Ebola: Does the CDC think we can’t handle the truth?

March 18th, 2015

Public health communications – particularly during a deadly epidemic that threatens to go global – is an artful science. But sometimes you don’t need a weatherman to know which way the wind blows. It seems to me the public health message on Ebola has been primarily about public reassurance chased occasionally with a straight shot of fear. The latter is to make sure the media keep their trumpets handy. Mission accomplished. The other use of fear and pressure is to remind politicians and the powers that be worldwide that they don’t want to end up on the wrong side of history on this issue –the mother of all Ebola outbreaks no matter how it ends.

Thus the Centers for Disease Control and Prevention is playing this Ebola epidemic at both ends against the middle, ratcheting up the fear factor to grab global attention – and presumably investment and action – even while downplaying the likelihood that its worst-case scenarios will actually come to pass. Yet the worst case numbers are already running in bold black in various iterations in thousands of headlines across the globe: “CDC projects 550,000 to 1.4 million Ebola cases by Jan. 20, 2015.” The caveats fall somewhere lower in the story. Wow, who would have thought that journalism -- a profession enamored with the phrase “if it bleeds it leads” – would go so negative in the headline?

No, it turns out these numbers were based on old data from August and do not account for the massive surge underway by the U.S. government and a growing cadre of international partners. Actually, the outbreak can be halted if at least 70% of cases are admitted to Ebola treatment centers or cared for at home under proper infection control measures -- as long as funeral practices that involve touching dead victims are also stopped, the CDC recently reported. Indeed, if that 70% of the infected are under safe care that prevents transmission the Ebola outbreak could be over before the year ends, the CDC model suggests. Worst case, best case. Forgive one for infusing just enough skepticism into a horrific situation to suggest that these numbers may be more about bending political will than the X axis on a chart of Ebola cases.

“It's imperative that we keep the pressure on the international community to respond as quickly as possible -- so we can get ahead of this and get ahead of it quickly,” Gayle Smith, special assistant to the President of the United States and Senior Director of the National Security Council, said at a Sep. 23 press conference.

That seems transparent enough I guess, but the award for best follow-up question goes to Donna Young of Scripps News: “Since you've already acknowledged that you don't think the 550,000 number will come to pass, and you've acknowledged that you think that this could be turned around if efforts [underway] continue, and that this data is already out of date -- what was the point in putting it out there? Was it to create the hysteria that it appears to be creating to get the international community more on board? What was the point if it's already out-of-date data?”

Now that is a good question, similar to the loaded inquiry defense attorney Lt. Daniel Kaffee asks Col. Nathan Jessup in A Few Good Men: “If you gave an order that Santiago wasn’t to be touched, and your orders are always followed, then why would Santiago be in danger? Why would it be necessary to transfer him off the base?”

The fictional Jessup was eventually unmasked on the stand, but CDC Director Tom Frieden, MD, MPH, was cool under pressure. That said, he did not reject the premise of the reporter’s question and came very close to confirming it.

“Part of the point of having a projection of what might happen if we don't take urgent action is to make sure that it doesn't happen,” Frieden said at the press conference.

Are we clear? Crystal.