As an Ebola outbreak in West Africa turned into a global epidemic, public panic mounted with the rising death toll. The US only had a small and contained handful of cases, but it quickly became clear that facts about the virus could not calm people's fears.
We saw calls for travel bans. We saw a volunteer nurse returning from West Africa get locked up in quarantine tent outside of a New Jersey hospital. We saw the forced resignation of a Kentucky teacher because parents were afraid that she might have Ebola after visiting Kenya in East Africa. (Kenya is about 5,000 miles away from the Ebola-affected region.) And we saw rage directed at a New York physician — who had been doing the good work of helping Ebola patients in Guinea — after it came to light that he had gone bowling in the city before coming down with the disease. In each of these cases, we lost our compassion and reason, and fear took hold of us.
Today, a new article in the New England Journal of Medicine looks at how public-health officials could have done better at communicating uncertainty during this crisis, perfectly encapsulating why fear mattered, and why it couldn't be overcome with facts:
Beyond its inherent unpleasantness, fear is a risk in itself because it demands a response... Mandatory quarantines for Ebola aim to assuage fear but may pose greater public risk than no quarantine, if they make it too difficult for U.S. health care workers to provide aid in West Africa.
My instinct is to tell people who fear Ebola how much more likely they are to be sickened by influenza or heart disease. If fears were guided by facts, such comparisons might help. But when we face an uncertain prospect that we deeply fear, we evince what Cass Sunstein calls "probability neglect": we tend to conflate the horror of what might happen with the likelihood that it will. Unless we can prove there's zero risk, the dreaded event feels exceedingly likely, and thus making probabilistic comparisons may not feel reassuring.
The author of the article, Dr. Lisa Rosenbaum — a national correspondent for the journal — writes that over-reassurance by public-health authorities may have had the opposite of the desired effect: "The public suspects they're insufficiently worried or insufficiently candid and becomes more frightened."
This played out as the Centers for Disease Control and Prevention and Texas health officials projected a know-it-all cool while they were handling (and seen to be fumbling) the first-ever Ebola cases on US soil.
Perhaps they should have admitted that they were in uncharted territory, letting the public know that they were doing the worrying for them. Since people seem to be drawn to "confident projections of any sort," another way the fear could have been better handled would be if public-health agents admitted how uncertain they were.
Rosenbaum also suggests that health officials could have quelled public fear by celebrating the "good nonevents," or all the horrible things that never came to pass. For example, we focused on the fact that America's "patient zero" — Thomas Duncan — infected two of the nurses who cared for him at the end of his life. But it seemed to escape our collective attention that he didn't infect any of the people he was living with, including his fiancée, in the days before his hospitalization.
Same goes for Dr. Craig Spencer, of the now infamous New York bowling incident: no one he came into contact with prior to his hospitalization got sick, not even his fiancée.
Of course, hindsight is 20-20, and all of this seems clear as we appear to have passed through the worst of the Ebola situation here in the US. In future, the guardians of public health need to remember and apply these learnings to the next great global-health challenge.
We also need to remember that, while all the cases that stoked our fears are contained here and public attention seems to be drifting away, the epidemic continues to rage in West Africa, a crisis worthy of our attention and concern.
Learn more about this Ebola outbreak with our 13 things you need to know.