_ Sen. Rand Paul, R-Kentucky, interview with Bloomberg News. Oct. 16, 2014
This is an interesting set of remarks from Sen. Rand Paul regarding the administration's response to the Ebola outbreak in West Africa. Did the administration suggest Ebola was like AIDS? Did it play down the possibility of direct contact?
Before entering politics, Paul was an ophthalmologist, so his expertise in medicine might carry extra weight with some readers.
First, let's look at the warnings and cautions posted on the White House Web site.
_ Ebola cannot be spread through the air, water, food in the U.S., or casual contact with someone who has no symptoms of the disease.
_ Ebola can only be contracted through body fluids, contaminated objects, or infected animals.
_ Ebola can only be contracted from someone who is showing symptoms.
Now, here are the Centers for Disease Control exposure risk levels. Note that a "low risk" exposure is being within three feet of a patient with Ebola. The Ebola virus, as far as is known, does not circulate in tiny droplets that hover in the air, such as influenza. But an Ebola patient could cough, sneeze or spit, transmitting bodily fluids that might land on a person nearby — and then you might get Ebola if the virus finds a break in your skin or you touch your eye and it goes in through a mucous membrane.
High-risk exposures
_ Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD (Ebola virus disease) patient.
_ Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE).
_ Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard bio-safety precautions.
_ Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring.
Low-risk exposures
_ Household contact with an EVD patient
_ Other close contact with EVD patients in health-care facilities or community settings. Close contact is defined as:
_ Being within approximately 3 feet (1 meter) of an EVD patient or within the patient's room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations).
_ Having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
_ Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact
Low risk does mean some risk, so Paul is not entirely off base to note the three-feet caution, except that it concerns a person confirmed to have Ebola. People who are diagnosed with Ebola generally don't circulate at cocktail parties.
"Senator Paul's portrayal of a cocktail party as a potential setting for exposure just uses another example of an event during which close contact with a sick person could occur — leading to potential exposure to bodily fluids containing the deadly virus," a Paul aide said. "Imagine being sneezed on directly by a sick person or using a bathroom after someone sick with Ebola. In both cases, what was once just 'close contact' moves to direct exposure."
What's Paul's evidence that the administration equated Ebola to AIDS? On the face of it, it seems strange because people do not wear hazmat suits when treating people with AIDS. Clearly, on the face of it, Ebola and AIDS require different treatment protocols.
A Paul aide pointed to this comment by CDC Director Tom Frieden on October 9, when he spoke before the World Bank and International Monetary Fund annual meeting as nations pledged funds to help stem the outbreak in West Africa: "I've been working in public health for 30 years. The only thing like this has been AIDS. And we have to work now so that this is not the world's next AIDS."
But this is not saying that Ebola is transmitted like AIDS; instead, it is a call to arms for the public health community to treat the Ebola outbreak as seriously as AIDS. "Dr. Frieden equated Ebola to AIDS twice," the Paul aide responded. "Senator Paul was responding to Frieden's own analogy."
As for the White House playing down the risks, the Paul aide pointed to this statement by President Barack Obama, in a September 2 address to West African nations: "You cannot get it from casual contact, like sitting next to someone on a bus."
But Paul is ignoring other parts of that statement. First, before he made the bus reference, Obama stressed that Ebola is not an airborne disease: "First, Ebola is not spread through the air like the flu."
Then the president went on to say: "Second, the most common way you can get Ebola is by touching the body fluids of someone who's sick or has died from it — like their sweat, saliva or blood — or through a contaminated item, like a needle. That's why the disease is continuing to spread where patients are being cared for at home or during burials when families and friends lay their loved one to rest. That's why health-care workers wear protection like gloves and masks."
That certainly doesn't sound like AIDS, either. No one gets AIDS by simply touching the body fluids of an infected person.
Frieden, in a conference call with reporters on October 15, was asked about the bus statement and whether it was accurate in light of the fact that the CDC has contacted people who flew on the same commercial flight as a nurse who had a fever after being in contact with an Ebola victim.
He said:
"Yes, CDC vetted the message and yes, we believe it is accurate. I think there are two different parts of that equation. The first is if you're a member of the traveling public and are healthy, should you be worried that you might have gotten it by sitting next to someone. The answer is no. Second if you're sick, and you may have Ebola should you get on a bus, the answer to that is also no. You might become ill; you might have a problem that exposes someone around you. Because the risk is so low, we think there is an extremely low likelihood that anyone who traveled on this plane would have been exposed, but we're putting into place extra margins of safety and that's why we're contacting everyone who was on that flight."
In other words, the administration has to perform a delicate balancing act in terms of public-health messages. "Can't get it on a bus" refers to the fact that Ebola is not an airborne disease. Officials do not want to inspire panic that simply using public transportation puts you at risk of getting the disease (in contrast to the flu). But, given a known incident, the CDC out of an abundance of caution decided to monitor anyone who was potentially exposed on the plane, despite "an extremely low likelihood" of a problem.
The Paul aide argued: "President Obama said something that is misleading. If you 'can't get it on a bus' then why are all the people who flew Frontier Airlines being monitored? A person on a bus is analogous to a person on a plane, and if the CDC is worried about people on a plane, then they presumably would treat people the same way who are on a long bus trip. A bus trip from DC to NYC would actually take longer than a plane trip from Cleveland to Dallas."
Paul's accusations that the administration has not been accurate in its descriptions of Ebola do not stand up to scrutiny. The administration never suggested that Ebola was transmitted like AIDS, only that it was a public-health emergency of the same potential scale.
Both AIDS and Ebola are not airborne viruses, but it should be clear to anyone watching the news that Ebola is spread differently from AIDS, given the required attire of hospital staff treating Ebola patients.
Indeed, administration officials, from the president on down, have made it clear that people should not touch Ebola patients, which again is different than the protocol for AIDS patients. Paul's citation of a three-foot zone, in fact, comes directly from the CDC's informational material on exposure risks. In the meantime, one can hardly fault the CDC for wanting to be extra careful, even if the risks are extremely low, by contacting passengers on the plane, given that it was a mistake to allow the nurse to travel on public transportation in the first place.
- - -
Video: Rand Paul: "White House made 'mistakes' on Ebola"
Video embed code:
