Prior to September 28th this would not have happened. I wish I were making this scenario up. With all the information we have received about Ebola Viral Disease (EVD), you would think we would be better informed. Yes, think Ebola in every patient coming to the emergency room, but for goodness sake, this woman traveled to Jamaica!
In the wake of Thomas Duncan’s arrival in the United States from Liberia with Ebola last month, the fiasco surrounding his being sent home from the Emergency Room after his first visit, and the ensuing media hysteria, everybody is on the alert for Ebola. There actually now is a built-in prompt in the Emergency Room’s electronic medical record (EMR) that reports out “Patient DENIES travel to or contact with anyone who has traveled to Liberia, Sierra Leone, or Guinea, or any countries identified by WHO as having significant Ebola transmission in the past THREE weeks (21 days)” just in case somebody has been living under a rock.
Unfortunately, as proven time and time again, checklists even in electronic format are not substitutes for critical thinking. In the case of the returning traveler from Jamaica this EMR prompt and the CDC infographic did not help prevent her from being racially profiled. All anybody ever saw or heard was “black person”, airplane travel”, “fever” and no-one wanted anything to do with her. Paralyzed by irrational fear, made confused and full of self-doubt by media-driven conspiracy theories and pseudoscience, and maybe spurred by the current litigious environment, none of the ER physicians present wanted to be the one to come up with the most logical conclusion of “fever after travel to Jamaica is not Ebola”. Nor did they want to be the one to consider that the fever may have nothing to do with Jamaica. Maybe she came home and drank the spoilt milk in her fridge and now has gastroenteritis. Just maybe.
This is a problem. The lack of critical thinking that is.
Just the other day, a school nurse in New Jersey prompted a family with recent travel to Rwanda to keep their children home for 21 days just in case they had Ebola. Worse, was that no-one in the school district had the good sense to point out the obvious. There is no Ebola in Rwanda. That Rwanda is as far away from the West African countries being ravaged by Ebola as Alaska is from New Jersey did not seem to make a difference in the decision-making process. Africa is Africa and Africa has Ebola seemed to be the reasoning. If one African family has to sacrifice so the whole town feels better, so be it.
Just last week, the governors of New York and New Jersey decided that any healthcare worker coming back from taking care of Ebola patients in West Africa would be placed in mandatory involuntary quarantine for 21 days. This was prompted by a New York physician testing positive for Ebola upon arriving from Guinea where he had taken care of Ebola patients. To many in society this sounds perfect. But to the experts in infectious disease and public health, this actually makes no sense and is quite foolish. Furthermore, politicians should not be practicing medicine if they are not licensed to.
Already, we have caved in to societal and political pressure spurred by the hysteria whipped up by the media and decided to limit all flights originating in Liberia, Sierra Leone, or Guinea to entry into the United States only at five airports where entry screening is to be performed. Those without fevers or symptoms that could be interpreted as Ebola will then be monitored daily for 21 days by their local health departments. Monitoring in this instance includes a daily call in to report the presence or absence of fever, headache, muscle aches, vomiting, diarrhea, stomach pain as well as any travel plans within or outside of state lines. This in itself is stringent. This in itself should pacify the masses. But no.
It’s an election year. It’s almost election time. So what do the politicians do regardless of medical and expert advice? They impose even stricter mandatory protocols that are senseless, much like the Rwandan children being kept out of school. Protocols that are limiting the movements of a Yale University public health student who went to Liberia to help out with computer informatics and had no contact with anyone with Ebola and a nurse detained in New Jersey despite two negative Ebola tests when she arrived in the country after taking care of patients with Ebola in Liberia.
It saddens me though it shouldn’t. Why I stay idealistic I can’t fathom. The actions of the governors is somewhat akin to my Emergency Room physicians deciding to cast suspicion for Ebola on a returning traveller from Jamaica with fever. If a clinician cannot exercise medical judgment and analytical skills even with the use of a checklist, we have a problem. I guess, if an emergency room clinician can’t think straight, then I should not be too harsh on the governors who have no medical background. But just as the emergency room clinicians have the infectious disease physicians available to consult to set them straight, I’m sure the governors have access to experts in public health and infectious disease as well. So I’m still miffed, that they are ignoring the words of the experts and doing their own thing.
If a politician decides to ignore the advice of the experts, we have an even bigger problem. That such unnecessary action would discourage healthcare workers from volunteering in the countries affected notwithstanding it’s an action that promotes stigma, incites fear, and caters to the public’s ignorance. It is not true leadership nor is it a voice of reason. Their actions offer nothing in actual public health benefit and plenty in terms of a disastrous effect where in fact humanitarian response is greatly needed. We should not allow these politicians to think they can practice medicine and public health. They need to be held accountable to evidence driven science and public health no matter what their constituents may feel based on their ignorance. Feelings aren’t science. Feelings aren’t even truths sometimes. Ignorance. Stigma. Discrimination. Racism. Xenophobia. Indifference. This must have been how it was in the early 1980s when HIV and AIDS was making a splash.
Fear and stigma should not be the driving force in official responses to any disease. Such fear-based policies will only serve to cause more harm than good in the long run. I am sure there are ways to assuage public anxiety without stoking public hysteria. The simple fact remains that protocols need to be based on scientific and medical grounds. If not, what is the purpose of experts.
It’s all rather embarrassing and quite depressing.
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