Maine Judge Charles LaVerdiere: The EBOLA Czar

In his recent decision to lift the Ebola quarantine on Maine nurse, Kaci Hickox, Judge Charles LaVerdiere - in one fell swoop-  has made himself the “Ebola Czar” for Maine. His decision is not just about Kaci’s right to evade the personal inconvenience of a quarantine imposed by experienced health officials and the governor, it sets a troubling precedent for all other similar, Ebola quarantine situations. It makes an unelected judge, with no medical qualifications or expertise  the “kingpin” of the Ebola problem in Maine. Its impact on public health morale and management must be devastating. It leaves unanswered the question: Who in Maine is in charge of future plans and actions for Ebola - LaVerdiere or public health officials? It is an example, in our opinion, of “judicial power” gone wild, as LaVerdiere carves out an inappropriate role for a jurist: self-appointed “epidemiologist in chief” for Maine!

Judge LaVerdiere  resoundingly scorns the lack of science and the fear mongering on the part of Maine’s trained public health officials, and claims to be operating on the basis of “science”. One has to ask, “Does this new public health “Emperor” have any clothes?” His own scientific ‘bona fides’ seem very scant indeed. We suspect LaVerdiere’s opinions are based on “All I know is what I read in the paper.” And, as we know, many “newspapers”, such as our very own PPH, are using the American Ebola problem as a political tool to support, “Scientist-in-Chief” Obama - and local partisans.

In dealing with Ebola in Maine - or for that matter in the US - we are addressing a public health problem of preventive medicine - preventing a potentially lethal epidemic that could have devastating effects on our populations. It is important in thinking about Ebola to separate “prevention” from “treatment” of actual cases. Wherever possible we want “to prevent”. It is about “population oriented” public health programs of prevention in a population where Ebola hasn’t surfaced. And... we don’t want it to surface! Quarantine is, and always has been, our major “prevention” tool when facing an epidemic.

The major tool for prevention of Ebola (or any disease with epidemic potential) is isolation of “at risk” persons. This is in no way to say that “at risk” will inevitably shift into “very high risk” and, then, into  frank clinical Ebola. Prevention is always a safety first approach, which has been tried and proven by public health officials in many countries over a period of over a century. A classic “population oriented approach” cannot ever be based on “perfect certainty”; therefore, it defines “risk” and moves to isolate it in order to protect large, vulnerable populations from exposure to risk. In brief, this is the essence of public health practice when faced with the potential threat of a difficult to control epidemic. It may inconvenience individuals in the process, but its higher purpose aims at  the best level of public protection for the greater number of people.

“Dr” LaVerdiere is basically defining the Ebola “risk” down, minimizing it without presenting his evidence. He has also deemed the personal “inconvenience of quarantine” for one person as of a higher public value than public safety or public protection. He is in this matter at odds with the reported 80% of the public who vote for safety and quarantine! “Personal inconvenience” has just been been raised by Judge LaVerdiere to the highest social value and, at the same time, he implies that public safety is just for “sissies”!

Public fear of Ebola was scorned by LaVerdiere in his comments. Public fear of the disease he inferred was media manufactured or ”neurotic”. But one asks, is it  “neurotic” for any of us to fear a potentially lethal epidemic when someone like LaVerdiere is trashing our protections and our protectors in public health? His recent decision effectively “fires” the public health officials (and the governor) on whom we rely for public health protection! Were people in past ages “fearless” or “neurotically fearful ' when facing “the Black Death”? How about modern day Africa? Any fear of Ebola there? Fear is a logical normal reaction to a possible death threat. LaVerdiere should stop using this sort of “junk science/pop psychology” unorthodox, "unscientific" tools acquired, perhaps, from his long exposure to family courts where “junk science” and “pop” psychology are rampant.

We hope that Tuesday’s court hearing on the Kaci Hickox story can lead to our public health officials to be put back in charge of Ebola epidemiology. Can LaVerdiere back off? If he can’t the state of Maine should send him for a sabbatical to the Harvard School of Public Health for instruction in epidemiology!

For the welfare of the public, LaVerdiere should immediately resign as ‘de facto’ Maine state epidemiologist. He is totally unqualified. His recent public health decision is a fair sample, for those who have never seen other evidence, of his similar questionable judgments in family court matters!

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Ebola: Public Health Practice vs post modern politics

Traditionally, public health practice looks at any epidemic in terms of levels of prevention: primary, secondary and tertiary prevention. For a successful battling of an epidemic all three types of prevention activities are needed, if possible. Primary prevention is the notion of an absolute prevention of new cases (reducing incidence), using whatever methodologies are available. A vaccination program - when vaccine exists- is one excellent example of primary prevention. Eliminating infected water or food sources is another tactic for food or water borne infections. Isolating or strictly localizing infected persons is yet another classic preventive approach, which aims at halting further spread of the disease.

Secondary prevention is treating actual, existing, known cases of the disease and conducting the treatment in such a manner as to prevent spread of the illness from the known cases of the illness to those around them, in contact with them: family, friends, caregivers, children. The aim here is to reduce the prevalence by reducing the numbers of sick by early treatment and intervention- and thereby eliminating spread of the disease to the extent possible.

Tertiary prevention is reducing the pools of disability and dysfunctions that may result in people who have recovered from the infectious stage of the illness, but who retain secondary damage, dysfunction or disability. It is commonly thought of as "rehabilitation" from secondary (non-infectious) disabling effects of an illness (such as paralysis in polio).

In all of its activities public health aims at keeping the public well and functioning. It is what is called a "population oriented approach" defining populations at risk and intervening in the ways noted above. It works for the greater good of the "at risk" population, and to do so it must have medical control over those who can cause contamination/infection of those who are potential victims of the epidemic.

This classic public health approach is at odds with the rampant, "I have a right", personal rights of the post-modern generation.  Officials must minutely titrate risk/benefit so as to avoid offending politically.  In the present Ebola epidemic there are larger, always latent political issues: the epidemic is in a "black African country" (watch out for the "race card"), there are national interests vs the liberal fear that we don't want to appear "nationalistic". We have elements in the country (US) that believes passionately in "diversity" and in the myth of "the international community". The liberal concern is "what will our neighbors think".

So public health becomes "political health" and our leaders try to cut things as close as possible to protect individualistic rights, feminist rights in the face of potential contagion. Is it better to exhibit "politically correct" 'bona fides' than to protect our huge population from death? Today's Portland Press Herald has multiple reportages, editorials, opinions about Ebola is a near perfect demo of the liberal interpretation of the issue and the problems for partisan political purposes. Since the epidemiology of Ebola, or any viral disease, is not a precise matter, the mantra of "only if you have contact with body fluids" gets repeated again and again. But viruses are prone to change genetically over the course of an epidemic, and human resistance/immunity is highly variable.

Does the Ebola virus know that the US President will only allow it to cause disease via body fluids?  What about used Kleenexes, door knobs, cutlery, dinner plates, clothing wash basins, bath tubs, towels, face cloths? And ... which body fluids: spray from coughing and sneezing, sputum, sweat, feces?

The question for the US public is: How safe do we want to be? How much risk of medical danger can we tolerate? Is being scrupulously politically correct more important to everyone than getting a potentially deadly disease? Look what the military is recommending. Look at other countries.

Governor LePage Issues Statement About Healthcare Worker in Fort Kent Who Worked in West Africa

October 29, 2014

For Immediate Release: Wednesday, October 29, 2014
Contact: Adrienne Bennett, Press Secretary (207) 287-2531

AUGUSTA – Governor Paul R. LePage issued a statement Wednesday morning about a healthcare worker who had been quarantined in New Jersey and is now in Fort Kent still under voluntary quarantine.

“We commend all healthcare workers for their humanitarian work in West Africa and other regions in the world, and we are proud that Americans are always ready to help others,” said Governor LePage. “However, the healthcare worker who is in Fort Kent has been unwilling to follow the protocols set forth by the Maine CDC and the U.S. Centers for Disease Control for medical workers who have been in contact with Ebola patients.”

“We hoped that the healthcare worker would voluntarily comply with these protocols, but this individual has stated publicly she will not abide by the protocols,” Governor LePage said. “We are very concerned about her safety and health and that of the community. We are exploring all of our options for protecting the health and well-being of the healthcare worker, anyone who comes in contact with her, the Fort Kent community and all of Maine. While we certainly respect the rights of one individual, we must be vigilant in protecting 1.3 million Mainers, as well as anyone who visits our great state.”

Upon learning the healthcare worker intends to defy the protocols, the Office of the Governor has been working collaboratively with the State health officials within the Department of Health and Human Services to seek legal authority to enforce the quarantine.

Governor LePage and the Maine CDC have been following the care and movements of the healthcare worker since Monday. The Maine State Police will monitor the residence in Fort Kent where the healthcare worker is staying, for both her protection and the health of the community.

To protect privacy and security, neither this person’s identity nor the location of quarantine will be released by the state.

The original press release may be found by following this link: Governor Paul LePage