Ebola, Leadership and Responsibility
I am a surgeon. I am not an Epidemiologist nor an Infectious Disease specialist. Anything I say on this subject should be regarded as the musings of an educated layman. That said, I have been profoundly disappointed in the response of my profession to the current Ebola scare in this country. I don’t use the word crisis because it is not a crisis in the United States. The crisis is in West Africa. Nevertheless, the media have done little to calm fears of rampant spread of the disease to America.
The response of our professional organizations and public health institutions has been scientifically correct and yet has been an abject failure in the eyes of the public. The guidelines coming out of CDC and the Public Health Service seem fragmented, incoherent and sometimes contradictory. Measures which in the public mind seem reasonable, such as flight bans and quarantines, are dismissed with an attitude of superiority that borders on arrogance. I know the reasons that such measures were not recommended, but those reasons were not communicated in such a way that the lay person could understand and support. Instead, the response of the experts sounds dismissive and political rather than reasonable and scientific. Leadership involve more than issuing the correct orders and directives. It also means effective communication of the mission and goals of the organization. In this case, there has been a failure of leadership from the top.
Some of the irrationality about this disease can be blamed on the media, both the immediate reaction and the more general flight from science and distrust of expertise on the part of much of the general public. But in the 24hr news cycle of today, perception becomes reality. The experts in this case have done little to alter the perception that they are either political hacks or arrogant academics who are out of touch with the fears of the general public. The overly aggressive reaction of officials in New York and New Jersey appear decisive and prudent to a fearful but poorly informed lay person.
The unfortunate handling of the Ebola admission in Dallas and the subsequent exposure of two nurses to potential infection further confirmed the poor preparation of the healthcare system and the lack of effective training of frontline personnel.
Appearances by celebrity physicians in isolation garb that was improperly donned and removed and then purport to show how easy it is to become exposed do little to allay public concerns.
Statements by public health officials that we don’t need such aggressive containment and quarantine procedures as countries in the immediate area of the outbreak because ‘our healthcare systems are better’ simply sound arrogant rather than explaining the reality behind that assertion.
Then there are the actions of a pair of healthcare professionals who in my mind should have known better. If I were returning from the Ebola hot zone and had had direct contact with infected patients, no matter how thorough my precautions may have been, I would place myself in voluntary home quarantine for the duration of the incubation period. Even if I had no fever or symptoms, it would seem irresponsible to me to ride a crowded subway or engage in public social activities until there was absolutely no question that I might have the disease.
Similarly, even if I thought a public health official had overstepped the bounds of common sense in placing me in quarantine, I would not bleat about it in a public forum, or hire a lawyer to defend my ‘human rights’. Such action only makes our profession look arrogant and irresponsible; more concerned with our own rights and prerogatives than with the public good. It undermines any rational discussion of true risks and benefits and places the handling of public health in the political arena.
In truth, the risks to the public in this country are low. This outbreak will eventually be contained and burn out in West Africa. But I fear that the message to the public will be that the medical profession is out of touch with their fears, arrogant in their treatment of the problem and inept in the implementation of that treatment.