This is how to get Ebola: Come into direct contact with the bodily fluids of a person who is infected with the virus and already symptomatic. Ebola doesn't travel through the air. A person in Washington, D.C., can't catch Ebola from an Ebola-infected person in Dallas without going there and coming into direct contact with the patient's bodily fluids.
Still, amid the deadliest Ebola outbreak in history, in West Africa, the news of the first case diagnosed in the United States has prompted people to act as if they're a half-breath away from catching the virus anyway.
America's Patient Zero is in Texas. He's in isolation, and the people who were in an apartment with him when he became sick are under quarantine. None of the people who potentially came into contact with the man while he was symptomatic have yet become sick with Ebola. Multiple potential U.S. cases elsewhere — from New York to Washington — have come up negative.
The virus has not ravaged the United States. But the word — Ebola! — is ubiquitous, and so is the fear that comes with it.
As The Post noted today in a front-page story about the global health disaster: "This is both a biological plague and a psychological one, and fear can spread even faster than the virus."
An example, from Wednesday: Mehmet Oz — aka Dr. Oz — went on television to pronounce that the epidemic could alter the world "as much as any plague in history." Dr. Oz's apocalyptic statement depended not on the realities of the disease as it exists now, but, he said, on "the question no one wants to ask, but everyone fears": Will the Ebola virus mutate and go airborne?
Cue a terrifying segment during which little blips on a spinning globe turned the world red with disease. The doomsday potential is "a question that keeps [experts] up at night," Dr. Oz said, adding: "It should keep you up as well."
But should it?
"People are feeling out of control. They had no control about whether Ebola comes to the United States," David Kaplan of the American Counseling Association said last week. For Americans, Kaplan said, there's a cultural imperative to gain and maintain control of one's own health and safety — an imperative that something like Ebola confounds. "We always like to feel in control of what we do," he said. "That's why people are often much more afraid of flying than of driving, even though it is much safer."
Even if the threat of something like Ebola is minuscule or remote, hysterical media coverage, Kaplan argued, can lead us to "develop a cognitive bias that things occur more frequently than they actually do."
— Lainna Fader (@lainnafader) September 24, 2014
Just consider how the New York tabloids covered a potential Ebola case in the city two months ago.
— New York Daily News (@NYDailyNews) August 5, 2014
Fear of Ebola eclipses other health crises around the world, including diarrhea, a preventable and treatable condition that still kills 1.5 million children each year.
When Dr. Oz called Ebola "the biggest medical crisis our country, and the world is facing," he couldn't possibly have been referring to the number of cases, deaths, or the infrastructure needed to fight it. There are other ailments that are bigger in all of those senses. But we fear few of them like we fear Ebola.
That fear has a familiar narrative, one that plays out like a movie. "There's a fascination with the drama of the disease," said Priscilla Wald, author of "Contagious: Cultures, Carriers, and the Outbreak Narrative" and a professor at Duke University. "Why are we so afraid of something like Ebola? You hear about liquefying organs. There's the bleeding from the eyes."
Ebola is a scary way to die, to be sure. But there are other dramatic ways to meet one's end. And yet, we don't talk about car crashes like a contagion, nor do we apply the same focus to other, more common killers, such as influenza or pneumonia. "We're not scared of hearing that someone's lungs fill up with fluid," Wald said. "That's not scary. It's just deadly."
In a sense, Ebola has captured our collective fear because it, like epidemic movies, relies on a fictional burst of imagination. Ebola is an ingredient in an outbreak story we're already primed to tell, in zombie stories and films such as "Contagion."
When applied to a real epidemic, Wald said, the speculative outbreak narrative sidelines a necessary discussion about the underlying causes of the actual outbreak. "We are not talking about global poverty," she said.
The reason Ebola — a disease that has a relatively low transmission rate — has spread so dramatically and quickly through Liberia, Sierria Leone and Guinea has little to do with the characteristics of the virus. Now, as before the outbreak, "people are malnourished, with ill shelter, and most importantly, no access to adequate healthcare," Wald said.
In the West African regions at the center of the epidemic, the spread of Ebola has been nothing short of disastrous. On top of the 3,400 people in the region who have died from the disease, Ebola's spread has crippled the already fragile health-care systems of the hardest-hit countries. In Liberia, people are dying of treatable, preventable illnesses, because the health system there is so overwhelmed by Ebola.
In other words, one could view Ebola as a real doomsday for the Liberian capital of Monrovia, one of the worst-hit cities in the Ebola epidemic. In Liberia, Guinea and Sierra Leone, the virus has spread at an unprecedented rate, and the death toll has long since surpassed all previous Ebola outbreaks combined. It is going to take a significant international effort to help contain Ebola in West Africa under these conditions.
The United States should be a different story, with Ebola easier to contain. But the mere potential of an outbreak here is exactly what many Americans are imagining.
Even before the first U.S. Ebola case, four in 10 adults were concerned about the possibility of a large-scale outbreak of the disease in America, according to a Harvard poll conducted in August. The concern is probably fueled in part by a widespread lack of knowledge about Ebola: Nearly 70 percent of Americans incorrectly believe the virus spreads "easily," and a third of Americans believe (incorrectly) that there is an effective treatment for Ebola. Twenty-six percent of Americans are concerned that they or one of their loved ones will get Ebola within the next year.
Ryan Hall, a psychiatrist who has written about the 1995 Ebola outbreak in the Democratic Republic of Congo, said that the "long-term maintenance" following an acute crisis like the U.S. Ebola case can be more severe than the initial panic, with people who believe a case of the sniffles could be Ebola flooding hospitals or, he said, something like a "spike in heart attacks at home" because no one wants to go to the hospital because they think they'll be at risk of Ebola infection there.
"This is going to eat at people for 20 to 30 days until we see if there's a new case," Hall said, referring to the length of time it can take for Ebola to become symptomatic. (Generally, symptoms appear within 21 days of exposure.) If there is a second case, Hall said, the anxiety period will be extended: "That 20 to 30 days is going to restart."
Humans have a long history of overreacting like this, often to threats that turn out to be false. When the brain comes into contact with a perceived threat, there are generally one of three outcomes. If the threat is real, and the individual reacts to the threat properly, it's called a "hit." "If it is a genuine fear and I don't act, it's a miss. If I act and it's not, it's a false alarm," said Shmuel Lissek, founder of the ANGST Lab at the University of Minnesota, where he studies the human brain's responses to fear.
As it turns out, our brains may have evolved to avoid "misses." In early human history, Lissek said, "the cost of a miss ... of not taking it seriously, could potentially be lethal." But the cost of a false alarm is much lower. The simple version of this idea? Better safe than sorry.
Some people, more than others, have trouble inhibiting this fear response, even when the logical part of their brains tell them that the threat isn't real. "Somebody might rationally be 95 percent sure they're not gonna contract Ebola, but there's still a five percent chance they could," Lissek said. "They focus on that five percent and say 'what if?'"
According to Lissek, one of the best things health officials can do to help to calm that reaction is to find the "stop, drop, and roll" of Ebola prevention. "Being over-trained with things helps in the face of stress," he said, adding that it's helpful to "have concrete things that people can do" to prevent an Ebola infection, or to respond if the virus reaches where they live.
This is why the military drills emergency responses into soldiers. If responding to an emergency is as easy as drinking a latte, the anticipation of that emergency produces less anxiety; it removes the mystery, the dramatic appeal of the disease, to have a solution to the problem.
Susan Sontag knew this decades ago. She wrote in "Illness as Metaphor" that "any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious." At the time, in the late 1970s, the author had cancer, a disease that she observed had carried something of a taboo among the rest of society. She applied the same characterization to TB in the past, and eventually, to the AIDS/HIV epidemic.
Although Ebola is not present here in the way that TB, AIDS, or cancer ever have been, the same principle arguably applies.
So what should you do if you fear Ebola is coming to get you? Kaplan had one idea. "Turn off the TV," he advised.