Monday, October 27, 2014

Ebola Quarantines and the Arrogance of Governor Chris Christie

by Nomad

Governors Christie and Cuomo's decision to implement a quarantine for all travellers for Ebola may be an idea that both will soon regret.
It opens a whole lot of questions about their quality of leadership and the ability to think rationally in a crisis. 

On Friday of last week, we witnessed Republican New Jersey Governor Chris Christie and Democratic Governor Andrew Cuomo of New York giving a press conference. They had come to announce that all travelers from the Ebola-stricken areas of West Africa would be put into a 21-day quarantine. All people entering the country through Newark Liberty and Kennedy International Airport would be affected by the ban. The decision had been made following the report of a Dr. Craig Spencer who was New York's first and only case of Ebola. 

The Decision to Quarantine
In some ways it was an astonishing bit of theatre.
Christie and Cuomo implied that the CDC had failed to protect the American people. In fact, he said that the measures were necessary because "the CDC keeps changing its mind." He offered no examples. 
Christie went on to imply that he, as a governor, knew more than nearly of all of the experts who have studied Ebola for years.  

From all reports, neither governor consulted medical experts or the White House before taking this step. These measures went far beyond what federal guidelines advised and what infectious disease experts have recommended.

Actually, the president had already issued its opinion that such a quarantine would most likely do more harm than good. In all three states, New York, New Jersey and Illinois, the governors have decided to, as Cuomo put it, "err on the side of caution."

So, to put their words into action, on Friday, Kaci Hickox, a nurse and epidemiologist for Doctors Without Borders, was detained at at Newark International Airport and was immediately forced into a mandatory quarantine. She had just returned from Sierra Leone, one of the three worst-hit countries,  yet showed absolutely no signs of an infection (the only time when the disease is contagious.)

The quarantine, which consisted on a unheated tent structure outside a university hospital in Newark, provided only the bare essentials, a port-a-potty, no shower. She has been also reportedly given only paper scrubs to wear. If Ms. Hickox was not sick when she arrived, she now has perhaps a better chance of catching a nasty flu.
Hickox is understandably upset (and who wouldn't be?) International travel is hard enough and she isn't even returning from a vacation. Working in the primitive conditions of West Africa must have been hard enough. Watching people die had to be hard enough. And now she is thrown into a plastic-sheet prison for it.

She is, not unexpectedly, planning legal action against the state of New Jersey and perhaps against the governor's office. In something of an understatement, the nurse told reporters 
"I feel like my basic human rights have been violated.”
Christie in the past has been accused of -how shall I put- heavy handedness to the point of bullying. And this ill-advised decision certainly supports that profile. I guess that's inevitable when you grab people from airports and lock them up. 

His rationale for quarantining all travelers for 21 days simply makes no sense. Especially when you consider that the one infected person in New York, had wandered through the streets, and carried on life as normal before showing signs and to date, there was no sign of transmission. Not even to those who were closest to the patient.

Governor Cuomo has since backtracked on that press conference statement. Yesterday, this office announced that travelers will be allowed to remain at home instead of locked down at a health facility. Allowed or Required or Forced? When one is talking about 21 days of strictly no contact with the outside world, every word and every detail is important. There are other questions too.
  • How is this person expect to eat without some kind of outside support? 
  • Who will be in charge of providing for a quarantined person's needs in the three weeks?
  • What happens to the other family members who may share the same environment? 
  • Are they also to be quarantined? 
  • If not, then what is the point? 
  • How this quarantine would even be enforced is not clear. Wouldn't it require twenty-four hour round the clock police surveillance? 
Bean-counting penny-pinching conservatives are not going to like paying for that. And all this needless "erring" for a person who has shown no sign of being infected with anything. 
In short, the entire plan seems to have been thrown together without any real thought to the practicalities. 

Hysteria and Nonsense
It's hard not to see the political side to the recent events. While Cuomo is, at least, nominally Democrat, it has been a hot topic for the GOP.
Republicans have made several attempts to portray the president as reckless and negligent in his handling of the Ebola crisis. The media has joined in, creating an atmosphere of hysteria and dread. 

For instance, Sen. Rand Paul (R-Ky.) and Rep. Louie Gohmert (R-Texas) slammed the president's decision to stop Ebola in its tracks by sending 3,000 U.S. military personnel to the region. 
Their mission is to supply medical and logistical support to overwhelmed local health care systems and to boost the number of beds needed to isolate and treat victims of the epidemic. Paul and Gohmert claimed that infected troops would spread the disease back to the US. Paul told one right wing radio interviewer:
"When you're in a very close confines on a ship -- we all know about cruises and how they get these diarrhea viruses that are transmitted very easily. Can you imagine if a whole ship full of our soldiers catch Ebola?"
But, wouldn't a ship be much easier to quarantine than say a plane? To compare a battleship with its strict adherence to protocol and secured zones to a luxury cruise where people are allowed to wander about in relative freedom is just plain dishonest. Besides, a luxury cruise ship has already had an Ebola scare and the crew and other passengers were able to follow the correct protocols without much fuss. 

Anyway, is sending troops any more dangerous than sending them into harm's way in a war zone? The Far Right has taken quite a different view about sending troops to Syria or back to Iraq. Comparing Ebola hot zones and Middle-Eastern war zones, it's clearly easier to protect oneself with a set of well-considered SOPs, a hazmat suit, and a box of rubber gloves than to attempt outrun a jihadist bullet or to survive a roadside bomb. 

True to his character, Rep. Gohmert, for his part, added a just little more hysteria, incoherence and nonsense. That's about the only thing he seems good at. He told reporters:
"The military is not trained to go catch Ebola and die. They're trained to go in and kill the people that want to come back and kill us. The president’s priorities are all mixed up here. All you got to do is shut down traffic in and out of places where there’s high risk of Ebola.”
Since Texas was the first case of Ebola, perhaps we should shut down the state borders there? Of course, Governor Perry has had a hard enough time defending the state borders from naughty runaway children.

Critics have viewed the whole idea of the quarantine was a means of thumbing the nose at the president, trying to accuse him of incompetence (and worse) and generally defying his leadership in the most arrogant way possible. What Rand and Gohmert are doing is certainly not about formulating a logical and efficient means of addressing the challenge. 
Not on a national level or on a global one. 
The worst result of this political showmanship is to create doubt and suspicion and fear in the mind of the public.  
And it is shameful.

When the mayor of New York issued a statement of disapproval of the quarantine, Bill de Blasio attempted to put a brake on the rush to bad policy. He repeated what experts have been saying again and again.  
“New Yorkers who have not been exposed to an infected person’s bodily fluids are simply not at risk."
There was no need to overreact.
We have the finest public health system, not only anywhere in the country but anywhere in the world."
According to the mayor, the quarantine effectively punished doctors and health care experts for making a humanitarian effort.

Medical researchers concurred that the governor's plan would discourage health care professionals from traveling to Africa. The window of opportunity to stop Ebola from being the next AIDS crisis is quickly closing and the time to act is now. 
To put obstacles in the way of treatment and containment is not only stupid but dangerous for every person on the planet. 

The Incoherent Christie Defense
On Fox News, Christie attempted to defend his position by repeating what Cuomo had said.
“I don't believe that when you're dealing with something as serious as this that we can count on a voluntary system.”
The former view of conservative Republicans was  that government was the enemy, that regulations were nothing more than interference. 
Magically that's been replaced by a very big arrogant government that refuses to listen to anybody. The idea that big government should not intrude into the lives of its citizens has suddenly vanished. 
“This is government’s job. If anything else, the government’s job is to protect the safety and health of our citizens.”
So let's get this straight. It is government's duty to incarcerate the perfectly healthy citizens in the name of appeasing the fears stoked by the Republicans and the raving media outlets like Fox News. After all, this mandatory quarantine isn't actually protecting anybody. 

Imagine the reaction if the president have implemented the same poorly-thought out idea? There would be a new round of calls for his impeachment from the Right.

Is it, as Christie said, government's job to protect the safety and health of its citizens? 
While intelligent people would not disagree with the idea, it's a very interesting thing for a member of a political party that has sworn to abolish affordable healthcare for Americans to say. 

Perhaps Christie should be addressing those remarks not to the president but to the twenty or so governors that have brushed aside Medicaid expansion in their respective states. Governors like, Rick Perry and Scott Walker don't seem to think government has any responsibility to provide adequate health care. They haven't show any sign of recognizing the safety when it came to the low-income families in their own states.

Alabama Gov. Robert Bentley claimed that the government had no business interfering between the doctor and his patient. The federal government, he said, doesn't deserve our trust. Unwittingly, it is Chris Christie, not President Obama, that is providing a strong argument for exactly that position.

In fact, when President Obama espoused the same notions about the government's job, his affordable healthcare act was so firmly opposed by the Republican Party that not a single Republican voted for the final version that Obama signed into law. 
No, not one.
Governor Bobby Jindal, in defending his own rejection, said "the era of big government is here." and Republican Christie likes it just fine when big government allows him to bully innocent people.

Tough Guy in the Corner
Christie's tough guy approach and hard nose attitude has forced the governor into a rather tight corner. Given his arrogance it will not be easy for him to admit that the quarantine was a bad idea. 
And eventually he will have to.  

The nurse who sits in quarantine probably has a very good legal case against the state. So we add that to the cost of implementing the quarantine. New Jersey taxpayers are going to be shelling out a lot of money thanks to their governor. It's clearly a case of false imprisonment, since the nurse has not been charged with a crime, nor found to be infected with any disease. It cannot be considered a health issue at all. The nurse has also been deny the pretense of due process or the right to challenge the decision by an independent and qualified board of physicians.

It could also be a human rights issue with according to Article 9 of the Universal Declaration of Human Rights "no person shall be subjected to arbitrary arrest, detention or exile." 

Erring whether on the side of caution or for any other reason is still erring and ignoring the advice of medical experts will count heavily on any legal defense the governors attempt. 
When you think about it, health concerns are the only reasons they offer for a quarantine. It's their only justification. Yet most doctors and health care policy experts all seem to think it is, at best, pointless and at worst, counter-productive. So the quarantine seems completely arbitrary.

After ignoring the experts and putting himself above the medical community, Christie (and the other governors) now has no option but to press ahead with an indefensible stand on imprisoning the very people attempting to do good.  

Christie- like all bullies- will no doubt attempt to portray nurse Hickox as an irresponsible person (even though she has done nothing wrong in any way.) Blaming the victim is par for the course for such a mentality. The tragedy is that more Africans could die because doctors will simply refuse to be subject to governors' whims, arrogance and ignorance. 

Who can blame them? 
Ann Coulter- always prepared to add a noxious ingredient to any discussion- complained that mission aid workers and doctors have only themselves to blame for going to god-forsaken areas. They should stay at home. Cuba showed more humanity than anything so far seen in the ranks of America's right wing.

Some of the comments I read online have already showed how eagerly some people are to trash doctors and nurses who went out of their way to do good. And Christie, Gohmert, Rand and others bear some responsibility for exciting this mindless and hate-filled over-reaction.
Of course, the most ironic aspect to this stupidity is that Chris Christie should have listened to his own advice. In the past, Christie said:
Everyone wants to demagogue everyone else. That may be good politics, but it's awful policy.
To add bit more clumsiness to Governor Christie's idea, the governor has issued a statement last evening. According to that, the protocol for quarantine has not changed. The policy is clear, the statement reads: 
A New Jersey resident that shows no symptoms but who has come into contact with someone with Ebola, such as a health care provider, would be subject to a mandatory quarantine order and quarantined at home. Non-residents would be transported to their homes if feasible and if not, quarantined in New Jersey.
This leaves the embarrassing question about why Ms. Hickox was given this kind of treatment the first place. Some kind of plausible explanation for her case is required. And an apology. 

All of it adds up to just another fiasco for Christie completely of his own making.