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The Czar of Ebola

By JOHN IRVINE

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As every American now knows, Ebola is a horrible African hemorrhagic fever with a high mortality rate and relatively low risk of transmission, except in cases where the disease is transmitted, where the risk of transmission is very high.

The disease has infected 8,000 people in West Africa. WHO officials predict that up to 1.5 million people could be infected by the end of January 2015.

In the United States Two people are known to have been infected with the disease.  Both are nurses.  Their names are Nina Pham an Amber Joy Vinson.

We now have an Ebola Czar to educate us about these facts and others as they become available.

Facing criticism from Congress this week over the handling of the crisis, President Obama named Ron Klain, a former chief of staff for vice president Joe Biden and Washington loyalist.  Critics wanted either somebody with a medical backround or experience handling infectious diseases. Until yesterday, Klain worked for Steve Case.

Technically, of course Klain is not a czar, although almost everybody will call him by that title. His technical title is Federal Ebola Response Coordinator.

“He is smart, aggressive, and levelheaded; exactly the qualities we need in a czar to steer our response to Ebola,” said Sen. Charles Schumer (D., N.Y.).

“By appointing a Democrat political operative as the Ebola czar, it is clear that the president sees Ebola as a political crisis and not a health crisis,” said one critic, Rep. Bill Cassidy (R., La.).

Obama’s announcement will move the ball away CDC director Tom Frieden temporarily, which seems like a good thing but may not be.

It has not been a good couple of weeks for Frieden, who until recently enjoyed an almost flawless reputation. thanks to a distinguished career in public health. His time with the Obama administration had been relatively quiet, uncharacteristically quiet when compared to his role in . Then came a series of bad breaks in the fight against Ebola. As stories of widespread problems in the handling of the case of Thomas Eric Duncan emerged, public confidence sagged.   emerged from the Texas hospital. (See the statement of the Dallas nurses below), public confidence in the CDC began to fall.  It went dowhill from there.

This weekend in Washington officials from the Pentagon, the National Institutes for Health and the Centers for Disease Control.

The news about the Pentagon is liable to make some people .

Travel Ban / No Travel Ban 

Much of the criticism has centered on  Frieden’s insistence that a travel ban is a bad idea.  . Hence the conclusion that .

Quarantine / No Quarantine

Frieden believes that the best way to eradicate Ebola is stamp the disease where it is strongest. If you’re noting the irony of a Jewish-American doctor first American president of African ancestry . This may be politics it may not be.

read this interview with Peter Pinot, who discovered the Ebola virus  in the Congo in 1976.

Frieden explained his position in a letter to The Financial Times

This week I announced the first Ebola case diagnosed in the US. I have been asked whether we should stop travel to Liberia. The answer is no: to keep Americans and people in non-affected countries safe, we must continue to work to support efforts to stop the spread of Ebola in Liberia, Guinea and Sierra Leone. One strategy that won’t stop this epidemic is isolating affected countries or sealing borders. When countries are isolated, it is harder to get medical supplies and personnel deployed to stop the spread of Ebola. And even when governments restrict travel and trade, people in affected countries still find a way to move and it is even harder to track them systematically.

Involuntary quarantine and isolation of communities and regions within countries will also backfire. Restricting travel or trade to and from a community makes it harder to control in the isolated area, eventually putting the rest of the country at even greater risk. Isolating communities also increases people’s distrust of government, making them less likely to co-operate to help stop the spread of Ebola.

There are productive ways governments can support isolation. This includes providing services that increase patients’ chance of survival and that reduce the risk that caregivers will get infected. This breaks the chain of transmission.

Would removing Frieden from his position be a good idea? Probably not. Former FDA Chairman head Scott Gottlieb, wrote a very good defense of Frieden in Forbes, which is well worth your time.

We don’t fully understand this Ebola strain. There is speculation from top experts that the virus might have drifted in ways that could make it spread more easily — for example, mounting higher loads of viral particles earlier in the course of illness.

If our political leaders had shown more humility on describing the risk, and our ability to contain it, public confidence might not be so badly shaken.

If only they had not been so absolute in declaring that there is zero risk of airborne transmission (when we know that there is a risk of ‘droplet’ spread).

If only they had not been so outright in arguing that there is zero risk of transmission before someone gets a fever (we know some patients present with other symptoms first, even after they are viremic, and don’t mount high fevers).

If only President Obama hadn’t taped a weird video for Liberians declaring that you can’t get Ebola by sitting next to an infected person on a bus; at the same time U.S. hazmat teams were wrapping a building in plastic over a suspected Ebola case.

Enter CDC director Dr. Thomas Frieden. And listen closely. His public comments in all of these regards, while too bold in hindsight, have been far more nuanced than other leaders’, including those of his boss, the President of the United States.

Additional steps that could come soon: Obama could federalize the Ebola fight, something public health officials have resisted doing so far. That will probably come as a surprise to many Americans who somehow assumed that the response already was federalized.

“I wouldn’t rule it out,” White House spokesman Earnest said, “but that’s not something that we’re actively considering right now.”

To date, the CDC has provided “guidance,” advice and encouragement to Texas and Ohio officials, to Dallas health authorities, and to the nation’s health care providers. But the CDC stepped lightly in Texas, arguing publicly that its experts could not assert federal control over Ebola treatments or safety protocols.

The jurisdictional challenges, should Ebola involve more than a handful of confirmed cases in the United States, could be significant.

Friedan has repeatedly described the federal government’s need to defer to Texas authorities and the Dallas hospital after offering the government’s best guidance. Obama on Thursday night thanked Mayor Rawlings for being “cooperative,” but did not commend administrators Texas Health Presbyterian Hospital, where Duncan was initially misdiagnosed.

Expect calls from the right for Frieden to resign to continue.  Another major CDC bungle or a string of small bunglings, such as a repeat of the decision to allow a nurse to travel or the (with the benefit of 20-20 hindsight) overly ambitious decision to allow local medical centers to handle Ebola cases and things could get ugly. The timing so close to the Midterm elections was also not good. It frankly does not help that .

CNN’s Ford Vox:

When the first nurse’s infection was announced Sunday, Frieden immediately blamed a “breach in protocol” for her situation. It was perhaps beyond his imagination that the CDC protocols themselves — including the training and infrastructure — failed in Dallas.

Finding an effective way to handle and dispose of medical waste from Ebola has been a problem as well, and the CDC should have solved it long before the first domestic diagnosis. The fact that more than 70 health care workers were involved in Duncan’s care points to Presbyterian’s lack of preparedness; hospitals that have a plan know it’s essential to limit staff coming into contact with Ebola patients, who become progressively more contagious the sicker they become. In transferring the third patient, Amber Vinson, to Emory, the CDC is admitting that Presbyterian isn’t prepared.

While serving with the New York City Department of Public Health and Hygeine, Frieden is credited with leading innovative programs that aggressively attacked major public health challenges including smoking and obesity.  That unfortunately makes him a lightning rod for conservative critics and others who hate his Bloombergian views on public health. (Or Bloomberg’s Frieden-ian views on public health)

John Irvine is editor of THCB. He can be reached by email and on Twitter @thcbstaff

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