October 19, 2014

Ebola Ban – Let’s Look Before We Leap.

by Hal Gershowitz

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 Of Thee I Sing Heading AuthorsPerhaps, the fastest growing meme since the evolutionary biologist Richard Dawkins first coined the term in his 1976 best seller, “The Selfish Gene,” is the cable-news mantra – Stop Ebola, Quarantine West Africa. A solid majority (58%) of Americans recently polled now embrace the idea of a quarantine of West Africa. At best, it is a poorly thought-out idea. At worst, it is a disastrous idea.

It is a tantalizing coincidence that Dawkins’ notion of a meme (an idea that can be transmitted from one mind to another through writing or speech in a manner that imitates the way genes self-replicate), was introduced to the world at almost the identical time that Mabalo Lokela, a school headmaster, came down with a mysterious illness along the banks of the Ebola River in Northern Zaire.

There is an intuitive appeal to the idea of isolating the West African nations of Liberia, Sierra Leone and Guinea where the disease is rampant. But the fact that such a notion is appealing doesn’t make it wise, or effective. The disease, while highly infectious (it spreads rapidly throughout the body of its victim), is actually not very contagious.

Let’s turn off the noise (especially cable news) for just a moment of reflection. Approximately 140 people a day were arriving, indirectly, in America last year from these affected West African nations. The first Ebola case of the current outbreak was reported in March of this year, about 200 days ago. So, let’s assume the same daily rate of travel into the United States this year of about 28,000 (140 X 200) travelers from the affected areas (actually, it is certain to be much less). To date, there have been only two cases of Ebola contracted in the United States, both by health-care workers who came in direct physical contact with the same dying Liberian victim of the disease. Now, admittedly, the longer the disease spreads in the three West African countries, the greater the risk of infected people from those countries showing up among those 145 visitors to the US each day. But so far, only one single case has emerged from among those travelers, which suggests that careful screening of incoming travelers, while not a perfect solution is better than quarantining all of West Africa, which would be just as imperfect.

Also consider this, no one who was in the home and living in close quarters with the victim (now deceased) before he was admitted to the hospital has contracted the disease, and no one has been reported with the disease in any of the other countries of the world where daily travel has been on-going for the last 200 days since the first case was reported.

In reviewing data for this essay we came across a paper delivered at the 35th Interscience conference on Antimicrobial Agents and Chemotherapy which was held in San Fransicso in 1995. The researchers studied the surviving members of 27 different households in which someone had been infected with Ebola. There were 173 household contacts within those 27 households, 28 of whom (16%) developed Ebola. Every one of those 28 cases had direct physical, hands on contact with the Ebola victim or the victim’s body fluids. None, we’ll repeat that, none of the 78 household members who had no physical contact with the victim during the clinical illness were infected…none!

The vast majority of Americans, it seems, would either approve or simply not object to a quarantine of West Africa. It would have been an easy call for President Obama, who is currently contending with a multitude of crises, to impose severe restrictions on travel to and from West Africa. Even Bill O’reilly, Shawn Hannity and Rush Limbaugh would have joined the more mainstream media in applauding. Instead, he listened to the experts at the world’s best disease control center, our own Centers for Disease Control (CDC), and they, unfortunately, let him down. They so emphasized the low level of contagion with Ebola that they severely downplayed the potential for infection among those who would be involved in physical contact with an Ebola patient, or his or her bodily waste, blood, swabs, urine, etc. So when two nurses who were in direct contact with the patient developed Ebola, it was, understandably, treated as an “outbreak” of Ebola in the United States, suggesting that as many of 800 people who were subsequently in some proximity to the two nurses were now at risk for coming down with Ebola. That is, in our judgment, simply an unrealistic projection of health risk.

The idea of imposing travel restrictions when communicable diseases erupt is not new. Mike Leavitt who was responsible for managing the 2005-2006 threat of the deadly H5N1 so-called bird flu when he was at Health and Human Services considered a travel ban. A travel ban “is intuitively attractive, and seems so simple,” Leavitt said. “We studied it intensely in preparation for H5N1, and I became persuaded that there are lots of problems with it.”

We have not imposed a quarantine on other areas of the world to stop a disease outbreak in recent memory. This is not the time to start given how thoroughly the disease is contained here.

“If we know anything in global health it’s that you can’t wrap a whole region in cellophane and expect to keep out a rapidly moving infectious disease. It doesn’t work that way,” according to Lawrence Gostin, a professor and global health expert at Georgetown University Law Center. “Ultimately people will flee one way or another, and the more infection there is and the more people there are, the more they flee and the more unsafe we are.”

People, who can escape from a disease ravaged area will. They will make their way to safety as far from the quarantined area as they can. If they are, indeed, highly contagious, they will infect others wherever they wind up, others who are not subject to travel bans. So it makes far more sense to concentrate our efforts on stopping the disease where it is active rather than trying to contain it, which in today’s world may turn out to be a fool’s errand that merely exacerbates the problem.

A quarantine of West Africa would simply increase illegal travel, which, in turn, would make it harder to effectively contain the disease. America’s Ebola “outbreak” is a fiction. Two people, who had close direct physical contact with an Ebola patient or the physical fluids or wastes attendant to his treatment have contracted the disease. No one else has.

Nearly all of the calls for quarantining West Africa have come from politicians and media talking heads. Almost none have come from medical experts or others who have studied past attempts to quarantine large geographical areas.

CDC has stumbled badly in its efforts to manage the Ebola narrative in America, and it certainly underestimated (or failed to communicate) the extreme demands required to protect the healthcare workers treating an Ebola patient. But, it seems to us, CDC understands quite well the communicable aspect of the disease as it relates to the general public.

Let’s cool the “Quarantine West Africa” rhetoric. We will disastrously further impoverish these countries while achieving no quantifiable additional protection for our own people.

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2 responses to “Ebola Ban – Let’s Look Before We Leap.”

  1. Irwin Yablans says:

    Thank’s for a clear assessment of the Ebola hysteria.
    The cable news and perhaps all media should be chastised for the 24 hour drumbeat of impending catastrophie.

  2. Jerry Kaufman says:

    Unfortunately for us, “not highly contagious” does not sell newspapers and does not allow politicians to showcase their efforts to “protect” us. H.L. Mencken said that it’s the government’s and the media’s jobs to keep us in fear.

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