The American media has been extensively covering the current West African Ebola outbreak. Consequently, the American public is anxious that the epidemic might spread to the United States; a worry likely fueled by Ebola’s horrible symptoms, which can include extensive internal and external bleeding (although not the liquefying of internal organs depicted in disaster movies), and by a fatality rate that has been as high as 90% in the developing world.
Yet aside from two American medical workers, Dr. Kent Brantly and missionary Nancy Writebol, who were infected in Africa, and returned to the United States for treatment at Emory University Hospital, no other Americans have been infected with Ebola. Moreover, public health experts, speaking through the media, have repeatedly assured the American public that the chance of an Ebola epidemic here at home is extremely slight. [One reason is that Ebola is not highly contagious, as it is transmitted only by direct contact with body fluids from an infected person. Moreover, infected individuals cannot transmit Ebola to others until they begin to express symptoms themselves. For these reasons, an Ebola outbreak in the United States should be quickly contained by isolating infected individuals. What’s more, supportive care in American hospitals would dramatically decrease the likelihood of any infection being fatal.]
Consider the following facts. By August 6, the current Ebola outbreak was estimated to have killed about 1,000 persons. The largest previous Ebola outbreak, which occurred in Uganda in 2000, claimed 244 lives, and Ebola has killed a total of about 2,000 people since it first emerged in 1976. All Ebola outbreaks occurred in Africa, and no Ebola infection has ever occurred in the United States. In each of the previous Ebola outbreaks, the virus ran its destructive course and then “disappeared.”
In contrast, consider that seasonal influenza claims on average about 40,000 lives annually in the United States alone, and 500,000 lives worldwide. And, the influenza virus reappears in a somewhat different immunological guise each and every year. Yet with the exception of those occasions when a seemingly exotic new influenza strain emerged (e.g., the H1N1 swine flu of 2009), the public seems rather indifferent to influenza. Indeed, even the 1918 influenza pandemic (which claimed 196,000 American lives in the single month of October, 1918, and 50,000,000 lives worldwide) did not cause any panic. And, despite the fact that a vaccine is available to prevent the flu, all too many individuals pass up that opportunity to protect themselves.
So, how might we account for the disparity between public apprehensions regarding an Ebola outbreak in Africa, versus public complacency regarding influenza here at home? Perhaps we simply take for granted that influenza will appear every year, and afterwards we forget about it. We even confuse influenza with the much less severe common cold, saying we have the flu, when we are merely experiencing the sneezes and sniffles of a cold.
We might think that the public is more worried by newer emerging viruses (e.g., West Nile virus, the SARS virus, and Ebola), than by actually more dangerous older ones (e.g., measles and influenza), at least in part because the newer viruses are relatively unfamiliar. Also, the current spate of post-apocalyptic movies, the 24-hour news coverage on cable television, and continuous commentary on social media, have each fostered public concern over new emerging infectious agents. But, that can’t be all, since it does not explain the intense fear that polio elicited in America until the Salk and Sabin polio vaccines appeared in the mid to late 1950s; decades before cable television and social media? I was a young teenager in the early 1950s, and remember well the panic that set in every summer when the newspapers reported the first polio cases of the season. What’s more, panic increased dramatically if a neighbor or schoolmate were stricken. You were kept home from school, and couldn’t even play outside. Yet the number of poliomyelitis cases was on average “only” about 20,000 per year, which was about half the average number of influenza fatalities. [The peak year for poliomyelitis was 1952, when there were 57,879 cases.]
So, how might we account for the difference in the public’s concern for polio, versus its relative lack of concern for influenza? A possible reason for the greater fear engendered by poliomyelitis was that the paralytic disease struck mainly children, adolescents and young adults, whereas influenza threatens mainly the elderly. People are usually much more emotionally invested in their children’s well being than in their parents or even themselves.
Yet the public did worry about influenza on occasions when a novel new influenza strain appeared (e.g., the H1N1 swine flu strain that emerged in 2009). Here is another situation in which influenza caused alarm. Unusual circumstances led to flu vaccine shortages in the United States during the winter of 2004/2005. When news of the vaccine shortage first broke in October 2004, there was panic as many individuals clamored for the limited vaccine dosages then available, which, as a matter of policy were being reserved for people at highest risk (e.g., the elderly and the immunologically compromised). But, as small numbers of extra doses began to trickle in from outside sources, demand for the vaccine suddenly disappeared. Indeed, there actually was a surplus, with many doses going to waste.
The outbreak of HIV/AIDS in the early 1980s was one of the defining moments of our time, and merits a longer posting of its own. In brief, because of the association of AIDS with human sexuality in all its forms, the media of that more prudish time had difficulty speaking openly and frankly about the disease. For instance, it used the term “body fluids” to avoid mentioning “semen,” leading to misinformation regarding how the then invariably fatal disease is transmitted. Also, AIDS was associated with intravenous drug abuse. That fact, together with homophobia, resulted in infected individuals (including hemophiliacs who were infected via the contaminated blood supply) being blamed for their illness, and there was blatant discrimination against them. About 15,000 Americans still die from AIDS each year.
The above examples, taken together, point up that the public’s response to infectious disease is shaped by a variety of factors. Furthermore, we might expect that as more and more people crowd into urban areas, and also intrude into once remote areas, new exotic viruses, as well as the older familiar ones, will continue to threaten the human population.
One final point: Whereas the American media has extensively discussed the risk (or non-risk) to Americans from the West African Ebola outbreak, it has barely mentioned America’s responsibility to the West African nations attempting to deal with the outbreak there. And aside from the moral issue, it is clearly in our own self interest to address an epidemic early, at its source, rather than to allow it to spread. [Donald Trump praised Brantly and Writebol for helping out in Africa, but argued that they should not be brought back for treatment because of the risk imposed. He said, “People that go that far away to help are great but must suffer the consequences!”]
Leonard Norkin Virology Site 