By Ben Locwin
I’ve been involved recently in some of the media discussions and decision-making sessions surrounding what to do in Maine with Kaci Hickox, the nurse who traveled back from Africa, fought New Jersey Governor Chris Christie over quarantine, then went home to Fort Kent, Maine, and resisted “voluntary” quarantine orders there, which were intended to bring her past the 21-day potential long term incubation period for the viral disease.
Clearly, with World Health Organization (WHO) estimates at over 13,000 afflicted with Ebola, the world is averse to having these numbers grow. But there are a couple of problems currently with how the situation is being handled: The federal guidelines have been poorly applied at the outset, leading to a few travelers returning to the USA and not reporting their symptoms―one of whom died―and state-level freedom to act beyond the federal level in a situation that is more perception-based than actual disease vector-based.
Public Perception of Risk
People do not operate well when determining their relative risks for things under low-probability circumstances. In fact, many people don’t even use precise likelihood data when it’s available to inform their decisions. Which is why with all of this talk about Ebola, quarantines, and the White House’s handling of the situation, no one is reflecting on the actual risks this time of year which include automobile travel and seasonal influenza. According to the Centers for Disease Control, seasonal influenza kills about 3,000–49,000 people in the United States every year. Now put the Ebola “crisis” in context―we’ve had 3 cases in the news, 1 of which was fatal, and Ebola continues to rank as the top news search term for over the last four weeks.
So, then―it’s not reality, but novelty: Novelty of the exotic disease and its potential impact which is the real specter here―the science almost becomes irrelevant when put up against human emotion. But we need to deal with that head-on. The reason why news stories have begun last week to circulate with headlines such as ‘Why Aren’t People in the United States Dying from Ebola?’ is because we believe in the Germ-theory of disease, developed in-part by Louis Pasteur. We know that there’s no magic about this, but simply viral vectors, fomites, and R-nought. And science, not hysteria, is the tool we wield against it: proper sanitization, gowning practices, and personal protective equipment stop the vectors from the sick and act as barriers for the well.
The other side of the issue that puts travelers more on-edge is the entirely un-scientific measurement of human body temperature at airports as a proxy for Ebola status. With literally a handful (a single handful) of Ebola cases outside of Africa in the rest of the world, a forehead infrared measurement of temperature to correlate fever with Ebola is total nonsense. Given the statistics, it’s just measuring travelers with (in about his order): too many clothes on, too much stress and anxiety, a head that was just on a pillow or jacket for a nap on the plane, a case of rhinovirus, some other general illness, or almost any other condition on Earth. Ebola is literally at the virtual very end of the list of possible conditions statistically-related to travelers with an elevated temperature.
So with botched tracking of the few cases in the USA, including the doctor in New York who continued to travel around New York City while not feeling well, to the terrible correlation between the analytical procedures on travelers and actual Ebola cases, the public is understandably confused and frustrated. And it does not help for someone like Hickox to continue to address the media and defy quarantine orders from the state of Maine. We can’t rely on the ”honor system” for people reporting feeling well as our benchmark for preventing disease. And we cannot act based on flawed understanding of the science: By Hickox’s own admission, she was definitively not affected because she had been taking her oral temperature daily―a totally non-evidence-based measure. In these cases, proper caution including quarantines not only prevent the spread of potential disease, but also reduce the spread of public fear.
What we can do within AAPS is to keep up with supporting and advising on the latest science which is being driven by (and often mangled by) the media. It is for this reason that we offer public relations and outreach so that the general public can separate fact from fiction. Join us for the session Ebola: A Global Health Problem In Need of Expediting Treatment Options today from 12:15 pm to 1:30 pm in room 33ABC.