Stop Playing Cowboy on Ebola

Before the recent cases of Ebola infection in the United States, the Centers for Disease Control and Prevention (CDC) was one of the country’s most trusted federal agencies. According to polling by the Pew Research Center in October 2013, the CDC was viewed favorably by 75 percent of the American public; by contrast, Congress was viewed favorably by just 23 percent. Today, however, if a quick, layman’s read of the public mood is any indicator, it is hard to imagine that this high level of trust in the CDC remains — and for no good reason.

Despite the fact that the size of the West African Ebola epidemic made it virtually certain a few cases would emerge in the United States, the infections in Dallas and now in New York City have unleashed a panic unprecedented in recent American history. Even the AIDS epidemic didn’t send so many Americans into paroxysms of fear the way Ebola has over the past few weeks. Among the usual suspects, Fox News has trumpeted claims that the CDC is "lying" to Americans about the threat of the virus. More surprising, however, have been Democratic Senate candidates calling for travel bans from West Africa, in defiance of CDC recommendations, and journalists questioning how safe it is to take public transportation, despite a plethora of information from the CDC about how Ebola can only be contracted through direct contact with the bodily fluids of infected individuals.

In times of crisis, people need sound guidance about what to do, how to react. U.S. public health and medical institutions, with their deep expertise and experience, are the agencies that must take the lead in disease outbreaks of this kind. Namely, it is critical to rely on the CDC and the National Institutes of Health (NIH). Yet there is currently a fracturing of national consensus on public health that goes beyond the usual Capitol Hill second-guessing and political posturing, and that may endure for a long time to come.

Nowhere is this fracturing more apparent than in the decision by three northeastern governors, in New York, New Jersey, and Connecticut, to break ranks with the CDC on how to handle people arriving in the United States from West Africa, whether they are health workers, travelers, or immigrants. The governors have insisted on a 21-day quarantine for these people. Currently, in Connecticut, where I live, there are eight people without any symptoms under quarantine, including at least one who had a fever but has since tested negative for Ebola. In New Jersey, a nurse was quarantined — and threatened to sue. (She has since been released.)

For those who care for the facts, these kinds of quarantines of asymptomatic individuals are scientifically unsound and also risk discouraging much-needed medical volunteers from going to West Africa to fight on the front lines of the Ebola crisis. All major public health and medical institutions, from the New England Journal of Medicine to the Infectious Diseases Society of America, and groups such as Doctors Without Borders and the International Medical Corps that are sending health workers to Liberia, Sierra Leone, and Guinea, have come out strongly against the blanket quarantine of people traveling from West Africa who have no symptoms associated with Ebola. But governors Andrew Cuomo, Chris Christie, and Dannel Malloy do not care for the facts — or for what federal agencies have to say, based on those facts. Indeed, the CDC, with support from the White House, released new Ebola monitoring rules earlier this week. The governors, however, have already spoken out against them: "I work with the federal government, but I disagree with the CDC," Cuomo told reporters on Monday, as quoted in the New York Times. "My No. 1 job is to protect the people of the state of New York, and do what I think is prudent to protect the people of the state of New York." 

It is critical to note, but has gone under-discussed, that these three northeastern governors, two of them Democrats, have dealt a serious blow to the credibility of the CDC and the NIH as well — and that the political and public health ramifications could linger well after the Ebola crisis has dwindled. By instituting evidence-free policies, these politicians are effectively telling the American people, "You can’t trust the folks in Atlanta or Bethesda to take care of you, and you can’t believe their version of the facts; we know better." It is a message that is not easily forgotten.

The governors’ words and actions play into a general distrust of government and a sort of scientific denialism, where each person gets to decide what the facts are. It creates confusion about which institutions Americans should listen to, and whose advice they should follow, when it comes to public health. In ignoring the expertise and mandates of the CDC and the NIH, the governors are claiming, wrongly, that the public should look closer to home for correct guidance. The risks of this situation cannot be overstated.

Perhaps in a few months, Americans will turn back to the CDC and other federal health agencies with renewed respect and confidence. Yet there is a real danger that if the governors — and others who may join them — continue to hammer away at these institutions, other public health advice will start to become suspect in some people’s minds. Maybe getting vaccinated for influenza (which will kill more Americans this year that Ebola ever will) will seem questionable. Or maybe getting a mammogram or colonoscopy, procedures unpleasant enough to seek excuses to avoid them, as recommended under federal guidelines will seem unnecessary. And what about when the next global disease scare arises? When another SARS or AIDS emerges, along with fears about it getting into the United States or over state lines once it arrives, what if people do not trust the CDC, and instead look to state capitals for direction? 

These are trying times for U.S. public health. There has already been a cleavage on access to care, between states that have expanded Medicaid and those that have not. Now there is a new fracturing in public health practice and guidance, with both national and international dimensions. Cuomo, Christie, and Malloy have endorsed a free-for-all in which there may be 50 different versions of what constitutes scientific fact and reasonable policy. This does not serve people well now, and it certainly does not ensure a coordinated, efficient response to the next public health crisis.

Damage has been done. I hope we can repair it.