Court Rules Against Quarantine Of Hickox Representing A Victory For Science And Civil Liberties

A judge in Maine has ruled against the quarantine of Kaci Hickox which the governor of Maine has attempted to impose, agreeing with the medical evidence that Hickox “currently does not show symptoms of Ebola and is therefore not infectious.” This is a victory for Hickox personally, along with a victory for both science and civil liberties.

The politicization of Ebola has demonstrated the usual divisions between left and right in this country. As on so many other issues, the right wing has rejected scientific findings, distorted scientific information which conflicted with their political goals, and ignored the rights of the individual. This also provides another example of the emptiness of Republican claims of wanting to keep government out of health care decisions.

While the media has concentrated on a small number of people who have returned from West Africa, Médecins Sans Frontières (Doctors Without Borders) has had a staff of over 3300. Of these 3300 MSF staffers, only 23 have contracted Ebola. The staff includes over 700 who came to West Africa from other nations with only one developing symptoms of Ebola after he returned home.The one doctor who did return to New York subsequently followed protocols for continued monitoring and was hospitalized prior to spreading the infection to anyone else.

With these odds, there is no justification in assuming that Hickox, or any other medical worker, is infected with Ebola merely due to having worked in the affected nations. People who are infected have a very low viral load early and do not spread the disease until after they exhibit symptoms, which Hickox has not done. It is becoming increasingly unlikely that she will. While a twenty-one incubation period is commonly cited by the media, and should be used as a precaution, in reality the vast majority of patients exhibit symptoms in six to twelve days. Monitoring for twenty-one days provides an ample additional margin of safety to the public.

While some Republicans have played politics with the issue and, as happens far too often, some Democrats such as Andrew Cuomo initially acquiesced in fear, the guidelines from the CDC and precautions already in effect are sufficient to protect the public and, to err on the side of safety, call for greater restrictions than are necessary based upon the science. There is no need for politicians to go beyond these precautions and unjustly restrict the civil liberties of Americans. The monitoring protocols already in place from Doctors Without Borders can be seen here.

In response to the controversy engendered by those who have been ignoring the science, the American Nurses Association released this statement on October 29:

The American Nurses Association (ANA) opposes the mandatory quarantine of health care professionals who return to the United States from West African nations where Ebola is widespread. ANA supports registered nurse Kaci Hickox, who recently returned to the United States after treating Ebola patients in Sierra Leone, in her challenge of a 21-day quarantine imposed by state officials in Maine, her home state. Hickox arrived at Newark airport on Oct. 24 and was immediately quarantined in a hospital tent by New Jersey state officials, who eventually allowed her to travel to Maine via private transport on Oct. 27. After testing negative twice for Ebola, nurse Hickox, who continues to be symptom free, poses no public threat yet is restricted to her home.

ANA, along with the American Hospital Association and American Medical Association, supports the Centers for Disease Control and Prevention’s (CDC) guidance based on the best available scientific evidence. The CDC guidance would not require a mandatory 21-day quarantine of Hickox given risk levels outlined by the CDC in her particular case. ANA urges authorities to refrain from imposing more restrictive conditions than indicated in the CDC guidelines, which will only raise the level of fear and misinformation that currently exists.

ANA supports a policy of appropriate monitoring for health care workers who have cared for or been in contact with patients with Ebola. Those who are not exhibiting symptoms of illness consistent with Ebola do not require quarantine. Monitoring should follow recommendations outlined by the CDC based on risk levels and the presence or absence of symptoms, including regular monitoring of body temperature and oversight by a public health agency. If symptoms do occur, the appropriate next step is isolation and transport to a medical facility for further evaluation. ANA seeks to balance protection of public health and safety with individual liberties. Policies to protect the public from the transmission of Ebola must be based on evidence and science, not fear.

Mandatory quarantine for individuals who do not have symptoms or risk factors is not backed by science. Such actions undermine efforts to recruit sufficient numbers of volunteer nurses and other health care professionals, who are essential to help contain the spread of the disease in West Africa.

ANA’s position emphasizing evidence and science as the foundation for decision-making extends to proposals to ban travel to the United States from West African nations affected by the Ebola outbreak. There is no evidence to suggest that a travel ban would be effective; public health experts oppose it. In fact, a ban could be counterproductive, encouraging individuals to try to circumvent reporting and other systems. ANA supports the current requirement that those traveling to the U.S. from affected nations in West Africa, including health care professionals who have provided care to Ebola patients, once they have passed initial screening, engage in monitoring according to CDC guidelines and reporting to their respective public health agencies.”

Multiple other medical organizations have issued statements in opposition to imposing quarantines including the American Medical Association, the Infectious Diseases Society of America, and the Association for Professionals in Infection Control and Epidemiology.

Ebola Hysteria Leads To Lousiana Interfering With Medical Conference

The hysteria continues regarding Ebola. We still don’t know how things will turn out with Kaci Hickox’s fight against the unconstitutional restrictions on her civil liberties when she returned from West Africa, and I’ve heard a doctor who is returning from West Africa also plans to resist the unscientific quarantine requirements.  We continue to face a variety of right wing conspiracy theories.

NPR reports on yet another counterproductive action arising from the current hysteria–preventing scientists from participating in a conference, which could interfere with the development of a disease or cure for Ebola:

Louisiana health officials say that anyone who’s been in an Ebola-affected country over the last three weeks will be quarantined in their hotel rooms.

The American Society of Tropical Medicine and Hygiene is telling researchers who’ve recently traveled to Ebola-affected parts of West Africa that they can’t come to the society’s annual meeting. That wasn’t the medical group’s idea.

The convention opens this weekend at the New Orleans Sheraton, but the specialists with the most current experience with Ebola in the field aren’t expected to be there.

The Louisiana Department of Health and Hospitals just ruled that anyone who’s been in Sierra Leone, Liberia or Guinea in the past three weeks “should NOT travel to New Orleans to attend the conference.” (That big “NOT” is in the original letter.)

“While the state of Louisiana’s policies are outside of the scientific understanding of Ebola transmission — and acknowledged by the state health officials’ own admission — we recognize that the state has determined its policy in this matter,” the society said in a statement. “ASTMH does not agree with the policy as outlined by the Louisiana DHH…

Dr. Piero Olliaro had big plans for the conference.

“This is the place to be,” says Olliaro, a researcher at Oxford University who specializes in setting up clinical trials to test drugs in the developing world. “It’s once a year. This is where you get to meet all the others.”

Olliaro was going to present several papers on his recent work involving treatments for malaria and river blindness. But two weeks ago he was in Guinea for the World Health Organization scouting a site to test an experimental Ebola medication.

Yesterday Olliaro got a letter from the Louisiana health department saying that anyone who’d been in Sierra Leone, Liberia or Guinea in the past 21 days would be quarantined…

Olliaro, who’s in England, says the decision is unfair, unwarranted and not based on medical science. But he’ll abide by it…

Olliaro says the problem is much larger than just this one convention. The world’s leading tropical disease researchers often fly back and forth from Africa to their labs in the United States.

The new patchwork of Ebola-related travel bans and quarantine policies, he says, make it unclear whether they’ll be able to continue to do that. And that could ultimately undermine research into a vaccine or cure for this terrifying viral disease.

Posted in Health Care. Tags: , . No Comments »

Kaci Hickox Is A Hero–Now On Two Counts

Kaci Hickox is a hero. First for volunteering to help treat Ebola patients, as eradicating Ebola in West Africa is the only way to handle this disease. She became a hero again for standing up to unjust restrictions upon her civil liberties upon returning home and supporting the concept of making political decisions based upon science and reason as opposed to giving in to public hysteria.

It was Hickox’s protests which forced Governors Christie and Cuomo to back away from guidelines policies which were both unnecessary and counterproductive. Some state governments are still going beyond the extremely cautious CDC guidelines with policies such as home quarantine of individuals who show no sign of the disease for twenty-one days. We know that this is unnecessary based both upon our knowledge of how the Ebola virus is transmitted and based upon our experience to date.  Ebola is not contagious early in the disease and is not transmitted by casual contact. While highly contagious when people are having symptoms such as projectile vomiting and uncontrolled diarrhea, those who do not have symptoms are not contagious. People with Ebola do not yet pose a danger of spreading the disease when they initially reach the CDC’s threshold of a fever of 101.4 degrees, and they certainly are not contagious before reaching this point.

We have seen one patient in Texas be released in error by an Emergency Room and return to the community. We have seen a nurse later revealed to be infected with Ebola fly with a low grade fever. We have had a doctor traveling around a city as densely populated as New York City just prior to meeting criteria for isolation. Not a single person has contracted Ebola due to contact with these individuals. That is the nature of the disease.

Kaci Hickox, well aware of the science, has stated she plans to fight the involuntary home quarantine being imposed:

“I will go to court to attain my freedom,” Hickox told “Good Morning America” today via Skype from her hometown of Fort Kent, Maine. “I have been completely asymptomatic since I’ve been here. I feel absolutely great.”

One of her attorney’s explained her legal position:

New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.

“The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty,” he said.

Hickox will abide by daily monitoring, as recommended the by updated guidelines released Monday by the federal Centers for Disease Control and Prevention, Hyman said. She has been in regular contact with state health officials, Siegel said.

U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three African nations at the center of the epidemic — Sierra Leone, Liberia and Guinea — would require daily monitoring without isolation.

The new guidelines recommend considering isolation only for individuals exposed to Ebola who show symptoms. Those with no signs of illness should be monitored for 21 days after the last potential exposure, with symptom-free individuals at the highest risk subject to “restricted movement within the community” and no travel on public transportation, according to the guidelines…

“She understands the nature of the disease, she treated it,” Hyman said. “She understands the nature of the risk.”

The American Civil Liberties Union has posted an article on the over-reaction to Ebola coming from some politicians, in contrast to the more rational guidelines proposed by the Center for Disease Control and the Obama administration:

One over-reaction to the disease that has emerged is a proposal for a blanket travel ban from the affected countries in West Africa. Public health experts say that such bans are not necessary, would not be effective, and would be a poor use of resources. Worse still, experts say they would most likely make matters worse by further isolating the countries where the outbreak is taking place, worsening the situation in those countries and therefore the threat to the United States. Travel bans “hinder relief and response efforts risking further international spread,” as the World Health Organization warned. Experts say such bans would also inevitably drive travelers underground, making it difficult to retrace the path of a disease when a case does appear.

Proposals to close the border to all travelers from affected nations are not a scientifically and medically legitimate exercise of government power and therefore would be arbitrary and discriminatory whether applied to citizens or non-citizens.

Now, of course, we are also seeing the questionable use of quarantine powers in some states. Medical experts have opposed such steps given that Ebola is not transmissible until after a fever begins and is not a highly transmissible disease generally, and given that individuals have strong incentives to carefully monitor themselves. Doctors Without Borders, for example, has condemned these quarantines as a threat to its battle against the disease in Africa. It cites the effect the quarantines will have in deterring doctors and nurses from taking the already remarkably brave step of entering the fight against the disease—and in stigmatizing them when they do. In short such quarantines threaten to weaken the most effective weapon we have in stopping the disease at its source. (It’s also shameful to treat returning health care workers, who have put their own lives at risk to help others, as anything less than heroes.)

Where individuals cooperate with the authorities in allowing close monitoring of their health and other reasonable precautions, the imposition of quarantines on those without symptoms appears to be driven by politics rather than science, and therefore raises serious civil liberties concerns.

While some political leaders have acted out of fear, Obama Administration officials deserve praise for largely sticking to science and not caving in to some of the fear mongering that is swirling around them. The White House has prioritized medicine over politics. It has resisted calls for travel bans, tried to persuade the governors of New Jersey and New York to reconsider their quarantines, and has largely followed the advice of public health experts in the recommendations that they have made. The Administration has also taken helpful steps such as expediting emergency FDA authorization for the use of new machines for rapid detection of the Ebola virus—which could allow detection of the disease before symptoms appear.

In fact, the Obama Administration has a history of good policy on communicable diseases. As we described in a 2009 white paper on that year’s H1N1 flu scare, the Administration acted calmly and appropriately in response to that epidemic, and overall, President Obama has turned away from his predecessor’s military/law enforcement approach to fighting disease, which we criticized in detail in our 2008 report on pandemic preparedness.

Arguing Against Counterproductive Hysteria Over Ebola

While the outbreak of Ebola began in West Africa about ten months ago, we have now had only nine patients with Ebola in this country. Most were brought in for treatment after contracting it elsewhere. One is currently undergoing treatment. One died. All the rest have recovered. There have been zero cases of transmission in the general population but two nurses have become infected while treating the patient who died.

There is a remarkable amount of hysteria in this country for a disease which has had so little actual impact. Some of this is natural fear, seeing how less developed nations have been affected, and some is due to hysteria being generated by Republican politicians for political gain. Unfortunately the proposals made by Republicans would be counterproductive, making it harder to treat Ebola at its source. Eliminating Ebola in West Africa is the only way to eliminate the problem and prevent further spread.

This is also turning out to be a learning experience, at least for those who respect science and are willing to consider the facts. In terms of treatment, hospitals around the country have learned from the mistakes made in Texas, and these are not likley to be repeated.

In terms of the political reaction, there are many sources which are trying to counter the over-reaction with reason. As we have seen on so many issues, some will pay attention to the facts, and others won’t.

The New England Journal of Medicine has released their editorial for next week’s issue, which includes a repetition of how Ebola is transmitted and the dangers of over-reaction:

The governors of a number of states, including New York and New Jersey, recently imposed 21-day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease. We understand their motivation for this policy — to protect the citizens of their states from contracting this often-fatal illness. This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal. The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.

Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan’s family members who were living in the same household for days as he was at the start of his illness did not become infected…

The American College of Physicians has made the same argument:

The American College of Physicians is strongly concerned about the approach being taken by some state health departments to impose strict, mandatory quarantines for all physicians, nurses, and other health professionals returning from West Africa, regardless of whether they are showing symptoms of Ebola virus infection. ACP agrees that physicians and other health professionals must take the necessary precautions to ensure the safety of others and prevent the spread of infection. However, the College maintains that mandatory quarantines for asymptomatic physicians, nurses and other clinicians, who have been involved in the treatment of Ebola patients, whether in the United States or abroad, are not supported by accepted evidence on the most effective means to control spread of this infectious disease. Instead, such mandatory quarantines may do more harm than good by creating additional barriers to effective treatment of patients with Ebola and impede global efforts to contain and ultimately prevent further spread of the disease…

Some newspapers, such as The New York Times, have repeated these arguments for a larger audience:

The Dangers of Quarantines

Ebola Policies Made in Panic Cause More Damage

… two ambitious governors — Chris Christie of New Jersey and Andrew Cuomo of New York — fed panic by imposing a new policy of mandatory quarantines for all health care workers returning from the Ebola-stricken countries of West Africa through John F. Kennedy and Newark Liberty international airports. There is absolutely no public health justification for mandatory quarantines…

Lost in this grandstanding was one essential point. The danger to the public in New York in the case of Dr. Craig Spencer, who had worked in Guinea for Doctors Without Borders, was close to nonexistent. Health experts are virtually unanimous in declaring that people infected with the virus do not become contagious until after they develop a fever or other symptoms, such as diarrhea, vomiting, or severe headaches, at which time they need to be hospitalized and taken out of circulation.

Health care workers like Dr. Spencer know that it is in their interest to ensure that — if symptoms do arise — they get care quickly to improve their chances of survival and to reduce the risk of infecting their friends and families. Dr. Spencer reported his temperature promptly when it was a low-grade fever of a 100.3 degrees and was rushed to Bellevue Hospital Center for isolation and treatment while his fiancée and two friends were put into voluntary isolation…

The problem with a mandatory quarantine, even if done at home, is that it can discourage heath care workers from volunteering to fight the virus at its source in West Africa. Doctors Without Borders, the nongovernmental organization that has led the battle there, typically sends its workers on arduous four- to six-week assignments. The risk of being quarantined for another 21 days upon return has already prompted some people to reduce their length of time in the field and may discourage others from volunteering in the first place…

Fortunately the response has been more rational at the federal than state level, including the statement from Barack Obama earlier today, pointing out that “If we don’t have robust international response in West Africa, then we are actually endangering ourselves here back home.”

President Obama pledged support for health care and aid workers in West Africa Tuesday, saying new rules for monitoring them for Ebola once they return to the United States would be “sensible and based on science.”

Obama gave brief remarks on the federal response to the disease after speaking with U.S. aid workers on the front lines of battling Ebola in West Africa.

“They’re doing God’s work over there, and they’re doing that to keep us safe, and I want to make sure that every policy we put in place is supportive of their efforts. Because if they are successful, then we’re not going to have to worry about Ebola here at home.”

Besides being counterproductive, there are civil liberties concerns when the government forcibly quarantines people who do not have the disease or who are not contagious.

Juan Williams Debunks GOP Attempts To Blame Democrats For Lack Of A Surgeon General

While discussing the Republican hypocrisy in their response to an Ebola Czar earlier this month, I pointed out how the Republicans blocked  Barack Obama’s nominee for Surgeon General due to his concerns about gun violence, which kills far, far more people than Ebola in this country. Republicans who 1) are rarely willing to take responsibility for their action,  and 2) are fond of projecting their faults upon others, have been trying to shift the blame and falsely claim that the Democrats are responsible for blocking the nomination. Juan Williams of Fox News has called them out on this in a column at The Hill (also a Republican-leaning site even as not as overtly Republican as Fox). Williams also debunked the Republican claims that Harry Reid has not been fair due to not allowing them to add their “poison pill” amendments to bills, which would cause even greater gridlock. Williams wrote:

Republicans on the campaign trail tell voters that the Senate gets nothing done because Senate Majority Leader Harry Reid (D- Nev.) blocks votes on GOP legislation.

Away from the Halloween funhouse mirror, the reality is this: Reid is willing to hold votes — but not with an endless open amendment process that merely creates a stage for Republican political theater. “Poison pill” amendments on partial birth abortions and gay marriage would sprout everywhere.

The real problem is that Senate Republicans can’t agree on which amendments to attach to bills because of the Tea Party versus Establishment war raging among them.

Yet I’ve personally seen voters nodding in agreement at Senate debates and campaign events as Republicans put the fright-night mask on Reid as the evil ogre responsible for dysfunction in the Senate.

The GOP is having success by repeating this distorted version of political life on Capitol Hill. Their tactic on that score is consistent with an overall strategy that includes blocking President Obama’s nominees to courts, federal agencies and ambassadorial posts while condemning any mistakes made by the administration.

According to the Senate’s website, there are currently 156 nominations pending on the executive calendar.

With all of the fear-mongering by Republican candidates over the administration’s response to Ebola — part of a broader approach to scare voters by undermining faith in government, the president and all Democrats — there is one screaming nomination still pending that reveals the corruption of the GOP strategy.

The nation has not had a surgeon general since November 2013 because the GOP is blocking the president’s nominee, Dr. Vivek Murthy. At a time of medical emergency, what is the Republicans’ problem with Murthy?

In October 2012, the doctor tweeted: “Tired of politicians playing politics w/guns, putting lives at risk b/c they’re scared of the NRA. Guns are a health care issue.”

Dr. Murthy, a graduate of Harvard and the Yale School of Medicine, has impressive credentials for a 36-year-old. He created a breakthrough new company to lower the cost of drugs and bring new drugs to market more quickly.

But his big sin, for Senate Republicans, is that as a veteran of emergency rooms Dr. Murthy expressed his concern about the nation’s indisputable plague of gun violence.

When Dr. Murthy was nominated, the National Rife Association announced plans to “score” a vote on the doctor’s nomination, meaning any Republican or Democrat running in a conservative state who voted for Murthy would be punished in NRA literature and feel the pain in their fundraising come midterm election season.

When public anxiety over Ebola became a GOP talking point, 29 House Democrats wrote to Reid calling for the Senate to expose the Republicans for their deceitful strategy. They wanted, and still want, Senate Democrats to push for a vote on the surgeon general nominee and force the Republicans to explain their opposition. Their thinking is that swift action is needed to put a surgeon general in place and give the American people a trusted source of guidance on Ebola.

The Tea Party’s favorite senator, Republican Ted Cruz of Texas, last week agreed on the need for a surgeon general in a CNN interview. But in the funhouse mirror-style so loved by the Republican base, Cruz blamed Obama for the vacancy.

“Of course we should have a surgeon general in place,” Cruz told CNN’s Candy Crowley. “And we don’t have one because President Obama, instead of nominating a health professional, he nominated someone who is an anti-gun activist.”

Sen. Roy Blunt (R-Mo.) was also put on the spot recently over the GOP’s refusal to deal with the surgeon general vacancy.  As he railed against the president for perceived errors in handling the situation, NBC’s Chuck Todd interrupted to ask: “The NRA said they were going to score the vote and suddenly everybody froze him… Seems a little petty in hindsight, doesn’t it?”

“Well, the president really ought to nominate people that can be confirmed to these jobs, and frankly then we should confirm them, there’s no question about that,” said the senator, trying to find his footing as he backpedaled.

The fact remains that Senate Republicans, in lockstep with the NRA, have left a worthy nominee dangling while this vital post remains vacant.

This kind of game playing is what led Senate Democrats to consider using the so-called “nuclear option.” In its original form, it would have changed the Senate rules to require a simple majority for all confirmations, instead of the current 60-vote supermajority. But the Democrats decided to go with a more modest change that allowed a simple majority vote to confirm only federal judicial nominees, not presidential picks for the Supreme Court, the cabinet or the position of surgeon general.

Reid, speaking on the Senate floor this summer, said that despite the rules change “Republicans are still continuing to try and slow everything down…It is just that they want to do everything they can to slow down [Obama’s] administration, to make him look bad…even though they’re the cause of the obstruction… Everyone will look at us and say, Democrats control the Senate — why aren’t they doing more?”

As a matter of brazen politics, the Republican strategy of obstruction has worked.

What a shame.

I have seen contradictory interpretations regarding the filibuster rules as to whether the Surgeon General can be confirmed with 51 votes or if the post still requires a super-majority. It is academic in this case. Republican Senators have placed a hold on this nomination and if it goes to a vote are likely to vote unanimously against it. The NRA has indicated that they will include a vote on Murthy in their ratings, which makes it difficult for some Democratic Senators in red states who are up for reelection. Between these Democrats and the uniform Republican opposition there are probably not 51 votes for confirmation, although this could change after the election.

Despite the Republican actions to block the Surgeon General nomination, it is questionable as to how much of a difference it would have made. We don’t know how much Murthy would have said on the topic, and if he could have gotten a discussion of the science through, considering all the fear and misinformation being spread about Ebola by Republicans.

Despite all the panic, we have seen how small a threat Ebola actually is in a developed nation such as the United States. Ebola is a problem of developing nations which lack an adequate Public Health infrastructure. While the outbreak began in West Africa last December, we have had a tiny number of people who are infected enter this country, and the potential harm has been easily contained. Even in Texas, which does share some of the problems of a third world nation due to Republican rule, multiple mistakes were made with minimal harm. A patient was sent home despite meeting criteria for hospitalization, and yet he did not spread the infection to anyone else in the community. This is because Ebola is not contagious early in the disease before someone is symptomatic, and even then it does not spread by casual contact.

Maybe if there was a Surgeon General speaking about Ebola, the Emergency Room staff at Texas Presbyterian Hospital would have been better acquainted with the guidelines and hospitalized Thomas Duncan when he first presented. Maybe the hospital would have done a better job at following protocols to protect the staff. While possible, it is far from certain that having a Surgeon General would have made any difference.

Perhaps if there was a Surgeon General discussing the science there would have been less panic when Dr. Craig Spencer was found to have traveled on the subway and visit a bowling alley, where he did not spread Ebola. (Similarly the nurse from Texas Presbyterian who flew with a low grade fever has not spread the disease despite turning out to be infected). This might have prevented the poor, and unscientific decisions made by the governors in states such as New Jersey and New York. While I can see Chris Christie make such a mistake, I would  hope for better from Andrew Cuomo, even if he is faced with a Republican using fear tactics against him in his reelection campaign. This might have spared Kaci Hickox from being quarantined in an unheated tent in New Jersey despite showing no signs of being infected. Inhibiting health professionals from volunteering can only harm the cause of eradicating Ebola in West Africa–which is the only way of ending this matter.

It is impossible to know if a Surgeon General could have been effective in reducing the hysteria. Republicans are masters at spreading fear, and never have any qualms about ignoring science. It is very possible they could have still won out. We already have many Infectious Disease experts explaining the facts about Ebola, but that hasn’t been enough to maintain reason. While a Surgeon General might have had a little bigger soap box to speak from, I don’t know if that would have really mattered.

SciFi Weekend: Doctor Who; Lex Luthor; Agent Carter; Constantine; Aaron Paul on Breaking Bad Toys; The Fall; Revolution; Person of Interest; Arrow; The Flash

Doctor Who In The Forest Of The Night

With In The Forest of the Night, I feel that Doctor Who has gone overboard with preposterous solutions to problems this season. We had the golden arrow in Robot of Sherwood and then the mass of the moon growing because the moon is an egg in Kill The Moon. At least Robot of Sherwood was more a comedy, so I didn’t mind the ending as much.  Kill The Moon did at least address the question of what would happen after the egg hatched, when they knew the moon still existed. In The Forest of the Night made bad science was made even worse with such a weak attempt to explain away what happened.

Once we found out that a solar flare was threatening to destroy earth it became predictable that the trees were acting to save us, not attack humans. Although the Doctor also figured this out, are we to really believe that government agencies working on attempts to clear out paths through the trees would stop based upon a child’s text message? We got an indication of how unlikely this was earlier in the episode when we learned how a child was ignored, and medicated, rather than be listened to.

It is implausible enough that the trees could quickly cover the earth, including the oceans based upon the pictures shown of the entire planet. It also implausible that the trees would be impervious to fire, and would be able to save the earth from the solar flare. However if this is possible, any chance that they removed the excess carbon dioxide from the planet and reversed global warming?

The worst aspect of all of this was to have something so major, which clearly everyone would remember and be talking about for a long time, be dismissed as something which humans will quickly forget about. If Torchwood was still around, perhaps they could have been called to Retcon the planet.

The episode did touch on other themes, and was actually enjoyable to watch despite being so implausible. There was self-mocking by the Doctor (“I am Doctor Idiot”) and sort of an acknowledgment that the Doctor solves far too many problems with his sonic screwdriver (“Not everything can be fixed with a screwdriver. It’s not a magic wand.”). Peter Capaldi had a good line when he first ran into a young girl looking for him: “Do you have an appointment? You need an appointment to see the Doctor.” There was also more on Clara’s relationship with Danny and the Doctor, and the Doctor’s relationship with the planet earth. Plus there was another appearance from Missy, who  plays a major role in the two part season finale starting next week (with a Christmas episode to also follow). The synopsis for the finale, Death in Heaven, written by Steven Moffat:

With Cybermen on the streets of London, old friends unite against old enemies and the Doctor takes to the air in a startling new role. Can the mighty UNIT contain Missy? As the Doctor faces his greatest challenge, sacrifices must be made before the day is won.

The Doctor Who Extra is above.

Jesse Eisenberg, who plays Lex Luthor in Batman V Superman: Dawn Of Justice, might also play the same villain in the Suicide Squad movie.

The Marvel television and movie universe has already had appearances by Cobie Smulders of How I Met Your Mother. Now another cast member (even if rarely seen) joins the cast of Agent Carter. Lyndsy Fonseca, who played Ted Mosby’s daughter, will play Angie Martinelli, an aspiring actress who befriends Peggy (Hayley Atwell)

The TV Addict interviewed Neil Marshall, who has directed for Game of Thrones, and now directs Constantine, which premiered on Friday night.

Aaron Paul has responded to the decision of Toys R Us to not carry Breaking Bad toys.

We finally have an air date for second season of The Fall, an excellent mystery staring Gillian Anderson. It will air on an Irish television channel starting on November 9 and on BBC2 at approximately that time. Netflix released the entire first season on in the United States when it started to air internationally, and hopefully this will be the case with the second season.

Revolution creator Eric Kripke is still talking about continuing the story in some form and has discussed what he had planned for season three before it was canceled:

While he ruled out the show’s return to television, Kripke provided some insight into what a Revolution Season 3 would have looked like, “It was going to be great. It was gonna be this kind of treasure story where they were going to hear a legend of a very mythic treasure. It wasn’t gonna be gold, it was gonna be supplies.”
“It was gonna be this incredible stockpile of supplies. All the good guys and all the bad guys in the show were going to fight for this gold mine of material and supplies. It was going to be fun. It wasn’t going to be a war season. It was going to be a treasure hunt season, which would have fun and mixed up the show in a really interesting way. But, alas…”

Reading this does not have me very interested in seeing the story continue and still has me thinking that NBC was right in canceling the show.

Person of Interest had another episode dealing with Samaritan and artificial intelligence last week, showing Samaritan get involved in politics. I hope we see more of this.

Arrow Laurel and Sara

Now that the Black Canary has been killed in the season premier of Arrow, everyone is convinced that Laurel will take on the role as in the comics. Katie Cassidy even discussed this:

“It’s so sad when somebody leaves,” Cassidy told reporters on the “Arrow” set in Vancouver last week. “Caity and I were really close, and she is a great actress, and we loved having her. It’s always sad when somebody leaves, but exactly like Colin Donnell, it’s like he took one for the team, because something drastic needed to happen, and he is an amazing an actor as well. It’s always tough when you lose an actor, but she seemed to be very supportive, and yes, of course I was excited to continue to see what was going to develop for Laurel and her journey, and hopefully one day becoming the Black Canary.”

The Flash Things You Can't Outrun

The Flash, along with Jane the Virgin, have received full season orders from CW. Last week’s episode of The Flash, Things You Can’t Outrun, included flashbacks to the night of the particle accelerator launch, ending with a scene clearly showing that Harrison Wells knew what would happen to Barry Allen to turn him into The Flash. When he started the accelerator he said, “I feel like I’ve waiting for this day for centuries.” He clearly has knowledge of the future. Is he also a time traveler, and how long has he really been around for?

Time travel is clearly going to play a role in this series. I heard one reviewer (sorry, I don’t recall which), state that in the flash backs to the night of Barry’s mother’s death there are both yellow and red streaks present, speculating that the red streak was The Flash. It certainly is possible that Barry Allen at some point goes back in time to try to save his mother. I would go on from there to speculate that a rescue form his future self could be how young Barry suddenly appeared far from the murder scene.

There is a lot of speculation about where the series is going from those who have been following the comics. For example, Giant Freakin Robot speculates on another time traveling super hero who might wind up on the show.

Before this happens, Felicity (Emily Bret Richards) visits in a cross-over episode from Arrow, going on an awkward double date between Felicity/Barry and Iris/Eddie, and they confront Captain Cold.

Not Hearing Anything Lately From Republicans About Their Frivolous Suit Against Obama

Remember a few months ago when John Bohner was talking about filing a ridiculous law suit against Barack Obama? Politico points out that, despite the Republican hype, we haven’t heard anything about this suit recently:

House Speaker John Boehner came out swinging hard last June when he announced that his chamber would take President Barack Obama to court. The suit, charging that the president grossly exceeded his constitutional authority by failing to implement portions of the Obamacare law, was billed as an election-season rallying point for aggrieved Republicans. But days before the midterms the House’s legal guns seem to have fallen silent.

Lawyers close to the process said they originally expected the legal challenge to be filed in September but now they don’t expect any action before the elections.

Some attribute the delay to electoral politics — suggesting that Republicans were worried it could rile up the Democratic base — though the GOP is mum on why the suit has yet to be filed.

Whatever the reason, the delay means the core of the suit could effectively be moot before the Obama administration even has to respond to it in court. The case was expected to center on an employer mandate provision that Obama twice delayed but is now set to kick in for many employers on Jan. 1.

Bloomberg says the suit might be more trouble than it is worth for the Republicans:

Part of the problem may lie in the troubled history of the suit. In mid-September, the GOP’s law firm dropped the case over “political pressure,” according to a Republican aide speaking to Politico. That same week, the Seventh Circuit Court of Appeals tossed out a lawsuit similar to the House’s from the Association of American Physicians and Surgeons.

Politically, the lawsuit presents catch-22s for the GOP. First, the party has to choose between upsetting conservatives (some of whom support impeachment) by not suing the president or bewildering the rest of the country by suing the president.

A July CNN/ORC poll found that 65 percent of Americans don’t think the president should be impeached, 57 percent don’t support the lawsuit, and less than half of respondents thought Obama has gone too far with his executive orders. Fifty-six percent of conservatives were in favor of the impeachment, compared to 26 percent of moderates.

The lawsuit was a compromise, but appeasement didn’t really work. The pro-impeachment conservative wing of the party has been given voice by Sarah Palin, who told Breitbart News that “you don’t bring a lawsuit to a gunfight.”

Second, if Boehner had gone through with suing the president before the midterm elections, it might have help Democrats fundraise and motivate the liberal base even more than it already had. The Democratic Congressional Campaign Committee made $7.6 million in the month after the suit was announced, including $2.1 million in one weekend off emails warning of impeachment.

Plus Republicans might be embarrassed if small businessmen realize that the Republican Party is pursuing a lawsuit which seeks to punish Obama for trying to make conversion to the Affordable Care Act easier for small business, as many small business owners had requested. This hardly sounds like where the Republicans should draw the line in the sand against what they claim is tyranny from the Obama administration. Of course they had to settle for this suit as they couldn’t find anything of substance with which to pursue this absurd claim.

Quote of the Day: Jimmy Fallon on TSA & Ebola Czar

“TSA Chief John Pistole announced that he is stepping down. So whoever takes his place is going to have some pretty big shoes to take off.” –Jimmy Fallon

Bonus Quote:

“President Obama just appointed someone named Ron Klain as the new ‘Ebola czar’ to oversee the government’s response to the crisis. You know that’ll be a tough job, but not as tough as introducing yourself as the Ebola czar and extending your hand.” –Jimmy Fallon

Joni Ernst’s Defense Of Using Guns To Defend Her Rights, And To Use Government To Impose Her Views Upon Others

One of the reasons that the Republicans now have a better than even chance of taking control of the Senate is that there is the very real possibility that Joni Ernst will win in Iowa. We got another example of how extreme Ernst is from the manner in which she defended carrying guns:

“I have a beautiful little Smith & Wesson, 9 millimeter, and it goes with me virtually everywhere,” Ernst said at the NRA and Iowa Firearms Coalition Second Amendment Rally in Searsboro, Iowa. “But I do believe in the right to carry, and I believe in the right to defend myself and my family — whether it’s from an intruder, or whether it’s from the government, should they decide that my rights are no longer important.”

When she speaks of defending herself against the government, context is quite important. We can certainly conceive of situations in which self-defense against a more repressive government would be justified. However, in the past Ernst has ran an ad in which she pointed a gun towards the camera and vowed to “unload” against Obamacare.

Paul Waldman thought of some contexts in which her statement would make sense but had some serious questions:

But if Ernst is talking about some hypothetical situation in which government’s disregard for her rights may necessitate an armed response it’s fair to ask her: What exactly is it? Is she saying that when law enforcement officers come to arrest her on some trumped-up charge, instead of submitting and fighting the charges in court she’ll shoot those officers? Who else is an appropriate target here? Members of Congress who pass laws taking away her rights? FBI agents? Who?

The problem with this new quote is that it borders on anti-democratic. I don’t care how many times you praise the Founding Fathers or talk about your love of the Constitution, if you think that the way to resolve policy differences or personal arguments with the government is not just by trying to get different people elected or waging a campaign to change the laws or filing suits in court, but through the use of violence against the government, you have announced that you have no commitment to democracy. In the American system, we don’t say that if the government enacts policies we don’t like, we’ll start killing people. It’s not clear that Ernst meant this, but it’s fair to ask her to explain what she did mean.

We might like to ask Ernst more clarification, but she is not likely to respond to questions. She has decided to cancel her scheduled interview with the editorial board of The Des Moines Register.

The National Review is not concerned about Ernst’s statement, seeing it as a the right of any free person. While there are conceivable situations where this might apply, opposition to Obamacare hardly qualifies. Ernst has also had no reservations against using the power of government to impose her views upon others. The Des Moines Register has criticized her support of the “personhood” amendment:

In a country that prides itself on personal freedom, politicians still think they should have a say in whether a woman continues or terminates her pregnancy. The issue of abortion always surfaces in political debates, and the recent U.S. Senate debate in Indianola between Democrat Bruce Braley and Republican Joni Ernst was no exception…

Would miscarriages be investigated by law enforcement to make sure there were no nefarious actions involved? When a woman swallowed legal medication to terminate a pregnancy, would she face murder charges? If a fetus is really a “person,” a pregnant mother not seeking prenatal care might be engaging in child neglect.

Ernst very well might not want to speak with the editorial board of The Des Moines Register due to editorials such as the one quoted above, or because of their criticism of her support for nullification in another editorial. This leads back to the initial question of when Ernst feels laws can be disobeyed, and when individuals have the right to use a gun to prevent enforcement of laws she disapproves of.

Bruce Bartlett Argues That Obama Is A Republican

Obama is a Republican

There’s nothing really new here, but it will be interesting to see conservative response to Bruce Bartlett’s article in The American Conservative entitled, Obama Is A Republican. The article is a rehash of how Obama’s record is actually quite conservative, clashing with the conservative myth that he is a socialist. He started with mentioning other Republicans who supported Obama’s election, and next discussed foreign policy:

One of Obama’s first decisions after the election was to keep national-security policy essentially on automatic pilot from the Bush administration. He signaled this by announcing on November 25, 2008, that he planned to keep Robert M. Gates on as secretary of defense. Arguably, Gates had more to do with determining Republican policy on foreign and defense policy between the two Bush presidents than any other individual, serving successively as deputy national security adviser in the White House, director of Central Intelligence, and secretary of defense.

Another early indication of Obama’s hawkishness was naming his rival for the Democratic nomination, Sen. Hillary Clinton, as secretary of state. During the campaign, Clinton ran well to his right on foreign policy, so much so that she earned the grudging endorsement of prominent neoconservatives such as Bill Kristol and David Brooks.

After further discission of foreign policy, he went on to discuss economic policy and the deficit. The most important point is how the deficit has fallen under Obama and how fiscally conservative Obama has been:

With the economy collapsing, the first major issue confronting Obama in 2009 was some sort of economic stimulus. Christina Romer, chair of the Council of Economic Advisers, whose academic work at the University of California, Berkeley, frequently focused on the Great Depression, estimated that the stimulus needed to be in the range of $1.8 trillion, according to Noam Scheiber’s book The Escape Artists.

The American Recovery and Reinvestment Act was enacted in February 2009 with a gross cost of $816 billion. Although this legislation was passed without a single Republican vote, it is foolish to assume that the election of McCain would have resulted in savings of $816 billion. There is no doubt that he would have put forward a stimulus plan of roughly the same order of magnitude, but tilted more toward Republican priorities.

A Republican stimulus would undoubtedly have had more tax cuts and less spending, even though every serious study has shown that tax cuts are the least effective method of economic stimulus in a recession. Even so, tax cuts made up 35 percent of the budgetary cost of the stimulus bill—$291 billion—despite an estimate from Obama’s Council of Economic Advisers that tax cuts barely raised the gross domestic product $1 for every $1 of tax cut. By contrast, $1 of government purchases raised GDP $1.55 for every $1 spent. Obama also extended the Bush tax cuts for two years in 2010.

It’s worth remembering as well that Bush did not exactly bequeath Obama a good fiscal hand. Fiscal year 2009 began on October 1, 2008, and one third of it was baked in the cake the day Obama took the oath of office. On January 7, 2009, the Congressional Budget Office projected significant deficits without considering any Obama initiatives. It estimated a deficit of $1.186 trillion for 2009 with no change in policy. The Office of Management and Budget estimated in November of that year that Bush-era policies, such as Medicare Part D, were responsible for more than half of projected deficits over the next decade.

Republicans give no credit to Obama for the significant deficit reduction that has occurred on his watch—just as they ignore the fact that Bush inherited an projected budget surplus of $5.6 trillion over the following decade, which he turned into an actual deficit of $6.1 trillion, according to a CBO study—but the improvement is real.

Screenshot 2014-10-20 12.59.16

Republicans would have us believe that their tight-fisted approach to spending is what brought down the deficit. But in fact, Obama has been very conservative, fiscally, since day one, to the consternation of his own party. According to reporting by the Washington Post and New York Times, Obama actually endorsed much deeper cuts in spending and the deficit than did the Republicans during the 2011 budget negotiations, but Republicans walked away.

Obama’s economic conservatism extends to monetary policy as well. His Federal Reserve appointments have all been moderate to conservative, well within the economic mainstream. He even reappointed Republican Ben Bernanke as chairman in 2009. Many liberals have faulted Obama for not appointing board members willing to be more aggressive in using monetary policy to stimulate the economy and reduce unemployment.

Obama’s other economic appointments, such as Larry Summers at the National Economic Council and Tim Geithner at Treasury, were also moderate to conservative. Summers served on the Council of Economic Advisers staff in Reagan’s White House. Geithner joined the Treasury during the Reagan administration and served throughout the George H.W. Bush administration.

There is certainly nothing new. Forbes pointed out a couple of years ago how Obama has been the most fiscally conservative president since Eisenhower.It is worth repeating considering how many people have been fooled by the Republican line that Obama and other Democrats, as opposed to the Republicans, are responsible for the size of the deficit.

Bartlett next discussed how Obamacare is based upon old Republican policies proposed by the Heritage Foundation and later Mitt Romney. He discussed at length how the individual mandate was originally an idea which was strongly promoted by Republicans. While Bartlett concentrated on Romney, many other Republicans shared this view.

Bartlett then had briefer discussions of several other issues–drugs, national-security leaks, race, gay marriage, and corporate profits. His argument for Obama being a Republican is weaker on social issues. While Obama took “two long years to speak out on the subject and only after being pressured to do so,” there remains a big difference between Obama keeping quiet on the issue and Republicans who actively promoted bans on same-sex marriage and Obama.

Bartlett concluded with:

I think Cornell West nailed it when he recently charged that Obama has never been a real progressive in the first place. “He posed as a progressive and turned out to be counterfeit,” West said. “We ended up with a Wall Street presidency, a drone presidency, a national security presidency.”

I don’t expect any conservatives to recognize the truth of Obama’s fundamental conservatism for at least a couple of decades—perhaps only after a real progressive presidency. In any case, today they are too invested in painting him as the devil incarnate in order to frighten grassroots Republicans into voting to keep Obama from confiscating all their guns, throwing them into FEMA re-education camps, and other nonsense that is believed by many Republicans. But just as they eventually came to appreciate Bill Clinton’s core conservatism, Republicans will someday see that Obama was no less conservative.

There is considerable truth to what Bartlett wrote, especially if social issues are ignored. However to be less progressive than Cornell West desires is not sufficient to prove someone is a Republican. Anyone who saw Obama as a candidate of the far left, as opposed to being more centrist, just wasn’t paying attention to what he was saying. Of course there is room for disappointment in some of these areas from the left, especially on drug policy and aspects of his foreign policy.

If Obama is said to be governing like a Republican, the key point which would need to be stressed is he is governing as a moderate Republican from the past–something which no longer exists. Obama certainly would not fit in with the Republican Party of today, which has moved to the extreme right. Bartlett is viewing Republicans from the perspective of his days as an adviser to Ronald Reagan and George W. Bush. The reality is that today neither Reagan nor Bush would be sufficiently conservative to survive in the Republican Party. Therefore, while it is ludicrous to consider Obama to be a socialist, or even from the far left, those who share the extreme views of current Republicans are correct in not seeing Obama as one of their own.