Today,  Dr Margaret Chan, director-general for WHO delivered an overview to the Presidents of Guinea, Liberia, and Sierra Leone in Conakry, Guinea.

Here is a link to the complete transcript.   

First, this outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries. As I said before, this meeting must mark a turning point in the outbreak response.

In addition, the outbreak is affecting a large number of doctors, nurses, and other health care workers, one of the most essential resources for containing an outbreak. To date, more than 60 health care workers have lost their lives in helping others. Some international staff are infected. These tragic infections and deaths significantly erode response capacity.

Second, the situation in West Africa is of international concern and must receive urgent priority for decisive action at national and international levels. Experiences in Africa over nearly four decades tell us clearly that, when well managed, an Ebola outbreak can be stopped.

This is not an airborne virus. Transmission requires close contact with the bodily fluids of an infected person, also after death. Apart from this specific situation, the general public is not at high risk of infection by the Ebola virus. 

At the same time, it would be extremely unwise for national authorities and the international community to allow an Ebola virus to circulate widely and over a long period of time in human populations. 

Constant mutation and adaptation are the survival mechanisms of viruses and other microbes. We must not give this virus opportunities to deliver more surprises.

Third, this is not just a medical or public health problem. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment. This social dimension must also be addressed as an integral part of the overall response.

Fourth, in some areas, chains of transmission have moved underground. They are invisible. They are not being reported. Because of the high fatality rate, many people in affected areas associate isolation wards with a sure death sentence, and prefer to care for loved ones in homes or seek assistance from traditional healers.

Emphasis mine.

Ebola in GuineaOn Thursday I wrote about the need to understand the spread of disease in context beyond a medical frame. There are political, economic, media and sociological systems to understand. Hubris, compassion, ego, greed, fear and lack of knowledge all play a huge part of the process.

I used examples of food-borne pathogens like salmonella and e.coli to show that given the right incentives, and lack of controls, sickness and death become acceptable and efforts to limit them are blocked. It’s nothing personal, it’s just business.

Late Thursday from USA Today I read this:

A medical transport plane departed the United States on Thursday afternoon, headed to Liberia to pick up an American Ebola patient.

Two American medical missionaries working with Ebola patients in Liberia have been diagnosed with the virus. Kent Brantly and Nancy Writebol, who worked at a medical center operated by the North Carolina-based Samaritan’s Purse, were listed in stable but grave condition, according to a statement from the organization.

I’m curious about the reasons this happened. Were medical decisions overruled by power players? Were powerful political players overruled by medical doctors confident in their abilities to contain and control?

I find Dr. Chan’s third point especially important. What are the “deep-seated beliefs and cultural practices” in the US that enable and encourage illness and disease to spread?

  • We have the best health care system in the world
  • We are smarter than backwards Africans
  • We don’t have to play by the rules of other countries
  • Private health care is better than public health care
  • Cutting funding to “big government medical programs” will have no consequences that the private sector can’t fix
  • If push comes to shove the military can handle it, even if it is not their expertise

Now I’m pretty good at predictions, at least where the media is concerned. As this unfolds you will see how the US media accept America’s “deep-seated beliefs and cultural practices” in the response to this crisis.  They will both play up the fear for the “news value” and play down fears with quotes from medical experts on the medical realities of Ebola. But they will not be bringing in anyone to talk about the other problems that must be addressed for future pandemics. Problems specific to countries with unfettered capitalistic market worshiping economies. As the good director-general said, “…this is not just a medical or public health problem. It is a social problem.”

I don’t anticipate that the two patients at Emory University Hospital in Atlanta will spread the contagion. But while the media might question the decision to bring the patients here, they will not question the underlying assumptions of US authorities.  We don’t listen when someone outside the US says it is, “extremely unwise for national authorities and the international community to allow an Ebola virus to circulate widely.” 

Will we learn from this? Probably. The people who need to learn are ‘free market’ conservatives, who only learn when something is happening to them personally. Then they have an excuse to change their minds. Do not underestimate the power of giving them a good excuse to do the right thing.

I’m not a fan of “I told you so.” if it doesn’t lead to changes. In this case, when there are problems I hope we learn the right lessons. Let’s be prepared to point them out and make suggestions that disabuse these deep seated beliefs.   Otherwise it will be just another disaster capitalism event and an opportunity for private industry to suck up taxpayer money.

Photo by European Commission DG ECHO under Creative Commons license