Up till now, we’ve been lucky. Ebola has infiltrated the United States but has only claimed one victim here. It has, however, exposed some of the serious flaws in our health care system. As several experts have pointed out, our country is not west Africa, but our relative safety thus far may be more a matter of environmental and socio-historical good fortune than the benefit of our efforts and our technological prowess.
Ebola arose in Africa because of its animal populations and tropical rainforest. It crossed over into the human population in repeated minor outbreaks during the past three decades, but without causing widespread damage. Outside of Africa, we largely ignored it, regarding it as a minor threat isolated to one relatively small and impoverished region, not the kind of thing our pharmacological-centered and profit-based medical systems are interested in handling. Because of the small number of victims—and the poverty of those threatened—there was little profit incentive for developing a vaccine.
Now, for reasons that are not yet clear, ebola has assumed significant epidemic proportions. It was always limited by its extreme virulence, killing so quickly that it did not allow itself time to spread. Perhaps the virus has evolved to act a bit more slowly, more effectively, or perhaps it finally found its way into more densely populated locations. In any case, some experts are now predicting that ebola might infect more than a half million people in Africa, and we have already seen it appear in several countries outside that region, including the United States.
The case of one unfortunate traveller from Liberia, Thomas Eric Duncan, demonstrates that our health care system may not be capable of responding properly to a serious epidemic. Soon after he arrived in the United States, Duncan reported to Dallas Presbyterian Hospital with a fever. He was asked if he had been traveling, and he replied that he had just arrived from Liberia, one of the African countries most affected by the ebola virus. Presumably, he was also asked if he had any medical insurance–hospitals always ask this question, even in Emergency Rooms, which are required by law to admit and treat anyone. Duncan was not insured.
At this point, the hospital’s response is disputed. There is no question about what they did–they gave Duncan antibiotics and sent him home. The question is why they did it. At first, hospital representatives stated that there was an unspecified breakdown in communication that kept the Liberia travel information from reaching the people who made the decision to send him away. A few days later, perhaps spurred by the possibility of lawsuits, the hospital insisted that proper procedures had been followed. This second interpretation is probably the truth, for it lines up with what is standard procedure at virtually all hospitals in the United States–at almost all our health care facilities patients are given the minimum assistance possible, for the minimum amount of hours, and then released. This is especially true of patients who, like Duncan, do not have medical insurance. For days, as a direct result of the minimalist policies of our privatized system, a highly contagious individual was out in contact with members of the general population.
When Duncan returned to the hospital he was finally isolated, but inadequately, so that two of the nurses attending him later came down with the disease. The nurses apparently were exposed because the hospital failed to provide the nurses with adequate protective clothing or with the appropriate supportive personnel (i.e., assistance of a properly trained and equipped “buddy” for preparation and clean-up). A good description of these precautions is available here. Later, one of these nurses was cleared to fly across the country even after she was beginning to exhibit signs of illness.
We are fortunate that Duncan remained at home after the hospital released him. We are fortunate that Duncan’s girlfriend and her family managed to live in the same apartment with him without coming into contact with his bodily fluids, and that they returned him to the hospital before he became so sick that they couldn’t avoid such contact. We are fortunate that the sick nurse managed to survive her flight without vomiting. We are fortunate that ebola itself can only spread through contact with fluids, not through aerosols released through coughs. We are also fortunate that some segments of our health care system have apparently been learning from the mistakes. As of this writing, there are still only six people who have entered the United States with ebola and only two who have been infected within the country.
Overall, however, it is not clear that our profit-driven health care system has responded with effective plans to improve its policies. In the political sphere the responses to this threat are even more disappointing. There has been a great deal of fear-mongering, greatly exaggerating the current threat, thrashing about for scapegoats, and promoting false solutions. Anti-immigrant pundits and politicians have (predictably) used the recent events to call for heightened border security and for a counter-productive ban on travel from Africa. In a hearing on the topic in the House of Representatives, Dr. Thomas Frieden of the CDC explained at length that a travel ban would push many travelers to find alternate, often clandestine, routes to get into the United States, making it more difficult for customs officials to monitor and control the movement of infected people. Committee chair Fred Upton immediately responded by continuing his call for a travel ban, indicating that he had not bothered to listen to Dr. Frieden’s explanation. It was clear that conservatives on the committee were interested only in the most simplistic of potential solutions, and not in anything that would actually improve the readiness of the immigration or health care systems to respond to an epidemic.
Conservatives have also shown themselves ready to use ebola as a tool to attack President Obama. In some cases, this involves claims that the president is not really American, that he favors African interests over the safety of U.S. citizens. Some have even argued that President Obama is ignoring ebola in order to punish the United States and promote retribution for colonialist crimes. In other cases, pundits vaguely state that the president and his administration are incompetent, an argument they often tie in with their continuing campaign against government.
If our current government is the problem, however, should not much of the blame go to Republicans in Congress who have forced cuts in the budget of health-related agencies like the CDC? Funding for the CDC public health preparedness and response efforts were $1 billion lower in the 2013 fiscal year than in 2002. Perhaps Congressional conservatives should also be called out because they continue to block the nomination of Dr. Vivek Murthy, a highly qualified individual, as surgeon general. They have kept this important leadership post unfilled for more than a year simply because Dr. Murthy offended the NRA when he said that gun violence is a serious public health problem.
And perhaps we should note that all of the ebola victims brought into the United States by Federal government agencies were transported and treated with no hazard to the general public. The only case in which the infection spread and in which a real threat of public contamination existed occurred at a private hospital in Texas, a health facility governed by a state that is controlled by anti-government, anti-regulatory politicians. Yet the conservative pundits who repeatedly rail against President Obama or who call for the resignation of the CDC director have never mentioned the role of Congress or the leadership of the state government most closely associated with the Dallas outbreak.
Finally, let’s put this all in perspective. Each year, there are around 50,000 deaths from flu and pneumonia. Motor vehicle accidents kill more than 30,000. Tuberculosis kills more than 500. The enterovirus this year has hospitalized hundreds and killed at least four in the United States. Thus far, only one person has died from ebola in this country, and he became infected in Liberia. Let’s not copy the stupidity of schools that have suspended teachers and students because they visited Dallas, or because they were on a cruise ship, or because they came from Rwanda (which is 2500 miles away from the ebola-affected countries). Let’s not ban all travel from Africa. Thus far, the only real epidemic in the United States is paranoid fear and/or misinformation. Let’s fight that infection.