TIME ebola

The Psychology Behind Our Collective Ebola Freak-Out

Airlines and the CDC Oppose Ebola Flight Bans
A protester stands outside the White House asking President Barack Obama to ban flights in effort to stop Ebola on Oct. 17, 2014 in Washington, DC. Olivier Douliery—dpa/Corbis

The almost-zero probability of acquiring Ebola in the U.S. often doesn’t register at a time of mass fear. It’s human nature

In Hazlehurst, Miss., parents pulled their children out of middle school last week after learning that the principal had recently visited southern Africa.

At Syracuse University, a Pulitzer Prize-winning photojournalist who had planned to speak about public health crises was banned from campus after working in Liberia.

An office building in Brecksville, Ohio closed where almost 1,000 people work over fears that an employee had been exposed to Ebola.

A high school in Oregon canceled a visit from nine students from Africa—even though none of them hailed from countries containing the deadly disease.

All over the U.S., fear of contracting Ebola has prompted a collective, nationwide freak-out. Schools have emptied; businesses have temporarily shuttered; Americans who have merely traveled to Africa are being blackballed.

As the Federal government works to contain the deadly disease’s spread under a newly appointed ‘Ebola czar,’ and as others remain quarantined, the actual number of confirmed cases in the U.S. can still be counted on one hand: three. And they’ve all centered around the case of Thomas Eric Duncan, who died Oct. 8 in a Dallas hospital after traveling to Liberia; two nurses who treated him are the only other CDC-confirmed cases in the U.S.

The almost-zero probability of acquiring something like Ebola, given the virus’s very real and terrifying symptoms, often doesn’t register at a time of mass paranoia. Rationality disappears; irrational inclinations take over. It’s human nature, and we’ve been acting this way basically since we found out there were mysterious things out there that could kill us.

“There are documented cases of people misunderstanding and fearing infectious diseases going back through history,” says Andrew Noymer, an associate professor of public health at the University of California Irvine. “Stigmatization is an old game.”

While there was widespread stigma surrounding diseases like the Black Death in Europe in the 1300s (which killed tens of millions) and more recently Tuberculosis in the U.S. (patients’ family members often couldn’t get life insurance policies, for example), our current overreaction seems more akin to collective responses in the last half of the 20th century to two other diseases: polio and HIV/AIDS.

Concern over polio in the 1950s led to widespread bans on children swimming in lakes and pools after it was discovered that they could catch the virus in the water. Thirty years later, the scare over HIV and AIDS led to many refusing to even get near those believed to have the disease. (Think of the hostile reaction from fellow players over Magic Johnson deciding to play in the 1992 NBA All-Star Game.)

Like the first cases of Polio and HIV/AIDS, Ebola is something novel in the U.S. It is uncommon, unknown, its foreign origins alone often leading to fearful reactions. The fatality rate for those who do contract it is incredibly high, and the often-gruesome symptoms—including bleeding from the eyes and possible bleeding from the ears, nose and rectum—provoke incredibly strong and often instinctual responses in attempts to avoid it or contain it.

“It hits all the risk perception hot buttons,” says University of Oregon psychology professor Paul Slovic.

Humans essentially respond to risk in two ways: either through gut feeling or longer gestating, more reflective decision-making based on information and analysis. Before the era of Big Data, or data at all, we had to use our gut. Does that look like it’s going to kill us? Then stay away. Is that person ill? Well, probably best to avoid them.

“We didn’t have science and analysis to guide us,” Slovic says. “We just went with our gut feelings, and we survived.”

But even though we know today that things like the flu will likely kill tens of thousands of people this year, or that heart disease is the leading cause of death in the U.S. every year, we’re more likely to spend time worrying about the infinitesimal chances that we’re going to contract a disease that has only affected a handful of people, thanks in part to its frightening outcomes.

“When the consequences are perceived as dreadful, probability goes out the window,” Slovic says. “Our feelings aren’t moderated by the fact that it’s unlikely.”

Slovic compares it to the threat from terrorism, something that is also unlikely to kill us yet its consequences lead to massive amounts of government resources and calls for continued vigilance from the American people.

“Statistics are human beings with the tears dried off,” he says. “We often tend to react much less to the big picture.”

And that overreaction is often counterproductive. Gene Beresin, a Harvard Medical School psychiatry professor, says that fear is causing unnecessary reactions, oftentimes by parents and school officials, and a social rejection of those who in no way could have caught Ebola.

“It’s totally ridiculous to close these schools,” Beresin says. “It’s very difficult to catch. People need to step back, calm down and look at the actual facts, because we do have the capacity to use our rationality to prevent hysterical reactions.”

TIME ebola

Dozens Who Had Contact With the First U.S. Ebola Patient Are in the Clear

Mayor Mike Rawlings speaks during a news conference about the recent Ebola infections with Dallas County Judge Clay Jenkins and Dallas County Health and Human Services Director Zachary Thompson at the Dallas County Administration Building on Oct. 20, 2014 in Dallas.
Mayor Mike Rawlings speaks during a news conference about the recent Ebola infections with Dallas County Judge Clay Jenkins and Dallas County Health and Human Services Director Zachary Thompson at the Dallas County Administration Building on Oct. 20, 2014 in Dallas. Chip Somodevilla—Getty Images

"We are so happy this is coming to an end"

The first wave of people who were being monitored because they had direct contact with the first Ebola patient in the U.S. were declared free of the disease early Monday, an important step in the containment effort.

The Texas Department of State Health said 43 people were in the clear after they had contact with Thomas Eric Duncan, who died of the disease Oct. 8. Health officials have been taking their temperature twice daily for 21 days, the longest incubation period for the virus, and said that none have developed symptoms. Those individuals will now be taken off the watch list and will no longer need to be checked for symptoms.

At least two health care workers who helped treat Duncan have been infected, amid an outbreak that has killed more than 4,500 people in West Africa.

The group taken off the watch list Monday includes “a mix of health care workers, household contacts and community members whose last possible contact with the state’s first patient was Sept. 28,” the department said. They had to make themselves available for daily monitoring and were told not to leave the state during the incubation period.

The four people who lived with Duncan after he arrived from Liberia, where he contracted the disease, have also shown no signs of infection and will be taken off the watch list. They included Louise Troh, Duncan’s girlfriend, his son with Troh and two young men. They were placed under quarantine because of their high risk but will be now allowed to leave their temporary home.

“We are so happy this is coming to an end, and we are so grateful that none of us has shown any sign of illness,” Troh said in a statement. “We ask to be given privacy as we seek to rebuild our home, our family and our daily living.”

Texas state health officials and the Centers for Disease Control and Prevention continue to monitor 120 people, including health workers who cared for Duncan while he was hospitalized at Texas Health Presbyterian before he died, and passengers who sat within three feet of a nurse from the hospital who flew on two commercial flights on Oct. 10 and Oct. 13. Those health care workers have now been told to remain at home and avoid public places.

Read next: Nigeria Is Ebola-Free: Here’s What They Did Right

TIME ebola

Spanish Nurse Tests Negative for Ebola After Contracting Disease

After she was diagnosed, the regional government euthanized her dog

The Spanish nurse who became the first known person to contract the disease outside of West Africa in this current outbreak has tested negative for the disease, her family announced to Spanish media.

Teresa Romero’s doctors said the results are preliminary and that more tests would be needed to confirm she no longer has Ebola, according to the BBC. (Her name has also been reported as Teresa Romero Ramos.)

The 44-year-old contracted the virus while caring for two missionaries who had been in West Africa. Both missionaries ultimately died from the disease.

Romero has said she may have contracted the disease while removing her protective gear. As a precautionary measure, the regional government euthanized her dog, Excalibur, though to date there is not a single case of dogs transmitting Ebola to people or people to dogs.

[BBC]

TIME ebola

Obama on Ebola: ‘We Can’t Give in to Hysteria’

"This is a serious disease, but we can't give in to hysteria or fear," Obama said

President Barack Obama on Saturday urged Americans to remain calm about the Ebola virus that has thus far been diagnosed in three people in the United States and killed one, emphasizing that cautious practices on the part of health authorities as well as aid for the West African countries hardest hit by the disease are the best approaches to preventing it from spreading.

“What we’re seeing now is not an ‘outbreak’ or an ‘epidemic’ of Ebola in America,” Obama said in his weekly video address. “This is a serious disease, but we can’t give in to hysteria or fear.”

“We have to keep this in perspective,” Obama continued. “Every year, thousands of Americans die from the flu.” The President also pointed out that five people who contracted Ebola in West Africa had been brought back to the U.S. and treated successfully without infecting others.

The Ebola outbreak has so far killed 4,500 people in Liberia, Sierra Leone and Guinea. Liberian national Thomas Eric Duncan, who was diagnosed with the disease in Dallas after traveling from his home country to the U.S., died of the illness Oct. 8. A pair of American health workers have been diagnosed after coming in contact with Duncan and are being treated for the illness. More than 100 people who have been in contact with Duncan and the two sick nurses are being monitored for symptoms. Ebola has an incubation period of up to 21 days and is only transmitted by direct contact with the bodily fluids of a person who is already showing symptoms of the disease.

The Centers for Disease Control and Prevention, under fire for not adequately instructing medical staff in how to deal with Ebola patients, took steps this week to address those criticisms. Several lawmakers have also criticized Obama’s handling of the crisis directly, with the President announcing Friday the appointment of a so-called “Ebola czar” to manage the country’s response to the virus.

Obama, however, warned against calls by some politicians to halt travel between the U.S. and West Africa. CDC officials and other experts have said cutting off the border would be ineffective because sick passengers can still take connecting flights through third countries, and it would make it harder to know who was entering the country and perform contact tracing if travelers later showed symptoms of the virus.

Obama also argued that stopping travel would halt the flow of health workers to West Africa, where they could help contain the disease. “We can’t just cut ourselves off from West Africa,” Obama said. “Trying to seal off an entire region of the world — if that were even possible — could actually make the situation worse.”

TIME ebola

Canada Shipping Experimental Ebola Vaccine to Curb Outbreak

Liberia Races To Expand Ebola Treatment Facilities, As U.S. Troops Arrive
U.S. Navy microbiologist Lt. Jimmy Regeimbal handles a vaccine box with blood samples while testing for Ebola at the U.S. Navy mobile laboratory on October 5, 2014 near Gbarnga, Liberia. John Moore—Getty Images

The vaccine is being tested on humans, Canadian authorities say

Canada will begin shipping an experimental Ebola vaccine to the World Health Organization in Geneva on Monday, the government announced Saturday, with the hope of addressing the current outbreak of the deadly virus.

The effects of the vaccine in animals have been “promising,” Canadian authorities said. The vaccine is just beginning to be tested on human subjects in order to determine the safety of the vaccine and the dosage required to stimulate a person’s immune system into producing the proper antibodies.

Canada is sending 800 vials of experimental Ebola vaccine contained at -80 degrees celsius in three separate shipments via aircraft to the WHO in Geneva. Canada’s Public Health Agency is supplying it to the WHO so it can be used as an “international resource.”

“This vaccine, the product of many years of scientific research and innovation, could be an important tool in curbing the outbreak,” said Dr. Gregory Taylor, Chief Public Health Officer of Canada.

TIME ebola

Texas Tells Ebola Health Care Workers Not to Travel

Dr. Daniel Varga, Chief Clinical Officer, Senior Executive Vice President, Dallas Mayor Mike Rawlings, Dallas County Judge Clay Jenkins and Dallas County Human and Health Service Director Zach Thompson held a news conference about the new Ebola case on Oct. 15, 2014 at Dallas County Commissioners Court in Dallas.
Dr. Daniel Varga, Chief Clinical Officer, Senior Executive Vice President, Dallas Mayor Mike Rawlings, Dallas County Judge Clay Jenkins and Dallas County Human and Health Service Director Zach Thompson held a news conference about the new Ebola case on Oct. 15, 2014 at Dallas County Commissioners Court in Dallas. David Woo—Dallas Morning News/Corbis

The news comes as one nurse self-quarantines on a cruise

Health care workers who came in close proximity to the first Ebola patient diagnosed in the U.S. are being told they need to avoid public places or they may be involuntarily quarantined.

Under the new rules, which were issued late Thursday by the Texas Department of Health and affect almost 100 people, nurses who entered the hospital room of the first patient must stay away from restaurants and theaters, and forgo travel on airplanes or trains. The new directives from the state, which has seen each of the first three Ebola diagnoses on U.S. soil, lay out explicit guidelines for monitoring health care workers. They come as the federal government is under increasing pressure to do more to contain the virus. After officials were grilled by lawmakers Thursday, President Barack Obama on Friday tapped a longtime Washington aide to be an Ebola “czar” and coordinate the federal response. And the Centers for Disease Control and Prevention (CDC), which has been under particularly harsh scrutiny for its handling of the crisis, is expected to issue new guidelines for health care workers treating Ebola patients soon, Bloomberg reports.

Under the new Texas directives, hospital employees directly involved in caring for Thomas Eric Duncan, the Ebola patient who died Oct. 8, will be monitored with twice-daily check-ins for the 21-day duration of the disease’s incubation period. One of the daily check-ins must be conducted in person.

The state has threatened to subject anyone who ignores the guidelines to a “communicable disease control order”—or in other words, to quarantine them—but officials said they expect compliance.

“These are hometown health care heroes,” Clay Jenkins, a Dallas judge who has been closely involved in managing the containment effort, told the New York Times. “They want to do this. They’re going to follow these agreements.”

The announcement comes amid news that two health care workers who had treated Duncan later traveled out of state—Amber Joy Vinson by plane and another on a cruise ship. Vinson was diagnosed with Ebola following her flight and is being treated at Emory University Hospital in Atlanta. The other, who has not been unidentified, is self-monitoring in isolation aboard the cruise ship.

The new restrictions prevent both flights and cruises, along with any other “commercial transportation” or travel to “any location where members of the public congregate.”

The Ebola outbreak has killed more than 4,500 people in West Africa.

TIME ebola

Nurse Infected With Ebola in Dallas Now Being Treated in Maryland

Texas Nurse Infected With Ebola Transferred To Maryland
The airplane carrying Texas Health Presybterian Hospital nurse and Ebola patient Nina Pham takes off from Love Field airport October 16, 2014 in Dallas, Texas. Chip Somodevilla—Getty Images

Nina Pham now has a staff of 50-60 trained health care workers taking care of her at the National Institutes of Health

Nina Pham, the first person to be infected with Ebola in the U.S., arrived at the National Institutes of Health Special Clinical Studies Unit in Maryland just before midnight Thursday evening, the NIH said Friday.

Dr. Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), and Dr. Rick Davey, deputy director of NIAID’s division of clinical research, said Pham was in fair condition and resting comfortably. Davey will be the physician overseeing Pham’s care.

Fauci said that from the time when Liberian Ebola patient Thomas Eric Duncan became the first person diagnosed with the disease in the U.S., “we made very clear that we could make the highly specialized facility available if called upon. We were called upon to accept Nina and we did.”

The seven-bed NIAID unit in Rockville, Maryland was created in 2011 as part of the U.S.’s bio-terror preparedness efforts. It’s designed and equipped to care for patients with the most dangerous infectious diseases. The unit has a dedicated staff of 50 to 60 personnel who are specially trained in infection control for biohazards, and, said Fauci, retained continuously to keep their education up to date. The unit’s isolation unit has a separate ventilation system that directs air into specialized filters, and the unit has a dedicated system for removing patient waste and other biohazardous materials.

The center is not just a hospital, but also a research facility. Every patient treated there is also a research subject, and Pham will be no exception. Dr. H. Clifford Lane, clinical director of NIAID, said that Pham’s virus and her immune system’s response to it will be studied extensively. The researchers at the unit are also part of vaccine studies and are working on ways to intervene earlier in the disease’s course with better treatments. Such treatments may help not just Pham, but also the thousands in West Africa currently battling Ebola.

As far as what therapies Pham will receive, Fauci would only reveal that Pham has so far received, while in Dallas, plasma donated from Dr. Kent Brantly, the first American patient successfully treated for Ebola — Brantly was diagnosed while in Liberia before being flown to the U.S. for treatment. Pham is at all times being cared for by four to five nurses working 12 hour shifts; two of these nurses are allowed into her room at one time, with the remaining nurses serving support duties. One full-time infectious disease doctor and one critical care intensive care physician is also assigned to her care in rotating shifts.

TIME ebola

CDC Expands Ebola Alert to Passengers on Both Flights Nurse Took

The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland.
The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland. Tony Dejak—AP

The Centers for Disease Control (CDC) asked passengers on Frontier Airlines flight 1142 from Dallas to Cleveland on Oct. 10 to call their hotline

The Centers for Disease Control expanded precautionary efforts Thursday night by reaching out to passengers on an earlier flight that Ebola patient Amber Vinson took before she had reported any symptoms of the virus.

The CDC said anyone on Frontier Airlines flight 1142, which flew from Dallas to Cleveland on Oct. 10, should call the agency at 800-CDC-INFO (800-232-4636). Amber Vinson, the second nurse to test positive with Ebola in the U.S., took that flight after taking care of the U.S.’s first diagnosed Ebola patient, Thomas Eric Duncan, who died on Oct. 8.

The passengers will be interviewed by CDC officials about the flight and about any potential symptoms they may have developed since flying. “Individuals who are determined to be at any potential risk will be actively monitored,” the CDC said in a statement about the notification.

Ebola is transmitted by an infected person when that person is symptomatic, and only through direct contact with that individual’s body fluids, which include blood, saliva, vomit or diarrhea. Vinson had a slight fever of 99.5 degrees before flying Oct 13 from Cleveland to Dallas. CDC director Dr. Tom Frieden said that passengers on the flight from Cleveland back to Dallas were being notified out of an abundance of caution. He said that they were at very low risk of exposure since Vinson presumably did not vomit or spread body fluids during the flight.

Now the agency says, “Based on additional information obtained during interviews of close contacts to the second healthcare worker from Texas Presbyterian Hospital who tested positive for Ebola, the … CDC is expanding its outreach to airline passengers now to include those who flew from Dallas/Fort Worth to Cleveland on Frontier flight 1142 on Oct. 10.”

TIME ebola

Here’s Who Is Being Monitored for Ebola

Contact monitoring after the U.S. Ebola cases

The key to containing spread of a virus like Ebola, public health experts tell us, is tracking down every person with whom an infected person had direct contact. Such contact tracing includes people in their family who might have shared hugs or kisses, or health care workers who handled any specimens.

Who is currently being traced in this way? Here’s what we know.

How many people are being monitored?

48 people who had direct contact with Thomas Eric Duncan

For now, officials at the Centers for Disease Control (CDC) say that 48 people had direct contact with Thomas Eric Duncan before he was isolated on Sept. 28 and diagnosed on Sept. 30. CDC has not clarified where those people might have had contact with Duncan. Four members of his immediate family who were staying in the same apartment as Duncan since he arrived in the U.S. have been quarantined for 21 days, the incubation period for the Ebola virus. But it’s not clear whether the remaining 44 include public citizens in the same apartment building or whether it also includes others in the community.

76 health care workers who cared for Duncan

Between Sept. 28, when Duncan was put into isolation at Texas Health Presbyterian Hospital, and Oct. 8, when he died, 76 health care workers participated in his care, performing duties that potentially exposed them to his infectious body fluids. All are being monitored, according to the CDC. At the minimum, that involves having the health care workers take their own temperature twice daily, and report any fever above 100.4F or any other symptoms of Ebola, including nausea, headache, vomiting and diarrhea.

It’s not clear how many, if any, are being actively monitored, which involves public health officials performing the temperature checks twice daily and asking detailed questions about any other possible symptoms.

Can contacts travel?

According to CDC director Tom Frieden, people who are part of contact tracing are advised not to use public transport. They are limited to so-called controlled movement, such as a personal car.

Amber Vinson, the second nurse to test positive, however, traveled by plane from Dallas to Cleveland on Oct. 10, two days after Duncan’s death. Vinson had apparently been intimately involved in Duncan’s care while he was alive, including drawing his blood and inserting catheters. Even if she did not have a fever before she boarded the plane, Frieden said, “because she was in a group of individuals known to have exposure to Ebola, she should not have traveled on a commercial airline.”

While in Cleveland, Vinson reported a temperature of 99.5F. That is below the CDC threshold of 100.4F for Ebola isolation, but because of her direct contact with Duncan’s body fluids, Vinson was told by CDC to return to Dallas, according to a CDC spokesperson. She did, on Oct. 13, on a commercial flight.

Frieden said on Oct. 15 that Vinson reported no symptoms of Ebola; Ebola patients can only spread their disease when they are symptomatic and through direct contact with their body fluids, including vomit, diarrhea or blood.

Why isn’t every contact of Duncan’s under quarantine?

Because Ebola only spreads through contact with body fluids when the patient is symptomatic, the risk of contracting Ebola through casual interactions is very low. Passengers on the plane that brought Duncan into the U.S., for example, are not at risk because he was not symptomatic during this trip.

Passengers on Vinson’s flight from Cleveland to Dallas, however, are being monitored out of an abundance of caution. Because she had a fever, the CDC notified Frontier Airlines, the carrier, that Vinson “may have been symptomatic earlier than initially suspected, including the possibility of possessing symptoms while on board the flight,” according to Reuters. Those passengers are now being monitored for Ebola symptoms.

Duncan’s family members are under quarantine because they were in direct contact with Duncan when he first became ill, and have a high chance of having touched his infectious body fluids.

Health care workers are also at high risk, since they handled Duncan’s body fluids as he became more and more symptomatic in the hospital. They are supposed to be protected from exposure by personal protective equipment, but Frieden acknowledged that the gear used by health workers in the Duncan’s early hospitalization was “variable” and that both Vinson and Nina Pham, the first nurse to test positive for Ebola, might have been infected during this time.

TIME ebola

5 Reasons Ebola Was Contained in the Congo

Researchers report on another cluster of Ebola cases in the Democratic Republic of Congo, where Ebola first emerged

While the world rightly focused on the growing number of Ebola cases emerging from Africa’s west coast this summer, the virus made another appearance in the heart of the continent: in the Democratic Republic of Congo (DRC), where Ebola was first identified in the 1970s. That outbreak—which was of another strain of Ebola Zaire—spread to just 69 people, however, and a report in the New England Journal of Medicine, has some answers as to why.

The DRC outbreak began with a pregnant woman who butchered and ate a dead monkey her husband had found in the Inkanamongo village, near a remote, forested area in the equatorial province. Presumably, the monkey was infected with Ebola; the woman became ill on July 26 and died on August 11. A local doctor and three health workers who performed a Cesarean section to remove the fetus before burial were also infected and died of Ebola.

Nearly two dozen others who were infected had direct contact with the woman, and most of them had helped care for her after she became sick. Forty nine of the 69 people who either had confirmed or suspected infection died. The number of cases was kept to a minimum, say the study authors, for five reasons, which could help inform how to contain the epidemic in the west.

1. While both regions practice similar cultural rituals surrounding burial, including touching the bodies of the dead, some behaviors in the equatorial DRC differ from those in West Africa, and thus help to limit spread of the virus from person to person.

2. The strain circulating in DRC is also genetically different from that in Guinea, Sierra Leone and Liberia, and may have a different disease trajectory.

3. The remote and relatively isolated locations of villages in DRC helped to contain the virus and prevent it from spreading as quickly as it does in large, mobile populations.

4. The DRC may have a stronger health response to Ebola given its longer history with the virus. Since it first appeared there in 1976, the Congo has weathered six outbreaks and may have more experience in responding quickly and educating its citizens about how to control infection.

5. Finally, because the virus has circulated among the people in DRC, they may have more immunity to it, and could be in a better position to fight off infection.

The DRC outbreak provides a stark contrast to the way Ebola has erupted in West Africa; it shows how an experienced and prepared community might be one of the most important ways to help stop spread of a deadly disease. Similar strategies have helped to contain the epidemic in Nigeria and Senegal, which neighbor the most heavily affected countries in West Africa but are close to declaring their outbreaks over.

Read next: Lawmakers Grill Obama Administration Over Ebola Outbreak

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