Richard E. Besser is chief health editor at ABC News.
When you work in public health, you become tuned in to fear. And the fear level in the United States just ticked up a notch. All our high-tech equipment, protective gear and disease management didn’t protect two Dallas nurses from Ebola. When government officials tell us we are safe and then caregivers get sick, what does this do to trust?
Wearing protective equipment seems straightforward, but it isn’t. When you remove all those layers, you can contaminate yourself, and avoiding that takes training, practice and supervision. The Centers for Disease Control and Prevention made a tactical error when it said that any hospital in the United States could safely manage a patient with Ebola if it followed the proper protocol. Sure, any hospital with sufficient training and expertise in handling infectious disease can do this, but it may be that only four U.S. hospitals meet that standard — the ones with specialized units created for this kind of emergency. Transmission in the first regular hospital to treat an Ebola patient stokes fear, and fear is one of Ebola’s most common side effects.
This week, I was scheduled to speak at Case Western Reserve University in Cleveland on “Pandemics, Public Health, and Political Change: The Critical Importance of Communication.” I’ve given the talk before. It’s a reflection on how we handled the 2009 flu pandemic when I worked at the CDC, as fear was outracing the disease. The weapons we used to attack the fear — transparency, truth and constant communication — were critical. It helped Americans understand what they were facing and what to do about it, and it helped lessen the impact of the pandemic. Ironically, the university canceled my visit because I had recently returned from a 10-day trip covering the outbreak in Africa. The level of risk posed by my appearance was vanishingly small, but fear won anyway.
Sharona Hoffman, the professor of law and bioethics who invited me, wrote: “Unfortunately, The University President and Provost have decided against having you come to campus on October 15th. Although they understand how small the risk is, they felt that we needed to err on the side of extreme caution because we don’t have the ability to ask all potential attendees if they feel comfortable with the situation.”
Would I like to address the students via Skype? I turned them down. I did not want to feed the idea that anyone who has been to West Africa, even if not sick, poses a risk.
Infectious disease often leads to irrational behavior. It’s a primal defense. We saw this during the early days of the AIDS pandemic, as infected children were barred from schools and some health professionals wouldn’t provide care. We are seeing it again now with Ebola. Proactively, before I returned from Liberia, ABC News addressed employee concerns during a call with experts from the CDC. It made sure that employees could ask questions of some of the world’s leading experts on Ebola transmission. It also made sure anyone who was uncomfortable with my presence knew they could keep their distance.
Most employees have been willing to work with me, but some have chosen not to. I respect their right to make that choice, but I’ve been surprised by how many colleagues have waved from across the room and quickly made an exit. Others won’t enter my office. A colleague told me she received a note from two mothers of children her daughter plays with. Would she be having contact with me at work? If so, they didn’t want her daughter to play with their children for 21 days, the longest known incubation period for Ebola.
My post-Liberia appearance on “The View” was initially canceled because some felt uncomfortable being near me, but it was rescheduled after I appeared on “Good Morning America.” The hosts of “The View” weren’t just trying to make me feel welcome when they hugged me after I walked onto the set — they were trying to reduce fear in everyone.
The best way to fight fear and stigma is with facts. The fact is that many viruses are easily transmitted, but Ebola is not one of them. You can get infected with the flu, the common cold, chicken pox and measles from someone who doesn’t even know that he or she is sick. That is one reason those viruses can spread so quickly. To get infected with Ebola, you need direct contact with the bodily fluids of a patient who is symptomatic of the disease — someone very sick indeed. This is not casual contact. Yes, two nurses have caught it. In some Ebola outbreaks, 25 percent of cases are the medical workers who are taking care of Ebola patients, and the rest are mostly those who provide care in the home and who have touched the bodies of victims at funerals. You cannot get Ebola walking through an airport or speaking to someone with the disease.
It’s natural for people to think, “Wow, even if you’re taking every precaution in the world, like those nurses did, you can catch Ebola.” But this is wrong. You are putting yourself in much greater danger if you don’t get a flu shot than if you talk to someone from West Africa.
You cannot catch Ebola in a lecture hall hearing about the power of communication during a public health crisis. I expect universities to fight this kind of fear, not feed it. What we need to do is communicate, as strongly and as often as we can, what the real risks are and aren’t.