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On Ebola, a ‘Philosophical Choice’

How much do our individual and collective responses to the virus depend on the way we see the world -- especially institutions?

Washington DC resident Andrea Castillo is going all prepper on Ebola. She is way more panicked than I would be, but there are things worth considering in her post. Excerpts:

Then there’s [CDC director Tom] Frieden’s baffling justification for allowing continued non-critical travel from Ebola-striken countries to the U.S. While I’m inclined to agree that closing the border would not automatically guarantee an Ebola-free America, Frieden steps on shaky ground when his first two contentions invoke: (1) a vague “right of return” for touring foreigners that immediately trumps domestic health, and (2) an insulting feigned ignorance of the possibility for aidworker exceptions. (To my knowledge, Frieden has yet to alert African nations nearer to danger that they’re doing it all wrong.)

It is clear that sacred science here is far from settled on Frieden’s side. In 2013, scientists at MITpublished research suggesting “that even moderate measures of mobility restriction would be effective in controlling contagion in densely populated areas with highly interconnected road and transit networks,” with the caveat that this was a solely domestic simulation. The hatemongers at the Brookings Institution review the literature on the 1968-1969 influenza epidemic and find that, when combined with proper vaccination and conducive seasonality, the benefits of travel restrictions can exceed the relatively minimal costs and urge that “policymakers should not be too quick to rule out their implementation…in certain pandemic situations.” Previous CDC research in calmer times notes that “throughout recorded history, travel has been a major factor in the spread of disease” and calls for enhanced “border interventions” to control outbreaks.

But maybe this time is different. Today’s CDC may have good reasons to allow unfettered travel from blighted nations tempered only by limited screenings of dubious efficacy at five U.S. airports, but the ones provided so far ain’t so. If only for the administration’s own sake, public health officials should provide evidence-based reasoning for their decision to forgo basic travel restrictions, lest the fever swamp theories swirling in comment sections of high-level conspiracies to preserve open border purity (and secure millions of reliable Democrat votes) be allowed to gain dreaded credibility.


Come to think of it, the priorities laid out by Secretary of State John Kerry in a press conference last week—that “[w]e need airlines to continue to operate in West Africa and we need borders to remain open”—did smack of a revealing non sequitur. Stephen Morse, an epidemiologist at Columbia University, decodes for the rest of us: “It’s partly a philosophical choice.”

A “philosophical choice”? Here’s the full context of the Morse quote, from a National Geographic article:

Public health experts generally back the administration’s actions, and most oppose a travel ban, at least for the moment. But they say the issue is more nuanced than Frieden has made it out to be. A travel ban would have kept Duncan from bringing Ebola to the U.S., they say, and could keep out some future infected travelers.

“It is a question, I think, on which people can honestly disagree,” said Stephen S. Morse, professor of epidemiology at Columbia University’s Mailman School of Public Health. “There are good arguments to be made on both sides. It’s partly a philosophical choice.”

What do you suppose the philosophy is? Serious question.

The Washington Post does the math on Ebola spread, and it’s pretty frightening. Excerpt:

As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.

“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”

Elsewhere in the WaPo, a writer says that there is little danger to America. Excerpt:

The reason Ebola — a disease that has a relatively low transmission rate — has spread so dramatically and quickly through Liberia, Sierra Leone and Guinea has little to do with the characteristics of the virus. Now, as before the outbreak, “people are malnourished, with ill shelter, and most importantly, no access to adequate healthcare,” Wald said.

In the West African regions at the center of the epidemic, the spread of Ebola has been nothing short of disastrous. On top of the 3,400 people in the region who have died from the disease, Ebola’s spread has crippled the already fragile health-care systems of the hardest-hit countries. In Liberia, people are dying of treatable, preventable illnesses, because the health system there is so overwhelmed by Ebola.

Back to Andrea Castillo’s blog entry. She’s not really freaking out, but she’s more freaked out than she has been, simply because in her view, the institutions that were supposed to be taking care of this Ebola outbreak have failed so far to understand the seriousness of it. It’s hard to know when skepticism of institutions is important and valid, and when it comes from sheer panic. I have a friend who, if you don’t share her panicked reaction to news events, accuses you of not caring. That is a temptation in this Ebola thing. It is certainly possible that the fact that our government officials are not freaking out disappoints we who want to be encouraged in our freaking out. Again, if the Katrina situation exemplifies the dangers of government institutions not taking it seriously enough, Katrina also exemplifies the dangers of government institutions — or at least government officials — losing their heads:

The New Orleans police chief during Hurricane Katrina, Eddie Compass, says he unnecessarily “heightened people’s fears” by repeating unconfirmed reports of out-of-control crime in the city during the aftermath of the storm, adding to the confusion caused by the disaster and potentially hampering rescue efforts.

“There were reports of rapes and children being raped. And I even got one report … that my daughter was raped,” Mr. Compass says in the Spike Lee documentary “When the Levees Broke: A Requiem in Four Acts,” scheduled to air on HBO tonight.

Mr. Compass resigned from his post as New Orleans police superintendent in September 2005.

“In hindsight, I guess I heightened people’s fears by me being the superintendent of police, reporting these things that were reported to me,” Mr. Compass said of the unverified accounts of crime and disorder in flooded New Orleans that he repeated to the press and on “The Oprah Winfrey Show.”

“But there was really no way for me to check definitively. So instead I erred on the side of caution. I didn’t want people to think we were trying to cover anything up. So I repeated these things without being substantiated, and it caused a lot of problems,” he said.

So, I repeat: what is the philosophical choice, or choices, here? People love to say that they’re just following the science, but scientific facts require interpretation. Anybody care to lay out the choices? I think it has to do with the degree to which people trust our institutions to be honest and competent in the face of a deadly, gruesome crisis. Americans are dispositionally opposed to trusting institutions.  Given the general performance of our institutions over the last 15 years, who can blame us for not trusting them? That does not make the CDC right or wrong in its Ebola response. But it does make it far easier to be skeptical than it ought to be in a time like this. When you consider how few Ebola cases in the US it would take to overwhelm our health care capacity, it is hard to understand why the US government is not far more aggressive in turning away people traveling from Ebola zones, or at least requiring a strict quarantine before letting them into the general population.

Again, I think it has far more to do with philosophy than science.



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