In his 30 years as director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci has seen his share of public health scares.
When AIDS exploded in the 1980s among gay men, Fauci recalls that some people didn’t want gay waiters to serve them in restaurants. And during the anthrax scare that followed the 9/11 terrorist attacks, many were afraid to open their mail.
But when it comes to Ebola, “This one’s got a special flavor of fear,” Fauci said at the recent Washington Ideas Forum, sponsored by The Atlantic magazine and the Aspen Institute, a nonpartisan policy group.
The growing death toll in West Africa has helped create “an epidemic of fear” in the U.S., Fauci said, even though most experts feel the likelihood of a widespread outbreak in this country is minimal.
James Colgrove, a public health professor at Columbia University, said the chances of an outbreak in this country are “extremely remote.” Pamela Cipriano, president of the American Nurses Association, went even further. “What we know right now would suggest that there is no risk of an epidemic,” she said.
Enhanced screenings of West African visitors allow U.S. health officials to “very quickly identify and sequester and evaluate and care for anyone who shows any type of risk,” Cipriano said. “That’s a very high level of control.”
Even in Dallas, where Liberian Ebola patient Thomas Eric Duncan triggered the nation’s first potential outbreak, only two nurses contracted the virus after direct contact with Duncan while he was desperately ill. That’s out of 70-plus health care workers and 48 family and community members who interacted with him.
Despite the flawed federal and local response, the Dallas episode proved what Fauci and other experts have said all along: Ebola is tough to catch and even tougher to spread when contact tracing, patient isolation and quarantines are in place.
But rather than validate experts’ calls to trust the science and impose public health precautions that reflect actual risk, the Dallas scare triggered a policy backlash driven by fear. Individual states imposed mandatory quarantines for all health care workers returning from Ebola-stricken West Africa, even if they had no symptoms and weren’t contagious.
Kaci Hickox, a Doctors Without Borders nurse who treated Ebola patients in Sierra Leone, was, upon returning, kept in an isolation tent for a weekend by New Jersey officials, even though she showed no symptoms of the virus.
She was permitted to return home to Maine, where officials tried to legally quarantine her. A judge ruled in her favor, requiring only that Hickox monitor herself for signs of Ebola for 21 days, which ended Monday night.
“The fear is trumping science,” said Dr. Georges Benjamin, executive director of the American Public Health Association.
Lawmakers continue to call for outright travel bans from West Africa, which, experts say, would only cause people to seek alternative entry while discouraging U.S. caregivers from helping out in Africa.
Fauci said the severe responses are simply good-faith efforts by politicians to protect fearful constituents.
“You have to respect the fear of people,” he said. “You can’t denigrate it and say, ‘Why are you afraid?’ You’ve got to try and explain to them and you’ve got to do it over and over. . . . It’s just that as a health person, as a physician and a scientist, I would say you look at the data, and it tells you what the risk is.”
Ebola is only transmitted by direct contact through broken skin or mucous membranes with the body fluids of infected people. Airborne transmission of the virus – through tiny, dry particles that float through the air – does not occur.
But if larger saliva or mucous droplets from an infected person are expelled by coughing or sneezing and come in contact with another’s eyes, nose or mouth, that person could become infected. No such infections, however, have ever been documented.
Americans’ lingering fears about the disease stem partly from health officials’ misstatements about the nation’s readiness to fight it.
Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, originally said hospitals in this country were ready to care for Ebola patients. Many, in fact, were not.
The agency then had to revise its outdated and insufficient guidance on personal protective equipment to ensure the safety of Ebola caregivers. The CDC also provided contradictory information about whether people being monitored for Ebola symptoms should be allowed on public transportation.
“Some of the missteps have eroded some of the trust that the public has had,” said Cipriano, the nurses association president. “I think that it certainly has added to the sense of, ‘Well, who do we trust?’”
Colgrove said Frieden’s mistakes were surprising, because the CDC director had always excelled in the art of communicating risk. Frieden used to refer to public health in an epidemic as “the art of controlled hysteria,” Colgrove said.
“You want people to be worried enough that they give you the resources that you need to do the job,” explained Colgrove, the Columbia professor, “but you don’t want them to be so worried that they do stupid things. It’s a very, very delicate balance that he has to walk. That any public health official has to walk.”
With a lull in the number of new Ebola cases, many are hoping the U.S. has seen the worst of the deadly virus. But Benjamin, of the American Public Health Association, knows better.
“I always remain skeptical and vigilant,” he said. “So while I’m hoping that we have, I still believe that we have to keep a high index of suspicion.”