What Can We Learn from the Ebola Epidemic?

What Can We Learn from the Ebola Epidemic?

October 19, 2014

Ebola continues to spread. At the time of this writing, over 8,300 people are officially reported to have contracted the virus. Mortality rates are between 50%-70% and cases are doubling every 3 weeks. Hospitals in Liberia are being forced to turn down sick patients due to a lack of capacity.

“The level of outbreak is beyond anything we’ve seen—or even imagined.” - Thomas Frieden, Director of the CDC, Daily Beast

The CDC has projected that between 550,000 and 1.4 million people could be affected with Ebola by the end of January 2015. The 1.4 million figure was their “worst case scenario,” but that number doesn't include any case projections outside of West Africa. Of course, we’ve already seen the first cases hit the U.S. and Spain, as well as the first person-to-person transmissions in both countries. The 1.4 million projection also doesn’t include a scenario where Ebola mutates into a more deadly or contagious strain.

“It is clear that the virus is mutating... Even in 2014, we hardly have any way to combat this virus.” - Professor Peter Piot, the researcher who originally discovered Ebola, The Guardian

Despite the scary forecasts - or maybe because of them - officials also seem intent on calming us down:

“WHO believes that the risk of cases outside of West Africa is extremely small.” - Gregory Haertl, spokesperson for the World Health Organization, 57 days before the first U.S. case,
“There is no doubt in my mind that we will stop it here.” - Thomas Frieden, Director of the CDC, after the first U.S. case, Washington Post 
“Speculation that Ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation, unsubstantiated by any evidence.” - World Health Organization, Ebola Situation Assessment

With so many mixed messages, it’s no wonder everyone’s feeling a bit on edge. 

Should we take the threat of an Ebola outbreak seriously? 

Yes, it seems Ebola deserves our full and sober attention.

The reasons are simple: Ebola is fatal. The disease is spreading exponentially in a place that sorely lacks the infrastructure to handle it. Every time the virus transfers to another host, there is another chance for mutation. It’s infecting a large number of health workers, suggesting this strain is quite contagious. The incubation period is long enough for the virus to get past travel screens and disperse globally. And there are no established vaccines or cures.

“Overall we've made great progress but unfortunately we are still far away from commercial use. It is hard to say when a vaccine might be available, if ever.” - Dr Heinz Feldmann, Rocky Mountain Laboratories, BBC

History is filled with many examples of deadly plagues and outbreaks. There has been a prior Ebola scare possibly involving a more contagious mutation. While pandemics have precedents, what's unprecedented about the situation today is that we have a global population of over 7 billion people, plus modern air travel.

“We have to work now so that this is not the world's next AIDS.” - Thomas Frieden, Director of the CDC, Washington Post 

It’s not to say a global outbreak is likely. Who knows. But among devastating scenarios that could cause massive human suffering, this certainly seems to be on the list of concerns. If the virus continues to spread at its current pace, we could soon be living in a world where anyone with a fever might be regarded with caution - or worse, immediately tested and quarantined.

Let’s also not forget how difficult large-scale crises are to resolve, and how they often play out over a much longer period than we initially expect. The Gulf Oil spill. The Haiti earthquake. Fukushima.

I think people generally underestimate the downside risks of the times we live in. We quickly deny, avoid, numb, distract - especially when the situation feels outside of our control. But if we do not take threats like Ebola seriously, we will not respond adequately.

The risks of our response

While we shouldn’t be complacent about Ebola, we also don’t want to respond in an irrational, knee-jerk manner. Specifically, we don't want to let Ebola justify policies that deprive us of important civil liberties or that serve broader, unrelated agendas. It’s well known in politics that crises present opportunities for rapid actions.

“Never let a good crisis go to waste.” - Winston Churchill

The U.S. has committed 3,000 troops to West Africa. The TSA is rolling out enhanced screening at major U.S. airports. Connecticut has declared a Public Health Emergency, which allows for the isolation of anyone deemed at risk of passing on the virus. It’s clear that the response to any global health crisis will deeply involve the military and security complex. We should be attentive to the scope and duration of these types of heightened powers.

“Why is it that infectious disease and terrorism provoke such hysteria in the media, whereas the threat of a nuclear accident – which is far more likely – is downplayed? Let me offer a rule to predict what gets pumped up and what gets ignored: If the crisis provides ready means to increase the amount of control over society, it gets played up. If it is a crisis that defies our technologies of control, and especially if it is crisis that reveals the futility of control, then it is hidden away. I am not claiming a conscious conspiracy among the power elite to use ebola as an excuse to tighten their control over society, but it certainly plays out that way: any crisis that can be used as a pretext for more control, will be.” - Charles Eisenstein, Ebola in America: A Modest Proposal

We should also stay cognizant of commercial incentives inevitably involved with vaccines, hazmat suits, coffins, patents, etc.

Médecins Sans Frontières (Doctors Without Borders)

One organization that’s been consistent in its warnings about Ebola, and has been on the front lines since the beginning of the epidemic, is Médecins Sans Frontières (MSF) - also known as Doctors Without Borders.

MSF is a humanitarian aid organization, focused on delivering medical care and training wherever it’s needed in the world. The organization receives ~80% of its funding from private donors and employs over 30,000 people globally. The organization received the Nobel Peace Prize in 1999. 

“MSF was created on the belief that all people have the right to medical care regardless of gender, race, religion, creed or political affiliation, and that the needs of these people outweigh respect for national boundaries.” - Founding of MSF 
“The first to respond to the Ebola crisis in West Africa, Doctors Without Borders remains the primary international medical aid group battling the disease there. As local health systems have all but collapsed and most outside institutions, including the United States military, have yet to fulfill all their pledges of help, the charity has erected six treatment centers in West Africa, with plans for more. Its workers have treated the majority of patients, just as they have in previous Ebola outbreaks and some other epidemics in the developing world.” - The New York Times

Inspired by MSF’s mission and work, and because we believe this to be the most effective way to fiscally contribute, we’ve made a Namaste Foundation Impact Gift to Doctors Without Borders. We hope the funds find their way to the people who need it most. Our hearts and prayers go out to the many victims already affected by the disease.

Make a donation to Doctors without Borders 

Lessons from the Ebola crisis

Beyond targeted financial donations and vigilance around policy-making, what else can we do in response to the Ebola crisis? Most of us aren’t vaccine researchers or health workers, so it’s easy to feel a sense of helplessness. Without clear opportunities to assist, our concern can easily transmute into blame, panic, or other counter productive behaviors.

I propose we focus more attention on the lessons to be learned from Ebola. Many patterns involved in the epidemic mirror other challenges facing humanity. In particular, here are a few lessons we might take to heart:

Being humble - Despite nearly 40 years of knowing about the Ebola virus, we were clearly caught off guard by this epidemic. Governments didn’t respond for months after the initial outbreak in Guinea in December 2013. Health care infrastructure has been quickly overwhelmed. We have no stockpiles of vaccines, even experimental ones, to broadly distribute. On September 15th, 2014, President Obama delivered a speech saying: 

“We’ve been taking the necessary precautions, including working with countries in West Africa to increase screening at airports so that someone with the virus doesn’t get on a plane for the United States. In the unlikely event that someone with Ebola does reach our shores, we’ve taken new measures so that we’re prepared here at home… We’re working with hospitals to make sure that they are prepared, and to ensure that our doctors, our nurses and our medical staff are trained, are ready, and are able to deal with a possible case safely.” - President Obama, WJCL News

Just five days after Obama’s speech, Thomas Duncan flew from Liberia to Texas with Ebola. He went to a Dallas hospital later that week with a 103-degree temperature and was discharged the same day. After being contagious for another three days, he then checked back into a hospital and this time was properly diagnosed. The ambulance used to transport Duncan remained in use for two more days after the diagnosis. The apartment Duncan was staying at wasn’t cleaned out for multiple days.  

Now I’m not trying to point fingers at the Liberian government, President Obama, our airports, the Dallas hospital, Thomas Duncan, or anyone. There are a lot of reasons why events can happen this way. What I’m trying to highlight is that despite our best efforts and intentions, things often don’t go according to plan. We can’t control everything. Mistakes happen.

If we cultivate more humility, we can be more realistic in our preparations and expectations. We’ll be less likely to underestimate risk. We won’t gravitate to over-bearing policies. We’ll have more patience. We’ll examine root causes rather than just reacting to symptoms. I believe these behaviors will lead to deeper insights and systemic change.

“The more I see, the less I know for sure.” - John Lennon

Appreciating complexity - The outbreak in Liberia has been partially attributed to the civil wars that have plagued the country over the last two decades. These wars led to a deep distrust of government and lack of health care infrastructure. The World Health Organization’s recent budget cuts have been blamed for the sluggish response at the beginning of the epidemic. The Ebola virus we are seeing today is a different strain than prior outbreaks, so we know less about it. Thomas Duncan’s flight path from Liberia passed through Europe first, so he wasn’t screened as carefully at the U.S. airport. 

Bottom line: the situation is complicated. Seemingly unrelated events suddenly become highly relevant. The Ebola outbreak is ripe with examples of unintended consequences. By taking more of a systems thinking approach, we can better understand cause and effect in a holistic context.

Prioritizing prevention - As is common in complex systems, there are compounding dynamics at work with the Ebola epidemic - many of which brew under the surface awhile and then viciously appear. The more the virus spreads, the more our health care infrastructure is strained. The longer the pandemic lasts, the more fatigued people on the front lines become. Patients stop wanting to go to the hospital because they fear contracting the virus there. Health care workers understandably get worried about their own safety.

In Dallas there are 150 people being monitored with just 2 confirmed cases. If there were 1,000 cases, the monitoring required wouldn’t be possible in its current form. That’s why stopping the outbreak early is so crucial. The same actions taken at a later date will have a substantially diminished effect.

“An ounce of prevention is worth a pound of cure.” - Benjamin Franklin

The World Bank forecasts that the economic impact of Ebola in West Africa could top $32 billion by the end of next year. Just one year ago, a tiny fraction of that amount could have substantially multiplied the emergency health care infrastructure in Guinea and Liberia, possibly containing the outbreak before it started. 

We live in a society where acting to prevent unpredictable risks is not incentivized. There are rarely positive feedback loops for events that don't happen. And so we tend to optimize for short-term practicalities - this quarter’s earnings, the upcoming election, the ease of using plastic bottles, etc. Worse, calls for caution are often mocked with smugness or labeled as paranoid and wasteful.

Recognizing interconnectedness - Isn’t it interesting that the virus started in one of the world’s most impoverished areas and then jumped to one of the world’s wealthiest? The Ebola virus doesn’t differentiate based on border, gender, race, or religion. That’s the type of philosophy we need to adopt. We are interconnected together on this spaceship Earth. The people of West Africa are our neighbors, and because of “globalism” we can better understand and help our neighbors in unprecedented ways. A system is the sum of its parts, each aspect affects the whole. 

“Any death is tragic… If we can care that much about one person in the United States who gets Ebola, we need to care that much about the families who are contracting it in West Africa.” - Melinda Gates, CNN
Ebola Treatment Center, Tony Cairns

Ebola Treatment Center, Tony Cairns

Where to go from here

So how can we apply and integrate these lessons? 

One of the most obvious areas is in the context of other diseases and health threats. Sadly, there have recently been a high number of cases of dengue fever in China and Enterovirus 68 in the United States, plus a case of the Marburg virus in Uganda (a sister strain of Ebola). 

Another area of complex system dynamics is around militarism and war. We confidently get involved in conflicts with a plan to “surgically” accomplish one thing. All too often the scope expands and we end up embroiled in long-standing disputes with countless innocent victims paying the price. There are unintended consequences where arms and weapons end up. Mistakes occur. We lose sight of our interconnectedness as people. And when we place a different value on human life based on borders or religion or skin color, we’re propagating the very mindsets that led us into conflict. During times of peace, we should vigorously prioritize prevention of violence through treaties and disarmament. During times of war, we should do the same.

Another example is our economy. Despite it being an enormously complex and unpredictable system, we place faith in centralized structures to calibrate and control the distribution of resources. We accumulate runaway debts for short-term desires and eschew voices focused on preventing major collapses. We fail to appreciate the role of our economic system in war. And again, we face massive unintended consequences with compounded effects to the downside.

Perhaps most worrisome of all, the ecological and environmental challenges we face involve a lot of these same patterns. We don’t know exactly how the climate will change due to our behaviors. But we do know that we’ve dramatically changed the landscape of this precious planet in the last 100 years: species extinction rates are skyrocketing, the oceans are warming and acidifying, millions of acres of forest are being cleared, and we’re blindly pumping more carbon into the atmosphere. If we don’t change course quickly, we’ll see a warming of the planet that will have catastrophic and exponential effects for all of life. It’s heart-breaking to imagine the consequences for future generations. 

We live in pivotal times. The good news is, just as these global challenges are the result of unconscious behaviors and manmade systems, they can be addressed by consciously choosing new ways of being. It will not be easy. It will not be an overnight process. But the journey will be intensely rewarding and give our lives a sense of purpose far beyond anything we previously imagined. 

Internet connectivity and social media have made us all story tellers and meme curators. We get to choose what messages we spread. Let’s recognize the Ebola threat. Let’s be discerning in the response we support. Most importantly, let’s try to collectively learn from the patterns, becoming students of history and halting the behaviors that continue to drive us into crisis. If we rise to the occasion, perhaps future generations will gratefully look back at these times as when we united together to make real change.

Make a donation to Doctors without Borders 

Additional quotes:

“Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak.” - World Health Organization, Situation Assessment
“We believe there is scientific and epidemiologic evidence that Ebola virus has the potential to be transmitted via infectious aerosol particles both near and at a distance from infected patients, which means that healthcare workers should be wearing respirators, not facemasks.” - The Center for Infectious Disease Research and Policy, CIDRAP
“It is so horrific, that once you realize how dramatic the situation is, then you just keep thinking about Ebola all the time. But until you make that step, you prefer to get away from it.” - Sophie Delaunay, U.S. Director of Doctors Without Borders, NPR
“I would hope that things like the Ebola virus today tell us that just thinking about our own backyard can have devastating consequences if we only think what’s over there is over there and we don’t recognize humanity is interconnected. So I believe donors can be local, national, and global in their interests and concerns, and those things aren’t in conflict. It’s not a zero-sum game.” - Emmett Carson, chief executive of the Silicon Valley Community Foundation, The Chronicle of Philanthropy

Links in this article:

Additional links:

  • Doctors Without Borders, USA, Charity Navigator
  • United Nations Special Briefing on Ebola (9/2/14), Doctors Without Borders
  • Secretary-General's Remarks to the Security Council on Ebola (9/18/14), United Nations
  • 'Complacency is a worse enemy than the Ebola virus': MSF's Dr. Joanne Liu addresses the UN (9/25/14), Doctors Without Borders 
  • Questions and Answers: Estimating the Future Number of Cases in the Ebola Epidemic—Liberia and Sierra Leone, 2014–2015, CDC
  • Why Isn't Silicon Valley Doing More to Fight Ebola, The Daily Beast
  • See How Ebola’s Spread Compares to Other Deadly Outbreaks, TIME Magazine
  • Bill for cleanup of Ebola-tainted apartment: over $100K, USA Today
  • It’s highly unlikely that you’ll become infected with Ebola. So what are you so afraid of?, The Washington Post
  • Ebola’s deadly toll: Portraits of grief, The Washington Post
  • Out of Control, The Washington Post

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