Health

The Media Coverage of Ebola is Terrifying -- But the Actual Impact of Ebola is at Least as Scary

Much has been made of the media frenzy following Thomas Eric Duncan’s Ebola diagnosis and subsequent death, the first such death on American soil. While I agree with the widespread consensus that indiscriminate hysteria is unhelpful, rational assessment of the situation in Liberia, Sierra Leone and Guinea is crucial as this epidemic continues to explode in the region. Opinions on the subject run the gamut, but mostly I’ve encountered the dismissive “it won’t affect us, stop worrying” line of thinking among peers, one that, while comforting, perhaps has as little utility as its opposite as we stare down the barrel of this crisis.

Thomas Eric Duncan, the first person with Ebola to die in the United States

That this is a crisis is not in debate; whether Ebola manages to take hold elsewhere, it is already a horrifying reality for those living near the outbreak’s epicenter. Over recent weeks, I’ve seen and heard people reference the idea that “scientists” are encouraging the public not to concern themselves, but in fact, experts are calling attention to the situation urgently.

On October 9, a “Defeating Ebola” conference commenced in London. As the New York Times reported, “The International Rescue Committee (IRC), on behalf of 34 NGOs battling Ebola in West Africa, has warned that the number of cases is doubling roughly every three weeks and the globe has only four weeks to stop the crisis from spiraling out of control.” A representative of the IRC, Sanjayan Srikanthan, warned the assembled delegates that there remains only a small “window of opportunity” left to slow the spread of the disease. The article goes on to quote Dr. David Nabarro, in charge of the UN Ebola response, as stating that the virus scares him more than the early years of the HIV crisis. Thomas Friedan, Director of the CDC, echoed Dr. Nabarro’s statements in remarks to the World Bank last week, saying “The only thing like this has been AIDS”. Bruce Aylward, the assistant director-general of WHO's humanitarian response division, shot back at those downplaying the epidemic, that there is no such thing as acceptable number of cases. “That’s like saying you’re only a little bit pregnant. This is Ebola. This is a horrible, unforgiving disease. You've got to get down to a level of zero.”

Equally sobering are the remarks of Margaret Chan, Director General of the World Health Organization, gave to the UN Security Council on September 18th. “In the hardest hit countries, an exponentially rising caseload threatens to push governments to the brink of state failure. WHO has successfully managed many big outbreaks in recent years. But this Ebola event is different. Very different. This is likely the greatest peacetime challenge that the United Nations and its agencies have ever faced. None of us experienced in containing outbreaks has ever seen, in our lifetimes, an emergency on this scale, with this degree of suffering, and with this magnitude of cascading consequences.” Her full comments are worth reading at the link provided.

In September, the CDC estimated that between 550,000 and 1.4 million people could be infected in West Africa by the end of January 2015, a mere 3 and a half months from now. On October 13, a new WHO forecast indicated that by December, we can expect 10,000 new infections to occur each week. As of this past Friday, October 10, the death toll stood at 4,024 people; on the 14th, it jumped to 4,447, indicating that over 400 people died in a matter of 4 days. And this trend is only accelerating as Ebola continues to experience exponential growth. That growth seems less and less likely to break or slow as what remains of the healthcare infrastructure in Liberia and Sierra Leone teeters on the brink of collapse. The hospitals are so overwhelmed that, acknowledging the severe shortage of beds and space, officials in Sierra Leone have been forced to begin distributing kits for care of patients at home. Experts acknowledge that this measure is a last resort, as patients at home are contagious, but at this point it is the best option at hand. Given these circumstances, transmission is likely to continue accelerating.

To illustrate the power of exponential growth, I always find it helpful to consider an exercise you may remember from math class. You’re offered a month-long job with two salary alternatives: $100 million total, or $1 on the first day, $2 on the 2nd day, $4 on the 3rd day, and so on, doubling every day for a month. Most people instinctively choose the first option, the lump sum. If you choose the other option, on the 7th day, you’ll only make $64. On the 14th day, you’ll make $8,192. On the 21st day, you’ll take home $1,048,576. And on the last day of the month you’ll make $1,073,741,824, over 1 billion dollars. This type of growth, the very sort we are seeing with the epidemic in West Africa, is what makes the disease so threatening. Though it may well take several more months for the death toll to top 100,000, from there it will be mere weeks before it tops 1 million.

Over and over and again I’ve heard statements like “only a few thousand people have died” and “you’re more likely to die in a bike accident” and “malaria is a much bigger problem”, but each of these statements discounts the awesome power of exponential growth and the current strain of Ebola’s quite recent emergence. Although the Ebola virus has been around for decades, past outbreaks were extremely limited in scope. The next largest one, in 2000, infected fewer than 500 people before burning out. With only 224 deaths, the outbreak was both quantitatively and qualitatively different. Early, aggressive intervention prevented the virus from gaining a foothold, a point we are now well past, and growth was reversed within 6 weeks. For a clear picture of what this new outbreak may mean, we need to look not at particular numbers, but at the rate those numbers are changing; not only data, but analysis. Comparing the mortality numbers coming out of West Africa with mortality numbers for other diseases is to compare apples and oranges. Yes, malaria kills many people every year- but no, the total number of deaths isn't doubling every few weeks, and if it were, you can bet that international public health experts would be similarly concerned.

When people speak dismissively about this epidemic, they are, perhaps unwittingly, showcasing a Western-centric, startlingly privileged attitude. An attitude that implies, if we have good infection controls in place here, it won't affect the "developed" world to have millions of people in impoverished countries dropping dead. We shouldn't be talking about this casually because it isn't yet widespread enough to pose a threat to us, personally, and we shouldn’t be so callously disregarding the fate of those who share neither our luck nor our circumstances.

Still, this outlook is unsurprising in the face of our cultural reluctance to acknowledge or explore the extent of privation and abject poverty in "poor countries", coupled with widespread ignorance about our historical and present-day role in perpetuating those circumstances. We've been conditioned to be dismissive of problems affecting the poor, black people, and the developing world, and Ebola is a trifecta. We shouldn’t have to justify interest in this crisis by framing it as dangerous to ourselves, but if we are on the topic, yes, it is dangerous to everyone for such a scourge to rage anywhere. Even if an outbreak here never becomes a significant risk, the economic and political ramifications of allowing the disease to continue spiraling out of control in Africa will be incalculable. The truth is, the developing world does not exist on some distant, untouchable plane. If Ebola is able to take hold across Africa, across Latin America, or across South Asia, the risk of spread within developed countries, once marginal, will begin to rise apace.

Even putting aside the idea of transmission in the US and other western countries, the rest of the developing world is clearly at risk. What will happen in say, Mumbai, or Mexico City, or Bangkok, or Rio, when the disease begins to pop up there? Any city with massive slums could easily be the next Monrovia, and every nation should understand that it is our shared responsibility as human beings to contribute resources before this explodes into a global epidemic. The more out of control the epidemic becomes in the developing world -say, over the next 8 months to a year- the less secure we can feel about our ability to control potential cluster outbreaks here.

As to transmission in the “developed” world, it is likely that spread will be very minimal while cases (on a global scale) are few. But if cases of the disease continue to grow wildly, our protocols, health care workers, and hospitals will become more and more burdened, and mistakes will become more costly. Certainly, the advantages of the US healthcare system are huge when compared with the infrastructure of the affected countries, but talking about said healthcare as though it's the best in the world, unparalleled in its efficiency, and supremely well-funded seems to me a very generous characterization. We have a huge population of uninsured people for a Western country, something that in this case could be a big risk factor for spread. Uninsured people are unlikely to seek treatment until their symptoms are severe. Same goes for jobs without paid leave, like service industry jobs, which encourage sick people to go to work. It is easy to say “well, those people shouldn’t go to work,” but that is not the reality we inhabit, and the reality we inhabit is the one we must address.

The story surrounding Duncan involved several mistakes which have been consistently referred to as the type of thing that “wouldn’t happen” here. He traveled into the country despite airport screenings in place to prevent symptomatic people from boarding flights. He was turned away from the emergency room and left at home for several days while symptomatic. His home was not cleaned for five days after clean-up crews balked at the task; another issue that may be widespread if cases continue to emerge. Duncan’s family was quarantined at home with soiled materials until a judge belatedly ordered their removal. And as I worked on this piece, it was announced that two nurses treating him contracted the virus while wearing protective gear, one of whom traveled from Cleveland on Frontier Airlines the day before being admitted to the hospital with symptoms.

It is being reported that the hospital in Dallas, while far better equipped than a Liberian hospital, was far from prepared to handle the situation, and health care workers across the country report that their hospitals similarly lack necessary training and resources. In a survey of 2,000 nurses conducted by National Nurses United, 76% said their hospital has provided no guidance regarding admission of Ebola patients, 85% said hospitals have provided no interactive education to health care staff, 37% said the hospitals did not have sufficient eye protection, 36% said their hospitals are lacking fluid resistant gowns, and 39% said the hospitals have no plans to use plastic covered bedding in isolation wards to be discarded afterwards. Only 8% of those surveyed said that their hospitals did have such a plan in place.

Texas Health Presbyterian

Healthcare workers in West Africa have had a much higher rate of infection than the general public, but it has been argued that infection controls would prevent such transmission in the developed world. However, even assuming perfect protocols and resources, we must bear in mind that people are not perfect. A nurse in Spain contracted the virus while treating a patient there; she is said to have touched her face while removing her contaminated suit. Yes, such transmissions are mistakes, human error. But we must assume that in a system run by fallible people, all of whom make mistakes, these same situations will arise again and again. Even if 99% of health care workers follow protocol perfectly, if the epidemic is affecting millions and millions of people, the 1% who contract the virus this way represent a huge problem for containment efforts. Saying, “well that shouldn’t have happened” or “well that person is an idiot” ignores the fact that it did happen, and that quite a lot of people are idiots (which is not to disparage any of the brave health care workers who have willingly faced this pathogen and given their lives for doing so; rather, I am attacking the logic of those who dismiss the infection of “idiots” as irrelevant.)

The American and Spanish nurses’ infection also brings to the fore questions of transmission. It is well-established that Ebola cannot travel through the air, that it is present only in bodily fluids. However, there has been inaccurate conflation of this type of contagion and a disease like HIV. Unlike HIV, you do not need to have blood-to-blood or sexual contact with an infected person to catch the disease. The virus is present in vomit, feces, saliva and sweat. Complicating the issue is the dearth of research about this particular strain. While the disease is not airborne, a cough or a sneeze is not air, a fact many seem unclear on. The WHO released guidelines that acknowledge that coughing or sneezing directly on someone could transmit the virus, although they have not observed such a transmission occurring.

Ebola patient transport requires special suits and equipment to avoid disease spread

Additionally, the length of time that the virus can survive on contaminated materials like soiled bedding is still being determined; under lab conditions, it can survive up to 6 days, but lab conditions are particularly hospitable to the virus. The NBC cameraman who was recently transported to a hospital in Nebraska says that he contracted the disease while cleaning a car after a man died of Ebola inside it.

As far as we are aware, sneezes and sweat are not significant disease vectors. However, dismissively commenting, "well just don't touch anyone's vomit" as though that’s a given fails to address the millions of people working in janitorial positions around the country. The employees who clean planes at La Guardia are striking for this very reason; they state that they not only don't have "proper training" to deal with the situation (something people often reference confidently re: Ebola concerns), they also aren't given much protective gear and often do come into direct contact with bodily fluids. And consider how many people around the country likely work under similar conditions. Additionally, Ebola has been called a "caretaker’s disease” because it disproportionately affects mothers who are often dealing directly with their children's waste.

In light of the continuing escalation of the Ebola crisis, relief organizations like Doctors Without Borders, the American Red Cross, and UNICEF, among many others, are racing to catch up; unfortunately, the disease continues to ramp up even as aid does. A recent article in the Washington Post quotes CDC Director Tom Frieden as saying, “Exponential growth in the context of three weeks means: ‘If I know that X needs to be done, and I work my butt off and get it done in three weeks, it’s now half as good as it needs to be.’ ” The article also quotes the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, Michael Osterholm, as saying, “The virus is moving on virus time; we’re moving on bureaucracy or program time. The virus is actually picking up the pace. Even as we add resources, we get farther behind.” In other words, what we are doing, we need to be doing more of, and we need to be doing it faster. Last month, Osterholm warned, “The Ebola epidemic in West Africa has the potential to alter history as much as any plague has ever done.”

As world governments move to provide resources, private citizens are also joining the fray. This week, Mark Zuckerberg pledged $25 million to the fight against Ebola , and Bill Gates has already given $50 million in emergency funds via the Bill & Melinda Gates Foundation. This money is desperately needed, and the sooner funds materialize the better; with each passing day, the value of a given resource, a given dollar decreases proportional to the disease’s growth.

Ebola is not the flu. But Ebola IS a 70% fatal epidemic growing exponentially every day, and, to me, it requires a lot of hubris to say 'well, we can handle it" and act like the topic is closed. At the very least, we should be acknowledging that this is a crisis for West Africa and promises to be a crisis for some time to come, a tragic one, a terrifying one, an unacceptable one. The reality the people of Liberia, Sierra Leone and Guinea are experiencing is one we cannot imagine and hopefully will not have to, one that does require attention, one that does require fear. The hysteria continually provoked by salacious media outlets is a problem, but it is not the problem. If we devote more energy to attacking said outlets than to exploring the scope of the disease, we promote some truly odd priorities.

It’s time to worry about Ebola. And not in the aimless, cowardly way of those who half-seriously (or in cases all-too-seriously) suggest cutting affected nations off from the world, leaving everyone there to die. It’s time to worry about Ebola, to acknowledge Ebola, to face Ebola, to attack it. Anything we can do, anything we can give, be it time, resources, money, or expertise can be used, will be needed. In America, we’ve become so ensconced in security, we dislike being reminded that all things are tenuous. We’ve become so disinterested in the fate of the poor, we resent being told of their deaths. We’ve become so cynical, that to read the news is to be defeated by forces that seek to control us.

Doing nothing, reacting not at all to world events, has become cool, and at times, necessary. It is a technique for survival when so many in positions of power lie, mislead and confuse, when we are continually both inundated with information and made to feel powerless. But doing nothing, while an effective defense mechanism, contributes nothing to the world. Stop complaining about the media reporting on Ebola; you can still complain about the media’s obsession with Kim Kardashian all you like. Instead, learn to filter your media. Turn off the cable news programs, but stay abreast of developments. Ignore tone and conjecture, but read the information, the numbers, the advice of experts at the CDC, WHO and the UN. This is important. This is our race, our brothers and sisters. This is their reality. This is our fight.