Ebola politics

There’s been a raging battle in the United States between governors and public health officials concerning the Ebola outbreak, with lessons we might want to derive for the Philippines.

The governors of New York, New Jersey and Maine have ordered very strict quarantine measures for volunteers returning from the African countries where the Ebola outbreak has been most virulent, where they were helping to control the spread of the disease. The quarantine extends for as long as three weeks; it requires confinement to the house or, in the case of one nurse, Kaci Hickox, to a tent set up in a hospital in New Jersey. The nurse has since been released but is fighting an order in her home state of Maine to be “monitored” in her house.

CNN’s Anderson Cooper interviewed another Maine resident, an information technology expert who had come back from Africa and who had tested negative but was still confined to his home. He explained that this quarantine policy would discourage other people planning to volunteer to help control the epidemic. For example, someone wanting to give six weeks of volunteer work in Africa would in effect have to sacrifice nine weeks away from work, if you include the quarantine when they return to the United States.

The US Centers for Disease Control (CDC), a government agency, has guidelines that are much less stringent compared to what the governors have been prescribing, mainly requiring those who have had contact with Ebola patients to undergo a checkup and to receive a phone call from local public health authorities. The CDC points out that infection occurs only when there has been direct contact with a patient’s blood, urine, vomit, or saliva. Even with direct contact, this might not mean automatic infection. In fact, one of the treatments being used is getting blood from an infected person and injecting this to another patient, with the objective of stimulating the production of antibodies that will fight the virus.

US President Barack Obama has supported the CDC’s guidelines, but politicians like the governors say they are only protecting their constituents through the strict measures.

The Philippines’ health authorities should be looking at what’s going on in the United States and learning from the battle there between politics and science. But even among medical scientists involved in public health, we see disagreements—a battle between two models for controlling disease.

Cordon sanitaire

One is the police model, exemplified by the use of the cordon sanitaire. The term is now often used to refer to politicians or leaders who surround themselves with, and listen only to, a small group of advisers. But the term’s origins are actually in public health, in the 19th century, when a disease outbreak would result in the affected community being cordoned off, with no one allowed to leave and no visitors allowed in.

In the most extreme form of a cordon sanitaire, the community would be left on its own, without any external support, until the epidemic or outbreak ends, by which time many residents in the cordoned area would have died, not necessarily from the disease but from starvation and other forms of deprivation.

This police model of public health is what we see with the American governors. In Maine, the state police has actually been deployed to force the isolation of the nurse, Kaci Hickox.

In the early years of the HIV/AIDS epidemic the police model was also strong, with politicians and doctors in many countries, including the Philippines, teaming up to call for the quarantine of people found to be infected with HIV. Calls for quarantine are popular with politicians, who ride on the fears of their constituents and thus make of themselves seeming protectors of public health.

But this police model has been opposed because such draconian measures would only drive infected people underground, and, as we see now with the Ebola outbreak, drive away health professionals and others who could be helping to control the diseases.

Community participation

A second model for disease control looks into maximizing community participation for education, for reporting of infections, and for caring for patients. This was the model we adopted for HIV/AIDS, with the vulnerable groups themselves conducting information and education campaigns, and looking for ways to get patients the medicines and care that they need.

This model recognizes how certain population groups might be more vulnerable than others, and searches for ways to deal with that vulnerability. With Ebola, for example, it recognizes that the Philippines is vulnerable because we have so many Filipinos working overseas.

But it would be a mistake to label all returning overseas Filipino workers as potential Ebola carriers, especially if they are returning from West Africa.

We might want to pick up a lead from a report published in The Lancet, a British medical journal, that looks at data from the International Air Transport Association concerning the destinations of travelers originating from Guinea, Liberia and Sierra Leone. Among the findings was that most of the travelers were just flying within Africa, and to Britain, France and Belgium. The analysis did show that China was the 10th largest destination, and India the 13th largest, so both countries are now on alert for the possible entry of Ebola.

A final word: While we fret about the possible entry of the Ebola virus, we let our guard down vis-à-vis other diseases that have quietly been taking their toll. With the cold season coming in, the world is preparing for outbreaks of flu and pneumonia, which each year kills thousands of people, especially the very young and the elderly.

Flu spreads very easily because the virus is airborne, spread when an infected person coughs or sneezes. This does not happen with the Ebola virus.

So if you are older, or have a weak immune system, do make sure you have flu and pneumonia shots.

As for Ebola, we should be vigilant, but not paranoid.

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E-mail: mtan@inquirer.com.ph