How much does it cost to care for a single case of Ebola in the United States? Between specialized treatment, identifying and tracking down every possible contact, decontaminating every possible touched or vomited-upon surface, the cost of containing an Ebola outbreak is substantial, though perhaps not all of the expense is necessary.
"It's really routine public health work. Interviewing people, visiting them, educating them, identifying their contacts. From a public health perspective, given that this is a single case, this is not very expensive," says Dr. Robert Haley, an epidemiologist at UT Southwestern and a veteran of the CDC. "Now the hospital is spending a lot of money, there's probably more of a cost than we realize, which they won't get reimbursed. So they're really taking a shot here."
But that's not nearly as costly as containing (or contributing to?) an epidemic of fear. Dallas ISD, and now likely Richardson ISD, are pouring resources into excessive school cleaning efforts, and an education campaign for parents. Dallas police are out in full force around the affected schools and apartment complex where Thomas Eric Duncan became sick. News crews have helicopters and photographers casing the joint, ready for a hint of action. City and state officials have also been active holding news conferences and going door-to-door assuring the general public of its safety.
"DISD is putting in work to assuage the irrational fears of their parents," says Haley. "There's really no need to clean anything. There's no risk in the schools period. But I'm not faulting them for doing that. They have to deal with the fears of their parents. And businesses may have to deal with the fears of their employees."
"The epidemic of disease is a relatively low budget thing, and the hospital is taking the brunt of that," he continues, "but the epidemic of fear is another expense altogether."
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And quelling the fears of the public is as important an investment as containing the virus. At this point, says Haley, an epidemic of fear may be the greater public health concern. "We saw this with the early HIV days. Infinitely low risk and infinitely high consequences are confusing to the average human," he says. "Many people become paralyzed with fear and they can't deal with that. The catastrophic nature of the consequences makes it unlikely to calculate the low probability. And right now the probability is zero for kids getting Ebola from school, and yet some people are taking their kids out of school."
Still, public fear is not without reason. "I think there's an important caution. The epidemic in Africa is increasing at an exponential rate. And the larger number of people there, the greater the probability that people will go outside to other areas during their incubation period and will thus show up to other countries. So as it gets bigger, we're going to have more importations. And we probably can't stop that, so this may happen again. And the next time it may not be as containable," says Haley. "That's where all the cost is coming, this epidemic of fear. And I think all our public officials are trying to reduce the fear so maybe we don't have to take as much trouble with future cases."
While we should be ready for future cases, says Haley, public fear is generally unfounded. As we have been repeatedly reminded in the last week, Ebola is not an easily transmittable illness -- "When it dries, it dies" is the common expression epidemiologists use to describe the passage of the virus through bodily fluids -- and American hospitals are better equipped than most to deal with treatment.
"When people get sick, we will recognize them. And the local health departments will go to action and do the same kind of thing as here," says Haley. "I don't think anyone really thinks there will be active transmission in the community, because of the way our population is educated. When the government comes and tells you you've been exposed, you go to the hospital and you trust them."