Stopping Ebola: Mali Matters; Maine and Manhattan Don't

Health workers at an Ebola quarantine facility in Kayes, Mali on Oct. 25 Photograph by Baba Ahmed/AP Photo

This has been an attention-grabbing week for Ebola in America. Starting with the diagnosis last Thursday of Dr. Craig Spencer, a physician who returned to New York City from West Africa, and continuing with the involuntary quarantine in New Jersey of Kaci Hickox, a nurse who had similarly returned from abroad, the nation has been transfixed by the perceived risk from a tiny group of health-care professionals. Hickox made headlines today by going for a bike ride after leaving New Jersey’s quarantine for her home state of Maine.

It’s time to look beyond Manhattan and Maine. The most frightening event from last Thursday didn’t concern a humanitarian-minded doctor from Harlem—it was confirmation by the World Health Organization that a two-year-old girl in Western Mali had Ebola. The virus appears to have crossed the border into yet another country that may not have the resources to contain it. The announcement was preceded just hours earlier by a strikingly different and misleading message given by the WHO’s assistant director general: “There is reasonable confidence right now that we are not seeing widespread transmission of Ebola into neighboring countries.”

Problems with public-health messaging are emblematic of our continuous misunderstanding of this vicious disease. Weeks earlier, the Centers for Disease Control had assured Americans repeatedly that our “superior health-care infrastructure” was fully capable of handling any Ebola cases on our soil. While a full blown epidemic in the U.S. is implausible, the fragility of our health-care system was exposed with a series of grave missteps involving the Thomas Duncan case in Dallas and then again by the unchecked travels of Dr. Spencer immediately after his return from treating Ebola patients.

Health organizations are currently operating off of a long list of hypotheses. We do not know the true numbers of asymptomatic patients, those with Ebola who don’t run fevers or give other signs. Nor do we know how long it takes to incubate without symptoms or the most efficacious way to treat the disease.

This brings us to the most troubling issue yet to be addressed with the Ebola threat. Given the inaccurate assurances of our government about Ebola and its fumbled response thus far, we can only speculate on what would happen if and when an outbreak occurs anywhere else. Since Ebola has traveled to the U.S., there is a high probability it has also traveled to other parts of the world undetected or unreported. The recent case of the child who traveled through Mali is a reminder that the virus sees no borders. If our data and understanding of Ebola are insufficient—or worse, wrong—it’s only a matter of time before we experience far more serious incidents. Will individuals delay notifying authorities, like Spencer, or refuse quarantine, like Kaci Hickox?

The WHO has been very vocal about the epidemic in West Africa and has concentrated its efforts toward vigilance in spite of its logistical limitations. But it cannot take meaningful action against Ebola. The WHO is a bureaucratic group of “thought leaders” that need widespread financial and political support before accomplishing anything of measure. The format the organization typically utilizes involves more than 200 key opinion leaders to discuss an issue with a normal two-year time frame to prepare properly for action. This is clearly not an option with Ebola.

As we wrote in Bloomberg Businessweek last month, no known therapeutics or vaccines can currently address this outbreak. Proving efficacy and safety of any treatment will be an incredible obstacle given historical constraints. Even if any treatments were widely available, no infrastructure exists in West Africa for their efficient administration. Although President Obama recently appointed an “Ebola czar” to oversee U.S. efforts, the key to stopping the disease will be to establish effective quarantine zones in West Africa and expansive health-care delivery systems. The inability of the health-care systems in West Africa to handle an overwhelming surge in patients has been a major contributing factor to Ebola’s spread.

To pull off an effective response requires greater military familiarity than medical prowess. The best way to prevent a global pandemic is to attack Ebola at its point of origin. Only a military presence can establish an infrastructure that will allow for restabilization of the affected countries. To slow Ebola’s exponential growth, concentric circles must be drawn around hot spots, establishing zones where containment and medical efforts should be the most vigorous. Control can be returned to local authorities once the virus is gradually cleared from the infected areas. If control is not soon established in the affected regions, then, as a simple tactical matter, Ebola threatens to become a ubiquitous menace and exponentially more difficult to eradicate.

We are still focused on the wrong aspect of the virus. Ebola in Manhattan is a sensational story; Ebola in Mali is neglected and is a harbinger of a potentially much bigger problem than currently believed. We need to stop Ebola at the source, as CDC Director Tom Frieden has stated, but the source is not a quarantine tent in New Jersey. The developed world has learned the price of hubris and of postponing action, and now we must learn from past mistakes quickly while we still have time.

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