Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Ebola in America: Stop with the hyperbole

David L. Katz, MD
Conditions
August 11, 2014
Share
Tweet
Share

To be quite blunt about it, Ebola is a very scary disease. Among those infected, the mortality rate is, as is perhaps now widely known, an appallingly high 90%. That would seem a very good reason to keep our borders closed to this scourge — and the consequences to the poor souls who already have it be damned. That, apparently, was just the kind of thinking behind at least one rather high-profile tweet.

But perhaps we might characterize this thinking as the subjugation of epidemiology to hyperbole. And like all rabid opposition, it is the product of anxiety rather than analysis.

And speaking of rabies, that is a virus already well established here in the U.S. with a case fatality rate of either 100%, or something very close to it. In other words, rabies is a more lethal virus even than Ebola. Yet we don’t live our lives in fear of rabies for an obvious reason: we are very unlikely to get it. Rabies is not the common cold; a sneeze is not going to transmit it.

The transmission of rabies almost always involves the bite of an infected animal. Most human cases involve dog bites, not because there is much rabies in dogs — but because humans are more likely to come into contact with infected dogs than the species in which rabies is more prevalent, including raccoons, skunks, bats, and foxes.

But let’s move on, because my aim here is not to wade into rabies esoterica but to make a general point. Rabies is a horrendously bad disease, but we don’t live in fear of it because we take some basic precautions, like vaccinating our pets, and know we are unlikely to get it. We do not deport those rare individuals infected with it to some foreign land in the name of homeland security; we treat them here. And, to my knowledge, even Donald Trump has not called for the deportation of our raccoons.

The Ebola virus is nearly as lethal, and thus nearly as scary, as rabies. Like rabies, it is rather hard to catch. Direct contact with infected body fluids is required. There is, to date, no known case of respiratory transmission — meaning Ebola is not spread by coughing or sneezing. Conceivably, the virus could evolve so that changes; but in theory, the same is true of rabies. Fear of an Ebola outbreak in the U.S. is only justified among those who avoid the woods for fear that a skunk might sneeze.

What makes Ebola such a devastating disease in Africa is the lack of medical facilities to contain it. When family members in remote villages tend to one another, there is — of course — routine and rather copious exposure to infected body fluids, including blood. This is the very thing the gloves and gowns in routine use in every hospital in the U.S. are intended to prevent. When isolation precautions are taken, the degree of personal protection is considerably greater still. When need be, we have recourse to even more extreme forms of quarantine. Tuberculosis patients, for instance, can be treated in negative pressure rooms that preclude the release of any potentially infected air droplet.

To my knowledge, there are no negative pressure rooms in Sierra Leone. More importantly, there are few modern medical resources of any kind. Ebola spreads, as it is doing now in West Africa, when unprotected family and village members do the best they can to care for one another without recourse to gloves, gowns, masks, or perhaps even clean water. It is neither feasible nor reasonable to bring every Ebola-infected person to the U.S. for treatment in a state-of-the-art facility, but if it were, the current outbreak would come quickly to an end. There would be some risk of infection among the health care professionals directly involved, but that has always been one of our occupational hazards, and the risk is very, very small with suitable precautions. There would be no risk to anyone else.

So there is certainly no basis for either fear of, or opposition to, the ongoing treatment of an infected American doctor in Atlanta. We may instead all be thankful that in return for the courageous service he was providing in Liberia, Dr. Brantly is now receiving an American standard of medical care himself.

Perhaps the exaggerated fear of Ebola is in part due to the vanishingly remote likelihood of an outbreak here in the U.S., and the fact that there has never been one. When it comes to risks, familiarity does seem to breed contempt. We Americans routinely dismiss, for instance, the perils of eating badly or want of exercise — which will be the leading causes of premature death among us. We are dismissive about the threat of flu as well, because the virus is familiar. Our perceptions often distort risk, hyperbolizing the exotic and trivializing the mundane. As Jared Diamond pointed out, there is considerable risk involved in taking a shower — to say nothing of crossing a busy street.

If we were at all rational about health risks, we should certainly consider closing our borders to tobacco. We would close them to soft drinks as well if a considered assessment of net harm were the basis for our actions. And maybe we would even do something to stave the trade of high-capacity, semi-automatic weapons.

Exhortations about the risks of Ebola in the U.S. are not the product of rational assessment. They are the product of excitement and exaggeration, and fear of the exotic. They are born of hyperbole, not epidemiology. They represent opposition of the rabid, knee-jerk variety.

If you don’t avoid the woods for fear that a fox might cough, we have no basis to deny any small contingent of Ebola-infected Americans an American standard of care. An effort is under way to approximate those standards in West Africa, and I’m sure we are all hoping for its prompt success. The brave participants should be secure in the knowledge that while most of their countrymen might be disinclined to join them over there, we won’t be over here clamoring to close the border to them.

ADVERTISEMENT

The current Ebola outbreak, bad as it is, will come under control. In the interim, we should all keep calm and carry on rendering the best care we can to those among us who bravely confronted risks abroad from which we are, thankfully, reliably defended here at home.

David L. Katz is founding director, Yale-Griffin Prevention Research Center. He is the author of Disease-Proof: The Remarkable Truth About What Makes Us Well.

Prev

7 ways patients can help reduce medication errors

August 11, 2014 Kevin 23
…
Next

Medical lessons from Robin Williams

August 11, 2014 Kevin 31
…

Tagged as: Infectious Disease

Post navigation

< Previous Post
7 ways patients can help reduce medication errors
Next Post >
Medical lessons from Robin Williams

ADVERTISEMENT

More by David L. Katz, MD

  • There are only 3 ways to allocate health care resources

    David L. Katz, MD
  • Dr. Oz: I have met the enemy. It is us.

    David L. Katz, MD
  • a desk with keyboard and ipad with the kevinmd logo

    The dietary guidelines are for which Americans, exactly?

    David L. Katz, MD

More in Conditions

  • Why dietary advice changes: It is not the food, it is the world

    Gerald Kuo
  • Blood in urine after a child’s injury: When to worry

    Martina Ambardjieva, MD, PhD
  • Living with vitiligo: Overcoming shame and control

    Dr. Reshma Stanislaus
  • Post-stroke cognitive impairment: the hidden challenge of recovery

    Rida Ghani
  • The milkweed and the wind: a poem on aging as renewal

    Michele Luckenbaugh
  • Alex Pretti’s death: Why politics belongs in emergency medicine

    Marilyn McCullum, RN
  • Most Popular

  • Past Week

    • The hidden costs of the physician non-clinical career transition

      Carlos N. Hernandez-Torres, MD | Physician
    • The gastroenterologist shortage: Why supply is falling behind demand

      Brian Hudes, MD | Physician
    • AI-enabled clinical data abstraction: a nurse’s perspective

      Pamela Ashenfelter, RN | Tech
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why private equity is betting on employer DPC over retail

      Dana Y. Lujan, MBA | Policy
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
  • Past 6 Months

    • Physician on-call compensation: the unpaid labor driving burnout

      Corinne Sundar Rao, MD | Physician
    • How environmental justice and health disparities connect to climate change

      Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta | Policy
    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • A physician father on the Dobbs decision and reproductive rights

      Travis Walker, MD, MPH | Physician
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
  • Recent Posts

    • Medical expertise does not prevent caregiving grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why AAP funding cuts threaten the future of pediatric health care

      Umayr R. Shaikh, MPH | Policy
    • Oral Wegovy: the miracle and the mess of the new GLP-1 pill

      Shiv K. Goel, MD | Meds
    • Why dietary advice changes: It is not the food, it is the world

      Gerald Kuo | Conditions
    • Blood in urine after a child’s injury: When to worry

      Martina Ambardjieva, MD, PhD | Conditions
    • Managing a Black Swan in health care: a lesson in transparency

      Joseph Pepe, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden costs of the physician non-clinical career transition

      Carlos N. Hernandez-Torres, MD | Physician
    • The gastroenterologist shortage: Why supply is falling behind demand

      Brian Hudes, MD | Physician
    • AI-enabled clinical data abstraction: a nurse’s perspective

      Pamela Ashenfelter, RN | Tech
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • Why private equity is betting on employer DPC over retail

      Dana Y. Lujan, MBA | Policy
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
  • Past 6 Months

    • Physician on-call compensation: the unpaid labor driving burnout

      Corinne Sundar Rao, MD | Physician
    • How environmental justice and health disparities connect to climate change

      Kaitlynn Esemaya, Alexis Thompson, Annique McLune, and Anamaria Ancheta | Policy
    • Will AI replace primary care physicians?

      P. Dileep Kumar, MD, MBA | Tech
    • A physician father on the Dobbs decision and reproductive rights

      Travis Walker, MD, MPH | Physician
    • What is the minority tax in medicine?

      Tharini Nagarkar and Maranda C. Ward, EdD, MPH | Education
    • Why the U.S. health care system is failing patients and physicians

      John C. Hagan III, MD | Policy
  • Recent Posts

    • Medical expertise does not prevent caregiving grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why AAP funding cuts threaten the future of pediatric health care

      Umayr R. Shaikh, MPH | Policy
    • Oral Wegovy: the miracle and the mess of the new GLP-1 pill

      Shiv K. Goel, MD | Meds
    • Why dietary advice changes: It is not the food, it is the world

      Gerald Kuo | Conditions
    • Blood in urine after a child’s injury: When to worry

      Martina Ambardjieva, MD, PhD | Conditions
    • Managing a Black Swan in health care: a lesson in transparency

      Joseph Pepe, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Ebola in America: Stop with the hyperbole
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...