So What Now, Since the First Us Ebola Outbreak Seems to Be Contained?

Before coming to a specific answer for this question, let’s briefly review the history of this small Ebola outbreak in Dallas, and consider what would have happened had the outbreak continued or been larger.

I am going to walk you through my answer to this question, and explain why that is my answer. Ultimately, we will each answer this question for ourselves, and a no-response is itself a response.

You may have heard Thomas Eric Duncan occasionally referred to in the news as Patient Zero. This is because, in medical science, the index case or initial patient in the population of an epidemiological investigation is called Patient Zero. Epidemiology is the science that studies the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and informs policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare. So Duncan was termed Patient Zero because someone thought he fit this definition.

Major areas of epidemiological study include disease etiology, transmission, outbreak investigation, disease surveillance and screening, biomonitoring, and comparisons of treatment effects such as in clinical trials. Epidemiologists rely on other scientific disciplines like biology to better understand disease processes, statistics to make efficient use of the data and draw appropriate conclusions, social sciences to better understand proximate and distal causes, and engineering for exposure assessment. You should know this information because government officials sometimes rely on epidemiologists, to varying degrees, in determining governmental responses to outbreaks.

If you intend to do something in response to an outbreak, be it Ebola or otherwise, ask yourself this question: at what point in time should I begin to take action? Here is the Dallas Ebola timeline.

Sept. 19: Patient Zero flies from Liberia to Brussels
Sept. 20: Patient Zero flies from Brussels to Washington, DC
Sept. 20: Patient Zero flies from Washington, DC, to Dallas
Sept. 25: Patient Zero goes to the hospital ER, is treated and released
Sept. 28: Patient Zero goes to the hospital ER, is admitted
Sept. 30: Patient Zero confirmed to be infected with Ebola
Oct. 8: Patient Zero dies
Oct. 12: Nurse Nina Pham confirmed to be infected with Ebola
Oct. 14: Nurse Amber Vinson confirmed to be infected with Ebola
Oct. 19: Mandatory Quarantine ends for 43 people who came in contact with Patient Zero
Nov. 7: Quarantine ends for 120 people who came in contact with Pham and Vinson

It seems to me most logical to begin being concerned about a possible outbreak when a patient is confirmed to be infected with a deadly virus. We all have a limited amount of energy, focus, and time. Other than general preparation, getting too wound up prior to a confirmed case seems to risk burning too much energy, focus and time with no definitive benefit. The concern should escalate with each new confirmed case.

In my opinion, the more practical answer to “when” depends less on patients, and more on government officials. I was concerned about the Ebola outbreak and intentionally followed it in the news. Every morning, the first thing I did was check the news to see if any more cases had been confirmed. But I was moved to action by government officials’ responses to it. Specifically, on Friday, October 17, 2014, I watched (live via the Internet) the Dallas County Commissioners Court meeting. That scared me much more than any of the confirmed Ebola cases.

That Friday I watched the Commissioners debate about whether to adopt a disaster declaration. In Texas, disaster relief is bottom-up. It all starts at the local level-cities and counties. State resources are not generally brought to bear until a local government asks for help. Federal resources are not generally brought to bear until a local or state government asks for help. In outbreak situations, force may be required. The government actually used police power force in the Dallas Ebola outbreak. Hence my concern over the Dallas County Commissioners Court meeting. The disaster declaration would have been the next step to the local government seizing more control over persons and property.

And the Commissioners seriously considered whether or not to adopt a disaster declaration. At least one Commissioner indicated she would vote yes. Now, at this point, 3 cases of Ebola had been confirmed in Dallas. Patient Zero was dead, one nurse was in Maryland, and the other nurse was in Atlanta. What I realized from watching that meeting is that the patients are a tangential concern. We should keep them in our peripheral vision, but our focus must be on the governmental bodies who are responding to the situation. And those officials are more concerned over who else may become infected.

If the Dallas area had experienced another one or more confirmed Ebola cases over the weekend of October 18-19, 2014, it is likely that the Dallas County Commissioners would have, in short order, adopted an emergency disaster declaration. Everyone is still on high alert until November 7, 2014. What does that mean, practically?

While impossible to know, having researched applicable law in advance, I think the next response from the government would have been to impose an area-wide quarantine. I’m not sure exactly what that would look like, but I think it is well within the realm of the possible that the government would have asked us residents to voluntarily self-quarantine for some period of time, maybe a week to start, with the risk of the government extending the quarantine up to 21 days (the time it takes Ebola to show symptoms). If that didn’t work, and the Ebola continued to spread, I think the voluntary quarantine may have quickly become a mandatory quarantine backed up with state and local police power.

I mentioned above that Dallas actually employed state force in this case. The day Patient Zero tested positive for Ebola, Dallas County health officials asked his fiancé and others who had been staying in the same apartment with him, to stay inside the apartment (at the time, with soiled/contaminated bed linens, rags, towels, etc.). They refused. Because they were not sick, they couldn’t technically be quarantined.  So David Lakey, commissioner of the Texas Department of State Health Services, issued a “confinement order.”  The order required them to stay inside the apartment. Later, Dallas County moved them to secure quarters for continued monitoring. I am still investigating this order, but it appears to be based on the Communicable Disease Prevention and Control Act in the Tex. Health & Safety Code.

In the case of some 120 medical workers who treated Patient Zero or the two nurses, Dallas County gave the workers two options: either voluntarily agree to self-quarantine and monitor for symptoms, or, if they refused or broke the self-quarantine, the State would issue a confinement order forcibly quarantining them. Of course they all agreed to voluntarily self-quarantine, and the government has generally kept hush-hush the coercive nature of the agreement.

So here’s what I did. Very shortly after the Commissioners’ meeting ended, I called my doctors and got 30 day advance supplies of my prescriptions. Come to find out, that’s not as easy as it sounds. For a couple of mine, the insurance company had to approve the advance supply for it to be covered, and for another I had to actually go to the doctor’s office and pick up the written prescription. If you have medications you take every day, I strongly suggest you run this exercise to see what obstacles you may encounter.

Then I stocked up on food items and cleaning products and toiletries, things I would use regardless of the outbreak. Costco plus the grocery store. I made sure the LP gas tanks (grill) and my vehicle’s gas tanks were full. I did not stock up on water. I assumed water and electricity would continue. I didn’t see this Ebola situation as threatening the termination of those services. I work with folks who work at the utilities. They know how important it is to keep providing those services. It will take a lot to terminate utilities services.

Fortunately I can work at home as efficiently as anywhere else, and with electronic filing capabilities with the TCEQ, State Office of Administrative Hearings, and the courts in which I have cases, a quarantine would not affect my work as long as I can connect to the Internet. So all I needed was to bulk up on paper.

And that was basically the extent of my preparation. Next thing I knew the Cowboys were 6-1 and former Tennessee Vol Peyton Manning set the NFL touchdown passes record.

The world didn’t change when Patient Zero arrived in Dallas. It just caused us to recognize more of the risk that is present every day. Be practical with preps, and carry on with life.

And watch the government’s response to disasters and possible disasters. Disease in the area will not restrict your movements. It’s the government that can and will take away your freedom. Individuals have due process rights and protections available in emergencies. In these instances it is my job to be prepared to hold the government accountable to the law, protecting my clients’ rights and property.

This is a continuing series of blog posts on the Ebola outbreak in the Dallas area. Please subscribe to this blog for notice of future posts.

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