After a series of missteps in dealing with an Ebola patient from Liberia, two health care workers who cared for the man are now infected "“ raising fresh concerns about the capacity of government agencies, private health care systems, and the American public itself to grapple with the virus. Five questions quickly came to mind. I asked them on Twitter and at the White House.
Why didn't the CDC immediately deploy teams to the Texas hospital for training and oversight of containment protocols? "I wish we had put a team like this on the ground the day the first patient was diagnosed. That might have prevented this infection," Dr. Tom Frieden, the CDC's director, said Tuesday. "But we are prepared to do this in the future with any case anywhere in the U.S."
One reason for the delay: The CDC didn't think deployment was necessary; it overestimated hospital preparedness and underestimated the virus.
Another reason: The CDC didn't want to feed public anxiety. While that is an important consideration of crisis managers, it shouldn't be the overriding one.
Did the White House play a role in the CDC's delay? While the White House insists that it's letting health care experts take the lead, there is ample reason to suspect that the CDC is at least following President Obama's example.
Admirably, the president abhors drama, overreaction, and (most) political theater. But those sentiments "“ infused throughout the clunky apparatuses of governing "“ create a culture that is almost always reactive. The Obama administration habitually waits until a problem becomes a crisis before reacting. It's almost always on the defensive.
The first rule in crisis management is to overwhelm a problem before it becomes a crisis. A shrug and soothing words never cut it, especially in a time of declining public faith in social institutions "“ including hospitals, doctors, the government, and even the U.S. presidency. Once you understand these basic facts, dispatching CDC teams at the first sign of Ebola becomes a no-brainer.
Should the United States restrict travel? Again, the CDC and White House made a decision that is understandable in a vacuum. From the beginning, Frieden has insisted that a mandatory travel ban would not contain Ebola and could backfire on the United States. "If we isolate these countries, what's not going to happen is disease staying there," he said. "It's going to spread more all over Africa, and we'll be at higher risk."
A ban would have economic consequences, affecting flights and/or travel throughout Europe because no flights come directly from the outbreak zones to the United States.
Still, two-thirds of Americans are concerned about an outbreak. While about 60 percent express at least some confidence in the federal government and local hospital to handle the situation, equal percentages want the government to do more. Two-thirds specifically support "restricting entry to the United States by people who've been in affected countries." These numbers are from an ABC-Washington Post poll conducted before Americans learned that two health care workers had become infected.
Astonishingly, the second health care worker who tested positive for Ebola flew by air Monday, the day before she reported symptoms, the CDC announced Wednesday. Here's a question: Why would somebody exposed to Ebola be allowed on a plane?
If the virus continues to spread, even slowly and in small numbers, the president will be forced to reconsider a travel ban. He will look reactive again, not proactive.
What series of (very) hypothetical events would keep Americans out of malls, airports, churches, schools, and other places of financial and social significance? I don't feel threatened by the virus. I trust the science, and I am reasonably hopeful that the relevant institutions will prevent a major outbreak. Still, officials at the White House and the CDC know that there is a tipping point in public opinion that they don't want to approach. Where is it? The answers I received via Twitter suggest that although Americans aren't panicking, they're starting to think about the unthinkable.
@ron_fournier an outbreak unrelated to Duncan may change life as we know it.— Madlaw (@madlaw1071) October 15, 2014
@ron_fournier already considering canceling vacation planned for Nov. I don't trust govt to tell truth or protect.— klg (@Phxwarpedview) October 15, 2014
.@ron_fournier certainly not a handful of isolated cases. Spread the fear all you like, until cases are in the 1000s, not worried about it.— Captain Steve Rogers (@CaptainSRogers) October 15, 2014
Should the president go to ground zero? It's one thing to tell Americans they're safe. It's another to show it. What message would Obama send by visiting federal, state, and local health care officials in Dallas? I care. We're on top of this. You'll be OK. In addition, Obama could personally thank first-responders on the nation's behalf, which can't be done enough. I asked a White House official about this idea. He laughed. "We don't do grandstanding," he said. "It would be a circus." Still, he didn't rule it out.
This article is from the archive of our partner National Journal.