Ebola: An Abundance Of (un)Caution

Originally published in The Havok Journal on 18 October 2014.

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Here is what cautious people do.  Cautious people know that all firearms are loaded until checked.  Cautious people know that you should check behind the vehicle before you move it.  Cautious people do not use a hair dryer in the shower.  Uncautious people give you Ebola.

The CDC and others say that they will use an “Abundance of Caution” with situations that may involve Ebola.  To borrow a quote, “You keep using that word. I do not think it means what you think it means.” (Princess Bride, Inigo Montoya)

One person on a plane from Africa unleashed Ebola in our country.  This act raises many questions.  First, why was anyone who arrived from the affected areas of Guinea, Sierra Leone, or Liberia not quarantined at Customs?  If I was exercising even the tiniest bit of caution, much less an “abundance” of caution, I would make sure we could contact the individual and have a physician monitor them until I was certain they did not have a transmittable life threatening disease.

The CDC says that are confident that it is not transmitted by air, that it requires bodily fluids.  When you cough, are there not bodily fluids?  Isn’t that the critical point?  The transmission method isn’t the issue here, their misplaced “confidence” is the problem.

The CDC, the Center for Disease Control, doesn’t understand how Ebola is spread.  They don’t know where this strain came from.  They have limited testing and evaluation, but they know it is not airborne.  There are some very critical items of information missing before they start making some claims what they are or are not confident about.  Confidence is just a motivated way to die while still being dead wrong.

I’m not epidemiologist, but I do know about managing risk.  The first rule of risk assessment is, if you don’t know, you prepare and act like the threat is the worst you can imagine.  That is not only a reasonable and logical solution, which is also what agencies like the CDC have been taught to do.  Establish control, prepare for the worst, and evaluate the situation.  Then you can lower protection levels if it turns out they were too high.  You do not put new fire extinguishers into a burned house.

Now we have two health care workers infected.  They both got the virus from the original patient who managed to get all the way home and was not properly screened who has since died.  The second infection was to a nurse who happened to take a flight.  Now local communities are closing schools, parents are terrified that their children will get infected, the school district is reacting and the city is in a low grade panic with rumor and fear beginning to outpace common sense.

Why?  Because the CDC keeps putting out garbage and calling it science.  This does not have to spiral into chaos and no one in this nation need be afraid for no reason, but for that to happen, the CDC and the Administration needs to get their heads out of their collective asses and realize that this is not a time for loose standards and read up on the definitions for ‘abundance of caution’.

The blame party has started and the hospital is accepting responsibility for the ‘failures’ to adequately diagnose and treat Thomas Duncan, patient zero for the United States.  If the CDC had been doing their jobs, Thomas Duncan would not have ended up going to a hospital that did not know how to handle him.  If the CDC had been doing their jobs, the hospital might have rock solid procedures in place to deal with viral threats of this nature.  But the CDC is just now updating their protocols and the hospital is taking the heat for the mistakes.

My confidence level in the CDC is so low I have to dig to look at it.  If you take a look at the CDC webpage   you see the word “interim guidance” six times and all were updated in the last few months.  The definition of Interim guidance is ‘we don’t know for sure, you’re the guinea pig, your sacrifice will help others’.

Ebola has an uncertain mortality rate in America.  We don’t know how bad it can get here but we do have absolutely qualified medical personnel, they just need guidance. However, the CDC is issuing interim guidance, after an infection and successful transmission to medical staff.  They do not own up to the fact that they left that hospital, the passengers on several different planes, and everyone that came in contact with Thomas Duncan with a possible death sentence because they are idiots.

Should we panic?  No.  The best prevention methods are already known to every American.  Treat it like the flu.  Keep your hands clean, cover your mouth when you cough and ensure others do, disinfect everyday items with bleach solution.  You could wear a mask if you really want to but for the most part, it might be excessive.

The problem is not that this is difficult to deal with.  The problem is that the CDC has lost the public confidence and the administration has not had it in a while.

A patient with Ebola is infection from the first signs of the symptoms and fever is a symptom.  Average body temperature is 98.6 but it is just that, an average.  What happens if the patient runs a baseline normal temp of about 97.2, they could be reading a fever at 98.6 but the hospital staff would be unaware?

Their recommendation for handling the dead, no autopsy, no mortuary preparation, do not open the bag, put in a hermetically sealed casket and burn.   Why this level of security?  Because the infection remains after death.

Do we need a travel ban?  Maybe; we need some legitimate precautions on travel and information on people and passengers.  You cannot lock people up but at the same time, you cannot just let possibly infected people wander around without keeping track of them.

Dr. Thomas Frieden, Director for the CDC, said that since the second victim of infection, Amber Vinson was not symptomatic, the risk to the other passengers remains extremely low but out of an abundance of caution, the CDC will reach out to the passengers and the crew of the flight.

The CDC was notified by Vinson that she had a fever; the CDC cleared her to fly anyway, now they are saying she lied to them.  Fever is a symptom but apparently, out of an abundance of caution, it was not a concern.  Now we have 132 potential infections and not a small amount of panic as family members are worried about their children and themselves and the Government still has not found all of them after two days.

All of this could have been prevented with more accurate guidance and better understanding of the precautions local hospitals should be expected to deal with.

Wanting to quell potential panic is one thing; making light of a situation like this that could lead to a pandemic is another.  And using a line like abundance of caution, after all the failures they have already had in this situation, is a bit much.

But they will get “SWAT Teams” according to the President.  Wait, what?  We are going to have armed agents who arrive at a hospital to perform raids?  Someone needs to inform the President that Special Weapons And Tactics, are not what is required, or maybe someone needs to tell him to stop using acronyms that he does not know the meaning to.

How bad is it?  I don’t know and neither does the CDC.  It is possible to take action and be authoritative without causing a panic.  All it takes is, wait, and abundance of caution.  Like detailed information about travelers from suspected threat areas with supervision by specific physicians until we know that they don’t have an infection.  We don’t know the latency so we need to establish a timeline but these are simple steps that could have been initiated with little disruption or fear.

We know it is a virus and we know it can kill.  That is all that is factually known everything else is a guess based on a small sample base in a third world country without proper evaluations, healthcare, or control measures.  When you don’t have sure answers, you prepare for what you don’t know.  We have better healthcare but you still don’t take chances.

Or you put lives in jeopardy.  Two women, secure in their medical knowledge, failed by the organization that did not prepare them for the risks they were exposed to.  Abundance of caution my ass, it is not time to panic, yet.  It is time to get the politicians in lab coats out of the way and put real medical professionals who understand the lethal threat and can issue the correct preventive and handling guidance without the ‘interim’ (we are guessing) attached.  The CDC and our President aren’t doing their jobs; if anything, they are demonstrating an abundance of “uncaution.”