All right, this is ridiculous. Obama has appointed an Ebola Czar. By the most pessimistic speculations, we might have “as many as two dozen” infected people by November — right now, it’s a tiny handful. But we need an “Ebola Czar”. We had almost 2000 cases of malaria in 2011, do we have a “Malaria Czar”? We have at least 3000 deaths per year from flu — where is our “Flu Czar”?
We don’t even have a Surgeon General right now — the appointment has been held up by our Republicans in congress — but we have this very modern major figurehead installed in office. And the guy they’ve appointed is unqualified to be assessing the Ebola risks.
Klain is highly regarded at the White House as a good manager with excellent relationships both in the administration and on Capitol Hill. His supervision of the allocation of funds in the stimulus act — at the time and incredible and complicated government undertaking — is respected in Washington. He does not have any extensive background in health care but the job is regarded as a managerial challenge.
Oh. So Obama has created a prancing puppet to dance beneath the announcement, “we’re doing something about Ebola!” This is pure politics that has nothing to do with improving the health and safety of the country. You might be wise instead to look at the CDC’s list of primary US concerns for 2014.
Increase rates of HPV vaccination.
Promote the wise use of antibiotics.Reduce the risk of prescription opioid deaths while
making sure patients have safe, effective pain treatment.End polio everywhere.
Detect, fight and prevent infectious diseases to improve global health and protect health security
Make a “czar” for those, guy.
This guy actually seems perfect for the position. He can make the politicians feel like they’re doing something, give reports on Capitol Hill, and stay out of the way letting the real experts do their jobs. It’s been stupid that they keep having the heads of the NIH and CDC testifying instead of working.
It is idiotic but it’s very important that people feel reassured. The domestic economic and political damage from the epidemic of fear can become very grave. It also prevents us from dealing with the problem in west Africa, which only the U.S. has the resources to do.
This isn’t just about Ebola in the U.S. also, it’s about dealing with the crisis in western Africa. There are already U.S. soldiers in Liberia working to build treatment facilities, and I’m sure there will be more of them sent elsewhere in the region to do the same. While the experts at the NIH and CDC deal with the response in the U.S. to the Ebola virus, there is also a need to coordinate non-medical measures, and having a ‘czar’ for this is appropriate.
We’ve had the bread and circuses for a while. Apparently, it is now time to send in the clowns.
Klain’s real job is actually PR. Like I say, there’s a need for that.
If Democratic politicians didn’t have it in their blood to take a dive every time it looked like they accidentally got their hands on a real weapon against Republicans…
Obama would be on TV every night saying, “Please Congress… Give back the budget cuts you took from the CDC so we can deal with the threat of Ebola in this country.” Republicans would be squished between their compulsions to spread fear about the disease, fight Obama’s every request, cut government spending to nothing, and look like they’re actually doing something.
Designated flackcatcher. Security theater.
Oh well. It’s better than appointing an expert in epidemiology and treatment of fatal viral diseases. We don’t have very many of them and they are busy right now with real jobs.
I realise that this isn’t the main issue here but…
… is that not a bit… bad?
I mean, I know doctors won’t stop doctoring if there’s no Surgeon General, but surely that’s a post that needs to be filled kinda quickly?
Yes, for some people – in an election month…
Actually, the Czar can be on TV every night saying the same thing. And, since it isn’t coming directly from the President, some in congress may actually listen and not dismiss it out of hand.
davidnagle@6
Also throw in the ‘please get the Surgeon General into office so he can coordinate our efforts, as is one of the jobs of the Surgeon General’. Again, make it clear that it is up to Congress to get us a Head US Doctor, so that Republicans feel like if they don’t, every Democratic candidate in the midterms will be making ads about how the Republicans fiddled during the Great Ebola Scare of 2014.
I thought we already had a CDC Director?
This is just a counter to right wing fearmongering aimed at mid-term voters.
As Tina Dupuy has mentioned, so far the only people that have contracted Ebola in the U.S. were trying to help people. You’re safe Republicans.
I also like the meme going around pointing out how quickly St. Ronnie responded to the AIDS epidemic.
But you see…the nominee for the Surgeon General believes that we have an epidemic of gun violence. So the NRA told all the Republicans (and I’d bet a fair few Democrats as well) that if they voted for him they’d be out of a job next election cycle. Because we live in a country where protecting the right to have guns without consequences trumps actual deaths of our citizens.
OK, let’s give him a chance: if he appears on the sunday morning TV bloviations to tell the right wing idiots to shut up and quit promoting sensationalism, I might warm to him.
this is governance by pacifier at it’s best. Wailing babies making soundbites for knuckledragging constituents were in need of a plug for their filthy, lying pieholes, and his name is Ebola Czar. Following OP’s thought, we need an alcoholism czar, heart disease czar, and most importantly, a natural causes czar. People just won’t be safe until all forms of human misfortune are covered by taxpayer funded government featherbedding. Shit, I forgot all about a czar for Republican imbecility.
PZ, are you really complaining that there is a PR-capable person in a job which requires PR? Just yesterday you were happy that Shep Smith was talking people down off the ledge about ebola, and now you are advocating that Obama just let the hysteria put more people up on the ledge.
Often when when people complain that X is more important than Y, your rejoinder is: don’t be an idiot, we don’t have to pick just one. Fine, the flu kills more people than ebola (in the US), but that doesn’t mean we can’t tackle both.
I think you have your cranky pants on today.
The jokes, they write themselves:
State Dept: Worker Who May Have Handled Ebola Samples Is On Cruise Ship
Just what Carnival needs, another round of bad PR.
So let me see if I understand this correctly: you object to doing something about one thing because there are other things that you see as being of greater importance? Now what does that remind me of?
Athywren #8
Actually, I do think that is important to the main issue. If the NRA wasn’t run by a self-centered asshole, and if the Senate was composed of vertebrates instead of jellyfish, we’d have someone to spearhead not only our Ebola response, but also malaria and flu and, oh, I don’t know, actually have a coherent national health policy!
Republicans want government to fail. The less government, the better, they say.
But then along comes a scary virus and suddenly they want maximum efficiency out of government agencies they have worked to defund.
This is one of the few medical issues where I disagree strongly with PZ. We do need a czar. The same way we needed a czar when the AIDS epidemic broke out, and Reagan didn’t care about the “gay plague”. I predicted then (early 80’s, as soon as I read it in the MMWR when there were just a few hundred cases known) that AIDS was going to be a huge problem because of the long asymptomatic period when it could be transmitted, meaning there would be lots of transmission. Ebola has a different reason for lots of transmission: after a symptomless period long enough for infected patients to disperse anywhere, patients become totally incapacitated and highly contagious for any caretakers at home or at hospitals.
Flu and malaria in the US are vastly better understood and managed than Ebola. There’s no chance of their death rates going up much (unless we get a particularly lethal and infectious flu without enough time to roll out a vaccine.)
Ebola has the potential of overwhelming our medical system very quickly. We simply do not have the isolation facilities, the equipment, the supplies and the training to deal with more than a handful of patients. We have no confirmed effective treatments for the disease: all we can do is try to keep patients alive to see if their immune systems enable them to recover. Any care we give patients is an opportunity to spread the disease, and who will stand to watch their loved ones die in filth?
Obama is beginning to take this seriously enough: White House Takes Drop-Everything Approach to Respond to Public Health Crisis. However, I agree with PZ that his appointment of a political flack rather than somebody with epidemiological training and experience is a serious mistake.
Mike @18:
I’m picturing Obama as Mayor Joe Quimby, looking at Homer and his angry mob of citizens demanding action on Springfield’s “bear problem.” “Are these morons getting dumber or just louder?” he asks an aide.
The Ebola Czar, of course is the Springfield Bear Patrol.
We need a Czar Czar…or is that Tsar Tsar…just like organizations need a process process.
True. The US biomedical system has been starved of money for many years. It’s starting to show. A few Ebola cases and the system is floundering. What to do is old medicine that is well known.
The best example of small government right now is…Liberia!!! They are competing with Somalia and Honduras for the Next Libertarian Paradise.
Due to a long, drawn out civil war, they barely had a functioning government. Or a functioning medical system. The government is trying its best but they don’t have the resources and expertise to do much. Their health system simply collapsed.
The result is an epidemic of an often fatal viral disease, dead and dying people in the streets, and a lot of foreigners trying to stop it before it goes everywhere in the world.
Ayn Rand would be so proud of them. Her magic god, The Invisible Hand of the Free Market would stop the Ebola epidemic in…well about the time everyone in Liberia gets Ebola and either recovers or dies.
re @24:
++1. I hate to admit it but often, Managers are necessary to get a job done. The manager doesn’t have to be an expert in the field the job is of, he just needs to be able to get all the pieces the experts need, at the right time, and to assemble the proper team of experts to address the problem. My only objection to this announcement is the “title” they’ve given the job: Czar. I’m sure Peter-the-Great takes objection to denigrating his title to a simple functionary. I don’t think he is a PR person, but a manager to handle all the logistics of addressing the Ebola issue. The mortality of Ebola is orders of magnitude greater than flu, etc. so the fewer instances does not make it trivial. Maybe I’m being mislead also, but I too am happy that at least Obama’s doin b>something about the issue of Ebola and not just pointing at the Republicans blocking everything (which they are, but wacha-gonna-do)
re ^^
EDIT: …but I too am happy that at least Obama’s doin something about the issue of Ebola…
We have an Ebola Czar…
/Flips table
I’m done, America.
http://en.wikipedia.org/wiki/Czar_(political_term)
26. Robro,
I didn’t realise there were any Gabors left.
mikehuben @24:
I think you ought to read this:
http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola
and this:
I remember hearing jokes about Ebola growing up (children are horrible), so it’s disturbing that it’s been this long and we still don’t have much in the way of treatment. Maybe the cases in America and the panic will spur more research, which would be a good thing.
To quote Fox News, CNN, MSNBC and every republican running for office between now and the November election:
“Why did it take Obama so long to appoint an Ebola Czar? And why doesn’t Obama even have a Surgeon General? [whispering]please don’t look at my voting and filibustering record[/whisper]. Oh yeah, and BENGHAZI! Isn’t Benghazi in Africa? Just saying.”
Just saying…
@36:
They wouldn’t want a REAL investigation on why there was no funding to implement the security measures needed in Benghazi. One reason they weren’t implemented.
No bucks, no Buck Rodgers.
The main (and, IMNSHO, the only) problem with this is that it cedes the terms of the fight to the Republicans–it will be played, at best, as an admission that Obama wasn’t ‘doing enough’ about Ebola before this. The proper tack to take would’ve been, “I have sent a directive to the office of the Surgeon General that an Outbreak Czar be appointed immediately, to oversee the reaction to any new incursions by diseases we have less of a handle on; obviously, Ebola will be the Outbreak Czar’s first priority. I’m sure the position would already been filled, in fact, but unfortunately, we don’t have a Surgeon General right now. Someone may wish to speak with Sen. McConnell about that. Of course, I could just appoint the Czar directly without going through Congress, but the Republicans always take it so hard when I do something without their express approval.”
Quick! We must have a War on Panic!
It’s urgent!
How is health a managerial problem? Last time I checked viruses and bacteria didn’t sit down at a table to negotiate. How about a health education czar?
Six Fake Ebola Cures Promoted Online
What
I’m 100% in favor of this guy having this position — as long as it leaves the rest of the people at the CDC and the NIH intact to do their jobs.
Tony Fauci is the head of the CDC’s infectious disease division. I think he waded through the craziness of the HIV early days pretty well. Let him keep his eye on the ball, and let the other guy handle “Meet the Press”.
Plus, it shuts up Grandpa McCain.
Win-win-win.
Here’s an expert on the subject of Ebola:
The U of M’s Osterholm: What we should — and shouldn’t — be worried about regarding Ebola
unfortunately politics and the public expect and need to see something like this a high powered appointment of someone to fix things.
It would not be so necessary if there was not such a predominance of ignorance and fear in the population as a whole and by extension the political class. The times we are in like to call this a Czar which is a Caesar. in the past we might have called for a blue ribbon commission with a chairman.
Yes some of the problems we are having are the direct result to the war on government (government is the problem) we have been experiencing since the 70’s.
I doubt the Pres. will risk the charge of politicization of the issue by pointing out the republican history in this, he does seem to not prefer open disputes . He does not approach things like Harry Trueman or LBJ who did not back off from conflict.
The best I can realistically hope for is for us is to muddle through for now.
uncle frogy
I really wish Obama had nominated Sarah Palin to be the Ebola Czar just to hear the Rethugs say she isn’t qualified.
@busterggi: Genius. Create a superfluous position. Ensure it has no power to get in the way of the CDC. Appoint a ridiculous Republican to head the organization.
As it is, Obama’s been outmaneuvered. By attacking him for not doing enough, Republicans tricked him into doing the one thing they can rail against: appointing a “Czar”. Now their field operatives can stir up the base about how rounding up the population and taking away their guns is next and everything they warned us about is coming true.
They’re just loving this in every way. Your proposal would turn the tables on them.
McCain speaks. Obama jumps.
http://thehill.com/policy/healthcare/220506-mccain-calls-for-ebola-czar
I honestly believe the President made this appointment just to get some of the flying monkeys off his back. One less arrow in their quiver: “Why doesn’t the President appoint a “czar”?” Well, now he’s done it, and those of you asking that question can sod off. Yes, it’s ridiculous, but he can’t get a Surgeon General nominee through the Senate (thanks, Mitch! Heckuva job…) so this looks like the next best thing. Of course, he’s not a real substitute for an SG, but it’s the best we will get right now. Give him some time, and then judge him on his merits.
Well, that’s sure one way for Obama to show the Republicans who’s in charge…
um…
oh.
Given that the criticism of the Ebola response is primarily a politically driven issue, we know what has to be done medically but it takes time to get it right, it makes sense to put a PR, perception management guy in charge.
…because:
Even though Ebola probably isn’t that scary the U.S. medical sytem seems woefully unprepared to deal with any kind of highly contagious disease and by preparing for the largely overHyped threat of Ebola maybe US will be ready in the advent of a real epidemic.
I work at a hospital and at least we are getting all new PPE out of it
Tony @ 33:
Yes, the R0 of only 1.5-2 is a good thing. Yet AIDS with an R0 of 2-5 has become an enormous world-wide epidemic with no cure, only perpetual treatment.
The question is whether the R0 can be reduced to less than 1 FOR ALL POPULATIONS where infection is occurring. That obviously hasn’t happened with AIDS. I recommend the wikipedia article Basic reproduction number, which points out: “In populations that are not homogeneous, the definition of R0 is more subtle. The definition must account for the fact that a typical infected individual may not be an average individual.”
Maybe R0 can be reduced to less than one in the US as long as we are not overwhelmed. Tracing contacts might work well if there are only a few cases: how well will that scale up to a thousand cases? Right now, only a few people are coming from remote hot spots: what happens when high-traffic routes such as India become hot? How many patients can we keep isolated? How can we get ordinary people to recognize the need to isolate family members with slightly elevated temperatures before they contaminate homes with bloody vomit and diarrhea? Especially considering that 99+% of the time (right now) this is a false positive for Ebola? How are ordinary people going to react to that contamination, how can they clean it up safely (outside of burning down their houses) without risk of infection?
The problem of reducing R0 in the third world has not been solved except by massive infusions of first world aid, luck in catching initial cases and fortuitous isolation in remote areas. When outbreaks occur in denser populations as they are now, we are not being successful at all, which is why we are now seeing thousands of deaths and infections in West Africa.
Until we have a plentiful supply of cheap vaccine or isolation protocols that work for unskilled impoverished people, R0 is going to stay above 1 for most of the world. Our current first world strategies have already been overwhelmed in West Africa.
If this guy knows what he is doing, he could be useful.
The issues here are not entirely medical. There are also of inter-agency coordination. We need someone who knows what levers exist to be pushed.
One of the things that needs to happen is hospitals need to be prepared to take an Ebola patient. That’s apparently not happening everywhere, as this blog post (http://talkingpointsmemo.com/edblog/its-an-object-of-gallows-humor-for-the-staff ) at TPM suggests. The CDC has most of the relevant expertise (although it sounds as if the infection control people there need to listen to the experience of MSF more). The CDC does not generally a hospital regulator, however. That’s a function that’s not well centralized; I think some of the useful power might be in the Department of Health and Human Services by way of Medicare and Medicaid.
Antigovernment thinking is so much the air we breathe* in the US that our minds sort of rebel at the idea of an expert bureaucrat or politician. We know experience counts in most areas, but tend to reject the idea of expertise in dealing with government institutions. That’s a mistake. Let’s hope this is someone who will except the necessary medical expertise of others and know how to urge the institutional machinery in the right direction.
*I’ve said “we,” but this is just is my guess at a common progressive mindset based on reading and personal experience.
Perhaps he can take the “war on ebola” to West Africa and help the people most in need?
@mikehuben (#53): AIDS is hardly comparable simply because it has a similar R0 and is also passed by bodily fluids.
AIDS has an asymptomatic period, during which it is contagious, that lasts an average of 10 years. That means people are walking around infected, transmitting the disease, and have no idea for a decade if they aren’t getting tested routinely.
Ebola has an asymptomatic period of about three weeks, during which it is not contagious. The disease becomes contagious at the same time it becomes symptomatic and it progresses rapidly, which means contagious people aren’t walking around. Maybe the first couple of days, then they’re not going anywhere. Which is why so many of the infected people are care givers. Then you either get better or die after a couple of weeks, about 50% odds with this outbreak, under less than ideal care.
All that means that do stop the spread of Ebola is much easier than to stop the spread of AIDS. You just have to make sure that people delivering health care are on the lookout for it and take the proper precautions. If you find a case, you locate their contacts and monitor them closely for three weeks and isolate them if they spike a fever until they’ve been tested and cleared. This is not that difficult in the United States. Our mobility is a challenge, but the fact that we have orders of magnitude more doctors per thousand people than Liberia is a huge advantage.
We have to do the right things from a public health standpoint, but it’s just not that hard. Nigeria was in the same situation we were, except without our health care system, and they did basically what we’ve done: isolate the infected people, identify their contacts, and monitor them. Lagos is a city of millions of highly mobile people. Nineteen people were infected with Ebola. Eight died. That’s tragic for those people and their loved ones, but no one in Nigeria has Ebola now. They stopped it. Surely we can, too?
There’s already a “public health czar” job. it’s called The Surgeon General of the United States. The job’s been there for a long time. We even have an appointed Surgeon General-designate. But, he wants to include firearms injury as a potential health hazard, and so the NRA has whined that they mean to score the vote. So of course, the Filibuster Party has declared that there will be no vote on the Surgeon General. In a time when we should actually have one.
As it is, this “Czar” will have to have his own office set up, his own staff, his own infrastructure… all of which will take months to institute. Ebola will no longer be an issue by then. (as issues go, this was never a cause for alarm . Concern, yes. action required, absolutely. Panic ? not at all. )