It is such a relief about that Ebola thing. The threat of a U.S. outbreak turned out to be overhyped. A military operation is underway to help those poor Liberians. An Ebola czar (what is his name again?) has been appointed to coordinate the U.S. government response. The growth of the disease in Africa, by some reports, seems to have slowed. On to the next crisis.
Except that this impression of control is an illusion, and a particularly dangerous one.
The Ebola virus has multiplied in a medium of denial. There was the initial denial that a rural disease, causing isolated outbreaks that burned out quickly, could become a sustained, urban killer. There is the (understandable) denial of patients in West Africa, who convince themselves that they have flu or malaria (the symptoms are similar to Ebola) and remain in communities. And there is the form of denial now practiced by Western governments — a misguided belief that an incremental response can get ahead of an exponentially growing threat.
The remarkable success of Nigerian authorities in tracing and defeating their Ebola outbreak has created a broad impression that the disease is contained. Some administration officials are privately citing the news of empty hospital beds in parts of Liberia as a welcome development.
But the disease is not contained within Liberia and Sierra Leone. Aid officials debate the reasons for empty beds in some health-care facilities. Are people infected with Ebola staying at home out of fear (since reporting to a health-care facility must seem like a death sentence)? Is this a dip in infections before the next rise — a phenomenon we’ve seen before? Are there many more invisible cases beyond the reach of roads and communications? (The relief organization Samaritan’s Purse reports finding some remote villages in Liberia decimated by the disease.) The least likely explanation, at this point, is that Ebola has run its course.
Until there is a vaccine, limiting the spread of Ebola depends on education and behavior change. People must be persuaded to do things that violate powerful human inclinations. A parent must be persuaded not to touch a sick child. A relative must be persuaded not to respectfully prepare a body for burial. A man or woman with a fever must be persuaded to prepare for the worst instead of hoping for the best. This is the exceptional cruelty of Ebola — it requires human beings to overcome humane instincts for comfort, tradition and optimism. And this difficult education must come from trusted sources in post-conflict societies where few institutions have established public trust.
The Ebola virus has sometimes been like a fire in a pine forest — burning in hidden ways along the floor before suddenly flaring. There are, perhaps, 12,000 Ebola cases in West Africa. The World Health Organization warns there may be 5,000 to 10,000 new cases each week by December. This would quickly overwhelm existing and planned health capacity (1,700 proposed beds in Liberia from the U.S. military, perhaps 1,000 beds in community care centers).
At this level of infection, the questions become: Is Ebola containable? Will we see disease-related hunger? How will rice crops be harvested and transported? What effects will spiking food prices have on civil order? Might there be large-scale, disease-related migration? What would be the economic effects on all of Africa? Many are still refusing to look at these (prospective) horrors full in the face.
This denial is reflected in the scale and urgency of the global response, including by the United States. Of the 3,000 troops promised by President Obama in September, just a few hundred are now on the ground. The first U.S.-built hospital — a 25-bed facility for foreign health workers — will not open until early November. The airlift of supplies for aid groups within Liberia is still not functioning at scale. Some local capabilities (such as corpse removal) have improved. But few aid officials believe Liberia or Sierra Leone are prepared for the coming wave.
The appointment of Ron Klain as Ebola czar — commanding no immediate respect from either the military or the public health community — reveals a disposition. The White House believes it has a management and communications challenge. But the problem is far larger: the inability (so far) to get ahead of the crisis in West Africa with decisive action. This points to a useful role for Klain and other White House staffers — not to make the current Ebola policy process run smoothly but to blow it up in search of sufficient answers.
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