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Editorials

Response to Ebola in the US: misinformation, fear, and new opportunities

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6712 (Published 07 November 2014) Cite this as: BMJ 2014;349:g6712
  1. José G Merino, US clinical research editor
  1. 1The BMJ, USA
  1. jmerino{at}bmj.com

On 30 September 2014 the Centers for Disease Control and Prevention (CDC) confirmed the diagnosis of Ebola virus disease in a man who had arrived in Dallas from Liberia, without symptoms, four days earlier. Two nurses who took care of him at a Dallas community hospital became infected with the virus shortly afterwards. Although the man died, both nurses recovered. And at the end of October, a physician who recently returned from Guinea had Ebola diagnosed in New York City. These four cases of Ebola in the US have led to overreaction and unjustified fear among politicians, the media, and the public that is driven by misinformation, lack of scientific evidence, and demagoguery.

The disease caused by the Ebola virus is terrifying. The virus is highly contagious through direct contact with bodily fluids and has a high case fatality rate. The current epidemic in Liberia, Sierra Leone, and Guinea has had devastating personal, social, medical, and economic consequences: as of 5 November there have been 13 042 confirmed, possible, or suspected cases and 4818 deaths.1 Because of the fear of contagion, children orphaned by Ebola are often shunned from their communities, and because of the risk of infection, patients often die in isolation without the comfort of their loved ones. The disease has been particularly severe among healthcare workers; 546 have been infected, including the two nurses in the US, and 310 have died. The epidemic has devastated the healthcare infrastructure in the most severely affected countries. Although there is a lot we do not understand about the virus, we know that transmission occurs only from people with symptoms and that appropriate measures can decrease transmission in healthcare environments. A pandemic in the US is extremely unlikely.

Confused response

The reaction to the first cases of Ebola diagnosed in the US was fear, and over the past month the reaction has turned to panic. Many factors led to this response. The risks of contagion and of a pandemic in the US have been overplayed by the media, particularly by cable outlets but also by newspapers.2 The situation was further aggravated after a fourth patient had the disease diagnosed in New York. Mistakes made at the Dallas community hospital and misstatements and retractions by CDC officials fed the public’s perception that the experts were not in control of the situation and did not know how to handle the problem. To aggravate matters, the CDC has changed its guidance over time.3

Because the Ebola scare has occurred during a bitter mid-term election process, the issue has been politicized. Democrats argued that budget cuts endorsed by Republicans hampered the response to the epidemic and slowed the development of a vaccine. Republicans attacked President Obama’s leadership, portraying the response of the administration, including the CDC, as disorganized and insufficient. Wanting to appear in control and with a clear plan to handle the situation, they called for travel bans, measures to seal the border, and quarantining travelers returning from west Africa, including healthcare workers. Adding to the confusion, the federal and state governments have enacted contradictory quarantine policies. Nine states (including those with the airports that travelers arriving from Liberia, Sierra Leone, and Guinea must use to arrive in the US) and the District of Columbia have rules to quarantine most healthcare workers, and there are well founded concerns about the effect of these policies on civil liberties and personal privacy.4 The CDC, on the other hand, recommends quarantine for only the few people in the highest risk group.5 President Obama has sent conflicting messages to the public by opposing quarantine measures for civilians yet supporting them for the military, even if the soldiers returning from west Africa were not exposed to patients with Ebola.

Misinformation and conflicting messages have led to panic about contagion among the public. Students from Texas and Ohio who had traveled in the same plane as one of the Dallas nurses infected with Ebola virus were asked to stay home for 21 days, and their schools were closed so they could be disinfected. The crew was placed on administrative leave. In a separate incident, a Pulitzer prize winning photojournalist who had returned from covering the epidemic in Liberia three weeks earlier and who did not have any symptoms was disinvited from a workshop at the Journalism School of Syracuse University for fear of contagion and panic among the students. Despite the exhortation of infectious disease experts, physician organizations, UN agencies, and international aid groups who oppose quarantine measures because they hamper the efforts to contain the epidemic in Africa and will be ineffective to prevent the spread to the US, a recent NBC/Wall Street Journal poll found that three quarters of Americans favor mandatory quarantine for returning care workers.6

Better preparedness

In the coming weeks further cases of Ebola may be diagnosed in the United States but an epidemic is extremely unlikely. The reaction to the current situation shows that the country was unprepared to meet the challenge of an emerging infectious threat. It is important to take steps to ensure that next time the response will be proactive rather than reactive. There are encouraging signs that change is taking place. In response to the current crisis, the CDC strengthened its recommendations for identifying and isolating patients with highly infectious diseases and now provides clear guidance to hospitals and healthcare workers on the use of protective equipment and other measures to prevent the spread of disease. It has also developed specific guidelines for categorizing the level of risk of people exposed to Ebola virus and for implementing measures needed to monitor their health and, if necessary, restrict their movements.5 In addition, federal and state governments have identified specialized hospitals with containment units that may safely treat patients with Ebola and other highly infectious conditions.

These are positive steps. But to be fully prepared, we need a national conversation on the best way the country can approach public health challenges. The American people deserve to have their elected representatives make decisions based on medical advice in order to improve the health of the nation rather than to score political points. We hope that the ongoing quarantine debate will lead to a greater coordination between the federal government (including the CDC and other federal agencies) and the states to ensure that sound science drives public health decisions and that civil liberties and individual privacy are not eroded. We look forward to a debate on the ethics and value of disclosing private personal information about potential patients. There also needs to be frank discussion on the ethics of responsible journalism. Only by action on these issues will we be ready for the next pandemic.

Notes

Cite this as: BMJ 2014;349:g6712

Footnotes

  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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