Wake me up when there are more actual cases of Ebola infections in the United States than there are chattering heads on television screens launching uninformed speculative comments. All this palaver might serve a purpose (other than generating ratings) if it weren’t composed of, and targeted toward, the intellectually disenfranchised.
We’ve seen all this before – Swine Flu, Bird Flu, MERS, SARS – each one a Threat to Humanity! Like never before. Like nothing we’ve ever seen. Except we have. It was AIDS.
By the end of 1981 there were 159 cases of AIDS recorded in the United States, it wasn’t until 1982 with 771 cases reported and 618 deaths that the CDC labeled the disease AIDS and associated it with male homosexuality, intravenous drug use, Haitian origin, and hemophilia A. The CDC didn’t add women as being a group at risk until 1983, and cautioned blood banks that there might be a problem. By then 2807 cases had been reported, and 2118 deaths were associated with the disease.
No one was screeching about the need for an AIDS Czar in 1984, and no one was calling for the government to “move faster.” But 7,239 cases were recorded, there were 5,596 deaths, and one Congressional hearing.
In 1985 we were introduced to the tragic story of Ryan White, who was barred from attending school in his Indiana home town. The Department of Defense announced it would screen recruits for AIDS, and actor Elizabeth Tayler, Dr. Michael Gottlieb, and Dr. Mathilde Brim announced the creation of the American Foundation for AID Research in September. There were 15,527 cases reported, and 12,529 deaths.
It wasn’t until 1986 that the U.S. Surgeon General called for a comprehensive program of sex and AIDS education, and more information on condom use. 1986 was also the year in which the National Institutes of Health planned the formation of the AIDS Clinical Trials Group. Dr. Krim and Elizabeth Taylor testified before Congress about the need for clinical research, accelerated research, and more timely access to experimental HIV/AIDS medication. In 1986 there were 28,712 cases reported, and 24,559 deaths.
“And the Band Played On” was published in 1987 while the FDA finally allowed condom manufacturers to advertise that the use of their product would reduce the possibility of contracting HIV/AIDS. 50,378 cases were reported, and 40,849 deaths. In 1988 the federal government finally responded with legislation – the HOPE Act, during that year there were 82,362 cases and 61,816 deaths. At the end of 1989 there were 117,508 cases of AIDS, and 89,343 deaths. The numbers were worse in 1990, 160,969 reported cases, and 120,453 deaths. 1991, 206,563 cases, with 156,143 deaths. Fast forward to another bad year, 1995 with 513,486 cases reported and 319,849 deaths, however the research funded earlier is beginning to pay off in terms of therapeutic drugs and better prevention education. As of 2011 there were approximately 1.1 million people in the United States living with HIV/AIDs and more than 33 million living with the disease in other parts of the world. [AmFar]
There’s been enough hyper-partisanship about the way the Reagan Administration handled the AID epidemic. However, the President was not one to discuss it publicly – not until a September 17, 1985 press conference. There are conflicting stories about whether Reagan moved Koop to speak out, or if it were the other way round. Democrats in Congress did manage to move the money, from $8 million in research funding in 1982 to $26.5 million in 1983 bumped up to $44 million, and more during the remainder of the decade. [RCP] What can be said with some certainty is that the Reagan Administration was painfully slow in addressing the calamity that was HIV/AIDS, and did not adopt a leadership role until late in 1985, some four years after the disease was first noted (1981).
The national media and D.C. press corps weren’t helpful either – Chris Geidner notes 13 instances researched by Jon Cohen during which the press corps erupted in laughter at insensitive comments made from the podium by White House Spokesperson Larry Speakes beginning in October 15, 1982.
It doesn’t take too many little gray cells to figure out why conservatives are so adamant about “blaming the Ebola crisis” on the current President. To discuss the executive branch reactions to a public health problem invites comparison to the Reagan years, and the comparison doesn’t polish the lustrous image of the the conservative President.
The Congress passed a budget in January 2014 which severely constrained the budgets for the CDC and the National Institutes of Health, calling for across the board cuts in spending – including research on the Ebola virus. [CNN] On March 23, 2014 Officials in Guinea confirmed 49 cases of Ebola infection, and by March 31 Ebola infections were at an epidemic level. As of May 2014 cases are reported in Liberia, and by the end of the month cases are confirmed in Sierra Leone. [NHReg]
On August 8, 2014 the World Health Organization issued a full-on warning about the spread of the Ebola virus in west Africa, saying, among other warnings, that the infections constituted an “extraordinary event,” and a public health risk to other countries.
The Obama Administration’s response in this instance is to be measured in days, not years. On August 5, 2014 the CDC issued a Level 2 travel alert for travelers to Nigeria, and a Level 3 travel alert notice remained in effect for Guinea, Liberia, and Sierra Leone. [CDC] The agency had also deployed health professionals to the affected area as of August 4th – 6 to Guinea, 12 to Liberia, 4 to Nigeria, and 9 to Sierra Leone. The CDC also initiated the use of the Epi-Info software tool to determine “contact tracing” to break the chain of transmission. [CDC] By September 17th the President announced that 3,000 troops would be sent to Liberia to establish a command center to oversee the construction of 17 health care facilities of 100 beds each to isolate and treat victims. The U.S. mission would also be tasked with training 500 health care workers per week. [VOA]
By October 22nd the Administration had launched the deployment of 170 medical professionals from multiple agencies and departments, some of whom were part of the USAID’s Disaster Assistance Response Team to the core of the epidemic area in west Africa; had scaled up the deployment of DoD teams including members from the U.S. Naval Medical Research Center to operate three mobile laboratories providing 24 hour turnaround results on samples. The Administration had obligated $300 million for fighting the outbreak in west Africa, including funds for the construction of one hospital completed and staffed by U.S. Public Health Service officers. The efforts also included initiating 65 “safe burial teams” to help Liberians facing the epidemic. [WH]
The conservative response to these measures was quick and predictable. One opinion given much air time was that the mission to Liberia wasn’t a legitimate military operation in the commonly held sense of the term, and therefore beyond the scope of “fighting and winning wars.” Another complaint was that the Commander in Chief was sending soldiers, “valuable highly trained war-fighters” just to support health care workers. And, then there was the “why are we sending troops over there when we should be doing something here,” complaint – missing the point that this was precisely the argument for sending more troops to the Middle East in 2003. [MMA]
Meanwhile on the Home Front
Speaking of the domestic front – In March 2014, the Republicans in the U.S. Senate balked at the nomination of Dr. Vivek H. Murthy to be the Surgeon General because the doctor had run afoul of Chris Cox, the head lobbyist for the National Rifle Association. Dr. Murthy’s experience in hospital emergency rooms caused him to believe that assault weapons do serious damage to human bodies, and that limiting ammunition sales might reduce the number of such fatalities and serious injuries. [NYT] Right wing pundits called for the “immediate withdrawal of the nomination” in October 2014, so an “experienced professional” could be considered. [PJM] The ever-media-seeking Senator Ted Cruz (R-TX) dismissed Murthy’s nomination saying, “And we don’t have one because President Obama, instead of nominating a health professional, he nominated someone who is an anti-gun activist,” which got an immediate smack down from Politifact.
While the obstructionists in the Senate blocked the nomination, the CDC was adjusting its guideline and issued revised, or “interim,” guidance for hospitals dealing with Ebola infections on August 8, 2014. The August interim guidance sounds predictive in the case of the Texas hospital which later experienced infections:
“It emphasized that anyone collecting or handling such specimens are to follow standards compliant with the Occupational Safety and Health Administration bloodborne pathogens standards, including wearing appropriate personal protective equipment (PPE) and implementing other safeguards.
For specimen collection and laboratory testing, PPE recommendations include full face shield or goggles, masks to cover all of the nose and mouth, gloves and fluid-resistant or impermeable gowns. For laboratory testing, the recommendations also include use of a certified class II biosafety cabinet or plexiglass splash guard.”
Politics and Protocols
The CDC tightened the guidelines further, issuing revised guidance to health care workers and hospitals on October 20, 2014. It also provided more stringent guidance for travel and airline operations, and prospective patient monitoring.
Back in the Senate, Arizona Senator John McCain issued a call for an “Ebola Czar” to coordinate the response to the cases on U.S. soil on October 12-13th. [Hill] This would be the self-same Senator who decried the Administration’s appointment of “more czars than the Romanoffs.” [HuffPo] The nomination of Surgeon General Murthy was still the subject of a Republican filibuster. No sooner than President Obama had appointed an experienced administrator, Ron Klain, an individual with a solid reputation for dealing with complex bureaucratic issues, [CNN] than the GOP lambasted the appointment as “tone deaf and insensitive,” whatever that might mean; and, Senator Cruz criticized the appointment of anyone. [CNN] The nomination of the Surgeon General nominee remains in Senate limbo.
All this partisan bickering was highlighted by the October 23rd performance of Rep. Jason Chaffetz (R-UT) who announced that the Surgeon General needs to be in charge of the efforts to prevent the spread of the Ebola virus, evidently unaware that his GOP colleagues in the Senate were filibustering the nomination of Dr. Murthy. [HuffPo]
While the Republicans squabbled over who should be appointed to what if anyone should be appointed to anything – the Administration continued to ramp up the coordination of public health efforts.
In addition to increasing the stringency of screening measures and travel restrictions, activating post arrival monitoring, tightening CDC health care protocols, the Administration approved the creation of a Dedicated Response Team to be assigned to any hospital that receives a confirmed case of Ebola, a “Lessons Learned” training and outreach program based on what occurred in Texas, a Northern Command 30 person short notice assistance team to provide service to civilian medical professionals, and the offering of FEMA coordination for federal assistance to meet “needs on the ground.” [WHFS]
Now, imagine what might have been different if the Reagan Administration had adopted the same robust response to those first 159 cases of AIDS in 1981? Little wonder the conservatives are cranky.