Ebola Thrives on Poverty and Disparity

Oct 1st, 2014 | By | Category: Featured Articles, Lead Article, Public Health

With the first confirmed case of Ebola in the United States, I suspect at least a few of you are freaking out.

Ebola–like many viruses, including the recently popular enterovirus 68–is spread by filth. You need exposure to infected body fluids (blood, tears, sweat, vomit, diarrhea) to get it.

Ebola thrives on poverty and disparity: Places were the people at the bottom of the ladder have no access to clean water to drink and wash with, no access to decent healthcare, no public health providers to track and contain outbreaks. West Africa is nearly ideal for Ebola. Increasingly, so is Central Texas and the rest of the United States.

To protect yourself, your household, your community from communicable diseases like Ebola requires decency for the poorest, the most marginalized in your community–the people who pick your produce, make your food, clean your streets and workplace, working the myriad of minimum-wage service jobs that make most of our lives possible.

Decency for the poorest is what makes a developed country a developed country: a place where one does not die from easily prevented diseases (among other things). Decency isn’t our long suit.


You’d be correct to be exasperated with the emergency room in Dallas, sending home with a handful of antibiotics a man recently arrived from West African, with classic symptoms of Ebola. How could this happen? Why weren’t we better prepared?

The CDC has actually been a leader in responding to the crisis. It’s helped that so many American doctors and experts, at significant personal peril, have been involved in the response in Africa. Reams of guidelines are available.

Still, there needs to be local public health experts–someone to translate the guidelines into concrete steps and plans for a given community–before a plan can work. It’s tough work. How do you get a patient from an outlying clinic to an isolation room in a proper hospital without exposing ambulance crews? To which hospital should the patient be taken? Who is going to clean up the vomit, blood, other bodily fluids, and medical waste? How will those people be protected from exposure. Where will the waste be taken? Who will incinerate it? Who will track down others who might have been exposed, and watch them for symptoms? Who will check arriving airline passengers for symptoms? Which symptoms should be looked for?

Even in King County (still a high-water mark for public health in the United States), years of cutbacks–cheered on by the likes of the Seattle Times editorial board and Tim Eyman–have degraded the infrastructure to answer these questions and implement the answers.

It’s not time to panic. Honestly, the biggest risk for most people in the US remains the flu (get vaccinated!). For new things floating around, Enterovirus 68 is probably a bigger risk than Ebola. If you want to sleep better at night, vote for better public health funding.