Debate forum: 11/11

Debate Center: Ebola: a political tool?

By Paul Noah

Maine nurse Kaci Hickox is now free to do as she pleases, after returning from Sierra Leone, West Africa, where she was treating Ebola patients. In a case that many across the nation have been watching closely, District Court Judge Charles C. LaVerdiere rejected imposing tight restrictions on Hickox, including the 21-day quarantine the state of Maine was demanding. Hickox views this as a victory, asserting she was never contagious and that an immediate quarantine would discourage healthcare workers from traveling to Ebola-stricken countries (an opinion shared by the president). But decision-makers in the state and beyond contend sanctioned quarantines for those who have been in contact with Ebola are necessary for public health. Some now wonder whether Ebola has become a political tool – a gross overreaction sensationalized by the media and election contenders as the hot issue of the moment.

Historically, the public and lawmakers are quick with knee-jerk reactions to the unknown. Historically, epidemics have often led to both necessary and unnecessary precautions on the part of the public. Education, however, appears to always win.  

The AIDS epidemic of the later part of the 20th century is no longer the “death certificate” it once was. At its height, AIDS victims were quarantined, shunned and even victimized by an unknowing and fearful public. Now, we know better when it comes to precisely how AIDS and similar contagious diseases are spread. Today, people are significantly less hesitant to shake the hand of an AIDS victim than they were decades ago.

Despite clear and known evidence regarding the transmission of Ebola, reactions vary worldwide. Where some countries permit entry of persons traveling from Ebola-stricken African countries as long as they are symptom-free (no fever, vomiting, etc.) and willing to report personal vital data for 21 days, others take more extreme approaches. North Korea, for example, has declared everyone entering the secretive nation be quarantined for three weeks prior to official entry.

Although the United States has stumbled several times and decontamination procedure failures have resulted in infections of altruistic healthcare workers, no one has died and all the workers have recovered. The only Ebola-related death that has occurred in the U.S. thus far was that of a Liberian national brought into the country for treatment. Despite CDC and other healthcare industry and government failings, it appears there won’t be other deaths in the U.S. resulting from domestically transmitted Ebola infections. It appears those whose jobs are to control the Ebola outbreak have learned their lessons. In fact, more people have died on U.S. soil as a result of the recent Enterovirus D68 outbreak (a possible total of 11, so far, according to the Centers for Disease Control) than from Ebola. 

Yet, despite the more statistically deadly Enterovirus or even the logarithmically more deadly common flu, which killed over 54,000 U.S. residents in 2010, the Ebola virus has become the political hot potato of this century, so far. It’s hot because when someone does die of Ebola, it’s painful, uncontrollable and can be insanely contagious. In comparison to their yawn reaction toward the flu, the media and election-year politicians have sensationalized Ebola.

In addition to political divisions created by sensationalism surrounding the domestic Ebola phenomenon, a divided public appears to hunger for more on a daily basis. The plight of both the infected and, in this case, the uninfected, provides the daily reality show that could easily be entitled Ebola Today. And the media loves it.

Although nurse Hickox has been completely symptom-free since her return to the United States, political figures (not medical decision-makers) have sought to quarantine her. Quarantine proponents include political figures such as Maine’s LePage, Texas Governor Rick Perry and New Jersey Governor Chris Christie, who, citing the greater public good as the reason for such caution, wanted to keep Hickox in isolation upon her arrival at Newark Liberty International Airport from Sierra Leone – citing the greater public good as the reason for such caution. In addition, Defense Secretary Chuck Hagel recently ordered all U.S. troops who deploy to West Africa as part of the force assisting in the Ebola crisis be subjected to “controlled-monitoring” for 21 days, even though none are expected to treat patients directly. 

Opponents of Ebola quarantines say such cautions are unnecessary once it is confirmed that an individual, such as Ms. Hickox, is virus- and symptom-free. Those opposed include President Obama, public health experts and the United Nations.

Reach DCP Publisher Paul Noah at Publisher@DaytonCityPaper.com

Debate Forum Question of the Week:

Was the judge’s decision freeing nurse Kaci Hickox a bold leadership decision, or ignorant to the public greater good?

Debate Left: Pen-demic

By Ben Tomkins

It is a tremendous shame that so many people who know so little are having the lion’s share of the impact on public opinion.

Ebola is one of the extremely few diseases remaining on the planet in which its physical outbreak is rivaled by its psychological. Although its symptoms are both debilitating and deadly, our modern understanding of germ theory, sanitation and medicine give us powerful tools to effectively combat and contain a disease that, in another century, would manifest as a plague stalking the land in the guise of a black-clothed angel of death. 

These advances should serve as a powerful palliative against the panicked fear that, unlike the virus, is transmitted on the wind. Within a month and when left untreated, the infected bleed from their eyes and suffer organ failure. However, it is only a matter of hours after a potential infection that the symptoms of social excommunication manifest. Unfortunately, unlike an antiviral medication, the antidote for ignorance must be taken aurally, not orally, and intellectual bed rest negates its effect.

In a sense, the debate over Kaci Hickox’s quarantine is merely an example of the archetype of fear and sensationalism that has accompanied the manifestation of the disease. By examining the individual (one of our own, no less), we are seeking a guarantee of absolution for allowing our lowly instincts to override our consciousness and humanity. Science should be the candle we place on a candlestick, rather than under a bushel, to waylay our fear of the dark, but our archaic physiological hardware succumbs far too easily to the artificial intellectual empowerment of modern social media.

Twitter, Facebook, Pinterest and many other programs that are splattered across our social fabric have created a culture of answers instead of questions. In a very real sense, the entitlement to opinion has grown inversely in proportion to the number of characters or amount of data allowed for its expression. By lobbing every thought we have out into space, we are essentially answering an endless stream of questions in a vacuum of solicitation, and it has eroded our understanding of what knowledge really is. 

When I am asked, “Should Kaci Hickox be quarantined for working with Ebola patients?”, what is really going on is that I am being invited to ask myself two questions, one implicit and one explicit, and share my response. The explicit question is a direct yes or no regarding the specific issue, but the implicit is the far, far more important one. It is the foundational question that permits the majesty that is the scientific process to occur and the one that was passed down to us centuries ago by Socrates: 

What do I know, and on what ground do I stand to offer a response?

The greater our fear, the more disciplined we have to be when answering that question, and all of the advancements modern medical science has made that allow us to combat the actual disease of Ebola in the physical world (where it really matters) have come from the deepest adherence to that principle. 

Unfortunately, social media has eroded our realization of the implicit question to the point that the very idea of what it means to be educated has devolved into spasms of intellectual impulse. We are posed a question, we consider it briefly and we fire out our response so as to quickly move onto the next, all on the back of a casual justification that “that’s the age we live in.” This is crazy.

If you stop for a second and consider the vast wealth of knowledge that serves as a foundation for the opinions of the world’s leading Ebola experts and the ground on which the rest of us stand, the notion that politicians and judges, much less you or me, should have any confidence in asserting policy is both comic and tragic. The fact that so many unqualified people are splattering idiocy over all available media outlets can only be chalked up to the willingness of the public to take it in at face value. 

Even a professional thinker like the judge who released Kaci Hickox from quarantine betrays the low level on which non-experts can form their opinions. As part of his logic for releasing her, he said, “We owe her and all professionals who give of themselves in this way a debt of gratitude.”

What the hell does that have to do with the only question that really matters, which is: “Is it safe for Kaci Hickox to be released into the public sphere?” 

Again, it is a tremendous shame that so many people who know so little are having the lion’s share of the impact on public opinion. Like a pack of dogs barking at every passing squirrel, our impulse is to answer our experts rather than listen to and attempt to absorb the advice and conclusions their decades of knowledge have afforded them. 

Therefore, the only responsible and logical answer I can give to the explicit question before me is to advise you of my consideration of the implicit one. I am a musician, a writer and an educator. My knowledge base is only sufficient to place trust in the virtual unanimity of leading medical experts that it is safe to release Kaci Hickox from quarantine.

Ben Tomkins is a violinist, teacher, journalist and critically acclaimed composer currently living in Denver, Colorado. He hates stupidity and generally believes that the volume of one’s voice is inversely proportional to one’s knowledge of an issue. Reach Ben Tomkins at
BenTomkins@DaytonCityPaper.com.

Debate Right: Ebola: epidemic threat or political stance?

By Dave Westbrock

Ebola! Ebola! Ebola! Doesn’t the term itself strike terror? Just think of it: a virus that is extremely virulent, can be disseminated in ways epidemiologists still do not fully understand, has a 50 percent mortality rate and has claimed more than 4,000 lives in Sierra Leone, Liberia and Guinea. Fears abound among the American public largely as a result of the unknown. Can I get the virus from someone infected while on public transportation? Can the virus live outside of a host for more than a few days? I asked Professor of Internal Medicine at The Ohio State University and infectious disease specialist Michael Para these questions. His answer: we just do not know.

Now comes the once highly respected Centers for Disease Control (CDC), represented by its director Thomas Frieden, who is a former New York City health commissioner. Generally, scientists direct health agencies and have scientific understandings of diseases. As an infectious disease specialist, Frieden, more than anyone, understands the meaning of isolation and quarantine, as well as how a virus begins, is propagated and can be eradicated in order to avoid an epidemic. Examples are plentiful. For example, in the 19th and up to the mid-20th centuries when tuberculosis (TB) was more widespread, patients with tuberculous pneumonia, spread by sputum, were isolated in various hospitals and TB sanitaria. 

Part of my residency was spent on the TB ward at Means Hall, the former Ohio TB hospital. Each morning I made rounds with a facemask in place in order to avoid contracting TB and spreading it to nurses and patients. Frieden made a name for himself by working to reduce the incidence of TB in New York. But I would bet he did not do this by allowing active TB pneumonics out on the streets where they could infect others. Was it a violation of civil rights to isolate active TB patients and prevent others from being exposed to them?

Another example: Anyone over the age of 50 remembers the requirement to have a VDRL or syphilis test before receiving a marriage license. Was that against our civil right to infect our fiancés from getting syphilis? Most doctors have never seen a case of syphilis, and in my 37 years of practice, I have only seen one case of primary syphilis. It has largely been stamped out because of surveillance, prevention and rapid treatment with penicillin.

So it occurs to anyone who has any experience in the field of epidemiology and infectious disease that the best way to prevent spread is isolation and quarantine. As a small boy, I was quarantined for a period of time when my brother was diagnosed with polio. He was placed in hospital isolation. I never once heard my mother, a registered nurse, complain that her family’s civil rights were being violated. But, in 2014, we are not practicing good science and medicine – rather, we are practicing what is perceived to be good politics in relation to our national health. 

Was it political that Frieden, who should know better, agreed to bring Ebola-infected people to the U.S.? Was it good preventive medical practice that isolation procedures he deemed appropriate backfired when two nurses were found to have been infected by a traveler from West Africa, readily admitted to the U.S. by our politically correct TSA agents? Perhaps we are to ignore good preventive practice not based on science but on some lame progressive logic that we cannot isolate Ebola to Africa because those traveling to this country are no longer foreigners but citizens of the world. Isn’t it unfair to allow those suffering in Africa to remain so and not share this virus with the rest of the world? That is the issue no one really wants to talk about: liberal guilt, now pervading even our public health system. Such a political motive, then, may explain the wacky memo in the State Department that it would be better to bring Ebola victims to the U.S.

With our past history of good preventive practice, now comes the story of Kaci Hickox, a story that illustrates the me-me attitude of 21st century culture. Rather than spend 21 days in isolation, Ms. Hickox boldly violated good preventive practice based, apparently, on the attitude shared by many of her colleagues who had gone to West Africa, itself a highly commendable act, that the recommended isolation period “was not based on good science.” Ms. Hickox, tell that to the two nurses infected in the Dallas hospital. 

Despite Libertarian Judge Andrew Napolitano’s opinion that it is not legal to isolate someone when no prior law or ordinance has been violated, in extreme circumstances, which an Ebola epidemic would be, extraordinary measures are appropriate to protect American citizens. To say the CDC guidelines are not political defies logic. Why did the CDC initially take such a cavalier attitude and then adopt a progressive tightening of recommendations? And why has the government refused a travel ban on the three affected African nations when their neighbor nations have reported its effectiveness? The White House has been firm in its refusal, clearly implying CDC decisions are not based on science but on political considerations. The Texas Democrat gubernatorial candidate’s staff even ludicrously blamed Ebola as a factor in her recent loss.

Unfortunately, loss in confidence for some of our most respected federal agencies is due to this administration’s politicization of every facet of our national life and an encouragement that every American act for his own benefit, notwithstanding the good of his neighbor.

Dr. Westbrock has been in private medical practice for 35 years. He was the Republican candidate for the U.S House of Representatives in 1994 and 1996. He has written and lectured extensively on the subject of healthcare reform and healthcare policy. He can be reached at
Dave.Westbrock@DaytonCityPaper.com.

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Reach publisher Paul Noah at publisher@daytoncitypaper.com.

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