The current controversy about how to deal with Ebola in America tells us a lot about America, and very little about Ebola. In an excellent blog, Scott Alexander discusses how Ebola has become the latest battleground between the ‘red tribe’ and the ‘blue tribe.’
It’s very telling that the opinions on the need for quarantine have polarized along the party lines – yet another sign of how polarized the country has become. Perhaps the Democrats, who charge that Chris Christie, the Republican governor of New Jersey and a possible candidate for presidency in 2016, is using the issue for political gain, are right. But it doesn’t negate the basic wisdom of the policy that takes steps to prevent an occurrence of a catastrophic event, even if an unlikely one.
I don’t belong to either red or blue tribe. And this blog is resolutely non-political and non-partisan. Yet I agree with Christie. In fact, in the previous blog (published before the New Jersey quarantine was announced) I wondered why such a sensible precaution as imposing quarantine on travelers from the West African countries afflicted with the Ebola epidemic was not in place by the time Dr. Craig Spencer came back to New York.
Folks, it’s true that the chances that Ebola will develop into a catastrophic epidemic in the United State are indeed not very high. But they are not zero. We really don’t know as much about Ebola, or epidemics in general, as we may think. If we really understood Ebola, then why did Craig Spencer or Amber Vinson (the Dallas nurse who cared for the first patient in the US to die of Ebola) become infected? Surely they took all the necessary precautions.
Small probability events do happen. They are Black Swans, popularized by Nassim Taleb.
Suppose that the chance of an Ebola epidemic in the US is 1 percent, and it’s a relatively mild one, as they go, say, it will kill 10,000 people. That’s the mathematical expectation of 100 deaths. Balanced against 100 human lives, what’s 21 days spent in isolation by Traci Hickox and by other travelers from West Africa, including medical professionals (who are not really great in numbers)?
Traci Hickox sees it differently.
“I feel like my basic human rights have been violated,” Hickox told CNN on Monday.
“I sat alone in the isolation tent and thought of many colleagues who will return home to America and face the same ordeal. Will they be made to feel like criminals and prisoners?” she wrote in a commentary in the Dallas Morning News.
She sounds like all she cares about is herself. It’s particularly jarring, because she supposedly went to Africa because she wanted to help people, not for her own selfish reasons. So why not make a small sacrifice for the sake of New Yorkers, now that she got back?
What’s surprising to me is how solidly the blue tribe has lined up behind her – from the White House down. The framing of the quarantine issue as a human rights issue is all wrong. Public health is a public good. Public goods are produced by people cooperating, and cooperation requires sacrifice. In this case sacrifice is quite mild (a few days of freedom) and the pay-off is potentially huge.
Our “human rights” are constantly sacrificed for the sake of common good. For example, I am made feeling like a criminal and a prisoner every time I want to board a plane, even though I know perfectly well that I am not a terrorist. More broadly we all have to pay taxes, even though many feel that it’s a legalized theft.
The nature of cooperation, which is the only way to produce costly public goods, is that it requires sacrifice. It has nothing to do with human rights.
One sad realization I had while following the debate over quarantine is that neither of the tribes in America cares about cooperation. The blue tribe allows the rhetoric of individual rights to trump considerations of the public good. The red tribe is as bad, with its fascination with competition and untrammeled markets and its hatred of government (one the most effective ways to coordinate the solution of cooperation problems, especially at the national level). No wonder cooperation is declining America. No wonder cooperation has been declining between the two tribes.
Should they quarantine people at the airports if they arrive with the flu?
It depends. If it is bird’s flu, these people need to be quarantined, because it’s lethal. About five years ago when there was the bird’s flu outbreak, they prevented people with high tempreture and sometimes even with too much red to their face boarding the plane.
As for Ebola:
Ebola virus is one of the most lethal viruses known. In the current outbreak, an estimated 60–70% of those infected have died, and in previous outbreaks the figure has reached almost 90%.
http://www.nature.com/news/the-ebola-questions-1.16243
You might find this interesting: http://www.bbc.co.uk/programmes/p0244jdt
I see the argument for mandatory quarantines, and I actually assumed before I looked into it that it would be normal operating procedure if an epidemic reached a certain level, but even so I still think your portrayal of a 3 week isolation period as a mild inconvenience is slightly misleading. Coming back from treating a deadly virus in a foreign country with underdeveloped medical facilities is, according to accounts from returning physicians, psychologically traumatising. So compounding this experience with a mandatory 3 week isolation from family and friends seems to be a little more than a ‘mild sacrifice’. On top of this we know that “fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community” (source: http://www.nejm.org/doi/full/10.1056/NEJMe1413139). This means that even just from pure self interest, a returning health worker who develops a fever will report it ASAP, as they will be undoubtedly aware that doing so will provide them with their best chance of survival and they will also have seen first hand what happens to those who contract the virus.
Regardless of the above, if mandatory quarantines didn’t discourage health workers from travelling to help tackle the spread of the virus from its source, then I think you could still make a pragmatic case to support them, but relevant professionals all seem to be saying that such policies will decrease volunteers, at a time when tens of thousands more are required. Thus, it seems that what is the ‘public good’ sacrifice depends on your level of analysis; from a global perspective it is clear that the public good would be for US citizens to accept a remarkably small personal risk (currently well below the chance of being eaten by a shark) to encourage more US health professionals to make the very dramatic personal sacrifices required to go and volunteer to help treat a deadly epidemic at its source. At the national level, the equation admittedly becomes more murky as, on the one hand mandatory quarantines will definitely decrease the risk of healthcare professionals spreading the disease, but on the other, if such measures mean that the epidemic is able to spread further, due to a decreased number of volunteers, then are they really improving the US’ overall safety from the epidemic? I guess such a threat could be countered with increasingly draconian immigration policies but this seems to be a self-defeating strategy.
I agree that it’s not a black and white issue and that political polarization exacerbates the divide between those on both sides but I’m not sure if this represents a US specific response or whether you would see the same kind of politically motivated divide in a lot of countries.
I quit following the ebola news after the first wave of hysteria fueled by the media, which then started backpeddling and reporting on the ignorance of the hysteria they stirred up.
But from scanning headlines, I surmised what your blog points out. The US is a very sick nation and I’m not talking about ebola.
I liked your last post much better than the linked article: overwhelming desire to try to make the two sides polar opposites, thus ignoring contrary evidence. The elite vs common paradigm is much stronger.
It is true that it has become more partisan, but that is a. more at the elite/leadership class level, especially the second tier, opinion journalism and b. very recent.
The big things that changed the dynamics were the upcoming midterm elections and President Obama coming out passionately against bans or returning medical personnel quarantine.
He’s not just the leader of the country, but the leader of his party and his supporters have little else they can do but go along with whatever it is he puts forth and try to, if not talk themselves into this position, at least be a good team player.
Before, liberal Alan Grayson was the leading voice for a ban when ebola was under the radar for everyone else. The lack of controversy over having the soldiers quarantined is a relic from that previous mindset that hasn’t had enough time to internalize the new moral belief. Inconsistent.
Scott Alexander has some revealing things to say about political narratives. I also like Arnold Kling’s “Three Language of Politics”. Extending your point on cooperation, the shouting narratives is surely undermining the accountability of US government.
http://lorenzo-thinkingoutaloud.blogspot.com.au/2014/10/ebola-ferguson-and-political-narratives.html
This morning I read that Scott Brown has upped the ante in his run and has introduced the issue of poor central Americans bringing in contagious diseases. This cynical ploy has caused his enemies to mock and deny this, scapegoat anti-vaccinators for all and every uptick in contagious disease, and brush it off.
I’m despondent. We need more Alan Graysons. A dear friend of mine has been crippled by tuberculosis (it caused meningitis) and three weeks ago, my baby and I were exposed to whooping cough at a flea market; I’m up to date, but he has not finished his series of vaccinations. Both of these were brought across southern border.
I’m too poor to leave and wealthier liberals don’t want to believe it. I think they’d change if they knew our suffering.
Seriously people, don’t think that, what’s happening in Africa can’t happen here because it can. All it takes is those doctors and nurses roaming free when they return. That disease is a killer. I totally agree with quarantine and traci Hickox is a selfish <>. I was hoping they would shoot her ass today when she left her boyfriends house. There’s nothing political about this. Funny I didn’t see anyone complaining about rights being violated when Duncan’s family was quarantined. The news media never talked about their rights. Now all of a sudden, Miss almighty hero comes back and all hell breaks loose because she’s so much better than the rest. She’s the Greatest American Hero, and she needs dignity, respect, hugs and attaboy. Seriously, what the hell good are they doing over there but watching people suffer hell and die after two weeks. They’re not stopping it from spreading here because they are bringing it here. I’m glad the states got involved. I agree her conditions were bad in NJ all she wanted to do was be monitored at home. Well she lied. She’s causing more trouble there. I hope they never allow her back once she leaves. She cares only for traci, oh and ebola patients. So what if they don’t go back to Africa and treat ebola. I’m sure those people in Africa are wondering what they’re doing there anyway since they are still dropping dead like flies. That crap lives on surfaces for 48 hours. You want to sit on the toilet after her.
comment edited to remove ad hominem attack
Hi all, I had to remove one comment because it did not comply with the standards everybody must follow on this blog. Remember, no personal attacks, no partisan attacks – address the substance of issues. Avoid inflammatory language.
Why wouldn’t Trishia Jacobs come to the UK with her healthy bank balance instead of Iraq or Pakistan if nobody in the US is willing to sacrifice anything for their community and society is disintegrating?
Think of the attraction of the UK –
– we’ve got a cheap and cheerful monarchy
– really generous free speech laws
– a government that we don’t blame for anything because we have outsourced its law-making to the United Nations and Brussels
– a ruling class of Eton-educated geniuses who come up with all sorts of crazy green energy schemes that will probably shut down the economy by 2050
– whole swathes of the country that have gained the suffix “-istan”
– extremely high property prices and cost of living
– fantastic weather all year around
Despite all of this, apparently 177,000 American-expats living in England and Wales have found something to like about the UK. This is up a bit more than 10% over a decade but the demographic is more significant than the number. How much of the UK’s biggest selling point right now is “at least we’re not America?”
How many more wealthy Americans are going to renounce their citizenship and live abroad? In the UK?
http://www.telegraph.co.uk/expat/9904314/Americans-renouncing-citizenship-to-become-British-thanks-to-tax-rise.html
I suggest talking to doctors who have treated Ebola patients. You would learn some things.
PPE is very hard to use correctly even with good training, and apparently the training in that Dallas hospital was imperfect. This doesn’t reflect uncertainty about Ebola transmission, but uncertainty in how to best put in an IV or a ventilator or perform other procedures while minimizing the chance of getting bodily fluids in contact with the clinician. While we are ignorant about other aspects of Ebola’s biology (e.g. the nature of the animal reservoir, exactly which proteins it uses to enter the cell, etc.) this has nothing to do with the cases of accidental infection of clinicians.
Your speculation about Hickox’s motives is another case you seem to be making things up. Her claim is that she is fighting so that other health-care workers will not have the same experience as her, so that they will not be deterred from volunteering. Here is her explanation.
http://www.dallasnews.com/ebola/headlines/20141025-uta-grad-isolated-at-new-jersey-hospital-as-part-of-ebola-quarantine.ece
Ok, maybe you don’t believe her or you think she’s misguided, but certainly her claimed reason for fighting is for a cause bigger than her own individual rights. It also doesn’t make sense that someone would go through that much hassle, hire a lawyer and speak to the media just for their own right to sit at home. It seems clear to me that she’s trying to set a precedent.