why ebola scares me (hint: it’s not why you think)

It’s not the ridiculously high mortality rate of Ebola that scares me.  It’s not the fact that health care workers are contracting it simply because they’re doing their jobs.  It’s not even the extremely long latency period before symptoms develop.  No, it’s something much more benign, but critically important.

The media has been doing an “exceptional” job of covering the Ebola “crisis” in America.  (I put those two words in there as sarcasm.)  The media has been doing a great job of scaring the public with Ebola, and it’s not a crisis as they have defined it.  There is a public health crisis here on two fronts, but not as reported.  First, the people in Liberia and on other African fronts are truly in a crisis.  Their substandard public health system and the lack of a pre-planned world response to this type of outbreak have set them substantially behind the curve for being able to contain the disease.  The number of deaths and suffering are unacceptable from a human perspective.  Additionally, the lack of public understanding on this issue will lead to second and third order effects in this area.  For example, there is already evidence that food prices are escalating, due to many of the key routes providing medical and humanitarian supplies being cut off.  That is a crisis.

The second crisis is here in America.  We are missing a prime opportunity to prepare for a real health crisis.  (Side bar: Get your flu shot.  More people will die this year of flu in America than Ebola.  I’ll take bets.)  While the American public is being bombarded with images of men in white bio-hazard suits and talk of isolation chambers, we are missing the chance to educate the public on measures that will help in a legitimate pandemic.  The transmission of Ebola is extremely limited (as far as infectious diseases go).  While we have seen diseases with limited transmission have huge impacts before, they are nothing compared to impacts that could strike us in a situation such as the 1918 flu.  Otherwise known as the Spanish Flu, this pandemic wiped out an estimated 8-10% of the young adult population.  For perspective, WHO says the death toll for Ebola today is about 4,000 (an undoubtedly low estimate,given that so much of the affected population is hiding their disease).  The devastation in 1918 was up to 100 million dead.

So what’s the difference between the 1918 influenza and Ebola today?  Most importantly: transmission.  1918 influenza was absurdly communicable (transfer from one person to another.)  Transmission of Ebola today only occurs with contact of bodily fluids.  It is not airborne like the 1918 flu.

Here’s why I’m worried about the the crisis in America.  We’re not using this limited transmission disease to emphasize precautions and hone our response in preparation of a larger pandemic.  Hand washing and isolation techniques are the fundamentals we should be teaching.  While social isolation is overkill for Ebola (handwashing is always important), this is an opportunity to educate the public on a plan for a large-scale highly-communicable pandemic.   We should be teaching our steps for addressing this type of situation.  We’re not closing the borders for Ebola (right call by the CDC), but what situation would need to occur for us to consider that step?  We’re not shutting down schools in Dallas (the #1 impact we can have on preventing highly-communicable disease spread), again this is not something we should do for Ebola.  We should, however, be communicating to the public when we would close them in a pandemic.  I assume that medical facilities are testing their own response plans, but that’s probably something to be emphasized as well.

I understand the public’s desensitization to these alerts.  We’ve had swine flu, bird flu, and any number of other pandemic threats in recent past.  Unfortunately, it’s just a statistical likelihood that we will have another large scale pandemic.  If anything, these previous alerts have shown us how ill prepared we are for a larger outbreak.  The CDC and federal government should use this opportunity to test their communication techniques, and improve their response strategies with the general public.

If you’re interested in reading up on public health preparedness, I suggest The Great Influenza by John M Barry as a fantastic read.

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