The understanding within the medical community that treatment protocols employed must have cogent efficacy has led to the development of translational medicine, which focuses on identifying and converting basic science research into therapies and procedures physicians can implement. The applicability of translational medicine, as medicine is a dynamic interdisciplinary field, is ubiquitous and gives researchers and medical providers the opportunity to collaborate on various issues affecting the medical community, including infectious disease protocols.
Similar to many issues in medicine, the handling of the Ebola crisis has been anything but straightforward. Strife between the CDC and medical professionals at the forefront has been made evident by the actions of Dr. Gil Mobley, a Springfield, Missouri based emergency medicine physician who recently donned a pseudo-hazmat suit with the words, “CDC is lying” printed on the back on his flight from Guatemala to the United States.
Laura Faiver: Thank you, Dr. Mobley for allowing me to interview you. I want to start by getting some clarification as to what was your true motivation for doing this; you have said both that the CDC is lying and that they are “asleep at the wheel.” Do you believe the CDC is incompetent and unable to properly handle this situation, or do you believe they are lying to the public about the precariousness of the situation?
Dr. Gil Mobley: That is a tough question — is the CDC grossly incompetent, or are they employing “incrementalism,” only releasing pieces of information, and honestly I don’t know which would be worse, but I can say that there are glaring discrepancies on what information is coming out.
LF: Could you provide a specific example of a discrepancy?
Dr. Mobley: That Ebola is hard to catch. What is considered “close contact” has now been changed to mean within three feet of someone infected.
LF: So despite public reassurance that Ebola is not airborne and is unlikely to become airborne, the definition of close contact seems to be expanding, literally. To you, is this indicative of health officials harboring concern over possible preemptive proclamation of the mode of transmission or the possibility of it becoming airborne?
Dr. Mobley: I can say that we don’t know everything about this disease’s transmissibility and for the CDC to say otherwise is reprehensible.
LF: Given that Ebola is still a bit of an enigma to researchers and that we live in a global society, do you think all international flights, not just ones from West Africa, should be screened for potential carriers?
Dr. Mobley: Absolutely. 10,000 people are flying out of West Africa every day, and we are way past due for a pandemic. Third-world countries have inadequate health care infrastructures, poor sanitation, and are not equipped to handle an outbreak. Mr. Duncan was not the only infected individual to make it out of West Africa.
LF: Especially when one considers the incubation period can be up to 21 days.
Dr. Mobley: Exactly.
LF: That being said, how effective can these airport screenings be? Or do health officials know they aren’t an effective method, but employ them simply to placate the public?
Dr. Mobley: One thing these screenings do is heighten alertness, and hopefully that will be the start of the new norm; for people to be aware of the symptoms, aware that this is serious. And even catching some infected individuals can help prevent some clusters. What we need are fever centers. Anyone with a fever, send them to one of these centers, keep them out of the hospitals. If physicians and health care providers start getting sick, we lose the ability to respond; we have to preserve the ability to respond.
LF: And that brings up a rather poignant comment you made about the CDC being reactionary, with the example of Mr. Duncan’s family residing in his apartment for several days after his Ebola diagnosis before being isolated from what was a potential hot zone. What would you like to see done, besides these airport screenings?
Dr. Mobley: Months ago the CDC should have been developing guidelines for physicians, particularly those working in the emergency department. What is the threshold for when we say, from here on out, everyone is in PPE. From here on out, everyone with a fever is considered a risk. That’s why I say fever centers; we have to protect the ones on the frontline, which would be the doctors, nurses and other health care workers.
Although some may disagree with Dr. Mobley’s actions, it is evident the medical community either grossly overestimated their ability to manage the outbreak or grossly underestimated the capability of the virus. Reports have recently confirmed several health care workers have contracted Ebola outside of West Africa, and, as Dr. Mobley mentioned, the CDC has changed the guidelines regarding what is considered close-contact; it is clear that until there is enough compelling, scientifically-supported evidence, comprehensive statements regarding transmissibility should not be rendered. As Karl Marx noted, history repeats itself, “first as tragedy, then as farce.”
It is time health care officials take note from past outbreaks and realize translating research into practice is only as beneficial as the quality and thoroughness of the research itself. Until 1997, for example, it was believed that avian influenza viruses could not be transmitted to humans. That was demonstrated to be false when humans contracted H5N1 directly from birds, resulting in 53 deaths. Lesson: complacency kills. With deadly pathogens, protocols must account for the unknown, and to do this, health care providers must recognize their limits, which are, at times, constrained by the availability of scientific evidence.