WASHINGTON — As U.S. public health officials and hospital workers race to help contain the global Ebola epidemic, they are confronting an equally pressing challenge at home: tamping down public hysteria.
Although the virus has wreaked havoc on West Africa, claiming more than 4,400 lives, according to the latest estimates by the World Health Organization, only three cases have been diagnosed in the United States. The disease is not airborne and can be spread only through contact with the bodily fluids of an infected person who is exhibiting symptoms. Still, the news that a second health care worker was infected in Dallas after caring for an Ebola patient and allegations by nurses that the hospital where he was treated had sloppy protocols have added to unease across the United States.
“Ebola is serious. People are understandably afraid of what it means and what the implications are for them,” said Peter Jacobson, a professor of health law and policy at the University of Michigan. “At the same time, we have really excellent public health professionals who are able to communicate the extent of the threat, what we know and what we don’t know.”
Lawmakers and other public officials have attempted to walk a fine line between urging caution and vigilance against the disease and reassuring a jittery population.
“I often urge my colleagues not to use our positions of influence to promote fear in the public,” said Rep. Bennie Thompson, D-Miss., at a congressional field hearing in Dallas on the United States’ preparedness late last week. “While it is proper to have serious concerns about the Ebola virus, it would be irresponsible to foster a narrative that an Ebola epidemic in the United States is imminent.”
It’s a message that officials from the Centers for Disease Control and Prevention, the lead agency combating the epidemic, have emphasized again and again in their briefings and media statements over the last several weeks.
“We remain confident that Ebola is not a significant public health threat to the United States,” said Toby Merlin, director of the CDC's division of preparedness and emerging infections. “It does not spread from people who are not ill.”
He urged lawmakers to keep their attention on containing the disease in West Africa. “The disease outbreak in Liberia is now at a point where we may be able to stop it if we focus our efforts,” he said. “We know how to do it. We just need the resources.”
Still, the death of Ebola patient Thomas Duncan in Dallas after he became the first person to carry the disease to the United States, the transmission of the virus to two health care workers who treated him, and images of health care workers donning hazmat suits to go into the apartment buildings of victims have stoked fears. Moreover, while patients have been successfully treated at U.S. hospitals, Ebola remains fatal in many cases, and there is no proven cure or vaccine.
“People are really concerned about the disconnect about what they’re seeing and what they’re hearing,” said Rep. Mark Sanford, R-S.C. “They’re hearing that this disease is not very communicable, but then there are these pictures of people coming out of homes wearing spacesuits. People are saying ‘Well, I don’t have a spacesuit. Am I safe?’”
The fear has spawned a number of false alarms all over the country, from Honolulu to Washington, D.C., to Salt Lake City. People have gone to hospitals with Ebola-like symptoms, only to test negative. Planes have been held on the runways and quarantined because of scares that were ultimately debunked.
In an election year, the virus has seeped into the political consciousness, with Republicans suggesting the virus is another sign of the failed leadership of President Barack Obama, with Democrats lambasting budget cuts to the National Institutes of Health and the CDC that they say undermined preparedness and with members of both parties wondering if flights from West Africa should be halted — a step that most experts say would be counterproductive to containing the disease.
“A temporary ban on travel to the United States from countries afflicted with the virus is something that the president should absolutely consider along with any other appropriate actions as doubts about the security of our air travel systems grow,” House Speaker John Boehner said in a statement Wednesday.
In the world of public health, where there are limited resources, widespread hysteria can have serious consequences.
“It impedes the effort to fight the disease to the extent that people either file false reports or flood the emergency rooms with symptoms that have nothing to do with Ebola or spread panic among others who then may take action against someone prematurely,” Jacobson said. “I don’t see anything like that happening at this point. What you want is people coming forward voluntarily to to say, ‘I might have been exposed.’”
Gavin MacGregor-Skinner, an infectious disease expert in Penn State’s department of public health sciences who has advised other governments on how to contain the disease, said effective communication is key to the containment effort.
“Winter is flu season, and we’re about to have a lot of people in this country with fever, body aches and fatigue. The message needs to be out there that if you haven’t recently traveled to West Africa and you haven’t had contact with someone who is infected, you shouldn’t be worried about Ebola,” he said.
He added it would also help to give the public more glimpses into what containment units look like and exactly what happens when a person receives Ebola treatment.
“If we showed the good work that the hospital workers here are doing, the U.S. public would have much more confidence,” he said.
Jacobson said having a higher-ranking public official, like the U.S. surgeon general, and more public health workers on the ground to talk to the public would be useful. He also noted, as others have, that the current episode should be a wakeup call for the need to invest in emergency preparedness with regard to infectious disease.
“Public health is an enterprise that only gains our attention at a time like this,” he said. “For the last few decades we’ve seen a decline in state and local revenue devoted to public health.”