Today, The Washington Post writer, Max Ehrenfreund, authored an article that quotes my colleagues, Lawrence Gostin and Mark Rothstein, both longtime public health law professors. Max did not call me, or I would have given him a different perspective. (I have had interviews with The Wall Street Journal, FOX, Time Magazine, the Atlanta Journal Constitution, over the past months since the Ebola epidemic began to emerge in the United States, but not The Washington Post.)
The article suggests that Governor Christie's action in quarantining people who have had contact with Ebola may be unconstitutional -- the word "may" is key to understanding the way quarantine law is applied.
As Mark Rothstein noted, the court will decide if the risk to the public is high enough to burden the freedom of the individuals detained because of their contact with Ebola patients. In addition, this detention must be the least burdensome means possible. That is the test the court will apply.
My recommendation to Governor Christie is that returning individuals be detained long enough to give them a more in depth interview about their exposure which would reveal more about the risk of that individual contracting Ebola, because we know certain exposures make it more likely that an individual will become sick, i.e., handling the bodies of people who have died of Ebola when the viral load is at its highest. After this interview process, instructions will be given to them to log into a website and self-report their temperature each day. This requires little in the way of additional staff for the public health agency and when the computer program would notify the agency when the temperature is rising, or when the individual fails to report. The first time there is a failure to report, the individual would be detained in quarantine for the duration of the 21-day period.
This is the least burdensome method of protecting the public health, and that is the question the court will ask about this quarantine order.
Monday, October 27, 2014
Wednesday, October 8, 2014
Creation of the Texas Task Force on Infectious Disease Preparedness and Response
Making national news, the Governor of Texas appointed a Task Force to provide recommendations on the current Ebola response and to develop plans for coordinating with local governments in their responses. Here is the Executive Order: Governor Rick Perry's Executive Order RP 79 Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response, Monday, October 6, 2014 .
Governor Perry noted the "significant expertise of medical professionals" in Texas, as a resource. In fact, we have the National Biodefense Laboratory at UTMB-Galveston, one of two BSL-4 laboratories in the nation and the only one, that is fully functional at this point. The federal government relies on this laboratory for confirmation of suspected diseases and information and analysis. Many of the scientists and medical professionals here in Texas are among the virus hunters who fearlessly enter hot zones to help analyze and assist in outbreaks.
In full disclosure, I will add that I was included in the named members to the Committee and my role is to provide insight where legal issues are important to responding and planning to this incident and others. It is an honor to work with these scientists and medical professionals, developing a strategy to address the threat made very real by the recent appearance of Ebola in Texas, September 30, 2014.
Here is the full text of Governor Perry's Executive Order:
WHEREAS, infectious diseases are responsible for more deaths worldwide than any other single cause; andWHEREAS, the State of Texas has a responsibility to safeguard and protect the health and well-being of its citizens from the spread of infectious diseases; and
WHEREAS, on September 30, 2014, the first case of Ebola diagnosed in the United States occurred in Dallas, Texas; and
WHEREAS, addressing infectious diseases requires the coordination and cooperation of multiple governmental entities at the local, state and federal level; and
WHEREAS, public health and medical preparedness and response guidelines are crucial to protect the safety and welfare of our citizens; and
WHEREAS, Texas has nationally recognized infectious disease experts and other highly trained professionals across the state with the experience needed to minimize any potential risk to the people of Texas;
NOW, THEREFORE, I, Rick Perry, Governor of the State of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following:
1. Creation and Duties. The Texas Task Force on Infectious Disease Preparedness and Response (the "Task Force") is hereby created to:
• Provide expert, evidence-based assessments, protocols and recommendations related to the current Ebola response and a strategic emergency management plan for the incident command team and their partners at the state and local level of government.
• Develop a comprehensive plan to ensure Texas is prepared for the potential of widespread outbreak of infectious diseases, such as the Ebola virus and other emerging infectious diseases, and can provide rapid response that effectively protects the safety and well-being of Texans.
• Serve as a reliable and transparent source of information and education for Texas leadership and citizens.
The Task Force will establish this plan by:
• Using the significant expertise of medical professionals in Texas and elsewhere;
• Collaborating with local government officials and local health officials;
• Utilizing, where possible, the Texas Emergency Preparedness Plan and structure;
• Identifying the various responses necessary in the event of an epidemic of infectious disease;
• Establishing a command and control structure that will ensure effective preparations and response that may be included in Chapter 418 of the Government Code or related statutes and that also ensure the authority of a Governor to take emergency action as needed; and
• Coordinating with appropriate entities to ensure public awareness and education regarding any pandemic threat.
2. Composition and Terms. The Task Force shall consist of the following members:
Dr. Brett Giroir, Executive Vice President and CEO, Texas A&M Health Science Center, shall serve as the Director of the Texas Task Force on Infectious Disease Preparedness and Response.
Other members include:
Dr. Gerald Parker, Vice President, Public Health Preparedness and Response, Texas A&M Health Science Center. Dr. Parker shall serve as the Deputy Director on the Task Force.
Dr. Tammy Beckham, Director, Veterinary Medical Diagnostic Laboratory and the Institute for Infectious Animal Diseases, Texas A&M University.
Dr. Peter Hotez, Founding Dean, National School of Tropical Medicine, Baylor College of Medicine; Professor, Departments of Pediatrics and Molecular Virology & Microbiology; President, Sabin Vaccine Institute.
Richard Hyde, Executive Director, Texas Commission on Environmental Quality.
Tim Irvine, Executive Director, Texas Department of Housing and Community Affairs.
Dr. Kyle Janek, Executive Commissioner, Texas Health and Human Services Commission.
Nim Kidd, Division Chief, Texas Division of Emergency Management.
Dr. Thomas Ksiazek, Virologist and expert in the field of epidemiology/ecology and laboratory diagnosis of hemorrhagic fevers and arthropod-borne viral diseases, The University of Texas Medical Branch at Galveston.
Dr. David Lakey, Commissioner, Texas Department of State Health Services.
Dr. James LeDuc, Ph.D., Director, Galveston National Laboratory; professor of Microbiology and Immunology; Director, Program on Global Health, Institute for Human Infections and Immunity.
Dr. Scott Lillibridge, Professor of Epidemiology and Assistant Dean, Texas A&M Health Science Center School of Public Health.
Colonel Steve McCraw, Executive Director, Texas Department of Public Safety.
Major General John Nichols, Adjutant General, Texas National Guard.
Dr. Victoria Sutton, Associate Dean for Research and Faculty Development; Director, Center for Biodefense, Law and Public Policy, Texas Tech University School of Law.
Lt. General Joseph Weber, Executive Director, Texas Department of Transportation.
Michael Williams, Commissioner, Texas Education Agency.
The Governor may fill any vacancy that may occur and may appoint other members as needed. All appointees serve at the pleasure of the Governor.
Any state or local employees appointed to serve on the Task Force shall do so in addition to the regular duties of their respective office or position.
3. Report. The Task Force shall make written reports on its findings and recommendations, including legislative recommendations, to the Governor and the Legislature. The first report is due by December 1, 2014, which should include preliminary recommendations that require legislative action. A second report is due by February 1, 2015, and should contain, in part, any additional recommendations for legislative action during the 2015 legislative session. The Task Force may issue other regular reports as it deems necessary.
4. Meetings. The Task Force shall meet at times and locations as determined by the Director. The Task Force may meet telephonically. The Task Force may hold public hearings to gather information; when conducting public hearings the Task Force shall meet in various parts of Texas to encourage local input. The Task Force also may meet in executive session to discuss matters that are deemed confidential by state or federal statutes or to ensure public security or law enforcement needs.
5. Administrative Support. The state agencies involved shall provide administrative support for the Task Force.
6. Other Provisions. The Task Force shall adhere to guidelines and procedures prescribed by the Office of the Governor. All Task Force members shall serve without compensation or reimbursement for travel expenses.
7. Effective Date. This order shall take effect immediately.
This executive order supersedes all previous orders inconsistent with its terms and shall remain in effect and in full force until modified, amended, rescinded or superseded by me or by a succeeding Governor.
Given under my hand this the 6th day of October, 2014.
RICK PERRY
Governor
Governor Perry noted the "significant expertise of medical professionals" in Texas, as a resource. In fact, we have the National Biodefense Laboratory at UTMB-Galveston, one of two BSL-4 laboratories in the nation and the only one, that is fully functional at this point. The federal government relies on this laboratory for confirmation of suspected diseases and information and analysis. Many of the scientists and medical professionals here in Texas are among the virus hunters who fearlessly enter hot zones to help analyze and assist in outbreaks.
In full disclosure, I will add that I was included in the named members to the Committee and my role is to provide insight where legal issues are important to responding and planning to this incident and others. It is an honor to work with these scientists and medical professionals, developing a strategy to address the threat made very real by the recent appearance of Ebola in Texas, September 30, 2014.
Here is the full text of Governor Perry's Executive Order:
RP 79 - Relating to the creation of the Texas Task Force on Infectious Disease Preparedness and Response
WHEREAS, infectious diseases are responsible for more deaths worldwide than any other single cause; andWHEREAS, the State of Texas has a responsibility to safeguard and protect the health and well-being of its citizens from the spread of infectious diseases; and
WHEREAS, on September 30, 2014, the first case of Ebola diagnosed in the United States occurred in Dallas, Texas; and
WHEREAS, addressing infectious diseases requires the coordination and cooperation of multiple governmental entities at the local, state and federal level; and
WHEREAS, public health and medical preparedness and response guidelines are crucial to protect the safety and welfare of our citizens; and
WHEREAS, Texas has nationally recognized infectious disease experts and other highly trained professionals across the state with the experience needed to minimize any potential risk to the people of Texas;
NOW, THEREFORE, I, Rick Perry, Governor of the State of Texas, by virtue of the power and authority vested in me by the Constitution and laws of the State of Texas, do hereby order the following:
1. Creation and Duties. The Texas Task Force on Infectious Disease Preparedness and Response (the "Task Force") is hereby created to:
• Provide expert, evidence-based assessments, protocols and recommendations related to the current Ebola response and a strategic emergency management plan for the incident command team and their partners at the state and local level of government.
• Develop a comprehensive plan to ensure Texas is prepared for the potential of widespread outbreak of infectious diseases, such as the Ebola virus and other emerging infectious diseases, and can provide rapid response that effectively protects the safety and well-being of Texans.
• Serve as a reliable and transparent source of information and education for Texas leadership and citizens.
The Task Force will establish this plan by:
• Using the significant expertise of medical professionals in Texas and elsewhere;
• Collaborating with local government officials and local health officials;
• Utilizing, where possible, the Texas Emergency Preparedness Plan and structure;
• Identifying the various responses necessary in the event of an epidemic of infectious disease;
• Establishing a command and control structure that will ensure effective preparations and response that may be included in Chapter 418 of the Government Code or related statutes and that also ensure the authority of a Governor to take emergency action as needed; and
• Coordinating with appropriate entities to ensure public awareness and education regarding any pandemic threat.
2. Composition and Terms. The Task Force shall consist of the following members:
Dr. Brett Giroir, Executive Vice President and CEO, Texas A&M Health Science Center, shall serve as the Director of the Texas Task Force on Infectious Disease Preparedness and Response.
Other members include:
Dr. Gerald Parker, Vice President, Public Health Preparedness and Response, Texas A&M Health Science Center. Dr. Parker shall serve as the Deputy Director on the Task Force.
Dr. Tammy Beckham, Director, Veterinary Medical Diagnostic Laboratory and the Institute for Infectious Animal Diseases, Texas A&M University.
Dr. Peter Hotez, Founding Dean, National School of Tropical Medicine, Baylor College of Medicine; Professor, Departments of Pediatrics and Molecular Virology & Microbiology; President, Sabin Vaccine Institute.
Richard Hyde, Executive Director, Texas Commission on Environmental Quality.
Tim Irvine, Executive Director, Texas Department of Housing and Community Affairs.
Dr. Kyle Janek, Executive Commissioner, Texas Health and Human Services Commission.
Nim Kidd, Division Chief, Texas Division of Emergency Management.
Dr. Thomas Ksiazek, Virologist and expert in the field of epidemiology/ecology and laboratory diagnosis of hemorrhagic fevers and arthropod-borne viral diseases, The University of Texas Medical Branch at Galveston.
Dr. David Lakey, Commissioner, Texas Department of State Health Services.
Dr. James LeDuc, Ph.D., Director, Galveston National Laboratory; professor of Microbiology and Immunology; Director, Program on Global Health, Institute for Human Infections and Immunity.
Dr. Scott Lillibridge, Professor of Epidemiology and Assistant Dean, Texas A&M Health Science Center School of Public Health.
Colonel Steve McCraw, Executive Director, Texas Department of Public Safety.
Major General John Nichols, Adjutant General, Texas National Guard.
Dr. Victoria Sutton, Associate Dean for Research and Faculty Development; Director, Center for Biodefense, Law and Public Policy, Texas Tech University School of Law.
Lt. General Joseph Weber, Executive Director, Texas Department of Transportation.
Michael Williams, Commissioner, Texas Education Agency.
The Governor may fill any vacancy that may occur and may appoint other members as needed. All appointees serve at the pleasure of the Governor.
Any state or local employees appointed to serve on the Task Force shall do so in addition to the regular duties of their respective office or position.
3. Report. The Task Force shall make written reports on its findings and recommendations, including legislative recommendations, to the Governor and the Legislature. The first report is due by December 1, 2014, which should include preliminary recommendations that require legislative action. A second report is due by February 1, 2015, and should contain, in part, any additional recommendations for legislative action during the 2015 legislative session. The Task Force may issue other regular reports as it deems necessary.
4. Meetings. The Task Force shall meet at times and locations as determined by the Director. The Task Force may meet telephonically. The Task Force may hold public hearings to gather information; when conducting public hearings the Task Force shall meet in various parts of Texas to encourage local input. The Task Force also may meet in executive session to discuss matters that are deemed confidential by state or federal statutes or to ensure public security or law enforcement needs.
5. Administrative Support. The state agencies involved shall provide administrative support for the Task Force.
6. Other Provisions. The Task Force shall adhere to guidelines and procedures prescribed by the Office of the Governor. All Task Force members shall serve without compensation or reimbursement for travel expenses.
7. Effective Date. This order shall take effect immediately.
This executive order supersedes all previous orders inconsistent with its terms and shall remain in effect and in full force until modified, amended, rescinded or superseded by me or by a succeeding Governor.
Given under my hand this the 6th day of October, 2014.
RICK PERRY
Governor
Gallup polling may not analyze the most important question.
Does fear of getting Ebola relate to confidence in government to contain it?
Yesterday, Gallup released a poll, comparing fears of Americans to getting Ebola to previous polls asking similar questions about H1N1(2009) and Bird Flu (2005-6). The most interesting finding, I thought, was this: The poll found that more Americans were concerned about getting Ebola than they were concerned about getting H1N1, even though there was a lot more of it in closer proximity to Americans.
Could this be related to confidence in the federal government to contain Ebola? The poll data suggests it might be. When asked about confidence in the federal government to contain Ebola, 61% were confident; while the poll during the 2009 H1N1/Swine Flu outbreak, confidence in the federal government to contain it was 74%.
While Gallup did not make this association, I suggest that there may be a correlation if the data were analyzed with these two bivariate responses and if the same people who were concerned about getting Ebola were also not confident in the government at a frequency that was statistically significant, then that could be one of the most important findings in the poll, if they had taken this next step in their analysis.
Here's the report if you would like to read it more closely: Gallup poll report .
Yesterday, Gallup released a poll, comparing fears of Americans to getting Ebola to previous polls asking similar questions about H1N1(2009) and Bird Flu (2005-6). The most interesting finding, I thought, was this: The poll found that more Americans were concerned about getting Ebola than they were concerned about getting H1N1, even though there was a lot more of it in closer proximity to Americans.
Could this be related to confidence in the federal government to contain Ebola? The poll data suggests it might be. When asked about confidence in the federal government to contain Ebola, 61% were confident; while the poll during the 2009 H1N1/Swine Flu outbreak, confidence in the federal government to contain it was 74%.
While Gallup did not make this association, I suggest that there may be a correlation if the data were analyzed with these two bivariate responses and if the same people who were concerned about getting Ebola were also not confident in the government at a frequency that was statistically significant, then that could be one of the most important findings in the poll, if they had taken this next step in their analysis.
Here's the report if you would like to read it more closely: Gallup poll report .
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