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Ebola: Fear, not facts, drives frenzy

November 13th, 2014

by Jonathan H. Burroughs

"The world is a tragedy to those who feel and a comedy to those who think." -- Horace Walpole

There are times in history when feelings and emotions transcend reason and the outbreak of more than 13,000 active cases with 4,950 mortalities from the Ebola virus in Western Africa (as of November 7, 2014) is a case in point.

Although the West African outbreak is a significant public health issue that demands international resources and support to contain and manage, the incidence of active Ebola cases and deaths outside of Africa is infinitesimally small with only four laboratory confirmed cases, one death in the United States and one laboratory confirmed case, and zero deaths in Spain.

Despite the extremely low risk of transmission of the virus outside of Western Africa (due to low viral loads from the rare exposure to someone without advanced disease), President Barack Obama requested more than $6.2 billion from Congress in emergency funds that would include establishing 50 Ebola treatment centers throughout the country to prepare for a potential epidemic of Ebola cases that will probably never occur. Twenty percent of Americans currently live in fear they will contract Ebola and some politicians reinforce these fears through advocating strict quarantines for everyone traveling from Western Africa whether they are symptomatic or not.

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To put things in perspective, the following are essential facts concerning Ebola and its potential risk to Americans:

FACT: The vast majority of Ebola cases are centered in Western Africa. All travelers from Western Africa are currently screened at five major airports (in New York's JFK, Washington D.C.-area's Dulles, Chicago's O'Hare, Newark Liberty, and Atlanta Hartsfield) where anyone with signs or symptoms of disease are quarantined and those who may be carriers are monitored.

FACT: The virus is not transmitted through the air like many microorganisms or by casual contact, but through direct contact with bodily fluids (e.g. blood, mucous etc.), typically from someone with high viral loads in the advanced phase of the disease. The virus can live on soiled surfaces with blood or bodily fluids but dies instantly with simple cleaners and bleach.

FACT: If an individual with potential exposure comes down with viral-like symptoms (e.g. fever, headache, body aches etc.), simple laboratory tests for antibodies and viral DNA can reliably make the diagnosis. The three individuals in the United States who were exposed to the patient who died from Ebola made uneventful recoveries and both medication (convalescent serum made up of Ebola antibodies and an anti-viral agent Brincidofovir) and vaccine are under development and active study.

To put all of this in perspective:

  • Half of the world's population is at risk for malaria (a parasite carried by mosquitos) and there are almost ¾ million deaths annually from the disease.
  • One-third of the world's population is infected with tuberculosis (a bacteria) and more than 1.5 million people die every year from the disease.
  • Tobacco and nicotine use cause more than 5 million deaths per year worldwide, 10 percent of which are in the United States.
  • Excessive alcohol use causes more than 2.5 million deaths per year worldwide, more than 10 percent of which are in the United States.
  • Finally, influenza infects 3 to 5 million people worldwide with a 10 percent mortality rate (typically the very old and very young). The most extreme example was the influenza pandemic of 1918 that killed 20 to 40 million people worldwide including 675,000 Americans.

Why the extreme disconnect between fear and fact?

First, Ebola was successfully politicized in a mid-term election year where it is easier to exploit human fear than to support educated reason. Ironically, Republicans who normally advocate for economic deregulation want more stringent measures and Democrats who normally advocate for economic regulation want a more moderate approach.

Second, it's easier to look at the enemy without rather than the enemy within. Ebola originates in an African region that most Americans have little direct awareness of or dealing with. Therefore it is easier to create a shroud of fear around the unknown outside whereas the causes of true healthcare risk are known behavioral issues that we either partake of our own free will or enable and support in others.

It would be better for healthcare professionals who can provide healthcare advice/opinion based upon scientific knowledge and not upon fear or political survival to make healthcare policy. It would also be good for the public receive proper information before arriving at conclusions that may impact themselves and their families.

Requiring fifty U.S. healthcare organizations to focus on Ebola preparedness is an expensive distraction in an era where 50 percent of hospitals will probably not survive the transition from fee-for-service to risk-based capitation. Four identified Ebola cases and one death should promote education and thoughtful discussion, not multibillion dollar expenditures and over-reaction. Let's go after low-hanging fruit such as smoking cessation, exercise, nutrition, alcohol moderation and mitigation of high risk personal behaviors before we throw resources at something we fear but don’t yet understand.

Jonathan H. Burroughs, M.D., is president and CEO of The Burroughs Healthcare Consulting Network. He's also a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives.

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