WASHINGTON, October 11, 2014 – Dallas Ebola patient Thomas Duncan died on Wednesday, and Dallas sheriff’s deputy Michael Monnig was taken to Texas Health Presbyterian Hospital with possible symptoms of Ebola. He tested negative for the disease on Thursday.
Monnig, who was in Duncan’s apartment after Duncan was isolated for Ebola, did not come in direct contact with Duncan, and public health officials from the CDC and the state of Texas insisted that he was extremely unlikely to have contracted the disease. Comments to articles about the case and chatter on social media indicate that many Americans were not convinced, and remain unconvinced by assurances from the CDC.
Ebola is a potential public health crisis. Public health crises cannot be solved just by proper medical treatment; they require public confidence in the political and public health officials involved.
Public confidence is in short supply in the U.S. right now. Public and political institutions have taken a beating in the last two years. Some of it has partisan roots; positions on scandals at the IRS, State Department and Justice Department have broken along party lines. But other scandals have crossed party lines: revelations about the NSA, the Veterans Administration, and the Secret Service.
If the government can’t take care of veterans and can’t protect the President, why should I trust it to protect me? Why should I think it has my best interests at heart?
The explosion of the Ebola epidemic in Africa was the result of a disastrous confluence of problems: recent civil war, impoverished health care systems, and a complete lack of confidence in government. That last one has led Ebola sufferers and their families to ignore pleas and directives from government officials designed to slow the spread of disease. Many West Africans remain unconvinced that Ebola was a real disease, seeing government public health measures as simply a means to undermine any political gains made in the wake of war.
America is in a much better position to deal with Ebola. Our hospitals are far superior to those in West Africa, our health care delivery systems much better staffed and with vastly superior resources. Basic hygiene is not a problem here, nor do our burial practices promote the spread of the disease. And while many Americans are not fond of our government nor convinced of its honesty and efficiency, most are willing to cooperate with public health measures.
Yet there remains a nagging lack of confidence in government, and questions about its ability to deal with Ebola.
The front line of our domestic defense against Ebola is at our international airports. There are plans to begin taking the temperatures of people arriving from West Africa at some U.S. airports, including New York’s JFK, Newark, Chicago, Washington Dulles and Atlanta. Those people will also be given questionnaires about possible contact with Ebola sufferers in Africa.
Screening began this weekend at JFK. Will it do any good? It appears to be a public relations response; few experts think that it will do any good at all, but people want the government to do something. Screening is as close to nothing as we can get and have it look like something, but in a public health crisis, optics matter. There is widespread doubt about the efficacy of temperature scanners, which look something like small radar guns. They wouldn’t have detected a problem with Duncan, who was asymptomatic for Ebola when he arrived in the U.S.
There is no reason to panic over Ebola, yet after Duncan, people have popping up with symptoms all over the country. So far they’ve all tested negative. If another real case comes up, as it probably will, half the cases of fast-food induced indigestion may be self-diagnosed as Ebola. And the demands will grow to “do something,” even if that something is more dangerous than Ebola; closing the borders, for instance.
The most important work to stop the spread of Ebola to the U.S. will be done in Africa. Screening airline passengers there will be far more effective and far more important than screening them here.
Beyond that, the Obama Administration should remember that this isn’t just a health emergency, but a public health emergency. The administration must speak with one clear voice, and it should make sure that voice is authoritative. It does no one any good when the President says one thing (as when he said that you can’t get Ebola by sitting on a bus with someone who has it), and CDC officials say another (sitting next to an Ebola sufferer on the bus, even if you don’t touch each other, is not entirely safe).
There is no reason to panic, but whether we do will be largely determined by how much we trust public health officials to do what they must with the backing of the government. On that score, things aren’t looking so good.