The Ebola problem

Could Ebola be the kind of event Strauss and Howe had in mind when they predicted a great crisis 20 years ago--a threat that forces our society to mobilize and literally adopt new values to cope with it?  I believe that it could, although my worthless, amateur opinion is that the chances of avoiding a self-sustaining outbreak in the United States such as has occurred in West Africa are still quite good.  The example of Senegal, where several cases crossed the border but no new ones have now occurred for 40 days, is encouraging.  But it occurred to me, oddly enough, that the crisis has something in common with the crisis that Franklin Roosevelt faced 74 years ago in the fall of 1940, as I detailed in No End Save Victory.

The threat then was a political virus--Nazi and Japanese totalitarianism--transmissible by military force. Today it is a virus, transmittable by close contact.  But what is rather interesting is that the problem Roosevelt and the country faced in 1940 and well into 1941 was the same as the one we face today: keeping the threat away from the western hemisphere.  Roosevelt at that point thought it quite possible or even probable that the Nazi virus would spread into the British isles, and that was why he bargained with Churchill to secure an arc of bases in the western Atlantic from Newfoundland to Trinidad, and why he decided to occupy Iceland in the middle of 1941.  In the same way, our priority is to keep the self-sustaining outbreak of Ebola where it is now, in West Africa.

To do this, it seems to me, some very serious thinking may be called for.  I am in no way speaking authoritatively here; I am no epidemiologist, although I have always had some feel for numbers and statistics.  It seems to me the outbreak could grow sufficiently in Sierra Leone, Liberia and Guinea to make banning travel out of those countries a real option.  The CDC currently argues that this would force people to travel outside their borders in uncontrolled ways, but they could be kept out of the United States, which they need a visa to enter, and out of other advanced countries via air travel, which obviously is the easiest way for an infected person to cross the ocean undetected, as one already has.  Another alternative deserving consideration, it seems to me, would be to set up secure holding areas in those nations for people wishing to travel, where they would have to spend the weeks necessary to ensure that they are free from infection.  It is equally possible, however, that we have to do the critical work right here at home.

So far, it seems that Thomas Duncan infected only two people--both of whom are nurses in the hospital where he was treated.  This becomes, in one sense, more reassuring every day.  The nurses are already sick, but no one whom Duncan was in contact with before the hospital admitted him has gotten sick.  Hospitals are already notoriously easy places to get dangerous infections--probably one of the easiest places to do so in our society.  One reason, I am reliably informed, is that some hospitals at least have cut back on their cleaning staffs when budget crunches hit.  It seems to me that particular hospitals in any metropolitan area have to be designated to treat possible Ebola cases, that they set up special areas in which to do so, and that the number of people allowed into those areas be kept to an absolute minimum.  Obviously they have to wear protective gear at all times.  Medical personnel who come into contact with Ebola patients may have to accept limitations on their movement, as the second infected nurse obviously should have, and they should probably be monitored for infection continuously.

These are defensive measures, designed to contain Ebola where it is.  But it behooves us as well, for a great many reasons, to do what Roosevelt did beginning in the second half of 1941, and organize a coalition to wipe the epidemic out at its source.  The world needs a volunteer corps of public health workers who will organize quarantines and medical care in the three most affected countries to try to keep the spread of the disease to a minimum.  The situation right now seems to be as discouraging as the parallel spread of Nazism was in the spring of 1940: in at least one affected country, hospitals have stopped accepting patients.  There are a number of armies in the world, including our own, that can set up temporary field hospitals.  We need new, creative thinking to handle something that the world has never successfully dealt with.  Ebola spreads much less easily than the influenza epidemic that killed tens of millions in 1918, but it also has a mortality rate of 50%, much higher, I believe, than that killer flu.

The real goal, however, should be the one that Roosevelt adopted in the second half of 1941: to eliminate the disease.  That means treatment, a vaccine, or both.  And these are needs, like the threat of German air power in 1940, that we are disgracefully poorly equipped to meet.  Big pharma is notoriously uninterested in either new treatments for infections or vaccines.  Already people are dying from antibiotic-resistant bacteria of various kinds, because no new antibiotics have been developed for so long.  Vaccines are used only a few times per person at most, and they also create legal liability issues.  I don't know whether a better defense against HIV could have been developed by now, but it's fair to say that the drug cocktail which infected people now take for the rest of their lives is exactly the kind of treatment big Pharma loves, since it provides a steady stream of income.  This is an opportunity for the drug  companies to redirect their efforts, and if they take it it will have a big long-term benefit, perhaps, for us all. Alternatively, either the US or a coalition of governments could set up a public laboratory to work on these treatments, funded by taxpayer dollars.

Last spring I wrote a series of commentaries on Thomas Piketty's book, Capitalism in the 21st Century.  I noted his finding that inequality in advanced nations had been substantially reduced in the middle third of the twentieth century, largely because those nations had to mobilize so much of their resources for common efforts.  War was the biggest of those efforts, but not the only one.  The Ebola epidemic is a tragedy, but it is also a chance to do something similar on a smaller scale.  We are not used to discipline for the common good.  We need to learn once again that it can be necessary for our survival.