If you do a search on Ebola on the net, there are tons of articles, blogs, and editorials from outlets like CNN and the LA Times to Al Jazeera and even scientific publications like Microbeworld, encouraging us all not to panic about the Ebola epidemic – but is ‘Don’t Panic’ the right message? I am certainly no expert on Ebola, and I do get the need for the government and health organizations to counter the tendency towards media hysteria when it comes to epidemics. Nothing sells publications, news stories, and bottled water like stories about deadly epidemics. In the face of a virus with a 50% mortality rate, however, the phrase ‘don’t panic’ is perhaps too easily misinterpreted. To some, this admonition implies that there is little to worry about; and to others it means ‘don’t fret, we have this under control’, or even ‘this threat is over-blown’. Skeptics, and there is no dearth of these, might take this reassuring word from government and health care sources like the CDC as a clear indication that the end is nigh, and a conspiracy is underfoot.
Ebola may not be the most infectious virus to tour the planet (unlike many air-born agents that have made the rounds recently, or changed the course of history), but it sure seems able to surmount even the most meticulous protective measures available to prevent transmission, especially to health care workers. I am an emergency physician, and I have to say that retiring from clinical practice after 34 years in the ED is looking more and more like a fortuitous decision. EMTs, Paramedics, ED nurses, and ED physicians stand at the front lines of all the wars we wage against viral epidemics, influenzas, terrorist attacks, nuclear accidents, and the like; and in most such cases the victims do not present to Paramedics or come to the ED with a sign hanging around their neck proclaiming ‘I have SARS’ or ‘I have been contaminated with radioactive materials’.
It’s one thing to be working in a West African community stricken by Ebola, where every single patient is presumed to be infected until proven otherwise (and believe me when I say I am not brave enough to even consider it). It is an altogether different thing when you are working in an ED and are presented with yet another patient with typical gastroenteritis symptoms who just happens to have been sitting next to a passenger on a plane from Paris with ‘air sickness’ 10 days earlier, who had in turn used a toilet in a restaurant just after another traveler from Nigeria experienced diarrhea as the first sign of their prior exposure to Ebola. Ok, I know, this is a thin thread in an unlikely scenario that, statistically, is a bit like the risk of getting run over by a train. I guess my point is that ED physicians do occasionally see the patient who has been run over by a train, and this far-fetched story is not unlike the stories that epidemiologists root out when tracking back to the source of a new outbreak. It is a pretty safe bet that some ED nurse or physician in the US will find themselves being tested for Ebola in the near future, because this is a virus with a two week gestation period and a presentation that is not so different from the five other patients treated in the ED that day with vomiting and diarrhea.
Obviously, panic is never an appropriate response to an epidemic, but if ‘don’t panic’ is not quite the right message, what is? At least for health care workers and especially EMS and ED staff, the message perhaps ought to be: be prepared to make significant changes in the way you do what you do. By ‘be prepared’ I don’t mean just do some reading up on the topic: I mean do some hands on training, and consider how to modify triage in the field and in the ED for early identification of, and response to, at-risk patients. For the rest of the public, perhaps ‘Get Informed’ might be a better message – linked to a thoughtfully written article. It is not inevitable that there will be an outbreak of Ebola in the US, but it is not impossible, either. You can be certain that if this does happen, the same kind of irrational response, denial, stigmatization, resistance to isolation, challenges to civil rights, and political backlash that is happening in West Africa will also happen here, cultural sophistication notwithstanding. Yes, we in the industrial world are in a much better position to contain such an outbreak, but those who entreat the public with ‘don’t panic, don’t panic’ are going to sound just a bit more anxious, and will be perceived as being just a bit less sagacious, than they do now. If there was a ‘Chicken Little’ voicing dire warnings in West Africa two months ago, he or she might have earned a lot of respect at this point.