Experts Slam Christie on Ebola Response, Air Concerns About Future Outbreaks

Andrew Kitchenman | December 11, 2014 | Health Care
Doctors see politics trumping science, but officials contrast state response with federal delays

Credit: Governor's Office/Tim Larsen
Gov. Chris Christie and state Health Commissioner Mary O'Dowd announce the activation of a statewide Ebola preparedness plan in October.
How Gov. Chris Christie and state health officials handled the response to the Ebola outbreak this fall has drawn criticism from some public-health experts, who say that politics took precedence over science.

“The governor in my judgment did not make a medical or scientific decision. He made a political decision,” said Dr. Melvin P. Weinstein, chief of infectious diseases, allergy and immunology at Robert Wood Johnson Medical School. “He responded to the fears of the population.”

Former state Health Commissioner Dr. Fred M. Jacobs agreed.

“One of the things missing in New York and New Jersey was the Department of Health wasn’t out in front of this,” Jacobs said. “This was kind of preempted by the political people, mainly the governor, so that the credibility of the message was tainted by seeing it through a political prism — that shouldn’t happen. The commissioner of health or the deputy commissioner, whoever’s the most credible person, should be out in front of that announcement right away.”

The criticism stems from how Christie and New York Gov. Andrew Cuomo announced on October 24 that those who had direct contact with Ebola patients would be quarantined. That policy that was criticized by federal Centers for Disease Control and Prevention (CDC) officials for running the risk of discouraging healthcare workers from volunteering to fight the spread of the disease in Africa.

Maine nurse Kaci Hickox, quarantined at University Hospital in Newark, denounced the policy. When a forehead scanner found that she was running a temperature, she said she was flushed after being questioned and then isolated for several hours, adding that she never ran an internal temperature, which was confirmed by a thermometer.

The administration defended its handling of the outbreak.

“New Jersey’s first order of business is to protect the public health and ease public uncertainty, nothing less, and we did that in contrast to a listless, unpredictable federal response,” Christie spokesman Michael Drewniak wrote yesterday in an emailed response to questions.

He said administration officials were in 24-hour consultation with the best public and private clinicians, epidemiologists, and health institutions inside the state and around the country.

“I think it’s fair to say that Dr. Jacobs is completely uninformed about the depth, scope and intensity of the Department of Health’s preparedness and response efforts under Commissioner (Mary E.) O’Dowd’s experience and direction,” Drewniak said.

A Monmouth University poll taken between October 30 and November 2 found that likely voters in New Jersey favored Christie’s approach over the federal response. While 37 percent of respondents approved of the federal response compared with 46 percent that disapproved, Christie’s handling of Ebola received 53 percent approval compared with 27 percent disapproval. Of quarantining Hickox, 67 percent approved.

As an alternative to an outright quarantine of those who’ve treated Ebola patients, the current CDC guidelines, in which public health officials actively monitor potentially exposed residents, are a good approach, Weinstein said during a panel discussion of the issue hosted by the New Jersey Health Care Quality Institute.

That’s because those who’ve contracted the Ebola virus but don’t have symptoms aren’t contagious, while those who have the early symptoms — which are similar to the flu — are highly unlikely to infect others.

Two nurses in Dallas were infected after coming into contact with a patient in an advanced state of the disease. Patient Thomas Eric Duncan of Liberia died while nurses Amber Vinson and Nina Pham were successfully treated and released.

How the federal government responded before it reached its current recommendations received criticism from infectious disease specialists outside of state government.

Dr. Leon G. Smith, former chairman of medicine at Saint Michael’s Medical Center in Newark, said CDC director Dr. Tom Frieden “probably should be removed from office” and that he and other CDC officials should have been better prepared for the outbreak. He added that the federal government should have worked to develop a vaccine for Ebola sooner.

While Weinstein agreed that the initial CDC response appeared to be poor, he said the federal response has improved. This includes working with states to designate regional hospitals for additional Ebola preparedness — Robert Wood Johnson University Hospital in New Brunswick will treat long-term Ebola cases, while Hackensack University Medical Center and University Hospital in Newark will also handle patients who are being tested for the disease.

Several experts said the details of each individual Ebola case are important in determining what the appropriate public-health response should be.

Smith said the case of Hickox — who faced a multiday quarantine in a tent at University Hospital — would have been better handled if she had been sent to Robert Wood Johnson University Hospital, which has facilities better suited to quarantine patients.

But Smith said the entire national response to outbreaks has been hobbled by a lack of public-health funding. “These hospitals — they need money bad,” Smith said. “This whole thing can be solved by one thing: money.”

The CDC and National Institutes of Health need more funding, as does infectious diseases as a medical specialty, he said.

“We’ve got to really start thinking about the future of the country,” said Smith, adding that he’s most concerned about the potential for a future influenza pandemic.

Bernard W. Gerard, first vice president of the Health Professionals and Allied Employees union, noted that nurses have been receiving intensive treatment in using protective gear since the Ebola outbreak. He said this was similar to the response that they received for bioterrorism after the September 11, 2001, attacks. He asked how nurses could ensure that the state maintains a long-term commitment to outbreak preparedness as the immediate threat fades.