What we learned from ‘Ebolanoia’

The awarding of TIME magazine’s “Person of The Year” to the heroic Ebola workers provides us the opportunity to take a serious look back at the lessons learned from dealing with Ebola virus in the U.S. For the time being, there are no patients being treated for Ebola in the U.S., yet the arrival of two healthy workers from the region, and their willingness to voluntarily quarantine themselves, is front page news. The Ebola outbreak rages on in Africa and there is no easing of our own outbreak of “Ebolanoia,” the unfounded hysteria over Ebola caused by fear mongering that is far more dangerous than the virus could ever be. There is no vaccine against Ebolanoia, except factual and scientific information.

We have learned that Ebola makes great cannon fodder for politicians to take potshots at one other. No opportunity was missed by public figures — none with any expertise to qualify them — to stretch the truth. None were immune to the blame and mudslinging, leaving the public with no one to trust. The pundits and politicians have set their sights on new targets, and Ebola has all but disappeared from our conscience. The outbreak rages unchecked in Africa, but the silence from politicians is deafening now that we are not directly affected and the political gain has lessened for the time being. Fortunately, rational preparations for treating and controlling the virus continue here. Unfortunately, as soon as there is an opportunity to use Ebola or any other fearful thing again for political gain, Ebolanoia will rear its ugly head.

{mosads}We have learned that there no end to the lack of ethics and underhanded tactics the dietary supplement industry will use to push their wares in the absence of desperately needed regulation. Despite the threat of prosecution, companies continue to defend their marketing of unproven and potentially harmful supplements for the treatment of Ebola. This behavior was egregious enough that even the industry trade associations have circled their wagons and are trying to appear credibly offended. Where were they with all of the other dangerous claims coming from the industry?

We have learned that, in the proper hands and when diagnosed in a timely manner, Ebola is far less deadly than it is in an overwhelmed, undersupplied and understaffed medical system. All of the patients treated for Ebola in the United States, other than Thomas Eric Duncan and Dr. Martin Salia, have survived and have been discharged from the hospital. Some to be hugged, albeit awkwardly, by President Obama. Duncan was the gentleman who was sent home from the emergency room in Texas only to return with fulminant disease. Salia was transferred, unfortunately too late from Sierra Leone, already in the late stages of the disease.

We have learned that Ebola is not that easy to transmit. None of Duncan’s family members has been infected. The two nurses who cared for him who were infected have recovered. They were caring for Duncan at the most contagious phase of the disease, and were not being required to follow protocols that are now much more stringent, which even include a second person watching to make sure you put on and take off protective garments properly.

We have learned that panic often wins over reason. In addition to the inept way orders for quarantine were issued, we now have an Ebola Czar. Thousands of people are dying every year in the U.S. from preventable diseases, such as influenza. Two people have died in the U.S. of Ebola. Similarly, we have learned that preparedness is far better than public health decisions made in a panic and based on political pressures. There was a significant backlash against the governors of New York and New Jersey for their decisions to forcibly quarantine anyone returning from the affected areas (or was it just caregivers, or was it just people directly exposed?). Do we really think that we can expect that, when faced with being locked up for 21 days, people are going to reliably report their exposure? Does the Fifth Amendment apply?

We have learned that Ebola is an expensive disease, at least in the U.S. Millions of dollars are being spent to create bio containment units, each with the capacity equivalent to an intensive care unit, each taking away space and staffing, and each able to treat only one or two patients at a time. Costs upward of $20 million are being quoted as having been incurred by New York City for caring for Dr. Craig Spencer and monitoring his contacts after he returned from treating patients in Africa and developed the disease last month. Not being prepared and missing the diagnosis are also expensive. The hospital that sent Duncan home has agreed to pay an “undisclosed sum” to his family to create a foundation to help fight Ebola in West Africa. One can imagine that the notoriety suffered by the hospital cost it a pretty penny, too.

We have learned that Ebola, and the fear stirred up for political gain and notoriety, makes a great excuse for expressions of racism and hatred. Schoolchildren have been mistreated because their families are from Western Africa. And just as insidious have been the refusal of schools to allow students to attend because of far-fetched possible fourth-hand exposures.

We have learned some good things from Ebola, too. Medical ethicists have opined that offering cardiopulmonary resuscitation (CPR) may or may not be appropriate for patients with Ebola, particularly in the advanced stages, because of the risks to providers, the likelihood of futility and the logistics that make it even less likely to be able to perform CPR promptly. This has opened the door to long overdue conversations about whether CPR should be assumed to be correct for everyone. While CPR is considered life-sustaining therapy, survival after CPR is unusual except in certain very specific situations. Perhaps we can now we can continue these discussions to ask whether we should continue to require, by law, a traumatic and often futile intervention, and continue to devastate families by requiring them to give us permission not to do CPR.

Crisis is often required before society has the motivation for significant change. While the only Ebola-related crisis we have had to face in the U.S. is one of perception and panic stirred up by the usurious and attention-seeking, and while society-destroying crises continue in Africa, perhaps we can take stock of how our leaders might more responsibly approach future communications about Ebola, and other crises, making the impact on the populace their priority rather than their self-promotion. And while I am a strong proponent of free speech, perhaps communicating about a potent threat such as Ebola should be left to those who know what they are talking about.

Seres, M.D., is associate professor of medicine at Columbia University Medical Center and a Public Voices Fellow with the Op-Ed Project. He is a national award-winning medical educator and runs trainings on Ebola for volunteers with the New York City Medical Reserve Corps. All opinions are his own. Follow him on Twitter @davidseres1.