Friday, August 28, 2015

NEJM: Ebola in the United States — Public Reactions and Implications


# 10,559


Eleven months ago America woke up to learn that the first imported Ebola case had been hospitalized and isolated  - after first seeking treatment in a local emergency room three days earlier – in a Dallas hospital. Ten days later, the first of two nurses to contract the virus – Nina Pham – tested positive.

The first few weeks of October were chaotic, with the 24/7 news cycle pounding the Ebola story for ratings, politicians using the crisis to grab headlines and votes, and internet conspiracy sites speculating in the most lurid way that we would all soon be infected.


Understandably, the American public’s concern (and distrust) grew with each passing day. Fighting for their attention was a three-ring circus of media hype, disinformation, and paranoia – one we looked at in A Look Down The Ebola Rabbit Hole  and  All The Ebola News Not Fit To Print.


Complicating matters, around the same time that the CDC was releasing `worst-case’ estimates of 550,000 and 1.4 million Ebola cases in Liberia and Sierra Leone by the end of January cases in Africa, they were also trying to minimize the American public’s fear of the virus.


Except from CDC Infographic

As an example, in August of 2014 the CDC released a reassuring infographic (see above) that - among other things - stated that `You can’t get Ebola through Air’, which immediately set off an internet firestorm of disbelief and derision. While `technically correct’   (Ebola is not an airborne virus) - it overly simplified the threat - which I considered a communications misstep (see The Ebola Sound Bite & The Fury).  


In response to the `airborne’ debate  Dr. Ian Mackay produced a series of excellent blogs on how the Ebola virus can be transmitted (see VDU Blog: Droplets vs Airborne - Demystifying Ebola Transmission and Mackay On Ebola: Blood, Sweat & Tears). 


But the vast majority of Americans were getting their information from ratings-hungry news organizations, or social media outlets, not from science based blogs.  The public’s trust in official statements took yet another hit when, in late October, the CDC Announced Stricter PPE Recommendations For Ebola - after two Dallas nurses were infected.

Of course, Ebola did not spread in the United States, and after an early false start, hospitals did  figure out how to safely treat patients.  Just as the CDC predicted. Gradually, the public’s level of concern subsided.  


But the experience showed how fragile public’s trust of the government can be, and how important it is to get the messaging `right’.  As we’ve discussed so often in the past, overly simplistic or reassuring messaging  can easily backfire (see Sandman & Lanard On Ebola Crisis Communications Lessons).


Looking back on all of this, and how things might be handled better the next time a public health crisis like Ebola arrives on our shores, is a perspective article that appeared yesterday in the New England Journal of Medicine.  A good read, and after you return, I’ll have a bit more.



Ebola in the United States — Public Reactions and Implications

Gillian K. SteelFisher, Ph.D., Robert J. Blendon, Sc.D., and Narayani Lasala-Blanco, Ph.D.

N Engl J Med 2015; 373:789-791August 27, 2015DOI: 10.1056/NEJMp150629

Although there had been only two cases of Ebola transmission inside the United States and both patients had survived, a November 2014 opinion poll revealed that the U.S. public ranked Ebola as the third-most-urgent health problem facing the country — just below cost and access and higher than any other disease, including cancer or heart disease, which together account for nearly half of all U.S. deaths each year (see Table S1 in the Supplementary Appendix, available with the full text of this article at

(Continue . . . )


The timing of Ebola’s arrival in the United States – 2 months before the mid-term elections – undoubtedly added to the public’s level of enmity, but the degree of distrust of science seems to grow worse with each passing year.


While many scientists decry this trend as a return to a backwards `flat earth’ mentality, it is sadly at least partially earned.


Back in early 2012, in Science at the Crossroads, I wrote about this decline the public’s trust in science. While I cited a number of reasons for this disturbing trend, prime among them has been the abrupt rise in the number of scientific papers that have been retracted sometimes for outright fraud - over the past decade. 


In a presentation made in March 2012 (see Dysfunctional Science) before a committee of the National Academy of Sciences, journal editors Arturo Casadevall and Ferric C. Fang warned that the number of retraction notices for scientific journals has increased more than 10-fold over the last decade, while the number of journals articles published has only increased by 44%.


Add in the parade of FDA approved drugs that we’ve seen withdrawn for safety reasons after years of use, allegations of biased industry funded clinical trials (see RCTs: All That’s Gold Standard Doesn’t Glitter), and a string of high profile government lab `incidents’ involving Ebola, H5N1, anthrax and smallpox and it’s little wonder that a white lab coat doesn’t engender as much confidence as it once did.


These recent lab accidents have led to calls from major journals to improve biosafety, and to even consider blocking certain types of potentially dangerous experiments unless a substantial benefit can be shown that offsets the risks. (see The Laboratory Bio-Safety Backlash Continues and Making Viruses Deadlier – An Accident Waiting To Happen.). 


While scientists engaged in this type of work insist that the risks are negligible (see Scientists For Science: GOF Research `Essential’ & Can be Done `Safely’), many others  (see Updating The Cambridge Working Group) are less convinced.


Meanwhile a perplexed and increasingly worried public watches on, not knowing which side to believe.


As a child of the space age, raised on the science writings of Willy Ley and Isaac Asimov, I am about as `pro-science’ as they come, and will continue to promote it in this blog. But I also realize that science has some serious work to do if hopes to regain its previous high standing with the public.


And for everyone’s sake, that’s a change that needs to come sooner rather than later.

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