How Politics Risks Making Ebola Epidemic Much Worse
Deadliest Ebola outbreak ever
The current Ebola outbreak in Africa is the deadliest in history. The death toll is currently estimated at over 5,000. Around 70% of cases are fatal. Amid increasing panic in the West, controversy has arisen over how the virus should be contained. There is a consensus among experts – including the aid organizations and government agencies working to combat the illness and the officials that run them - that Ebola can best be defeated by stopping its spread in Africa itself. It is impossible to completely seal off the region from the rest of the world, they say. Politicians, however, are demanding exactly that – that the US government implement myopic policies to isolate infected countries and keep out the sick. While seemingly logical, some of these efforts could actually make the situation worse by obstructing the effort to stop Ebola at its source.
Ebola flight ban
One policy proposed by many in Congress is a ban on flights to and from infected countries. While intuitively appealing, there are numerous problems with this plan. A flight ban could cause immense economic damage to African countries which have already been hurt by a reduction in travel. Impoverished and desperately short of resources, affected governments are under enormous strain. A travel ban would make conditions worse and could even lead to the collapse of governments. It could also obstruct the movement of aid workers and supplies, both critical in containing the disease. As Eric Werner writes for the Associated Press,
“Although it would be theoretically possible to get supplies and medical personnel to West Africa even while shutting down commercial air travel, in practice it would turn into a logistical nightmare, they say. They cite expenses and difficulties in chartering private aircraft or enlisting the military's assistance to transport thousands of personnel and huge amounts of supplies from around the world that is now moving freely on scheduled air travel.”
By damaging African economies and preventing the movement of aid and personnel, a travel ban could significantly worsen the epidemic in Africa itself, and therefore greatly increase the risk that the virus will spread elsewhere. Another problem is that a travel ban
“Renders useless the two best methods we have for stopping Ebola. Determined people will find ways to cross borders anyway, and if they don't go through airports or they lie about where they came from, health officials can't track their movements. And this is an important point because, to fight Ebola, we need to be able to follow up with the contacts of the infected.”(Belluz and Hoffman, 2014)
Travel bans to contain diseases have never worked
The idea of a travel ban is nothing new. Governments throughout history have tried restricting travel to contain infectious outbreaks, but to no avail. In the 14th century, the Venetians quarantined ships for 40 days in order to ward off the Black Plague, but the illness still devastated the republic. After HIV began to spread in the 1980’s, dozens of governments implemented travel restrictions, but they were costly and ineffective. Following the 9/11 terror attacks, flights were temporarily banned and air travel decreased, but the spread of the flu was not prevented. In fact, flu deaths spiked by over 300%, according to the CDC. Travel restrictions were also found to be ineffective in containing the H1N1 Swine Flu in 2009. As history suggests, travel restrictions are “expensive, resource-intensive, and potentially harmful to the countries involved,” and they simply do not work. (Belluz and Hoffman, 2014)
Quarantines are another popular yet problematic policy. Several U.S. states have implemented mandatory 21 day quarantines for all aid workers returning from infected African countries. An ABC poll found that 80% of respondents support such restrictions. The main problem with quarantines is that they could deter people from volunteering to go to Africa to fight Ebola. Statements from aid organizations suggest that this is already occurring. Jaya Vadlamudi, a spokeswoman for the International Medical Corps, says that they “have seen a reduction in the number of volunteer applications for the Ebola emergency response (Akner 2014).” Tim Shenk, a press officer from Doctors Without Borders, said that “some people shortened their assignments due to the restrictions they face when they return home (Akner 2014).” USAID says that in the 18 days following the announcement of quarantines by the governors of New York and New Jersey, volunteer applications to fight Ebola in Africa dropped by 17%. Margaret Aguirre, head of global initiatives for International Medical Corps, says they “have seen a big deterrence… People are worried. They don’t want to sign up (Akner 2014).” Sophie Delaunay, executive director of Doctors Without Borders in the U.S., said that her organization is “witnessing rising stigmatization and vilification of health workers, which is creating a chilling effect on efforts to combat the Ebola outbreak at its source in West Africa. Quarantine measures have fed this rising stigmatization by feeding misperceptions that health workers constitute a de facto threat to public health (Akner 2014).” As a result of this stigma, one nurse in Maine reportedly received death threats on social media. Potential volunteers are also worried about losing an additional three weeks of work, about the continually changing rules on isolation, and about the conditions they might encounter under quarantine. Recruitment is difficult enough as it is, and workers are in short supply. Any further reduction in volunteers could exacerbate the problem, again making it more likely that the virus will spread to the US and elsewhere.
Longer Ebola quarantines needed?
Even with quarantines in place, the current 21 day duration may not be long enough. A recent study found that Ebola incubation may exceed this period in up to 12% of cases, and that symptoms may not appear until as long as 31 days. Other data suggests even longer. Even without mandatory quarantines, there are already systems in place that reduce the chance that aid workers returning from Africa will spread the illness. The CDC recommends that they monitor their conditions and take their temperature twice a day, and many workers oblige. The virus supposedly cannot be spread until symptoms manifest. Some even voluntarily quarantine themselves in their homes, or at least avoid many public places. While such practices are obviously flawed, they are less risky than the alternative.
Another controversial policy to contain Ebola is that of screening. Everyone that flies out of infected countries is screened before they leave and in most countries (including the US) again when they arrive at their destination. They are asked about their travel, health, and contact with the infected, and their temperatures are taken with infrared devices. Unlike quarantines and flight bans, screening measures have been widely criticized, and rightly so. People can simply lie, as did Thomas Duncan, who flew to the US infected with Ebola after falsely claiming that he had not had contact with the sick. People may not show signs of illness until after being screened. Again, Duncan only developed symptoms a week after arriving in the US. People may not be aware that they had contact with the sick. Infrared scanners do not always work. People can decrease their temperatures by taking medication, as was done during the SARS outbreak. Body temperature can rise for reasons other than illness. Again, past experience demonstrates the futility of screenings. During the SARS outbreak, screenings in Canada failed to detect a single case of the illness, despite the immense cost. A study found that thermal scanners used to detect the flu were ineffective and generated many false positives.
Ebola screenings may be necessary
Despite the limitations, screenings may still be necessary. A recent study projected that without screenings, three people with Ebola could fly out of affected countries each month. It is also during screenings that people are instructed to take their temperatures each day, and that information is gathered about passengers so that their movements can be tracked, a critical step in containing the illness.
Stopping Ebola in Africa
Ultimately, measures used to keep out the infected are costly and largely ineffective, and risk making the epidemic significantly worse. In today’s hyper-connected world, countries cannot be completely isolated. If people want to get somewhere, they will find a way. Ebola can best be contained by stopping it at its source. If impoverished African nations don’t receive enough aid or personnel, or if the economies of affected countries are further damaged, the disease could spread much further in Africa. The more it spreads Africa, the greater the chance it will spread elsewhere. Fears of an Ebola outbreak in the West are greatly overblown. Despite thousands of passengers arriving in the US from infected countries, only 2 cases have managed to slip in undetected. The first case spread to two nurses, but was ultimately contained. In the second case, health workers quickly and effectively isolated the patient, having learned from the mistakes of the first. As long as sufficient personnel and aid are given to affected African countries, Western nations have the resources to contain the few cases that find their way abroad. It’s only when we ignore experts and listen to politicians that we will be in trouble.
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Akner, Claude Brodesser. “Ebola aid groups say Christie's quarantine rules hampering relief effort.” NJ.com, 18 Nov. 2014. Web. 27 November 2014.
Belluz, Julia and Hoffman, Steven. “The evidence on travel bans for diseases like Ebola is clear: they don't work.” Vox, 18 October 2014. Web. 27 November 2014.
Werner, Eric. “Effectiveness of Ebola travel ban questioned.” Associated Press. 18 October 2014. Web. 27 November 2014.