OPINION:
At the end of the classic novel “Love in the Time of Cholera,” a ship remains at sea, with its star-crossed lovers keeping their secret as long as they don’t reach port. The ship raises the yellow flag of cholera, so no port will allow them to dock. I was reminded of this rudderless ship when I had the experience this past week of visiting a Frontier Airlines plane that lacked passengers. The company’s CEO, David Siegel (no relation), led me on a camera tour of the stigmatized, lonely plane, and he boldly sat in the same seat where Ebola nurse-turned-patient Amber Vinson had sat just a few short days before.
To use a popular term from my childhood, the plane had “cooties,” and could not be returned to its regular schedule despite Centers for Disease Control (CDC) clearance because people were afraid to fly on it no matter how many times it was cleaned. This was because Ms. Vinson didn’t feel well but flew anyway, suppressing a fever with Tylenol. It was because the CDC and the Texas health authorities didn’t isolate her after she had cared for “patient zero,” Thomas Eric Duncan.
Consider that in the days of the plague in 14th-century Europe, plague caregivers were compelled to take a holiday for a fortnight before they could resume human contact, and you will understand the extent of the public health bungle in Dallas.
Consider that the rate of Ebola spread in Sierra Leone, Guinea and Liberia — where health care practices are outdated, substandard and based on superstition — is two new Ebola patients for every one infected. This multiple is the only way Ebola can spread. Properly isolating Ebola patients should cut the rate to well below one new patient for each patient infected, squashing any potential outbreak.
It is a blow to public confidence in our health care system that the first patient diagnosed here quickly led to two additional cases. When we no longer trust our health officials, we grow more fearful in the face of an emerging threat. The nuance that health care workers are most at risk because the sickest Ebola patients exude the most virus and are, therefore, the most contagious is lost on an anxious public. The roving eye of the media fixates on every additional case, and people naturally jump to believing the worst case scenario, that a large outbreak could occur even if it isn’t medically feasible. Fear costs a lot of money in terms of ramped-up airport screenings, contact tracing of those exposed, direct health care costs in instituting consistent Ebola protocols and, frankly, paranoia of taking Frontier Airlines planes.
Fear diminishes if you confront it head-on with courage, the way David Siegel does by flying in the seat that recently held Ms. Vinson. The more he sits in her seat, he says, the less fearful he feels. He flies from airport to airport, a lonely CEO in search of passengers for his plane.
If our public health authorities and our hospitals continue to make the kind of Ebola mistakes that petrify the public and put us at risk with case clusters that also spread to asymptomatic animals, such as fruit bats, we may have no choice but to consider a temporary travel ban — just to treat our fear. In the meantime, the current funneling of passengers from the affected countries in West Africa to five airports here where they undergo enhanced screening will temporarily reassure us, even if it doesn’t prevent a single person infected with Ebola from entering the United States. Similarly, outfitting all our hospitals with the proper personal protective equipment based on an updated CDC protocol will calm our fears, even if these Ebola uniforms are never needed for an actual case.
Ebola scares us because it is an invisible killer. If we have the feeling that we can’t control or contain it, we immediately jump to the irrational conclusion that it could kill us next no matter how difficult a virus it actually is to catch.
I know a travel ban doesn’t really make good public health sense. People will slip past it. It didn’t work for SARS or new flu strains or the plague. Our real priority right now is West Africa. A U.S. travel ban, no matter how short-lived, could lead other countries to follow suit, ultimately destabilizing governments and causing people to try to escape, both from fear of Ebola and fear of starvation. People panicking take fewer precautions, which also could spread more Ebola. What we need instead is an influx of resources, both workers and supplies. Helpers need to know they can get back out. Our military will help, but free-flowing civilian aid is crucial, too.
If we restrict travel, it needs to be temporary. That means more effective and consistent public health interventions here. Any actual Ebola cases should not be treated in regular hospitals without experience — no matter how well equipped. They should be brought instead to one of the four centers in Nebraska, Atlanta, Maryland or Montana, where special facilities and trained health care providers are at the ready.
No country can afford to have its airplanes flying without passengers and without a destination.
Marc Siegel, a physician, is a professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center.
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