Much public skepticism about the government’s response to Ebola stems from the dogmatic pronouncements of Obama administration officials. In a video message early last month on stopping the virus, for example, President Obama asserted that “we know how to do it.” He was wrong.
The world has learned that dealing with Ebola in remote African villages is a very different challenge from confronting an unfamiliar virus in large cities and modern hospitals.
The Centers for Disease Control and Prevention, despite a rocky beginning, now recognizes that containing Ebola presents unexpected challenges of technique and execution. The White House, for its part, apparently thinks it is a messaging problem.
To fix his messaging problem, President Obama has appointed political fixer Ron Klain as its new Ebola response “czar.” Mr. Klain’s most significant contribution to public-health spin control came when he was Vice President Joe Biden’s chief of staff during one of the worst public-health communications missteps of recent memory. During the 2009 H1N1 pandemic, Mr. Biden said on NBC’s “Today” show that “I wouldn’t go anywhere in confined places now.” The White House press office scrambled to walk back Mr. Biden’s words, which threatened to disrupt public transportation and air travel.
The CDC’s lapses—such as failing to intensify the recommended protective gear for medical workers or tighten techniques for handling hospital waste—may have contributed to the unnecessary secondary spread of the virus to two nurses. Misstatements by its director, Thomas Frieden, about the risk to U.S. citizens and hospital personnel, have rightly fueled some of the criticism directed his way. But Dr. Frieden deserves credit for chasing down the agency’s errors and readily acknowledging its bad decisions.
One insight about the Ebola epidemic has already emerged: Health-care workers inside a modern U.S. hospital, paradoxically, may be at greater risk for contamination and infection than those in West Africa’s spartan clinics. That’s because of the comprehensive way that critical care is delivered in the U.S., reflecting the health-care system’s greater sophistication. Dr. Frieden has cited kidney dialysis and intubation with a breathing tube as two such high-risk procedures. But many other seemingly routine services in an intensive-care unit—including frequent blood draws and bedding changes, and the use of feeding tubes and IVs—can be sources of contamination.
As a result, the CDC is changing its approach. Initially the CDC’s plan was to let patients be treated in place at major hospitals. The idea was that these institutions would gain experience that would be essential in the event of a larger outbreak. Now the CDC seems to be moving toward a model of expert referral centers, where a smaller network of hospitals can be specially equipped and trained to handle Ebola, and where the CDC can exert tighter controls.
The CDC might also recommend limiting the scope and size of the medical teams assigned to Ebola care. Smaller teams could increase the level of expertise among those assigned to these panels, and reduce the number of health-care workers exposed to each patient. This arrangement would resemble how hospitals have adapted to deliver other specialized services where skill and tight infection controls are paramount, such as bone-marrow transplant wards.
Mr. Obama has stated repeatedly that the U.S. has helped to snuff out every other outbreak of Ebola and that the country will do the same with this one. However, past outbreaks occurred almost exclusively in remote villages, and entire locales would be cordoned off while the virus burned itself out. Liberia, a country of 4.4 million people, can’t be encircled. Nor can Dallas be quarantined.
Instead, medical countermeasures are critical. Despite early swagger by public-health officials at the National Institutes of Health and CDC that this crisis will be solved with public-health tools alone, and that a vaccine or treatment won’t be available in time, smart medical experts are recognizing the need for a therapeutic drug or vaccine.
One leading plan is for a 30,000-person clinical trial to begin as early as December with two experimental vaccines. Two groups of 10,000 West Africans will each receive one of the two novel vaccines. A third group of 10,000 West Africans will serve as a control group and receive a hepatitis B vaccine. The plan is dependent on completing early-stage trials under way now and having vaccine supply on schedule.
While a vaccine is needed to help stop the epidemic in West Africa, it is equally important to develop a drug to treat the disease in those who have been infected. This is especially so for the U.S., where a drug or drugs can combat containable outbreaks.
The Ebola epidemic this year has also revealed to everyone how little is really known about the disease. We don’t fully understand how the virus attacks patients, or how it is spread. Or how it can change.
For example, some expert observers have said that patients with Ebola may be developing high loads of the virus more quickly. Peter Jahrling, chief scientist at the National Institute of Allergy and Infectious Diseases, told Vox.com last week that if the virus burns hotter and faster, it could make patients more contagious earlier in the course of illness. It’s a theory at this stage. But it reminds us that there are many things we don’t know, and a lot of ways Ebola can adapt to become deadlier.
In part to deal with these uncertainties, the CDC has revised recommendations for the protective gear that health-care workers should wear and updated guidance on handling patients and medical waste. The CDC’s models for the spread of the disease in West Africa are also notably more transparent, and dire, than those of other world-health agencies.
The CDC tracks, traces and advises the health-care system regarding disease outbreaks; it doesn’t deliver medical care. The agency’s virtue is its reliance on data and evidence for decision-making. When that evidence is scant, it can lead to errors of judgment. What seems obvious in hindsight about the episode in Dallas—that a nurse, caring for an Ebola patient, who comes down with a temperature of 99.5 degrees might have contracted the virus—is not always obvious in real time during an outbreak with a wily, unfamiliar pathogen. The CDC is already becoming more cautious in its recommendations to deal with greater unknowns.
The broad, early assurances from Mr. Obama prove that the best political messages don’t make for good public health. The public won’t be spooked by an admission that we don’t have all the answers, as long as people sense that they are being spoken to honestly and believe that officials are pursuing key uncertainties.
The good news is that the CDC is learning from early missteps and adapting its strategy. As for Mr. Klain, we hope he gives the president better briefings than he apparently gave Joe Biden.