Obama and Ebola: Perception and Reality

The president is frustrated.

obama-ebola-cdc

Friday, President Obama appointed a political operative trained as a lawyer to handle the Ebola crisis, prompting our own Doug Mataconis to ask why we need an Ebola czar at all. Given that the president already has a team of highly qualified medical personnel, notably the Centers for Disease Control and the National Institutes of Health (but not a permanent Surgeon General), it’s a reasonable question.

Michael Shear and Mark Landler of the NYT provide an answer in their report titled “Amid Assurances on Ebola, Obama Is Said to Seethe.”

Beneath the calming reassurance that President Obama has repeatedly offered during the Ebola crisis, there is a deepening frustration, even anger, with how the government has handled key elements of the response.

Those frustrations spilled over when Mr. Obama convened his top aides in the Cabinet room after canceling his schedule on Wednesday. Medical officials were providing information that later turned out to be wrong. Guidance to local health teams was not adequate. It was unclear which Ebola patients belonged in which threat categories.

“It’s not tight,” a visibly angry Mr. Obama said of the response, according to people briefed on the meeting. He told aides they needed to get ahead of events and demanded a more hands-on approach, particularly from the Centers for Disease Control and Prevention. “He was not satisfied with the response,” a senior official said.

The difference between the public and private messages illustrates the dilemma Mr. Obama faces on Ebola — and a range of other national security issues — as he tries to galvanize the response to a public health scare while not adding to the sense of panic fueled by 24-hour cable TV and the nonstop Twitter chatter.

On Friday, Mr. Obama took a step to both fix that response and reassure the public, naming Ron Klain, a former aide to Vice President Joseph R. Biden, to coordinate the government’s efforts on Ebola.

The appointment followed the president’s statement Thursday that the job was necessary “just to make sure that we are crossing all the t’s and dotting all the i’s going forward.”

“Part of the challenge is to be assertive, to be in command, and yet not feed a kind of panic that could easily evolve here,” said David Axelrod, a close adviser to the president in his first term. “It’s not enough to doggedly and persistently push for answers in meetings. You have to be seen doggedly and persistently pushing for answers.” [emphases added]

While I’ve admittedly been following the domestic Ebola situation casually, seeing it as largely overhyped, the president’s response has struck me as reasonable and prudent. All he can reasonably be expected to do is stay on top of the situation and follow the best advice of his experts, especially those at NIH and CDC. They’re career professionals, not political hacks, and work in an area where the US government attracts some of the very best performers in their field. If I were to offer a criticism at all, it’s that he has been unsuccessful at combating the hysteria coming out of certain media circles; but I’m not sure exactly what more he could have done in this regard.

Axelrod’s analysis here strikes me as spot on: with cases mounting and panic rising, it’s not enough to be doing the best possible job one could reasonably be expected to do with a novel crisis. As much as I share Doug’s skepticism, if not disdain, for “czars,” seeing them as simultaneously extra-constitutional and ineffective, the impetus to appoint them is understandable. That I can’t think of a single problem for which we’ve appointed a czar that was subsequently resolved satisfactorily is rationalist; the goal in appointing them is psychological. It sends a signal to the public that the president takes the problem seriously and is doing everything he can to get it resolved.

The secondary reason offered in the report, however, is something of a head-scratcher:

Senior officials said they pushed Mr. Obama to name an Ebola coordinator as a way of easing pressure on the staff at the National Security Council.

Czars don’t have staffs, or at least not significant ones. The very nature of being a coordinator is the need to coordinate. The Ebola crisis remains almost entirely external, which means the National Security Advisor, Defense, State, Homeland Security, and various border security agencies will continue to play the same roles they’re playing now. I suppose a czar could handle the domestic response issue but, again, he’s still going to have to do it in conjunction with NIH, CDC, the National Guard Bureau, and other agencies that have actual expertise and resources with which to solve the problem.

 

FILED UNDER: Government, Health
James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. edmondo says:

    Yes, and Obama “seethed” when Geithner didn’t follow his instructions to nationalize one of the TBTF banks to show that Wall Street would pay even a small price for blowing up the economy.

    And Obama was “frustrated’ when Sebielius didn’t deliver on the website that was supposed to be his legacy.

    And Obama “was mad as hell” that Holder never indicted one Wall Street bankster for fraud.

    Maybe the problem lies in the personality of the man who can’t get his subordinates to do what he supposedly wants and just “seethes” and “gets frustrated” on background interviews with The New York Times.

  2. the goal in appointing them is psychological. It sends a signal to the public that the president takes the problem seriously and is doing everything he can to get it resolved.

    I don’t discount that factor, and of course it is important that the government be projecting an image that there is someone in charge, especially when we’re talking about something like Ebola where, although the risk to the vast majority of Americans is exceedingly low, there is a certain level of fear and concern (much of it stoked by the media I’d suggest). Additionally, the fact that missteps by the C.D.C. and the hospital in Texas have contributed to the level of concern here can’t be ignored. Given all of that, the idea of having one person who speaks authoritatively as the one organizing the government’s efforts here makes sense.

    However, don’t we already have people who should be fulfilling that role? Perhaps the heads of the C.D.C. or N.I.H. are too far down the totem pole, and too much immersed in the science side of this, to be effective at the public relations side of things. But, there’s also at least one Cabinet Secretary who could fill this role at DHS who has been relatively quiet while his Deputy fulfills the role of Administration point-person. There’s the Acting Surgeon General, who has been completely off the radar. And, of course, there’s the President himself.

    Perhaps Klain will be able to organize all this disparate voices inside the White House and that will end up projecting an image of being in control, but that seems to me to be more an indication of dysfunction in the West Wing than an indication that we need yet another “Czar” accountable only to the President.

  3. James Joyner says:

    @Doug Mataconis: The problem is that letting the professionals do their jobs is a status quo move and the crisis seems to be spreading exponentially to those who watch Fox News all day. Appointing a czar is “doing something,” even if something meaningless.

  4. @James Joyner:

    I understand the reality, I just lament the fact that meaningless symbolism is, yet again, more important than actually doing anything.

    And, again, I note that it should be possible for an Administration to project the image that it is “doing something” without having to bring in a political hack to act as stage manager.

  5. C. Clavin says:

    Let the czar show up on Sunday shows and let the professionals do their jobs .
    The role of the head of the CDC is not to do press conferences in order to counter Republican fear mongering.
    Reality: 2 people in the US have Ebola…largely because a hospital in Texas f’ed up …there should be just 1person.
    Perception: the Government is incompetent and it’s the worst epidemic ever…driven largely by the Right-Wing Entertainment Complex .
    Let the Czar deal with their nonsense .

  6. beth says:

    @Doug Mataconis: Really Doug? A political hack? The guy seems to have had a successful political career so far – maybe it’s not your choice for a career but it is a valid one. Way to contribute to lowering the bar of political discourse and adopting the language of the worst of political commenters.

  7. OzarkHillbilly says:

    It’s just political theater, from all sides, and Obama is just playing the game called by his opponents with the cards he has been dealt. If somebody finds this upsetting, they need to stop following politics.

  8. @beth:

    He worked on a Presidential campaign in 2000 and as Chief of Staff to Gore and, at least for awhile, Biden during their time as VP. I’m not discounting his resume but I’m not sure what about it makes him so immensely qualified for this position, especially since I continue to maintain that the position is entirely unnecessary for the reasons I’ve recounted here, and in the comments to this post.

  9. Tyrell says:

    From what has happened the last few months there are some clues. The first two ebola patients were taken to a hospital in Atlanta, one that was thoroughly prepared and knew what to do. There were no further infections from that, it stopped right there. That is one answer. People are told that flying is “perfectly safe”. Now they are trying to track down hundreds of people who may have flown with an infected nurse. We are told that a person who may have been in contact with ebola infection should not travel on a commercial plane. Yet a nurse was told that it was okay. We are told that there has to be direct contact. Yet a dress shop is advised to close. Mixed messages, contradictions. It depends on who you ask. There needs to be consistent, clear answers, policies, training, and procedures. There needs to be special transport planes and vehicles.
    So far it has just been a handful of people infected. But if it were dozens or a few hundred, would there be the facilities, equipment, and trained personnel to handle it ?
    Ebola is not something that just started in the last year or so. It has been around for decades, so there should be plenty of information and data available.
    The testimony of the CDC chief in the congressional hearing was shocking in that just basic questions could not be answered. This is the image and perception that the people are getting from the news. The uneasiness and doubt did not start until the problem in Texas. And there should have been restrictions on travel out of that area until they had a handle on who had been around whom.

  10. beth says:

    @Doug Mataconis: So that makes it okay to use a derogatory term? Would you call him that to his face? Why stoop to Fox News level?

  11. @beth:

    How is “hack” derogatory? I consider it descriptive.

  12. @C. Clavin:

    Let the czar show up on Sunday shows and let the professionals do their jobs .

    Isn’t that what Cabinet Secretaries are for?

  13. OzarkHillbilly says:

    @Doug Mataconis: How many cabinet secretaries are involved here? Considering that, would it not be better if we had but one voice talking about this?

    And for the record Doug, I agree with your distaste of Czars, I just acknowledge the political reality of them.

  14. C. Clavin says:

    The person on the cruise ship that Jack was wetting his panties over has been cleared.
    http://www.cnn.com/2014/10/19/health/us-ebola/index.html

  15. C. Clavin says:

    @Doug Mataconis:
    Which Cabinet secretary?
    Sure…I don’t disagree with you but who cares?
    McCain, who is against Czars, wants a Czar. So toss him a bone to shut him up and get on with the real business at hand.
    You somtimes have to placate the children so the adults can get stuff done .

  16. @OzarkHillbilly:

    There really only needs to be one, DHS. For some reason, though, the Administration has chosen to make a Deputy DHS Secretary the public face of the government response to Ebola.

  17. C. Clavin says:

    @Doug Mataconis:
    It’s a derogatory term. You know it.
    By all accounts this guy is a great manager, can work well across bureaucracys and gets shit done.
    So you can cherry pick some political assignments…but in doing so you are being a hack…and I don’t mean that descriptively.

  18. OzarkHillbilly says:

    @Doug Mataconis: I suppose so for speaking purposes but more are involved in the actual management of the response and there will be turf battles between them and… Wait a minute, am I making a case for a czar now? I’m shutting up.

  19. al-Ameda says:

    We’ll always have “Brownie.”

  20. superdestroyer says:

    Once again the government faces the problem of how to talk to the public about health risks and once again, the government fails. How can the party that claims that the XL Pipeline is extremely dangerous and could render Nebraska unfit for habitation come along as say that Ebola is nothing to worry about. How can the party that claims that Genetic modified plants are super dangerous, the high tension power lines will give everyone cancer, and that coal fired plants will cause us all of die young then to an about face and claim that ebola is not much of a risks.

    Maybe if the government and the dominant political party in the U.S. was consistent in its risk communication strategy, then it would be much easier to handle issue such as Ebola.

  21. Liberal Capitalist says:

    @James Joyner:

    … the crisis seems to be spreading exponentially to those who watch Fox News all day.

    THIS !!! This is currently the greatest threat to the heath and sanity of the USA.

    We went from “better to light one candle than curse the darkness” and the “million points of light” to a knee-jerk reaction and condemnation of anything as political leverage.

  22. JKB says:

    @al-Ameda: We’ll always have “Brownie.”

    And that may be the best this guy can hope for, that he won’t be Obama’s “Brownie”.

  23. JKB says:

    Given that the president already has a team of highly qualified medical personnel, notably the Centers for Disease Control and the National Institutes of Health

    I have all kinds of faith in the people down in the lab, but, at the policy and advisory level, all those “highly qualified medical personnel” have been shown up by a nursing student home caring for four of her family in Africa. Oh, and her family’s nightmare started when the hospital put her father in a bed where an Ebola patient had died. So it isn’t just direct contact with bodily fluids, but also contaminated linen, surfaces, etc. A fact supported by the reaction of the CDC in pushing the closing of the restaurant in NJ, the bridal shop, the air plane, the ship, etc.

  24. steve says:

    “Ebola is not something that just started in the last year or so. It has been around for decades, so there should be plenty of information and data available.”

    IIRC, there have been a total of about 2500 Ebola patients before the current outbreak in Africa. Most of our info comes from those patients. The CDC has been following the genome to look for changes. We have tracked the disease to find out when it becomes infectious. We have a good idea about how it works. However, we have had essentially zero experience handling this in American hospitals except for a couple of cases in specialty facilities. This is our first experience handling someone coming from the community. The response from the Texas hospital was pretty bad at first, especially sending the pt away on the first visit, but they responded pretty quickly. I am not sure many other hospitals would have been much better. However, we are adapting quickly. We have learned that protocols that work in Africa need to be modified here.

    Steve

  25. Ben Wolf says:

    @Doug Mataconis: If the President had meant to do something more than symbolic he would have appointed a representative of MSF as czar rather than a Washington insider. Strangely I can’t find much evidence of the CDC or the Administration consulting in a significant manner with the only institution which has called it correctly from the very start and been continuously ignored. Maybe America is too exceptional to need advice from ferners, an arrogance which is by no means limited to the Republicans.

  26. C. Clavin says:

    @superdestroyer:

    How can the party that claims that the XL Pipeline is extremely dangerous and could render Nebraska unfit for habitation come along as say that Ebola is nothing to worry about

    Because, absent your partisan hyperbole, they are both true.

  27. C. Clavin says:

    @steve:
    Thanks for continuing to bring facts and rational thought to this forum.

  28. michael reynolds says:

    Here’s the CDC link. Number of cases in the US? 3. Just like yesterday, and the day before,and the day before that.

    If ebola is “spreading” it’s taking its sweet time. At this rate we could get as high as four within, oh, a week or two.

    http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html

  29. michael reynolds says:

    Here’s one for the pants-wetters of the GOP:

    William Pooley, the British nurse who contracted Ebola while volunteering in West Africa, has returned to Sierra Leone to resume his work.

    That’s a mensch. That’s the real deal.

  30. C. Clavin says:

    @michael reynolds:
    They say three…but only describe.two. Interesting.

  31. @C. Clavin:

    The third one is the NBC cameraman who was infected while on the job in west Africa and was brought to the hospital in Nebraska that has the same high-level biocontainment facilities that Emory and NIH does. I can’t say I’ve heard much about his condition myself either, but the press attention is on the two nurses at this point.

  32. @michael reynolds:

    And at the end of the day, the first group of people who treated Duncan at the Texas Presbyterian ER will be released from their 21 day quarantine. None of them have shown any signs of Ebola. This, however, is the first group that encountered him on his first visit to the ER (when he was sent home). The two nurses, along with I think something like 25-30 other people are in the group that were involved in his treatment when he was admitted several days later and during the time he was treated before he died. That group has, I think, another week to ten days left in their quarantine period.

  33. michael reynolds says:

    @Doug Mataconis:
    And meanwhile the Great Ebola Zombie Death Cruise comes to an end when it turns out no one had ebola.

  34. C. Clavin says:

    @Doug Mataconis:
    So the CDc is counting him…but I don’t think he counts.
    2. 3. Minuscule danger either way.

  35. anjin-san says:

    @Doug Mataconis:

    I’m not discounting his resume

    Well, you called him a “hack” – do you know what hack means in this context?

  36. PJ says:

    @michael reynolds:

    That’s a mensch. That’s the real deal.

    Not to argue, but I think he became that the first time he went to Sierra Leone. As did Brantly and Writebol whether they will return or not, and so did also a number of others who traveled there to help treat people.

    Oh, and William Pooley is probably now immune to at least this strain of Ebola. The fact that you get immunity might make it quite a good idea to start training survivors of Ebola to care for those infected by it.

  37. C. Clavin says:

    @michael reynolds:
    https://www.outsidethebeltway.com/second-ebola-nurse-may-have-shown-early-symptoms-longer-than-first-reported/#comment-1979026

    Oh for f*cks sake…she is exhibiting Ebola symptoms!!!!!

    We ‘re talking five exclamation points scared.

  38. @michael reynolds:

    Quiet now, you’re messing with the cable “news” fear mongering

  39. @C. Clavin:

    I think the bigger concern is the fact that she traveled when even the head of the C.D.C. said she should not have been. It’s unlikely to have posed a serious risk, but its the kind of ball dropping that I’d prefer not to see. Rather than panic over things like this, though, my reaction is that we need to recognize the mistakes that were made and learn from them.

  40. michael reynolds says:

    I’m conflicted n the word “hack” because people generally are undecided on its meaning. I used to use “series hack” as my email address, but then that started looking like a red flag for FBI looking into hacking. I consider myself a good hack writer, and wear that proudly.

  41. beth says:

    @Doug Mataconis: Given how screwed up that hospital seems to be, I guess that’s the right call. I do worry that the CDC is now being pushed to give in to the panic of the pants wetters on Twitter. There’s no reason a well-trained lab worker should have to restrict travel after handling an Ebola sample. There’s plenty of companies and research labs working on Ebola and other contagious, dangerous diseases and no one ever suggests their employees have any restrictions.

  42. wr says:

    @superdestroyer: ” How can the party that claims that the XL Pipeline is extremely dangerous and could render Nebraska unfit for habitation come along as say that Ebola is nothing to worry about.”

    To start with, the two situations have nothing in common. The argument against the XL (one of them, anyway — the one you seem to be referencing) is that if we build the pipeline and it leaks, as most pipelines do, that leakage could render an aquifer that serves a huge chunk of the nation unusable. So we have a choice over whether to build or not to build.

    Ebola is a deadly but not particularly communicable disease that a handful of people in the country have come down with. They are being treated, and many who came into some contact with them — or with people who have had contact with those people — are being quarantined due to an abundance of caution.

    Where is the point of similarity in the two situations? What’s the point of even mentioning them in the same breath?

  43. JKB says:

    CDC Ebola (Ebola Virus Disease) Healthcare Workers:

    Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals

    Personal Protective Equipment (PPE) PPE Recommendations are forthcoming

    One should always try to overcome the errors revealed, but the way to ensure confidence is to get it right, even overcompensate at first then trim back rather than do the minimum and work up from there.

  44. wr says:

    @michael reynolds: “That’s a mensch. That’s the real deal.”

    Not to downplay his menschlitude — of which I am in awe — I still have yet to see an answer to the question of whether having beaten Ebola leaves you immune to it or not. Maybe there simply haven’t been enough cases of people having survived before now to know…

  45. anjin-san says:

    @wr:

    What’s the point of even mentioning them in the same breath?

    Don’t mess with him, he is trying to figure out how to cook them up in an omelette with Benghazi and the coming one party state.

  46. beth says:

    @wr: From what I’ve seen reported, doctors think it leaves you immune from the same strain. However, you would need to have a willing volunteer to be re-infected to test this theory and that degree of menchitude is practically non-existent (for very good reasons).

  47. Gustopher says:

    @steve:

    We have learned that protocols that work in Africa need to be modified here.

    Why? Which protocols fail, and what is the difference between Africa and here?

    Serious question. Most indications are that the Texas hospital screwed up and didn’t follow guidelines. Am I misunderstanding the word protocols? Do we need something special to say “The first rule for caring for Ebola patients is to follow the rules for caring for Ebola patients?”

  48. Matt says:

    @C. Clavin: Yeah I had a chance to talk with one of the nurses from that hospital. My mom isn’t far from Dallas and she’s a nurse herself albeit in management now. One of her nursing friends works at that hospital.

    The biggest issue was the lack of proper safety gear. The hospital was NOT setup to deal with a case of ebola. What you’ve heard about ad hoc procedures like using tape to cover skin is true. Also they didn’t even use protective gear for the first few days. Top it off with the hospital having difficulties with disposing of the biowaste and you have a horrible recipe for infected nurses.

    Fortunately the hospital my mom works at has full protective gear and has been on the ball about being ready for this. Unfortunately Texas has a lot of hospitals that aren’t as well run. ALso the fact that the governor rejected the medicare expansion means that a large chunk of the population aren’t insured and aren’t likely to see a doctor when sick. Everything will go to hell when the first poor person gets Ebola and doesn’t seek treatment until it’s too late.

  49. Gustopher says:

    @PJ:

    The fact that you get immunity might make it quite a good idea to start training survivors of Ebola to care for those infected by it.

    They are doing this a lot in Africa, training survivors to provide supportive care, take care of linens, etc.

    It’s got to take a lot to lie in bed, bleeding horribly, watch half your family die (it affects the people who were caring for you, and in Africa that is often the family), and then get up and start working right there. Physically probably safe, but still, wow.

    Lots of heroes handling this.

  50. gVOR08 says:

    @michael reynolds: I took a minute to look up “hack” in Wiktionary. Multiple meanings too numerous to quote, but it appears to be an evolving word. In programming contexts, it’s mostly a compliment. In any context that would apply to Mr. Klain, it’s a pejorative, basically one who succeeds despite doing mediocre work. I’ve seen no claim that Mr. Klain has done mediocre work. Except maybe for getting out-lawyered in FL in 2000.

  51. MikeSJ says:

    @beth:

    Given how screwed up that hospital seems to be, I guess that’s the right call. I do worry that the CDC is now being pushed to give in to the panic of the pants wetters on Twitter.

    Beth, not to quibble but technically the term is “Bed Wetters.”..If you are referring to pants it should always be “Pants Sh*tters”

  52. anjin-san says:

    @gVOR08:

    Except maybe for getting out-lawyered in FL in 2000.

    Being beaten by James Baker III is not exactly a cause for disgrace.

  53. C. Clavin says:

    More importantly…what has happened to the Seahawks ?????

  54. ElizaJane says:

    I assumed that the Czar’s sole function was to absorb the hysteria of the right in case there is another catastrophe case of ebola in the USA.

  55. James Pearce says:

    @C. Clavin:

    More importantly…what has happened to the Seahawks ?????

    Meh…who cares?

    (Yes, those grapes are bitter.)

  56. C. Clavin says:

    Yeah…I have family in Seattle and they’re obnoxious.
    Sour grapes indeed.
    Still… Put a shirt on.

  57. SC_Birdflyte says:

    @James Joyner: “Czar” sounds like a position with real authority, whatever the reality. “Interagency coordinator” is so unromantic, but more descriptive. I blame it on Richard Nixon; until the oil embargo of ’73, we didn’t have a czar for anything.

  58. Tony W says:

    I have it on good authority that the Czar has Arabian Horses, so we can all rest assured that ebola is on the ropes.

  59. DrDaveT says:

    @Doug Mataconis:

    How is “hack” derogatory?

    Seriously?

    If you have to ask, you’re not qualified to write for a living. Or even as an amateur.

    From Merriam-Webster:

    hack (noun)
    3
    a : a person who works solely for mercenary reasons : hireling
    b : a writer who works on order; also : a writer who aims solely for commercial success

    Nothing derogatory there, clearly.

  60. michael reynolds says:

    @DrDaveT:

    Actually, I resemble that remark. I work for mercenary reasons. I hope for commercial success.

    The professional writers who say they don’t are liars. Check in on their next contract negotiation and tell me they don’t write for money. I’ve hung out with a pretty good cross-section of kidlit at least and the conversation always goes to agents and editors and deals. I live with a big-time kidlit literary star and yes, we talk voice and tense and POV but we talk a lot more about money.

    Now, that having been said, do I do my job to the best of my ability, and do I care about my work? Do I have something to say and do I say it? Absolutely. I think the vast majority of us do. But yes, it’s also about the money. We are all in that sense, hacks.

  61. grumpy realist says:

    @SC_Birdflyte: There’s a great Japanese term for this sort of person: madoguchi. Literally: “window mouth.” Means the person who is the gatekeeper through which all communication flows, coordinates where the requests go on the other side of the window, answers questions, manages the first interface, etc. etc. and so forth.