Contagion on the honor system

In response to Ebola Patient Thomas Eric Duncan’s Long Journey to a Texas Hospital:

What was this guy thinking?  The Liberian government is now talking about prosecuting Duncan for lying on his airport questionnaire about making close contact with an Ebola victim.  “We expect people to do the honorable thing,” said the chairman of the board of directors of the Liberia Airport Authority, quoted by the Associated Press.

Good Lord!  How could any adult human being on Earth have failed to understand that the honor system isn’t sufficient to halt the spread of a contagion?  Especially when infected people in places like Liberia have every reason to lie and get themselves to the United States, where superior care awaits.  This is idiocy on a cosmic scale, the kind of thing that makes you wonder if you’ll be able to defend the human race when aliens show up to pass judgment on us.  “I got nothing,” you’ll sign, and they’ll push the big red button, and poof, the average intelligence of the galaxy will go up a bit.

But don’t be too hard on Liberia, because the American government is equally complicit in this stupidity.  A gaggle of domestic goofballs, leading right up to the White House, thought Liberia’s self-screening questionnaires were good enough to rely on.  They’ll do all the heavy lifting in Monrovia – no reason to cancel any visas!  And if some infected person does decide to follow the blindingly obvious incentives to fib about his infection status, no worries, the TSA will spot that guy at the airport, and he’ll go into a Ziplock bag toot-sweet.  And if he gets past the airport, he’ll be spotted as soon as he starts manifesting symptoms and goes to the hospital.

None of that happened.  None of it worked.  Even when the sick man ended up at the hospital, he either failed to communicate his status correctly, or deliberately concealed the little detail that he physically carried a woman dying of Ebola to a taxicab, where he held her down while she went into convulsions, because he was unleashed for two days of contagion fun after getting a dose of antibiotics that would have been useless against a normal flu, never mind Ebola.  Since he had to know he was likely suffering from Ebola at that point, Duncan either misunderstood the treatment he was receiving – maybe he thought he was getting a shot of the new experimental Ebola treatment? – or didn’t understand how the virus works.  I’ve heard suggestions people in Liberia are reluctant to admit they have Ebola, or even that they’re superstitious about the consequences of discussing it.  In any case, too much of the screening process depended on informed and honest patient interaction, and it didn’t work any better than the Liberia Airport Authority’s questionnaire did.

And evidently we’re still relying on a good deal of voluntary cooperation and self-policing from potentially infected people, because Duncan’s family was told to quarantine themselves in their apartment, under threat of criminal charges if they disobey.  They belatedly realized the CDC had just asked them to chill out in an apartment full of contaminated bedsheets from Patient One.  One of the people locked down in that apartment is a 13-year-old child.

We don’t want people to panic, of course, but it’s also possible to work so hard at suppressing panic that the authorities and media end up putting people needlessly at risk.  The only confidence we still have in the authorities is the absolute certainty that they’ll give us incomplete or false information, if they think we can’t handle the truth.  Thus do we arrive at a curious and unsettling moment where the system simultaneously trusts people too much and too little.  And all this chaos was caused by a single patient plowing through the system and leaving it in ruins.  There are more coming.


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