August 18, 2014

Ebola: Even extra precaution spreads fear, misinformation

Fear and panic have taken hold since two American aid workers contracted Ebola. Some well-known Americans complained we never should have brought Nancy Writebol and Dr. Kent Brantly to the US.

In March, when I read about the first Ebola cases in what has become an epidemic in West Africa, I remember thinking the outbreak was so far away it would never be a concern in my life.

I hoped it wouldn’t ignite a panic like the ones we’ve seen with other epidemics and pandemics, such as HIV, swine flu, West Nile virus and SARS.

Too late.

There has been plenty of panic since Nancy Writebol, a Charlotte missionary serving in Liberia, contracted the often-deadly virus. She was evacuated earlier this month to Atlanta, where she and the other American who became infected, Dr. Kent Brantly, are being treated at Emory University Hospital.

Then last week, Writebol’s husband, David, and two other U.S. missionaries working in Liberia arrived in Charlotte, where they were quarantined on the campus of SIM USA, the international mission group that sponsors their work.

Fear and panic have taken hold. Some well-known Americans such as Donald Trump complained we never should have brought Nancy Writebol and Brantly to the United States, introducing Ebola into this country for the first time. Others spread fear by implying the virus can be transmitted by sitting next to someone on an airplane or that quarantines should be ordered for anyone returning from West Africa.

The decision to quarantine David Writebol and the two missionary doctors – even though they’re all healthy – was made by officials at the Mecklenburg County Health Department in consultation with state and federal agencies. Because all three had direct contact with Ebola patients, their movements were restricted and their visitors limited until they pass 21 days since their first exposure to Ebola virus. That’s the longest known time it has taken anyone to develop symptoms of Ebola disease.

David Writebol completed his quarantine Sunday and has visited the Emory hospital, where he said his wife “is continuing to slowly gain strength.” The other missionaries apparently remain in quarantine because their first exposures to the virus came at different times.

A tricky message

While in quarantine, the missionaries live in recreational vehicles on the 90-acre SIM campus off Carowinds Boulevard. The area is spacious and pastoral, with trails for walking and biking. Writebol has said it was “like being in your favorite campground in the woods.”

That’s not exactly the image of barbed-wire fencing and confinement many people think of when they hear “quarantine.”

But we’re not always logical when faced with the unknown. Ebola is rare and mysterious. In West Africa, about 60 percent of victims have died, sometimes horrible deaths with raging fevers and terrible bleeding.

Even public health officials trying to reassure the public can send the wrong message.

For example, they’ve emphasized that, although Ebola is contagious, it can be spread only by someone who is already sick with symptoms, such as fever, diarrhea and nausea. The virus is not airborne and does not spread as easily as the flu or the common cold. It can be transmitted only to those who come in contact with an infected, ill person’s bodily fluids.

Despite that, health officials chose to quarantine three healthy missionaries. Dr. Stephen Keener, medical director of the county health department, said the action was taken out of “extreme caution,” partly because this is “new territory” and they wanted to “err on the side of protecting the public health.”

‘3-foot rule’

Still, confusion quickly became apparent.

On the day after the missionaries’ arrival in Charlotte, I attended a news conference at SIM headquarters. Bruce Johnson, the organization’s president, told reporters about having visited the missionaries that morning and said they followed a “3-foot rule,” staying at least that far away from each other. Johnson demonstrated the “air hug” he gave David Writebol, taking care not to touch each other.

That afternoon, I got a phone call from a woman who was clearly worried:

“If someone does become infected, he (Johnson) then has to be quarantined, and the reporters have to be quarantined, and all of you have now left the facility, got in your cars and have driven to gas stations and probably restaurants and gone home,” she said. “And now your families are going to have to be quarantined. It’s just going to be a mess. We’re talking about a deadly virus that has no cure.”

Remember: The missionaries were healthy then – and remain healthy – and could not have infected Johnson with Ebola. And he could not have infected us. The “3-foot rule” was not ordered by the health department. It was self-imposed by David Writebol and the missionaries in an attempt not to frighten anyone.

Fear and the facts

But quarantine and Ebola are scary words. And even “extreme caution” isn’t comforting to some people.

“We all operate in a world of only partial knowledge and we gauge what we know through the lens of how scary it feels,” said David Ropeik, a Massachusetts-based consultant on risk communication and management.

“What’s on our radar screen carries more emotional weight than what isn’t,” he said. “And despite the fact that the risk to the United States (from Ebola) is negligible, as close to zero as you could possibly get, it’s getting covered (in the news) out the ying-yang.”

Ropeik, author of “How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts,” said the same thing happened during the West Nile outbreak in 1999 and the early 2000s.

“When it was new, it was exotic,” he said. “We didn’t have any experience with it. Now, we see the likelihood of (infection) is low. If we’re familiar with it, even though it’s killing people all over the place – car crashes, heart disease – it’s less scary.”

The Ebola outbreak provides “a great teaching moment” about how to calculate risk “so you end up safer,” Ropeik said.

Instead of thinking a quarantine is scary, the perception could be that health officials are “going further than the medical evidence requires,” he said. “The abundance of caution approach instills trust that the authorities are doing everything they can.”

Although it may be difficult when bombarded by news reports, Ropeik advised resisting a knee-jerk reaction.

“We sometimes worry more about the wrong things because of our emotions,” he said. “The stress alone is bad for your health Don’t make up your mind right away. Pause and let the facts have more of a say in the conversation in your head.”

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