A couple of points about the following column in today's Washington Post: Those who are sanguine about the risk to the US and those who are concerned both agree that controlling the epidemic in West Africa is essential. Stop it there and and concerns about it spreading widely and in the same out of control fashion largely disappear. So how the effort there is going is very important.
That only 300 of the 3,000 troops promised by President Obama are actually in West Africa may be no more than a logistics issue, but it would also would not be atypical of the history of promises made by this Administration: Talk a good game, but deliver far less.
Max has repeatedly made the point that the cultural difference between West Africa and the US explains why Ebola could not be a problem in this country. I would say though that it is less culture than level of technology and modernity. Americans care for their family members as much as Liberians do and if there weren't medical facilities to which they could bring their sick loved one, they would be lavishing the same close contact personal care Liberians do. Similarly if there weren't undertakers in every American town, American families would take on the grim job of preparing and burying a loved one's corpse. No matter how they died, I doubt too many American families would either throw their family member's body out their back door or leave it in a bedroom and vacate the house.
However, where an advanced level of services and capabilities will likely make little difference is with children. Should a child come down with Ebola, once they show symptoms and become contagious, the chances are great that they will receive close personal care from adults within their family. Fortunately, no child has come down with the disease, but they are at the same risk as the average American, and perhaps even more. It is ridiculous to warn adults not to eat (or touch) strange mucous or feces, but these and other warnings for practical prevention are lost on small children. Still this increased risk comes on top of a risk that is very, very low and there is no reason to scare kids by warning them about a virus that will cause them to bleed from their eyes. However, if I found that a child exposed to an Ebola patient, like Mr. Duncan, was attending my small child's school, I think I would play it very safe and not send them, and I reject any notion that this would constitute panic. No matter what the odds are, people are very reluctant to play any game that involves their children's lives. I think my wife or I could do a fine job of homeschooling for the 21 days or so before the All Clear was sounded.
Quote:The world is in denial about Ebola’s true threat
Michael Gerson
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.
