When it Comes to Ebola People Lie

I suppose people lie about…just about everything.  Some lies are understandable and even societally justified; for example, when the Nazis knock on your door in the middle of the night and ask if you are Jewish—lying seems appropriate if you are Jewish!   When it comes to life and death, lying is to be expected.  When we learn that Mr. Duncan, the man who brought Ebola to Dallas, lied about having close contact with an Ebola victim (as reported on 60 minutes last week), we should not be surprised.  Yet much of the federal response to the Ebola epidemic relies on people telling (or knowing) the truth.  Airport screening for arriving passengers relies on taking temperatures and asking about contact with Ebola victims.  We know that temperatures rises in about 87% of Ebola patients and only as the disease is progressing.  Enter the U.S. before the virus causes a fever and you pass.  The other component of the federal program is to question passengers as to their contact history with Ebola.  People lie.  Mr. Duncan lied.  And who could blame him?  If you suspect that you might be carrying Ebola what better country to fly into than the U.S. to receive the very best (and free) treatment for Ebola?  Could you think of a better reason to lie—I can’t.

The nurse in a tent violated the Hippocratic oath and the most basic bioethics taught to all health care providers—first do no harm.  She knew the horrors of Ebola, she knew she was in close contact while treating patients with Ebola, yet she protested her forced isolation at University Hospital Newark New Jersey, she escaped from N.J. to Maine, her home, where she has stated that she will leave her home when she so desires.  Sunday, October 30, she left her house to go for a bike ride.  She has caused much anxiety already and may pose an infection risk in addition.

Much more egregious is the case of Dr. Craig Spencer, the N.Y. physician who also violated the Hippocratic oath; who, upon returning from treating Ebola patients carried the Ebola virus replicating in his body into the U.S., potentially spreading his Ebola infection in the N.Y. subways, in a bowing ally, in taxi cabs and to his friends and fiancée.

Now we see signs popping up everywhere in health care facilities stating “if you have a fever and have travelled to West Africa in the past 21 days…”.  Again, relying on people to tell the truth—who are we kidding?

So what does it really matter if people lie about Ebola?  A couple of nurses caught Ebola in Dallas, many were isolated and quarantined, we spent millions of dollars treating Mr. Duncan, millions of dollars treating the nurses, quarantining their contacts and decontaminating the living spaces.  Similarly, we are spending millions of dollars treating Dr. Spencer and tracking down his contacts and isolating and quarantining them—what does it matter?  Hopefully we will get off easy with just a couple of million dollars spent and few if any fatalities in the U.S.  There are many lessons to be learned however—we seriously botched our Ebola response, our federal government failed on many levels, we must learn and improve our response to infectious agents—perhaps next time we will not be so lucky.

Steven Keller, Ph.D.

Professor New Jersey Medical School—Rutgers University