Thursday, October 16, 2014

Risky Communications


# 9201


One of the reasons I try to leave my opinions out when reporting inflammatory stories in this blog – even if they often leave me initially appalled - is I know at some point more information may come out to either substantiate, or discredit, early reports. 

And unlike many in the media, I actually care that you can’t un-ring a bell. 


People’s lives, and careers are often at stake, and sitting on the sidelines we can’t always know all of the factors that went into their decision making, particularly based on early reporting.  


Case in point, yesterday’s revelation that the second nurse diagnosed with Ebola flew home last Monday.  


In his telebriefing yesterday afternoon,  CDC director Thomas Frieden stated:


The second health care worker reported no symptoms and no fever. However, because at that point she was in a group of individuals known to have exposure to Ebola, she should not have travelled on a commercial airline. The CDC guidance in this setting outlines the need for what is called controlled movement. That can include a charter plane, a car, but it does not include public transport. We will from this moment forward ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement.


The health care worker number two, who traveled from Ohio on the 13th of October, Monday, should not have traveled, should not have been allowed to travel by plane or any public transport by virtue because of the fact that she was in an exposed group. And although she did not report any symptoms, and she did not meet the fever threshold of 100.4, she did report at that time that she took her temperature and found it to be 99.5.



Although he never actually said it, a lot of people assumed by Dr. Frieden’s statement that this nurse decided fly home despite her  fever and known exposure to Mr. Duncan.


That immediately gave rise to a number of quick-to-condemn commentaries in the news and on social media that a `nurse should have known better’, and that she selfishly put `others at risk’.


But based on this CBS news report (below), and reports from other news media overnight, it now appears this nurse did the right thing. 


She called the CDC while still in Ohio – reported her fever – and was told it was okay to fly since it wasn’t 100.4 or greater.  A depth of detail not included in the CDC’s original statement.

In the case of Amber Vinson, the Dallas nurse who flew commercially as she was becoming ill with Ebola, one health official said "somebody dropped the ball."

The Centers for Disease Control and Prevention said that Vinson called the agency several times before flying, saying that she had a fever with a temperature of 99.5 degrees. But because her fever wasn't 100.4 degrees or higher, she didn't officially fall into the group of "high risk" and was allowed to fly.


This clarification (assuming the CBS news report is accurate) should absolve this nurse of responsibility for flying home, suggests the CDC missed another opportunity to control this virus, and should have been made far clearer in Dr. Frieden’s remarks.


I only have the highest respect for the technical skills of CDC, but this is the kind of omission that – once revealed –  serves to undermine the public’s confidence in what they are being told. 


The CDC’s over reliance on `talking points’  - where reporter’s questions are often not answered, but are simply used as an opportunity to repeat `reassuring messages’ -  and an apparent unwillingness to work `off script’ are problems I’ve discussed before (see Ebola Risk Communications).  


And it really isn’t necessary.


Americans know that with Ebola, we are in uncharted territory.  They don’t expect perfection on the part of the CDC, local public health agencies, or local hospitals. They can accept that mistakes will be made, and they can handle – even embrace – a degree of uncertainty.


But to engender that kind of public confidence, the CDC would be better served to speak in a `natural voice’ – one that admits mistakes when they happen, discusses both the challenges and areas of uncertainties that lie ahead, and one that doesn’t sound like their daily message was pre-approved by a committee of lawyers.

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