Exclusive Q&A: David Quammen on Ebola 2014

Ebola By David Quammen (Book Cover)
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Ebola By David Quammen (Book Cover)

Ace science writer David Quammen has released an Ebola-specific excerpt of his book Spillover: Animal Infections and the Next Human Pandemic.

To help frame the 2014 Ebola outbreak within the broader context of emerging zoonotic diseases, Quammen recently published Ebola: The Natural and Human History of a Deadly Virus with a thought-provoking, updated and expanded introduction. Interview by Dayna Kerecman Myers, Associate Editor of Global Health NOW.

Early on in the debate over travel restrictions, you warned of the dangers of such isolationist measures. Why are quarantine measures announced by states a bad idea?
It stirs complex conflicts involving civil liberties as well as public health, which many of us saw coming. I believe that closing borders completely would be not only impracticable, but counterproductive, because we if we close borders entirely then we won’t be able to get human and material resources needed to fight the outbreak in West Africa.

One of the most unfortunate things about the quarantine kerfuffle is that it distracts from the crucial efforts to contain Ebola. No one will be completely safe anywhere until we stop it in West Africa. Still, I respect the complexity of the decisions that people in the government are making. Voluntary quarantining seems like a reasonable notion for some. But people following voluntary quarantining, then going out to restaurants and riding the subway, undermine that case.

What is the mainstream media missing in its Ebola coverage and what do most people in the West not understand about Ebola?
People don’t understand that Ebola 2014 is not a one-time concern; it’s part of a pattern of emerging zoonotic diseases. It’s not random misfortune; there is a cause and effect related to human activity and the disruption of ecosystems.

We need to solve Ebola 2014, but it isn’t the next big one, it’s just a dress rehearsal—one that is going poorly and showing us that our preparation is in disarray. To change that, we might need legislation specifying who is in charge, more investment in infectious disease research and monitoring, and clear, consistent protocols. It’s a terrible crisis, but it also represents a dark opportunity to educate the public. We have their attention, and we need to honor that with real information rather than just scaremongering.

It's hard for media outlets not to let Ebola dominate global health news lately. How should the media cover the current Ebola crisis?
They should emphasize that Ebola 2014 is a very dramatic event in a larger pattern, and if we do contain it, the story isn’t over. We need to keep the public alert.
 
There’s been a lot of fear about Ebola; people believe that Ebola causes victims to bleed out and shed bloody tears—all these grotesque ideas—which are myths, created to a great degree by the book The Hot Zone, I’m afraid. Unfortunately, that has added to the terror we see now and the media needs to correct that. Ebola is a horrible disease; it kills a high percentage of the people it infects. But it’s not a preternatural miasma; it’s not a monster movie—it’s just a virus that causes disseminated intravascular coagulation and organ shutdown.
 
Given all of your work over many years trying to raise awareness on the risks of such outbreaks, is it frustrating for you to see attention finally pick up when Ebola lands in America?
It’s a bit frustrating but not surprising at all. It’s also understandable, given what people have been told about Ebola, that they’d be freaked out by a case in Dallas. Suddenly people want to know, is Ebola going to come and get us? Well, that’s the wrong question. The right question is: how do we stop Ebola? And we stop it by stopping it in West Africa.
 
Let’s bounce back to early 2003, when SARS coronavirus hopped rides to Toronto, Hanoi, Singapore, and Beijing within the space of a day, thanks to a super spreader in Hong Kong’s Metropole Hotel. SARS was a dangerous event that could have turned into a devastating global pandemic—but a strong public health response and fast diagnostic science stopped it at about 800 deaths. But the affected cities all have strong governments and public health infrastructure. If it had gone to Monrovia, Kinshasa, Montevideo, São Paulo, for example, it could have been a lot worse.
 
What were some of the most fascinating things you saw and learned in your research, trekking through Central African forests?
One point I’d like to emphasize is that Ebola comes from a reservoir host somewhere in the forest. Ebola 2014 results from the way people interact with the forest and wild animals, and the next outbreaks will probably come from the forest, too. That is crucial information that could help us prevent the next big one, whether it’s MERS 2015, or a brand new virus—Borneo Coronavirus 2016, or Congo Hemorrhagic Rodent Virus 2017, perhaps.
 
Of course we have to respect cultural elements, and realize that changing a burial practice, for example, is not an easy thing for people to do when their loved ones are dying. The same is true with wildlife contact. When African people eat wildlife, we call it bushmeat—a word with a negative onus. When people in the US, as in Montana where I live, eat wild meat, we call it game, and there’s no negative onus—but it’s the same thing.

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