Traveler Preferences for Reporting During the 2014-2016 Ebola Epidemic

During the 2016 National Conference on Health Communication, Marketing and Media, I presented with my colleagues a poster titled “Traveler Preferences for Reporting to State and Local Public Health Authorities as Part of Post-Arrival Monitoring During the 2014-2016 Ebola Epidemic”. The poster examined how travelers arriving from countries with Ebola outbreaks reported (e.g. by phone, text) their temperature and symptoms to public health authorities versus how they wanted to report. We also examined if there was an association between how someone reported and their self-reported compliance with post-arrival monitoring.

State and local public health departments would find the results salient as they prepare for intaking reporting data from the public for future epidemics that require monitoring.

You can view the poster here.

Williams, P., Macom, J., Johnson, M., Zulkiewicz, B., Taylor, O., Ray, S., … Southwell, B. (2016). Traveler Preferences for Reporting to State and Local Public Health Authorities as Part of Post-Arrival Monitoring During the 2014-2016 Ebola Epidemic. Presented at the National Conference on Health Communication, Marketing, and Media, Atlanta, GA.

Social science the first line of defense for Ebola

A great article sent to me by Brian Southwell. Robert Wingwall penned a piece on Social Science Space entitled “Ebola: The Human Cost of Neglecting the Social Sciences”.

Wingwall argues that social science will always be the first line of defense for epidemics, even before biomedical science, because social science is needed to understand the culture and values of a population to help break the movement of disease through the population. 

Great work has been done building hospitals in West Africa to treat Ebola but less work has been done building the community relations with tribes and populations to help them with stopping Ebola.

Community engagement is critical because it has become clear that traditional contact tracing is not acceptable in a population that is, rightly, suspicious of anyone perceived as agents of states that they have no reason to trust.

People must for themselves discover the value of medical services and treatment:

Ebola will only be contained by voluntary actions, by people presenting themselves for treatment or segregating themselves from their neighbours.

Wingwall says “Ebola has been fitted into a colonial narrative where we have to rescue the benighted heathen with our superior technology" 

The Ebola epidemic further speaks to the value of social science:

Politicians who ask what the point of the social sciences might be are sometimes right to do so. However, there are also times when the social sciences matter immensely. Newly emerging infectious diseases, epidemics and pandemics are prime examples. On their own, biomedical sciences can achieve only limited impact.

Notes from “Ebola NC: Local Response – Global Impact”

Some notes from the event that was held Monday at the Triangle Biotechnology Center on Ebola. The event was about what local NC companies are doing for the response. 

Some great thoughts from Dr. William Roper, Dean UNC School of Medicine and CEO of UNC Health Care:

  • Communicating uncertainty undermines perceived expertise.
  • But if you don’t communicate uncertainty, and you are wrong, you lose more credibility.
  • How to do it well is to “proclaim uncertainty”.
  • Dean Roper took these ideas from the recent Lisa Rosenbaum article in the NEJM

Some other interesting notes:

  • Any patient with a point of origin from the affected countries must enter US into one of 5 designated airports.  Also if they were in any of the affected countries for any part of time in the past 21 days the same rule applies. 
  • CDC is doing some amazing work in Africa and sending staff there to work and help rebuild medical infrastructure, teach hygiene and protective practices, and providing other technical assistance. 
  • NC Dept of Public Health has a dashboard to show current NC data; is updated weekly. 
  • Almost every NC hospital has conducted some type of Ebola drill.
  • Both Duke and UNC hospitals have worked together to prepare for a potential patient.  
  • It costs about $30K/day to treat an Ebola patient (so total bill around $600K).
  • Two biggest risks for spread: unrecognized cases in a clinic (as in Dallas), & transmission during doffing of PPE.
  • “More people are dying because of Ebola in West Africa than of Ebola.”  The healthcare infrastructure is stretched thin; unable to handle normal health needs.  Child mortality rising. 

Summary of meeting from NC Biotech Center:

Ebola primer from Diane Rehm Show

A great primer on Ebola for those interested from the Diane Rehm Show. One quote that really grabbed me was this one from Laurie Garret about why Sierra Leone, Liberia and Guinea seem so affected. 

Cultural beliefs are at play here in part, she says:

[One feature] we’re seeing as a key problem in this outbreak is the resistance of the general population to measures that could conceivably bring the epidemic under control, measures that worked in other outbreaks… Pretty basic things, but scary things for populations, like removing the ill from the care of their loved ones and placing them in quarantine and denying public burials so that there’s no contact with a cadaver.

Going further is a misunderstanding of the nature of disease and how the Germ Theory is not understood:

In the case of Ebola, we’re really up against cultural beliefs that when a disease hits a given family, it’s because your ancestors committed some sin against some other family and they have leveled evil spirits against you.

…[S]o you have a situation where outsiders are trying to say to people, there’s a virus. And this virus causes this disease. And we are outsiders dressed in space suits and we don’t look like you and you should believe us. And meanwhile the average person doesn’t even have a concept of what a virus is.

Dr. Billy Fisher of the University of North Carolina talks about difficulties in health education: 

So education is a big part of this and there have been some efforts, in fact I was met at the airport when I arrived in Guinea by a large placard that announced how Ebola was transmitted. But I think that’s one of the critical pieces that’s missing in this outbreak, and particularly because this is in such an under-served area, is information infrastructure. So there is not a great way to disseminate a lot of information about how this virus is transmitted and how to protect themselves within all the villages that are affected.