(task) Like AIDS Before It, Ebola Isn’t Explained Clearly by Officials - NYTimes.com

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Ebola risk communication
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Like AIDS Before It, Ebola Isn’t Explained Clearly by Officials

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The Gay Men's Health Crisis information table outside a health food store in 1985. Credit John Sotomayor/The New York Times
WASHINGTON — A mysterious virus emerges in Africa and makes its way to our shores. An anxious and skeptical public rejects scientific evidence that the lethal virus is transmitted only through body fluids. There are no drugs to effectively treat infected patients, nor a vaccine to prevent new cases.

People shun the infected and their contacts; some demand quarantines. Conspiracy theorists contend the virus escaped from government laboratories.

No, the virus is not Ebola. It is the outbreak in the early 1980s of the virus that causes AIDS.

The epidemics have prompted eerily similar reactions from health officials and the public, raising crucial questions about why the world remains persistently unprepared to react to the sudden emergence of viral threats.

For decades, scientists have warned that diseases obey no national boundaries. New and old contagions can pop up in hours anywhere in the age of jet travel. And as a rapidly growing population invades previously wild habitats, more dangerous microbes are bound to be discovered.

While the world has learned many lessons about containing them, it has forgotten a few — and probably will need to learn others.

Experts underestimated the extent of the spread of both viruses. After development of an H.I.V. test, doctors discovered that millions of people were infected in one of the worst pandemics in history. The Ebola epidemic, which involves thousands, is smaller and confined to West Africa for now.

But as long as the infection spreads in West Africa, it poses a major threat to the rest of the world; many countries will have a very difficult time controlling its spread if it reaches them.

In circumstances like these, epidemiology’s immense power deserves respect. Scientists quickly and clearly delineated how Ebola and H.I.V. are transmitted. For H.I.V., the routes include sexual intercourse, blood transfusions, contaminated needles and childbirth.

Ebola requires direct contact, which means that the fluids splash or spray into someone else’s mouth, eyes or nose, or enter through the bloodstream through cuts or breaks in the skin.

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But public officials, then and now, failed to communicate this information in ways most people understand.

At the onset of the AIDS epidemic, officials and journalists spoke of “bodily fluids” to avoid using words like penis, vagina and sperm. Only later did officials became explicit about the risks of rectal intercourse.

Ambiguity was costly. People avoided restaurants where waiters were perceived to be gay out of fear of getting the disease from “contaminated” food and dishes. Parents refused to send their children to schools where a student was known to be infected. Some people called for quarantines, which made no scientific sense.

Conspiracy theorists were not far behind, embracing the fiction, disseminated by Soviet Union officials, that scientists created H.I.V. at Fort Detrick, an Army base in Maryland, from which it escaped to infect the world.

Health officials have had ample time — years — to polish their language skills. Yet the phrase “bodily fluids” is again with us, and confusion has arisen over whether the virus can be “airborne” as officials try to explain that Ebola virus is not dispersed like the influenza and measles viruses.

The New York Times’s Well blog has been inundated with questions about whether Ebola can be caught from subway poles, bowling balls, toilet seats, mosquitoes, sweat, coughs, sneezes and even pets.

And so history repeats. An uncertain public, fearful of the unknown, has stigmatized many Ebola survivors and workers who cared for Ebola patients, as AIDS patients once were, even though they are not infectious to others. Governors and health officials have clashed over the need to quarantine people returning from West Africa, though — as a court has stated — such policy is not based on scientific evidence.

As for the inevitable conspiracy theory: Dr. Peter Piot, a co-discoverer of the Ebola virus and now dean of the London School of Hygiene and Tropical Medicine, recalls that an attendee at a recent meeting about Ebola asserted that the virus escaped from a Centers for Disease Control and Prevention laboratory in Sierra Leone. Others have claimed that the epidemic is a ruse intended to squeeze foreign aid money from donors.

By its very nature, public health involves politics. As politicians, health officials have traditionally tended to play down, or even ignore, risks to calm anxiety and panic.

But the official foot-dragging that first greeted the AIDS epidemic wound up pitting activists against government agencies and officials. Trust was lost, and “silence equals death” became a rallying cry.

Federal officials have not been silent about Ebola, but sometimes, they have been too emphatic and absolute in their choice of words. Despite lack of prior experience, the experts predicted that any American hospital could safely handle Ebola patients with little risk to noninfected individuals. That assurance came back to haunt them in Texas.

To their credit, the officials quickly corrected themselves. But by then, the damage was done.

Fear of the unknown plays a great role in fanning anxiety during outbreaks of deadly diseases. H.I.V. was truly a mystery at the beginning of the AIDS epidemic. At first, scientists debated whether the cause was an infectious agent (even an old one in disguise) or a drug, or combinations of them.

Ebola was identified in Central Africa in 1976 but was unknown in West Africa when cases began to occur in Guinea earlier this year. It is the largest epidemic of the disease. As of Friday, Ebola has infected 13,268 people, of whom 4,960 have died, the World Health Organization says.

As in the early years of AIDS, standard support therapy is the only proven therapy. If drugs are found to treat Ebola, health workers will need ways to get them to Africa’s poor. If nothing else, the AIDS epidemic may have prepared us for that.

Both viruses continue to raise major challenges. A decrepit infrastructure for delivery of health care and other services is the result of years of political unrest in West Africa. Hundreds more doctors and nurses are needed from elsewhere to care for the ailing.

The fact is that Ebola, like AIDS, will leave behind a tragic legacy: hundreds of thousands of orphans.

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