To The Daily Sun,
Have you noticed that when Dr. Thomas R. Frieden, director of the CDC, is asked if the safety protocols are adequate, he responds by explaining the mechanics of Ebola transmission and does so in a manner that does not consider the possibility of incomplete knowledge of all aspects of Ebola transmission. It has only been studied since the 1970s. Dr. Frieden's confidence that there will not be a significant outbreak in the United States is appreciated in light of today's poll that suggests one-third of our local hospitals do not have the necessary equipment and 86 percent have had no training, or protocol they can immediately access.
Consider four failures of our policy and CDC protocols which recently exposed hundreds, perhaps thousands of Americans to this disease.
1. A foreign patient was tested but not identified as positive at the airport in Monrovia, Liberia.
2. This same patient lied on a health form at the airport.
3. A Texas hospital staff failed to diagnose Ebola even when the patient cited the symptoms, and told them he just arrived from Liberia.
4. A parent of exposed children decided to ignore the CDC's instructions and sent the exposed children to school. In these instances the CDC protocols and related national policies relied upon the notions that people always tell the truth, people always following CDC instructions, hospital personnel always function perfectly, and a patently inadequate airport-administered test for Ebola is good enough. Of course none of these things are true thus the overall policy outcome: The detection of an Ebola-infected immigrant failed at every level.
As astonishing as these failures are, there is an even greater concern. News reports lead us to understand that experts in the relevant CDC protocols, with every incentive to strictly adhere to these protocols, while working in a hospital environment, albeit in Western Africa, have contracted Ebola. In sum, the question is not whether the protocols are failing. Whether due to protocol inadequacies themselves or unaccounted for human failings, these protocols have already failed.
In risk-management terms, the risk — as currently understood — is the probable death of all Americans afflicted. Given this assumption, is it not reasonable to assume that our national policies and CDC protocols be reasonably robust? If so, is it reasonable to assume that these national policies and protocols not be based upon assumptions such as: 1. We already know everything relative to Ebola transmission; 2. A demonstrably deficient airport-administered test is good enough; 3. Foreign nationals will forego leaving their country for vastly improved treatment rather than lie about exposure; 4. Hospital staffs always function perfectly, and 5. Unsupervised exposed people will always following CDC instructions?
As this issue attains purchase in public discourse, positions have begun to polarize. I have noted that people who even question the confirmed weaknesses of our present Ebola containment strategy are called "alarmist," "a nut," "should be ashamed of himself," and is only "scaring people."
Predictably, bureaucrats will defend their turf. Dr. Thomas R. Frieden, director of the CDC, while failing to recognize the widely reported weaknesses of CDC protocols, has conjured up all of his border control and international relations expertise to assert that "We can not close our borders" to this disease, (as England and France have done), and we can not "isolate" the inflicted countries.
The problem with these absolutist mutually exclusive options presented by Dr. Frieden is that they are false choices. They represent extreme notions that retard applied critical thinking and genuine problem solving. To assert that we should not minimize the number of Ebola afflicted immigrants because we cannot identify every Ebola afflicted immigrant is nonsensical. The very core of epidemiology is that the benefit of limiting the number of afflicted patients includes the minimization of the number of future patients.
Likewise, it is as obvious that altruistic motives as well as American self interest, mandates that we assist Ebola afflicted countries. Only Dr. Frieden's straw-man argument speaks to the irrational possibility of "isolating" Ebola afflicted countries.
Rather than utilize television interviews to defend the obvious inadequate current CDC protocols and related immigration positions beyond his area of expertise, Dr. Frieden needs to immediately grasp the reality of the demonstrated frailties of the protocols within his area of responsibility.
Next, Dr. Frieden needs to focus the CDC's efforts on the epidemiological aspects of these flaws as rapidly and efficiently as possible. To accomplish this Dr. Frieden needs to understand that any protocol that anticipates that every policy element will always work perfectly is not grounded in reality. People lie and will often fail to follow CDC instructions, well intended screening tests still need to be reliable, and well intended hospital staffs are not infallible.
Accepting this, and understanding the risk, Dr. Frieden needs to depart from minimally effective superficial protocols. America needs a defense in depth emphasizing closely supervised redundant procedures that collectively minimize the potential death of American citizens from Ebola--even if one or more elements of the protocol fail due to human or institutional mistakes. Continued flat-earth debates that defend the current failed CDC protocols, as well as irrelevant straw man arguments is a myopic waste of valuable effort and time.
I hope that Dr. Frieden needs to rise above these tactics quickly or eventually be remembered for providing less than optimal service to America when his leadership was required.
Michael D. Breen, Ph.D.
- Category: Letters
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