Ebola and Chaos Theory

Editor's note: The New York Times has confirmed that Thomas Eric Duncan "had direct contact with a woman stricken by Ebola on Sept. 15, just four days before he left Liberia for the United States[.]"

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But we have soothed ourselves into imagining sudden change as something that happens outside the normal order of things. ... We do not conceive of sudden, radical, irrational change as built into the very fabric of existence. Yet it is.

–Ian Malcolm, in Michael Crichton’s Jurassic Park

Deadly outbreaks begin when a nasty virus finds a victim and then, because of the frequency and intimacy of human interaction, handily spreads from one subject to the other through the air or those convenient bodily fluids.  Once it begins, it is hard to contain.  The public health system – no matter how sophisticated and prepared – will always be vulnerable, because it is run and implemented by fallible human beings.  One mistake, or series of mistakes, can change lives in a heartbeat.  We witnessed this in Dallas, where, instead of erring on the side of caution and isolating a patient exhibiting Ebola-like symptoms who told authorities he had traveled to West Africa, the hospital sent him home, because somewhere in the chain of communication, a decision-maker was not told he had been to the region.

According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, "It was a mistake. They dropped the ball."  "You don't want to pile on them, but hopefully this will never happen again."  Warm words that will be cold comfort if this deadliest of viruses gains a foothold in this country. 

Actually, we should pile on the public health system.  This isn’t a careless mistake on a math test or a fender-bender in the parking lot.  This is one of those horrific train wrecks you see play out in slow motion.  I can just hear Obama saying, “Mistakes were made.  Lives were lost.  But we’ve grown stronger and learned some valuable lessons.”  Or “Yes, I think my experts underestimated the strength of this virus and its potential for disaster.”

It was not long ago that our President reassured us: 

The chances of an Ebola outbreak here in the United States are extremely low.  We've been taking the necessary precautions, including working with countries in West Africa to increase screening at airports so that someone with the virus doesn't get on a plane for the United States.  In the unlikely event that someone with Ebola does reach our shores, we've taken new measures so that we are prepared here at home.

Well, low chances or not, Ebola did reach our shores, the patient did get on a plane, and we were caught with our pants way down on the home front.  This virus doesn’t discriminate, can’t be stopped by 3,000 boots on the ground, and spreads exponentially.  There are no do-overs.  Is it not surprising we saw the same scenario play out with the Secret Service dropping the ball when Omar Gonzalez stormed the White House?  There are longstanding procedures in place for almost every foreseeable contingency for the president’s security, and one goof-up could have resulted in him being shot. 

In all aspects of life on Earth, there are unpredictable and unanticipated factors that can change expectant outcomes.  The smart person prepares for all foreseeable contingencies, recognizing that you-know-what happens, but you do your best to prevent it.  So far, the CDC and our public health system are not doing their best.   

Another fatal flaw in our Ebola prevention system is this bizarre belief that people – sometimes, sick, scared, and desperate people – will provide authorities with accurate information about where they’ve been and to whom they’ve been exposed.  Blindly relying on information obtained this way introduces countless variables into the equation that could knock any sense of control into a state of chaos. 

Sure, ask the questions, but don’t be so gullible as to take all of the answers as gospel.      

It is not clear how Patient Zero was screened at the airport.  All we know is that he did not have a fever or symptoms when he got on the planes and was therefore not contagious, thus, no one in the airports in Liberia, Brussels, or Texas need worry.  And I have a bridge to sell you…

But what if he took a Tylenol before he went to the airport for a headache or an aching knee?  That would have masked a fever, so it is possible he (or someone else on the plane who was exposed and took a Tylenol) was actually symptomatic and contagious.  One sneeze into your row-mate’s Pepsi, and the virus is on the prowl, with a chaotic chain of events unleashed. 

The CDC’s Dr. Frieden is confident that the system will contain and prevent the spread of the virus and will successfully track and, if need be, isolate all potential contacts.  But does anyone honestly believe that once this genie is out of the bottle, it can be shoved back in? 

Ebola is an R2 disease, which means for every infected person, two more will be infected…and so forth and so on.  We already know that five kids were exposed, as were the paramedics in the ambulance and 12 to 18 others.  We can never be sure the authorities located all of the people he encountered on his journeys to and from the hospital. 

The system is not sound, and, without inciting a panic, we shouldn’t feel safe, because this government did not do what it said it had done.  Preventing this kind of exposure to a deadly disease and its potential outbreak is precisely the CDC's raison d’être.

During an interview with CNN’s Sanjay Gupta, Dr. Frieden claimed that simply standing next to each other would not constitute contact.  Gupta pointed out that the CDC guidelines indicate that if an individual is within three feet of someone who is infected, he or she is at a higher risk.

Frieden then replies: 

We look at each situation individually and we assess it based on how sick the individual is and what the nature of the contact is and, certainly if you’re within 3 feet, that’s a situation we’d want to be concerned about, but in this case, where we haven’t hugged, we haven’t shaken hands, we have not had any contact that would allow either of our body fluids to be in contact with the other person.

Gupta: "So, to Michaela’s point, the reason we talk about coughing and sneezing not being a concern, if you were to have coughed on me, that, you’re saying that would not be a concern?"

Frieden: "We would look at that situation very closely to see at what point in the person’s illness and, you know, we’re always gonna  err on the side of caution."

So here’s the confusing summary of what we know:

  • Ebola is not spread through the air.  Only through direct contact of bodily fluids – saliva, mucous, blood, sweat, urine, feces, vomit, etc. 
  • Ebola is not contagious unless the infected person is exhibiting symptoms of fever, vomiting, etc. 
  • To determine if someone is infected, take his temperature and ask him questions.  Assume that he is telling the truth at your own risk. 
  • Ebola, it seems, can be contracted through direct contact – shaking hands, hugging, standing within three feet of an infected person, sneezing, or coughing.

Okay.  Now that that’s clear, Frieden further cautions us that cutting off flights to the infected regions in West Africa would backfire: 

The impulse might be to isolate these countries.  If we do that, we'll actually be increasing our own risk because, really, the simple truth is, by stopping it there and by helping them stop it there, we're helping ourselves.

I don’t think anyone opposes stopping the spread of the disease in Africa – it’s similar to Bush’s strategy (now Obama’s) about terrorists.  But does Frieden really believe his own words?  Or does he think we’re just that stupid?  That if he smiles and makes light about hugging and shaking hands, and constantly reassures us that we can keep our good health if we want to, we’ll believe that isolating the afflicted countries will increase our risk?  I cannot imagine even liberals buying this one.    

Riddle me this, CDC-man: if people in West Africa are being isolated as they become infected, if other countries have canceled air transportation to and from these nations to prevent the contagion from crossing their borders and ravaging their populations, if we are isolating Patient Zero and, potentially, his contacts in Dallas, if we isolated the Samaritan’s Purse doctor and missionary when we brought them back here a few weeks ago, then why would we isolate people and countries if it was debilitating to us?  Obviously, it works.  It prevents Patients One through Infinity from flying around the globe, spreading death like it's some skeletal figure in a painting from the Middle Ages or some dystopian-apocalyptic movie on SyFy. 

In the best of all possible worlds (or La La Land), the citizens of this country might be able to convince themselves, like Dr. Frieden has, that the public health system can trace, track, and isolate all contacts and contain this virus.  And if a contact slips through the cracks and goes out to the desert to die without meeting anyone along the way, and the body decomposes before anyone can touch it, then maybe it can be contained. 

But if that contact slips through the cracks – as chaos theory and life experience dictate – then the potential for disaster increases dramatically.  To be this confident about something this lethal, for which there is no cure or vaccine, is the height of arrogance and stupidity and demonstrates an unwillingness to face the music.

We don’t even have the ZMAPP – the serum that was successfully administered to the doctor and missionary from Samaritan’s Purse – to fall back on.  Turns out, ZMAPP is in short supply – in fact, stocks have run dry.  It is experimental, and not all of the patients who were administered the serum survived.  The animal trials were performed with a different Ebola strain (not this one, which is the Zaire varietal), and it takes months to grow on tobacco leaves the three man-made antibodies that are required to produce the ZMAPP.  The use of blood plasma remains hopeful – some patients were injected with antibody-rich blood plasma from Ebola survivors, and it seems to have worked – but thousands will die in the interim, and now some of those deaths might be on our shores.

Life will always have its Pollyannas – like the grandfatherly John Hammond character in the movie Jurassic Park, who created the dinosaur-themed amusement park and could not see the chaos unfolding before his very eyes.  He arrogantly thought of everything, except that which he could not foresee – those nasty extraneous factors or idiosyncratic events that can undo anything at any moment, like a guy from Liberia getting on a plane to visit his family in Texas.

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