© 2014 Roy Benaroch, MD
In June, a man became very ill during a flight into Lagos, Nigeria. On the plane, he developed vomiting and diarrhea, and he collapsed in the very busy airport. Contacts on the plane and on the ground had no idea that he had Ebola—initially, he was treated for malaria—and many healthcare workers and bystanders on the plane and in the airport were exposed to his infectious body fluids. One of his close contacts, while ill, flew across the country to consult with a private physician.
A nightmare? Well, it wasn’t good. But health officials in Nigeria stepped up to the plate and dealt with it. Following protocols (yes, protocols) recommended by the WHO and CDC, and relying on a fairly meager public health infrastructure built to track polio cases, workers carefully tracked every single contact, and kept tabs on all potential cases. People who became sick were then isolated. In total, Nigeria experienced 19 cases of Ebola (including 7 deaths), all traceable to the single imported case.
Nigeria has not had any new diagnoses of Ebola disease in 42 days, twice the maximum incubation period of 21 days. The WHO has declared Nigeria Ebola-free.
No special medicines, no vaccine, no high-tech anything. Nigeria is Africa’s largest country, and the case was imported through a planeload of about 50 people, all potentially exposed to infectious material. All of these people then traveled through the country’s largest airport in its largest city. Yet there was no widespread illness—the outbreak was contained through the boring, tedious, essential work of screening and following. And it worked.
The media are in an absolute frenzy over Ebola in the US, pointing fingers and practically frothing at the mouth. I realize that in the noisy world of the internet, one has to shout to sell, and shout to be heard; I also realize that there’s an election coming up in just a few weeks, so anything that makes someone else look bad is going to be a tool that just has to be used. Politicians are doing what politicians do (grandstanding), and journalists and those-pretending-to-be-journalists aren’t far behind.
One example: everyone seems to clamoring for us to shut down flights from countries affected by the epidemic (Liberia, Sierra Leone, and Guinea). Politicians from both sides and pundits on the TV news are blasting the administration and public health authorities:
“Of course we should ban all nonessential travel…” – Bret Stephens, Wall Street Journal
“…we should not be allowing these folks in. Period.” – Rep Fred Upton (Republican, MI)
“It starts with a travel ban for non-citizens coming to the US from affected areas…” – Sen. Mark Pryor (Democrat, AR)
But a widespread travel ban will do more harm than good. There already are no direct flights from any affected countries into the USA—anyone getting here will actually be coming from somewhere else. If a travel ban is in place, people who are potentially exposed will do what humans do: they’ll lie. And they’ll get here anyway, from Morocco or France or wherever. (The Liberian man who flew into Dallas, starting our only outbreak here, flew from Belgium). A travel ban will create a panic and a logistical nightmare. We won’t be able to know who is actually coming from where, and people who need to be tracked (maybe including people already sick with disease) may end up hiding from authorities. What happens then?
There are other reasons why a travel ban is a bad idea. It will prevent aid from getting where it’s needed (and the longer the epidemic brews in Africa, the longer we are at risk.) It will further destabilize struggling governments in the heart of the crisis. We should not take steps that will prolong the primary source of cases in West Africa. In fact, the most effective way to end this mess is to end it in Africa. We need to be there, helping with the fight.
None of that seems to matter—it’s all about the symbolism and messaging. Politicians want to look like they’re taking a Tough Stand to Protect America, and journalists want to sell their stories and newspapers. Shut the border! Meanwhile: there have been no further cases of Ebola from the small Texas outbreak. Though infection-control procedures needed to be tighter at first, it looks like health authorities have quickly adjusted their response to contain the spread, and it worked.
There will be more cases of Ebola appearing in the USA. We’re a big country, and we cannot practically just stop travel from an entire side of a continent. Despite what’s being screamed in the media, the CDC has done a good job at responding to this crisis. Future cases will be identified, and spread will almost certainly be limited to a handful of people genuinely at risk (not you, and not your kids.) There’s no need for panic. If Nigeria can do it, so can we.