Institutional breakdown in a time of Ebola

So, how is everybody feeling about Ebola today?

If exponential projections are to be believed (and the mealy-mouthed afterthoughts of our lizard authorities are not), then it looks like things could be shaping up to get pretty real. Or did you already know that?

Personally, I vacillate between mindblind social scientific absorption and horrified disbelief. As a good libertarian, I try to balance my sometimes-myopic trust in market coordination and social resiliency against a healthy awareness of black swan events and radical uncertainty—all underpinned, of course, by an awesome appreciation for those devilish cognitive biases that can make a lone summer shark attack look like a spree of sharknados. But I gotta admit that this Ebola thing is starting to bug me in a way that other spectacles don’t.

I first got the feeling that something might be amiss when I noticed the Vox set trying so hard to convince me otherwise. Then things got a little too close to the demonpit for comfort, so I summarily paid tribute to the Amazon gods for provisions. Having recently received my 2-day deliveries of the basic rations on the cheap—DuPont elastic waist hooded coverall suits (plus booties!) (2); Uvex stealth safety goggles; disposable latex gloves (100); plenty o’ Purell®; a 3M P100 respirator mask and particulate filter packs (3)—assuredly all very highly recommended by the buzzing prepper forums that I briefly browsed in a wild moment of womanly panic, I’m now feeling like I’m sitting a tiny bit more pretty in this gaping biotarget that is our nation’s capital. All that I really need now is the appropriate safety equipment for my sweet pugdog (hit a sister up if you’ve got the goods) and my superstitious Spanish soul will be that much more at ease.

You can think me a scaredy cat, but I could say I’m “building robustness.” Best case scenario, I get a last-minute tasteless Halloween costume at the reasonable cost of one brunch foregone and a couple of yucks at my morbid imagination. Worst case scenario, I get a few more worry-free days of life in an airborne Ebola situation.

Ok, so maybe I have more legitimate reasons to fear a fluke transmission from ordinary hospital errors than from airborne mutation or a 4GW surprise. Whatever, it made perfect sense at the time.

Clearly, my ritualistic and meager stockpiling does not indicate a real fear that a blood-letting global pandemic lurks in our near future. What truly worries me is the revealed massive failure of governance and series of pathetically botched responses that have allowed the epidemic to grow beyond control.

Those tin foil hatters over at the New York Times saw fit to print this grim diagnosis: “What is not getting said publicly, despite briefings and discussions in the inner circles of the world’s public health agencies, is that we are in totally uncharted waters and that Mother Nature is the only force in charge of the crisis at this time.” And Mother Nature is a bitch.

I can’t tell whether I should take comfort or despair in this shared realization. Looking around, I’m getting the hint that I can’t expect the relevant leaders and institutions to do an adequate job to protect me from the nasties they were created to monitor. A quick jog down memory lane might show you what I mean.

It’s been almost six months since the Guinean Ministry of Health first notified the World Health Organization (WHO) of a new flare up of the dread disease. Ebola had come and gone in the past, claiming a few hundred faraway souls at its worst. We collectively filed under “developing world problems” and went about our business: Out of information feeds, out of mind. Surely our well-funded, well-trained, well-pedigreed network of public health administrators and Neil DeGrasse Tyson were plugging away at the proper science magic.

It turns out that they really weren’t. Aid workers had been freaking out about the unusual rapid transmission rate since at least April, when the virus first started outstripping rascally missionaries‘ (and proper secular NGOs’) means to contain it. By late June, the 337 deaths and 528 known cases tabulated for the current outbreak exceeded all precedents. “The epidemic is out of control,” reported Doctors Without Borders/Médecins Sans Frontières (MSF) director of operations Dr. Bart Janssens on June 23, “With the appearance of new sites in Guinea, Sierra Leone, and Liberia, there is a real risk of it spreading to other areas.” MSF and others desperately urged international leaders to quickly send replenishing resources lest the outbreak become unmanageable.

But they didn’t, and it did. Google says that we didn’t start caring until around July 20th, around the time that an American doctor contracted the disease for the first time. Joanne Liu, the international head of MSF, flew to the gilded WHO headquarters in late July to beg the bucolic bureaucrats to declare the outbreak an international health emergency. WHO Director-General Margaret Chan told Liu to stop being so pessimistic. Chan had “high-level meetings to convene and discuss over cocktails and petits fours” to attend to, after all.

Our grand science wizards and rational democratic planners of the world are so out of touch that the morbid reality of Ebola’s unprecedented transmission rate struck these “leaders” at around the same time that the god-fearing public really caught wind. Kind of makes you wonder what those guys actually do all day.

By August 8, the WHO finally declared the outbreak a “public health emergency of international concern,” which is only to be used to indicate “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.”

The U.S. Centers for Disease Control and Prevention (CDC) got busy that day, releasing a series of infographics on its website, with helpful tips for the concerned citizen like “Likely host = bats.” Our so-cool, so-collected, so-experienced CDC director Tom Frieden had just testified before the relevant House Committees that he was “confident that a large Ebola outbreak in the United States will not occur,” and committed to “accelerat[ing] progress toward a world safe and secure from infectious disease threats and to promot[ing] global health security as an international priority”—for the low, low starting price of $45 billion.

Strong words from a man whose most recent previous testimony concerned the humiliating admission that his own CDC staff exposed themselves to deadly strains of anthrax and mistakenly unleashed mislabeled samples of the avian flu on unsuspecting Department of Agriculture employees. (This is not the first series of deadly samples that the CDC has unwittingly released to the great unknown.) When Frieden assures us that “the public health of the world is in [the CDC’s] hands,” you can be confident that he has sorted out his staff’s “potential for hubris” that barely fell short of re-introducing smallpox to the U.S. this January.

Obama was roused into semi-action a month later after the New York Times editorial board started to get spooked, committing U.S. resources to fight the raging outbreak. The White House floated another one of their stellar fact sheets from on high in an unsuccessful effort to quell lingering kulak unrest. Fear not, peasants! Our crack team of international relations majors will be “fortifying global health security infrastructure in the region and beyond.” Meanwhile, a preliminary survey by National Nurses United reports that 80% of solicited nurses say that their hospital had provided no policy for handling potential infected patients as of October 3.

These guys are the absolute lamest. In the clearest hour of crisis for which the esteemed alphabet soup of international bodies was created to boldly administrate, our leaders dawdle and deflect. What else do you think they can do?

A slump-shouldered Joe Biden, as usual, prematurely let the cat out of the bag (at the Kennedy School, of all shrines), “The international order that we painstakingly built after World War II and have defended over the last several decades is literally fraying at the seams.” Bummer. We’ve spent trillions of dollars building a global security empire and all West Africa got was a few thousand unprepared G.I. Josés and half-hearted promises that more beds are on the way—the flow of inadequate resources trickling to hotzones has barely picked up and is still many months too late.

Then the blood menace indeed infiltrated U.S. shores in September, prompting Vox to unceremoniously update its confidently scientific Ebola cardsVarieties of ugly prejudices, usually kept at benign bay in times of plenty, bubbled to the surface following the Dallas discovery. The inevitable subsequent series of false alarms, misinformation, and domestic tension only further rattled nerves.

The CDC and White House’s contradictory and sometimes perplexing statements—seesawing between uninspiring confidence in zero-risk rates of in-flight transmission and afterthought roll outs of dinky health screenings provided by our widely-respected Transportation Security Administration agents at select U.S. airports—did little to soothe anxieties.

The half lives of the credibility of the CDC’s health recommendations are similarly disappointing. The New York Times now tells us that a Dallas health care worker who cared for patient zero Thomas Duncan tested positive for the virus despite “following full C.D.C. precautions” and wearing full protective gear—“Asked how concerned he was that even after those precautions, the worker tested positive, [chief clinical officer of Texas Health Resources Dr. Daniel Varga] replied, ‘We’re very concerned.'”

Frieden dutifully took to the podium to do some ‘splaining. While the Hill reports that the “agency is unsure what or how it happened,” Frieden is sure that “a breach in [safety] protocol” must have occurred “at some point.” Stick to the protocol, urged Frieden, or else, “it is possible that we will see additional cases of Ebola.”

Then there’s Frieden’s baffling justification for allowing continued non-critical travel from Ebola-striken countries to the U.S. While I’m inclined to agree that closing the border would not automatically guarantee an Ebola-free America, Frieden steps on shaky ground when his first two contentions invoke: (1) a vague “right of return” for touring foreigners that immediately trumps domestic health, and (2) an insulting feigned ignorance of the possibility for aidworker exceptions. (To my knowledge, Frieden has yet to alert African nations nearer to danger that they’re doing it all wrong.)

It is clear that sacred science here is far from settled on Frieden’s side. In 2013, scientists at MIT published research suggesting “that even moderate measures of mobility restriction would be effective in controlling contagion in densely populated areas with highly interconnected road and transit networks,” with the caveat that this was a solely domestic simulation. The hatemongers at the Brookings Institution review the literature on the 1968-1969 influenza epidemic and find that, when combined with proper vaccination and conducive seasonality, the benefits of travel restrictions can exceed the relatively minimal costs and urge that “policymakers should not be too quick to rule out their implementation…in certain pandemic situations.” Previous CDC research in calmer times notes that “throughout recorded history, travel has been a major factor in the spread of disease” and calls for enhanced “border interventions” to control outbreaks.

But maybe this time is different. Today’s CDC may have good reasons to allow unfettered travel from blighted nations tempered only by limited screenings of dubious efficacy at five U.S. airports, but the ones provided so far ain’t so. If only for the administration’s own sake, public health officials should provide evidence-based reasoning for their decision to forgo basic travel restrictions, lest the fever swamp theories swirling in comment sections of high-level conspiracies to preserve open border purity (and secure millions of reliable Democrat votes) be allowed to gain dreaded credibility.

Come to think of it, the priorities laid out by Secretary of State John Kerry in a press conference last week—that “[w]e need airlines to continue to operate in West Africa and we need borders to remain open”—did smack of a revealing non sequitur. Stephen Morse, an epidemiologist at Columbia University, decodes for the rest of us: “It’s partly a philosophical choice.”

But to solely focus on bio-guilt blowback is to miss the point. While the lurking vulnerabilities revealed in our “world-class health system,” make us uneasy, West Africa’s fate has long been sealed by ominous math.

Let’s unpack exactly what an exponential transmission rate means in terms of humans. “Only” 49 known cases of Ebola were reported on March 22. By August 31, that number ballooned to 3,685 known or suspected cases across Guinea, Liberia, and Sierra Leone. The most recent WHO tabulation reports 8,033 known infections and 3,865 known deaths as of October 5. Ebola infections are now thought to double roughly every 20 days. On September 26, the CDC released a grim picture of Ebola’s projected path using two models, one based on existing data and another taking possible underreporting into account. In the unadjusted model, around 20,000 cases are expected by the end of October, roughly 35,000 by the end of November, 128,528 or so around Christmas, and half a million by the end of next January. If the assumptions of the more pessismistic, adjusted model are correct, then Ebola infections could actually exceed 1.4 million next January. Behold the plague’s exponential plotting:

Screenshot from 2014-10-12 15:17:50

(Suspected underreported data are displayed on the left, the corrected projections are unfortunately to the right. You can download their dataset here.)

“The virus is moving on virus time; we’re moving on bureaucracy or program time,” said Center for Infectious Disease Research and Policy at the University of Minnesota director Michael Osterholm to the Washington Post on October 9, “The virus is actually picking up the pace. Even as we add resources, we get farther behind.”

By the way, we’ve already gone through the entire supply of ZMapp, the most promising experimental Ebola treatment that cured American aid workers, and have only enough doses of the second most promising option, TKM-Ebola, for around 25 rounds of treatment. (If only we stooges had given more money to the National Institutes of Health, we’d have all the Ebola vaccines we want!)

Barring manna from science, it is only a matter of time until the virus spreads to other congested developing nations with healthcare systems ranking a good number notches below “world-class.” What then?

This all raises uncomfortable questions about the reigning international BIOS that has quietly kept this background arrangement online for so long. If an expiration date indeed looms near, who or what, if anything, will rise to assume the world’s burdens?  And what of the macabre transition? When graphic images of the thousands and tens of thousands and hundreds of thousands of African victims begin to trickle into our media diets, how will people react?

My guess is not well. I’m not confident there’s much in the way of promising backup plans in the works, either. If any of you honorable liberals out there are willing and able to rise to the occasion, now might be the time to do it.

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