As a general matter, I think the world at large has been very slow to respond to this outbreak. On the other hand, I think the initial panic and furor are abating and cooler heads are prevailing.
When I say that the world response has been slow (excepting Medicins Sans Frontieres or MSF, otherwise known as Doctors Without Borders) I mean it has taken months for the World Health Organization, Centers for Disease Control, National Health Service or European Union to respond in any way. The above photo appeared in the March 2014 breaking news coverage by the British Broadcasting Company of Ebola in Conakry. Notice the suburban homes behind the guys in Personal Protective Equipment. That's suburban, not rural village. Ebola outbreaks up until now have occurred 2,000 miles from the African coast, and have been in isolated locations. Given the lack of medical care in these isolated areas, Ebola patients generally didn't survive long enough to get to cities of any size.
Conakry is the capital of Guinea and has 1.7 million people in it, an international airport serving Western Africa and Europe, and a deep-water port. It's in Wikipedia- you don't have to be CIA to figure it out. I find it hard to imagine not breaking out in a cold sweat realizing Ebola is in a large port city with an airport, especially if you are in government or public health. It does rather appear that the world-at-large only sat up and took notice when Westerners got Ebola. (warning: satire.)
At this point, Ebola has spread to adjacent countries but the ground response is more effective. This is largely due to hard-won lessons in nursing care, social networking and community support. For example, family members can now see and communicated with sick loved ones (by phone or the other side of a window) and can see workers don or remove PPE and can see the dead before their burial. Think about it: if this was happening here, how would we react to sick family members being taken into a big white tent or building from which no one ever comes out alive? And you never, never see them again? We are once again reminded that nursing care is critically important, and communication and emotional support are a big part of it. This New Yorker piece is an excellent history of the earlier ground war against the outbreak.
A big question now exists over quarantine.
Some perspective should be applied over general air travel out of the three affected countries. Last year, those three countries comprised under 0.02% of the world's commercial air travel. The US received 2% of these passengers, coming in 12th place as destinations from these countries. Projections suggest a total of 2.8 commercial air passengers per month flying out of these countries for the next year.
Also, bear in mind that this is not an airborne illness like a cold or flu. The current CDC recommendations that open with 21 day monitoring but not forced close quarantine are reasonable in this light.Similarly, the New England Journal of Medicine advises against forced quarantine of returning health care workers.
It is reassuring to consider that the only people in the US who have contracted Ebola did so through very direct contact. In fact, consider the Liberian patient who died in Texas. He slept with his fiancee for days before being hospitalized. She and her family were in mandatory quarantine in that apartment for close to a week before it was de-contaminated. None of those folks went on to develop Ebola.
I think it is now time to turn to increased global efforts to address the outbreak in the currently affected West African countries. Certainly, forcing returning symptom-free health care workers into 3 weeks of restricted quarantine is not the opening move here and neither is blockading travel in or out of those countries.
Aside from humanitarian reasons, impeding any effort from developed countries to flood in to combat the infection with money, personnel and resources is foolish in the extreme. As General MacArthur is famously quoted as saying regarding the Pacific Theater of Operations in World War II "Would you rather fight in Saipan, or in California?". Doing everything possible to quell the outbreak while it is still confined to Western Africa is to avoid fighting it in Karachi or Mumbai.
The sparks that have flown to the US and Spain have been well contained. It should not be assumed that sparks landing in large urban centers in developing countries with marginal health care and political infrastructure will fare as well. As an example, consider that 40% of the world's supply of generic prescription medication is manufactured in India. If Ebola were allowed to become pandemic in India, the humanitarian suffering would be unimaginable. Additionally, the rapid loss of generic medications for the world would have immediate impact on the entire world's population.
So, my $0.02? Don't panic, take reasonable precautions for self-protection, and put the resources where the real fight is before it gets out of control.
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