Ebola. What is going on?

Grand Potentate

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http://www.theverge.com/2014/10/17/6995429/the-fault-in-our-czars

At a meeting Thursday night, President Obama suggested that in order to effectively tackle the Ebola issue in the United States, he would "appoint an additional person… just to make sure that we are crossing all the t’s and dotting all the i’s going forward." By Friday morning, the media had dubbed Ron Klain, Obama's chosen appointee, the Ebola Czar.

At first blush an Ebola Czar, or any czar really, invokes an image of a cruel and omnipotent character parading around in heavy velvet robes, and carrying a jeweled scepter. Not an obvious choice for someone to manage a national healthcare crisis. But take a look under that robe and you’ll find that "‘czar" — at least in the context of American politics — is a relatively meaningless term, largely crafted by the media as convenient shorthand for long, cumbersome titles. It’s a blustery euphemism meant to inspire confidence when in fact, these czars are little more than run-of-the-mill government appointees, often faced with the same challenges as less imperious workers. Just like other employees, czars are eventually replaced, retire, or their positions are scrapped.

Today’s Ebola czar joins a long and storied rank of czars who have reigned over political kingdoms large, small, and on occasion, bizarre. So we thought we’d pull together a sample platter of our favorite presidentially-appointed government czars. It will, I’m certain, leave you czar struck.

Manpower Czar - Appointed in 1942 by Franklin Roosevelt
Rubber Czar - Appointed in 1942 by Franklin Roosevelt
Shipping Czar - Appointed in 1942 by Franklin Roosevelt
Cleanup Czar - Appointed in 1952 by Harry Truman
Missile Czar - Appointed in 1957 by Dwight D. Eisenhower
Savings & Loan Czar - Appointed in 1990 by George H. W. Bush
Border Czar - Appointed in 1995 by Bill Clinton
E-commerce Czar - Appointed by Al Gore in 1998
Bioethics Czar - Appointed in 2001 by George W. Bush
Reading Czar - Appointed in 2001 by George W. Bush
Cyber Security Czar - Appointed in 2001 by George W. Bush
Science Czar - Appointed in 2001 by George W. Bush
Bird Flu Czar - Appointed in 2004 by George W. Bush
Democracy Czar - Appointed in 2005 by George W. Bush
Birth Control Czar - Appointed in 2006 by George W. Bush
War Czar - Appointed in 2007 by George W. Bush
Weatherization Czar - Appointed in 2008 by George W. Bush
Copyright Czar - Appointed in 2009 by Barack Obama
Urban Affairs Czar - Appointed in 2009 by Barack Obama
Ethics czar - Appointed in 2009 by Barack Obama
Great Lakes Czar - Appointed in 2009 by Barack Obama
Guantanamo Base Closure Czar - Appointed in 2009 by Barack Obama
Iran Czar - Appointed in 2009 by Barack Obama
Safe School Czar - Appointed in 2009 by Barack Obama
Weapons of Mass Destruction Czar - Appointed in 2009 by Barack Obama
Asian Carp Czar - Appointed in 2010 by Barack Obama
 

Thruth

Big Winter Daddy
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I know it sounds strange to have an Asian Carp Czar just because if the mental image it creates but the Asian Carp threat to the Great Lakes is huge. In each Great Lakes state there is a mini-Czar or at least someone who has it in his or her portfolio to deal with this.

Not just the Great Lakes either.

But, could they not have come up with a better title?
 

Russell Street

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I'm all for civil liberties, but any quarantined person should be lucky to be alive and allowed in the country at all. I'd shoot a quarantine violator dead for the sake of public safety, no problem. We're all bending over to get violated in the name of national security concerning the whiff of terrorism, but when something really serious and deadly comes around, whining about inconvenience begins. WTF?
 

Grand Potentate

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I'm all for civil liberties, but any quarantined person should be lucky to be alive and allowed in the country at all. I'd shoot a quarantine violator dead for the sake of public safety, no problem. We're all bending over to get violated in the name of national security concerning the whiff of terrorism, but when something really serious and deadly comes around, whining about inconvenience begins. WTF?
Quit being ridiculous
 

Pauly Chase

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I'm all for civil liberties, but any quarantined person should be lucky to be alive and allowed in the country at all. I'd shoot a quarantine violator dead for the sake of public safety, no problem. We're all bending over to get violated in the name of national security concerning the whiff of terrorism, but when something really serious and deadly comes around, whining about inconvenience begins. WTF?

Exactly. Basic of epidemiology. Protect the herd and isolate the individual.

Not sure why someone with her background doesn't seem to undertand that.
 

Thruth

Big Winter Daddy
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Exactly. Basic of epidemiology. Protect the herd and isolate the individual.

Not sure why someone with her background doesn't seem to undertand that.

health care providers - nurses, docs and others - know nothing about epidemiology either because they were poorly taught in school or they forgot this because it is perceived as not being relevant to practitioners who treat one patient at a time.

on one hand, you have people wanting to ban flights from west african nations to limit the potential spread of ebola to the USA and other countries. this is a legitimate concern. the ease of global travel and no failsafes to limit infected patients movements contributes to epidemics.

in situations like the Ebola epidemic, individual rights and freedoms should take a backseat to protecting the population at large. if that means that people who have potentially been exposed should be quarantined, so be it. that is the standard protocol from a public health perspective. however, there is nothing in the article that describes the rationale for the state-mandated quarantine. on whose recommendation was this enacted? was it purely a bureaucratic decision or based on someone's opinion who has the education, training and experience in infectious diseases and epidemic control?

i am sorry but i will not defer to the opinion of a nurse and her lawyer with respect to proper protocol to deal with someone who has been in direct contact with ebola victims.
 

Grand Potentate

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Travel bans have been proven to be completely and utterly worthless. If you can't fly from west africa you can fly from east africa, or Europe, or some other place. Not to mention that symptoms don't materialize right away. And you can't often tell a entry level ebola fever from something like a flu fever.

Quarantine is a tricky thing. The nurse did not seem to be protesting the quarantine, more that she was treated like a criminal while in quarantine. Then again, who is deciding on quarantine? The TSA? Good luck getting that done properly. Did you read her report of the process before she got held? Sounds like a storm of incompetence.
 

Russell Street

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Travel bans have been proven to be completely and utterly worthless. If you can't fly from west africa you can fly from east africa, or Europe, or some other place. Not to mention that symptoms don't materialize right away. And you can't often tell a entry level ebola fever from something like a flu fever.
Proven? Really? Post 9/11, when travel is under a microscope? Even if we pretend that a successful human shell game can be perpetrated, that requires extra time, money, and effort. That drastically reduces the chances of any sicky conveniently getting over here asymptomatic, or even alive, won't it?
 

Grand Potentate

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Proven? Really? Post 9/11, when travel is under a microscope? Even if we pretend that a successful human shell game can be perpetrated, that requires extra time, money, and effort. That drastically reduces the chances of any sicky conveniently getting over here asymptomatic, or even alive, won't it?
Yep, proven:

http://www.vox.com/2014/10/18/6994413/research-travel-bans-ebola-virus-outbreak

The evidence on travel bans for diseases like Ebola is clear: they don't work
Updated by Julia Belluz and Steven Hoffman on October 18, 2014, 10:10 a.m. ET

Calls for travel restrictions are revived with every pandemic threat, most recently Ebola. US politicians are now demanding a travel ban on West Africa in response to the Ebola outbreak.And, in the midst of 'Ebolanoia,' the idea is gaining traction.

But there's a very clear problem with using a travel ban to stop Ebola: it renders useless the two best methods we have for stopping Ebola. Determined people will find ways to cross borders anyway, and if they don't go through airports or they lie about where they came from, health officials can't track their movements. And this is an important point because, to fight Ebola, we need to be able to follow up with the contacts of the infected. Getting aid and resources to the region to contain Ebola at the source would also become more challenging with travel restrictions.

This is why health officials unanimously agree that a travel ban is a bad idea. But don't believe the experts: the best-available evidence also suggests travel restrictions, and even airport screening, don't actually work. At best, they delay the spread of disease but they don't impact the number of people who eventually get sick. They are expensive, resource-intensive, and potentially harmful to the countries involved. Here's a guide to the research:

1) Travel bans in the wake of HIV/AIDS didn't stop the spread of the disease
After HIV/AIDS was discovered in 1984, governments around the worldimposed entry, stay and residence restrictions on people with the disease. As one 2008 study notes: "Sixty-six of the 186 countries in the world for which data are available currently have some form of restriction in place." In the US, the ban — instituted by President Ronald Regan in 1987 — was only lifted when Obama came into office.

But HIV/AIDS managed to spread anyway, reaching pandemic proportions by the 1990s. This 1989 review of HIV/AIDS travel restrictions found they were "ineffective, impractical, costly, harmful, and may be discriminatory." Prevention of HIV worked better than travel restriction, the authors concluded. "The rapidity and extent of HIV spread in any country is primarily determined not by HIV-infected travellers but by the risk-producing activities of its citizens, regardless of whether HIV is introduced by foreign travellers or returning nationals."

What's more, officials found that screening travellers for disease was an imperfect process that "will erroneously but unavoidably label some HIV-infected travelers as being [HIV-negative]." Barring the invention of a rapid, handheld Ebola test in airports, the same issues and limitations hold today with Ebola.

2) Flight bans post-9/11 did not prevent a deadly and prolonged flu season
Temporary flight bans and decreases in air travel following 9/11 provided a natural experiment in the impact of travel on seasonal influenza. Researchers found the reduced movement of people didn't stop the flu; it only delayed it by a couple of weeks and led to a prolonged flu season.So the researchers didn't find that restricting air travel prevented flu spread; only that it delayed it.

What's more, the researchers didn't test whether this delay reduced flu cases or saved lives. But a look at the CDC data shows that flu deaths actually massively spiked during the 2001-2002 flu season, rising from about 3,900 the year before to more than 13,000 post-9/11. This isn't to say that 9/11 had anything to do with the increase in flu deaths, but rather that travel bans didn't seem to prevent them.

3) Travel restrictions didn't cut bird flu infections
One 2006 study modeled various approaches for stopping the spread of H5N1 avian flu. It found that restricting travel wasn't effective: "Our simulations demonstrate that, in a highly mobile population, restricting travel after an outbreak is detected is likely to delay slightly the time course of the outbreak without impacting the eventual number ill."

It's expensive and nearly impossible to seal off the borders of a country, the authors wrote. People will inevitably move — even indirectly from the countries that are quarantined. A much more effective approach? Vaccination, which unfortunately is not yet an option with Ebola.

4) Swine flu travel restrictions achieved exactly "no containment"
After the arrival of H1N1 swine flu in 2009, some countries imposed travel restrictions on flights going to and coming from Mexico, resulting in a 40 percent decrease in overall travel volume. A study looking at this event found it "only led to an average delay in the arrival of the infection in other countries (i.e. the first imported case) of less than three days." So again, reduced travel delayed (by three days!) but didn't stop disease spread.

The authors wrote: "No containment was achieved by such restrictions and the virus was able to reach pandemic proportions in a short time."

5) Airport screening after SARS didn't catch a single case
The US never adopted a travel ban in response to the 2003 outbreak of SARS, even though it was a much more infectious disease than Ebola. Still, a Canadian study of public-health measures to combat SARS found that airport screening was a waste of money and human resources: it didn't pick up a single case of the disease. This screening was "inefficient and ineffective," the authors of the assessment concluded, noting that Canadian public health officials should seriously rethink using it again in the future.

Even the equipment used to screen for flu didn't work well. A study on thermal scanners for identifying travelers with influenza in airports found they were similarly useless when it came to stopping people with the flu from entering a country because of the high rate of false positives (raised body temperature isn't always a good predictor of flu), and the fact that sick people might be asymptomatic. Passengers could also take a drug like acetaminophen (Tylenol) to lower their body temperatures and avoid detection. The authors concluded:

Governments may decide to implement entry screening, including [thermal scanners], for reasons other than to actually detect most influenza-infected arrivals, for example to deter unwell people from traveling, or to demonstrate to their citizens that they are doing everything they can to protect population health.

The risks associated with this approach include the potentially very large opportunity cost of further investigating [thermal scanner] ‘positive' travelers, including quarantine of those febrile on tympanic temperature measurement pending specimen processing, and the potential for the loss of public confidence in the pandemic response when it becomes clear that many infected travelers were not detected by the screening and entered the country.
Travel restrictions are political theater
The push by lawmakers for Ebola-related travel restrictions — and the panic about the disease among the American population — have made a travel ban on Ebola-affected countries seem like an eventuality here.

But not only does the evidence suggest travel bans won't work, it doesn't account for the devastating economic impact and potential harm to the Ebola aid response that such restrictions would bring about. As Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "To completely seal off and don't let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can't get supplies in, you can't get help in, you can't get the kinds of things in there that we need to contain the epidemic."

The World Bank president Jim Kim used a burning house analogy to describe the problem of closing borders: "It's as if you were in a burning house, in your room, and you start putting wet towels under the door to keep the smoke from coming in." He added: "That is not an effective strategy. We've got to get back to putting out the fire."

So are there alternatives? Instead of using airport screening and entertaining plans to seal borders, the government should focus its attention and resources on West Africa where the outbreak is out of control and where real action could actually be helpful in protecting America's health security. Because we know this for sure: the longer Ebola rages on in West Africa, the more people get the disease there, the more of a chance it has of spreading throughout Africa and the world.
 

Russell Street

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Determined people will find ways to cross borders anyway, and if they don't go through airports or they lie about where they came from, health officials can't track their movements.
Are sick people that determined? Come here from Africa without an airport, and you're clearly not deathly ill. Lie? If you don't have documentation, we don't let you in.
At best, they delay the spread of disease but they don't impact the number of people who eventually get sick.
Yeah, delay so they die there, not here. Exactly!
"The rapidity and extent of HIV spread in any country is primarily determined not by HIV-infected travellers but by the risk-producing activities
And this is not how Ebola is spread, so ... irrelevant.
didn't stop the flu; it only delayed it by a couple of weeks and led to a prolonged flu season
And how long does it take for Ebola to kill? Die there, not here.
5) Airport screening after SARS didn't catch a single case
All the more reason to enact quarantines!
The World Bank president Jim Kim used a burning house analogy to describe the problem of closing borders:
Um yeah, wildfire fighting doesn't use ditches, clearcutting, and other containment measures. We need to be able to parachute firefighters into the center of the blaze...
 

ter1413

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This is why we cannot trust the honour system with even health care professionals who we expect to recognize to know the correct thing to do if exposed to a disease.

Meatballs trump professional responsibility.

FTFY
 

Pauly Chase

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She is single-handedly putting the rest of the public in danger. To me, her case is similar to those who refuse to allow their kids to get routine vaccines. Let's put politics aside, as a trained professional who is eager to work in the public health realm, she should be the first person to understand the quarantine is necessary to decrease the spread of airborne/droplet transmitted infections especially when the individual is asymptomatic.

I am unsure what advantages she will gain by remain defiant. It's a bit rather arrogant. This is not the case of could she possibly have come in contact with ebola. The first concept you learn in community health class when dealing with infectious disease is isolation of the infected or possibly infected individuals. Maybe she should revisit her nursing school class.

Most of my nursing friends ever are perplexed by her actions.
 

Pauly Chase

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Travel bans can be limited to civilians and make special exceptions for aid workers, doctors, physicians.
 

Fwiffo

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Why don't they just deport her back to the country she was helping - best form of quarantine. She loved being amongst those people. After all, she was saving them.
 

Fwiffo

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This has got to be single irony?

Truth be told I have this feeling banning an entire country will end up being like a perverted version of World War Z.
 

Pauly Chase

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Well it is not a STI. Just make sure no kissing and no bj.

I think the administration is again attempting and failing to be extremely PC. As much respect I have for Drs. Fauci and Frieden, both are acting like politicians rather than true physicians.
 

Thruth

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Well it is not a STI. Just make sure no kissing and no bj.

I think the administration is again attempting and failing to be extremely PC. As much respect I have for Drs. Fauci and Frieden, both are acting like politicians rather than true physicians.

Fauci politicking now outweighs his medical contributions.

As for nursie-nurse. Would not hit
 

Fwiffo

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It's quite over isn't it? No one is predicting a zombie apocalypse anymore. Even the doctor who decided after treating patients with ebola to go out for dinner after getting off the plane and go to a bowling alley is quite over it.
 

OfficePants

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It's quite over isn't it? No one is predicting a zombie apocalypse anymore. Even the doctor who decided after treating patients with ebola to go out for dinner after getting off the plane and go to a bowling alley is quite over it.

Yup, brother. That was a real close one. We almost all died. Cable news saved us again.
 

Thruth

Big Winter Daddy
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It is the hype & prediction of what is possible (but not probable) that the news outlets focus on.

I am amazed that either they do not seek out the right experts or that expert opinion is downplayed. There has not been much balance between hysteria and reason.

A virus that kills at a 50% rate is inefficient and will burn itself out. An effective virus kills but at a far lower rate so that it has reservoirs and carriers to propagate it.

HIV has skewed people's way of understanding outbreaks, their patterns and their control. It is traced back to 1959 yet it only became a serious public health issue because of the ease of worldwide travel and social behaviour. Couple that with it not being treated as a infectious disease but rather as an infectious disease that affects some people until it started being seen in the general population did not help. But it also made its way into the mainstream because organizations that should be protecting the public - blood service organizations, infection control were asleep at the switch. HIV pointed out flaws in the public health infrastructure.

So too has Ebola pointed out flaws in the infrastructure of the WHO as well as giving us clear understanding that Africa is still far more messed up than we imagine and except for a few countries cannot manage any population-based catastrophe let alone Ebola.
 

OfficePants

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I am amazed that either they do not seek out the right experts or that expert opinion is downplayed. There has not been much balance between hysteria and reason.

I'm surprised that you're surprised. How can you get ratings unless you yell the sky is falling? Having the voices of reason would serve to humiliate the network trying to scare people into watching.
 
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