In the response to Ebola, the medical community has quickly addressed its initial errors, which included the failure to promptly diagnose the first domestic case in Dallas and the inadequate protocol for caregivers. Lapses of this sort aren’t likely to happen again.
But what remains is an attitude from government officials that is sometimes condescending, bordering on arrogant. What message did the public receive in August, when officials said they have no doubt they will stop Ebola in its tracks? Or when they blamed a Dallas nurse for getting infected by breaching protocol?
During the AIDS epidemic in the 1980s, and the 1976 swine flu episode that really never materialized as an epidemic, the rhetoric of government officials damaged their credibility.
To avoid a repeat of those missteps in response to Ebola, officials should heed the following lessons from those medical crises:
1. Avoid patronizing the public. The unequivocal message delivered to the American public regarding Ebola has been “don’t panic.” This is the right message, but the delivery of that message has frequently been the equivalent of a patronizing pat on the head. Rather than an admonishment, “don’t panic” should be an exhortation to the public. During the Depression, when President Franklin D. Roosevelt told Americans not to panic over the parlous economic environment, he used the famous phrase, “The only thing we have to fear is fear itself.” He was exhorting citizens to engage in a communal effort, unencumbered by panic. That should be how officials reassure the public about Ebola.
2. Tell us what you know — and what you don’t know. At this stage, we have limited experience with Ebola. There is a reasonably good understanding of how Ebola is transmitted; the risk of transmission is low from an asymptomatic patient who is not shedding a large amount of virus. Yet on many levels, uncertainty remains. Exactly how did the two Dallas nurses contract the virus? The current explanation is that they became infected after removing their protective gear. Yet simple skin contact with the patient’s fluids, assuming the caregiver has no breaks in the skin, does not sufficiently explain transmission. Meanwhile, some officials and journalists say Ebola is “hard to get.” By itself, this means little. Hard, compared with what? It is quite hard to become infected with Ebola compared with exposure to measles or certain strains of influenza. But Ebola is obviously not hard to get if you are caring for a patient; it is certainly easier than acquiring HIV.
3. Understand and deal with the limitations of information. Computerized models are being used to analyze the Ebola outbreak and are critically important to understanding how Ebola will spread. But every model is based on finite information and is an imperfect predictor (something for climate scientists to remember). Models also fail to account for human frailty, e.g. an exposed health care worker who decides to fly, or unpredictable events like natural disasters or political instability in a stricken country. In contrast, our ability to gather information is exponentially better than it was for the AIDS epidemic. The private information companies like Google and Apple should be enlisted to employ their information retrieval expertise in West Africa and gather data on viral migration patterns and details on affected populations.
4. Exude humility, not arrogance. Currently, the chances of an Ebola pandemic in the United States are extremely low; there are simply not that many people in the country infected with the virus, and those infected are likely to be identified and isolated quickly. So long as the reservoir of infected people is small, and their contact is casual and limited, widespread transmission is unlikely. However, if those infected circulate with more people, and have longer and more intimate contact, the chances of viral spread increases. At present, hospitals are the key focal point of transmission in the United States, and spread can probably be contained. Whether there will be a future danger in large gathering places (subways, stadiums, airports) remains an unknown.
Ultimately, the key to preventing a pandemic will be eradicating Ebola in West Africa. The late Nobel Prize winner Joshua Lederberg, one of the world’s leading experts in molecular biology, once observed that a microbe that felled a child in a distant continent yesterday can reach ours today and seed a global pandemic tomorrow.
He warned, “The human race evidently has withstood the pathogenic challenges encountered so far, albeit with episodes of incalculable tragedy. But the rules of encounter and engagement have been changing; the same record of survival may not necessarily hold for the future.”
Humility, in the face of nature, is essential.
Dr. Cory Franklin is a Wilmette resident.
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