Hantavirus on a ship, spreading person to person. Ebola spreading in the Democratic Republic of Congo and in Uganda. 13 cases of Hantavirus, with three deaths. Over a thousand known cases of Ebola, with 17 confirmed and about 240 suspected deaths. What’s the world coming to? Is this the Zombie Apocalypse?
My first advice is to calm down. Excellent public health work appears to have contained the outbreak of Hantavirus by quarantining exposed people. Ebola, a very dangerous disease in fact, is probably more widespread than we know, but is unlikely to get here and be transmitted here, despite a late start in identifying this outbreak and lagging public health interventions, which will likely combine quarantine, travel restrictions and community education. Ebola is a very virulent disease, and easily transmissible, but is not known to spread through the air, so careful attention to sanitation and disinfection can usually control outbreaks. But poverty and politics have likely slowed the identification of and attention to this outbreak, which is likely to cause many unnecessary deaths before the combined work of public health authorities around the world get it under control.
That said, we as a nation and as a world population face many challenges when it comes to preventing and controlling outbreaks and epidemics. Viruses are constantly evolving in us and in other animals and can spread from people to animals and back. And viruses don’t follow our rules or act today the way they acted last week or last year. A virus with an incubation period of 18 days, for example, may turn out to be able to survive longer than we thought, and spread out of the incubation period. A virus that doesn’t spread in the air may develop the capacity to do so. (The reverse is also true – incubation periods can shrink. Viruses can become less virulent – but we never hear about those situations because those changes don’t cause disease or epidemics.) Human beings have become much more numerous, and we travel a lot, which means we have become the perfect medium to help viruses evolve and spread. A virus that develops in an isolated community of a few hundred people might wipe that population out, for example, but then may disappear because there is no one to transmit it. But there are no isolated communities anymore. Or almost none.
It turns out our ability to prevent and control epidemics is completely dependent on us, on our governments, on what we choose to do and when we choose to do that. China failed to prevent the spread of Covid-19 – and there were no repercussions for that failure, beyond the deaths of millions of people. We have and maintain good, not perfect, but good, public health systems to detect disease outbreaks and prevent disease spread, but even our good public health systems have been controversial recently. Other countries vary in their public health, and the US has, until recently, done its best to compensate for that variation, doing what helps protects us but lets others depend on us instead of depending on themselves.
That said, there are times when we need travel restrictions, masks, mass immunization campaigns and other measures to prevent the spread of infectious disease. Sorry. But it happens. That means public health folks need to walk a fine line – recommending restrictions on individual liberties when the science strongly supports them, but not recommending them until such a time, and always making sure that they are pursuing the outcomes people want. Not dying from a dread disease is the outcome we are aiming for. Preventing transmission of a disease that isn’t dangerous for most people isn’t such an outcome. Making sure at-risk populations are safe is such an outcome. Being clear on the difference, and on what we are trying to achieve together matters.
The public, on the other hand, needs to understand that the science isn’t perfect, and that sometimes an abundance of caution saves lives. Individual freedom matters. But so does life, as the first and most essential characteristic of life, liberty and the pursuit of happiness.
We need to talk and listen to one another when a public health threat emerges, as it will, over and over again, particularly as the population grows. Talk, listen and respect. Have patience. Cut one another some slack.
If it were up to me, I’d make tariffs, treaties, foreign aid and even diplomacy dependent on other countries having the high standard of public health we have.
In the near term, I don’t think there is any particular threat to Americans who aren’t traveling to a part of the world were Ebola is spreading.
But the big one is still out there, evolving. We all need to remember that. We need to support public health with both recognition and resources, so we have the capacity to respond when the time comes. We’ll all need to listen to public health folks and respond ourselves, when the next epidemic breaks out, which it will. And talk to, listen to, and respect one another, so we can respond together effectively when that time comes.
To do anything else is crazy.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com
