Homeland Security Watch

News and analysis of critical issues in homeland security

November 20, 2014

Ebola — no sitrep — but an update

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on November 20, 2014

One Wednesday the World Health Organization released a new update on the situation in West Africa.  The rate of new transmissions has continued to decline in Liberia and Guinea.  But the curve is continuing upward in Sierra Leone.

I have not seen a persuasive analysis to explain the difference between the three neighboring nations.  But there is some indication that too many social-networks in Sierra Leona may still be in denial.  Community engagement and organization are widely thought to be what turned-the-curve in Liberia.

On Tuesday a subcommittee of the House Foreign Affairs Committee held a hearing on fighting Ebola in West Africa.   You can see/hear a video of the hearing and read the prepared testimony at the committee’s website.

I probably will not prepare a new sitrep this weekend as I have the last few weekends.  A couple of new “day job” assignments are going to take a serious commitment through mid-February.  I may be a bit AWOL from HLSWatch.  We’ll see.

November 15, 2014

Ebola source sitrep 5

Filed under: Biosecurity,Public Health & Medical Care,Strategy — by Philip J. Palin on November 15, 2014

The number of deaths traced to the current Ebola outbreak now exceeds 5000.  The rate of transmission has not increased in Guinea and has slowed in Liberia. But the situation in Sierra Leone is continuing to worsen.  A new network of Ebola cases has emerged in Mali among health workers who were exposed while caring for a man with kidney failure.  The patient was also suffering from a non-diagnosed Ebola infection.

Ebola_November 14

The fatality rate among those exposed to the Ebola virus is falling. In June the fatality rate for this West African outbreak was estimated at 90 percent.  In September the fatality rate was still at least seventy percent.  In prior Ebola outbreaks — much smaller in scope — the fatality rate has averaged 50 percent of those infected.   There are some studies that suggest with early intervention the fatality rate is now as low as 25 percent.

These are small and still unconfirmed studies.  But on a preliminary basis it is reasonable to observe:

  • The amount of circulating viral load was higher in those who died than in survivors; those patients with the highest levels of virus were most likely to die.
  • One of the strongest determinants of survival appears to be patient age. Patients older than 40 years were nearly 3.5 times more likely to die than those aged less than 40. The association between an older age and a higher risk of death was found regardless of whether the patient had co-morbidities or not.
  • Evidence of substantial fluid loss and profound electrolyte derangement associated with severe diarrhoea appears to increase the risk of a fatal outcome. More aggressive supportive care, especially intravenous rehydration, is thought to improve the prospects of survival.

Seriously compromising the ability to provide early diagnosis and care is a public health infrastructure insufficient to conduct the necessary contact-tracing. According to the November 12 WHO update:

Between 3 and 8 November, 5301 new contacts were identified in Guinea, Liberia and Sierra Leone, compared with 4067 new contacts traced in the previouwoulds week. A total of 95% (124,214 of 130,140) of required daily contact visits were conducted. However, the proportion of contacts reached was lower in many districts. Each district is reported to have at least one contact-tracing team in place. On average, only 10 contacts were listed per case in the three countries in the past week. The low average number of contacts listed per case suggests that the estimate of 95% gives an unduly favourable view of the success of contact tracing. Active case finding teams are being mobilized as a complementary case detection strategy.

The situation in West Africa remains very bad, but it is not — yet? — as bad as some projected in September or even early October. The predictions have, in part, been disrupted by increased public health interventions, improved clinical care, and — especially — altered population behavior.  While the threat of the virus was too long underplayed, since August a creative and committed response has paid-off.

In recognition of the continuing high risks, Médecins Sans Frontières (MSF), an NGO with deep experience in the region, has recommended a new strategic approach, “Agile and well-equipped rapid response teams should be deployed quickly to actively investigate hotspots wherever they occur, and mount a comprehensive response.” This approach would depend much less on the construction and operation of isolation-and-treatment centers.

The rainy season is coming to an end in West Africa.  Typically the dry season sees a substantial increase in population movements.  This increased mobility will threaten the fragile progress that has been made.  The current ten-day forecast for Monrovia predicts almost daily rain and thunderstorms.  But early December is predicted to be bright and sunny.

Meeting early today in Brisbane the G20 affirmed and expanded commitments to fight Ebola in West Africa.  The world’s leading economies also signaled that more needs to be done to prevent and mitigate infectious threats much worse than Ebola: “This outbreak illustrates the urgency of addressing longer-term systemic issues and gaps in capability, preparedness and response capacity that expose the global economy to the impacts of infectious disease.”

November 8, 2014

Ebola source sitrep 4

Filed under: Biosecurity,Public Health & Medical Care,Strategy — by Philip J. Palin on November 8, 2014

This series of sitreps was initiated in midst of a media frenzy over the mishandling of an Ebola patient in Dallas. Yesterday Dallas was officially declared Ebola free.

In mid-October the nation seemed transfixed by symptoms and almost entirely distracted from their source.

In the intervening weeks there has been distinguished original reporting of the Ebola crisis by the New York Times and National Public Radio.  I have been less impressed with television news coverage.  But this Sunday, Sixty Minutes, the CBS news program, has scheduled a special report on The Ebola Hot Zone (2 minute video preview). Check your local listings.

As reported last week, the transmission growth rate in West Africa has slowed for hardest-hit Liberia.  It is increasing in Sierra Leone and Guinea.  There has — apparently — been successful containment elsewhere.  According to Friday’s special update by the World Health Organization the total numbers for Liberia, Sierra Leone, and Guinea are 13,241 confirmed cases and 4950 deaths.

Ebola Comparison

Click to open larger image.  Source: WHO November 5 Update

I have not seen a credible explanation for the recent divergence between Sierra Leona’s and Liberia’s transmission rates.  Guinea’s so far less virulent outbreak is probably a matter of geography, population density, and transportation networks.

As noted below, progress is being made on several aspects of the Ebola response strategy.

Ebola Mesures

Later today the USAID-US Army mission in Liberia will open its first Ebola Treatment Unit.

But clearly there remains much to be done.  The European Union has pledged over 1 billion Euros, but other than the Brits in Sierra Leone and the French in Guinea, actual engagement has been slow. On Thursday a Dutch ship departed Rotterdam loaded with ambulances, mobile hospitals, laboratories and other equipment. The cargo has been provided by nine EU Member States and UNICEF.

On Wednesday President Obama requested a special appropriation of $6.1 billion to address both domestic and international response to Ebola.  The Senate Appropriations Committee will begin hearings on the request on November 12.  The House Appropriations Committee is expected to follow suit before the end of the month.

November 6, 2014

Local conditions, globalized consequences

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on November 6, 2014

The following appeared in the November 3 edition of FrontPageAfrica, a leading Liberian news outlet.  The story was reported by Stephen D. Kollie.

As previously noted in Ebola Source Sitrep 3, there seems to have been an unexpected slowing of the Liberian rate of transmission. There are new reports this week, however, of increased transmission rates in neighboring Sierra Leone.  Here is the most recent WHO update.

There has been a remarkable absence of US broadcast media attention to Ebola as most of those treated for the disease in the United States have survived.  The “press” — digital and paper — has been much more attentive.

Late yesterday, President Obama requested a $6.18 billion special appropriation to combat Ebola.  According to the White House website, the funds will be used to

  • Fortify domestic public health and health care systems
  • Contain and mitigate the epidemic in West Africa
  • Speed the development and testing of vaccines and therapeutics
  • Establishing the capacity of vulnerable countries to prevent, detect, and respond to disease outbreaks before they become epidemics that threaten the American people.

–+–

Vahun, Lofa County - Barely seven months after the deadly Ebola Virus hit Lofa County, Liberia’s fourth most populated county (2008 national census) life seems to be returning to normal, but fear that the disease will resurface, exists among residents of the county. Schools remain closed, nonessential staffs working for the government; continue to remain home, while the culture of handshake, hugging and all forms of bodily contact is still prohibited.

At the crossing point, which connects Lofa and Bong counties, travelers are compelled by security officers to get of vehicles, wash their hands and undergo temperature screening. Those with high temperature levels are prevented from entering the Lofa County and refer to the local health authority for additional medical checks.

In Voinjama, the provincial capital of the county, posters of Ebola awareness messages are prevalent. Community radio stations still boom with anti-Ebola songs and messages. This, they say, is to remind residents that Ebola epidemic is not over yet. Many, including non-government agencies believe the disease spread because people did not believe in the existence of the virus.

“No one could listen when it was announced that Ebola is in town,” said Isaac Ballah, a local NGO worker in Voinjama City. Ballah told FrontPage Africa that nearly everyone in the city came to terms with the disease when a man showing signs and symptoms of the virus was seen lying at the entrance of the Lofa County Community college.

Ballah narrates that the suspected Ebola patient was lying helpless, vomiting and openly defecating as locals went to take a glimpse at the first apparent case, which signaled the coming of dark days. “After that morning, we all went home silently, with so much worried. The next day everyone picked up their clorax bottles and we stopped shaking hands and touching each other,” he said. “Few weeks later you could only hear the sound of ambulances everywhere and at the same time, see two to three pickups filled with dead bodies.”

All this epitomized the agony the people of the county were subjected to for months said Ballah. But for several weeks now, not many cases relating to the Ebola virus have been reported in the county. But residents are still taking safety seriously to prevent any widespread occurrence of the disease. They are skeptical in ruling out a new outbreak considering the county’s closeness to neighboring Guinea and Sierra Leone with which it shares borders.

Nationwide, the numbers in Ebola cases seems to be declining as has been acknowledged by the World Health Organization (WHO). The WHOs Bruce Aylward on Wednesday confirmed the decline in the number of Ebola cases in Liberia.

“The actual number of newly reported cases is beginning to decline in Liberia and the government is driving a multi prone investigation, looking at multiple strands of evidence to try and understand, is this real, is this reporting phenomenon or is this care seeking phenomenal that’s changing? So far based on the information received today… it appears that the trend is real in Liberia,” he said.

Despite this good news authorities and citizens of Lofa are taking the good news with a bit of caution. In Voinjama, all general markets remain closed to prevent public gathering. Residents are forced to sell their produce during regular weekdays instead of Fridays, which is recognized as the official market day.

Zangota’s Patient zero

In Zangota, a small town just 45 mins from Voinjama City, where over thirty deaths were reported, the Ebola nightmare began with Krubo Mamaie, who traveled to the town for medication, says 33 year-old Luana Korvah, a mental health supervisor who was actively working with the county’s Ebola task force.

According to Korvah, Mamie had cared for her sick husband in Voinjama who died of Ebola and later left for her town when she also fell ill. She was referred to the Konia Health Center by local officials in Zangota, but died en route to the Foya Ebola Treatment Center because her condition had turned for the worse.

Said Korvah: “She and her husband had burial activities in Guinea, when they went back into the community the husband fell sick.” “She was then caring for the husband and later the man died. They took the man to Letisu for burial and those that took part in the burial ceremony, who did the bathing and all the other traditional things died.”

Korvah said many residents in the area did not believe it was Ebola rather they held the general opinion that their wells were poisoned and thus causing them diarrhea and other illnesses. The residents’ failure to accept the virus existence left nearly 70 persons dead in Zangota and the numbers continued to increase spreading to nearby towns and villages.

Now, after nearly eight months battling the deadly virus, it seems Ebola has taught many lessons in the county. Precautionary measures are the order of the day. Hand washing, no handshake is just a few preventive methods that are still being religiously practiced even though infections have slowed in a County which has lost nearly 200 persons.

Careful barbing

At a local barbing shop in central Voinjama, barbers use hand gloves, bleach and other disinfectant before barbing. Not many people are allowed to sit in the barbing shop to avoid bodily contact. “We are still scared and are doing everything possible to ensure that no one get infected in this shop,” Mohammed Sore, owner of the two brothers barbing shop told FPA.

He says while there has been no case of Ebola reported in the county for the past few weeks, he and his colleagues have not stopped the preventive measures and will continue until the country is declared Ebola free. “We will stop using the gloves and chlorine when we hear that Ebola is not in the country again,” said one of our fears is that we are close to the border and people are still coming in from Guinea,” he said Sow.

At the over 80-bed facility run by the medical charity group Medicines Sans Frontieres in Foya, all patients have been discharged with zero cases reported so far. All schools in the county remain closed as part of President Ellen Johnson Sirleaf’s directive on the prevailing state of emergency in the country.

Non-governmental Organizations such as the Pentecostal Mission Unlimited (PMU Liberia) is moving in to help with preventive materials and support to many health facilities, as residents wait quietly to see a total eradication of the deadly disease. Residents of Lofa have seen hell; Ebola killed and obliterated entire families. Cultural and religious practices helped to rapidly spread the disease among community members who were also in strong denial of the virus according to residents.

Now, the numbers of cases being reported are few and no much news of suspected deaths in Lofa County. Hand washing buckets are still placed in nearly every household and those that cannot afford the bucket travel with a bottle of chlorine water just for protection against the deadly virus, which has killed a total of 2413 persons and infected 6535 individuals in Liberia alone.

Harvard Public Health School and Reuters: Ebola fear, not science, driving policies

Filed under: Biosecurity,Media,Public Health & Medical Care,Risk Assessment — by Arnold Bogis on November 6, 2014

The news agency Reuters and the Harvard School of Public Health have a partnership to produce “Health Watch,” which according to the School’s website is: “a web series featuring expert analyses and comments about the latest developments in health news. This series is presented by The Forum at HSPH and the Harvard School of Public Health in collaboration with Reuters.”

In this episode, “Dr. Paul Biddinger, Associate Director of the Harvard School of Public Health Center for Public Health Preparedness, tells Reuters that fear is driving certain non-science based policies like the involuntary quarantine of health workers.” Dr. Biddinger also directs the School’s Emergency Preparedness and Response Exercise Program.

 

November 5, 2014

RIP Former Boston Mayor Thomas Menino: The Public Health Mayor

This week Boston laid to rest it’s longest serving mayor, Thomas Menino.  He served as mayor in Boston for 20 years.  Yes. That’s right.  Twenty years.

To his admirers he was known as the “Urban Mechanic,” as the Boston Globe describes, ”leaving to others the lofty rhetoric of Boston as the Athens of America, he took a decidedly ground-level view of the city on a hill, earning himself a nickname for his intense focus on the nuts and bolts of everyday life.” To some of his detractors (and even his supporters) he was referred to as “Mumbles,” for his less than soaring rhetorical skills.

This humble man from the Hyde Park neighborhood of Boston rose to national prominence, with former President Bill Clinton paying his respects before the funeral procession and Vice President Joe Biden attending the ceremony. Impressive for a politician recognized to have no political ambition beyond running his city.

What does this have to do with homeland security? For some time I’ve heard from various colleagues that preparedness, particularly health-related preparedness, had an unusual amount of political support in Boston. Public health and EMS were not simply the minor leagues to law enforcement and fire service major league players. But it became vivid when I read the following description from a food-orientated homage to Mayor Menino from The Atlantic food critic Corby Kummer:

But aside from the coddling and special treatment any mayor who shows up gets, Menino cared about food for exactly the reasons today’s food-movement activists do, and long before it was fashionable to embrace what food can and should mean: access to fresh produce for everyone of every income level; gardens as ways to unite and repair communities; and, most importantly, fresh food as a route to better health. The mayor told everyone, including his biographer, longtime Atlantic senior editor Jack Beatty, that he wanted to be remembered as “the public-health mayor.” That made him work particularly closely with my spouse, John Auerbach, who served 10 years as Boston’s health commissioner. 

So….apparently I missed this self-appointment.  After the fact it was easy to find further evidence of Menino’s interest in public health.  See the videos I’ve posted below.

Again, how is this related to homeland security? Two points that at least I think of are interest. 

 

A lot, if not the majority, of public health work does not seem to fall into the category of homeland security. Expanding access to fresh produce in low income communities, anti-smoking efforts, childhood vaccination campaigns, etc.  It’s not always about responding to the next Ebola outbreak.  Yet when taken as a whole, improving the health of the community in general improves overall resilience.  Healthy people fare better during and following disasters than unhealthy ones.  People with access to health insurance are more likely to visit a primary care doctor than the emergency room for common maladies, thereby not taking up vital resources during events like the Boston Marathon bombing. A healthier community is a more resilient community.

Menino’s attention to public health underscores the importance of political leaders in homeland security. I have often heard professionals complain about meddling politicians (along with the annoying press) and how events can be run more smoothly when they are absent.  Yet not only do they play an important role in communicating with the public during and following disasters, they make or influence the choices made in a community before there is a bad day.  Menino’s focus on public health not only improved the overall health of Bostonians, but contributed to the competence exhibited during the response to the Marathon bombing, from the existence of a Medical Intelligence Center to the cooperation between city agencies such as Boston EMS and Public Health with the private hospital systems.

It is comparing apples and oranges, but in thinking about this I could not help but contrast Boston’s situation with that of New York City.  Size and resource issues aside, NYC has spent the most energy on security instead of general preparedness since 9/11.  I am not arguing that there has not been a lot of resources directed towards preparedness and response activities and organizations, only that it is lacking when compared with the radical changes enacted in the NYPD and other agencies charged with preventing a terrorist attack. I think I could make the case that Boston, under Menino’s leadership, took a more all hazards approach while NYC, under Mayors Giuliani and Bloomberg, remained primarily focused on terrorism. That is not a value judgement, but simply an observation.

If you are interested, the following video highlights many of Mayor Menino’s accomplishments in public health.  From the Boston Public Health Commission (which Menino created in 1996):

 

If you have a little more time, here is a longer discussion held at Harvard’s School of Public Health with Menino shortly after he left the Mayor’s office.  For those more security minded, at the beginning of the discussion he is asked and replies with a lengthy description of his point of view about the events surrounding the Boston Marathon bombing.

 

 

 

November 1, 2014

Ebola source sitrep 3

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on November 1, 2014

The World Health Organization released a new data summary late on October 29.  A few highlights:

The growth rate of transmission in West Africa seems to have slowed, especially in hardest hit Liberia.  This has surprised most close observers who suggest it is either the result of unrecognized and under reported transmissions or is a temporary trough in what can be a wave-like pattern on the part of the virus.

The region’s anti-Ebola capacity is much stronger now than at the beginning of October.  Several new diagnostic labs and treatment facilities are now in place (see map below).  Clinical personnel are more numerous and better equipped. Some have suggested the reduced transmission rate is the outcome of interventions — educational, clinical, and logistical — put in place over September and October.

Ebola Treatmentt

Despite this good news — or pause in worse news — a new scientific analysis published on Thursday concludes, “Under status quo intervention, our projections indicate that the Ebola outbreak will continue to spread, generating a predicted 224 (95% CI: 134 – 358) cases daily in Liberia alone by December…”  For the week ending October 25 fewer than 50 probable cases were reported in Liberia.

The key factor may be “status quo intervention”; how much effort, targeted where, will have the most effect?  It is widely recognized that the West African outbreak is the result of a failure to intervene early and effectively, before the virus was able to spread in dense urban environments.  The best evidence for this analysis being what has happened with an unrelated, but parallel, cluster of Ebola cases in the Democratic Republic of the Congo.

The first Ebola death in the DRC was on August 11.  The role of Ebola was identified before the end of August.  Aggressive public health measures were taken to isolate and treat those with the virus.  (Other factors probably helped.)  There have been a total of sixty-six cases and forty-nine deaths.  It has now been eighteen days since the last new case was identified.  The transmission cycle was contained and has apparently been stopped.

Public education and community involvement are, many emphasize, fundamental to this sort of success.  The same analysis projecting potential exponential growth in the number of West African Ebola victims found that four behavioral adjustments could produce a rapid decline in transmission (see chart below).  Of particular importance is a change in burial practices.  The “status quo” being studied was the situation in mid-September. Several of the practices have been increasingly adopted since.  Already enough to produce the recent declines?

Ebola 4 Interventions

Since the West African Ebola cases first emerged, many at HLSWatch have suggested that for the United States this is mostly an opportunity to “run the traps” for a much more easily transmitted, much less treatable infectious disease.  Important issues have surfaced related to early identification and treatment, clinical protocols, clinical training, and quarantine policy, strategy, and practice.

Some potentially less obvious lessons:

Isolation matters:  The economic isolation of eastern Guinea produced a level of poverty that resulted in hunting bats for food.  When a child and then his family members died of bat-borne Ebola they did not receive medical attention. The virus was given time to multiply.  In urban Monrovia the poverty-stricken West Point slum has been the epicenter of transmission.  The population’s lack of connectedness with wider society has impeded the application of effective public health strategies.

Culture matters:  Washing, caressing and otherwise honoring the body of dead family members has been a particularly virulent vector for transmission of the disease.  Working respectfully within the culture it has been possible — with remarkable speed — to adjust cultural behaviors.

Community matters:  Connecting those who were disconnected and building trust where there was little or none has been a precondition to adjusting population behaviors and bending the transmission curve.  Facilitating and supporting community self-organization has again and again been a big part of the public health approach.

Media matters:  Mass media and social media can significantly influence the velocity of public attitudes for both good and bad.   How to influence the velocity of media attention is, I suggest, quite similar to how we effectively engage the virus itself.  Think about it.

Reasoning matters:  Chris’ Tuesday post – and Haidt’s claim — have clearly been on my mind all week.  For what it’s worth, I perceive Haidt was mostly critiquing a tendency by some to perceive reason as self-evident and to dismiss those too stupid to recognize the obvious.  In this regard I agree with Bellavita and Haidt.  The noun can be pretentious.  But the verb — reasoning — when undertaken in a way that embraces culture, community, and respectful communication is the best tool we’ve got.

Maybe this is an opportunity to run the traps on more than the next infectious disease.

October 30, 2014

No Ebola sitrep yet

Filed under: Biosecurity,Public Health & Medical Care — by Philip J. Palin on October 30, 2014

As of early Wednesday morning the WHO had not released updated data on the Ebola transmission rate in West Africa.  Given the rest of my life, I have to pound out a post before 0900 on October 29 if I am to get you anything on October 30. There are related reports that I might share, but it is probably more helpful to minimize my contribution to the noise level until some meaningful signal is available.

UPDATE

Late on Wednesday afternoon WHO released an update.  Here it is.  Received too late for my further analysis.

By the way, trying to seriously follow major trends and events in order to have something to write to you each Thursday is a very helpful intellectual and temporal discipline.  I would not know half what I know about Ebola if I was not trying to fulfill my relationship with you.  Thank you.

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.

October 23, 2014

Ebola source sitrep 2

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on October 23, 2014

This is the second in an irregular update on efforts to slow and eventually stop the rate of Ebola virus transmission in west Africa.  The risk of transmission in the United States is a function of the rate of transmission at the source.

It is important to acknowledge issues with data quality.  Over the weekend a piece in Science magazine noted, “… it’s widely known that the real situation is much worse than the numbers show because many cases don’t make it into the official statistics. Underreporting occurs in every disease outbreak anywhere, but keeping track of Ebola in Guinea, Liberia, and Sierra Leone has been particularly difficult. And (as) the epidemic unfolds, underreporting appears to be getting worse.”

Still the data that is collected can help us understand some broad dynamics of transmission.

Yesterday afternoon — October 22 — the World Health Organization released a progress report on their response roadmap.  It provides details through the end of last week for all known cases of Ebola, but focuses primarily on the situation in Guinea, Sierra Leone, and Liberia.  Following is a timetable for transmission of the virus in Liberia and metropolitan Monrovia. Similar charts are available for Guinea and Sierra Leone in the online report.  The report also provides updates on treatment centers and other interventions underway.

WHO_liberiaClicking on the image will generate a larger version

CITYA.M., the City of London business publication, has produced a helpful visual analysis of the Ebola outbreak in Liberia, so far the hardest hit of the the three nations at the epicenter of the outbreak.  These maps communicate the crucial role that population density plays in transmission. They also suggest how the virus moved along human networks from the index case in southeastern Guinea into Lofa County and quickly to the economic/social/political center of metropolitan Monrovia.

Liberia density and number

Liberia per 100,000

MORE from CITYA.M.

While US media focus on early indications that transmission has been contained in the Dallas case, at least as important is the news that the Nigerian public health system has successfully contained an initial set of transmissions in densely urban Lagos.  Fundamental to this Nigerian success was a well-organized existing public health infrastructure and network of human expertise. An effective anti-polio process was essentially repurposed to rapidly contain a new infectious threat. Strategically it is important to recognize this was the adaptation of an existing capacity, not an ad-hoc insertion of a special or reserve capability.

According to the Associated Press, in Nigeria “Health workers tracked down nearly 100 percent of those who had contact with the infected, paying 18,500 visits to 894 people.”

The absence of such an existing capacity has been a principal cause of the outbreak in Liberia and its neighbors.  Sunday U.S. Army Maj. Gen. Gary J. Volesky, commanding general of the 101st Airbone Division and his thirty member command team arrived in Monrovia to assume leadership of DOD contributions to Operation United Assistance. The Army is sending approximately 700 Soldiers from the 101st, including members of the division headquarters staff, sustainment brigade, combat support hospital and a military police battalion. Another 700 troops will be deployed from multiple engineering units to build 17 100-bed medical treatment units and a 25-bed hospital. MORE.

New cases of transmission in Nigeria — the United States and elsewhere — are likely.  Until we can bend the exponential growth of transmission in Liberia, Sierra Leone, and Guinea, a networked and increasingly densely populated planet will be vulnerable.  (A few hours after the original version of this post appeared, a new case of Ebola was confirmed in New York City.)

The Foreign Affairs Council of the European Union met on Tuesday.  Despite some additional progress, the readiness and urgency of the European response will depend on the results of a summit of EU leaders that opens today in Brussels.

October 19, 2014

Who is my neighbor?

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care,Strategy — by Philip J. Palin on October 19, 2014

EBOLA_James harris

I perceive it is prudent — as well as accurate — to make the case that the best way to mitigate Ebola risk in the United States is to significantly degrade the risk in West Africa.

Recently Thomas Frieden, Director of the CDC, felt it was politically necessary to say, “I am not protecting West Africa. My number one responsibility is to protect Americans from threats.”

Over the last few weeks at HLSWatch we had cause to consider the potentially warping effects of self-interest too narrowly conceived or fatally denied.

Last week The Telegraph (London) offered a gallery of online photographs entitled, “Survivors: Portraits of Liberians who recovered from Ebola“.  Above is James Harris, age 29, who recovered after two weeks at death’s door.  He is now a nurse’s assistant in a Doctors Without Borders treatment center in Paynesville, Liberia.

October 18, 2014

Ebola source sitrep 1

Filed under: Biosecurity,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on October 18, 2014

This is the first in an irregular update on efforts to engage Ebola’s center-of-gravity.  As noted previously, I am concerned US media is not giving sufficient attention to fighting this disease where it matters most for all of us.

If the rate of transmission can be suppressed at the source, then the risk to the United States will be substantially mitigated.  If the rate of transmission in West Africa cannot be significantly reversed in the next 60-to-90 days some epidemiologists are concerned Ebola will establish itself well outside it’s historically native range.

Data collection in Guinea, Sierra Leone, and Liberia — the current outbreak’s epicenter — is far from state-of-the-art.  But following is the best information now available from local health agencies as aggregated by the World Health Organization:

Ebola Chart

These numbers will get worse — probably much worse — before they get better.  Current projections suggest 10,000 new cases per week by December.

But there is also some encouraging news.  The Ebola transmission cycle in Senegal and Nigeria has evidently been successfully interrupted and contained.

Ebola survivors who have developed an immunity to the disease are now involved in caring for other patients and may be the source of life-saving blood transfusions.

Population behaviors, such as burial practices, are adapting to the risk.

Several new treatment centers are under construction.  Early identification, isolation, and effective treatment of those with Ebola will cut transmission rates and improve survival rates.  This week US military operations to expand local capacity got seriously underway. (Further details)

There will, almost certainly, be more cases of Ebola presenting in the United States.  The best way to reduce vulnerability is to eliminate the threat at its source.

 –+–

Editorial Note:  It has long been my personal opinion that “homeland security” is most meaningful when it offers its legacy professions, policy-makers, and the public a strategically integrated angle on risk.  The risk environment is usually complicated, often complex and even chaotic.  There are important roles for an array of specializations, threat-specific strategies, operational expertise, and tactical competence.  Homeland security will be more successful to the extent it is well-informed of these related domains.  But homeland security delivers added-value when it can stitch together these diverse elements into a coherent — ideally mutually amplifying — whole.  Strategy, at least in my use of the term, is especially concerned with how risks can be intentionally engaged in a manner that deploys the threat against itself and reduces self-generated vulnerabilities.

What is the most effective strategy for the risk of Ebola?

October 17, 2014

The Ebola Czar and the missing Homeland Security Council

Filed under: Biosecurity,General Homeland Security — by Christian Beckner on October 17, 2014

The President has announced the appointment of Ron Klain as his new “Ebola czar”, as numerous news outlets have reported this morning. From the New York Times:

President Obama will appoint Ron Klain, a former chief of staff for Vice Presidents Al Gore and Joseph R. Biden Jr., to manage the government’s response to the deadly virus as anxiety grows over its possible spread, a White House official said on Friday.

…..

Mr. Klain will report to Lisa Monaco, Mr. Obama’s homeland security adviser, and Susan E. Rice, his national security adviser, the official said. His appointment was first reported by CNN.

The official praised the work already done by Ms. Rice and Ms. Monaco, but said that Mr. Klain would provide “additional bandwidth” in the fight against Ebola, which is important because the two women have to manage other national and homeland security issues.

I view this appointment of an “Ebola czar” and the need for such “additional bandwidth” as a symptom of a broader problem within the policy-making apparatus at the White House, due in part to the decision in 2009 to merge the National Security Council and Homeland Security Council staffs into a single integrated “National Security Staff” (since renamed the “National Security Council staff”).

Prior to the integration of the HSC and NSC staffs, the Homeland Security Council played a very active role on pandemic planning and response issues. It issued the National Strategy for Pandemic Influenza in November 2005, and the subsequent Implementation Plan for that strategy in May 2006, and a progress report on implementation in 2007. During the H1N1 flu pandemic in 2009, the Homeland Security Council was utilized as a primary convening mechanism by the White House.

But since the end of the H1N1 crisis in late 2009, the Homeland Security Council (which was retained as a policy-making entity, in part because it was mandated in law in Title IX of the Homeland Security Act) has almost entirely disappeared from view. From January 2010 to the present, I can find only one public record of the Homeland Security Council being convened: a meeting in July 2014 to address the unaccompanied minor issue on the southern border. (It is possible that there have been additional meetings of the HSC during the last five years, but there is no public record of it).

These concerns about homeland security issues being downgraded were predicted by opponents of HSC-NSC integration at the time. In February 2009, I helped to staff a Senate Homeland Security and Governmental Affairs Committee hearing where we heard a variety of opinions on the potential HSC-NSC merger, including from former DHS Secretary Tom Ridge, who was critical of a potential merger. His prepared remarks highlighted biosecurity as a particular area of concern, and are prescient in light of today’s decision to appoint an Ebola czar (emphasis added):

From HHS to Energy to DOD to the FDA and elsewhere – more than 30 departments and agencies have homeland security functions. Take biosecurity, for example. What the United States needs to do to improve our biosecurity against major biological threats is complex. Biosecurity depends on different programs managed by different agencies – there is no way to simplify it. DHS is in charge of the biological risk assessment that analyzes biological threats. HHS is responsible for the research and development of medicines and vaccines. DOD does its own R&D. The Food and Drug Administration has its role. Let’s not forget NIH. CDC is responsible for our national stockpiles and for coordinating the grant program and technical assistance to state and locals. The intel community is responsible for assessing the biological threats posed by our adversaries. Without close White House coordination, our bio programs will move in different directions to different goals and different timelines. Putting this and other challenges under the NSC’s purview would only complicate the NSC mission and the HSC’s ability to receive adequate attention from a Council that already has Iran, North Korea, Russia, Pakistan-India, the Mideast and other matters in its inbox.

There have been some benefits as a result of integrating the HSC and NSC staffs, in terms of breaking down domestic vs. international policy stovepipes and allowing for integrated decision-making on transnational issues such as cybersecurity. But I have become increasingly concerned over the past few years that the downsides of HSC-NSC integration are outweighing its benefits, largely due to the “bandwidth” issue highlighted in this post, but also because of the decreased public visibility into homeland security decision-making at the White House due to the adoption of NSC protocols, as I discussed in a blog post last year.

In the near-term, the focus needs to be on dealing with the Ebola pandemic, but these broader structural issues also deserve to be reviewed during the last two years of this Administration and/or by the next Administration, whomever is elected President in 2016. And in light of the Homeland Security Council’s statutory role, this is an issue that Congress should also take a fresh look at, including by convening hearings and requesting information on the activities of the Homeland Security Council since 2009.

(Note: this commentary is cross-posted by the author from the site HSPI.org)

Less czar than troika

Filed under: Biosecurity,Media,Preparedness and Response,Public Health & Medical Care — by Philip J. Palin on October 17, 2014

CNN, the New York Times, and others are reporting the imminent announcement of a White House “Ebola Czar”. The man-of-the-hour is Ron Klain.  The former chief-of-staff to Vice President Biden (and Vice President Gore) has been in the private sector since January 2011.

The appointment responds to a burgeoning cry of “who’s in charge?” from the news media and others.

It’s a very primitive question, not well-suited to an infectious disease emerging into a highly-networked global system.  Mr. Klain will, I perceive, actually be part of a troika involving Lisa Monaco and Susan Rice.  He is very experienced riding the back of both the “interagency” and the media. Despite rough rides in the past, the tigers have not yet eaten him up.

Hold on and best wishes.

October 16, 2014

Adjusting our signal to noise ratio

I am currently involved in planning three different tabletop exercises.  Each are efforts to enhance “whole community” involvement.  My particular role is to enhance private sector involvement.  Currently the news media is not targeted for participation in any of these exercises.  In my several years of being involved with various homeland security training and exercises I can only recall two occasions when news media have been involved as participants.

There are several impediments to involving news media in these sort of activities, including:

  • Effective exercises are designed to expose gaps and shortcomings in order to improve preparedness.  News media are inclined to expose gaps and shortcomings in order to increase readership/listeners/viewers.
  • Many public sector participants tend to be “authoritative” or “officious” or “control-freaks”.  This is troublesome enough with other private sector participants.  With members of the media it can be explosive.
  • News media participation can discourage the involvement of other private sector parties due to fear of exposure (see first bullet).

But it seems to me increasingly clear we must find a way to involve news media in preparedness activities or continue — and deepen — the risk of serious mis-communication and public mistrust on the very worst days.  While major media are no longer the only or even primary sources of information, they are a significant source of amplification and confirmation.  Too often they are amplifying and confirming misleading information.  An ongoing example:

The media’s attention to symptoms can obscure attention to the source of problems.  I am astonished by the extraordinary attention given to a few instances of Ebola in the United States in contrast with lack of attention to sources of the problem in West Africa… despite clear and consistent and, at least to me, very reasonable analysis that until the source of the problem is better managed the risk to the United States will only grow.

On Tuesday afternoon the United Nations coordinator for Ebola response told the Security Council that the world basically has sixty days to contain the virus or face a serious risk of pandemic.  In much of the world, this was the Wednesday morning headline.  Not in the United States.

Below are two screenshots.  The first is for the Google News US edition.  The second is for the UK edition.  According to Google, “articles are selected and ranked by computers that evaluate, among other things, how often and on what sites a story appears online.”  The source stories can be found in US media, but too often buried beneath the symptoms.

Google US edition

UK edition

In my judgment a similar symptom vs. source issue is endemic to most US media coverage of terrorism, urban wildfire, flooding, and many aspects of border security.  It even erupts in how longer-term electrical outages are reported.

I am not arguing against news coverage of symptoms.  The attention given to the series of false steps in Dallas has clearly facilitated enhanced readiness across the US health System. But these are tactical –symptomatic — issues, not strategic issues addressing the problem at its source.

When novel and especially deadly threats emerge, the failure to distinguish between symptom and source is at least distracting and too often misleading… in a manner that can undermine public health and safety and, certainly, competence.  Sources can be even more complicated to understand than symptoms, but this further underlines the need for insightful media coverage.

There are very few editors, producers, or reporters who can afford to specialize in any of the so-called “low-probability, high-consequence” risks that confront us.  That’s a problem for most of the private sector and across the public sector as well.  We all need help adjusting our standard-operating-procedures to these non-standard events.  We should start to do so in workshops and exercises before the symptoms explode.

Some possible discussion topics and exercise issues:

In dealing with “high-intensity-risk-environments” (HIRE), do not mistake ambiguity for inattention.  Recognizing ambiguity may be evidence of close attention.

In engaging a HIRE, do not confuse uncertainty with incompetence. The compulsion to sound certain in the midst of complexity is, in my opinion, a principal cause of incompetence.

In the midst of a HIRE, complexity and lack of control does not necessarily signal lack of organization or progress.  Efforts to control can escalate complexity and suppress resilient self-organization.

In a few months I should be able to let you know if I am successful in involving media in any of the exercises currently being planned.

–+–

And since I’m writing about attention to sources as well as symptoms, in regard to Ebola here are some potentially helpful sources on sources:

FrontPageAfrica – A Liberia based newspaper. (BTW, this is not the largest circulation Liberian newspaper, but some of its competitors have, in my opinion, their own serious noise-vs-signal problems.)

The Concord Times – A Sierra Leone based newspaper.

The Telegraph – A Sierra Leone based newspaper.

Doctors Without Borders Guinea News

Guinea (Conakry) Guinee Focus (French)

World Health Organization Africa Regional Office

US Department of Defense Africa Command

CDC Ebola Hub

Resources from the London School of Hygiene and Tropical Medicine here and here and here  (and it’s worth looking for more)

FRIDAY UPDATE:

Thursday evening NPR broadcast an interview with Dr. Lewis Rubinson.  An intensive care physician with the University of Maryland Medical Center, Dr. Rubinson spent three weeks in September serving Ebola patients in Sierra Leone.  The full interview (with transcript) is, I suggest, a good example of well-informed, realistic thinking about dealing with symptoms.  Following is an excerpt:

RUBINSON: There are nearly 6,000 hospitals in the U.S. It wouldn’t have made sense to me that every single facility would have the ability to be honestly prepared. It doesn’t mean that there doesn’t need to be an appropriate level of the ability to identify patients and provide early treatment and keep staff safe. I think that’s really on every institution because we can’t control where patients present. But I think out in West Africa, we got very, very good at being 100 percent all of the time. You had to. In the U.S. there’s no technological fix for this. We can’t buy a widget and just solve it and give it to the hospital and say, you’re prepared right now. Most of this is about diligence, it’s about discipline and it’s about 100 percent adherence. And I think, again, that’s very hard to imagine that every facility could do that. Not because they aren’t good facilities, it’s just there are other priorities that they need to be taking on at the same time. Again, every facility needs to be able to identify the patient, take care of the patient early, keep the staff safe, but I think it’s very hard to imagine that every facility would be good at managing a patient throughout their course of the disease, especially if they get very sick, like had happened in Dallas.

MORE

SECOND UPDATE:

In regard to sources rather than symptoms, here’s “top of the fold” attention being given British operations in West Africa.  According to Friday’s Telegraph,

Ebola is the “biggest health problem facing our world in a generation”, David Cameron has said, as he urged foreign leaders to “step forward” with more resources to fight the crisis.

The Prime Minister urged other leaders to “look to their responsibilities” to help tackle the Ebola epidemic ravaging parts of West Africa… 

He said: “Britain, in my view, has been leading the way. The action we are taking in Sierra Leone where we are committing well over £100 million, 750 troops, training 800 members of health staff, providing 700 beds; we are doing a huge amount.

“I think it is time for other countries to look at their responsibilities and their resources and act in a similar way to what Britain is doing in Sierra Leone, America is doing in Liberia, France is doing in Guinea.

“Other countries now need to step forward with resources and action because taking action at source in West Africa is the best way to protect all of us here in Europe.”

MORE

August 6, 2014

Ebola is not a homeland security risk…but insufficient public health funding is

Filed under: Biosecurity,Public Health & Medical Care — by Arnold Bogis on August 6, 2014

Ebola is scary. Ebola is exotic.  Ebola normally occurs “over there” not “here.” Ebola sounds like the stuff of Hollywood movies.

However, what Ebola is not is a homeland security threat.

Forgive me for being crude, but basically to catch the Ebola virus you have to come into contact with the bodily fluids of an infected individual.  That definitely means their blood and vomit, and I’m just guessing so please any public health professional feel free to correct me, but perhaps also urine, diarrhea, and any other fluid the body could eject in sizable amounts.

As the CDC describes it:

When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include:

  • direct contact with the blood or secretions of an infected person
  • exposure to objects (such as needles) that have been contaminated with infected secretions

The viruses that cause Ebola HF are often spread through families and friends because they come in close contact with infectious secretions when caring for ill persons.

During outbreaks of Ebola HF, the disease can spread quickly within health care settings (such as a clinic or hospital). Exposure to ebola viruses can occur in health care settings where hospital staff are not wearing appropriate protective equipment, such as masks, gowns, and gloves.

The important takeaway here is that the virus is not airborne. The people getting sick are the caregivers — family, friends, medical personal — who lack or are not taking proper infection control efforts or using protective clothing. Infected people are not infectious until they are sick, and when they are sick they are SICK.  So you are unlikely to run into an Ebola patient on the subway who then proceeds to either bleed or vomit on you.  And if that unlikely scenario occurs, public health officials will have a relatively easy time mapping the direct contacts that the original patient has as well as yours. They can then take appropriate measures to monitor those folks for any signs of infection. This results in no larger outbreak.

There has been some discussion about the possibility that terrorists could take advantage of this situation. Here is HSToday:

As the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) are on high alert to the international spread of the unprecedented outbreak in West Africa of the most lethal strain in the family of Ebola viruses, questions are being raised about whether individuals from West African nations where the virus is spreading trying to illegally enter the United States could bring the highly infectious pathogen into the country.

Federal and public health authorities who spoke only on background said “this simply isn’t a farfetched possibility, despite what some say to the contrary,” one told Homeland Security Today.

Since 2011, the majority of apprehensions of “Other than Mexicans” (OTMs) has been highest in The Rio Grande Valley, including individuals apprehended in Fiscal Year 2013 from Guinea, which is in the African Ebola hot zone. Other OTMs from West African nations bordering the region’s Ebola hot zone – Gambia, Ghana, Guyana, Nigeria and Burkina Faso – were also apprehended in FY 2013 trying to illegally enter the United States, according to Border Patrol data provided to Homeland Security Today.

Also:

“All any one of these terrorist groups would have to do is to have members infect themselves prior to departure, or, more likely, once they’re on the ground making their way to the Rio Grande Valley or some other human smuggling pipeline to the US border,” one of the officials said, noting that Al Qaeda has in fact discussed the deployment of so-called bio-martyrs, according to intelligence. “If they’re willing to stick a bomb up their ass and blow themselves up, then I have no doubt they’d be willing to be a carrier of a highly infectious virus like Ebola,” the official said.

“Now, would one of these groups be crazy enough to try something like this … who the hell knows,” the official said. “But what you have to understand is that these are extreme jihadists who believe a suicide mission in the name of jihad against us, the infidels, is the one true way to Allah. And some of them have already done some pretty crazy stuff … like the bomb up the ass, or the intelligence that they’re working on surgically implanting bombs. So being a host for a virus, like Ebola – no, I don’t think it’s a crazy notion at all. Not when it could set off an epidemic in the US.”

I think I’m going to go with the idea that this is far-fetched.  Terrorist groups have committed some impressive operations over the years, and I would argue the bigger ones that was not 9/11 came in the period before 9/11.  However, for this to work a terrorist would have to make sure they become infected in a time period that allows them to travel to Mexico and over the border before becoming incapacitated.  During that trip or shortly thereafter, they have to be sick enough to expel bodily fluids on others who would likely not seek professional medical help at the same time without becoming sick enough to remain mobile. Those exposed individuals would then have to contract the disease, not seek medical help, and expose others who would hypothetically attend to them during this illness.

This is not going to keep me up at night.

What is concerning is the lack of appropriate funding for the public health systems that are our front line protection from all natural and man-made biological threats.  As the Trust for America’s Health explains:

  • Inadequate Federal Funding: Federal funding for public health has remained at a relatively flat and insufficient level for years. The budget for CDC has decreased from a high of $7.31 billion in 2005 to $6.13 billion in 2012. Spending through CDC averaged to only $19.54 per person in FY 2012. And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $13.72 in Indiana to a high of $53.07 in Alaska.
  • Cuts in State and local Funding: At the state and local levels, public health budgets have been cut at drastic rates in recent years. According to a TFAH analysis, 29 states decreased their public health budgets from FY 2010-11 to FY 2011-12. Budgets in 23 states decreased for two or more years in a row, and budgets in 14 states decreased for three or more years in a row. In FY 2011-12, the median state funding for public health was $27.40 per capita, ranging from a high of $154.99 in Hawaii to a low of $3.28 in Nevada. From FY 2008 to FY 2012, the median per capita state spending decreased from $33.71 to $27.40. This represents a cut of more than $1.15 billion, based on the total states’ budgets from those years, which would be $1.9 billion adjusted for inflation. According to a survey by the Association of State and Territorial Health Officials (ASTHO), 48 state health agencies (SHAs) reported experiencing budget cuts since 2008. According to the Center on Budget and Policy Priorities (CBPP), states have experienced overall budgetary shortfalls of $540 billion combined from FY 2009 to FY 2012, and 31 states have projected or closed budget gaps totaling $55 billion in FY 2013. State and local health departments have cut more than 45,700 jobs across the country since 2008.6 During 2011, 57 percent of all local health departments reduced or eliminated at least one program.

If you want to worry about something public health related this week, worry about that.

For the latest from the CDC on this Ebola outbreak, see: http://www.cdc.gov/vhf/ebola/index.html
ADDENDUM: I meant to write, but forgot, that while I do not consider Ebola a broader homeland security issue for the nation, nor a potential terrorist threat, I do support current CDC actions that include travel warnings for the areas heavily hit by the spread of this disease, as well as increased awareness for U.S.-based medical personnel and even airline crews.  Just because we shouldn’t stay up at night worried about this disease outbreak doesn’t mean that there are not prudent steps to be taken.
Next Page »