By Laurie Garrett
Fear of Ebola has been climbing steadily in the United States since Tuesday's announcement that a Liberian traveler in Dallas, Thomas Eric Duncan, was diagnosed after having been in Texas for eight days. A month ago, a Harvard School of Public Health poll found that 39 percent of Americans thought an Ebola outbreak would come to the United States, and 26 percent felt concerned that they or a member of their family would get the disease.
But things got concrete when news of the Dallas case was blamed in part for the 266-point plummet of the Dow Jones. And while concern over the case in understandable — even, in some respects, warranted — most of what people are reacting to is nothing to fret over.
In his press conference remarks on Wednesday, Texas Gov. Rick Perry noted that his is one of only 13 states in the United States to have completed U.S. Centers for Disease Control training in Ebola diagnosis, laboratory verification and containment. That means 37 states are unprepared to respond swiftly to a potential Ebola case.
The Texas case has raised inappropriate fears. Unsubstantiated concerns include false claims that the virus was spread through the air between monkeys housed in a military facility in the 1990s; assertions that the virus -- spread only through physical contact with contaminated bodily fluids -- could mutate into airborne form; calls for denying travel visas to travelers from West Africa; and fears that there may be other Ebola-infected fellow travelers on the plane with the Dallas patient, now infecting Americans.
Each of these views is patently wrong.
The Reston Ebola strain that infected caged monkeys in an Army facility in the 1990s was not infectious to human beings, and there is no evidence that the monkeys inhaled their infections. The scale of mutational change Ebola would have to undergo to take on flu-like airborne transmission characteristics would be tantamount to mutating a common cold virus into one that causes polio.
And viruses do not recognize borders, visas, or passports, Shutting down U.S. airports and isolating travelers from specific regions have been tried as disease control measures, and failed.
The United States' special vulnerability is the enormous holes in our public health and medical care systems. Ebola has caused 21 outbreaks since its first in 1976. If people suffering early symptoms of (such as acute fatigue and high fever) are immediately taken into hospitals and cared for by doctors and nurses wearing appropriate protective gear, the virus has little opportunity to spread.
America's special risk is the 13.8 percent of Americans — about 43.3 million individuals — who still lack health insurance, and millions more whose policies entail copayments that are exorbitant for working people. These are the Americans who routinely tough out the flu, fever, aches, and pains because seeking medical care is prohibitively expensive. If they become sick enough to feel desperate, they go to emergency rooms, where waiting times in often-crowded settings can stretch for hours.
This reality is compounded by a weakened public health infrastructure: 52 health agencies, including 48 states, three territories, and Washington, D.C., have reported budget cuts since 2008.
If America wants to stop Ebola in its tracks, as CDC Director Tom Frieden put it in his Sept. 30 press conference, every state needs to ensure the following is mandated:
Nobody suffering from the primary symptoms of Ebola can be turned away from care for lack of insurance or ability to pay;
Recent travel histories must be taken on all patients suffering from high fevers and other Ebola symptoms, and those who have been in Liberia, Sierra Leone, or Guinea within the past 21 days — the maximum incubation time for Ebola — should be removed immediately from the ER setting and placed in isolation care pending lab diagnosis;
Public hospitals that routinely have crowded emergency rooms and long wait times for medical care should now put high priority on patients presenting with fevers.
The window for stopping hospital spread of diseases like Ebola is going to close as soon as the flu season begins, when feverish patients are commonplace. Once ERs and doctors' offices get swamped with influenza sufferers, spotting Ebola cases will be complex and perhaps impossible in the absence of a rapid diagnostic test.
America's special vulnerability to Ebola is its limitations on access to health care. In times of contagion, societal risk rises with every uninsured or underinsured individual who struggles to work or go to school with a fever, and avoids bankrupting visits to health providers. One doesn't need to have a political position up or down on "Obamacare" to recognize and solve this.