- Charles Humphrey@CDC-PHIL / Public Domain
With the first confirmed case of Ebola in the United States, I suspect at least a few of you are freaking out.
Ebola—like many viruses, including the recently popular enterovirus 68—is spread by filth. You need exposure to infected body fluids (blood, tears, sweat, vomit, diarrhea) to get it.
Ebola thrives on poverty and disparity: Places where the people at the bottom of the ladder have no access to clean water to drink and wash with, no access to decent healthcare, no public health providers to track and contain outbreaks. West Africa is nearly ideal for Ebola. Increasingly, so is Central Texas and the rest of the United States.
To protect yourself, your household, and your community from communicable diseases like Ebola requires decency for the poorest, the most marginalized in your community—the people who pick your produce, make your food, clean your streets and workplace, working the myriad of minimum-wage service jobs that make most of our lives possible.
Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn't our long suit.
You'd be correct to be exasperated with the emergency room in Dallas, sending home with a handful of antibiotics a man recently arrived from West Africa, with classic symptoms of Ebola. How could this happen? Why weren't we better prepared?
The CDC has actually been a leader in responding to the crisis. Many American doctors and experts, at significant personal peril, have been involved in the response in Africa. Reams of guidelines are available, written based on the experience of these experts.
Someone has to read these guidelines, and figure out how to make them happen in a community. How do you get a patient from an outlying clinic to an isolation room in a proper hospital without exposing ambulance crews? To which hospital should the patient be taken? Who is going to clean up the vomit, blood, other bodily fluids, and medical waste? How will those people be protected from exposure? Where will the waste be taken? Who will incinerate it? Who will track down others who might have been exposed, and watch them for symptoms? Who will check arriving airline passengers for symptoms? Which symptoms should be looked for? Every community needs experts in public health, to translate the general guidelines into concrete plans of action.
Any time you find yourself asking, 'why isn't someone doing something', think back to all the tax cuts over the years. Training experts is expensive. Experts deserve to be paid (even in the most libertarian, Randian sense of "deserve"). This is what government is for. From a myopic perspective—in between crises—spending on public health is waste. In King County (still a high-water mark for public health in the United States), years of cutbacks—cheered on by the likes of the Seattle Times editorial board and Tim Eyman—have degraded the infrastructure. We only feel it when a disaster looms.
It's not time to panic. Honestly, the biggest risk for most people in the US remains the flu (get vaccinated!). For new things floating around, Enterovirus 68 is probably a bigger risk than Ebola. If you want to sleep better at night, vote for better public health funding.