Oct 14 2014

Ebola and Human Error

It has been fascinating, and a little scary, to watch the first ever Ebola epidemic from the comfort of my Connecticut environs – about as far from the epidemic as you can get. Two thoughts keep coming back to me. The first, as this epidemic progresses and the CDC and WHO keep advancing their predictions about how bad it’s going to get, is this question: are we witnessing the unfolding of a major epidemic or even pandemic? Are we going to look back at the second half of 2014 and wonder how no one recognized how serious this is going to get?

Of course, I do not want to overstate the situation, stoke unnecessary fears, or come off as sensationalist. So I, like the CDC, will point out that the probability of a pandemic is extremely small. Unlike West Africa, most industrialized nations have a robust healthcare infrastructure and we’ll be able to deal with an outbreak before it gets out of control.

But this leads me to my second thought – how did it get so bad in the first place? The story is essentially a story of human error. The current epidemic represents a failure at many levels. This is not about finger pointing, but recognizing human limitations and frailty.

By all accounts the current Ebola epidemic is overwhelming the governments and the infrastructure in West Africa where it is still spreading, and in fact increasing geometrically. The world is reacting, some have charged, too late to this crisis. In fact, an Ebola rapid response infrastructure should have been in place, ready to squash any outbreak in its infancy.

I guess we were made complacent by past experience. Ebola has always caused small local outbreaks. When I first heard of a new Ebola outbreak, months ago, I assumed (probably like everyone else) that this would be yet another typical small outbreak, and it hardly caught my attention at all.

Now we’re launching a massive effort, but the disease may be growing faster than our efforts to stem it. The fire is already spreading out of control, it’s too late to install sprinklers.

The culture in West Africa is partly responsible. There is widespread superstition, distrust of government and outsiders (with good reason), and paranoia. In Guinea, for example, 8 health care workers, trying to treat the Ebola epidemic, were killed with clubs and machetes by villagers who believed they were spreading Ebola.

There are also reports that people who are sick often do not show up to treatment centers, for fear that they will simply be quarantined and left to die.

Victims are often not buried properly because of local burial customs. Funerals are therefore a very dangerous place to be.

There are also reports of profound individual failures. I wrote previously about an herbalist who may have been solely responsible for the spread of the epidemic to Sierra Leone by promising an herbal cure for Ebola. All she succeeded in doing was luring infected people across the border, spreading the infection, resulting in her own death from Ebola.

There is now also the case of the Liberian man, Thomas Duncan, who did not disclose his contact with Ebola victims, entered the US, and then was diagnosed with Ebola in Texas (and has subsequently died). A nurse caring for Duncan has now also contracted Ebola. The CDC reports that this must be due to some breach in protocol.

The assumption was that US hospitals have the training and equipment to deal with a virus like Ebola, but then the very first case diagnosed in an American hospital (so not counting health care workers who contracted Ebola in Africa and were brought home for treatment) resulted in a failure to prevent spread.

Ebola screening has now begun at JFK airport, and is likely to begin at other international airports.

Here are some updated Ebola statistics from the CDC.

Total Cases: 8400
Laboratory-Confirmed Cases: 4656
Total Deaths: 4033

And some good news:

Nigeria and Senegal have not reported any new cases since September 5, 2014, and August 29, 2014, respectively. All contacts in both countries have now completed their 21-day follow up, with no further cases of Ebola reported.

So it is possible to contain the virus’s spread in West Africa.


Whenever events like this unfold I always sense conflicting imperatives from officials responsible for dealing with the crisis. On the one hand they do not want to stoke fears and panic. So they reassure the public that we are dealing with the crisis and everything will be fine.

On the other hand, they have to convey the seriousness of the crisis so that proper resources will be allocated to dealing with it, and the public will take it seriously and do their part. This is serious, but don’t panic.

Further, it is essentially the job of those responsible for the crisis to prepare for it being much worse than it probably will be. Better to overprepare then to underprepare by even a little. We saw this with the H1N1 epidemic a few years ago. It was not as bad as projections predicted, and then the public criticized the CDC for being Cassandras. But that is their job.

Trying to write about the Ebola epidemic in a balanced way, I understand how difficult this can be. I don’t want to overstate the situation, but I don’t want to minimize it either. The fact is, the probability of a pandemic is very small. Outside of West Africa, you are probably safe and have nothing to worry about.

On the other hand, the epidemic is still in a phase where it is exceeding our prior projections, and we are still escalating our response in order to contain it. How draconian will containment measures have to get before the epidemic is over?

Thrown into this is the factor of human error. This is a variable that is difficult to predict, and we have already seen irresponsible decisions on the part of individuals foil our best efforts at preventing spread. In the end I suspect this will be a story of human error more than anything else.

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