Bushmeat. Bodily fluids. The homeless man, exposed to Ebola via Thomas Eric Duncan, who could not be found for 4 days in Dallas. Parents pulling their children from Dallas schools. Endless media stories.
From public officials: First, the chances of Ebola reaching our shores deemed an “unlikely event.” Then, the message that “we will stop it in its track.” Later, we get the message that officials are safeguarding all the contacts in Dallas.
Dr. Elspeth Cameron Ritchie
Except for the homeless man, who allegedly rode in the same ambulance that was used to transport Mr. Duncan to a Dallas hospital. And now we have a health care worker who has apparently tested preliminarily positive.
We seem to be divided into two polarized opposites on communicating risk, and we need to find an accurate middle ground.
On one side, many of our colleagues say, “What is all the fuss about? Many more people will die of flu this year than Ebola.” Or at least they did, a week ago.
On the other side, the media, meanwhile, continue to highlight every known possible case of Ebola outside of West Africa. Reports of dead and dying are legion in Guinea, Liberia, and Sierra Leone. Those three countries are in crisis, and their health care workers are dying in droves.
More recently, the nurse who developed Ebola in Spain is fanning concerns among health care workers in developed countries. Health authorities euthanized her dog, although there is not a clear reason as to why.
Here in the United States, people from Africa report stigma and discrimination.
What is the middle ground?
• Do not belittle concerns. Recognize that this is both a medical and psychological crisis.
• Acknowledge that this is a major issue, not only for West Africa but for the world.
• Emphasize the importance of supporting the public health infrastructure, not only for Ebola but for flu, SARS, rhinovirus, AIDS, and other infectious diseases.
• Stress basic infection control procedures, such as good old hand washing, of course. Ensure that masks and gloves are widely available and that people wear them.
• Develop widely visible protocols in every single clinic and emergency room – including psychiatric clinics and ERs. The protocols would emphasize that individuals who present with fever should be screened for a travel history in themselves or their families. Those with potential exposure to Ebola need to get to the hospital.
• Develop Ebola capacity, which we are calling Ebola Epidemic Management Initiatives, for each jurisdiction. Local workgroups with representatives from physical and mental health and safety officials could initiate the process.
• Do not assume that all fevers from West Africa are Ebola. Such fevers could be indicative of malaria or any number of other diseases.
• Encourage social distancing from people who might have been exposed to Ebola in community settings.
Many practitioners and jurisdictions are following the recommendations listed above, but not enough, and not on a systematic basis. The above are basic principles of health risk communication and public health measures. We have learned them over the last 30 years; let us use them.
Michael D. McDonald, Dr.PH., coordinator of the Global Health Response and Resilience Alliance and chairman of Oviar Global Resilience Systems, Washington, contributed to this commentary.
Dr. Ritchie is former chief of psychiatry for the U.S. Army and the current chief clinical officer in the department of behavioral health for the District of Columbia.