Fearmongering and Ebola
We write in response to the column published on Oct. 29 entitled, “Stem the Tide of Ebola.”
If the author had simply had a few conversations with clinicians or public health practitioners at Yale, her piece might have been more factually accurate, and her deep anxiety allayed in part. We write to correct her mistakes.
As many public health experts have said, travel bans to or from West Africa would be counterproductive to stemming the spread of Ebola. They are very hard to enforce, as there are no direct flights from the three affected countries to the U.S., which would mean expanding a ban on people coming from other major transportation hubs in Africa and Europe. The borders of these countries are fairly porous, and a travel ban stops no one from driving to a neighboring country and hopping a plane there. But the major objection we have is that such bans would restrict the flow of medical volunteers, public health experts and supplies to these countries, making it difficult to get in and out, and thus hindering the fight to stop the continuing spread of Ebola.
The author cited the U.S. travel ban against people living with HIV instituted by the Reagan administration and pushed forward by the late Senator Jesse Helms in the late 1980s as a model for how to handle Ebola. That travel ban was based on fear, not public health principles. It was a backwards, stigmatizing initiative that called into question the commitment of the United States to countering the spread of HIV, and it demonstrated a disdain for science and people living with HIV. The fight against AIDS requires evidence-based approaches to prevention and treatment and humane policies that don’t target individuals for discrimination and stigma because of who they are or where they are from. The same is and will be true for Ebola.
The author also speaks fondly of quarantining every single person who returns from spending time in Liberia, Sierra Leone or Guinea for 21 days. This is not only unnecessary and costly, but as Doctors without Borders and other medical relief agencies have said, it will discourage health care workers in the U.S. from volunteering in West Africa. Most of these aid organizations require a four-to-six-week stint with them for the Ebola effort; adding on an additional three-week quarantine at home upon their return is a big disincentive for people who have families and jobs to return to. If we want to stop Ebola in its tracks, we need more — not fewer — health professionals volunteering to fight it. Finally, people without symptoms of Ebola virus disease are not infectious — there is no scientific or medical justification for locking up asymptomatic individuals.
The greatest risk of transmission of Ebola is from prolonged, close exposure (within three feet) to a patient who is very ill, in whom the virus has reached high concentration in bodily fluids (more likely to be vomit, diarrhea and blood than sweat or sputum). We have to remember that although the family of Thomas Eric Duncan, the patient who died of Ebola in Texas several weeks ago now, cared for him in his early illness, they have remained Ebola-free. The greatest risk of transmission is to health care workers who tend to patients later in the disease. In the cases in Texas, there were problems in the application of the safety protocols, but since those cases, there have been no onward transmissions in the U.S. There will not be an Ebola epidemic in this country. There may be additional cases popping up until we have the epidemic under control in West Africa, but these will be quickly contained. People traveling through Grand Central Station after Dr. Craig Spencer took a train are not at risk of catching the virus from him. Dr. Spencer did the right thing — he monitored his temperature, and once he saw it was elevated, called the authorities and was put in isolation.
Though only four people in the U.S. have been infected with Ebola, far more have fallen prey to the outbreak of fear and panic in the face of this virus. Misinformed calls for travel bans and indiscriminate quarantine policies threaten the further spread of Ebola — exactly what the author of the October 29th column seeks to avoid. As with any outbreak, early intervention and treatment, accurate information, compassion and evidence-based policies and procedures are called for. That is the correct approach for stemming the tide of Ebola.
Gregg Gonsalves and Kristina Talbert-Slagle
Gonsalves is a research scholar in law and lecturer in law at the law school. Talbert-Slagle is a lecturer at the school of public health .