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Quora Question: Why You Should Trust the CDC on Ebola

ebola-hospital
Texas Health Presbyterian Hospital in Dallas, where the first case of the Ebola virus was diagnosed in the United States. Mike Stone / Reuters

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Answer from Jae Won Joh, M.D.

No, the CDC is not underplaying the risk of Ebola spreading in the U.S.

Let's look at some facts.

As of October 2, this is the latest available map of the 2014 Ebola outbreak in West Africa:

Source: 2014 Ebola Outbreak in West Africa

The map looks frightening, and rightly so. As of this writing, the combined numbers for Guinea, Liberia, and Sierra Leone currently stand as follows:

  • Total Case Count: 7157
  • Total Deaths: 3330

Why is this happening?

A virus that used to be isolated in small villages [1] made it into a large population center that is woefully under-equipped in terms of basic healthcare infrastructure and medical supplies [2]. It has since been further exacerbated by lack of knowledge in the general populace about how it is spread and how to avoid infection, driven by fear, misinformation, and distrust of local authorities.

Now, in stark contrast, let's look at what is happening on the same continent when a country that is significantly more prepared in terms of medical resources and infection control measures becomes affected: Nigeria.

Look at this map:

The distance from Monrovia to Lagos is ~2000km, or ~1250 miles. That's like driving from Seattle to San Diego.

A two-day road trip from one of the countries most affected by Ebola lies a country that has, with appropriate medical screening and infection control measures, limited its total cases to just 20.

In fact, the latest update on October 2nd indicates that Nigeria has not had a single new reported case since September 5th.

So let's get this straight: a country that spends 1/3 of what the U.S. does on healthcare by GDP [3] has, with some very basic protocols, managed to successfully contain and limit Ebola despite being a stone's throw away from where the disease is raging the worst.

If that's not reassuring, I don't know what is. For those living in the U.S., the discovery of a case in Dallas should not be cause for panic or alarm. We have the resources, and the healthcare field has already been at a heightened level of awareness for some time (my local county hospital has had a screening protocol in place for over a month). And after the Dallas case, you can bet every healthcare provider is on the lookout. We will be ok.

[1] Nota bene: this is nowhere near the first time Ebola has surfaced in Africa.
[2] See point #4 of my answer to "How is the US preventing the spread of Ebola after the first diagnosis in Dallas?"
[3] Health expenditure, total (% of GDP)

...

Answer from Rory Young, lives and works in Africa.

Everyone is underplaying the risk of Ebola spreading everywhere.

I will be travelling to Guinea next month to train anti poaching rangers for the government, organised by the UN. I have been in regular contact with people working in the region for months, to understand the risks, what precautions I will need to take and whether or not those risks are acceptable, considering the importance of the training (Haut Niger NP has the last lions in West Africa and a very important population of West African Chimpanzees, all under threat). These people have been telling me for months how underestimated and under-reported the scale of the outbreak is. They have also been telling me of the clear and simple precautions someone like me, who will be out in the forest and not amongst patients like a health worker for example, can take.

Amazingly, I have been inundated with calls not to go and even accusations of stupidity and irresponsibility. They are all crazy. My biggest concern is my family and the risk to them in Zimbabwe and the risk to my family and friends everywhere.

You see, in Guinea people are aware of the problem and the more responsible amongst them are taking precautions and avoiding infection. In Zimbabwe, where we are based, everyone is blissfully unaware. And so is everyone in Nairobi and Johannesburg and Addis Abbaba and overseas in New York and Hong Kong and London and everywhere else. I am sure cases will be contained quickly in first world countries, but I am concerned that it will reach and spread rapidly in African cities for the same reason that it has done so in Liberia; a poor response from the authorities, poor hygiene, poor knowledge of how to avoid infection and dangerous superstitions.

My family is already following the rules in Zimbabwe that health workers are trying to prevent the spread in West Africa. I believe everyone should do the same.

I don't for a second believe the CDC is deliberately playing down the risk for today. I am sure they are confident that with the American health infrastructure and federal emergency services and plans, they can contain any little outbreak quickly, at present. However, I do believe that many governments are playing it down for longer term outlook, to avoid panic, a drop in the markets and disruption of trade from borders closing, and because they are not really sure what is going to happen. 

They are not sure because the knowledge needed to ascertain the future spread from here on, will not be about our knowledge of the virus, it will be about our knowledge of likely the reaction of the populations and their governments.. and that is anybody's guess.

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