Homeland Security Watch

News and analysis of critical issues in homeland security

October 26, 2014

Embracing diversity

Filed under: Biosecurity,Border Security,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on October 26, 2014

obama pham(Official White House Photo by Pete Souza)

None of us much like what we perceive as mixed messages.  But many of us seek out diverse sources of information.

I am — as regular readers know too well — a big fan of diversity.  It is an intellectual and aesthetic preference, almost certainly a personality predisposition.

Diversity is also a key characteristic of resilience.  The more diverse a system the less prone it is to catastrophic collapse, the more creative combinations that exist the more likely the system (or sub-system) is to resist and, if necessary, rebound from challenges.

I am personally skeptical of most efforts to reduce variance, increase consistency, and especially any tendency to reserve decisions for some centralized authority.  I am aware such approaches can generate benefits.  But there are also trade-offs and I perceive we too often accept the trade-offs without recognizing what we are giving away.

Since Thursday I’ve been in Newark and New York.  The confirmation of Ebola in a physician who returned to New York after treating patients in West Africa has caused concern.  On Friday Governors Christie and Cuomo, acting more on their political instincts for advancing the common good than expert medical advice, announced a strict quarantine requirement for health care workers returning to JFK and Newark International airports.  This exceeds federal requirements. (Illinois soon followed for those arriving from West Africa into O’Hare.)

I was busy, but as I watched the local news a bit and read the reports I was pleased to see this diversity emerge.  I like it when state and local leaders exercise their best judgment and authority.  I respect political judgment, especially when it relates more to how human social systems actually operate and less about the next election.  I found the non-partisan, reasoned rhetoric of the Governors and Mayor de Blasio mostly helpful.  Medical therapies and social therapies can diverge.

At just about the same time, or at least during the same news cycle, President Obama was purposefully — and a bit awkwardly to my eyes — hugging nurse Nina Pham (above) who has recovered from the Ebola she contracted at her hospital in Dallas.  The intended message was, I hope, clear enough.  For the more literal minded, the President followed up explicitly in his weekly media message.

Meanwhile… Kaci Hickox a nurse arriving at Newark from Sierra Leone, asymptomatic, and according to a preliminary test virus-free, is nonetheless being kept in a 21-day quarantine against her will.  She writes in the Saturday Dallas Morning News:

I am a nurse who has just returned to the U.S. after working with Doctors Without Borders in Sierra Leone – an Ebola-affected country. I have been quarantined in New Jersey. This is not a situation I would wish on anyone, and I am scared for those who will follow me.

I am scared about how health care workers will be treated at airports when they declare that they have been fighting Ebola in West Africa. I am scared that, like me, they will arrive and see a frenzy of disorganization, fear and, most frightening, quarantine… (The nurse continues with a rather horrific story of her welcome to the United States.  You should read it.)

The epidemic continues to ravage West Africa. Recently, the World Health Organization announced that as many as 15,000 people have died from Ebola. We need more health care workers to help fight the epidemic in West Africa.  The U.S. must treat returning health care workers with dignity and humanity.

The ACLU has announced it will take action challenging the New Jersey quarantine order.

Then as if to put into even sharper contrast the different angles on reality alive in Trenton, Albany, and Washington DC, on Sunday morning I read our UN Ambassador Samantha Power is in West Africa.  She has already visited the Ebola wards.  Should she be quarantined in isolation on her return?  Or in deference to separation of powers, will a sanitary cordon of the Ambassador’s residence at the Waldorf be sufficient?

Thursday and Friday I was mostly impressed with how New York local-media was handling the story. Saturday I was too otherwise engaged to notice. Now early on Sunday morning there is a nearly palpable urgency to take sides… or, if one does not feel confident/competent to choose sides, to bitterly complain regarding the incompetence of the “authorities” who should have had this sort of risk fully thought-through.  “It’s not tight”, the President himself has complained.

In my experience reality is seldom tight. At a certain point working to make it tight strips the threads and even breaks the head.  Can we learn to engage diversity affirmatively, creatively, even systematically, as a potentially positive — in any case, persistent — aspect of reality?  In dealing with complex risks, I have found this to be an especially productive option.

MONDAY UPDATE:

According to several news sources, New York will “loosen” its screening protocols.  Here’s a bit of the AP report:

Gov. Cuomo back peddled Sunday on his insistence that medical workers returning to New York from Ebola-stricken countries would have to undergo a mandatory 21-day quarantine at a government-regulated facility

The governor, in a joint news conference with Mayor Bill de Blasio, said health care workers and citizens who have had exposure to Ebola patients in West Africa will be asked to stay in their homes for the 21-day quarantine.

During the 21 days, the quarantined person will be checked on twice a day by health care professionals to take their temperature and evaluate their condition, Cuomo said.

Here’s the official statement from the Governor’s office.

Constant change in response to feedback, adapting to new information (new expressions of reality) is another feature of diverse and resilient systems.  And just to be clear: in the most resilient systems while change is constant a core-coherence persists.  Which highlights the big difference between consistent and coherent, between control and collaboration…

SECOND UPDATE:

According to NJ.com and other news outlets, Nurse Kaci Hickox will now be allowed to quarantine at home in the state of Maine. The New Jersey Governor’s office released a transcript and video to provide context for this shift.

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5 Comments »

Comment by William R. Cumming

October 26, 2014 @ 9:23 am

Nice post but how will the Committee Chairs look of the forthcoming Republican Senate and House? Diversity?

Comment by Michael Brady

October 26, 2014 @ 11:23 am

Thanks for another fine post, Philip. If only sensible messages like yours could rise to the top instead of being ignored in favor of fear, loathing, and panic.

Comment by Donald Quixote

October 27, 2014 @ 9:33 am

Since public health quarantine orders are often executed under state and local authority, is this another issue that requires increased federal pressure, control and direction? How do we balance feelings, fears, liberties and public safety? The state and local laboratories may be a better place to develop the more effective and acceptable policies and procedures.

For those with experience (and interest) in the discussion of actively containing a serious pathogenic threat at a border, the commonly held belief is that you have a greater chance winning the Powerball lottery ten times in one year than a quarantine being successfully implemented at more than one port of entry involving more than ten suspected passengers at a time or multiple flights. Since it is such a logistic and political nightmare to contemplate true execution, it is better to just claim preparedness and wish for the best (which does often work very well). Cynically, if the ill travelers make it through, it is a state and local issue – for those higher up to judge their performance.

Many plans look acceptable on paper, but often do not withstand a serious and honest functional exercise. Like all good exercises, they are written to match the emergency plan and end with many backs slapped and a pint or two. It works well.

There is little doubt that politics are the driving forces on both sides of the Ebola quarantine and travel restriction issues.

Hopefully, the lessons learned from Ebola will prepare us for a genuinely significant public health threat that may or may not be around the corner.

Comment by William R. Cumming

October 27, 2014 @ 11:28 am

Would President’s do better if their staffs were all over 40?

What age diversity exists in the WH?

Comment by William R. Cumming

October 29, 2014 @ 8:29 am

I mention that few second opinions or dissents tolerated in this WH? Not much real deliberative process IMO? And little inn writing for posterity to figure out who, what, where, when, how!

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