#Ebola: Support, don’t stigmatise

It’s irrational to not be afraid of dangerous things. We tend to avoid them for good reason – but in some cases, they are dangerous enough that we need to suppress our fears and engage with them, because the danger of not doing so is even more acute.

“We” is of course a gloss on something far more complex. It’s only some of “us” who do this, partly thanks to relative courage levels, and partly thanks to having or not having the requisite skills and knowledge.

But in the case of Ebola, clinicians, epidemiologists and other healthcare workers are not going to Sierra Leone and elsewhere because they want to expose themselves to a very scary risk. They are doing so in order to help eliminate this very scary risk – for themselves, for their families, for you.

Ebola is scary enough that engaging with it – no matter how terrifying it must be to do so – is the only way to eliminate it.

When people do engage with it – for all of our benefit – the last thing we should do is punish them for doing so. Panicking and pandering to fear through stigmatising them in quarantine – whether mandatory or socially imposed – does just that.

downloadWe know that asymptomatic people are not contagious. We know that mob mentalities based on fear are dangerous in cases like this (and more generally), in that we need people to be honest about where they have travelled to, and the risks they might have been exposed to – and if you know you’re going to be quarantined or shunned, you might simply lie instead.

We know that self-monitoring works. We know that we want to incentivise those who are willing and able to engage in this fight to do so, rather than to make them fear stigmatisation.

Pandering to fear is not the solution to Ebola. Watch the video below to see State troopers making sure that Kaci Hickox doesn’t leave her home, even though she’s not symptomatic, and has twice tested clear. CNN reports:

Having to defend herself and not being able to hug her friends, especially after four tough weeks in West Africa, is “painful (and) emotionally draining,” the nurse said. Hickox also said “it’s frustrating to hear nasty things,” saying her intentions going to Sierra Leone was to make “a difference in people’s lives” and her aim now that she’s back is not “to put anyone at risk in this community.”

Of course she wouldn’t want to put anyone at risk – she has a lover, she probably has a family. It would be shamefully insulting to treat her as if she’s putting you at risk, when she’s surely thought of who she might be putting at risk already, and wouldn’t be in public (rather than in voluntary quarantine or hospital) if she thought she was putting others at risk.

Here are some examples of over-reactions based on fear, and ignorance:

  • A North Carolina school district forced an assistant principal to stay home for 21 days because she visited South Africa
  • Several universities cancelled talks by people from Africa or those who had visited lately
  • A Congressional candidate called for a citywide “no touching” edict in Dallas

I’m currently in the USA, and am hearing far too many fearful conversations about the risks people perceive themselves as being exposed to. Americans can be somewhat paranoid, but the fear is most likely quite universal. It’s difficult, I know, but let’s not make our fears more likely to manifest themselves through panic and misinformation.

On Ebola, death rates, misunderstanding and fear

The current Ebola outbreak has a personal element for me, seeing as a dear friend is working as an epidemiologist in Sierra Leone. You can read her account of what she’s doing there on the GroundUp website, and I’d encourage you to do so – as bad as this outbreak is, it would be far worse without the courageous work of people like her, and the least we can do is to become informed about the magnitude of the problem and the sacrifices people are making to address it.

Apparently, the Congo outbreak of Ebola in 2003 is the most virulent to date, but comparisons between various terrifying things provide little comfort for anyone impacted by any one of those things. Also, comparisons can be grossly misleading. Take this chart published by Vox as an example:


As 6000 rightly points out, context matters, and it’s obscene that so many people are dying of things that are relatively easily preventable. But even though there’s nothing false (that I know of) in the graphic above, it’s rather misleading.

Ebola outbreaks are relatively rare, and the chart above compares only 2014 deaths from Ebola with total estimated deaths over some (unknown) timespan. Represented this way, HIV/AIDS deaths dwarf Ebola deaths – but what if we compared HIV/AIDS deaths in 2013 (for Guinea, Sierra Leone and Liberia only) with the 4 000 Ebola deaths represented above?


Then we have an image that looks something like the one above, which makes it plain that if Ebola were a constant (like many of the causes of death in the Vox image), it would be sitting five or 6 positions from the top in that Vox image, rather than being something you need a magnifying glass to find.

What’s more, the total number of cases currently numbers over 8000, and the fatality rate of Ebola is around 70%. So another 5600 might die, meaning that Ebola is likely to kill just as many people in 2014 as HIV/AIDS did in 2013.

The comparison also obscures the fact that not everyone with HIV/AIDS passes it on to someone else, whereas the reproductive number (the average number of cases that each infected person causes) for Ebola is sitting at an estimated 1.4 – 1.8. On average, every case of Ebola is currently creating at least another case.


The epidemic will slow down and later end as epidemiologists get the reproductive rate to drop below 1, and that’s why people like Kathryn (the epidemiologist linked at the top) are doing what they are doing. And what they are doing isn’t easy – read this piece by a Hazmat-trained hospital worker to see how difficult it is to even wear the protective clothing one has to wear, never mind dealing with the paranoia of not trusting that you can touch anything or anyone, or fearing that your food might kill you (to make matters worse, Lassa fever, spread by rats via the food supply, is currently on the increase too).

We have no cases in South Africa.

Thank you to all those who are helping to keep it so.