This weekend, several stories appeared in the media related to fear over the spread of Ebola in the U.S. A portion of society is overemphasizing fear and failing to consider the big picture of risk.
In Maine, a teacher who went to a conference in Dallas, Texas was put on leave upon her return based on what may be just one or a few parents who demanded action from the school board. The Strong, Maine elementary school teacher is off for three weeks to ensure she carries no symptoms of Ebola.
Parents had an seemingly irrational reaction to the idea that she was in the metropolitan area where three people were diagnosed with Ebola and one person died. They also cite concern that others, possibly infected, could have been on the plane with her. There is no good evidence for this. There is also no evidence and extremely low odds that she was anywhere near an infected person. School administrators delivered a statement that confirmed this: "We have no information to suggest this staff member has been in contact with anyone who has been exposed to Ebola."
Yet, the school reports several parents were upset the teacher was allowed to attend the conference at all. There is no travel ban to Dallas nor are there any travel restrictions or warnings within the U.S. She had every right and every reason to think that this trip would not pose a hazard to herself, her own family, and her students.
Why did the school administrators overreact? They accepted the precautionary principle.
Missing from the discussions about these extreme actions from parents, travelers, and media outlets is any cost-benefit analysis of their choices to impose these restrictions. As typical with any societal issue, things are complicated immensely by conflicting opinions on economics, effects on commerce, violation of personal and civil rights, and personal beliefs and values.
However, each day, we gain additional scientific knowledge about Ebola that should influence policy decisions. Ebola is transmitted by blood or body fluids. It is not airborne and thus not so readily transmitted by casual contact. The people who are catching Ebola in the U.S are those who were in close contact with an infected person and who did not (or could not) follow the best protocol for care. Ebola has been halted in Nigeria - there have been no new cases that have shown up now that the incubation period as passed. Families of those infected in Texas who did not come into contact with bodily fluids, did not contract the disease. The model of how it is and isn’t spread is supported by the data. Therefore, there is no reasonable cause to freak out over a friend of a friend who contracts the disease.
The scientific information tells us that taking extreme caution is unwarranted but that there are reasonable precautions we should take such as screening, voluntary quarantines for those who came in contact with the infected, and detailed reporting of cases.
Some parents in the Strong school don’t see things that way.
Matt Dexter of Strong, who has a child in the teacher’s classroom, expressed his feelings about allowing the teacher to come back so soon.
“What the parents were saying last night is that, you sent (this teacher) to a potentially harmful area for exposure, and then come back and jump into the classroom on Monday seemed a little bit reckless,” Dexter said. The press also noted Dexter said he believes the government has failed to effectively educate people about Ebola and downplayed risk factors.
Did they? Many would disagree. We have been bombarded with stories and advice from medical professionals about what Ebola is and how it can be spread. The public has been kept up to date on the status of people infected with the disease. Education, however, does go two ways. You must accept the information you are given by sources is accurate and accept that those sources are reputable. We have no evidence to suggest that the government downplayed any risk factors. The risk of contracting Ebola in the U.S. is clearly ridiculously low. To overstate the risks is to be just as unethical in this situation and likely to spur panic and additional overreaction, which does have consequences.
At the school board meeting, parents expressed fear that the teacher could have come into contact with someone who came into contact with one of the nurses. As cooler heads noted: "You want to keep the kids safe. But I think it's a little ridiculous.” Indeed. This is the precautionary principle taken to an extreme.
A similar tale unfolded in Mississippi as a school principal returned from a trip to Zambia. Several parents pulled their children out of the Hazlehurst Middle School upon his return. Some even pulled their children out of the high school!
As the news spread on Facebook, parents took action even though a school official would not be in close contact with children and the CDC said the man does not have the virus . Zambia was not even a risk area as are Liberia, Sierra Leone and Guinea.
SWIFT contributor William M. London is a professor of public health at California State University, Los Angeles. He explained that most people use shortcuts in thinking rather than assess risk rationally based on numerical probabilities.
It's easier to use intellectual shortcuts called heuristics. The contagion heuristic leads people to develop general rules for protective and evasive actions, but they often apply the rules too broadly, especially when they learn about highly publicized, scary, exotic threats for which they lack relevant lived experience. It doesn't help when authorities with relevant responsibilities don't seem trustworthy.
When precautions taken to protect health care workers in the U.S. turned out to be inadequate in at least two cases, doubts were raised about authorities. When people are frightened and angry, they may not be inclined to carefully distinguish significant risks under special circumstances from risks that are much smaller than the ordinary, easily disregarded risks of daily living.
Whenever the precautionary principle is invoked, political grandstanding is right behind. With an election approaching, some politicians are stating their opinions in favor of a travel ban to appear tough on the issue. The Ebola overreaction is similar to that of the HIV/AIDS scare of the 1980s when members of Congress asked for quarantine of those infected just as a demand has been raised for a quarantine on people arriving from West Africa.
Thanks to the 24 hour news cycle, Internet news and opinions, and social media, it is much easier to spread misinformation and unwarranted fear over any threat.
Combine all these factors and what has developed is a case of “Fearbola”. As this Washington Post piece related, late night host Seth Meyers ran a segment about people who have an irrational fear of catching Ebola. Calling it “Fearbola”, the fake doctor in the segment said: “It is very easy to contract. . . . Just five minutes of exposure to CNN or Fox News, and you might have Fearbola.”
The fear quickly surpassed the relative risk. Now, we are faced with conflicts between the threat to public health and the threat to our personal and civil liberties. While no scientist or health professional will say that the risk is zero, the public can not comprehend weighing the minuscule risk (being effectively zero under typical circumstances) in relation to their daily lives.
Maybe we should invoke the “Perspective Principle”: Even though this is the worst outbreak of Ebola ever, we must keep things in perspective - there have only been 3 people infected within the entire country, with one death. It’s not an epidemic. The average person going about their daily life should not panic or drastically change their habits. The greatest hazard of Ebola is the fear mongering, opportunistic politics and the out of proportion reaction fueled by misinformation and extreme reactions of a few.