Don’t shake hands with Sotto and Ejercito

The thing about an ignoramus (as opposed to someone who is just misinformed) is he tends to shoot himself in the foot and knee and higher, while his random blasts are also hitting others. Thus, Senator Vicente Sotto III’s words on Acting Secretary of Health Janette Garin’s visit to the troops quarantined as a measure against the Ebola epidemic. 

“Dapat kaming mga public officials ang mangunguna sa pag-iingat. So kung ika-quarantine mo ng 21 days yung grupo, bakit ka bibisita nang hindi ka nakaprotective gear. ‘Wag namang ganun, eh porke official sila, hindi sila tatablan [ng sakit],” the senator said.

(We public officials should lead the way in being careful. So if you quarantine a group for 21 days, why should you visit without protective gear? Let them not say that just because they are officials, that they can’t get infected.)

This was of course seconded with great alacrity by another shoot-now-ask-later leader of the nation, Senator JV Ejercito.

This prompted the World Health Organization, the leading scientific organization tasked by the international community to oversee global health matters, to re-issue guidelines on the use of personal protective equipment in the handling of Ebola patients.

I suggest that the Filipino public and the Philippine government obey the WHO instead of Sotto and Ejercito. Their ideas are more likely to  cause the spread of Ebola. Garin’s actions, on the other hand, because they were within protocol, kept us safe.  

And so, indeed, public officials like Sotto and Ejercito are supposed to be exemplars in the cause of public safety. And, as they have said things that may yet jeopardize our nation’s health…maybe they should resign. At the very least, apologize to the nation. An apology might erase some of the harm they have done by making people focus on the proper information that is so vital to preventing an outbreak.

No quarantine needed

As the two senators seem to understand better if we give them short soundbites for purposes of talking to the media, let me give them a soundbite that is accurate: “Those soldiers should not have been quarantined, if they were not showing any signs and symptoms of Ebola. They should have been released to their families immediately with appropriate monitoring and proper instructions from the Department of Health.” 

Of course, this scientific statement does not serve as a criticism of Secretary Garin as she did not order that quarantine. Based on media reports, that decision was made before her appointment as acting secretary. Sotto and Ejercito prove yet again that there are intellectually-challenged types who will not let science and public health get in the way of hitting at a person from the other side of the political aisle.

Let me talk, therefore, to the general public. I won’t behave like certain senators. Instead, I will try to add to scientific information about our situation, instead of muddling the issue. I will speak as simply as possible so that certain senators might understand. 

Clinical protocol 

A clinical protocol in the sense that it should be used in the discussion of the quarantined military in this case, is a set of guidelines about a disease. It can cover many things but it also will include whom we might consider as being at risk to get a disease, how to handle people who are suspected of having a disease, how to confirm if a person has become sick from this disease, how to care for people who are confirmed to have it. Each disease, because it has its own characteristics in terms of diagnosis, treatment, cure, prevention, has its own set of guidelines.

Let us say that you have breast cancer. A clinical protocol on breast cancer tells you what tests should be done and what treatments should be undertaken. Should you be quarantined? Not if we want to prevent anyone else from getting breast cancer. But if your therapy has weakened your immune system so that you are very susceptible to disease, then you could be quarantined to prevent anyone from infecting you. 

Now let’s say you have the common cold. In truth a quarantine would stop you from infecting anyone. But what would be the benefit of quarantine as a preventive measure as opposed to its cost? Millions of people would have to be quarantined and the common cold usually causes only mild discomfort. So the protocol on this is bed rest and liquids and the frequent washing of hands. No personal protective equipment and no medications are necessary. 

The guidelines are based on our scientific understanding of a disease. What is the cause? Is it infectious? If so, how is it transmitted? When can a person infected with it infect others? Is there a cure? Is it fatal or disabling?

In the case of Ebola, the WHO’s clarification notes that what should be done is to screen people leaving the affected countries. That, anyone arriving in the Philippines from these countries should make the DOH aware of his or her presence in the country. That, these persons should monitor their health for the next 21 days. It does not recommend quarantine for those arriving from infected countries much less the use of personal protective equipment in interacting with them. From what we know of Ebola, even if someone is infected, that person cannot infect others until they begin to show the signs and symptoms (like fever) of Ebola. The WHO also notes that there is a likelihood that if anyone of those troops (that is anyone who came from the affected countries) developed a fever, there is a very big possibility that it isn’t Ebola but malaria.

If anyone of those troops becomes symptomatic, however, they should then be tested for Ebola. Ebola is indeed highly contagious and also highly fatal. Other persons can become infected if they come in contact with the body fluids (such as vomit, feces and blood) of the person infected by the Ebola virus. This is where the personal protective equipment comes in. 

PPE

Those PPEs should be used by anyone who will be dealing with persons we suspect to have Ebola, whether to test them or care for them. 

The PPEs are made to certain standards and those that need to use them have to be trained on their use.

Sotto and Ejercito’s call for Garin and her party who visited the troops to run around in protective equipment is treacherous. DOH has a limited stockpile of these vitally important PPE’s. In fact ensuring the supply of these “suits” is a major logistical issue for the governments in the affected countries. Because of the global concern, other countries are also stockpiling. Because it is made from special materials, production is not that fast. I understand that the demand for PPEs is greater than actual production so that orders for these have a waiting period. In short we had better use these suits properly and judiciously.

Preventing fear and panic

Preventing fear and panic is a vital part of handling any epidemic. Fear causes people and governments to take counter-productive measures that increase the likelihood of spread rather than actually help in preventing spread. Thus, some governments have actually banned people coming from the affected countries from entering their countries. This increases the likelihood that someone who is infected will sneak in, not tell health authorities, not receive the proper instructions and monitoring, and cause the spread of the disease.

Fear also causes other effects, such as stigmatization, which adds to the burden of those with the illness. Sotto and Ejercito should have learned lessons about Ebola from our current problems with HIV infections. When I heard them say that they would refuse to shake the hand of Garin when she visited the Senate, I remember the pain of my gay friends in the early days when people were first beginning to understand HIV infections. Ignorant people didn’t want to shake their hands also. That is still true of those living with HIV now. As our work on HIV shows, stigma also causes people to hide their status and that is not helpful.

If, heaven forbid, we do have an Ebola outbreak and we run out of personal protection equipment, I suggest Sotto and Ejercito  be assigned to care for the victims without protection. I suggest they be joined by all those who repeated and participated in the crafting of their criticism. I would include those members of the media who did their own share in pushing these myths. Like our leaders, members of the media are specially bound to protect our health with proper information.

In the meantime, I suggest no one shake the hand of Sotto and Ejercito. That would be a sign of respect that they don’t deserve. – Rappler.com