst patients.
There are a number of negative consequences to these ill-advised quarantines - the mistreatment of the health care workers, the cost, the lost productivity of the quarantined doctors/nurses, the disincentive for folks to volunteer to work in West Africa, increasing the possibility that people will lie/evade the system, etc.
But the worst consequence is that they validate the misguided and ill-informed fears of too many, contributing to the hysteria, panic and stigma around a disease that is not going to become an āoutbreakā in the United States.
When Governors order this kind of public health āsecurity theaterā they are not actually doing anything that protects the public - they are just pandering (and contributing) to an environment of unfounded fears.
By doing so, they send a message that other unnecessary steps are reasonable ā implicitly validating things like restaurants in Dallas refusing to serve West African customers, a school in Ohio closing because the parents of one of the children MAY have been in (no-risk) contact with the Dallas nurse, people living in the Dallas housing complex (with NO contact with Thomas Duncan) being told not to report to work, or teachers who had travelled to non-affected parts of Africa (Zambia, Rwanda) being told not to report to work for 21 days.
All of those things have happened in the past few weeks - and they are being justified in the same āabundance of cautionā language as the Christie/Cuomo quarantine.
We saw this same thing in the early days of the AIDS epidemic - despite scientific evidence, elected officials pandered to public fears by needlessly keeping children out of school, advocating various forms of quarantine, and justifying discrimination.
This environment made it harder for public health officials to do their jobs. It justified discrimination not just against HIV+ people, but also against those perceived to be at risk. And it created a great deal of bad policy.
Both houses of Congress actually passed an amendment to the Americans with Disabilities Act that explicitly allowed discrimination against HIV+ food servers. (Fortunately legislative maneuvering kept the āChapman Amendmentā out of the final legislation.) And it wasnāt until 2010 that the US finally lifted the ban on HIV+ people from entering the country (even for short visits).
Quarantines and travel bans, elected officials making policy based on public fear/political opportunism rather than scientific facts, and bad policy getting in the way of good public health practiceā¦ anyone (including Fauci) who was involved in the early days of AIDS in the 1980s can tell you weāve been down this road before. Letās not make the same stupid mistakes.
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Hereās another question. Will policy makers consult with experts and base decisions on the science and the best judgment of experts, or will they just do what seems politically expedient at the moment, without consideration of other factors? Thatās exactly what was done here. Public health and infectious disease experts are saying they had no input into this policy. Thatās practically a formula for unintended consequences. And another question. Are we going to have politicians (King, Paul, et. al.) running around stoking fear, telling people public health and infectious disease experts are lying to them, for political gain? Because we have that happening, too.
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A quarantine in no way VALIDATES misguided and ill-informed fears. There is a reason why every hospital has an isolation ward, which is a form of quarantine. And none of them were thinking of EBOLA when these units were designed. It is also true that there are many other diseases that are as dangerous, or more so than Ebola. But right now none of them has become a pandemic that is overwhelming the health resources of several sovereign nations. To compare AIDS and Ebola is not a useful comparison, they are very different diseases with very different lifecycles. Sometimes there are phenomena in this world for which no metaphor or simile applies.
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I was unaware that all the policy experts on pandemic management were in agreement on this issue.
Imposing a medically unnecessary quarantine on people who are not infectious does validate those fears.
And it does nothing to actually protect the public.
Whenever a scientist or doctor is being interviewed on Fox News Iām reminded of the gospel
āGive not that which is holy unto the dogs, neither cast ye your pearls before swine, lest they trample them under their feet, and turn again and rend youā
How do you know they are not infectious? Because they donāt vomit on you when you encounter them?
Maybe not. Most of the volunteers fighting the disease at the source leave their jobs for limited periods to do it. Someone may be very willing to go fight the disease at the source for four, six or eight weeks to do that, but hesitant or unable to tack on another three weeks when they return. It doesnāt help that the first person subjected to this policy was not treated well.
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Because people are not infectious until they are symptomatic.