Here are the facts about the state of the Ebola crisis. In West Africa, more than 8,000 people have contracted the disease and nearly half have died. In the U.S., there’s just one confirmed case—that of Thomas Duncan, the Liberian man who passed away in Dallas on Wednesday. Experts say that the caseload in West Africa is likely to get much, much bigger. As many as 1.4 million people could get the disease, with a large fraction of them dying from it. The same experts expect no similar outbreak here, even if a few more cases appear, because we have the personnel and the resources to limit exposure.
But all of the news on Wednesday was about developments here in the U.S.—in particular, new screening efforts at five major U.S. airports, Duncan’s death, and reports of possible new cases in the U.S., including one in Dallas. You could tell by the questions that Thomas Frieden, director of the U.S. Centers for Disease Control, fielded during a late afternoon press conference. He got more than a dozen of them. Only two were about the situation abroad. (And one of them, it so happens, came from me.)
The preoccupation with what’s happening here, as opposed to what’s happening over there, is perfectly understandable. On Tuesday, a Gallup poll revealed that Americans today are as worried about contracting Ebola as they were about contracting H1N1, the swine flu, during that outbreak two years ago. By that time, millions of people had gotten H1N1 and thousands had already died. But people die from flu all the time, usually because they are very young or very old or already otherwise infirmed. It’s a threat that people have factored into their daily lives, if at all. Ebola is quite literally a foreign menace, one to which almost nobody gave much thought until a few weeks ago. The virus kills about half the people who get it, with little regard for age or health status of the person infected.
That fear goes a long way to explaining why the U.S. is implementing the new screening process at the airports. Customs and Border Patrol agents were already on the lookout for people with visible signs of the disease. Now they will add another layer of scrutiny. They will use questionnaires to screen for people who have been in affected countries—and, then, subject these people to temperature tests and more questioning. People who have fever or show other Ebola symptoms will be evaluated by quarantine officers from the CDC, then referred to local health authorities who will decide how to handle the cases. The primary goal is to identify any passengers infected with Ebola before they leave the airport.
Experts have generally been skeptical that increased screening would make a difference, in part because the new precautions rely on candor from foreign visitors. Remember, similar screenings already take place at the points of departure in West Africa. Duncan got out of Liberia by lying and stating that he’d had no contact with an Ebola patient. But a secondary goal of the new steps is to calm the American psyche and there's a case for that. If it takes some extra vigilance and a quick temperature check to make the American people feel safe, and if it doesn't divert precious resources, it’s probably a price worth paying—in much the same way that security theater in the airports, following September 11, made it possible for the flying public and eventually the rest of the public to return to some form of normalcy.
Still, nobody should be under the illusion that these efforts get at the real problem, which is the outbreak in West Africa and the toll it is taking there. Shortly before Frieden spoke, I listened to a briefing by three more junior CDC officials, each of whom had recently returned from West Africa. They offered a mixed assessment. On the one hand, they said, they had seen real progress in some countries, particularly in urban areas where communication was better and a more educated public is taking the advice of public health authorities. They were particularly pleased about signs that West Africans were abandoning traditional burial rituals that involved a lot of touching, making it a huge source of contagion.
But while these officials felt they were close to a tipping point in some places—that is, the moment when they were finally containing the outbreak—they worried that it continues to spread elsewhere. Partly that's because more rural, less educated people are not changing their behavior so quickly. And partly that's because the containment, treatment, and prevention efforts underway still lack sufficient resources. Protective gear and basic medical supplies, beds and isolation wards, vehicles and professionals with Ebola training—you name it, and the region doesn’t have enough of them, although it’s hard to know how much of that is lack of supply and how much is inability to distribute the goods.
One particularly heartbreaking story came from Leisha Nolen, an epidemic service officer with CDC who has spent time in both Liberia and Sierra Leone over the last few months. The story was about a 7-year-old girl who showed up at a clinic with diarrhea, back in July. Without training to differentiate Ebola from the other diseases that cause diarrhea, health care workers tested her and then placed her in an Ebola isolation ward. The "ward" in this case was a big tent, with more people than beds. “So you’re this little girl,” Nolen explained, “and you’re sent there while your test results are pending. You are next to, sleeping with, often co-sleeping with people with Ebola, because that’s what’s happening there. Sure enough, the girl’s test came back negative. Eight days later, she got another test and it was positive.”
While stories like that tug at the heartstrings, they may not move public opinion, precisely because they seem very far off—in other words, somebody else’s problem. Out on the fringes of the respectable conservative press, at publications like the American Thinker, some are already questioning whether the CDC is spending too much time and effort trying to help people who are not Americans. Perhaps that is why Frieden on Wednesday went out of his way to say, over and over again, “Protecting Americans is our number one priority.”
The catch is that you can’t truly wipe out the Ebola threat, even for Americans, without controlling it overseas. As long as it’s un-contained, it will continue to make its way to other countries—carried by people over land, sea, or air—because the world is simply too interconnected to shut down borders completely. Meanwhile, the damage to social and economic fabric of Africa could be devastating, in ways that would hurt the U.S. over the long run.
Frieden made this point too. “The bottom line here is that we're stepping up our efforts to protect Americans,” Frieden said. But, he added, “as long as Ebola is spreading in Africa it will remain a risk here.” It remains to be seen whether the public and its politicians understand that.