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Is the U.S. overly confident about Ebola control?

October 15, 2014 at 6:40 PM EDT
Officials have been saying that the U.S. knows how to stop Ebola, but now another nurse has been infected. What's gone wrong? Judy Woodruff talks to Laurie Garrett of the Council on Foreign Relations.
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JUDY WOODRUFF: From the president on down, the federal government sought to tamp down any anxiety over additional Ebola cases in the U.S., while at the same time it adjusted and increased its response and delivered some disturbing news of a second nurse who contracted the disease just after she flew commercially.

Laurie Garrett, who has long written about infectious diseases and international health, joins us from New York. She’s a fellow at the Council on Foreign Relations.

Laurie Garrett, welcome back to the program.

Administration officials have been saying for some time that the U.S. knows how to stop Ebola, the protocols are in place, but clearly something has gone wrong. Is it clear what’s gone wrong?

LAURIE GARRETT, Council on Foreign Relations: I don’t think precisely what happened with each of these nurses.

But the nurses unions have been releasing some distressing photographs showing gaps in the protective gear, in particular the neck completely exposed, and the top of the protective suits were open, much as my collar is here. That wouldn’t be sufficient protection for Ebola contact exposure.

JUDY WOODRUFF: Well, the administration, we listened to the Centers for Disease Control news conference, or I should say telephone news conference today. And they said that the protocols are now in place, that any mistakes like this that happened are not going to happen again. How much confidence should we have that that’s the case?

LAURIE GARRETT: I think our biggest challenge in the United States is hubris. We have consistently heard and said — and, by the way, it’s not just the government saying this. It’s been all the public health associations, the American Medical Association, all the major physician groups and so on — for quite some time saying, look, what’s going on over there in Africa is the result of inadequate health systems, poor hygiene and so on. It wouldn’t be like that here in America. We know how to do this.

And I think it is kind of a smug attitude. And it’s very similar and reminiscent to a similar smug sense of self-assurance that dictated the response Canada had to the arrival of SARS in the Toronto hospital system in 2003.

When you contrast how quickly Vietnam in its poverty managed to control SARS in 2003, compared to how long — it just kept coming back again and again in the hospital system in Toronto — it shows that there’s a certain arrogance that happens with technology. We sort of think, well, we have this high-tech equipment, we can stop it.

But there’s a lot more to stopping the spread of a virus than just high-tech equipment.

JUDY WOODRUFF: Well, clearly, Americans now are looking for some reassurance, without getting overly alarmed about what’s happened.

For example, Dr. Frieden, who is the head of the CDC, said today that, going forward, all the individuals who All right, exposed to anyone with Ebola clearly knows they need to be monitoring themselves, they need to stay away from any sort of public forms of transportation. Again, how confident should we be? That message has gone forward.

The president just today reinforced the idea of these SWAT teams that are going to go to hospitals within 24 hours if there are new cases. Should we be confident that all this is going to happen?

LAURIE GARRETT: Look, I think the bottom line here is that what really matters in disease control is the way in which you have organization and rules of the road for all the various people that are players in the system.

Starts at your local hospital and your small town. Do people know what to do in an emergency room? And does the whole set of chain of events of calls and notification up the ladder proceed smoothly, accurately, in a timely fashion? Is everybody on board, and do they know what they’re supposed to do?

This is not technology. This is, do you know your job and do you know who to call if you’re suspicious, if there’s something wrong? And let’s go back and remember that Mr. Duncan told, we now know, three different times told people, I have been in Liberia. And, somehow, the knee-jerk response of the hospital was, does he have insurance or not? Let’s get him out of here. He sits in the waiting room, we now know, for hours, potentially exposing God knows how many people.

JUDY WOODRUFF: Well, based on the reporting you have been doing, the conversations you have been having with public health officials throughout the country, is it your sense that they are now at least working to convey guidelines, protocols in a way that will be followed going forward?

LAURIE GARRETT: Yes.

I think everybody is awake now. The alarms are ringing, and there’s a lot of distress and there’s a lot of trying to come up with better, smarter algorithms. What are the questions you ask at intake? Who do you call, how do you respond, what kind of equipment can be brought to bear?

And also some more thinking about how to get better compliance in that 21-day window for, not only people that are around the Duncan case, but for all those who go overseas to be involved in the Liberia and Sierra Leone outbreak and then return, what are the appropriate protocols for them, for the news reporters that were with the NBC crew with the one individual who got infected and is now in care?

How can we make everybody on board in a much more coherent and clearly understood said of rules of the game?

JUDY WOODRUFF: Finally and quickly, Laurie Garrett, any new information, any — what is your understanding right now of whether progress, there is a sense of progress being made in these West African countries that, of course, have a much worse problem at this point with Ebola?

LAURIE GARRETT: Well, Judy, of course, we all know the only way you are going to have 100 percent for America is to stop the epidemic at its source.

And there, unfortunately, we have some very bad news. Today, for the first time in WHO’s situation — daily situation report assessing how things are moving along, they had to concede they had no data from Liberia. It’s gotten so bad and so extensive that nobody really can even come up with numbers to put forward.

So the numbers you led with, roughly 9,000 cumulative cases and roughly approaching 5,000 deaths, everybody now admits these numbers are not even close to providing a reflection of reality, that it is almost certainly well over 22,000 cumulative cases at this point and approaching 15,000 or 16,000 deaths.

And as this keeps going out of control, it gets harder and harder to even have a glimpse of the reality of the size and scope of the problem. So while we’re very focused here in America on two cases, let’s keep in mind safety for us is stopping something that is orders of magnitude bigger overseas.

JUDY WOODRUFF: Laurie Garrett, we thank you.

LAURIE GARRETT: Thank you.

 

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