TIME ebola

Rick Perry Wants to Ban Air Travel From West Africa Amid Ebola Outbreak

Rick Perry
Republican Gov. Rick Perry of Texas, delivers the keynote address at a Heritage Foundation event titled "The Border Crisis and New Politics of Immigration," August 21, 2014. Tom Williams—CQ-Roll Call,Inc.

He joins a growing list of politicians calling for such a ban

Texas Gov. Rick Perry on Friday called on the federal government to impose a ban on air travel from the West African countries hardest hit by Ebola, joining a growing list of politicians supporting such a travel restriction.

Perry reasoned a ban is the right move given that the first patient diagnosed with Ebola in the United States, Thomas Eric Duncan, traveled from Ebola-ridden Liberia to eventually reach Texas, the Associated Press reports. The governor’s call for travel restrictions is a reversal of his stance from just 10 days ago when he said an enhanced medical screening process would be more effective at keeping Ebola out of the country.

“The impact from banning flights from these areas is not going to be an efficient way to deal with this,” Perry said last week, according to The Hill. Referring to a travel ban, Perry added, “There are some that would make the argument that it would [hamper the fight against Ebola].”

Several prominent Republican politicians in particular, including Mitt Romney, have called for flight restrictions, but many health officials say that such a ban would only hurt efforts to contain the disease.

[AP]

TIME Laws

The CDC Has Less Power Than You Think, and Likes it That Way

Ebola isn’t likely to lead to a widespread quarantine but it certainly raises interesting constitutional questions

Director of the Centers for Disease Control and Prevention Tom Frieden has come under fire in recent days for what some charge is the agency’s stumbling response to the appearance of Ebola in America. This week, reporters and lawmakers alike grilled Frieden over how two nurses in Texas contracted the virus and how one of them was able to board an airplane even after she reported a raised temperature.

Breakdowns in good practice notwithstanding, it’s important to remember that Ebola in the U.S. is largely contained and very unlikely to lead to any kind of significant outbreak. Still, the charges leveled against Frieden raise a question that leads to a surprisingly complicated answer: just what, exactly, can—and should—the CDC do?

Since time immemorial, public health officials’ main weapon against the outbreak of a disease as been to restrict the ability of people to interact with one another, also known as a quarantine. The term comes from the Latin “quadraginta,” meaning 40, and is derived from the 40-day period ships traveling from plague-stricken regions were kept at bay before being allowed to dock in medieval European ports.

Imposing a quarantine—effectively stripping innocent people of the most basic right to move freely in the world—is one of the most serious actions a government can take against its own citizenry. Partly for this reason, in the American federal system (designed from the outset to check the power of the national government) the power to quarantine resides largely with state and local authorities. Should Texas, or any other state, someday face the threat of a true epidemic, the states have broad authority to restrict the movement of people within their own borders. Public health codes granting the state power to impose quarantine orders vary from state to state, of course. Violating a quarantine order in Louisiana is punishable by a fine of up to $100 and up to a year in prison; in Mississippi the same infraction could cost a violator up to $5000 and up to five years in prison.

The federal government does have its own powers. The CDC, as the U.S.’s primary agency for taking action to stop the spread of disease, has broad authority under the Commerce Clause of the Constitution to restrict travel into the country and between states of an infected person or a person who has come in contact with an infected person, according to Laura Donohue, director of the Center on National Security and the Law at Georgetown Law School. Federal quarantine can be imposed, too, on federal property, like a military base or National Forest land. And as the preeminent employer of experts on public health crises, the CDC is always likely to get involved within any affected state in the event of a looming pandemic.

But its power to act is extremely restricted. The agency traditionally acts in an advisory role and can only take control from local authorities under two circumstances: if local authorities invite them to do so or under the authority outlined in the Insurrection Act in the event of a total breakdown of law and order.

And here the picture becomes murkier yet because authority does not always beget power.

“It’s not a massive regulatory agency,” said Wendy Parmet, a professor in public health law at Northeastern University in Boston. “They don’t have ground troops. They don’t have tons of regulators. They’re scientists. Even if the states asked them to do it it’s not clear how they would do it.

Even in the highly unlikely event that the CDC were called to respond to a—let’s reiterate: extremely-unlikely-to-occur—pandemic, quarantine and isolation would be imposed not by bespeckled CDC scientists but by local or federal law enforcement or troops. Most importantly, the CDC is extremely reluctant to be seen as a coercive government agency because it depends as much as any agency on the good will and acquiescence of citizens in order to respond effectively to a public health emergency. When the bright lights of the Ebola crisis are not on it, the CDC will still need people to get vaccinated, to go to the doctor when they get sick, and to call the authorities if they see trouble.

“Our public health system is built on voluntary compliance,” Donohue tells TIME. “If the CDC starts to become the enemy holding a gun to [someone’s] head and keeping them in their house, they lose insight.”

TIME ebola

Nurse Infected With Ebola in Dallas Now Being Treated in Maryland

Texas Nurse Infected With Ebola Transferred To Maryland
The airplane carrying Texas Health Presybterian Hospital nurse and Ebola patient Nina Pham takes off from Love Field airport October 16, 2014 in Dallas, Texas. Chip Somodevilla—Getty Images

Nina Pham now has a staff of 50-60 trained health care workers taking care of her at the National Institutes of Health

Nina Pham, the first person to be infected with Ebola in the U.S., arrived at the National Institutes of Health Special Clinical Studies Unit in Maryland just before midnight Thursday evening, the NIH said Friday.

Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Dr. Rick Davey, deputy director of NIAID’s division of clinical research, said Pham was in fair condition and resting comfortably. Davey will be the physician overseeing Pham’s care.

Fauci said that from the time when Liberian Ebola patient Thomas Eric Duncan became the first person diagnosed with the disease in the U.S., “we made very clear that we could make the highly specialized facility available if called upon. We were called upon to accept Nina and we did.”

The seven-bed NIAID unit in Rockville, Maryland was created in 2011 as part of the U.S.’s bio-terror preparedness efforts. It’s designed and equipped to care for patients with the most dangerous infectious diseases. The unit has a dedicated staff of 50 to 60 personnel who are specially trained in infection control for biohazards, and, said Fauci, retained continuously to keep their education up to date. The unit’s isolation unit has a separate ventilation system that directs air into specialized filters, and the unit has a dedicated system for removing patient waste and other biohazardous materials.

The center is not just a hospital, but also a research facility. Every patient treated there is also a research subject, and Pham will be no exception. Dr. H. Clifford Lane, clinical director of NIAID, said that Pham’s virus and her immune system’s response to it will be studied extensively. The researchers at the unit are also part of vaccine studies and are working on ways to intervene earlier in the disease’s course with better treatments. Such treatments may help not just Pham, but also the thousands in West Africa currently battling Ebola.

As far as what therapies Pham will receive, Fauci would only reveal that Pham has so far received, while in Dallas, plasma donated from Dr. Kent Brantly, the first American patient successfully treated for Ebola — Brantly was diagnosed while in Liberia before being flown to the U.S. for treatment. Pham is at all times being cared for by four to five nurses working 12 hour shifts; two of these nurses are allowed into her room at one time, with the remaining nurses serving support duties. One full-time infectious disease doctor and one critical care intensive care physician is also assigned to her care in rotating shifts.

TIME Diet/Nutrition

How Healthy Are ‘Secret Menus’ at Restaurants?

fast food burgers
Getty Images

The answer is more complicated than we expected

For years, Jamba Juice has marketed healthy and nutritious smoothies blended with 100% fruit juice. But the website Hack the Menu points out a “secret menu” with items like “Red Gummy Bear” and “Pink Starburst“—both allegedly blended to taste like their candy namesakes. The rumored off-menu offerings sound a little sweeter, but potentially less healthy.

Jamba Juice is not alone in its reputation for having a secret menu: according to Hack the Menu, restaurant chains like Starbucks, In-N-Out Burger and Chipotle also oblige off-menu requests for those in the know. TIME looked into why restaurants might bother with a whole other menu, and whether secret menu options are always less healthy than their advertised counterparts. The answer is more complicated than we expected.

MORE: Try Ordering These Delicious-Sounding Drinks From Starbucks’ Secret Menu

Surprisingly, most nutritionists we spoke to had never heard of the concept of secret menus. Their feelings were mixed, but most said they were concerned about the lack of readily accessible nutritional information for off-menu items.

“So many consumers are looking for transparency,” said Keri Gans, a registered dietitian and author of The Small Change Diet. “If you want a secret menu, at least make it obvious what the calories are and [put] the nutrition analysis where it’s available for people to see.”

MORE: There’s a $10 Secret Menu Item At Arby’s Called the Meat Mountain

Excluding unhealthy items from a menu helps avoid having to disclose their lack of nutritional value. This is especially true in places like New York, where the law requires restaurant chains to display certain nutritional information in menus. That regulation doesn’t apply to items that aren’t on the menu, or those listed on a menu for less than 30 days, the New York City Department of Health and Mental Hygiene wrote in an e-mail to TIME. Secret menu items “undermine the intention of the rule,” though they’re technically legal, it said.

A lack of transparency becomes a potential problem for people with allergies, who may not be aware of what ingredients are included in the item they’re ordering, nutritionists said.

“To me, the most important thing is that the staff would be educated on what the ingredients are,” said Gans.

Spokespeople for most of the chains contacted by TIME denied the existence of a “secret menu,” but acknowledged that customers can customize their orders.

“Our people are trained to make what customers want with the ingredients we have,” said Chipotle communications director and spokesperson Chris Arnold in a statement. Nachos and a quesarito, a mammoth burrito blanked inside a quesadilla, are among the items that customers order off-menu at Chipotle, according to Hack the Menu.

MORE: Taco Bell Is Adding A Quesarito To Its Menu

But despite their shroud of secrecy, secret menus don’t appear to be all bad news, nutritionists said. Some have options that appear healthy, while others allow customers to modify a menu offering in a way that makes it healthier, said Jessica Levinson, founder of nutrition consulting business Nutritioulicious. She cited an option to swap out mayo for mustard at Burger King as one such option.

Registered dietitian Judy Caplan praised efforts to offer healthy options, but said she wasn’t surprised that some fast food restaurants would offer less healthy options off the menu. While fast food has become more nutritious in recent years, and chains have recently cut calories in new menu items by 12%, there are still many customers who want unhealthy food, she argued.

“When you’re in business,” she said, “the customer is always right.”

TIME Aging

How to Talk About The End of Your Life

The toughest conversation might also be the most important

The video of Brittany Maynard, 29, describing her choice to move to Oregon for the right to end her life due to her terminal cancer has received well over 7 million views. It’s also left many people shocked, saddened and inspired by her decision.

“I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms,” Maynard wrote on CNN.com.

Talking about death—and the circumstances surrounding it—is uncomfortable for most people. But my colleague Lily Rothman, 28, just wrote her will. “My eventual death was something I’d been mentioning to lots of people, on Facebook and at engagement parties and at my high-school reunion,” she writes. “It wasn’t that I thought death was going to come any time soon or in any special way, it’s just that, as they say on Game of Thrones, all men must die.”

MORE: 5 Tips For Families Facing End-Of-Life Care

Many people argue that it’s time we had more conversations about the end of life and how we want to go. It’s a conversation that can become awkward, especially for adult children bringing it up to their parents, but it allows people to avoid having to make very difficult decisions at the most sensitive times. “It’s critically important for us to have these conversations at the kitchen table,” says Ellen Goodman, founder of The Conversation Project, a nonprofit organization that campaigns for the expression and respect of wishes for end-of-life care. “Too many people are not dying in the way that they choose, and we need to change that.”

Goodman, who had to make medical decisions for her dying mother that they had never discussed beforehand, also created the Conversation Starter Kit, which you can download for free. So far, people in 50 states and 176 countries have downloaded the kit. That’s great news, considering about 90% of Americans believe it’s important to talk about their end-of-life care wishes and those of their loved ones, but only 30% actually have those discussions, according to the Conversation Project. “We would hope that this really tragic story of [Brittany Maynard] has an outcome that will really help people talk about these issues,” says Goodman.

Here are some other preparations you might consider if preparing an end-of-life checklist, from the National Institute on Aging:

  • A living will, which records a person’s wishes for medical treatment near the end of life.
  • Designating a durable power of attorney for health care, which names a person, sometimes called an agent or proxy, to make health care decisions when a person can no longer do so.
  • Talking about a do-not-resuscitate (DNR) order, which instructs health care professionals not to perform cardiopulmonary resuscitation if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.
  • Writing a will—a document that indicates how a person’s assets and estate will be distributed upon death.
  • Naming a durable power of attorney for finances, someone to make financial decisions when the person no longer can. It can help terminally ill people and their families avoid court actions that may take away control of financial affairs.
  • Penning a living trust, which provides instructions about the person’s estate and appoints someone, often referred to as the trustee, to hold the title to property and funds for the beneficiaries. The trustee follows these instructions after the person can no longer manage his or her affairs.
TIME White House

Obama Appoints Ron Klain As Ebola Czar

Lawyer and politcal operative Ron Klain on May 13, 2008 in New York City.
Lawyer and politcal operative Ron Klain on May 13, 2008 in New York City. Andrew H. Walker—Getty Images

He's a longtime Democratic insider

President Barack Obama has appointed longtime insider Ron Klain to coordinate the administration’s global response to the Ebola epidemic, a White House official confirmed. The move came just hours after a Texas nurse diagnosed with Ebola after treating a patient with the disease was moved from Dallas to the National Institutes of Health Clinical Center in Bethesda, Maryland.

“The President has asked Ron Klain to take on the task of coordinating his administration’s whole of government Ebola response,” the official said Friday. “He will report directly to the President’s Homeland Security Advisor Lisa Monaco and the President’s National Security Advisor Susan Rice as he ensures that efforts to protect the American people by detecting, isolating and treating Ebola patients in this country are properly integrated but don’t distract from the aggressive commitment to stopping Ebola at the source in West Africa.”

Klain, who served as chief of staff to Vice President Biden and former Vice President Al Gore, helped to oversee the 2009 stimulus bill. He will now be tasked with coordinating both the domestic public health response and the international humanitarian and military efforts to stop the virus in West Africa. Klain will work out of the White House’s West Wing.

“Klain’s role is consistent with the view the President articulated in the Oval Office [Thursday] night that Monaco, Rice and others have done outstanding work in confronting this challenge so far – but given their management of other national and homeland security priorities, additional bandwidth will further enhance the government’s Ebola response,” the White House official said.

Republican lawmakers had been calling on the White House to appoint the so-called “czar” for weeks to lead the Administration’s response. The White House had been cool on the subject until Thursday, when Obama told reporters he was considering making such an appointment. Other Obama “czars” have coordinated the auto bailout and the Troubled Asset Relief Program, or TARP, to boost banks after the 2008 financial crisis.

 

 

TIME ebola

WHO Acknowledges Flubbed Response to Ebola Outbreak

A World Health Organization (WHO), instructor teaches new health workers during a training session on Oct. 3, 2014 in Monrovia, Liberia.
A World Health Organization (WHO), instructor teaches new health workers during a training session on Oct. 3, 2014 in Monrovia, Liberia. John Moore—Getty Images

It blamed in part "politically motivated appointments."

A new report reveals that the World Health Organization privately acknowledged it could have done more to contain the ongoing global Ebola outbreak, which has claimed the lives of around 4,500 people primarily in Liberia, Guinea and Sierra Leone.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” WHO said in a “draft internal document” obtained by the Associated Press.

The WHO, the United Nations health agency, blamed in part the “politically motivated appointments” of Dr. Luis Sambo, the WHO regional director in Africa, according to the AP. WHO also points fingers at its Guinea office for failing to obtain visas for Ebola experts and for tying up $500,000 in aid in red tape.

WHO Director-General Dr. Margaret Chan did not fully understand the agency’s leadership issues in West Africa until days after a June meeting of the agency’s top outbreak officials, according to the documents.

“This (was) the first news of this sort to reach her,” reads one of the forms. “She is shocked.”

[AP]

TIME ebola

Photographer Barred From Syracuse University Over Ebola Fears

Colgate v Syracuse
Seats on the Syracuse bench with the Syracuse Orange logo are seen prior to the game against the Colgate Raiders at the Carrier Dome on November 19, 2011 in Syracuse, New York. Nate Shron—Getty Images

He shows no signs of the virus

A three-time Pulitzer prize winning photographer was barred Thursday from teaching a workshop class at Syracuse University over fears that he had Ebola after covering the outbreak in Liberia, even though he is symptom-free and has been in the United States for more than the recommended incubation period.

The Washington Post’s Michel duCille, who found out about the school’s decision Thursday afternoon, told News Photographer magazine that he was “pissed off” for the revoked invitation.

“I just got off the phone with [Dean Lorraine Branham], and I am pissed off,” duCille told the magazine Thursday. “I am disappointed in the level of journalism at Syracuse, and I am angry that they missed a great teaching opportunity. Instead they have decided to jump in with the mass hysteria.”

“They missed a great teaching opportunity here for the students, to show them how to report the facts and practice good journalism,” duCille said. “Instead they went the alarmist route.”

Syracuse University Dean Lorraine Branham told the magazine that she had not known that duCille had been in Liberia until students raised concerns about their safety.

“This morning I learned that he had been at the CDC, I learned that he had been back 21 days, and I learned that he had been traveling with the [CDC] director, so yes, I knew,” Branham said Thursday.

“But even knowing that, it’s my responsibility to protect the students. 21 days is the CDC’s standard, but there have been questions raised about whether the incubation period is longer. I knew that parents would be upset. And at the end of the day my concern is about the students.”

[News Photographer]

TIME ebola

U.N.: We Botched Response to the Ebola Outbreak

(LONDON) — The World Health Organization has admitted that it botched attempts to stop the now-spiraling Ebola outbreak in West Africa, blaming factors including incompetent staff and a lack of information.

“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” WHO said in a draft internal document obtained by The Associated Press, noting that experts should have realized that traditional containment methods wouldn’t work in a region with porous borders and broken health systems.

The U.N. health agency acknowledged that, at times, even its own bureaucracy was a problem. It noted that the heads of WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr. Luis Sambo, who does not answer to the agency’s chief in Geneva, Dr. Margaret Chan.

In late April, during a teleconference on Ebola among infectious disease experts that included WHO, Doctors Without Borders and the U.S. Centers for Disease Control and Prevention, questions were apparently raised about the performance of WHO experts, as not all of them bothered to send Ebola reports to WHO headquarters.

WHO said it was “particularly alarming” that the head of its Guinea office refused to help get visas for an expert Ebola team to come in and $500,000 in aid was blocked by administrative hurdles. Guinea, along with Sierra Leone and Liberia, is one of the hardest-hit nations in the current outbreak, with 843 deaths so far blamed on Ebola.

The Ebola outbreak already has killed 4,484 people in West Africa and WHO has said within two months, there could be new 10,000 cases of Ebola every week.

When Doctors Without Borders began warning in April that the Ebola outbreak was out of control, a dispute on social media broke out between the charity and a WHO spokesman, who insisted the outbreak was under control.

At a meeting of WHO’s network of outbreak experts in June, Dr. Bruce Aylward, normally in charge of polio eradication, alerted Chan about the serious concerns being raised about WHO’s leadership in West Africa. He wrote an email that some of the agency’s partners — including national health agencies and charities — believed the agency was “compromising rather than aiding” the response to Ebola and that “none of the news about WHO’s performance is good.”

Five days later, Chan received a six-page letter from the agency’s network of experts, spelling out what they saw as severe shortcomings in WHO’s response to the deadly virus.

“This (was) the first news of this sort to reach her,” WHO said in the draft document. “She is shocked.”

TIME medicine

6 Common Prescription Mistakes You Might Be Making

Pill bottles
Getty Images

In honor of Talk About Your Medicines Month

It’s hard to imagine a time when there wasn’t a pill—sometimes dozens of different ones—to treat so many health conditions. Today, 70% of Americans take at least one prescription drug and more than half take two, according to the Mayo Clinic.

While the healing powers of modern medicine are pretty awesome, you still need to be cautious when it comes to any drug. The Food and Drug Administration (FDA) reports that medication errors cause at least one death every day and injure 1.3 million people annually.

HEALTH.COM: 14 Reasons You’re Always Tired

In honor of Talk About Your Medicines Month, read up on common mistakes to avoid with your prescriptions.

You get the brand name over generic

Yes, they’re cheaper, but generic drugs are just as effective as the brand name. To be approved by the FDA, a generic drug must have the same active ingredients as the original. The only difference is the inactive ingredients, like dye or preservatives, which don’t affect the action of the drug. “Small variations in the generic are permissible,” says Kim Russo, PharmD, chief clinical officer at VUCA Health, a medication video service available at certain pharmacies nationwide. “Most of the time we don’t even medically notice it.” If you don’t tolerate one of the inactive ingredients well, then you might need the brand name. Otherwise, save yourself the money and go with the generic.

You mix your meds with the wrong foods (or drinks)

Always check what foods or drinks could interact with your medicine. One to watch out for: grapefruit and grapefruit juice. “As many as 50 drugs on the market can be affected,” Russo says. Depending on the drug, grapefruit juice can reduce or increase absorption­—the latter could lead to overdose. Then there are certain drugs that shouldn’t be taken with calcium-rich foods because they interfere with your body’s absorption of the medication, Russo says. Plus, there are medications that cause you to lose or retain potassium, so you’ll want to talk to your doctor or pharmacist about whether you need to start (or stop) eating certain foods. And you should ask your doctor if it’s OK to drink alcohol while taking your prescription. “Alcohol can turn possible mild side effects into dangerous ones,” Russo says. The FDA has more info on bad food-drug combos.

HEALTH.COM: 16 Worst Birth Control Mistakes

You don’t check your Rx label at the pharmacy

To save yourself the stress of a medication error, make sure you have the right prescription before you leave the pharmacy. If your pharmacist only asks for your name at the counter, provide another identifier, like a birth date or address. That way you’ll know the drug is filled under the correct person, Russo says. Another good idea: open your bag. “I would read the label and open the prescription to see if you recognize it,” Russo says. A different color or shape may just mean the drug is coming from a new generic manufacturer, but it never hurts to be safe.

You don’t talk to your pharmacist

Most pharmacists will ask if you have questions about your medication. But when’s the last time you actually voiced one? It’s never a good idea to rush through picking up a new prescription. That’s the time to find out what the medicine is for as well as the benefits and possible side effects or drug interactions, Russo says. If you’ve been on the medication a while and have noticed unexplained changes lately, say a rash or constant headache, that’s also a good time to speak up. On three or more medications? “It’s a great idea once a year to make an appointment with your pharmacist to review them,” Russo suggests.

HEALTH.COM: 15 Tips for Saving Money on Prescription Drugs

You store your meds in the wrong spots

The number one worst place you could keep your medication is the bathroom. That’s because moisture can degrade medicine, Russo says. Medications also need to be protected from light. “That’s why prescription vials are the amber color, to block UV light,” Russo says. Still, you should keep medication in a dark place, especially if you have a pill organizer that’s clear and light can get through. Certain drugs shouldn’t be taken out of the vial at all. Some medications, like insulin, might need to be refrigerated initially, but can be taken out to warm up before injecting and then stored at room temperature for a set number of days. Just keep in mind some drugs are meant to be kept in the fridge and they can lose their effectiveness if left at room temperature for even a few hours, Russo says. Check with your pharmacist to know how long is too long.

You don’t dispose of old meds properly

Most pills remain effective up to two years after the expiration date, Russo says. When it’s time to get rid of them, though, don’t count on the toilet as your go-to disposal method. “Flushing certain cardiac, seizure, or hormone medications can be very harmful to the environment,” Russo says. Only a few medications, including ones for pain, are recommended by the FDA for disposal by flushing. The rest you should throw in a plastic bag with kitty litter or used coffee grounds so kids or pets won’t be tempted to eat them. Then, the bag’s ready for the trash. You could also ask your pharmacist about upcoming medicine take-back programs.

HEALTH.COM: 27 Mistakes Healthy People Make

This article originally appeared on Health.com

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