The illness itself is scary: first the sudden aches, then the spikes of fever and chills, before the massive internal bleeding and copious vomiting and diarrhea. Death comes amid delirium and hemorrhaging from the nose, mouth, and other mucous membranes. A handful of isolated cases in the United States have been enough to spark a nationwide frenzy of fear and recrimination. Imagine what would happen if the nation's capital lost a tenth of its population to the disease in the space of two months, and another half to panicked flight. And imagine if it happened again in the same city a few years later, then again, and again—four times in seven years.
The time was the 1790s, and the place was Philadelphia Vice President Thomas Jefferson even called for the city to be abandoned. The disease wasn't Ebola, but yellow fever, another of the viral hemorrhagic fevers that wreak such terrifying havoc on the body's internal organs. Yellow fever was also known colloquially by its most distinctive symptom: "black vomit," which occurred when large quantities of blood accumulated in the stomach. Its ravages in Philadelphia and other seaport cities in the nation's formative years constituted a serious national crisis.
The public discourse surrounding the ongoing Ebola epidemic has been singularly unedifying. In the United States, news media outlets have eagerly stoked groundless fears, which public officials have rushed to appease with policy responses that will do nothing to stop the disease's spread. Meanwhile, help has been slow to arrive where it is desperately needed, in Guinea, Sierra Leone, and Liberia. Rural health centers there turn away patients for lack of staff and equipment, while well-funded American hospitals prepare for an influx of patients that may never come.
But a dose of historical perspective can be therapeutic. American responses to disease threats going back to Philadelphia's yellow fever crisis show us that we systematically overreact to diseases that press certain buttons, and that salvation doesn't always come from a laboratory.
We should not be surprised that despite the small number of Americans affected by it, Ebola has triggered such alarm in this country. Like yellow fever in the 1790s, it is unfamiliar and of exotic origin. Yellow fever was known as a scourge of the tropics but had only infrequently struck North America before 1793, while Ebola outbreaks had until 2014 been seen only in central Africa—the "heart of darkness" of the Western colonial imagination as depicted in Joseph Conrad's novel. Also like yellow fever, Ebola is untreatable and often fatal, and it produces horribly lurid symptoms including projectile vomiting, copious diarrhea, and uncontrolled bleeding.
Philadelphians' panic in the 1790s was understandable: yellow fever's death toll was very real, very high, and very close to home. The same cannot be said of Ebola in the United States today. In 2014, we have extremely reliable knowledge about how the Ebola virus is and is not transmitted. We are capable of using our rational faculties to override our visceral fears, but too many of us do not. As cautionary tales, we also have decades of false alarms about putative epidemics that never materialized: mad cow disease, West Nile virus, SARS, bird flu, and others. But the cries of "Wolf!" still find receptive ears.
In 2014, the search for an Ebola vaccine or cure is depicted as a "race" in which "the clear front-runner is the virus," in the words of Forbes. Widespread expectations that microbiological laboratories will come up with miracle drugs are the logical by-product of pharmaceutical success stories dating back to penicillin. But we should not let our hopes for a cure (or a vaccine) make us lose sight of the value of care. Care can save lives, even in the absence of a cure.
The case-fatality rate of the current Ebola epidemic is about 50 percent, and even higher rates have been seen in prior outbreaks, but the disease has so far occurred almost exclusively in places with underfunded health-care infrastructures. Global health pioneer Paul Farmer estimates that with early diagnosis and effective supportive care (including intravenous rehydration), up to 90 percent of Ebola patients can recover. The experience of the patients infected in the U.S this year supports this optimistic outlook. Ebola doesn't have to be a fatal disease, and it doesn't have to sow panic everywhere. Care itself can cure, but it requires adequate facilities, equipment, and staffing. We have it here. Don't they deserve it there?
David Barnes, Associate Professor of History and Sociology of Science at the University of Pennsylvania, is writing a history of Philadelphia's Lazaretto quarantine station.
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