Ebola in America

Capitalist Criminality and Racist Indifference

With racist indifference to the lives of black Africans, for months the U.S. imperialist rulers ignored pleas for medical aid to deal with the epidemic of Ebola virus disease in West Africa. When President Barack Obama finally responded in mid September, it was by dispatching thousands of troops. As we noted in our article opposing this military intervention, “Obama made clear his motivation for intervening militarily: to curb the political and economic ‘ripple effects’ that the spread of the virus could have on the region and beyond. His calling Ebola a ‘national security priority’ is a declaration of U.S. intent to limit the epidemic to Africans and not let it reach American shores” (WV No. 1053, 3 October). The disease continues to spread in West Africa, where by official count over 10,000 people have been infected and 5,000 have died.

The American rulers’ hubris and contempt for victims of this disease in Africa was paralleled in the few cases that have now emerged in this country. Repeated warnings by health care workers unions that hospitals here were woefully unprepared to deal with an outbreak of the disease were ignored. Then on September 25, Thomas Eric Duncan, a black Liberian, went to Texas Health Presbyterian Hospital in Dallas. He had a high fever and severe pains, and told a nurse that he was recently in Liberia. He was sent home without being tested for Ebola, only to be rushed back to the hospital three days later, seriously ill. Ten days after that he was dead from Ebola, failed by a health care system riddled with the race and class bias of this society.

The hospital saw Duncan not as a patient but as potential trouble and a financial liability. His nephew wrote a powerful indictment of his ordeal for the Dallas Morning News (14 October):

“He was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol.... From his botched release from the emergency room to his delayed testing and delayed treatment and the denial of experimental drugs that have been available to every other case of Ebola treated in the U.S., the hospital invited death every step of the way.”

Meanwhile, the Dallas D.A.’s office considered bringing charges against Duncan for supposedly exposing the public to the virus.

The treatment of Duncan by hospital authorities is emblematic of what passes for health care in the U.S. for the poor and uninsured, especially black people and immigrants. If you have enough money, you can get some of the best care in the world. But if you’re poor and have black or brown skin, the care is far from adequate, as captured in overcrowded emergency rooms, long wait times and hurried examinations. What is needed is quality health care for all, provided free at the point of service.

After Duncan died, matters soon proved to be even more serious as two nurses who treated him, Nina Pham and Amber Vinson, tested positive for Ebola. The Centers for Disease Control and Prevention (CDC) initially tried to blame the nurses themselves, claiming there had been a “breach of protocol.” The truth was only revealed when nurses from the non-union hospital contacted the National Nurses United union (NNU), which in an October 15 statement summed up the situation: “There was no advance preparedness on what to do with the patient, there was no protocol, there was no system.”

That statement graphically describes the chaos and danger present at Dallas Presbyterian. When a nurse supervisor demanded Duncan be moved to an isolation unit, there was resistance from hospital authorities. Hospital personnel as well as CDC officials moved freely from the isolation unit into other areas. There was no mandatory Ebola training before Duncan was admitted and even after his positive test the training was limited. For example, not everyone got hands-on training with personal protective equipment. And the protective equipment available was grossly inadequate, including suits that left nurses’ necks exposed so that they had to use medical tape to try to seal the openings. That the infection did not spread beyond the two nurses (both of whom have fully recovered) can only be attributed to the conscientious actions taken by the nurses and other workers.

The CDC has scrambled to tighten up their protocols for training and protective equipment, although huge gaps remain. One Midwest nurse showed Workers Vanguard a set of typical guidelines that state: “Put on a mask and gloves and ask patient to put on mask, gloves, and gown (if available).” Meanwhile, hands-on training in the correct use of this specialized personal protective equipment remains largely nonexistent. Another nurse said, “It’s like they think you can learn to ride a bike by watching YouTube videos.”

Management then turns around and blames workers for safety violations, including the unsanitary conditions in hospitals, where patients routinely acquire infections during their stay. In fact, the cost-cutting reductions to staffing levels and nursing ratios are the real source of the problem in a system where the profit motive reigns supreme. Hospital staff are forced to work grueling shifts laden with responsibilities and not given sufficient time to scrub up and maintain hygienic practices. Poorly paid cleaners have to rush from one infected ward to another.

Organize the Unorganized!

It is not only in the health care industry that workers are now fearful of contracting Ebola on the job. On October 8, 200 cabin cleaners at New York’s LaGuardia Airport, locked in a union organizing battle, went on strike to protest their unsafe and unsanitary working conditions. For paltry wages, they’re expected to clean up all kinds of filth and bodily fluids in airplanes without the time to do a proper job or the equipment to do it safely.

Union control of safety makes all the difference in ensuring proper conditions on the job. Health care unions must demand sufficient staff levels and sufficient time to scrub up and to put on and remove protective equipment as needed. The bosses are not about to just grant such demands, which are part of the fight for better pay and work conditions. This requires the class-struggle mobilization of the unions, including for the crucial task of organizing the unorganized. But the NNU and other union bureaucrats betray the concerns of their members by pushing reliance on the bosses’ state agencies and political representatives, primarily the Democrats.

On October 21, 1199SEIU, the country’s largest health care union, and several hospitals hired the huge Jacob Javits Center in New York City to host a supposed Ebola training session. Rather than any hands-on training, though, there were only talks from government officials and a demonstration of personal protective equipment. In fact, this event was just an opportunity for Democratic mayor Bill de Blasio and governor Andrew Cuomo to address thousands of workers two weeks before the midterm elections.

De Blasio blathered: “We have the world’s strongest public health system here in this city and state.” Maybe the rats, head lice and bed bugs rampant in NYC can enjoy this sick joke. The rotten state of the public health system played a part in allowing HIV to reach epidemic proportions in the city in the 1980s, along with anti-gay bigotry and other social reaction. In his speech, 1199SEIU president George Gresham sermonized that being a health care worker is “a very special gift from God.” That’s all the union misleaders have to offer: trust in god and the Democrats.

The fight to mobilize the unions to protect their members as well as patients must be based on the elementary understanding that the interests of labor and capital are irreconcilably counterposed. What is needed is a leadership that looks to the social power of the workers as against the class-collaborationist viewpoint of the trade-union bureaucracy.

Racist Anti-Immigrant Hysteria

Historically, fear of disease has been a cover for all kinds of prejudice and discrimination. Today, the few cases of Ebola in the U.S. have become a political football, with right-wing yahoos blaming Obama for bringing this “African” disease to American shores and calling to seal the borders. Such calls have fueled a witchhunt atmosphere against West Africans. Students from various African countries have been banned from schools and colleges. Oretha Bestman-Yates, a New York health care worker and president of the Staten Island Liberian Community Association, was barred from returning to work after visiting Liberia in July, despite having no symptoms more than 21 days (the incubation period of the virus) after her trip.

This hysteria was ratcheted up a notch when Dr. Craig Spencer, who had recently returned from treating Ebola victims in Guinea with Doctors Without Borders (known by its French initials, MSF), tested positive in NYC on October 23. Spencer had followed MSF guidelines, including monitoring his temperature twice a day, and contacted health services as soon as he detected a fever. He was immediately rushed to Bellevue Hospital and placed in quarantine. His fiancée has been quarantined in the apartment they share.

The next day, Governor Cuomo and New Jersey Republican governor Chris Christie announced a mandatory quarantine for all those arriving at New York-area airports who report having had contact with Ebola victims in West Africa. This quarantine is an obvious political maneuver by the two governors. Cuomo is facing an election next week and his Republican challenger has called to close the airports to travelers from West Africa altogether. For his part, Christie is eyeing a run for the White House in 2016. The governors of Illinois and Florida subsequently announced their own quarantine orders.

Unsurprisingly in this irrational capitalist society, where every state issues its own set of guidelines, the first person quarantined in New Jersey, nurse Kaci Hickox, was treated like a criminal. Detained for six hours at Newark airport, she was then whisked off to Newark’s University Hospital. Although she tested negative for Ebola and presented no symptoms, which means she was not contagious, she was confined to a tent with a portable toilet and no shower. As she observed in a CNN interview: “To put me in prison is just inhumane.” In response to the public outcry generated by her accounts of the conditions, Christie released her after three days.

Mandatory quarantine of non-symptomatic health care workers has come under fire from many medical experts, who fear this policy will deter volunteers from traveling to West Africa. An editorial in the New England Journal of Medicine (27 October) judged that such an approach “is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal.” Several times in recent days, the details of the state quarantine directives have changed, as the White House butted heads with the governors.

The Cuban government has arranged for its doctors who are combating Ebola in West Africa to be quarantined before returning home. There is no shortage of Cuban volunteers, who receive their full salary plus a per diem. MSF protocols differ substantially from what was first announced by Cuomo and Christie, not least by encouraging staff members who have returned to take three weeks off with pay to recuperate from their arduous field work in West Africa. Quarantine of symptomatic individuals is clearly necessary, even if it impinges on their personal liberties, in the interest of public health. That also means training and properly equipping the workers who deal with those in quarantine.

For Socialized Medicine!

The Ebola epidemic in West Africa is a stark example that the capitalist profit system is an obstacle to providing the necessities of life, including health care, to wide swathes of the globe. Control of disease is as much a social question as a scientific one. Under capitalism, the profits of pharmaceutical and insurance companies almost always come before public health, which is indelibly imprinted with the reactionary bigotry of capitalist society.

The New York Times (October 23) reported that an Ebola vaccine had been developed and shown to be 100 percent effective in monkeys nearly a decade ago. However, it was never tested on humans because the big pharmaceutical companies saw no profits to be made from a vaccine that would mainly save the lives of poor Africans. If human trials had proceeded at the time, the vaccine might have been ready before the outbreak and thousands of lives saved. With Ebola now infecting a handful of Americans and Europeans and the U.S. military a potential customer, this vaccine and other treatments are being fast-tracked. The calculations of the profit-bloated pharmaceutical companies were captured in a recent headline in the satirical Onion: “Experts: Ebola Vaccine at Least 50 White People Away.”

The struggle for decent health care for all must be tied to the fight against the capitalist system. A hint of what is possible with socialized medicine based on a collectivized economy is provided by the case of Cuba, a bureaucratically deformed workers state where capitalism was overthrown following the 1959 defeat of the U.S.-backed Batista dictatorship. Despite poor natural resources and a suffocating U.S. embargo, Cuba has more than twice as many physicians per capita and lower infant mortality than the U.S. While Washington is sending soldiers to West Africa, Havana is sending hundreds of medical workers. We stand for unconditional military defense of Cuba, for socialist revolution in the U.S. and for workers political revolution in Cuba to oust its Stalinist bureaucracy.

For the masses of society to have full access to the benefits of medical science, the health care system and the whole economy must be ripped out of the hands of the capitalist class through a workers socialist revolution. The key element in that fight is a revolutionary party capable of instilling in the working class the consciousness that it alone has the power and interest to overthrow the rotten capitalist system. In a workers America, medicine for profit will be consigned to a museum of quackery, alongside exhibits on bloodletting and faith healers.