How About We Very Calmly Count the Failures on Ebola So Far? Calm Enough For You?
The absolute worst public image you can have is being dead.
Hieronymus Bosch, "Death and the Miser"
There has been much more talk in Dallas the last few days about the dangers of panic than about the dangers of Ebola. In the meantime if we are paying attention we must notice by now that our vaunted Western industrialized defenses against contagion are riddled with holes.
We know that the Dallas-area hospital screening protocol for identifying emergency room patients recently arrived from an Ebola hot-zone failed when Thomas Eric Duncan showed up at the hospital on September 26. But incredibly a full week later we still don't know why the system failed, beyond mumbled explanations about laptop record-keeping systems not talking to each other, the dog-ate-my-homework excuse of the digital era.
Maybe the digits are to blame. But we also know that Texas Health Presbyterian Hospital, where the failure occurred, has a history of pushing emergency room show-ups out the door without adequate treatment in violation of federal regulations and law. Why hasn't the mayor or the governor launched a law enforcement investigation with badges and subpoena power to run this question to ground?
If the screening system at Presbyterian failed because of computers, and we know that, great, then we need to go to every hospital in the region and inspect their digital record-keeping systems to make sure this same thing won't happen the next time an Ebola patient walks in. If the failure was less accidental, more intentional, then officials should pursue the kind of prosecution that would put the fear of God in the next hospital tempted to dump an expensive bad-news-story patient.
We know that the management of the local hot zone where Duncan was living, The Ivy Apartments on Fair Oaks in the crowded Five Points neighborhood, was slow and haphazard almost beyond belief. Duncan was confirmed to have Ebola on the afternoon of September 30. Not until 24 hours later did the county officials inform residents of the apartment complex that they were in danger, and even then the notification was by fliers printed in English in an immigrant community where many people do not speak or read English. A day later residents were still bringing the fliers out to the scrum of reporters at the gate pleading with them to explain what the fliers meant.
We know that the management of the super-hot-zone, the specific apartment where Duncan was living it the complex, has been a bungled disaster. Residents of that apartment were ordered not to leave it, but somehow they did, until police were called.
At that point they were confined inside the uncleaned apartment with bags of bed linens soiled by the body fluids of Duncan when he was infectious. Local officials have continued to misrepresent the mechanisms of contagion, offering the public an AIDS-like scenario in which contagion occurs only through intimate physical contact. The CDC's own circulars stipulate that Ebola virus can survive on surfaces outside the body. Their contagious properties on those surfaces are not known, but CDC bulletins suggest those surfaces should be treated as dangerous.
What this means is that the adults inside that apartment were jailed inside a hot zone at risk of infection until the county finally bumbled its way to getting the apartment decontaminated.
We know that the mechanisms employed by the school district to protect students from exposure are an abject failure so far. Yesterday an exposed student -- supposedly at home in isolation -- showed up at school, was admitted and spent an unknown amount of time there before anyone figured out the child was a possible carrier.
Every company, building and institution of any size in Dallas has some protocol for preventing entry by persons thought to be dangerous, usually involving photo identification of the person and specific instructions to security personnel and management. Whatever system the school district has -- there must be one -- is a failure.
What we need more than calm is action. Local officials need to dig hard into what happened at Presbyterian and take much more aggressive measures than they have so far to ensure it doesn't happen again. We already know that leaving this up to the self-policing of hospitals doesn't work.
We don't know yet if Thomas Duncan tricked his way into the United States to avoid dying unattended on the floor of a hospital in Monrovia. If he did, it's a trick you or I might try in his shoes. Even if he did not sneak in deliberately, if his arrival here was innocent, we should assume that others will follow him here who are not innocent, and our awareness of that should heighten our vigilance.
Local officials need to develop a much better and faster strategy for confining a hot zone, one that assumes Ebola is most likely to show up first among immigrants living in crowded conditions who may not speak or read English.
Emergency housing should be available so that people not yet exposed can be relocated. One assumes that notification, relocation, isolation and decontamination all would have been achieved much more quickly and efficiently had the people exposed been affluent college students rather than poor immigrants.
The schools need to get way faster and smarter about protecting children in classrooms.
The string of failures in Dallas that began at Presbyterian Hospital a week ago has only grown. In the meantime, we see a great deal of effort and time expended on television appearances by local officials offering blandishments to the community about the need to avoid panic.
Panic is not a good thing, but generally speaking people do not die of panic. Panic is bad for business, elections and public image. But people die of Ebola. In a city where the leadership is often obsessed with image, perhaps we need to remind them that the worst image you can have and the last one is death.
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