Belmont Club

Bureaucracy Versus the Germs

In general we believe that really important things, like epidemics, are above politics. The reverse appears to be true. The more important a thing, the more it attracts political interference. It now transpires that the experimental serum ZMapp was offered to a sick African doctor first; before Dr. Kent Brantly, the medical missionary from Samaritan’s Purse received the treatment. The New York Times describes the agonizing decision of Medecins Sans Frontieres over whether to accept the offer of the serum to treat an African doctor. The problem: politics.

The doctor who had been leading Sierra Leone’s battle against the Ebola outbreak was now fighting for his own life, and his international colleagues faced a fateful decision: whether to give him a drug that had never before been tested on people.

Would the drug, known as ZMapp, help the stricken doctor? Or would it perhaps harm or even kill one of the country’s most prominent physicians, a man considered a national hero, shattering the already fragile public trust in international efforts to contain the world’s worst Ebola outbreak?

The treatment team, from Doctors Without Borders and the World Health Organization, agonized through the night and ultimately decided not to try the drug. The doctor, Sheik Umar Khan, died a few days later, on July 29…

The previously untold story of Dr. Khan, recounted by two doctors involved in discussions about whether to use ZMapp, offered an unusual glimpse into the wrenching ethical dilemma of when and how experimental drugs should be used to combat the Ebola epidemic in West Africa. Had the treatment team decided differently in his case, the first person treated with the drug would have been African.

The problem MSF faced was simple. If they unsuccessfully administered ZMapp to Dr. Khan they might be accused of turning black Africans into lab rats.  And they couldn’t risk that. One MSF clinic had already been attacked by crowds who believed they had brought the virus from outside in the first place.

“What they really didn’t want to do was kill Dr. Khan with their attempt at therapy,” said Dr. Armand Sprecher, a public health specialist at Doctors Without Borders. “If word got out that M.S.F. killed Dr. Khan, that would have implications for outbreak control,” he added, using the initials for the French name of the relief group…. doctors feared stoking the considerable suspicion of Western medical institutions in the country, which was already making it harder to contain the outbreak.

So they didn’t give him the medicine. As I wrote a week ago before the case of Dr. Khan came to light, “the sad fact is that if they tested Zmapp on black Africans during this Ebola outbreak the media would claim they were being used as lab rats. The only acceptable way to test the new uncertified medication in Liberia was on two white Americans. That way if the serum failed the UN wouldn’t sue.” And so it proved. The success of the serum on Dr. Brantly and Nancy Writebol has reversed the situation. Now there indications it works, charges of racism are being made just the same, as in why were only white people being treated?

It’s ridiculous, but politics makes the world go round.

Politics also had a role in bringing Ebola to Nigeria. The Premium Times describes how Liberian government ministers intervened to get Sawyer on the plane, despite strong suspicions that he was afflicted with the disease.

The Liberian Government was aware that Patrick Sawyer, its citizen who brought the Ebola virus into Nigeria, had possibly contracted the virus from his late sister, yet cleared him to travel to Nigeria for a conference organised by the Economic Community of West African States [ECOWAS], PREMIUM TIMES can authoritatively report today.

Documents obtained by this newspaper showed that Mr. Sawyer’s employers, ArcelorMittal, an iron mining company, suspended him from work and isolated him after it became aware that he had contact with his sister who died of the virus on July 8….

But despite being under isolation and observation for the deadly disease, the Liberian Government, through its Deputy Finance Minister For Fiscal Affairs, Sebastian Muah, cleared Mr. Sawyer to travel to Nigeria for an ECOWAS convention in Calabar. The deputy minister personally admitted approving the trip in an online discussion forum, where some Liberian citizens raised questions about his action and competence. Mr. Muah could not be reached for comments on Monday. His mobile telephone was switched off the numerous times PREMIUM TIMES called.

Nor could Mr. Mr Jatto Asihu Abdulqudir, an ECOWAS protocol official who met the stricken Patrick Sawyer at the airport and transported him to the hospital be reached for comment. The reason? Abdulqudir is dead from Ebola.

“Mr Abdulqudir, a protocol assistant, was among those who assisted the Liberian delegate to a regional meeting Mr Patrick Sawyer, who died from the Ebola Virus Disease at a Lagos hospital on 25th July 2014.”

The official had been quarantined since Sawyer was confirmed as having Ebola, which has killed more than 1,000 people since the start of the year, most of them in Guinea, Sierra Leone and Liberia.

Because politics trumps germs, right? Maybe not. Ebola is having its revenge. The Nigerian government guidelines on handling Ebola now regard Ebola as being transmissible by air to a limited extent. Enumerating the of modes of transmission, it lists as number “6. Inhalation of contaminated air in hospital environment”. Five days ago ECOWAS closed their Lagos office and suspended its regional meetings.  The ministers are in full flight.

The shut down of the office, located within Victoria Island, is to enable health officials fumigate the buildings and the entire compound, Nigerian health officials said, adding that they were also fumigating the vehicle used in evacuating the late Patrick Sawyer, a Liberian-American who was the first victim of the disease in Nigeria.

Meanwhile, ECOWAS has suspended all its regional meetings, unless such meetings are “absolutely necessary” … the ECOWAS building would remain shut until the fumigation process had been concluded satisfactorily.

Does this mean Ebola is airborne in the true sense? Probably not. But this strain is perhaps more contagious than previous ones.  Wait of course, for the official determination.

Sergei Brin and Larry Page told an interviewer that they were reluctant to get into the health care business because there were too many lawyers in the medical business. Brin said, “generally, health is just so heavily regulated. It’s just a painful business to be in. It’s just not necessarily how I want to spend my time. Even though we do have some health projects, and we’ll be doing that to a certain extent. But I think the regulatory burden in the U.S. is so high that think it would dissuade a lot of entrepreneurs.”

Page added “I am really excited about the possibility of data also, to improve health. But that’s– I think what Sergey’s saying, it’s so heavily regulated. It’s a difficult area. I can give you an example. Imagine you had the ability to search people’s medical records in the U.S.. Any medical researcher can do it. Maybe they have the names removed. Maybe when the medical researcher searches your data, you get to see which researcher searched it and why. I imagine that would save 10,000 lives in the first year. Just that. That’s almost impossible to do because of HIPAA.” In the battle between doctors and lawyers, the lawyers have won, hands down.

a Health Affairs report of 2009 [estimated] that physicians, on average, spend 3 hours per week dealing with insurance companies and related paperwork. Nurses and other staff invest even more time in these efforts. A 2012 perspective in the NEJM on administrative costs of care highlights findings of an IOM study, and states this: “The United States spends $361 billion annually on health care administration — more than twice our total spending on heart disease and three times our spending on cancer.”

One day, when we have mastered quantum computing, discovered the secret of cold fusion and found the principles of Warp Drive, we’ll be able to put these products on the market without unnecessary interference from the attorneys. Then, “for the second time in history, man will have discovered fire.”

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