Sunday, 26 October 2014

The fear of dangerous and contagious diseases like Ebola

Last updated on November 3rd 2014

When the bird flu fear hit the world, including India, with a lot of culling of poultry (including in India) to prevent the spread of the disease, I had done some reading & viewing up on the matter. That was when the true extent of the danger of such dangerous diseases to human populations really came home to me. I then could far better understand the terror and massive damage in lives lost that diseases like the plague & cholera had caused in past centuries. Even Shirdi Sai Satcharitra has a reference to a boy suffering from plague (Section "Master Khaparde’s Plague-Case" in http://www.saibaba.org/satcharitra/sai7.html). So, plague in India was a terror even in the not-so-distant past (early 20th century).

But the bird flu problem got contained and, at least in India, it did not reach fear frenzy levels among the populace. From the time that I have been studying such matters (say over the past five years or so), this Ebola fear frenzy is the biggest dangerous contagious disease fear that I have come across. In the face of this kind of fear, fear of random terror attacks in stable countries (not facing civil war/other war conditions) seems minor! And, I don't think this fear is misplaced. The spread of these contagious diseases for which vaccines and rapid action medicines are not yet available in mass quantities, can be hard to control, as is seen in the West African countries that are affected by the Ebola outbreak.

Here's a recent article which sheds light on how Ebola fear has hit New York and New Jersey states of the USA, U.S. nurse quarantined over Ebola calls treatment "frenzy of disorganization", http://in.reuters.com/article/2014/10/26/health-ebola-usa-idINKCN0IE07T20141026.

Some comments on it:

* About "frenzy of disorganization, fear and, most frightening, quarantine": This is a really tough problem. On the one hand, we should salute and honour these courageous health workers from countries like the USA who risk their lives to contain Ebola and protect the rest of us. But on the other hand there is a genuine fear that when they come back they could be carrying the disease and infect others! Really, really tough problem, this one.

* Ebola has become a political issue in the USA ahead of Nov. congressional elections! But that is no wonder, given that the fear is impacting so many people.

* About Dr. Spencer having traveled around New York city between arrival at NYC and developing symptoms: That is the big issue. The doctor had moved around New York city. But how could he know that he was carrying the disease and was going to develop Ebola symptoms shortly? Poor chap! Not only has he contracted the disease but will be getting blamed for having moved around in NY city after returning from Ebola affected countries. For anybody who thinks that science has solved most problems (there was an article in The Hindu a year or two ago perhaps, from an IISc scientist (physisict), who made such an outrageous claim, or something to that effect), I think life sciences is one field of science where the sky seems to be the limit in terms of frontiers to be conquered.

* About the nurse, Hickox, stating that she had normal temperature for the oral test at the hospital and showed fever only on a non-contact forehead scanner, which could be because she was anxious: Hmm. This is real tricky stuff.

* Quarantine is no fun.

* About NJ Governor Chris Christie's statement, “... so I’m sorry if in any way she was inconvenienced but inconvenience that could occur from having folks that are symptomatic and ill out amongst the public is a much, much greater concern of mine.": I guess the straight-talking NJ Gov. Christie has got it right from an administrative/governance point of view.

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Overall comment: How vulnerable the human condition is! Nothing like a dangerous disease to truly drive home this vulnerability. And, interestingly, it is when such vulnerability hits home that many persons turn to God, spiritual masters & religion for succour and protection. In my case too, I turned to the devotional path to God only after I was battered emotionally and by health problems, and, to my very pleasant surprise, devotion to God did provide me a lot of (emotional) succour.

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An update:

Here's a recent Fox news interview of NJ Gov. Chris Christie where he is asked direct questions on the Ebola quarantine decision and the straight-talking Gov. Christie gives mostly straight answers without any fudging or ducking. The Ebola part of the interview is from the beginning to around 3 min 40 secs, https://www.youtube.com/watch?v=olqrbQ7asRs, published on Oct. 26th 2014. I think it is really worth a look for those who are interested in understanding this administration & human error vs. science issue in this Ebola matter.

Christie says:

* He trusts the scientists but (a leading scientist-administrator) himself/herself admits that CDC protocols have been a moving target [CDC stands for Center for Disease Control (and Prevention), http://www.cdc.gov/].

* He is in charge of public health of the most densely populated state of the union and these CDC protocols continue to move and change.

* The mandatory quarantine decision had to be taken to protect the public health of the people of New Jersey. ... Eventually the CDC will come around to our point of view on this.

* To the question of it not being good science when people who are not symptomatic are quarantined, as they cannot spread the disease in that situation, Christie says that the voluntary system does not work. Talks about an NBC news crew who were supposedly on volunatary/self quarantine but were out on the streets of Princeton picking up take-out food. ... For a matter as serious as this (Ebola) we cannot count on voluntary system.

* To the question of the unintended consequence (of mandatory 21 day quarantine) of disincentivizing those health care workers (from USA) who are willing to take chances (with contracting Ebola), from going to Ebola affected countries, Christie said that they won't be disncentivized [Ravi: That does not seem to be straight-talk :). But then one has to give politial leaders some leeway on such direct & tough questions.] And that health care workers will understand that the mandatory 21 day quarantine is both in their interest and the public's interest.

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USA Today editorial board is strongly critical of New Jersey Gov. Chris Christie's (and New York state gov.'s) mandatory quarantine, Governors' hasty quarantine adds to Ebola problems: Our view, http://www.usatoday.com/story/opinion/2014/10/27/new-jersey-new-york-quarantine-ebola-editorials-debates/18036733/.

Some short extract(s) (in quotes) and comments on it:

* Hmm. Who will foot the, I am quite sure, big bill for USA health standards quarantine? What about compensation for other loss that the quarantined persons face? These are inescapable and serious practical realities. I had read somewhere that the quarantined nurse, who did not seem to really show Ebola symptoms and was tested negative for Ebola, is planning to sue the government/agencies concerned.

* "The broader health impact is no less troubling. It's hard to imagine who will go to Africa if they must face not just mortal danger but also a large financial penalty and loss of their freedom. Yet virtually everyone agrees that containing the disease in Africa is the only way to defeat it."

[Ravi: The core issue is simply put by the USA Today editorial board in language which most English medium secondary school children will be able to understand. I really like the way some US press outlets, including editorial boards of such outlets, focus on communicating their message to its readers, rather than show off their knowledge of English language vocabulary.]

* I think a learning that is emerging out of this controversy is that the New Jersey and New York state governors should have engaged in vigorous, urgent and public debate with other key stakeholders like top scientist-administrators of concerned medical bodies (e.g. CDC) as well as the White House (it seems that US president Obama is not in favour of the actions of Christie and Cuomo). [They may have had private debate earlier but failed to agree, at which point Christie and Cuomo may have decided to go their separate ways.] A little delay over the mandatory quarantine for all travellers from the affected countries, would not have hurt so much, IMHO. But then I don't live in New York city or Princeton where there has been failure in self quarantine, and so I don't know how frightened the people in those areas are, and how many want such mandatory quarantine. The governors have to respond to serious concerns of the people they govern.

* "Punishing people for heroism and undercutting the main line of attack against Ebola are not just irresponsible actions. They are dangerous ones."

[Ravi: That's the concluding/bottom line of the article. What a dilemma for the top government guys!]

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Further update:

Under Pressure, Cuomo Says Ebola Quarantines Can Be Spent at Home, http://www.nytimes.com/2014/10/27/nyregion/ebola-quarantine.html?_r=0

Some comments:

* Fascinating how top US govt. and medical science administrators turned up the heat on New York state governor and got him to reverse the mandatory quarantine for all travelers from Ebola affected countries decision.

* The New Jersey governor followed the New York state governor, at least in some sense. Hmm. Really fascinating how this played out. But, I think, at the end of it all, a decent balance seems to have been struck in the matter, based on science. That's great and is a testament to the capability of the US democratic government system to eventually deliver good governance and overcome the inevitable mistakes in the face of such fear.

* The White House was not even notified!!! Well, in such matters then, USA is not so different from India where centre-state relations can sometimes be really terrible!
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Here's another report about the nurse Hickox being allowed to move to her home state of Maine, and her vigorous criticism of the way she was treated, Chris Christie’s stunning Ebola reversal: NJ to release quarantined nurse after heated criticism, http://www.salon.com/2014/10/27/chris_christies_stunning_ebola_reversal_nj_to_release_quarantined_nurse_after_heated_criticism/

Some comments:

* Hats off to Hickox for the fight she put up :).

The report quotes the nurse Hickox saying (he refers to NJ gov. Christie and his statement that she was "obviously ill"), “First of all, I don’t think he’s a doctor; secondly, he’s never laid eyes on me; and thirdly, I’ve been asymptomatic since I’ve been here,” and “There always needs to be a balance, because I also want to be treated with compassion and humanity. I don’t feel like I have been treated that way in the past three days.”

[Ravi: She certainly has strongly articulated her view of the matter.]

* The report quotes New York City Mayor Bill de Blasio saying: “This hero was treated with disrespect and was not given a clear direction. We owe her better than that, and all the people who do this work, better than that.”

[Ravi: Good to see such words from NYC mayor.]

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Nov. 3rd 2014
In a recent mail exchange with a correspondent, I wrote the following at the end of my mail response (slightly edited), which I felt appropriate to put up in this post:

In a sort-of concluding view I have the following to say:
I agree that fear should not be the main basis for reaction to such threats (Ebola). It should be primarily based on science. However, it must also be recognised that science is not perfect, medical institutions that have to implement procedures in line with current scientific knowledge are not perfect and that both science and medical institutions have its/their limitations. The two nurses who got infected with Ebola in Texas (if I recall correctly) certainly raise questions about either CDC protocols at the time they got infected OR the implementation of those protocols by the hospital and/or nurses concerned OR both. Therefore such decisions have to factor in these human error and/or science error aspects as well, IMHO. But these factors have to be backed by science and medical experts and cannot be taken only by a non-expert like an elected governor. Sure, the governor has the right to raise such questions to the experts and demand answers. But he/she cannot go ahead and impose such mandatory quarantine rules on all travelers from such Ebola affected countries on his/her own opinion, which is what the New Jersey and New York state governors seem to have done and so, were forced to roll it back partially or fully.

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