Dallas Shows That By the Time Ebola Gets Here, It’s Too Late

A second nurse in Dallas has contracted Ebola. Better yet, before she was diagnosed but while she may have been contagious, she flew to Cleveland and back.

This puts another nail-and hopefully the final one-into the CDC’s and the administration’s stubborn refusal to countenance a travel ban, or at least far more draconian travel restrictions, from the afflicted countries of western Africa.

The CDC justification was based on two arguments.

The first one was idiotic a priori, and has only been rendered more idiotic by experience. The CDC argued that restricting travel into the US would made it more difficult for health care workers to go to Africa to help in the efforts: they would be less willing to go if they could not return.

But health care workers treating the disease are at far greater risk of contracting it, and hence greater risk of spreading it, than just about anyone. So if they go, it is especially important to prevent them from returning until it is almost certain that they are virus free. Yes, this is a burden, but one that can be ameliorated by special quarantine facilities.

The fact that most of the cases outside of Africa are health care workers exposed to the disease just confirms the risk that they pose that should have been obvious on mere reflection.

The CDC’s second argument was: “We don’t have to restrict travel into the US, because we can stop the disease in its tracks here.” Um, no.

There is a dispute over whether the health care workers failed to follow protocol, or the protocol was inadequate. The dispute is really pointless, and terribly unfair to the unfortunate women who were thrown into a deadly situation totally outside of their normal jobs and training.

The CDC model is that any random hospital in the fifty states and DC into which an infected individual happens to wander is capable of diagnosing and treating him or her while incurring very low risk of having that individual infect others, including most notably the caregivers.

That requires believing that all major hospitals are capable of handling an extraordinary disease which requires extraordinary precautions. That tens of thousands of health care professionals are at this very minute prepared and trained to treat it, will do so flawlessly, and will do so in a way that they poses no risk of  transmitting the disease to the millions of people they interact with.

That is delusional.

This is a disease that requires highly trained, professional, and meticulous caregivers. Specialists, not generalists.

One model would be to dispatch teams to hospitals that have admitted an infected person. Another model is to take the infected person to a special facility where the teams operate. The first model would probably be best if it could be assured that there would be only one or two cases, as it would eliminate the necessity of transporting the patient with the attendant risks. But it is not a scalable model. Since a team can likely handle multiple patients, it’s better to have teams at select hospitals around the country, and bring the patients to them.

Regardless, at present neither system is in place and the CDC’s anybody can do it model is obviously fundamentally flawed. Which means that we can’t rely on it, that we can’t depend on the system stopping each case in its tracks without risk of further spread within the country. This in turn means we have to move the defense perimeter out, and prevent people coming in from the affected regions. Dallas demonstrates that by the time Ebola reaches the US, it’s too late.

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