Ebola Outbreak: Evolution Of Ebola Story Impacts Perception, Response

Like any organism, the Ebola virus evolves as it moves from host to host, a process that will eventually lead to mutated versions of the deadly virus with unknown differences from the one currently gripping the world with fear. But the media cycle surrounding Ebola evolves much more quickly, causing what the public thinks it knows about the virus to change more quickly as the U.S. Centers for Disease Control and Prevention updates its official death count number.

The impact of this series of reports, studies and guesses about the nature of Ebola and what it may or may not be capable of has a real impact on public perception and potentially even the response to the outbreak and the extent of its spread, experts say. Most basic facts about Ebola, from where it was first identified to what its symptoms are, have been established long before this outbreak by researchers and health authorities. But as the world’s attention has become focused on it in recent months, a number of questions have arisen, particularly given that the size of the outbreak is so much larger than ever before, creating a real-time laboratory to test some long-held beliefs about the disease.

For instance, health organizations like the CDC and World Organization have long said that Ebola has a maximum incubation period of 21 days. Hospitals and authorities quarantine people exposed to the virus for three weeks before deeming them to have avoided contracting the virus. That’s been the period of time imposed on the news crew that worked with NBC News freelancer Ashoka Mukpo after he came down with the disease.

But a new PLOS Current Outbreaks study released Tuesday by Drexel University environmental engineering professor Charles N. Haas highlighted the fact that between 0.1 and 12 percent of human cases in past Ebola outbreaks, Ebola’s incubation period was longer than 21 days.

“21 days has been regarded as the appropriate quarantine period for holding individuals potentially exposed to Ebola Virus (EV) to reduce risk of contagion,” Haas wrote in the study’s abstract. “There does not appear to be a systematic discussion of the basis for this period.”

The study caused alarm among people who had always been told by authorities that after three weeks symptom-free, the incubation period had passed and so had the danger posed both to and by a given individual.

But to some experts, the study’s findings did not come as a surprise, as they have always known that such numbers are not hard-and-fast rules, but rather a way to create a reasonable incubation period for people to follow. For virus experts, the risk of a patient beginning to show symptoms of Ebola after 21 days symptom-free following exposure to the disease is sufficiently low to allow him or her to leave quarantine at that point.

“It’s not like the incubation period is an exact number. It’s a spectrum, so you will get these outliers,” Marisa Eisenberg, an assistant epidemiology professor at the University of Michigan School of Public Health, said. “If you have a mean or a typical incubation number or something along those lines, you’d expect some spread along that and as you have more cases you’ll see numbers further outside the mean.”

The problem, however, is that much of the general public is not aware of the fact that 21 days doesn’t necessarily mean 21 days in this way. As such, when a study like Haas’s comes out, many people assume that health authorities don’t know what they’re doing, or worse that they’re being lied to. And that impacts behavior, and the way people react to the disease impacts the efficacy of response efforts.

That fact can be seen in another, more direct example of the ways that the approach to Ebola has seemingly changed. Americans were likely under the impression before Ebola broke out in West Africa earlier this year that its hospitals were highly equipped to deal with patients who have highly contagious viruses like Ebola.

But then the nurses’ union national Nurses United hosted a conference call Wednesday that revealed that hospitals across the nation are shockingly unprepared to handle Ebola patients — with some facilities expecting their staff to treat Ebola victims wearing little more than a permeable apron and surgical mask. Health officials and even President Barack Obama called on hospitals to get up to speed on Ebola, and the perception of Ebola once again changed. The public believed they were safe from Ebola, and now even many American hospitals were revealed to be totally unreliable and unsafe.

The changing storyline once again will have real impacts on public health, Michael T. Irvin, a registered nurse and CEO and president of nationwide healthcare consulting company MLTC Consulting, said via email, speaking to the real impacts of such shifting expectations on public health

“At the risk of sounding like a fear-monger, I predict that Ebola will continue to spread in the United States resulting in many unnecessary and preventable deaths,” Irvin wrote. “One of the main reasons for the spread of this viral killer may be due to the use of ‘Universal Precautions’ as recommended by the CDC … Universal precautions are not adequate to prevent the spread of Ebola or similar diseases.”

In the end, the constant spinning of every bad piece of news and the shifting face of the virus and the response to it has the impact of eroding public trust at a time when officials most need trust in order to continue to stave off hysteria and overreaction.

That breakdown in established trust between the public and health officials was on full display earlier this week, when Peter Jahrling, chief scientist at the National Institute of Allergy and Infectious Diseases, refuted the repeated claim that Ebola is not an airborne disease by revealing that he worried that it had mutated to become airborne. Now, the virus — not just impressions of it — may be mutating in a consequential way, he said in an interview with Vox.

That revelation drove an increase in concern about the disease among folks who had been told by the CDC, World Health Organization and other authorities that it couldn’t be caught via the air. And that drives paranoia.

“No one knows and the government is not being straightforward,” said Larry Klayman, a former U.S. Department of Justice prosecutor and founder of the Freedom Watch political advocacy group.


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