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Fears of American Ebola outbreak misguided, experts say

1918 Influenza Hospital
1918 Influenza Hospital

There is a scene in George Roy Hill’s classic film, "Butch Cassidy and the Sundance Kid," where Robert Redford’s Sundance expresses his reservations about leaping off a cliff and into the river below in order to evade the clutches of fast-approaching bounty hunters. He tells Paul Newman’s Butch that he can’t swim. At this, Butch bursts into laughter: “Are you crazy? The fall will kill you!”

The scene is an apt analogy for how Americans have been rationalizing their fears of catching Ebola, the same virus that is currently wreaking unspeakable havoc in at least 5 countries in western Africa. Polling data from a recent study conducted by the Harvard School of Public Health suggests that as many as a quarter of Americans believe that either they themselves or someone in their family will become infected with Ebola. In addition, 2 out of 5 respondents are concerned about a large Ebola outbreak in the U.S., and well over half of those polled think that Ebola is “easily” passed from the infected to healthy people.

While Ebola is a terrible disease, and while it is clear that the situation in Africa – specifically in Sierra Leone, Liberia, Nigeria, Guinea and, as reported yesterday, possibly the Democratic Republic of the Congo – is desperate as governments and World Health Organization agencies struggle to aid the sick and contain the spread of infection, those who believe that Americans are in danger at home are operating under at least a few misconceptions. In a comment to "Mother Jones," the publication that also reported on the above study earlier today, Gillian SteelFisher, one of the members of the team overseeing the Harvard study, pointed out that media coverage of the African outbreak has been, at best, incomplete. Coverage tends to focus on the more visceral images of the disease’s symptoms and on the posting of infected and death count totals. In doing so, it fails to make apparent the conditions peripheral to the disease itself that have allowed it to flourish.

Due to the impoverishment of the region, medical supplies are often difficult to come by. For example, rubber gloves, a basic item readily available at even the most parochial medical facilities in the U.S., are alarmingly scarce in Liberia. It has also been reported that reactionary, wrong-headed and sometimes egregiously outmoded methods of containment, such as mass quarantine zones, have been implemented under order from officials in at least three of the affected nations. Add to this that the American public continues to conflate pop-cultural depictions of airborne infectious disease with the actual nature of Ebola, which is spread only through direct contact with an infected person’s bodily fluids, and an explanation for the confusion becomes clear, but falls far short of justifying panic.

Most medical experts will admit to the theoretical possibility, even the likelihood, of an American contracting Ebola and reaching the U.S. undetected. The probability of an outbreak on the scale of the one in Africa, however, is incredibly small. In an interview for the "Washington Post," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, explained that standard protocols such as intake screening prior to diagnosis and levels of quarantine instituted once a disease such as Ebola has been confirmed effectively limit any chance of spreading infection. Fauci says that the “chance of [Ebola] being spread here the way you are seeing there [in Africa] is extraordinarily low, to the point that the CDC and me and other officials feel confident that there's not going to be an outbreak here."

So if Ebola is not being able to swim in this Butch and Sundance analogy, what is the fall? Perhaps its hubris. That same Harvard study indicates that around a third of poll respondents believe in the existence of a readily available and proven cure for Ebola. Although tests of the drug Zmepp have seen encouraging results during its role in the treatment of two American missionaries infected with Ebola, no cure-all is, as yet, on the market. If mere hubris isn’t compelling enough, Amesh Adalja of the Infectious Disease Society of America suggests that, despite what Ebola is doing on a continent where institutional controls are frequently and tragically absent, there are plenty of other far more horrifying bugs with which Americans can scare themselves. He mentions in particular the H5N1 bird flu, a virus that is as, if not more, lethal than Ebola, while also being far more contagious.

If what is desired is something closer to the apocalyptic, Tom Frieden, director of the Centers for Disease Control, has put forward drug-resistant bacteria and viruses as the likely culprit behind the next pandemic. As Frieden so sanguinely put it, “[a]nti-microbial resistance has the potential to harm or kill anyone in the country, undermine modern medicine, to devastate our economy and to make our health care system less stable.” In the context of Butch and Sundance, while the heroes survive that plunge into the river, things do not go well for them in the end. And for an American public seemingly preoccupied by plausible endgame scenarios, anti-microbial resistance just might be the Bolivian army.

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