Summary: Response to the Ebola epidemic has been woefully weak. This is a new type of menace which the government, in spite of all the supposed emphasis on Homeland Defense and Health Care, hasn´t prepared for properly. The lack of preparation is shown by the scrambling we see to fix gaps identified by the Dallas Ebola case (which has already led to a second infection in Dallas). The weak Government preparation and response was caused by the “nobody is in charge” and “rookies control the top post” syndromes.
Neither Homeland Security, nor Health and Human Services seem to be fully in charge, and their heads are new on the job. Homeland Defense´s Jeh Johnson, a lawyer,took over the job in December 2013. Health and Human Services´ Sylvia Burwell, a management type took over the job in June 2014. They weren´t chosen because they were top notch at stopping an epidemic.
The inadequate responses to the Ebola threat by both Federal, State, and local authorities in the USA are evident. The fact that a man landed in the USA after being in contact with an Ebola patient who died a few hours later, got sick with fever, went to a hospital in Dallas, was sent home with an aspirin…
If the reader isn´t aware of the lousy response, the mistakes piled on mistakes and the casual attitude taken by Dallas authorities, or the panic which ensued when the Frisco policeman was thought to have Ebola, the information is detailed in blog posts here
I´m not stating an isolated opinion. For example, here´s a quote from the Chicago Tribune:
Chicago Tribune Quote (shown with cleaning
crew at Thoma´s apartment in Dallas, CNN)
The Tribune continues:
“Checks with health departments in six states and cities that have large West African communities - Philadelphia, Boston, New York City, Minnesota, New Jersey, Maryland and Rhode Island - show that they are scrambling to adapt those generic plans to Ebola.
If they are not able to stay one step ahead of any cases, then lapses that characterized Ebola patient Thomas Eric Duncan's treatment in Dallas could recur.
There is a lot to do: hospital drills, 911 emergency operator guidelines, quarantine rules, even details such as checking that plastic body bags meet the minimal thickness - 150 micrometers - recommended by the U.S. Centers for Disease Control and Prevention.
"It takes a certain amount of reverse engineering to get the plan to where it can respond to new, emerging threats," said political scientist Chris Nelson, an expert on public health systems at Rand Corp.”
Is Ebola “a new emerging threat”? Or should the US government have prepared for the emergency? Are they being irresponsible allowing travelers from West Africa to enter the USA in such a casual fashion? You be the judge:
The first Ebola case was reported in Guinea in March 2014. Five months later the epidemic had spread to at least four other African countries and the eventual number of dead was projected to reach over 20 thousand (by now the number of people killed by the Ebola epidemic is projected to go as high as 1.2 million).
So let´s start the witch hunt. Is Homeland Security falling flat on its face?
The Bush administration created the Homeland Security Department and lumped under its command just about every agency and department which was supposed to help the country against attacks.
Jeh Johnson, the lawyer who
heads Homeland Security
So who is the guy in charge of Homeland Security? Jeh Johnson, a lawyer who “as General Counsel of the Defense Department, oversaw the development of the legal aspects of many of our nation’s counterterrorism policies”. Johnson took over the job in December 2013.
So the country has a rookie secretary of Homeland Defense, a lawyer who makes sure the legal issues are handled properly. On the other hand, the guy seems to be somewhat ineffective when it comes to homeland defense against Ebola.
The Secretary of Homeland Defense has a huge organization under his command. Here´s the department´s organization chart:
Homeland Defense Organization Chart (from their website)
I put red borders around the organizations which may have responded poorly to the Ebola threat. Now let´s dig a little deeper, what are two of these two groups supposed to do?
United States Customs and Border Protection (CBP) is one of the Department of Homeland Security’s largest and most complex components, with a priority mission of keeping terrorists and their weapons out of the U.S.
Office of Health Affairs (OHA) coordinates all medical activities of the Department of Homeland Security to ensure appropriate preparation for and response to incidents having medical significance. Kathryn Brinsfield, MD, MPH, FACEP is the Assistant Secretary for Health Affairs (acting). Her background includes serving as the supervisory medical officer for the International Medical and Surgical Response Team (1) .
I can´t find any material with information from the Office of Health Affairs with a response plan for something as simple as a single Liberian traveling to Dallas and infecting the population with Ebola.
The Office of Health Affairs doesn´t seem to have a real Homeland “Defense” focus. It seems to be quite happy allowing travelers from epidemic countries to enter the US and run around freely.
The only resource I found on the internet with information for local authorities was at the Centers for Disease Control (CDC).
These guys are so focused on terrorism they forgot Border Control lacks regulations or orders to stop the single Liberian with Ebola! Conclusion: After reading the Homeland Defense information I realized they weren´t really into preparing for the threat posed by a single person (never mind a dozen West Africans running loose in New York).
Digging around in those links I found out the National Advisory Health Council and the US Surgeon General can ask the president to issue an executive order to stop a potential epidemic from spreading:
“Regulations prescribed under this section shall not provide for the apprehension, detention, or conditional release of individuals except for the purpose of preventing the introduction, transmission, or spread of such communicable diseases as may be specified from time to time in Executive orders of the President upon the recommendation of the National Advisory Health Council and the Surgeon General.”
You see how it works? They got a Homeland Security Department which can´t really defend the population unless the National Advisory Health Council and the Surgeon General ask the President to issue an Executive Order. But the Surgeon General works in the Department of Health and Human Services…
The US Surgeon General sure seems to be worried about Ebola, as shown in this screen print of the Surgeon´s webpage
The webpage has a very prominent link to an Ebola page, which happens to be the CDC Director´s blog:
The CDC Director´s blog has a link called “Can you catch Ebola on a plane?¨. The link leads to a CNN webpage which includes the following quote from Stephen Monroe, deputy director of CDC's National Center for Emerging Zoonotic and Infectious Diseases:
"It's very unlikely that they would be able to spread the disease to fellow passengers," he said.
I don´t know about you, but I don´t like to see a government agency send me to a CNN webpage to read a statement by a government official. What´s the matter, they can´t get their business organized to offer the quote on their own webpage? Or are they afraid of giving information because the information may not be reliable?
Rear Admiral (RADM) Boris D. Lushniak, M.D., M.P.H., is the Acting United States Surgeon General who can ask the President for orders to stop the potential introduction of Ebola by travelers who aren´t showing symptoms but are already infected.
So where´s this National Advisory Health Council? I searched all over the place and I can´t find it! It seems the paperwork we get out of the CDC webpage is outdated, or this Council is super-duper secret and lacks its own webpage.
When I hit zero trying to find the National Advisory Health Council I decided to dig a bit in the Department of Health and Human Services, headed by Sylvia M. Burwell. Ms Burwell was the Director of the Office of Management and Budget (OMB). Before that she was the President of the Walmart Foundation in Bentonville, Arkansas. Prior to that she was President of the Global Development Program at the Bill & Melinda Gates Foundation in Seattle, Washington, and held a series of middle management posts in the Washington government.
Burwell sure seems smart and qualified to be a top level bureaucrat, but she has only been on the job since June 2014. Why didn´t she respond better to the Ebola menace? I suspect she was named to the post to fix the Obamacare system´s flaws (flaws which led to to Kathleen Sebelius´ resignation). Poor Burwell wasn´t focused on the Ebola epidemic at all.
Who else could have done something by this point? Nicole Lurie, M.D., M.S.P.H., Assistant Secretary for Preparedness and Response (ASPR). It seems she runs the Office of Emergency Management. She has held the post since 2009.
Dr. Lurie is very qualified for the job. But she has to work through the new Secretary of Health (the super smart accounting/management type, Ms. Burwell).
I could keep on tracing the individuals who are one way or the other involved in this mess. But thus far I´m finding very smart people who happen to be on the job, or aren´t qualified to make tough decisions when it comes to an epidemic. The ones who are prepared seem to be too low in the organizations to have an impact.
In recent weeks we have seen President Obama discussing Ukraine, the Middle East, ISIL, a little bit about global warming, but nothing much about Ebola other than to give us assurances everything is going very well and announcing he´s sending troops to fight Ebola in Africa. Meanwhile, the US has Jeh, Kathryn, Boris, Sylvia and Nicole defending the nation.
US Department of Health and Human Services buiding
Read This and Go Ballistic
(1) The International Medical Surgical Response Team (IMSURT) is a National Disaster Medical System team of medical specialists who provide surgical and critical care during a disaster or public health emergency. IMSURT personnel are Federal employees used on an intermittent basis to deploy to the site of a disaster or public health emergency and provide high quality, life saving surgical and critical care.