History is filled with “black swan” events. The writer Nassim Taleb, who popularized the Black Swan Theory, says these events share three characteristics. First, they are rare and defy conventional wisdom. Second, their impact is extreme. Third, we concoct reasonable explanations for them, retrospectively, to convince ourselves that they were, in fact, explainable and predictable, even though they weren’t. September 11 was a Black Swan. So were Pearl Harbor and the Great Depression. Beneficial events can be Black Swans as well: for example, the creation of the Internet.
Implicit in these commonalities is another: humans are inadequately prepared for Black Swans precisely because they were so unlikely to happen – before they did. But not all Black Swan events are created equal. Some happen in a flash – 9/11. Others take months or even years to develop – the rise of Hitler. I reference the Black Swan Theory because we may be in the middle of just such an event.
Since March, more than 7,400 people have contracted Ebola in Africa, nearly half of whom have died. The current outbreak is the worst in the history of a disease that was only discovered in 1979. Just last week, a nurse in Spain fell ill, leading the head of the World Health Organization to warn that Ebola’s spread in Europe is “unavoidable.” Closer to home, it emerged in Dallas with the late Thomas Eric Duncan, who contracted the disease in Liberia before boarding a plane to the United States. Beyond Duncan, Ebola scares have been reported in a handful of cities, including Kansas City.
A year ago, the odds of Ebola in the United States would have been more than 100 to 1. It would require an unprecedented and virtually uncontrolled outbreak in Africa. A perfect storm of events have made that long-shot a reality. Peter Piot, the scientist who discovered Ebola in 1979, explains the countries from which this strain emerged are just recovering from civil wars that chased doctors away. In Liberia, a country with more than 4 million people, there were only 51 doctors in 2010. To compound matters, this outbreak started in a highly populated area near the borders of three countries. Their tradition is to bury the dead where they were born – even if it requires moving their body for the funeral. Consequently, Piot notes that Ebola corpses were traveling across borders in pickups and taxis – spreading the disease far and fast. Then Thomas Duncan boarded a plane to Dallas.
Public health officials still believe our health care system can adequately contain Ebola – with good reason. We have the best health care system in the world. We have a better ability to find potentially impacted people than third-world countries, and there’s a promising treatment in Z-Mapp that has already saved at least three sufferers. The odds against widespread Ebola in the United States remain long, and Americans are thousands of times more likely to die from the flu than Ebola.
Still, it’s vital that government prepares for worst-case scenarios. Words aren’t enough. Plans must be clearly articulated and promptly followed. After reading initial reports from Dallas indicating that the hospital had treated, then released Duncan, I sent a letter to the Missouri Department of Health and Senior Services, requesting information on the Department’s plan to keep Missourians safe and avoid the mistakes of Dallas.
I’m a natural skeptic of government. Rather than trust, particularly in critical situations, I seek to verify. Here, I’m pleased to report it appears DHSS is ahead of other states. The Department has convened meetings with health care providers, law enforcement, and educators to discuss protocols if a person is diagnosed with Ebola. The Department has also identified experts in the treatment of hemorrhagic fevers. The Director has the authority to quarantine. And, while their protocol is to immediately contact and work with the CDC, they are assuming that, if the disease is present in several states at the same time, we may not be able to rely on the CDC.
Public health workers save lives with quiet preparation and execution of boring protocols. They don’t star in Hollywood movies, and are rarely credited for their work because the public never learns of the disasters they inoculate. They’re like running water. You never fully appreciate the importance of their role in society – unless they fail.
The Department’s response stands in stark contrast to recent decisions by the Obama administration. The standard protocol for containing hemorrhagic disease requires establishing a quarantine, creating a barrier between the healthy and the infected. Yet, with thousands already dead and predictions from the CDC that as many as 1.4 million people could be infected by January, the Obama administration has refused to stop commercial airline travel from the affected areas. Instead, it announced “screening” procedures to isolate passengers with any symptoms of the disease.
The Obama administration argues that banning travel from west Africa would impair efforts to stop the disease by restricting movement of health care professionals to and from the impacted areas. This argument strains logic. Flights limited to health care professionals or other humanitarian workers, if they agree to comprehensive screening on return, could and should be arranged. Organizing those flights wouldn’t be any more complicated than the logistics of getting hundreds of thousands of troops to and from Afghanistan or Iraq. Further, though it’s possible a person with Ebola could work their way around a ban on direct flights, it would be much more difficult, and the increased time required for the workaround would make it more likely that their illness is detected.
Experts outside the Obama bubble are warning that Ebola may spread easier than initially suggested. For example, though conventional wisdom is that it only spreads through physical contact, some strains of Ebola have shown an ability to spread through the air, according to recent published research and as observed in anoutbreak in research monkeys in Virginia in 1989. Every time this strain of Ebola passes from one human host to another presents an opportunity for mutation that would allow the disease to go airborne. The likelihood seems small, but it doesn’t appear that scientists have a sufficiently large sample set of Ebola experience from which we can infer with much certainty. (This is an element of the Black Swan theory. Small sample sizes skew probability calculations.)
Experts also warn that the screenings are too easily gamed. Before a flight is boarded, travelers in west Africa are screened for fever. Consider the incentives for a would-be flyer whose running a slight fever.
Unless they were vomited on by an infected person, most probably think they’ve escaped Ebola. That’s human nature. A fever could indicate many things. But they know that if they have a fever and it’s caught at the airport, they’ll be barred from the flight and likely detained with other people who have fevers, some of whom likely have Ebola. So if they’re not sick yet, they will be soon. And, because they’re now trapped in west Africa, they will likely die a terrible death.
Now consider the alternative. They could take aspirin to mask the symptoms for the screening. If it turns out that they don’t have Ebola (which most will believe), they will not have missed their flight and disrupted their life. Critically, they avoided Ebola purgatory – trapped in a holding area with people who very likely have the disease. If they do have Ebola, they probably believe that they are not yet contagious, but know that their only chance of survival would be to reach the United States.
What would you do? Most of us prefer to believe we’d act selflessly, and not board the plane. But, as Mike Tyson says, “Everyone has a plan ‘til they get punched in the mouth.”
The Obama administration’s refusal to enact a travel ban defies common sense and needlessly endangers Americans. Their alternative, new screenings at five major airports in the U.S. is a joke. As one expert explained, “At the very most, all we are buying here is some reduction of anxiety.” Reduction in anxiety is important, but doesn’t cut it. Rather than continue this farce, the Obama administration should immediately stop direct flights from west Africa, and keep a close eye on Nigeria and Spain.
In the case of the Missouri Department of Health and Senior Services, however, they have a plan. Let’s hope there’s no punch in the mouth – and that these quiet heroes continue to avoid public notice.