Epidemic

by Reid Wilson

  Days later, another man who had recently traveled from West Africa arrived at a hospital showing possible symptoms of Ebola. The hospital was one of those certified to handle an Ebola case, but it was the smallest, least experienced Ebola Treatment Center in the country. Rand Beers, a senior White House counterterrorism adviser who had served as acting secretary of Homeland Security, called Atlanta’s Hartsfield-Jackson International Airport to stop a commercial plane at the gate so a team from the CDC could get on board and fly to the hospital.

  But when they arrived, hospital administrators didn’t let the team in. They did not want the federal government interfering in their hospital. We know what we’re doing, the administrators said.

  While the CDC team cooled their heels in the hospital parking lot, Klain called the governor. Look, Klain said, I don’t have any authority to order you to allow the CDC team in. But if something bad happens and four CDC experts were waiting just outside the front doors, do you want to take that political heat? The team was quickly shown into the hospital, though they determined that the sick man was another false alarm.

  On one cold January night, Klain got a call at midnight: a woman had shown up at a California hospital that wasn’t among those trained to handle an Ebola outbreak. She had symptoms very like Ebola, including vomiting and a fever. She told doctors she had just returned from her honeymoon to Guinea. What scared Klain the most was that the woman was not in the government’s database of returning travelers; where had she come from? How had she slipped through the surveillance efforts?

  Klain spent a restless night trying to answer those questions in his own head. But another question nagged at him—who spends their honeymoon in Guinea, at the height of an Ebola outbreak?

  The next morning, arriving bleary-eyed at the White House, Klain found that his suspicions were well-founded. The woman knew she had been in an African country that started with a G. But she got the actual country wrong; she had been in Ghana. And her symptoms were easily explained too: She was pregnant.

  In all, during the 130 days Klain oversaw the American response, he got more than 300 warnings of possible Ebola cases. Every one turned out to be a false alarm.

  By the time Klain arrived at the White House, the Obama administration had already spent more than $350 million—most of it through USAID—to fight the outbreak. The Pentagon planned to spend $1 billion more. The legislative specialists in Klain’s office got to work on a new challenge: convincing Congress to appropriate billions more necessary to fight off the Ebola virus, both at home and abroad.

  The White House announced its new request on Wednesday, November 5, the day after Democrats suffered the election losses they feared. In a letter to House Speaker John Boehner—one of those Republicans who had called for a travel ban—Obama asked for $6.18 billion in funding, most of it to USAID and the CDC, and about half of which would be spent in Liberia, Guinea, and Sierra Leone. With spendthrift Republicans in charge of the House, and having just won back the Senate, such an amount could have set off serious objections on Capitol Hill.

  But the White House targeted a few key members of Congress: Senator Lindsey Graham, a South Carolina Republican who had built a career as a foreign policy expert, and Representative Jack Kingston, a Georgia Republican who would retire from Congress just weeks later, became critical players. Both warned the White House they could have trouble selling a bill that would spend so much overseas.

  Even in an era of hyperpartisanship, some of the old rules of politics still applied. The legislative experts at the White House made sure funding was included for every state to stock up on basic preparedness items, and for equipment for emergency medical services teams that might have to deal with an Ebola patient. Every member of Congress, in other words, could claim credit for helping his or her state prepare for a possible outbreak. On the contrary, if Congress voted down a measure to fight Ebola and an outbreak did occur, suddenly the onus would be on those members who voted no.

  Still, Klain, cognizant of the battles he had fought over the economic stimulus package in which every member of Congress, even those who voted against it, wanted money for their states included, was leery of creating what is known in Washington political circles as a Christmas tree—a piece of must-pass legislation on which members of Congress hang their own pet projects. Klain pushed back against members who wanted special goodies added to the bill, yielding for just one: The final package contained money that would help foreign countries establish their own versions of the CDC, long a top priority for Senator Tom Harkin, an Iowa Democrat who would retire at the end of the current Congress.

  The combination of carrot and stick—the ability to claim results for a member’s home state, coupled with the risk of doing nothing and owning political responsibility for an outbreak—focused Congress’s attention. And while the White House didn’t get all it wanted, on December 16, as one of its final acts of the year, Congress passed a $5.4 billion funding measure.

  The White House and Congress had sent two messages: first, the American public had evidence that their leaders were doing something to protect them from a deadly disease. Second, and perhaps more important, foreign governments once again got the message that the United States was leading the charge. Money invested by the United States yielded billions more in international commitments, both to the West African governments themselves and to the NGOs working on the ground.

  “It was critical in the international dialogue about the response in West Africa because we were able to dog other donor nations and other NGOs [with] the fact that we were putting a lot of cash up to fund these things,” Klain recalled a year later. “Our money yielded a lot of money from other countries.”

  Spurring action, both at home and abroad, remained an urgent priority. On October 22, the day Klain began his assignment in the White House, WHO reported 9,911 confirmed Ebola cases. By December 17, the day after Congress passed the funding bill, that number had almost doubled: 18,569 Guineans, Liberians, and Sierra Leoneans had been infected.

  FIFTEEN

  Panic and Quarantine

  EVEN BEFORE RON KLAIN arrived at the White House, the spread of the Ebola outbreak in the minds of the American people had made that fateful jump, from a far-off foreign problem to a perceived threat at home. Few concepts are scarier than the notion of a virus, something so small it is invisible except under an electron microscope, capable of killing in the most gruesome of ways, especially if, as Michael Osterholm had written in the New York Times in September, that virus goes airborne.1

  The White House, led by the cerebral and logical president, insisted on staying out of the way of the scientists who had both the knowledge and capacity to be able to stop the virus. But while those scientists had the expertise necessary to marshal the greatest Army against a pathogen in the history of the world, they lacked the diplomatic touch, the art of spin necessary to communicate with an already frightened and nervous public.

  On October 16, Tom Frieden of the Centers for Disease Control and Prevention (CDC) arrived at the Capitol complex in Washington, to give members of Congress an update on American efforts to fight Ebola. By then, the CDC had 139 staffers on the ground in West Africa, and more than 1,000 agency staffers had provided logistics, communications and analytics support, both in Atlanta and overseas. Three thousand U.S. troops were on their way to Liberia, and hundreds of doctors affiliated with global nongovernmental organizations (NGOs) were pouring back in. Still, Frieden said, the outbreak represented “the biggest and most complex Ebola challenge the world has ever faced.”

  Looking over his lectern, Pennsylvania congressman Tim Murphy, a Ph.D. psychologist whose public health experience included appearing on a Pittsburgh television station to offer medical advice and who had called the hearing, delivered his own verdict: “The math,” Murphy said, “still favors the virus.”

  Klain and others understood that they were battling public psychology, as well as a virus. Humans are conditioned, they knew, to
fear the new threat much more than the old, more common threat, regardless of any logic. When we hear about a shark attack off the Florida coast, or a terrorist threat against a major landmark, we are much more likely to fear that new threat than we are to fear threats that, statistically speaking, are much more likely to kill us. Humans fear the shark bite and the terrorist’s bomb more than they do being hit by a car, even though a car is thousands of times more likely to kill someone than a shark or a terrorist—or, for an American living across a vast ocean from the epicenter of an outbreak, than the Ebola virus.

  It is another trick of evolution, a mechanism that allows our brain to keep on living despite the threat of being hit by a car—or, thousands of years ago, being eaten by a bear or a tiger as we slept in a cave—without being consumed by fear, while at the same time adapting to and factoring in new threats.

  In his office on the grounds of the National Institutes of Health (NIH) just outside Washington’s borders, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, understood the sentiment. It was similar to one he had experienced with the rise of HIV and AIDS, a virus doctors struggled to understand and the public began to fear. Fauci, who has treated more AIDS patients than almost any other medical professional alive, remembered the panic of the 1980s, as the epidemic reached its peak, when people worried they might get AIDS from going out to a restaurant in Greenwich Village, where a gay waiter might be the server. Someone had asked Fauci: Can I get AIDS from eating spaghetti? Fauci had seen a similar panic after envelopes containing deadly anthrax were sent to some news outlets and members of Congress, just weeks after the September 11, 2001, terrorist attacks.

  In the midst of the AIDS epidemic, after the anthrax attacks and now again during the Ebola outbreak, Fauci made the media rounds, trying to convey that the respective threats of contracting a deadly disease—from a gay waiter in a restaurant, from handling one’s mail, or from a traveler returning from West Africa—were entirely out of touch with the actual risk. Once again, Fauci was called upon to appear on the Sunday morning news shows, on cable news, and on major radio programs, where he was asked about the threat of contracting Ebola. His strategy, honed over decades of dealing with a panicky public, was to repeat himself, again and again.

  “You have to respect the fear of people,” Fauci told an interviewer at the Washington Ideas Forum in October 2014, at the height of the U.S. panic. “You can’t denigrate it and say, ‘Why are you afraid?’ You’ve got to explain to [the public], and you’ve got to do it over and over.”

  The fear of contracting Ebola was, Fauci and Klain knew, entirely illogical. But logic and rationality are among the first victims in a dangerous situation, and both men understood they would have to factor in the public terror as they crafted their own response. Irrational fear was not even confined to those who didn’t do this sort of stuff for a living. USAID director Rajiv Shah recalled having returned from a trip to West Africa in mid-October, landing early in the morning and racing to his office to take a quick shower. Shah headed to the White House for a National Security Council meeting, to share what he had seen on the ground. When he told his fellow emergency responders—including some of the same medical experts who knew the real risks—that he had just returned from the epicenter of the outbreak, several of those at the table physically recoiled.

  Shah, Fauci, and, when he came on board, Klain found themselves on the same side of the next significant policy fight the administration faced. After successfully fighting off proposals to ban flights between infected West African countries and the United States, they now faced calls to quarantine anyone who had traveled to Liberia, Guinea, or Sierra Leone.

  To those at National Security Council meetings, quarantines were just travel bans by other means: quarantining travelers meant quarantining returning volunteers, the very doctors, nurses, logisticians, and Samaritans who were most needed to fight the disease. And that was before the 3,000 American troops would rotate home—how would the military quarantine so many of its own for three full weeks?

  The debate had only just begun when one of those volunteers, a young doctor with an office at Columbia University in New York, woke up with a headache.

  Senior government officials would later be struck by the image of Craig Spencer, a young hip emergency room physician who never lost his liberal idealism, sitting next to Kent Brantly, a deeply faithful man who worked for an organization run by the evangelist Franklin Graham, in the White House. The two men were from entirely different worlds, but both had traveled to West Africa to fight for some of the most impoverished people on the planet. More than a few in the Obama administration saw the common ground Spencer and Brantly found as refreshing evidence that, in a deeply polarized political environment, Americans on both sides of the ideological spectrum were good and selfless.

  In the middle of October, Spencer, age thirty-three, had returned from a tour of duty volunteering for Médicens Sans Frontières (MSF) in Guinea. He was exactly the kind of volunteer MSF needed, having worked in some of the most battle-scarred regions of Africa, in Rwanda and Burundi. But the deployment to Guinea affected Spencer more than his previous stints overseas, he wrote later.

  “The suffering I’d seen, combined with exhaustion, made me feel depressed for the first time in my life,” he wrote in the New England Journal of Medicine.2 He slept for hours on end and withdrew from his friends. Even back home, he felt the same angst about shaking hands or making physical contact that infused daily life in Guinea. He worried most about infecting his fiancée; the twice-a-day ritual of taking his own temperature caused minor panic attacks.

  Ten days after he returned to the United States Spencer woke up with the certainty that something was wrong. Despite another night of deep sleep, Spencer felt exhausted, and he had a fever. His breathing was too rapid to be normal. The thermometer showed his temperature was creeping up. Spencer quickly called New York City’s public health department to report himself. In a way, he felt relieved: “Although my worst fear had been realized, having the disease briefly seemed easier than constantly fearing it,” he wrote. Within hours, Spencer was admitted to an isolation unit at New York’s Bellevue Hospital, with a temperature of 100.3.

  That afternoon, October 23, was Klain’s second day on the job. He was sitting in the office of Sylvia Matthews Burwell, the secretary of Health and Human Services, when both of their phones vibrated. It was the CDC, activating a warning system established to alert top officials when someone showed up at a hospital to be tested for Ebola. Both Klain and Burwell scrolled through the CDC’s alert, which included a fact profile of the patient: physician, recently returned from Guinea, and more specifically from an area in Guinea with a significant outbreak, showing symptoms twelve days after his last possible exposure to the virus. Check, check, check. And Spencer’s temperature was rising every hour. Double check.

  Klain raced out of Burwell’s office, making his way back to the White House to mount his first response, little more than twenty-four hours after taking the job. Klain called New York governor Andrew Cuomo, and Tony Shorris, New York City’s deputy mayor, to share what he knew and hear their plans. He and Shorris were having maybe their third conversation ever; they had been introduced a few days before, through a mutual friend. Now the two of them would have to come up with a plan to prevent Ebola from spreading through America’s largest city.

  Fortune once again smiled: If any agency in America knows what it takes to fight an outbreak, it is the New York City Department of Health, which has decades of experience tracing contacts and performing medical surveillance—though maybe not in something as deadly or as scary as Ebola. Over the years, the agency had battled everything from cholera to AIDS to the spread of bedbugs.3 Contact tracing, the key first step to bring an outbreak under control, was old hat for New York’s frontline medical workers.

  Interviewers spoke with Spencer almost immediately to build a timeline of his activities after returning home, so t
hey could identify and track anyone with whom he might have come into contact. Spencer detailed his calendar: he had ridden the subway, of course (he was, after all, a New Yorker). He had gone bowling, eaten a meatball sandwich, ridden in an Uber. He was worried beyond words about his fiancée.

  Spencer represented a crucial test of the administration’s efforts to maintain an impression of competence. On one hand, treating Spencer effectively and watching him recover could give the administration the feel-good story it needed to show that the federal government was capable of handling whatever might come its way. On the other hand, if anyone else got sick, the downside risks were tremendous. The stakes were so high it forced a sort of clarity in the moment.

  “That was the beginning and the end of our communications strategy,” Klain recalled later.

  As far as I was concerned, the only thing that mattered was that no one else in New York get Ebola. If we could show in those hard first ten days that Craig Spencer could leave the hospital healthy, and that no nurse, or no person who rode the subway, or no person who got in an Uber, or no person who bowled, or no person who ate a meatball sandwich, or no person who lived in an apartment building with a nurse or a doctor got Ebola, that was the only communications strategy that mattered.… The thing that was going to be most effective in allaying public fears was to be able to say to people: Well, look, you saw it with your own eyes. Nobody got sick.