One great service Dallas could render to the rest of the country, should the dust ever settle on the local Ebola story, would be a thorough, no-holds-barred post mortem on information sharing. I am already hearing from people behind the scenes, speaking off the record, that there has been significant tension between officials on the question of what to tell people, when and how.
And it didn't start here. From the moment the Thomas Eric Duncan story first lit up, the Centers for Disease Control and Prevention has preached that risks to the public in this country are minimal, our healthcare system will beat Ebola with a first round knock-out and the most important thing to avoid is public fear. There are some good reasons for preaching that line, but there may also be some unanticipated bad consequences to carrying it too far, illuminated by the Dallas experience.
The first things to acknowledge are the good reasons for not publicly reporting every single twist in the story. If and when the full story can be told, for example, we will learn that there have been numerous incidences of people self-reporting that they have Ebola. In fact people have told authorities in Dallas County in the last week not only that they have Ebola but that they have had contact with Duncan, when neither claim turned out to be true upon subsequent investigation.
I haven't been able to get enough detail from anybody to give me an indication why this is happening. Maybe the people doing this are just mistaken. Maybe they are crazy. Maybe somebody thought he was about to get caught for embezzlement. No telling.
But if it happens with Ebola, it probably happens with every major public health scare. We must assume the CDC knows it will happen, and they are trying to avoid live helicopter coverage for every bank teller who didn't want to show up for work that day.
But we also have to look at the downside when officials deliberately manipulate public awareness. For one thing when the unexpected happens, official messages of absolute mastery and control melt away like a wedding cake left out in the rain. For another, public confidence is gravely eroded whenever the official message has to be retracted and re-stated in a less self-serving light, as when Texas Health Presbyterian had to eat its original version of why the hospital turned Duncan away on his first show-up in the emergency room.
There is also the distinct possibility that a tendency here to over control the release of information and to minimize risk may have contributed to a lack of urgency about the problem. Setting off alarms, after all, is the right thing to do in fires and burglaries, and maybe it's the right thing to do in an epidemic, within reason. It may be that a lack of urgency played a role in mistakes like the one where a bunch of sheriff's deputies marched into Patient Zero's apartment without protective gear. We could have used a little more alarm on that one.
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Local officials in Dallas, perhaps struggling to interpret the CDC's basic body language, have had serious disagreements about the public release of basic facts in the Ebola story, I am told by people speaking not for attribution. We're talking about the who, what, when and where of things that are known.
Those officials who have counseled not releasing basic information seem not to understand that in our American society, that basic information will get out anyway, usually pretty quickly in a case like this. That has been true, since ... hmm ... well, at least since 1840 when Alexis de Tocqueville published volume two of Democracy in Americaa," in which he described the typical American as, "in short, a highly civilized being, who consents, for a time, to inhabit the backwoods, and who penetrates into the wilds of the New World with the Bible, an ax, and a file of newspapers."
What we haven't had here -- what we certainly didn't get from the CDC -- is a basic over-arching model for information control. And why, when we are the ones at Ground Zero, would we expect a distant government agency to tell us how to handle urgent developments on our own turf? We need to know, and cities everywhere need to know, what kind of information should be disseminated right away, what kind that needs to be held temporarily for a truth check and what kind probably needs to go straight into the shredder.
Not telling people what's going on is not a viable choice in this country. You can withhold the stupid stuff, as long you're sure it's stupid. You can withhold things like the exposed family's exact location, and people will understand that you are protecting them. But withholding basic information or, goodness knows, fibbing about things? Now that's how you set off a real panic.