Homeland Security Watch

News and analysis of critical issues in homeland security

March 14, 2015

Watch carefully, explain frequently

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on March 14, 2015

According to the World Health Organization, deaths from the year-plus outbreak of Ebola now exceed 10,000.  But as of Friday, March 13 it has been three weeks since a new transmission was confirmed in Liberia.

A team of Reuters reporters — or their headline editor — summarize Liberia’s key lessons-learned as watch carefully and explain frequently.  Both depending on (and potentially contributing to) trust-building community engagement.

Liberia was hit hard and, the nation’s President admits, slow to react.  But what seems to now differentiate Liberia’s — tentative — eradication from continuing (if much slowed) transmission in neighboring Sierra Leone and Guinea has been the accuracy of “contact-tracing” — essentially a mapping of personal relationships and movement related to any confirmed transmission.

This is classic public health practice. But to actually do it depends on a shared sense of solidarity… community… common cause… and community-oriented organization that cannot be taken for granted.

The recent measles outbreak in the United States demonstrates the epidemiological challenges that can emerge from a break-down of trust in communities.  I am intrigued (tempted?) with analogies to public safety and counter-terrorism challenges. Many historians of community policing trace its origins to public health models.  But I will not go there today.

It is worth noting that in this week’s Nature, respected scientists warn that the H7N9 flu virus is rapidly mutating.  The Los Angeles Times reports,

Overall, this second wave of H7N9 influenza viruses represents “a major increase in genetic diversity” compared with the viruses in the first wave, the study authors wrote. Unless live poultry markets are permanently closed, merchants stop transporting chickens from region to region, and other control measures are put in place, the virus will “persist and cause a substantial number of severe human infections.” So far, most people were sickened by handling infected chickens; cases of the virus spreading directly from person to person have been limited. That might change if the virus mutates, as happened with the H1N1 swine flu pandemic that began 2009. 

In any case, Ebola is not the only potential epidemic (upon, on, among the people) to present a risk.

This may only be a projection of preconceived bias, but in trying to discern what is different in the experience of Liberia and Sierra Leone, I perceive a bottom-up strategy in Liberia and a top-down strategy in Sierra Leone.  Trust-building has been a challenge in both countries.  But the bottom-up strategy (or emergence?) in Liberia has been much more effective.  As a hypothesis to be tested, I would suggest the top-down strategy in Sierra Leone has potentially been as “effective” in suppressing a more sustainable bottom-up approach.

And I surmise this could have implications far-beyond Ebola.

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4 Comments »

Comment by William R. Cumming

March 14, 2015 @ 8:01 am

And of course that scourge of the late 20th Century HIV [really a pandemic but not labeled one for political reasons] failed to use and continues to fail to use contact tracing for political reasons and innocents continue to die annually.

Comment by Philip J. Palin

March 14, 2015 @ 8:47 am

Bill: I’m glad you mentioned HIV. The political problem that complicated use of contact tracing, it seems to me, precisely reflected a lack of trust in regards to what would be done with that information… other than working to contain the virus. Ditto for Ebola. Ditto for several other “viral” conditions.

Comment by William R. Cumming

March 14, 2015 @ 9:44 am

YUP!

Comment by Christopher Tingus

March 14, 2015 @ 9:07 pm

I have spoken to a number of professionals in the medical field and while for the most part they encourage vaccination, some can see the mistrust in government and such dictates and this administration especially has led many to distrust government so much that growing numbers of fellow Americans find their no 1 concern, the US government itself which dismisses its pledge to the people and carries on in such less than transparent ways and led by – Obama the Shia – lawless and finding no pledge to our Judeo-Christian values and protecting our Constitution nor our brave warriors at the “Benghazi Massacre” which We ill never forget as they both stood shoulder to shoulder in blatant lie for self-serving purpose!

Hold your (300 million guns high) for all lawful purpose and heed the cautions of our forefathers against the tyranny from those within!

God Bless America!

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