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