Thoughts on Ebola The only thing we have to fear is fear itself. -FDR, 1933 Apologies to those who tried but could not share the original ... links removed. Hopefully this works. Oct 17, 2014 A number of people have asked for my opinion on the situation with ebola. I’ve had enough requests now that I’ll simply write things down. To any reader, please be aware that I’m not trying to draw attention to myself or proclaim expertise on this particular disease. I believe that I have the education and experience to comment, but I don’t have all the information. These concerns are based upon my perceptions as an Emergency Physician with experience in emergency medical systems, infectious disease, international medicine, and health care disasters. I don’t have a crystal ball or an inside line on governmental action. My concern for the populace of the US in regards to ebola is that we will suffer economically and politically, and that we will hurt each other far more than this disease might. All of my concerns stem from a panicked populace and their leaders, impulsive and isolationist behavior, and ultimately and a hesitation to act to address the problem at it’s root. In regards to many of my worries, I desperately hope that I’m wrong. I will cite sources when I am drawing from them, but again, the rest of this is just my opinion. (Apologies - footnotes dont translate into a FB post. Msg me for the full file if you have interest in reading the citations.) If you are a conspiracy theorist, a science denier, or feel that ebola is political in some way … please take your tinfoil hat elsewhere. For anyone unaware, ebola is a virus that traditionally exists in animals, sometimes accidentally transmitted to humans. Once in humans, it limits its own effectiveness as a pathogen by killing people too quickly, too frequently. That lethality is the reason that an outbreak of this magnitude had not yet occurred, despite ebola’s discovery in 1976. The people that acquired the disease simply died before any large scale transmission could occur. Ebola’s ability to kill is unquestionably magnified by the fact that health care has been virtually non-existent where the disease has traditionally reared it’s ugly head. So yes, there are reports of ebola outbreaks with 90% lethality … but it is important to keep in mind that these outbreaks have occurred in locales where children still routinely die from diarrheal illnesses. Ebola spreads from person to person through bodily fluids, and is only transmissible when a person becomes physically ill. This is why Mr. Duncan, the individual who brought ebola to the U.S. as a patient, managed to fly from Liberia to the US but not infect a single other individual until he was very sick and in the hospital. It’s worth noting that ebola has, in fact, safely existed in U.S. research labs for decades. It’s worth noting that, while there are people concerned that the virus may mutate and become transmissible through respiratory transmission, this has never actually been documented in humans. Of course, it’s also theoretically possible that the cold virus you had last week might mutate to become as deadly as ebola. We don’t worry about that, because it’s pretty unlikely. The point here is that it doesn’t make a lot of sense to invest time worrying about something that hasn’t happened and can’t be predicted, particularly when we have a very large real and documented problem at hand. Understanding the situation with ebola requires a great deal of consideration as to where you draw your information. Having worked in Haiti for a decade, it has been my experience that it is rare for media to accurately or completely represent any given situation. The media, in general, survives on a business model that profits from your fear. If you are frightened, you will find yourself glued to CNN or whatever other media outlet you might prefer. If you consume more news media, more ads can be sold at a higher price, and more pockets are lined. This statement is true for conservative, liberal, and “apolitical” media if such a thing exists. To generate a more exciting or scarier story, media outlets will happily focus on the exciting and scary aspects of a story, even if that represents only a small portion of reality taken well out of context. Ultimately, what you observe on your TV is often a half-truth at best. Ebola is legitimately scary, but ebola stories sell better if they are even scarier. Remember: Scary = $. News media should only be utilized as a starting point. Do your own research, and draw it from REPUTABLE sources. Bloggers, Fox News, MSNBC, radio shock jocks, podcasts, and even CNN should NOT be considered definitive or reputable sources. Sources that I would suggest looking to: The Center for Disease Control. The World Health Organization. The National Institute of Health. The American Medical Association. Points worth understanding if you want to grasp the situation with ebola: Politicians peddle in the currency of fear just as the media does. If a politician can scare you and then convince you that he or she has a solution, that obviously benefits them. Both sides of the political spectrum are invested in convincing you that the other side is ushering the world to hell in a hand-basket. This is hugely problematic, as politicizing a disease like this is quite possibly one of the worst possible things we can do. It will delay solutions and has the potential to make the problem dramatically worse. We all have our opinions in politics, but now is not the time. Politicians and their constituents quite frequently deny and ignore science. This spans both sides of the political spectrum and is extremely dangerous. Traditionally on the left we have the anti-vaccine crowd and on the right we have the climate change deniers. Both sides are wrong, both sides are dangerous. There is a reason that when you flip your light switch, the lights come on. Science. There is a reason that when you push the gas pedal in your car, it moves. Science. There is a reason that pneumonia is cured when buffeted with the correct antibiotics. Science. Science got us out of the dark ages and is our hope for Ebola, along with cool heads and a collectivist attitude. We (globally) are all in this together, and the spread of disease such as ebola cares little for geopolitical border, race, or other context by which we isolate ourselves. What deniers fail to recognize is that science doesn’t require you believe in it to be true. You can deny gravity, but aren’t likely to find luck jumping from a cliff. On the political spectrum, we have climate change denial. We currently have legislators proposing that climate change not be studied, despite the fact that the overwhelming majority of climate scientists agree that it is a problem and caused by humans. No study means no solution, and the problem worsens. On a social spectrum, we have the anti-vaccine crowd. The data on vaccine effectiveness and safety could fill libraries, yet people still behave in such a fashion that diseases such as measles have now reappeared within the US. If we apply the approach of science denial to ebola … many, many, many people will die unnecessarily. Continuing my concerns with politicization, the CDC and the NIH are not political organizations. Any suggestion otherwise is ignorant and/or politically motivated in itself. They are a public health necessity and the most significant defense we have against diseases such as ebola. We must not mount political attacks against them and detract any attention from the task at hand. (Of course, demanding a higher level of performance is a different thing entirely.) These organizations address various health care needs and fill a gap in health care left behind by capitalism. In a capitalist economy, pharmaceutical companies and health care agencies don’t spend money on diseases such as ebola which are primarily prevalent in poorer countries. Thus, we have no approved medication or vaccination for ebola as of yet. Unfortunately, the U.S. (in recent history at least), has expressed little interest in investing in public health. We have minimal interest in combating obesity, smoking, environmental protection, or similar investments that do not obviously line our own pocketbooks or produce immediate results. This is not a political statement, but a reality that is reflected in how we behave as a people and where we spend our money. Collectively, we don’t value eating well, providing universal healthcare, protecting time for exercise, etc. As such, public health funding has been slashed. Specifically, since 2006 the CDC emergency preparedness budget has been cut in half. This despite SARS, H1N1, swine flu, etc. The problem is bipartisan. While the previously cited article cited blames the Republican Party, President Obama has also pushed for CDC funding cuts as well. And now ebola has reached the world’s doorstep. Perhaps ebola will be our wake-up call. Perhaps not. We should all be aware that the “not my problem” approach got us to where we are today, and that there are numerous other health care threats that continue to go underfunded simply because they are not yet a problem in the U.S. The situation in West Africa is not under control and nowhere near being so. Currently, the number of cases is doubling roughly every 3 weeks in an exponential trajectory. This is horrifying when extrapolated into the future. There will be potentially greater than 1 million cases by January, 2015. Governmental agencies in West Africa do not have the funding, general infrastructure, or health care infrastructure to generate a meaningful impact. If we (in the global sense) do not intervene, ebola easily has the capacity to become a worldwide epidemic. “Not our problem” has not protected us and will exacerbate the problem. You may be familiar with the increasingly louder calls for “closing the borders”. Closing the borders is simply a different spin to the “not our problem” concept. Ultimately, not only will this not work, but it is very likely to make the problem far worse. We cannot and should not do anything that slows down the international response. The projection of over 1 million infected by 2015 should be a convincing argument that we are way, way behind the 8-ball already. Health care workers and military personnel need to swarm West Africa and we need to facilitate these efforts, not hamper them. No flights in or out of West Africa means no aid workers in and out of West Africa. Fewer will go, less will be accomplished, more will die. Preventing a handful of Mr. Duncans from reaching the U.S. may come at the cost of tens of thousands of lives in the future. To offer an analogy … our world has become a series of row houses. Each house represents a nation. Each is independent, but each very, very closely interconnected with all of the others. Closing the borders and hoping ebola goes away is akin to becoming aware that a neighbor’s row house is on fire, only to respond by locking your doors and closing your windows. A locked door may delay your demise, but you will ultimately burn. It’s not difficult to understand that the neighborhood is most likely to survive if everyone gets involved to stop the fire before it spreads. This is exactly the problem with ebola. And even if stopping flights out of West Africa were to be of any effect, it is a fool’s errand unless we stop ALL flights EVERYWHERE. Ebola can incubate for 3 weeks, which is plenty of time to leave West Africa and hop around the globe before arriving in a place such as Oregon or Kentucky. Don’t stop flights from Liberia unless you’re also willing to also stop flights from London. And stop oil imports from Saudi Arabia. And produce from Mexico. And iPads from China. So what does this mean for us here in the US? More cases of Ebola will show up. It’s a statistical certainty. Before all is said and done, we are likely to see hundreds of cases. That being said, it’s not that difficult a disease to avoid for the average individual. As I have previously mentioned ebola is not transmissible unless you are symptomatic. Stated differently, if the fellow across from the aisle from you on the bus looks fine .. he is fine. If he looks ill, stay more than 3 feet away from him. The people who contracted ebola from Mr. Duncan are health care workers, not store clerks or traffic cops or even the people he lived with in Dallas. These healthcare workers are people who knew very well what they are getting into, but did so anyways. (As a side note, I find it rather tragic the blame these people have received. The system failed. These people deserve medals. Blaming them and failing to correct the system ensures that this tragedy will occur again.) Even accounting for these health care workers, if we look at all contacts with ebola patients within the US, it’s a very, very small percentage that become ill. There have been ebola patients in Atlanta, Omaha, and Dallas. Hundreds of people have been involved in the care of these patients, yet as of today, only two have become ill and none who were not healthcare workers. Let me repeat that. Not one single random, unexpected individual in the entire United States has contracted ebola. Not one. While the goal is zero … we’re not doing too badly. We have a much deadlier virus here in the US already. It’s called rabies. 99.9% fatal. It’s been here for far longer than the U.S. has been a country. In 2008, 40,450% more people died in the US from getting tangled in their sheets than have contracted ebola on US soil in 2014 thus far. Let’s keep perspective. Fear and panic are our worst enemy. Your fear and your panic can and will hurt people. If every person with an itchy elbow logjams the emergency departments, people are going to suffer and die needlessly. Patients are not going to have to stop having heart attacks and if those people can’t get to doctors, they will suffer. Car accidents are not going to drop off and those patients will require ambulances. As of today, there is not an outbreak of ebola in the U.S. If you do not have a fever and have not been to West Africa or exposed to someone who has been in West Africa, you do not have ebola. All of us need to restrain our impulse to seek reassurance from a doctor face to face in the ER. All of us need to remember that if a doctor needs to spend 15 minutes convincing you that the rash on your behind is just the same acne it was last week, and not ebola, that that doctor is spending 15 minutes not taking care of a sick person. If all of your neighbors need the same reassurance, that doctor can’t care for anybody. Please be aware that I am not suggesting that you shouldn’t seek care if you are truly ill. I am simply saying that is your responsibility as a citizen to make every effort to refrain from panicky behavior that consumes limited resources. An ER visit is simply not a treatment for ebola anxiety. (Important side note: A fever is defined as a temperature of 100.4 or greater. You do not have the special privilege of redefining a fever for yourself. 99.5 is not actually a fever for you. I don’t care if you “normally run low”. Don’t believe me? Try redefining other things for yourself as a test run. Next time you get pulled over, try to convince the officer that 90 isn’t speeding for you, because you normally drive 100. Or tell the bank teller that in your case, a checking account with $32.04 in it is actually worth $200 million and demand payout. I wish you luck. But just as 90 mph is 90 mph countrywide, and $32.04 is $32.04 in any bank, a fever is a temperature of 100.4 or greater. Period.) Remember that panicky behavior consumes other resources and causes other problems. I focus on healthcare because this is my area of expertise. In addition to clogged up Emergency Departments, panicky people hoard resources, become violent, stop doing important jobs, etc. As of today, two schools in Ohio have closed. As of today, there have been exactly zero cases of ebola diagnosed in Ohio. Zero. As of two days ago, the Dow plummeted 370 points due to ebola panic. So ask yourself, what happens when the local power company workers stop showing up to their jobs? How are you going to get to work because your child’s school is closed and you have to care for them? Bus drivers? Police officers? Grocery store workers? Gas station attendants? What is happening to your retirement account because people are panicking? Potentially the most important point that you may derive from this article is as follows: It is very conceivable that many, many, many people in the US will suffer because of the global ebola outbreak, while not many people in the US will actually contract ebola. Fear and panic will potentially drive our politicians to do foolish and unpredictable things. Please, please, please lobby your politicians to keep cool heads and listen to our scientists. That being said, they will probably do the opposite. If not controlled, this global outbreak will have massive economic impact. A global ebola outbreak will mean reduction in human global movement. Reduction in movement means reduction in trade which means scarcity and economic hardship. We survive on global goods and services. We import oil, food, the clothes you are wearing, and the computer I am typing this on. Consider a tomorrow where you can’t get those things. Consider a tomorrow where you can’t fill up your gas tank or get fruits and vegetables in the winter. Consider what happens to businesses that buy or sell goods internationally. While your local chocolatier may get their stock from a distributor in Ohio, that cocoa wasn’t grown in Cincinnati. And if your local chocolatier goes under, he or she cannot buy whatever goods and services you may be selling. And if you cannot get to work, or cannot sell your goods or services, you will suffer. All this despite the fact that you are not likely to ever encounter an individual with ebola. It is time to understand that the U.S. does NOT stand alone on this earth. It is time to understand that your livelihood, your family’s security, and your retirement account may hinge upon the trajectory of and response to this ebola outbreak so far far away in West Africa.
Posted on: Sat, 18 Oct 2014 16:43:04 +0000
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