A few days ago the appointment of Ron Klain as the White House’s Ebola czar and Karen DeSalvo as acting assistant secretary at HHS promised an end to the fragmented response to Ebola from our health agencies. The CDC also stepped up its game with new guidances while Homeland Security’s screening at the five major gateways seemed more proportionate than politicized fear mongering proposals to close our borders or institute wrong-headed travel bans. For a while there was the promise of a measured, national response.
Of course, the unthinkable happened. An MSF doctor, one of the few heroes of this tragedy, rode on a subway in New York and went bowling! Dr. Craig Spencer, who had been responsibly monitoring his condition since his return from West Africa immediately notified health authorities and is now being treated at Bellevue Hospital.
At which point everything fell apart. New Jersey Governor Christie issued Executive Order 164 and his colleagues in New York and Illinois followed with similar but not identical emergency orders. Thereafter, apparently symptom-free MSF nurse Kaci Hickox made the mistake of landing at Newark and soon found herself in isolation. Given the text of Executive Order 164, Ms. Hickox seems to be in a bad place legally. Habeas corpus aside persons in her position must hope that there is rapid deployment and reliance on the new one-hour PCR Ebola tests that have received emergency authorization from the FDA.
The immediate question is whether disproportionate state responses will stop here or spread to other locations with designated gateways for West African passengers? Worse, will governors of states without such international communication hubs issue similar emergency orders, not because their states are under threat but to show they are "tough on Ebola”? Unfortunately, Florida with its new "twice-daily health evaluations" order may be the canary in that particular coal mine.
Disincentivizing heroic health care workers attempting to stop Ebola at its source is not the only problem with these state orders. Harsh, emergency rules create expectations that our border and health officials will execute them, promoting officious mission creep, while abandoning a national approach promotes fragmentation and encourages dysfunction. Worse, draconian and disproportionate responses create fear where prevailing medical science tells us there should only be concern. And, in the unlikely event that the science was wrong and things were to get worse, officials are left with nowhere to go.