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Last week’s news cycle was consumed by the spread of the Ebola Virus Disease (EVD) in the United States. Liberian Thomas Eric Duncan was the first person to be diagnosed with the virus on American soil in U.S. history. Duncan was admitted to Texas Health Presbyterian Hospital in Dallas on September 28 and died of the virus on October 8. Since that time, two nurses that cared for Duncan have contracted the virus. Reports that one of the nurses was allowed to fly after having a fever alarmed the American public, which is showing signs of panic about a virus that carries a fatality rate of over 60%. Newscasters have labeled Ebola as the “October surprise” of this year’s midterm elections and the federal government’s handling of the situation is becoming a hot political topic. President Obama has reportedly shown signs of frustration in meetings with officials from the Centers for Disease Control and Prevention (CDC) and last Friday he appointed Ron Klain as the nation’s “Ebola czar.” Mr. Klain will be tasked with coordinating the federal response to the virus as well as assuaging public fears about the situation.
This topic brief will discuss the spread of Ebola into the United States, breakdown the federal government’s current response to the situation, and analyze what policies the United States may enact in future weeks and months to curtail the spread of Ebola domestically and internationally. Extempers are highly encouraged to read our topic brief on the West African Ebola outbreak, which was released in August, as well.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
The American Ebola Outbreak
The first Ebola case in the United States was diagnosed on September 24 when Liberian national Thomas Eric Duncan was admitted to Texas Health Presbyterian Hospital in Dallas. Duncan had flown into the United States on September 20 and began showing signs of the Ebola Virus Disease (EVD) on September 24. According to reports, Duncan sought treatment at Texas Presbyterian that day, but did not notify medical personnel that he had been in contact with a Liberian Ebola victim days before. Other reports suggest that the hospital never inquired about his past history when he was initially cared for. Time on October 12 reports that the hospital did not admit Duncan and sent him home despite the fact that he had a fever of 103 degrees. After his symptoms grew worse, Duncan was taken back to Texas Presbyterian where he was diagnosed with Ebola. The failure of Texas Presbyterian to appropriately diagnose Duncan has been criticized by civil rights groups and Dallas’s Liberian community, who argue that his race and unprivileged economic background played a role in his treatment. Hospital officials have admitted that Duncan could have been diagnosed sooner, but argue that after he was found to have Ebola that he received the best possible care. Duncan died of the virus on the morning of October 8.
Three days later, nurse Nina Pham, who treated Duncan for most of his stay at the hospital, became feverish and drove herself to the hospital. She was quickly isolated and subsequently diagnosed with the virus. The Centers for Disease Control and Prevention (CDC) are unsure how Pham acquired Ebola, but they initially blamed her for failing to follow protocol. The Wall Street Journal on October 16 writes that National Nurses United, a union and professional association for U.S. nurses, charged that Texas Presbyterian sloppily handled Duncan’s Ebola case and that the hospital was ill-prepared to deal with it. Nurses United charged that healthcare workers lacked proper equipment when handling Duncan, who was vomiting violently and had a case of diarrhea. The group also said that workers did not receive mandatory training for handling Ebola cases. Texas Presbyterian refutes these charges, but there was some breach that caused Pham to acquire the virus. Pham’s acquisition of Ebola has alarmed some segments of the public as well, who fear that the Ebola virus might be going airborne and may not merely be transmitted by bodily fluids (Note: Ebola is not an airborne virus at the moment).
Last Tuesday a second nurse that cared for Duncan, Amber Vinson, also tested positive for Ebola. This was disconcerting to medical professionals since it seemed to indicate that personnel caring for Duncan made errors in caring for him. As of the time of this brief, more than eighty healthcare workers who cared for Duncan are being monitored for signs of Ebola symptoms. More alarming, Reuters reports on October 16 that Vinson called the CDC last Monday and told them she had a temperature of 99.5 degrees Fahrenheit. Since Vinson’s fever did not top 100.4 degrees, which the CDC considers the bright-line for a contagious Ebola patient, she was permitted to board a Frontier Airlines flight from Cleveland, Ohio to Dallas. Vinson’s fever worsened and she was diagnosed with the virus last Wednesday. The CDC says those on Vinson’s flight and those who went on subsequent flights in that same aircraft will probably not contract Ebola since Vinson was not vomiting or bleeding, but it has asked more than 130 passengers on her flight to contact them. Vinson’s trip and travel history has also led Kent State to give three employees that are related to Vinson mandatory leave, and nurses on her flight that work for the Cleveland Clinic and Metro Health System have also been told not to report for work over the next twenty-one days (the estimated incubation time of the virus). Schools in the Cleveland suburb of Solon also closed on Thursday because a staff member may have flown on the aircraft Vinson was on. Even if Vinson was not contagious when she flew, the CDC’s decision to let her fly when she had a fever has worked to undermine its credibility with the American public. After all, the conservative National Review writes on October 16 that CDC Director Tom Frieden claimed all of the healthcare workers that card for Duncan were being carefully monitored. Vinson’s decision to fly regardless of the fever has also illustrated the limitations of voluntarily quarantining individuals that have been in close contact with Ebola.
As of right now, Pham and Vinson are being cared for in two separate medical facilities. Pham is being monitored at the National Health Clinical Center in Bethesda, Maryland. Vinson was transported to Emory University for care. Health officials are confident that they can help both women survive, but extempers should remember that there is no cure for Ebola. Russian scientists are reportedly working on three vaccines, while a Canadian health firm is working on a vaccine of its own, but no definitive cure has yet to be found. Medical personnel have tried an experimental serum called ZMapp that appeared to work on two American doctors last month, but the drug is experimental and has not cleared wider trials. Other healthcare professionals have experimented with using blood transfusions from Ebola survivors in hopes that their blood contains antibodies that will help infected persons fight the virus. The anxiety over the lack of a cure is what is fueling some of the panic among the American public and it produced some recriminations between Democrats and Republicans last week, with Democrats charging that Republican spending cuts have hurt the drive toward finding an Ebola vaccine. Republicans countered by saying that they increased spending on CDC and National Institutes of Health (NIH) initiatives since 2012 and that the spending they approved was more than what President Obama requested.
The Federal Government’s Response to Ebola
The federal government has multiple efforts underway to fight Ebola that center on containing outbreaks of the virus at home and fighting the outbreak in West Africa. Domestically, the Obama administration has pursued a policy recommended by health professionals of taking the temperatures of passengers flying into the United States from the affected West African states of Liberia, Sierra Leone, and Guinea. The Los Angeles Times on October 16 writes that five airports are carrying out these checks in New York City (John F. Kennedy International), Newark, Atlanta, Chicago (O’Hare), and Washington (Dulles International). The United States does not have direct flights to any of the affected West African nations, as Delta Airlines ended its flights to Liberia in August, but West African nations can get into the United States by flying to European countries first. Although most European carriers have stopped flights to the West African counties devastated by the virus, some companies such as Brussels Airlines have continued flights. Current policy calls for travelers to have their temperature taken when they leave West Africa and fill out a questionnaire about their exposure to Ebola. After they arrive in the United States they have their temperature taken again. If a passenger shows symptoms of Ebola they are either not allowed to fly (if traveling out of West Africa) or they will be quarantined at the airport if they make it to the United States. The Los Angeles Times points out that seventy-seven people were not allowed to board flights out of West Africa last month because they had fevers, but none of these people eventually came down with Ebola. Critics of the policy note that Duncan lied on his questionnaire about his exposure to Ebola, and since the Ebola virus can incubate over a twenty-one day period someone can board a flight and arrive in a new country before Ebola symptoms develop.
As a result of concerns about the present temperature check policy, the Obama administration is being pressured to enact a travel ban on passengers coming into the country from West Africa. There is a growing call from Republicans on Capitol Hill (although some Democrats have joined them such as Virginia Senator Mark Warner) to enact such a policy. The Washington Times notes on October 16 that former pediatric neurosurgeon and potential 2016 Republican presidential candidate Ben Carson has called for a travel ban, saying that the policy is “common sense.” Supporters of a travel ban contend that it makes little sense to allow West Africans that might have Ebola to fly to other countries and contend that the best way to destroy the virus is to keep it contained in its region of origin. According to The Los Angeles Times article previously cited, they also argue that twenty-four African nations have imposed severe restrictions or outright bans on travel to and from the three West African states fighting the virus. Opponents of a travel ban, who President Obama is listening to at the moment, argue that it would make the situation worse by hindering the ability for relief groups such as Doctors Without Borders, who use commercial flights, from operating in West Africa. They also warn that it would create more panic among West Africans, who may try to hide their condition from medical personnel and try to flee the region in larger numbers, thereby making it harder to fight the virus. The Washington Post on October 15 explains that travel restrictions did very little to keep AIDS/HIV out of the United States in the 1980s and similar policies would do little in the effort to fight Ebola other than give the public a false sense of security. The White House’s reluctance to impose a travel ban is becoming a hot topic in midterm races, with Arkansas Democratic Senator Mark Pryor having an embarrassingly long “umm” when he was asked if he supported the administration’s policy. Conservative critics say it is a policy grounded in political correctness as the Obama administration does not want to offend its liberal supporters and does not want to offend the affected countries, while the President defends his stance by saying that he is merely following the advice of trained experts.
To better coordinate the nation’s response to the Ebola outbreak, President Obama named Ron Klain as America’s “Ebola czar” last Friday. The Hill on October 17 writes that Klain was the former chief of staff for Vice President Al Gore and Vice President Joe Biden. However, Republicans bashed the appointment by claiming that Klain has no disease control experience. They argue that Klain is another political crony that will prove ill-suited to the task that he has been given. The President’s supporters counter that Klain’s administrative experience is enough for his position as his task will be to get medical personnel around the country on the same page. The appointment of an “Ebola czar” was likely done by the White House to alleviate some of the pressure on CDC Director Frieden after his response to the outbreak in Texas was criticized last week. The White House also hopes that Klain can be very proactive in his position and calm public fears that the federal government does not know how to handle the virus.
Supplementing its policies at home, the United States is sending troops and other medical personnel to West Africa to assist Guinea, Liberia, and Sierra Leone. The Jerusalem Post on October 16 writes that this aid is needed because countries that are experiencing Ebola outbreaks have seen a collapse of their national healthcare systems. For example, Guinea President Alpha Conde has issued an appeal for retired doctors to return to the country and help. According to CNN on October 15, the United States is planning to send 4,000 troops to West Africa to help healthcare workers fight the virus. The Hill on October 16 writes that more than 500 troops are currently working in the region to assist in logistical operations, train healthcare workers, and build treatment units. The Defense Department has told the media several times that these troops will not care for Ebola patients except for a select group of soldiers who are well-trained and will staff mobile testing laboratories. Some members of the Congressional Black Caucus (CBC) such as Representative Keith Ellison (D-MN) and Barbara Lee (D-CA) have called for troops to directly care for Ebola patients, but that task will seemingly fall to sixty-five medical personnel sent by the U.S. Public Health Service. The Hill notes that these workers will staff a twenty-five-bed facility in Monrovia, Liberia to treat healthcare workers that have acquired the virus. Such a facility is needed because The Los Angeles Times reports in a separate article on October 16 that more than 200 healthcare workers have died treating Ebola patients in West Africa. By sending resources to the region, American policymakers hope that they can help African authorities, charitable groups, and international health officials get the virus under control.
Future U.S. Ebola Policy
In assessing what the U.S. might do in the future about Ebola, extempers have to consider the likelihood of the virus continuing to spread. Bloomberg on October 16 reveals that computer models suggest that more than two dozen Americans could come down with the virus by the end of the month, although it should be noted that this model included airline passengers bringing the virus into the country. This number is quite alarming, but The Washington Post reminds readers on October 15 that more than 36,000 Americans have died of the flu so far this year. Still, a Washington Post-ABC News poll taken last week found that 66% of Americans are worried about Ebola, with four out of every ten Americans “very” or “somewhat worried” that they or a close family member may contract the virus. Despite these fears, Time on October 16 writes that the World Health Organization (WHO) has downplayed the odds of the United States and Europe having a widespread Ebola outbreak because of their advanced healthcare systems. If the U.S. is able to limit the outbreak to the two nurses who treated Duncan then that should be considered a success, but if those numbers grow the federal government will have to consider other policies.
If the Ebola problem worsens, the federal government would have to consider a significant reform of its quarantine rules. Politico on October 16 writes that the federal government’s quarantine policies are more than 100 years old and are in dire need of reform. The George W. Bush administration proposed new rules in 2005 that would have allowed for the detaining of airline passengers for three days if they were suspected of having a dangerous illness and would have required airlines and cruise lines to store passengers e-mails, travel histories, and returning flight information. The federal government would have access to this information if a national health emergency took place. However, these plans never passed Congress due to complaints from the airline industry and civil libertarians. In 2010, the Obama administration shelved a reform of the country’s quarantine rules for unknown reasons. If an outbreak became a significant problem, though, extempers could expect the federal government to move quickly to change these quarantine rules, with policies put in place to prevent the travel of those who might be suspected carriers of Ebola.
Also, if Ebola became worse in a portion of the country the federal government has prepared to call out troops. The San Francisco Chronicle on October 17 explains that President Obama has authorized a call-up of reserves and the National Guard if they are needed to contain the virus. These troops could also be sent to West Africa if it is found that the 4,000 troop contingent that the U.S. is sending there is too small to perform its duties. Deploying troops to help medical personnel in the U.S. would be alarming, reminiscent of the 1990s film Outbreak, but such action may be needed if Ebola becomes a public health nightmare.
Assuming that Ebola will get worse – something that public officials have to contemplate – more funding is needed for the nation’s healthcare infrastructure. Time on October 15 writes that there are significant questions about whether every hospital in the United States could handle Ebola. The CDC has said that they will now deploy rapid response teams to hospitals that report cases, but this probably should have been part of their policy before Duncan arrived in the United States. A big problem with a widespread Ebola outbreak, as Time indicates, is that there are only four facilities in the United States that specialize in handling the virus: Emory University; the National Institutes of Health Clinical Center in Bethesda, Maryland; the University of Nebraska hospital in Omaha, Nebraska; and St. Patrick Hospital in Missoula, Montana. These institutes only have nineteen available beds, though, so if the U.S. had more than that number of cases they would face a serious public health quandary. Some medical analysts wonder whether the U.S. should look into creating a specialized hospital that is solely devoted to Ebola cases. This idea is attractive, but there are questions about how to staff such a facility, where it would be located, and how much it would cost.
A worsening outbreak would probably lead to the Obama administration reversing its stance on a travel ban. Regardless of whether such a policy was feasible or helpful, the demands of politics would force the White House to cave on its current stance, especially if more Ebola cases come into the country through air travel. Another worry is that if Ebola comes into Central America that migrants would try to flood over the Southern border for care. This would jeopardize the President’s hopes for immigration reform by turning attention toward some of the inadequacies of America’s Southern border, which is what the child migrant surge did to the administration’s hopes of taking executive action on the immigration issue this past summer.
Finally, there is also the question of whether the federal government will be needed to bailout life insurance, health insurance, or airline companies if the Ebola outbreak worsens. The Washington Post article from October 15 writes that Delta, United, and Southwest Airlines have seen the values of their respective socks fall by more than five percent this month as investors fear that the public will travel less to avoid the disease. For this reason, Amber Vinson’s travel despite having the virus was unwelcome news. However, fears of airline stocks crashing are premature as only a widespread Ebola outbreak in various parts of the country would cripple the industry. CBS News on October 14 argues that the life insurance industry would be okay in a worst-case scenario because more than two-thirds of Americans have policies and the industry typically pays more than two million death claims per year. This pales in comparison to thousands of Ebola cases that could potentially emerge in a worst-case scenario within America’s borders. CBS News warns, though, that the health insurance industry would be in a precarious position depending on the size of the outbreak as it reportedly cost $500,000 to treat Duncan in Texas. Other problems for the healthcare industry that could increase costs include medical malpractice lawsuits and indeed, Duncan’s relatives are considering such a lawsuit against Texas Presbyterian.
It is still premature for extempers and Americans to worry about Ebola. Despite some missteps, federal officials finally seem to be taking the necessary steps to thwart a more severe outbreak, but the long incubation time for the Ebola virus means that the public will be walking on eggshells until Thanksgiving. Hopefully, this Ebola scare will go the way of other health scares over anthrax, SARS, and swine flu, but ending it will require adequate preparedness and response at home while assisting West African states abroad.