Wednesday, October 29, 2014



Kaci Hickox

Doctors Without Scruples

And why are soldiers being quarantined

Kaci Hickox, the nurse who was briefly quarantined at a Newark, N.J., hospital after flying into the state en route from Ebola-ravaged Sierra Leone, now says she won’t comply with the three-week home-quarantine requirements in her home state of Maine. “She doesn’t want to agree to continue to be confined to a residence beyond the two days,” her New York-based lawyer, Steven Hyman, tells the Bangor Daily News.The Associated Press quotes Hyman as saying: “She’s a very good person who did very good work and deserves to be honored, not detained, for it.”
At least two other medical professionals have acted as if public-health rules don’t apply to them. The New York Post reports that physician Craig Spencer—like Hickox a volunteer for Doctors Without Borders, in his case in Guinea—“lied to authorities about his travels around the city . . ., law-enforcement sources said”:
Spencer at first told officials that he isolated himself in his Harlem apartment—and didn’t admit he rode the subways, dined out and went bowling until cops looked at his MetroCard the sources said.
“He told the authorities that he self-quarantined. Detectives then reviewed his credit-card statement and MetroCard and found that he went over here, over there, up and down and all around,” a source said.
And let’s not forget Nancy Snyderman, a Princeton, N.J., physician who entered voluntary quarantine after a fellow traveler to Liberia was diagnosed with Ebola. On Oct. 9 the Planet Princeton website reported that “Snyderman allegedly was seen sitting in her car outside of the Peasant Grill in Hopewell Boro this afternoon. A reader reported that a man who was with her got out of the car and went inside the restaurant to pick up a take-out order. Another man was in the back seat of her black Mercedes. Snyderman had sunglasses on and had her hair pulled back, the reader said.”
The state issued a mandatory quarantine order, and on Oct. 13 Snyderman “issued an apology to the public . . . but did not indicate that she had violated the voluntary confinement agreement . . . or take personal responsibility for the violation.”
At least Doctors Without Borders is off the hook for Snyderman. She works for NBC as chief medical correspondent.
Secretary Hagel ENLARGE
Secretary Hagel Associated Press
Meanwhile, the Defense Department has announced that all U.S. servicemen “returning from areas affected by Ebola in West Africa” will be subjected to “a 21-day monitoring period.” As noted here yesterday, that has already been the de facto policy. The Pentagon press release doesn’t use the word “quarantine,” but every media report we’ve seen does.
The statement quotes a Pentagon spokesman as saying Secretary Chuck Hagel “believes these initial steps are prudent, given the large number of military personnel transiting from their home base and West Africa and the unique logistical demands and impact this deployment has on the force.” It’s hard to disagree, though one might add: and the irresponsible, if not downright dishonest, behavior of various civilian medics.
But of course Hagel’s announcement means that the Obama administration has two directly opposite policies on Americans returning from Ebola lands: quarantine for those in uniform, laissez-faire for civilians. And “laissez-faire” doesn’t quite capture it: The administration not only is not imposing a quarantine on civilians but is actively pressuring states to refrain from doing so. Hickox was released after—and possibly because of—that campaign.
What accounts for the double standard? Or, as a reporter put it to President Obama yesterday: “Are you concerned, sir, that there might be some confusion between the quarantine rules used by the military and used by health care workers and by some states?”
Let’s go through the president’s response point by point.
“Well, the military is a different situation, obviously, because they are, first of all, not treating patients.”
According to the Washington Post, some of them will “test samples for presence of the virus,” but if they are not going to have direct contact with Ebola sufferers, that would seem to militate against quarantining them upon return.
“Second of all, they are not there voluntarily, it’s part of their mission that’s been assigned to them by their commanders and ultimately by me, the commander in chief.”
Perhaps the president is unaware that the U.S. does not have military conscription. Which we suppose would be understandable, since Obama was 11 when the last draftee reported for duty.
“So we don’t expect to have similar rules for our military as we do for civilians. They are already, by definition, if they’re in the military, under more circumscribed conditions.”
Press secretary Josh Earnest had developed that argument further at a briefing two hours earlier:
There are a wide range of sacrifices that our men and women in uniform make for the sake of efficiency and for the sake of uniformity and for the success of our military.
So to take a more pedestrian example than the medical one that we’re talking about, there might be some members of the military who think that the haircut that’s required may not be their best, but that’s a haircut that they get every couple of weeks because it is in the best interest of their unit and it maintains unit cohesion.
We’ll return to the point, but let’s note here that taking servicemen out of circulation for three weeks obviously does not promote efficiency, and that instituting a policy that applies only to the relatively small number of servicemen stationed in Ebola lands obviously does not promote uniformity. That leaves only the catchall “success of our military” category to justify the quarantine.
Back to Obama:
“When we have volunteers who are taking time out from their families, from their loved ones and so forth, to go over there because they have a very particular expertise to tackle a very difficult job, we want to make sure that when they come back that we are prudent, that we are making sure that they are not at risk themselves or at risk of spreading the disease . . .”
It sounds here as if the president is continuing his justification of the military quarantine, but it turns out the “volunteers” he means here are the Doctors Without Borders types, who, he said in his prepared statement “are doing God’s work over there.” (Maybe, but didn’t God say something about bearing false witness?) The sentence continues:
“. . . but we don’t want to do things that aren’t based on science and best practices. Because if we do, then we’re just putting another barrier on somebody who’s already doing really important work on our behalf. And that’s not something that I think any of us should want to see happen.”
All of which leaves unanswered the central question: If a policy of quarantining returning personnel runs counter to “science and best practices,” how does it promote, in Earnest’s phrase, “the success of our military”?
Absent a satisfactory answer to that question, the answer to the question “Why are you quarantining servicemen?” seems to boil down to: “Because we can.” Because it is in the nature of military service to demand a considerable sacrifice of personal freedom. But if the administration viewed that as sufficient justification, it would not have pressed for legislation abolishing restrictions on service by homosexuals.
Anyway, we know of no one who denies that Hagel had the authority to establish the quarantine policy, absent a contrary order from the commander in chief. But the White House also concedes that states have the authority to order quarantines for civilians.
At his Monday press briefing, Josh Earnest answered a reporter’s question about the absence of “an overarching federal policy that rules” by saying this: “You can sort of take this up with James Madison, right? We have a federal system in this country in which states are given significant authority for governing their constituents. That is certainly true when it comes to public safety and public health.”
What is at issue, then, is the administration’s purely discretionary decisions to order quarantines for servicemen and lean on states not to order them for civilians—a contradiction with no obvious basis, and no basis the World’s Greatest Orator and his spokesman have managed to articulate, in philosophy, law or science.
Either servicemen are being subjected to burdens with no basis in “science or best practices,” or the administration is risking public health by prioritizing the personal comfort of civilian medical workers. Why in the world are they doing this?
Odd as it to say about this administration—especially with an election less than a week away—it’s hard to imagine the motive is political. CBS News reports that 80% of respondents in a new poll “think U.S. citizens and legal residents returning from West Africa should be quarantined upon their arrival in the U.S. until it is certain they don’t have Ebola”; just 17% disagree. (Though to be sure, that 17% is almost double the proportion describing themselves in another recent poll as “enthusiastic” about Obama.)
Let us suggest two practical distinctions, either or both of which may explain the disjunction in policy. The first is that forestalling the military quarantine order would have required Obama to overrule a recommendation of the Joint Chiefs of Staff—that is to say, to make a decision. Pressuring the governors, by contrast, involves only behind-the-scenes kibitzing and public bloviation.
The second is snobbery. Recall that quote from Nurse Hickox’s lawyer: “She’s a very good person.” She and others like her, according to the president, are doing God’s work, and—in pointed if inaccurate contrast to military servicemen—are “experts.” The logic would go something like this: You can’t quarantine her. She’s one of us.

1 comment:

  1. The "science" everyone keeps talking about is not conclusive and there are many variables and many unknowns. Recent John Hopkins presentation on these issues